Frame for atrioventricular valve with opposite groups of arms

Abstract

Devices and methods for use with a prosthetic valve (20) configured to be deployed within a native atrioventricular valve of a heart of a mammalian subject are described. The valve frame (22) includes a valve frame body (24) configured to support the prosthetic valve (20) within the native atrioventricular valve. A first set of chordal recruitment arms (34) is configured to extend from the valve frame body (24) and to bend circumferentially around the valve frame body (24) in a first circumferential direction. A second set of chordal recruitment arms (34) is configured to extend from the valve frame body (24) and to bend circumferentially around the valve frame body (24) in a second circumferential direction that is in an opposite direction from the first circumferential direction. Other applications are also described herein.

Description

[0001] Cross-references to related applications

[0002] This application claims priority to U.S. Provisional Patent Application No. 63 / 106,034, filed October 27, 2020, entitled “Atrioventricular valve frame with opposing sets of arms,” which is incorporated herein by reference.

[0003] Field of the implementation scheme of the invention

[0004] This invention relates to medical devices and methods, and more particularly to devices and methods for implanting an artificial valve at the atrioventricular valve.

[0005] background

[0006] The human heart is a muscular organ that pumps oxygenated blood through the lungs by the contraction of its four chambers, and then pumps the oxygenated blood to other parts of the body.

[0007] After circulating in the body, the deoxygenated blood enters the right atrium through the vena cava. In a healthy subject, the right atrium contracts, pumping blood through the tricuspid valve into the right ventricle. The right ventricle contracts, pumping blood through the pulmonary semilunar valve into the pulmonary artery, which branches into two arteries, one for each lung. The blood is oxygenated as it flows through the lungs and re-enters the heart through the left atrium. The left atrium contracts, pumping oxygenated blood through the mitral valve into the left ventricle. The left ventricle contracts, pumping oxygenated blood through the aortic valve into the aorta for distribution to the rest of the body. The tricuspid valve closes during right ventricular contraction to prevent blood from flowing back into the right atrium. Similarly, the mitral valve closes during left ventricular contraction to prevent blood from flowing back into the left atrium. The mitral and tricuspid valves are called the atrioventricular valves, and each of these valves controls blood flow between the atria and ventricles.

[0008] In the mitral valve, the mitral annulus defines the mitral orifice. The anterior and posterior leaflets extend from the mitral annulus. The leaflets are connected to the papillary muscles in the left ventricle via chordae tendineae.

[0009] During ventricular diastole, in healthy subjects, the left atrium contracts to pump blood through the orifice of the mitral valve into the left ventricle. As blood flows through the orifice, it pushes the leaflets apart and allows them to enter the left ventricle with minimal resistance. In healthy subjects, the leaflets of the aortic valve are kept closed by blood pressure in the aorta.

[0010] During ventricular systole, the left ventricle contracts to pump blood through the aortic valve into the aorta, pushing the leaflets of the aortic valve open. In healthy subjects, the mitral valve annulus contracts to push the leaflets inward, reducing the area of ​​the mitral orifice by approximately 20% to 30%. The leaflets clasp to accommodate the excess leaflet surface area, creating a mating surface that forms a seal. Blood pressure in the left ventricle pushes the ventricular surface of the leaflets, pressing them tightly together at the mating surface to form a tight, leak-proof seal.

[0011] Effective mitral valve sealing during ventricular systole depends on adequate constriction. Incorrect constriction can be caused by a number of physical abnormalities that result in leaflet prolapse (e.g., elongated or ruptured chordae tendineae, or weak papillary muscles) or prevent constriction (e.g., short chordae tendineae, or small leaflets). Several pathologies can also cause mitral regurgitation, including collagen vascular disease, ischemic mitral regurgitation (e.g., caused by myocardial infarction, chronic heart failure, or failed / unsuccessful surgical or catheter revascularization), lobular myxomatous degeneration, and rheumatic heart disease. Mitral regurgitation leads to numerous complications, including arrhythmias, atrial fibrillation, palpitations, chest pain, congestive heart failure, syncope, fatigue, low cardiac output, orthopnea, paroxysmal nocturnal dyspnea, pulmonary edema, shortness of breath, and sudden death.

[0012] The tricuspid valve consists of three leaflets: the septal leaflet, the anterior leaflet, and the posterior leaflet. Each leaflet is attached to the tricuspid annulus, which defines the tricuspid orifice. The leaflets are connected to the papillary muscles in the right ventricle via chordae tendineae. In healthy subjects, the tricuspid valve controls the direction of blood flow from the right atrium to the right ventricle in a manner similar to how the mitral valve controls the direction of blood flow on the left side of the heart. During ventricular diastole, the tricuspid valve opens to allow blood to flow from the right atrium to the right ventricle, and during ventricular systole, the leaflets of the tricuspid valve close to prevent blood from flowing back from the right ventricle to the right atrium.

[0013] Tricuspid regurgitation occurs when the tricuspid valve fails to close properly. When the right ventricle contracts, this causes blood to flow back into the right atrium. The most common cause of tricuspid regurgitation is right ventricular dilation, which leads to dilation of the tricuspid annulus, preventing the valve leaflets from properly engaging.

[0014] Overview of the implementation plan

[0015] According to some applications of the invention, an artificial mitral valve frame includes a valve frame body defining a ventricular portion (which, upon deployment, is configured to be disposed within the left ventricle of a subject) and an atrial portion (which, upon deployment, is configured to be disposed within the left atrium of a subject). The artificial mitral valve, typically comprising multiple leaflets (e.g., two or three leaflets as shown), is usually sutured or otherwise coupled to the valve frame body. Typically, in an unconstrained configuration of the artificial mitral valve frame, a first set and a second set of chord-recruiting arms extend radially from a portion of the valve frame body configured to be disposed within the ventricle of a subject. For some applications, the chord-recruiting arms are configured to extend axially from the ventricular end of the valve frame body (i.e., the end of the valve frame body configured to be disposed within the ventricle) toward the atrial end of the valve frame body (i.e., the end of the valve frame body configured to be disposed within the atrium). Typically, each of the first and second groups of chordae tendineae recruiting arms bends outward around the valve frame body in its respective, different circumferential bending directions. For example, the first group may bend counterclockwise, and the second group may bend clockwise, or vice versa. For some applications, the arms in the first group of chordae tendineae recruiting arms are configured to have a concavely rounded leading edge facing a first circumferential direction, and the arms in the second group of chordae tendineae recruiting arms are configured to have a concavely rounded leading edge facing a second circumferential direction.

