Minimally invasive heart valve repair in a beating heart
Disclosed herein are minimally invasive systems and methods for performing an edge to edge repair of a heart valve on a beating heart of a patient. One or more sutures are inserted into a plurality of leaflets of the heart valve while the heart is beating through a minimally invasive access. The sutures can be threaded through a suture crimp that is advanced to the leaflets. A movable gate on the suture crimp can be actuated to secure the sutures at an appropriate tension to maintain the leaflets in a coapted position.
1 . A suture crimp configured to crimp one or more sutures attached to a heart valve leaflet in a beating heart of a patient, comprising:
a crimp body having an open interior and a pair of locking grooves, the crimp body including a loading aperture through the crimp body configured to enable one or more sutures to pass through the crimp body; and
a suture clamping gate movable within the open interior of the crimp body and having a pair of locking tabs corresponding to the locking groove,
wherein the suture clamping gate is configured to move proximally with respect to the crimp body to move the suture clamping gate from an open position in which the one or more sutures can slide freely through the loading aperture and a closed position in which the locking tabs of the suture clamping gate interface with the locking grooves in the crimp body to lock the suture clamping gate in the closed position to securely hold one or more tensioned sutures between the suture clamping gate and the crimp body, wherein each locking tab of the suture clamping gate defines a locking tab aperture configured to interface with a gate actuator configured to move the suture clamping gate within the crimp body, and
wherein the crimp body includes a pair of slots, each slot extending from a proximal end of the crimp body to one of the locking tab apertures.
2 . The suture crimp of claim 1 , wherein the gate actuator comprises a first actuation wire configured to interface with a first of the locking tab apertures and second actuation wire configured to interface with a second of the locking tab apertures.
3 . The suture crimp of claim 1 , wherein the gate actuator comprises a crimp holder having a first actuation rod configured to interface with a first of the locking tab apertures and second actuation rod configured to interface with a second of the locking tab apertures.
4 . The suture crimp of 1 , wherein the locking tabs are configured to plastically deform into the locking grooves to lock the suture clamping gate with respect to the crimp body.
5 . The suture crimp of claim 1 , wherein the crimp body includes an anti-thrombotic cover.
6 . The suture crimp of claim 1 , wherein when the suture clamping gate is in the closed position the one or more sutures define a tortuous path through the crimp body.
7 . The suture crimp of claim 6 , wherein the tortuous path includes the one or more sutures extending through the loading aperture on a first side of the crimp body, along a first suture compression gap between the crimp body and the suture clamping gate, around the suture clamping gate, along a second suture compression gap between the crimp body and the suture clamping gate and out the loading aperture on a second side of the crimp body.
8 . A suture crimping system configured to crimp one or more sutures attached to a heart valve leaflet in a beating heart of a patient, comprising:
a suture crimp including a crimp body having an open interior and a pair of locking grooves and a suture clamping gate movable within the crimp body and having a pair of locking tabs corresponding to the locking grooves, the suture crimp further defining a loading aperture through the crimp body configured to enable one or more sutures to pass through the crimp body;
a crimp holder having a first plate and a second plate defining a suture crimp space therebetween configured to releasably contain the suture crimp, the crimp holder further comprising a pull rod extending between the first plate and the second plate and a pair of lock tab actuator rods extending between the first plate and the second plate configured to interface with corresponding lock tab actuator apertures in the suture clamping gate of the suture crimp to enable the crimp holder to move the suture clamping gate,
wherein a force applied proximally on the pull rod of the crimp holder causes the crimp holder and the suture clamping gate to move proximally with respect to the crimp body to move the suture clamping gate from an open position in which the one or more sutures can slide freely through the loading aperture and a closed position in which the locking tabs of the suture clamping gate interface with the locking grooves in the crimp body to lock the suture clamping gate in the closed position to securely hold one or more tensioned sutures between the suture clamping gate and the crimp body.
9 . The suture crimping system of claim 8 , wherein the crimp body includes a pair of slots, each slot extending from a proximal end of the crimp body to one of the lock tab apertures to enable the lock tab actuator rods of the crimp holder to extend through the crimp body to the lock tab actuators of the suture clamping gate.
10 . The suture crimp of 10 , wherein the locking tabs are configured to plastically deform into the locking grooves to lock the suture clamping gate with respect to the crimp body.
11 . The suture crimp of claim 8 , wherein when the suture clamping gate is in the closed position the suture defines a tortuous path through the crimp body including the suture extending through the loading aperture on a first side of the crimp body, along a first suture compression gap between the crimp body and the suture clamping gate, around the suture clamping gate, along a second suture compression gap between the crimp body and the suture clamping gate and out the loading aperture on a second side of the crimp body.