Replacement heart valves, delivery devices and methods
A system for implanting a replacement heart valve at a native valve location between an atrium and a ventricle of a patient includes a replacement valve having an expandable frame and a plurality of prosthetic valve leaflets positioned within the expandable frame. A delivery device is provided for delivering the replacement heart valve to the native valve location. The delivery device includes an elongate inner tube having an inner retention ring for coupling to and end of the replacement heart valve and an outer support tube slidable over the inner retention ring for securing the replacement heart valve to the inner retention ring. The inner retention ring preferably includes slots for receiving struts of the expandable frame. The expandable frame preferably includes a plurality of anchors extending from the downstream portion in an upstream direction for extending between chordae and for placement outside of the native leaflets.
1. A system for implanting a replacement heart valve at a native valve location between an atrium and a ventricle of a patient, the system comprising:
a replacement heart valve comprising:
a self-expandable frame having a collapsed configuration for delivery and an expanded configuration for anchoring at the native valve location, the self-expandable frame comprising:
an upstream portion sized to be positioned within the atrium, a proximal end of the upstream portion comprising a plurality of longitudinal struts having enlarged tabs;
an annular portion sized to be positioned within a native valve annulus;
a downstream portion sized to be positioned within the ventricle, wherein the downstream portion comprises a ring comprising longitudinal and undulating struts, wherein the ring comprises downstream free apices;
a skirt configured to longitudinally span a length of the self-expandable frame from the upstream portion to the downstream portion, wherein a downstream end of the skirt is generally or nearly coextensive with the downstream end of the self-expandable frame, and wherein the skirt is configured to control fluid flow through and around the replacement heart valve;
a plurality of downstream anchors extending from the downstream portion in an upstream direction toward the upstream portion when the self-expandable frame is in the expanded configuration, wherein each of the plurality of downstream anchors extends from a single downstream free apex of the ring and each anchor comprises a single base having a single base portion and a tip and the tip is wider than the base, wherein the number of tips equal the number of base portions;
an upstream anchoring feature formed by a plurality of anchoring struts extending generally radially outwardly from the upstream portion at a location spaced distally from a terminus of the proximal end of the upstream portion and then extending in a downstream direction when the self-expandable frame is in the expanded configuration,
wherein the upstream anchoring feature and the plurality of downstream anchors are shaped to grasp opposite sides of tissue positioned between the upstream anchoring feature and the plurality of downstream anchors; and
wherein the downstream portion has a larger cross-sectional dimension than a cross-sectional dimension of the upstream portion when the self-expandable frame is in the expanded configuration; and
a plurality of prosthetic valve leaflets positioned within the expandable frame adapted to allow antegrade blood flow in a downstream direction from the upstream portion toward the downstream portion and prevent retrograde blood flow in the upstream direction from the downstream portion toward the upstream portion, wherein the plurality of prosthetic valve leaflets are coupled to the skirt, wherein the downstream end of the skirt extends distally beyond the prosthetic valve leaflets; and
a delivery device for delivering the replacement heart valve to the native valve location, the delivery device comprising:
an elongate inner tube comprising an inner retention ring comprising teeth for engaging the enlarged tabs of the longitudinal struts of the upstream portion of the self-expandable frame of the replacement heart valve;
an outer support tube slidable over the inner retention ring for securing the end of the replacement heart valve within the delivery device; and
an outer sheath sized to slide over the outer support tube and cover the replacement heart valve when the self-expandable frame is in the collapsed configuration.
2. The system of claim 1 , wherein the replacement heart valve is sized to replace a damaged or diseased mitral valve.
3. The system of claim 1 , wherein the upstream portion has an inflow diameter and the downstream portion has an outflow diameter, the outflow diameter being greater than the inflow diameter.
4. The system of claim 1 , wherein the inner retention ring comprises a plurality of slots arranged to receive struts of the self-expandable frame.
5. The system of claim 1 , wherein the plurality of downstream anchors is sized and arranged to extend between chordae tendineae and radially outward of native valve leaflets at the native valve location.
6. The system of claim 1 , wherein the enlarged tabs comprise lower extension portions that extend laterally outward in opposing directions from points of connection to each of the plurality of longitudinal struts.
7. The system of claim 1 , wherein the skirt is stitched to the upstream portion of the expandable frame and to the downstream end of the expandable frame.