[0016] Typically, a delivery catheter is used to deliver an artificial mitral valve and its frame to the natural mitral valve, and the delivery catheter is configured to maintain the artificial mitral valve and its frame in a radially constrained configuration (i.e., a “crimped” configuration) during delivery. When the distal end of the delivery catheter is positioned in the left ventricle of the subject, a first set of chordae tendineae recruiting arms is allowed to be in a non-radially constrained configuration and at least partially radially expanded. After the first set of chordae tendineae recruiting arms is deployed between the chordae tendineae of the natural mitral valve (and typically, when the chordae tendineae recruiting arms of another set are maintained in a radially constrained configuration by the delivery catheter), at least a portion of the valve frame rotates in the same circumferential direction as the circumferential bending direction of the chordae tendineae recruiting arms of the first set. For some applications, the rotation of the first set of chordae tendineae recruiting arms causes the first set of chordae tendineae recruiting arms to (a) pull the natural mitral valve radially inward toward the valve frame and (b) twist the natural mitral valve around the valve frame by recruiting and deflecting at least a portion of the chordae tendineae.

[0017] Typically, before or after performing the first rotation step described above, the second set of chordae tendineae arms is allowed to assume a non-radially constrained configuration and at least partially radially expanded. Furthermore, typically, after performing the first rotation step, the valve frame is rotated in the same circumferential direction as the circumferential bending direction of the second set of chordae tendineae arms. Typically, this rotation of the valve frame causes the chordae tendineae of the natural mitral valve to entangle between the two sets of chordae tendineae arms, which strengthens the anchorage of the artificial mitral valve frame to the natural mitral valve device, compared to the case where the artificial mitral valve frame includes only a single set of chordae tendineae arms bent in a single circumferential direction. Typically, the angle through which the valve frame rotates in the second rotation step is less than or equal to the angle through which the valve frame rotates in the second rotation step, in order to prevent chordae tendineae tearing.

[0018] After the two sets of chordae tendineae recruiting arms have been released and the valve frame has been rotated in the first and second circumferential directions, the valve frame body is allowed to assume its non-radial constraint configuration. Typically, by assuming its non-radial constraint configuration, the valve frame body is configured to trap the natural valve leaflet in a partially closed and twisted configuration, thereby at least partially sealing the space between the natural mitral valve and the artificial valve.

[0019] When the terms "distal" and related terms are used regarding a device or a part thereof, the terms "distal" and related terms should be interpreted as meaning that, when the device or a part thereof is inserted into the subject's body, the end of the device or a part thereof is generally farther from the point where the device passes through and is inserted into the subject's body. When the terms "proximal" and related terms are used regarding a device or a part thereof, the terms "proximal" and related terms should be interpreted as meaning that, when the device or a part thereof is inserted into the subject's body, the end of the device or a part thereof is generally closer to the point where the device passes through and is inserted into the subject's body.

[0020] Therefore, according to some applications of the invention, a device is provided for use with an artificial valve configured to be deployed within a natural atrioventricular valve of a mammalian subject's heart, the natural atrioventricular valve comprising a valve annulus, valve leaflets, chordae tendineae, and papillary muscles, the device comprising:

[0021] Valve framework, the valve framework comprising:

[0022] A valve frame body configured to support an artificial valve within the natural atrioventricular valve;

[0023] A first set of chordae tendineae recruiting arms, extending from the valve frame body, the first set of chordae tendineae recruiting arms being configured to circumferentially bend around the valve frame body in a first circumferential direction; and

[0024] The second set of chordae tendineae arms extends from the valve frame body and is configured to bend circumferentially around the valve frame body in a second circumferential direction, which is opposite to the first circumferential direction.

[0025] In some applications, the first set of chordae tendineae recruiting arms is configured to extend radially from the valve frame body.

[0026] In some applications, the first set of chordae tendineae arms is configured to extend axially from the ventricular end of the valve frame body to the atrial end of the valve frame body.

[0027] In some applications, the second set of chordae tendineae recruiting arms is configured to extend radially from the valve frame body.

[0028] In some applications, the second set of chordae tendineae arms is configured to extend axially from the ventricular end of the valve frame body to the atrial end of the valve frame body.

[0029] In some applications, the valve frame is configured such that rotating the valve frame in a first circumferential direction causes at least a portion of the chordae tendineae of the natural atrioventricular valve to be recruited and deflected, such that the first set of chordae tendineae recruits the natural atrioventricular valve in a radially inward direction toward the valve frame and (b) twists the natural atrioventricular valve around the valve frame.

[0030] In some applications, the valve frame is configured such that rotating the valve frame in a first direction followed by rotating it in a first circumferential direction causes the chordae tendineae to become entangled between a first set of chordae tendineae recruiting arms and a second set of chordae tendineae recruiting arms.

[0031] In some applications, the valve frame body is configured to expand radially to capture the leaflets of the natural atrioventricular valve in a partially closed and twisted configuration, thereby at least partially sealing the space between the natural atrioventricular valve and the artificial valve.

[0032] According to some applications of the invention, a method for use with an artificial valve configured to be deployed within a natural atrioventricular valve of the heart of a mammalian subject, the natural atrioventricular valve comprising a valve annulus, valve leaflets, chordae tendineae, and papillary muscles is also provided, the method comprising:

[0033] The valve frame is placed inside the heart of the subject. The valve frame includes a valve frame body configured to support an artificial valve within a natural atrioventricular valve, and a first group and a second group of at least chordae tendineae arms configured to extend from the valve frame body.

[0034] Deploy the first set of chordae tendineae arms such that the first set of chordae tendineae arms is deployed between the chordae tendineae of the natural atrioventricular valve, and the first set of chordae tendineae arms is circumferentially bent around the valve frame body in the first circumferential direction.

[0035] In the first cycle, at least a portion of the valve frame is rotated in the direction of rotation so as to attract and deflect at least a portion of the chordae tendineae of the natural atrioventricular valve, such that the first set of chordae tendineae attracting arms: (a) pulls the natural atrioventricular valve radially inward toward the valve frame, and (b) twists the natural atrioventricular valve around the valve frame.

[0036] Deploy a second set of chordae tendineae arms such that the second set of chordae tendineae arms is deployed between the chordae tendineae of the natural atrioventricular valve, and the second set of chordae tendineae arms is circumferentially curved around the valve frame body in a second circumferential direction, which is opposite to the first circumferential direction; and

[0037] At least a portion of the valve frame is rotated in the second circumferential direction so that the chordae tendineae are wound between the first set of chordae tendineae recruiting arms and the second set of chordae tendineae recruiting arms.

[0038] In some applications, the method also includes radially expanding the valve frame body to capture the leaflets of the natural atrioventricular valve in a partially closed and twisted configuration, thereby at least partially sealing the space between the natural atrioventricular valve and the artificial valve.

[0039] In some applications, deploying the first set of chordae tendineae recruiting arms such that the first set of chordae tendineae recruiting arms is deployed between the chordae tendineae of the natural atrioventricular valve includes: deploying the first set of chordae tendineae recruiting arms such that the first set of chordae tendineae recruiting arms extends radially from the valve frame body.

[0040] In some applications, deploying the first set of chordae tendineae recruiting arms such that the first set of chordae tendineae recruiting arms is deployed between the chordae tendineae of the natural atrioventricular valve includes: deploying the first set of chordae tendineae recruiting arms such that the first set of chordae tendineae recruiting arms extends axially from the ventricular end of the valve frame body to the atrial end of the valve frame body.

[0041] In some applications, deploying a second set of chordae tendineae arms such that the second set of chordae tendineae arms is deployed between the chordae tendineae of the natural atrioventricular valve includes: deploying the second set of chordae tendineae arms such that the second set of chordae tendineae arms extends radially from the valve frame body.

[0042] In some applications, deploying the first set of chordae tendineae recruiting arms such that deploying the second set of chordae tendineae recruiting arms between the chordae tendineae of the natural atrioventricular valve includes: deploying the second set of chordae tendineae recruiting arms such that the second set of chordae tendineae recruiting arms extends axially from the ventricular end of the valve frame body to the atrial end of the valve frame body.

[0043] In some applications, deploying a second set of chordae tendineae arms such that the second set of chordae tendineae arms is deployed between the chordae tendineae of the natural atrioventricular valve includes: after rotating a portion of the valve frame in the first circumferential direction, deploying the second set of chordae tendineae arms such that the second set of chordae tendineae arms is deployed between the chordae tendineae of the natural atrioventricular valve.

[0044] In some applications, deploying a second set of chordae tendineae arms such that the second set of chordae tendineae arms is deployed between the chordae tendineae of the natural atrioventricular valve includes: deploying the second set of chordae tendineae arms such that the second set of chordae tendineae arms is deployed between the chordae tendineae of the natural atrioventricular valve before rotating a portion of the valve frame in the first circumferential direction.

[0045] In some applications, rotating at least a portion of the valve frame in the second circumferential direction includes rotating a portion of the valve frame in the second circumferential direction by an angle smaller than the angle through which the portion of the valve frame rotates during rotation in the first circumferential direction.

[0046] In some applications, rotating at least a portion of the valve frame in the second circumferential direction includes rotating a portion of the valve frame in the second circumferential direction by an angle equal to the angle through which the portion of the valve frame rotates during rotation in the first circumferential direction.

[0047] According to some applications of the invention, a device is also provided for use with an artificial valve configured to be deployed within a natural atrioventricular valve of a mammalian subject's heart, the natural atrioventricular valve comprising a valve annulus, valve leaflets, chordae tendineae, and papillary muscles, the device comprising:

[0048] Valve frame, comprising a valve frame body configured to support an artificial valve within a natural atrioventricular valve, and a first group and a second group of at least chordae tendineae retracting arms configured to extend from the valve frame body; and

[0049] Delivery device, the delivery device is constructed as follows:

[0050] Deliver the valve frame to the natural atrioventricular valve;

[0051] Deploy the first set of chordae tendineae arms such that the first set of chordae tendineae arms is deployed between the chordae tendineae of the natural atrioventricular valve, and the first set of chordae tendineae arms is circumferentially bent around the valve frame body in the first circumferential direction.

[0052] In the first cycle, at least a portion of the valve frame is rotated in the directional direction so that by attracting and deflecting at least a portion of the chordae tendineae of the natural atrioventricular valve, the arm: (a) pulls the natural atrioventricular valve radially inward toward the valve frame, and (b) twists the natural atrioventricular valve around the valve frame.

[0053] Deploy a second set of chordae tendineae arms such that the second set of chordae tendineae arms is deployed between the chordae tendineae of the natural atrioventricular valve, and the second set of chordae tendineae arms is circumferentially curved around the valve frame body in a second circumferential direction, which is opposite to the first circumferential direction; and

[0054] At least a portion of the valve frame is rotated in the second circumferential direction so that the chordae tendineae are wound between the first set of chordae tendineae recruiting arms and the second set of chordae tendineae recruiting arms.

[0055] In some applications, the delivery device is configured to radially expand the valve frame body in order to capture the leaflets of the natural atrioventricular valve in a partially closed and twisted configuration, thereby at least partially sealing the space between the natural atrioventricular valve and the artificial valve.

[0056] In some applications, the first set of chordae tendineae recruiting arms is configured to extend radially from the valve frame body.

[0057] In some applications, the first set of chordae tendineae arms is configured to extend axially from the ventricular end of the valve frame body to the atrial end of the valve frame body.

[0058] In some applications, the second set of chordae tendineae recruiting arms is configured to extend radially from the valve frame body.

[0059] In some applications, the second set of chordae tendineae arms is configured to extend axially from the ventricular end of the valve frame body to the atrial end of the valve frame body.

[0060] In some applications, the delivery device is configured to deploy a second set of chordae tendineae arms after rotating a portion of the valve frame in the first circumferential direction, such that the second set of chordae tendineae arms is deployed between the chordae tendineae of the natural atrioventricular valve.

[0061] In some applications, the delivery device is configured to deploy a second set of chordae tendineae arms before rotating a portion of the valve frame in the first circumferential direction, such that the second set of chordae tendineae arms is deployed between the chordae tendineae of the natural atrioventricular valve.

[0062] In some applications, the delivery device is configured to rotate at least a portion of the valve frame through an angle in a second circumferential direction, which is smaller than the angle through which the portion of the valve frame rotates during rotation in the first circumferential direction.

[0063] In some applications, the delivery device is configured to rotate at least a portion of the valve frame through an angle in a second circumferential direction, the angle being equal to the angle through which the portion of the valve frame rotates during rotation in the first circumferential direction.