8. A system for implanting a replacement heart valve at a native valve location between an atrium and a ventricle of a patient, the system comprising:
a replacement heart valve comprising:
a self-expandable frame having a collapsed configuration for delivery and an expanded configuration for anchoring at the native valve location, the self-expandable frame comprising:
an upstream portion sized to be positioned within the atrium, the upstream portion comprising a proximal end having enlarged tabs;
an annular portion sized to be positioned within a native valve annulus;
a downstream portion sized to be positioned within the ventricle; and
a plurality of downstream anchors extending from the downstream portion in an upstream direction toward the upstream portion when the self-expandable frame is in the expanded configuration, wherein a first portion of each of the plurality of downstream anchors extends radially outward from the self-expandable frame and a second portion of each of the plurality of anchors extends in the upstream direction, and wherein the first portion of each of the plurality of downstream anchors is longer than the second portion of each of the plurality of downstream anchors;
an upstream anchoring feature formed by a plurality of anchoring struts extending generally radially outwardly from the upstream in a downstream direction when the self-expandable frame is in the expanded configuration,
wherein the upstream anchoring feature and the plurality of downstream anchors are shaped to grasp opposite sides of tissue positioned between the upstream anchoring feature and the plurality of downstream anchors;
a plurality of prosthetic valve leaflets positioned within the self-expandable frame, wherein the prosthetic valve leaflets are adapted to allow antegrade blood flow in a downstream direction from the upstream portion toward the downstream portion and prevent retrograde blood flow in the upstream direction from the downstream portion toward the upstream portion, wherein each second portion comprises its own individual tip, wherein the individual tip is wider than the respective first portion of the plurality of downstream anchors, wherein the self-expandable frame further comprises a skirt configured to extend along the self-expandable frame from the upstream portion to the downstream portion, and wherein the downstream end of the skirt extends distally beyond the prosthetic valve leaflets; and
a delivery device for delivering the replacement heart valve to the native valve, the delivery device comprising:
an elongate inner tube comprising an inner retention ring shaped to engage the enlarged tabs of the proximal end of the upstream portion of the self-expandable frame of the replacement heart valve;
an outer support tube slidable over the inner retention ring for securing the end of the replacement heart valve within the delivery device;
an outer sheath sized to slide over the outer support tube and cover the replacement heart valve when the self-expandable frame is in the collapsed configuration.
9. The system of claim 8 , wherein the replacement heart valve is sized to replace a damaged or diseased mitral valve.
10. The system of claim 8 , wherein the upstream portion has an inflow diameter and the downstream portion has an outflow diameter, the outflow diameter being greater than the inflow diameter.
11. The system of claim 8 , wherein the inner retention ring comprises teeth for engaging the enlarged tabs.
12. The system of claim 8 , wherein the inner retention ring comprises a plurality of slots for receiving struts of the self-expandable frame.
13. The system of claim 8 , wherein the plurality of downstream anchors extending from the downstream portion are sized and arranged to extend between chordae tendineae and radially outward of native valve leaflets at the native valve location.
14. The system of claim 8 , wherein a longitudinal length of the skirt is substantially the same as a longitudinal length of the self-expandable frame.
15. A system for implanting a replacement heart valve at a native valve location between an atrium and a ventricle of a patient, the system comprising:
a replacement heart valve comprising an expandable frame having an upstream portion, an annular portion, a downstream portion having a larger cross-sectional diameter than the upstream portion, a skirt configured to longitudinally span a length of the expandable frame from the upstream portion to the downstream portion, wherein a downstream end of the skirt is generally or nearly coextensive with the downstream end of the expandable frame, and wherein the skirt is configured to control fluid flow through and around the replacement heart valve, and a plurality of anchors extending from the downstream portion toward the upstream portion, wherein each of the plurality of anchors extends from a single free apex along the downstream portion and wherein each of the plurality of anchors includes an elongate base portion and an enlarged tip; and
a delivery device comprising an elongate inner tube having an inner retention ring for retaining an end of the replacement heart valve, an outer support tube for securing the end of the replacement heart valve to the retention ring, and an outer sheath sized to slide over the outer support tube, wherein the outer sheath contains the replacement heart in a collapsed configuration during advancement to the native valve location;
wherein the upstream portion of the expandable frame of the replacement heart valve comprises a plurality of features having enlarged tips configured to engage the inner retention ring;
wherein prosthetic heart valve leaflets are coupled to an interior region of the expandable frame for allowing blood flow in only one direction, thereby replacing the function of the native valve after implantation, and
wherein the downstream end of the skirt extends distally beyond the prosthetic valve leaflets.
16. The system of claim 15 , wherein the plurality of features comprise longitudinal struts and wherein the enlarged tips comprise tabs.
17. The system of claim 16 , wherein the inner retention ring comprises teeth for engaging the tabs.
18. The system of claim 17 , wherein the inner retention ring comprises a plurality of slots for receiving the longitudinal struts.
19. The system of claim 15 , wherein the plurality of anchors extending from the downstream portion are sized and arranged to extend between chordae tendineae and radially outward of native valve leaflets at the native valve location.
20. The system of claim 15 , wherein the expandable frame further comprises an upstream anchoring feature comprised of a plurality of anchoring struts extending generally radially outwardly from the upstream portion in a downstream direction when the expandable frame is in the expanded configuration, wherein the upstream anchoring feature and the plurality of anchors extending from the downstream portion toward the upstream portion are shaped to grasp opposite sides of tissue positioned between the upstream anchoring feature and the plurality of anchors.