[0064] According to the appendix Figure 1 A more complete understanding of the invention will be obtained from the following detailed description of its application, as illustrated in the accompanying drawings: Brief description of the attached diagram

[0066] Figure 1This is a schematic diagram of an artificial mitral valve and an artificial mitral valve frame for some applications according to the present invention;

[0067] Figure 2A , Figure 2B , Figure 2C , Figure 2D , Figure 2E , Figure 2F and Figure 2G This is a schematic diagram illustrating the corresponding steps of deploying an artificial mitral valve and an artificial mitral valve frame at the natural mitral valve of a subject via a transseptal delivery method according to some applications of the present invention; and

[0068] Figure 3A , Figure 3B , Figure 3C , Figure 3D , Figure 3E and Figure 3F This is a schematic diagram of the corresponding steps of deploying an artificial mitral valve and an artificial mitral valve frame at the natural mitral valve of a subject via a septal delivery method according to some alternative applications of the present invention. Detailed Implementation

[0069] Now for reference Figure 1 , Figure 1 This is a schematic diagram of an artificial mitral valve 20 and an artificial mitral valve frame 22 according to some applications of the present invention. Typically, the artificial mitral valve frame includes a valve frame body 24 defining a ventricular portion 26 (which, upon deployment, is configured to be disposed within the left ventricle of a subject) and an atrial portion 28 (which, upon deployment, is configured to be disposed within the left atrium of a subject). The artificial mitral valve 20 typically includes a plurality of leaflets 30 (e.g., two or three leaflets as shown in the figure), which are sutured or otherwise connected to the valve frame body.

[0070] Typically, the valve frame 22 is made of a shape memory material (e.g., a shape memory alloy, such as nitinol or copper-aluminum-nickel), which is covered on one or both sides by a covering material 32, such as fabric and / or polymer (e.g., expanded polytetrafluoroethylene (ePTFE), or woven, knitted, and / or braided polyester fibers). Typically, the shape memory material of the valve frame is shaped as a stent-like structure comprising struts and / or units of the shape memory material. The covering material is typically attached to the shape memory material by sutures.

[0071] Typically, in the unconstrained configuration of the artificial mitral valve frame 22, a first group and a second group of chordae tendineae recruiting arms 34 extend radially from a portion of the valve frame body 24 configured to be placed within the ventricle of a subject. For some applications, each group of chordae tendineae recruiting arms includes multiple chordae tendineae recruiting arms, such as more than two chordae tendineae recruiting arms (e.g., more than four chordae tendineae recruiting arms) and / or fewer than 15 chordae tendineae recruiting arms (e.g., fewer than eight chordae tendineae recruiting arms), such as 2-15 or 4-8 chordae tendineae recruiting arms. Typically, the chordae tendineae recruiting arms are configured to extend radially from the valve frame body in addition to extending axially from the ventricular end of the valve frame body (i.e., the end of the valve frame body configured to be placed within the ventricle) toward the atrial end of the valve frame body (i.e., the end of the valve frame body configured to be placed within the atrium). Furthermore, typically, each of the first and second groups of chordae tendineae recruiting arms bends outward around the valve frame body in its respective, different circumferential bending directions. For example, the first group may bend counterclockwise, while the second group may bend clockwise, or vice versa. For some applications, the arms in the first group of chordae tendineae recruiting arms are configured with a concave leading edge facing a first circumferential direction, and the arms in the second group of chordae tendineae recruiting arms are configured with a concave leading edge facing a second circumferential direction.

[0072] Typically, a delivery catheter 40 is used (e.g., in...) Figure 1 (As shown in the right-hand portion) The artificial mitral valve 20 and the artificial mitral valve frame 22 are delivered to the natural mitral valve, and the delivery catheter is configured to maintain the artificial mitral valve 20 and the artificial mitral valve frame 22 in a radially constrained configuration (i.e., a “curled” configuration) during delivery. For some applications, the delivery catheter includes a proximal covering sheath 42 (which is configured to maintain the proximal portion of the artificial mitral valve frame in a radially constrained configuration by covering the proximal portion) and a distal nose cone 44 (which is configured to maintain the distal portion of the artificial mitral valve frame in a radially constrained configuration by covering the distal portion).

[0073] Now for reference Figure 2A , Figure 2B , Figure 2C , Figure 2D , Figure 2E , Figure 2F and Figure 2GThese are schematic diagrams illustrating the respective steps of deploying an artificial mitral valve 20 and an artificial mitral valve frame 22 at the natural mitral valve 46 of a subject via a transseptal delivery method according to some applications of the invention. Typically, the delivery catheter is guided on a guidewire 48 toward the subject's natural mitral valve 46. Depending on the application, the artificial mitral valve 20 and the artificial mitral valve frame 22 are delivered via the septum (i.e., via the vena cava, right atrium, and interatrial septum), via the apex (i.e., via the apex of the left ventricle), and / or via different delivery pathways. Although some aspects of this application relate to delivery via a transseptal method, with necessary modifications, the scope of the invention includes delivery of the artificial mitral valve 20 and the artificial mitral valve frame 22 via various methods.

[0074] like Figure 2A As shown, the distal end of the delivery catheter 40 is typically advanced into the left atrium 50 of the subject via the interatrial septum 52. Figure 2B As shown, the distal end of the delivery catheter is advanced toward the natural mitral valve, and is pushed through the leaflet 58 of the natural mitral valve and into the left ventricle 54. Figure 2C As shown, when the distal end of the delivery catheter is positioned within the left ventricle, the first group of chordae tendineae recruiting arms 34 is allowed to present a non-radially constrained configuration and at least partially radially expand. For example, as shown, the chordae tendineae recruiting arms belonging to the proximal group of the chordae tendineae recruiting arms are allowed to present a non-radially constrained configuration and at least partially radially expand. For some applications, this is achieved by releasing the arms from the radial constraints of the delivery catheter (e.g., by...). Figure 2C As indicated by arrow 59, the arm is allowed to assume a non-radially constrained configuration by partially retracting the proximal covering sheath 42 and / or by partially advancing the distal nasal cone 44. Typically, the chordae tendineae recruiting arms belonging to the proximal group are shaped to extend radially from the valve frame body 24 and bend circumferentially around the valve frame body (e.g., bend counterclockwise, as shown) upon release from the radial constraint of the delivery catheter. Furthermore, the chordae tendineae recruiting arms are typically configured to be deployed between the chordae tendineae 56 of the natural mitral valve upon release from the radial constraint of the delivery catheter. For some applications, at this stage, the chordae tendineae recruiting arms belonging to the second group of chordae tendineae recruiting arms are held in a radially constrained configuration by the delivery catheter 40 (e.g., the distal nasal cone 44 of the delivery catheter), as... Figure 2C As shown. Alternatively, for example, by advancing the distal nasal cone 44 of the delivery catheter and / or by retracting the proximal covering sheath 42, the chordae tendineae recruiting arms in the second group are also allowed to present their non-radial constraint configuration.

[0075] like Figure 2DAs shown, after the first set of chordae tendineae recruiting arms 34 is deployed between the chordae tendineae of the natural mitral valve (and typically when the chordae tendineae recruiting arms in another set of recruiting arms are held in a radially constrained configuration by the delivery catheter 40), at least a portion of the valve frame 22 rotates in the direction of arrow 60 to cause the chordae tendineae recruiting arms 34 to: (a) pull the natural mitral valve radially inward toward the valve frame, and (b) twist the natural mitral valve around the valve frame, by recruiting and deflecting at least a portion of the chordae tendineae. Typically, the first set of chordae tendineae recruiting arms 34 is configured to bend in a given circumferential direction relative to the longitudinal axis of the valve frame. For example, the arms may bend clockwise or counterclockwise relative to the longitudinal axis of the valve frame. Typically, after the chordae tendineae recruiting arms 34 are deployed between the chordae tendineae of the natural mitral valve, the valve frame rotates in the same circumferential direction as the circumferential bending direction of the arms. Figure 2D In the example shown, (viewed from the left atrium 50) the first set of arms is bent in a counterclockwise circumferential direction, and the valve frame rotates in that direction. As mentioned above, for some applications, during the execution Figure 2D Prior to the rotational step shown, the tendon-reclining arms in the second group of tendon-reclining arms are allowed to assume their non-radial constraint configuration. For such applications, in Figure 2D During the rotational step illustrated in the middle, the tendineae typically slide on the outer edge of the tendineae gathering arm, which belongs to the second group.

[0076] like Figure 2E As shown, for some applications, the second group of chordae tendineae recruiting arms 34 is allowed to present a non-radially constrained configuration and at least partially radially expand only after rotation of the valve frame. For example, as shown, the chordae tendineae recruiting arms belonging to the distal group of chordae tendineae recruiting arms (in the example shown, the distal group of chordae tendineae recruiting arms is the second group of chordae tendineae recruiting arms) are allowed to present a non-radially constrained configuration and at least partially radially expand. For some applications, this is achieved by releasing the arms from the radial constraints of the delivery catheter, for example by partially advancing the distal nasal cone 44 (e.g., Figure 2E (As indicated by arrow 61), allowing the arm to have a non-radial constraint configuration. Typically, the chordae tendineae recruiting arms belonging to the second group are shaped to extend radially from the valve frame body 24 and bend circumferentially around the valve frame body upon release from the radial constraint of the delivery catheter. Furthermore, typically, the chordae tendineae recruiting arms are configured to be deployed between the chordae tendineae 56 of the natural mitral valve upon release from the radial constraint of the delivery catheter.

[0077] As described above, the shape of the chordae tendineae recruiting arms belonging to the distal group is typically configured such that the circumferential curvature of the chordae tendineae recruiting arms belonging to the distal group is in the opposite circumferential direction to the circumferential curvature of the chordae tendineae recruiting arms belonging to the proximal group. For example, as Figure 2EAs shown (viewed from the left atrium 50), the arm belonging to the proximal group bends counterclockwise, while the arm belonging to the distal group bends clockwise. Figure 2E As shown, after the first rotation step, the valve frame rotates in the opposite direction of the circumferential bending direction of the second set of chordae tendineae recruiting arms. Figure 2E In the example shown, (viewed from the left atrium 50) the second set of arms bends in a clockwise circumferential direction, while the valve frame rotates in that direction, i.e., in the direction of arrow 62. Typically, this rotation of the valve frame causes the chordae tendineae 56 of the natural mitral valve to become entangled between the two sets of chordae tendineae attracting arms, which strengthens the anchorage of the artificial mitral valve frame to the natural mitral valve device, compared to the case where the artificial mitral valve frame only includes a single set of chordae tendineae attracting arms that bends in a single circumferential direction. Typically, the angle through which the valve frame rotates in the second rotation step is less than or equal to the angle through which the valve frame rotates in the first rotation step, in order to prevent tearing of the chordae tendineae 56.

[0078] After the two sets of chordae tendineae recruiting arms have been released and the valve frame has been rotated in the first and second circumferential directions, the valve frame body (i.e., the ventricular portion 26 and the atrial portion 28 of the valve frame) is allowed to present its non-radially constrained configuration. For some applications, the atrial portion is allowed to present its non-radially constrained configuration by releasing it from the delivery catheter (e.g., by further retracting the proximal covering sheath 42). For some applications, the ventricular portion is allowed to present its non-radially constrained configuration by releasing it from the delivery catheter (e.g., by further advancing the distal nasal cone 44). Figure 2F The ventricular portion 26 and the atrial portion 28 are shown in their non-radially constrained (i.e., radially dilated) configuration. Typically, by arranging the valve frame body in its non-radially constrained configuration, the valve frame body is configured to capture the natural valve leaflet 58 in a partially closed and twisted configuration, thereby at least partially sealing the space between the natural mitral valve and the artificial valve. For example, the ventricular portion may be configured to be radially dilated to capture the natural valve leaflet between the ventricular portion and the chordae tendineae attracting arms, and / or the atrial portion may be configured to be radially dilated to capture the natural valve leaflet between the atrial portion and the chordae tendineae attracting arms. Furthermore, typically, the valve frame is anchored to the natural mitral valve device by chordae tendineae 56 wound between arms belonging to the first group of chordae tendineae attracting arms and arms belonging to the second group of chordae tendineae attracting arms. After performing the above steps, typically, the delivery catheter 40 is then completely retracted from the subject's left atrium, as... Figure 2G As shown by arrow 64 in the image.

[0079] Now for reference Figure 3A , Figure 3B , Figure 3C , Figure 3D , Figure 3E and Figure 3F These are schematic diagrams illustrating the corresponding steps of deploying an artificial mitral valve 20 and an artificial mitral valve frame 22 at the natural mitral valve 46 of a subject via a septal delivery method according to some applications of the present invention. Generally, refer to Figures 3A-3F The process of description is similar to that of a reference. Figures 2A-2G The described process differs in that the order in which the proximal and distal groups of the chordae tendineae recruiting arms present their non-radial constraint configurations and the corresponding rotational order of the valve frame are reversed, as described further below. Therefore, although in Figures 2A-2G In the example shown, the proximal group of the chordae tendineae is considered the first group of the chordae tendineae (and the distal group of the chordae tendineae is considered the second group of the chordae tendineae), but in Figures 3A-3F In the example shown, the distal group of the chordae tendineae is considered the first group of the chordae tendineae (and the proximal group of the chordae tendineae is considered the second group of the chordae tendineae).

[0080] Typically, a delivery catheter 40 is used (e.g., in...) Figure 3A (As shown in the diagram) The artificial mitral valve 20 and artificial mitral valve frame 22 are delivered to the natural mitral valve, and the delivery catheter is configured to hold the artificial mitral valve 20 and artificial mitral valve frame 22 in a radially constrained configuration (i.e., a “curled” configuration) during delivery. Typically, the delivery catheter is guided on a guidewire 48 toward the subject’s natural mitral valve 46. Figure 3A As shown, the distal end of the delivery catheter 40 is typically advanced into the left atrium 50 of the subject via the interatrial septum 52. Figure 3B As shown, the distal end of the delivery catheter is advanced toward the natural mitral valve and then through the leaflet 58 of the natural mitral valve and into the left ventricle 54.

[0081] like Figure 3C As shown, when the distal end of the delivery catheter is positioned within the left ventricle, the first group of chordae tendineae recruiting arms 34 is allowed to present a non-radially constrained configuration and at least partially radially expanded. For example, as shown, the chordae tendineae recruiting arms belonging to the distal group of the chordae tendineae recruiting arms are allowed to present a non-radially constrained configuration and at least partially radially expanded. For some applications, the arms are allowed to present a non-radially constrained configuration by releasing the arms from the radial constraints of the delivery catheter (e.g., by partially advancing the distal nasal cone 44 and / or by partially retracting the proximal covering sheath 42). Typically, the chordae tendineae recruiting arms belonging to the distal group are shaped to extend radially from the valve frame body 24 and bend circumferentially around the valve frame body (e.g., bend clockwise, as shown). Furthermore, typically, the chordae tendineae recruiting arms are configured to be deployed between the chordae tendineae 56 of the natural mitral valve upon release from the radial constraints of the delivery catheter. For some applications, at this stage, such as Figure 3C As shown, chordae tendineae in another group of tendineae recruiting arms (i.e., in this case, the proximal group) are kept in a radially constrained configuration by the delivery catheter 40 (e.g., the proximal covering sheath 42 of the delivery catheter). Alternatively, chordae tendineae in a second group of tendineae recruiting arms may also be allowed to present their non-radially constrained configuration, for example, by retracting the proximal covering sheath 42 of the delivery catheter and / or by advancing the distal nasal cone 44.

[0082] like Figure 3D As shown, after the first set of chordae tendineae recruiting arms 34 is deployed between the chordae tendineae of the natural mitral valve (and typically when the chordae tendineae recruiting arms in another set of recruiting arms are held in a radially constrained configuration by the delivery catheter 40), at least a portion of the valve frame 22 rotates in the direction of arrow 62 to cause the chordae tendineae recruiting arms 34 to: (a) pull the natural mitral valve radially inward toward the valve frame, and (b) twist the natural mitral valve around the valve frame, by recruiting and deflecting at least a portion of the chordae tendineae. Typically, the first set of chordae tendineae recruiting arms 34 is configured to bend in a given circumferential direction relative to the longitudinal axis of the valve frame. For example, the arms may bend clockwise or counterclockwise relative to the longitudinal axis of the valve frame. Typically, after the chordae tendineae recruiting arms 34 are deployed between the chordae tendineae of the natural mitral valve, the valve frame rotates in the same circumferential direction as the circumferential bending direction of the arms. Figure 3D In the example shown, (viewed from the left atrium 50) the distal arm bends in a clockwise circumferential direction, and the valve frame rotates in that direction. As mentioned above, for some applications, during the execution Figure 3D Prior to the rotational step shown, the tendon-reclining arms in the second group of tendon-reclining arms are allowed to assume their non-radial constraint configuration. For such applications, in Figure 3D During the rotational step illustrated in the middle, the tendineae typically slide on the outer edge of the tendineae gathering arm, which belongs to the second group of tendineae gathering arms.

[0083] like Figure 3EAs shown, for some applications, the second group of chordae tendineae recruiting arms 34 is only permitted to have a non-radially constrained configuration and at least partially radially expanded after rotation of the valve frame. For example, as shown, the chordae tendineae recruiting arms belonging to the proximal group of the chordae tendineae recruiting arms (in the illustrated example, this proximal group of chordae tendineae recruiting arms is the second group of chordae tendineae recruiting arms) are permitted to have a non-radially constrained configuration and at least partially radially expanded. For some applications, the arms are permitted to have a non-radially constrained configuration by releasing the arms from the radial constraints of the delivery catheter (e.g., by partially retracting the proximal covering sheath 42). Typically, the chordae tendineae recruiting arms belonging to the proximal group are shaped to extend radially from the valve frame body 24 and bend circumferentially around the valve frame body when released from the radial constraints of the delivery catheter. Furthermore, typically, the chordae tendineae recruiting arms are configured to be deployed between the chordae tendineae 56 of the natural mitral valve when released from the radial constraints of the delivery catheter.

[0084] As described above, typically, the shape of the chordae tendineae recruiting arm belonging to the proximal group is configured such that the circumferential curvature of the chordae tendineae recruiting arm belonging to the proximal group is in the opposite circumferential direction to the circumferential curvature of the chordae tendineae recruiting arm belonging to the distal group. For example, as Figure 3E As shown, the arms belonging to the distal group bend clockwise, while the arms belonging to the proximal group bend counterclockwise. Figure 3E As shown, after the first rotation step, the valve frame rotates in the opposite direction to the circumferential curvature of the proximal group of the chordae tendineae recruiting arms. Figure 3E In the example shown, (viewed from the left atrium 50) the proximal group of the arm bends counterclockwise circumferentially, and the valve frame rotates in that direction, i.e., in the direction of arrow 60. Typically, this rotation of the valve frame causes the chordae tendineae 56 of the natural mitral valve to become entangled between the two groups of chordae tendineae attracting arms, which strengthens the anchorage of the artificial mitral valve frame to the natural mitral valve device, compared to the case where the artificial mitral valve frame only includes a single group of chordae tendineae attracting arms that bends in a single circumferential direction. Typically, the angle through which the valve frame rotates in the second rotation step is less than or equal to the angle through which the valve frame rotates in the first rotation step, in order to prevent chordae tendineae tearing.

[0085] After the two sets of chordae tendineae recruiting arms have been released and the valve frame has been rotated in the first and second circumferential directions, the valve frame body (i.e., the ventricular portion 26 and the atrial portion 28 of the valve frame) is allowed to present its non-radially constrained configuration. For some applications, the atrial portion is allowed to present its non-radially constrained configuration by releasing it from the delivery catheter (e.g., by further retracting the proximal covering sheath 42). For some applications, the ventricular portion is allowed to present its non-radially constrained configuration by releasing it from the delivery catheter (e.g., by further advancing the distal nasal cone 44). Figure 3FThe ventricular portion 26 and the atrial portion 28 are shown in their non-radially constrained (i.e., radially dilated) configuration. Typically, by arranging the valve frame body in its non-radially constrained configuration, the valve frame body is configured to capture the natural valve leaflet 58 in a partially closed and twisted configuration, thereby at least partially sealing the space between the natural mitral valve and the artificial valve. For example, the ventricular portion may be configured to be radially dilated to capture the natural valve leaflet between the ventricular portion and the chordae tendineae attracting arms, and / or the atrial portion may be configured to be radially dilated to capture the natural valve leaflet between the atrial portion and the chordae tendineae attracting arms. Furthermore, typically, the valve frame is anchored to the natural mitral valve device by chordae tendineae 56 wound between arms belonging to the first group of chordae tendineae attracting arms and arms belonging to the second group of chordae tendineae attracting arms. After performing the above steps, typically, the delivery catheter 40 is then completely retracted from the subject's left atrium, as... Figure 3F As shown by arrow 64 in the image.

[0086] Although in the example described herein, the proximal group of arms is bent in a counterclockwise circumferential direction (and the corresponding rotation of the valve frame is in this direction), and the distal group of arms is bent in a clockwise circumferential direction (and the corresponding rotation of the valve frame is in this direction), the scope of the invention includes the proximal group of arms being bent in a clockwise circumferential direction (and the corresponding rotation of the valve frame is in this direction), and the distal group of arms being bent in a counterclockwise circumferential direction (and the corresponding rotation of the valve frame is in this direction). Similarly, the scope of the invention includes the first group and the second group of arms being positioned at the same height relative to each other along the valve frame, or overlapping each other along the valve frame, alternating with each other along the valve frame, and / or other possible configurations.

[0087] The scope of this invention includes valve frames generally as described herein, but with a proximal group and a distal group of arms that bend in the same direction as each other. Typically, with necessary modifications, the arms and their method of use are generally as described above. For some such applications, each group of arms is configured to be deployed between the chordae tendineae at corresponding, different heights within the left ventricle. The arms are used to gather and deflect the shape of the chordae tendineae at corresponding, different heights within the left ventricle in the manner described above. Optionally, during surgery, only one group of arms can be selected to be deployed between the chordae tendineae and used to gather and deflect the shape of the chordae tendineae, while the other group of arms is only released from the delivery catheter when the ventricular portion of the valve frame is released (so that the other group of arms is not deployed between the chordae tendineae). Typically, the selection of which group of arms to be deployed between the chordae tendineae is performed by a healthcare professional based on the anatomical constraints of the specific patient in whose body the valve frame is to be deployed.

[0088] Although some applications of the invention are described as being used in combination with an artificial mitral valve and an artificial mitral valve frame, the scope of the invention includes the use of devices and techniques substantially similar to those of any artificial atrioventricular valve and artificial atrioventricular valve frame. Therefore, with necessary modifications, the scope of the invention includes devices and techniques substantially similar to those of artificial tricuspid valves and artificial tricuspid valve frames having a substantially similar configuration to those described herein. For example, an artificial tricuspid valve frame including a first set and a second set of chordae tendineae recruiting arms can be delivered to the subject's natural tricuspid valve via a delivery catheter 40 through the subject's right atrium. Typically, in addition to extending axially from the ventricular end of the valve frame body (i.e., the end of the valve frame body configured to be placed within the ventricle) toward the atrial end of the valve frame body (i.e., the end of the valve frame body configured to be placed within the atrium), the first set and the second set of chordae tendineae recruiting arms are also shaped to extend radially from the valve frame body. Furthermore, typically, each of the first and second groups of chordae tendineae recruiting arms bends outward around the valve frame body in its respective, different circumferential bending direction. For example, the first group may bend counterclockwise, while the second group may bend clockwise, or vice versa.

[0089] Typically, the chordae tendineae in the first group of chordae tendineae are allowed to be deployed between the chordae tendineae of the natural tricuspid valve by presenting their non-radially constrained configuration, and the valve frame rotates in the same circumferential direction as the circumferential curvature of the first group of chordae tendineae. Typically, this causes the chordae tendineae to: (a) pull the natural tricuspid valve radially inward toward the valve frame, and (b) twist the natural tricuspid valve around the valve frame by attracting and deflecting at least a portion of the chordae tendineae. For some applications, the second group of chordae tendineae is allowed to present a non-radially constrained configuration and be at least partially radially expanded so as to be deployed between the chordae tendineae of the natural tricuspid valve. As described above, typically, the chordae tendineae in the second group are shaped such that the circumferential curvature of the chordae tendineae in the second group is in the opposite circumferential direction to the circumferential curvature of the chordae tendineae in the first group. After the first rotation step has been performed, the valve frame rotates in the same circumferential direction as the circumferential curvature of the second group of chordae tendineae. Typically, the rotation of the valve frame in this manner causes the chordae tendineae of the natural tricuspid valve to wrap around between two sets of chordae tendineae accommodating arms, which, in contrast to the case where the artificial tricuspid valve frame only includes a single set of chordae tendineae accommodating arms bent in a single circumferential direction, strengthens the anchorage of the artificial tricuspid valve frame to the natural tricuspid valve device.

[0090] After the two sets of chordae tendineae recruiting arms have been released and the valve frame has been rotated in the first and second circumferential directions, the valve frame body is allowed to assume its non-radially constrained configuration. Typically, by assuming its non-radially constrained configuration, the valve frame body is configured to capture the natural tricuspid leaflet in a partially closed and twisted configuration, thereby at least partially sealing the space between the natural tricuspid valve and the artificial valve. For example, the ventricular portion may be configured to expand radially to capture the natural tricuspid leaflet between the ventricular portion and the chordae tendineae recruiting arms, and / or the atrial portion may be configured to expand radially to capture the natural tricuspid leaflet between the atrial portion and the chordae tendineae recruiting arms. Furthermore, typically, the valve frame is anchored to the natural tricuspid valve device by chordae tendineae wound between arms belonging to the first set of chordae tendineae recruiting arms and arms belonging to the second set of chordae tendineae recruiting arms.

[0091] Those skilled in the art will recognize that the invention is not limited to what has been specifically shown and described above. Rather, the scope of the invention includes both combinations and sub-combinations of the various features described above, as well as variations and modifications of the invention that will arise in the mind of those skilled in the art upon reading the foregoing description, and that are not found in the prior art.

Claims

1. A device for use with an artificial valve, the artificial valve being configured for deployment within a natural atrioventricular valve of the heart of a mammalian subject, the natural atrioventricular valve including a valve annulus, valve leaflets, chordae tendineae, and papillary muscles, the device comprising: Valve framework, the valve framework comprising: A valve frame body, the valve frame body being configured to support the artificial valve within the natural atrioventricular valve; A first group of chordae tendineae recruiting arms, the first group of chordae tendineae recruiting arms extending from the valve frame body, and each chordae tendineae recruiting arm in the first group of chordae tendineae recruiting arms being configured to be circumferentially bent counterclockwise around the valve frame body in a first circumferential direction; and A second group of chordae tendineae recruiting arms extends from the valve frame body, and each chordae tendineae recruiting arm in the second group is configured to bend circumferentially around the valve frame body in a clockwise direction in a second circumferential direction, the second circumferential direction being opposite to the first circumferential direction. The valve frame is configured such that rotation of the valve frame in the first circumferential direction causes at least a portion of the chordae tendineae of the natural atrioventricular valve to be recruited and deflected, such that a first set of recruiting arms of the chordae tendineae: (a) pulls the natural atrioventricular valve radially inward toward the valve frame, and (b) naturally twists the natural atrioventricular valve around the valve frame. The valve frame is configured such that rotating the valve frame in the first circumferential direction followed by rotating the valve frame in the second circumferential direction causes the chordae tendineae to become entangled between the first set of the chordae tendineae recruiting arms and the second set of the chordae tendineae recruiting arms.

2. The apparatus according to claim 1, wherein, The first set of the chordae tendineae recruiting arms is configured to extend radially from the valve frame body; and / or Wherein, the first group of chordae tendineae recruiting arms and the second group of chordae tendineae recruiting arms overlap each other around the valve frame; and / or The first group of the chordae tendineae is the proximal group of the chordae tendineae, and the second group of the chordae tendineae is the distal group of the chordae tendineae.

3. The apparatus according to claim 1, wherein, The first set of the chordae tendineae arms is configured to extend axially from the ventricular end of the valve frame body to the atrial end of the valve frame body.

4. The apparatus according to claim 1, wherein, The second set of the chordae tendineae recruiting arms is configured to extend radially from the valve frame body.

5. The apparatus according to claim 1, wherein, The second set of the chordae tendineae arms is configured to extend axially from the ventricular end of the valve frame body to the atrial end of the valve frame body.

6. The apparatus according to claim 1, wherein, The valve frame body is configured to expand radially to capture the leaflets of the natural atrioventricular valve in a partially closed and twisted configuration, thereby at least partially sealing the space between the natural atrioventricular valve and the artificial valve.

7. A device for use with an artificial valve, the artificial valve being configured for deployment within a natural atrioventricular valve of the heart of a mammalian subject, the natural atrioventricular valve including a valve annulus, valve leaflets, chordae tendineae, and papillary muscles, the device comprising: A valve frame, the valve frame including a valve frame body configured to support the artificial valve within a natural atrioventricular valve, and a first group and a second group of at least chordae tendineae arms configured to extend from the valve frame body. as well as Delivery device, the delivery device being configured to: The valve frame is delivered to the natural atrioventricular valve; The first group of chordae tendineae is deployed such that the first group of chordae tendineae is deployed between the chordae tendineae of the natural atrioventricular valve, and each chordae tendineae in the first group of chordae tendineae is circumferentially bent in a counterclockwise direction around the valve frame body in the first circumferential direction. At least a portion of the valve frame is rotated in the first circumferential direction such that, by attracting and deflecting at least a portion of the chordae tendineae of the natural atrioventricular valve, the first set of the chordae tendineae attracting arms: (a) pulls the natural atrioventricular valve radially inward toward the valve frame, and (b) naturally twists the natural atrioventricular valve around the valve frame. Deploy the second set of chordae tendineae arms such that the second set of chordae tendineae arms is deployed between the chordae tendineae of the natural atrioventricular valve, and each chordae tendineae arm in the second set of chordae tendineae arms is circumferentially bent in a clockwise direction around the valve frame body in a second circumferential direction, the second circumferential direction being the opposite direction to the first circumferential direction; as well as At least a portion of the valve frame is rotated in the second circumferential direction such that the tendineae are wound between the first set of tendineae recruiting arms and the second set of tendineae recruiting arms.

8. The apparatus according to claim 7, wherein, The delivery device is configured to radially expand the valve frame body to capture the leaflets of the natural atrioventricular valve in a partially closed and twisted configuration, thereby at least partially sealing the space between the natural atrioventricular valve and the artificial valve.

9. The apparatus according to claim 7, wherein, The first set of the chordae tendineae recruiting arms is configured to extend radially from the valve frame body; and / or Wherein, the first group of chordae tendineae recruiting arms and the second group of chordae tendineae recruiting arms overlap each other around the valve frame; and / or The first group of the chordae tendineae is the proximal group of the chordae tendineae, and the second group of the chordae tendineae is the distal group of the chordae tendineae.

10. The apparatus according to claim 7, wherein, The first set of the chordae tendineae arms is configured to extend axially from the ventricular end of the valve frame body to the atrial end of the valve frame body.

11. The apparatus according to claim 7, wherein, The second set of the chordae tendineae recruiting arms is configured to extend radially from the valve frame body.

12. The apparatus according to claim 7, wherein, The second set of the chordae tendineae arms is configured to extend axially from the ventricular end of the valve frame body to the atrial end of the valve frame body.

13. The apparatus according to any one of claims 7-12, wherein, The delivery device is configured to deploy a second set of chordae tendineae arms after rotating the portion of the valve frame in the first circumferential direction, such that the second set of chordae tendineae arms is deployed between the chordae tendineae of the natural atrioventricular valve.

14. The apparatus according to any one of claims 7-12, wherein, The delivery device is configured to deploy a second set of chordae tendineae arms before rotating the portion of the valve frame in the first circumferential direction, such that the second set of chordae tendineae arms is deployed between the chordae tendineae of the natural atrioventricular valve.

15. The apparatus according to any one of claims 7-12, wherein, The delivery device is configured to rotate at least said portion of the valve frame through an angle in the second circumferential direction, the angle being smaller than the angle through which said portion of the valve frame rotates during rotation of said portion of the valve frame in the first circumferential direction.

16. The apparatus according to any one of claims 7-12, wherein, The delivery device is configured to rotate at least said portion of the valve frame through an angle in the second circumferential direction, the angle being equal to the angle through which said portion of the valve frame rotates during rotation of said portion of the valve frame in the first circumferential direction.

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