Clip with opposing jaws for closing the left atrial appendage

Abstract

The clip (30) may be configured to close a portion of the heart to reduce blood flow and passage of thrombus or other undesirable material through that portion of the heart. The clip may be configured to close the left atrial appendage (LAA). Closure of the LAA may reduce the likelihood of stroke or other disease resulting from fluid flow through the LAA. The clip may include a first jaw (32) having a compression surface opposing a compression surface of a second jaw (34).

Description

[Technical field]

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS This application claims priority to U.S. Patent Application No. 63 / 231,427, filed August 10, 2021, entitled "CLIP WITH OPPOSED JAWS FOR LEFT ATRIAL APPENDAGE CLOSURE," the entire contents of which are incorporated by reference for all purposes. [Background technology]

[0002] Various examples disclosed herein relate generally to clips for medical implementation. Some examples relate to clips for the left atrial appendage (LAA).

[0003] Cardiac arrhythmias are abnormal rhythms that prevent the heart from pumping blood efficiently. Atrial fibrillation (AF) is one of the most common cardiac arrhythmia conditions. AF causes the left atrium to beat irregularly, making the "atrial kick" that helps pump blood into the left ventricle less efficient.

[0004] The left atrial appendage (LAA) is a muscular pouch located high in the free wall of the left atrium. Due to the anatomy of the LAA, blood has a tendency to back up and form clots inside the LAA. As blood flow decreases with the progression of AF, the likelihood of clot formation becomes much greater.

[0005] A clot formed in the LAA can embolize into the bloodstream and travel to the brain, where it may lodge and ultimately cause a stroke. It may be beneficial to close or occlude the LAA to reduce the likelihood of clots or other unwanted material entering the left atrium and into the bloodstream.

[0006] Left atrial appendage closure (also known as LAA closure or LAAC) is a minimally invasive procedure used to reduce the risk of stroke resulting from atrial fibrillation. Summary of the Invention

[0007] The systems, devices, and methods disclosed herein may be directed to clips for medical implementation, including clips for a portion of the heart. The clip may be configured to close a portion of the heart, thereby reducing blood flow and passage of blood clots or other undesirable material through the portion of the heart. In an example, the clip may be configured to close the left atrial appendage (LAA). Closure of the LAA may reduce the likelihood of stroke or other diseases resulting from fluid flow through the LAA. In an example, the clip may be positioned outside the LAA, thereby extending over the outer surface of the LAA for closure.

[0008] An embodiment is a clip for a portion of the heart.

[0009] The clip may include a first jaw extending from a first end portion to a second end portion and including a compression surface and an exterior surface facing opposite the compression surface.

[0010] The clip may include a second jaw extending from the first end portion to the second end portion and including a compression surface opposing the compression surface of the first jaw and an exterior surface facing away from the compression surface of the second jaw.

[0011] The clip may include a spring extending over an outer surface of the first jaw and over an outer surface of the second jaw and configured to urge the first and second jaws together to compress a portion of the heart between a compression surface of the first jaw and a compression surface of the second jaw.

[0012] In aspects, the method may include deploying a clip to close off a portion of the heart.

[0013] The clip may include a first jaw extending from a first end portion to a second end portion and including a compression surface and an exterior surface facing opposite the compression surface.

[0014] The clip may include a second jaw extending from the first end portion to the second end portion and including a compression surface opposing the compression surface of the first jaw and an exterior surface facing away from the compression surface of the second jaw.

[0015] The clip may include a spring extending over an outer surface of the first jaw and over an outer surface of the second jaw and configured to urge the first and second jaws together to compress a portion of the heart between a compression surface of the first jaw and a compression surface of the second jaw. [Brief description of the drawings]

[0016] [Figure 1] FIG. 1 shows a cross-sectional schematic diagram of a portion of the heart. [Diagram 2] FIG. 2 illustrates a perspective view of the clip. [Diagram 3] FIG. 3 illustrates a perspective view of the clip shown in FIG. 2 from the opposite side to the clip shown in FIG. [Figure 4] FIG. 4 illustrates a cross-sectional view of the clip shown in FIG. 2 taken along line 4-4 in FIG. [Diagram 5] FIG. 5 illustrates an assembly view of the clip shown in FIG. [Figure 6] FIG. 6 illustrates a cross-sectional view of the clip shown in FIG. 2 taken along line 6-6 in FIG. [Figure 7A] 7A and 7B illustrate steps in the deployment of the clip shown in FIG. [Figure 7B] Same as above. [Figure 8A] 8A-8C illustrate perspective views of the variable positioning of the clip shown in FIG. [Figure 8B] Same as above. [Figure 8C] Same as above. [Figure 9] FIG. 9 illustrates a perspective view of the clip. [Figure 10] FIG. 10 illustrates a perspective view of the clip. [Figure 11] FIG. 11 illustrates a perspective view of the clip. [Figure 12] FIG. 12 illustrates a top, front perspective view of the clip. [Figure 13] FIG. 13 illustrates a top view of the clip shown in FIG. [Figure 14] FIG. 14 illustrates a side view of the clip shown in FIG. [Figure 15] FIG. 15 illustrates a bottom, rear perspective view of the clip shown in FIG. [Figure 16] FIG. 16 illustrates a cross-sectional view taken along line 16-16 in FIG. [Figure 17] FIG. 17 illustrates a cross-sectional view taken along line 17-17 in FIG. [Figure 18] FIG. 18 illustrates a side view of the spring. [Figure 19] FIG. 19 illustrates a plan view of the spring shown in FIG. [Figure 20] FIG. 20 illustrates a perspective view of the first jaw of the clip. [Figure 21] FIG. 21 illustrates a plan view of the first jaw shown in FIG. [Figure 22] FIG. 22 illustrates a side view of a clip utilizing the first jaw shown in FIG. [Diagram 23] FIG. 23 illustrates a top view of the clip shown in FIG. [Figure 24] FIG. 24 illustrates a proximal end view of the clip shown in FIG. [Diagram 25] FIG. 25 illustrates a distal end view of the clip shown in FIG. [Figure 26]FIG. 26 illustrates a perspective view of the jaws. [Figure 27] FIG. 27 illustrates a distal end view of the jaw shown in FIG. [Figure 28] FIG. 28 illustrates a perspective view of the cushioning layer. [Figure 29] FIG. 29 illustrates a perspective view of the jaws. [Diagram 30] FIG. 30 illustrates a distal end view of the jaw shown in FIG. [Diagram 31] FIG. 31 illustrates a perspective view of the cushioning layer shown in FIG. [Diagram 32] FIG. 32 illustrates a perspective view of the clip. [Diagram 33] FIG. 33 illustrates an assembly drawing of the jaws. [Diagram 34] FIG. 34 illustrates a perspective view of the jaw shown in FIG. [Diagram 35] FIG. 35 illustrates a bottom perspective view of the jaw shown in FIG. [Diagram 36] FIG. 36 illustrates a side view of the clip. [Figure 37] FIG. 37 illustrates a cross-sectional view taken along line 37-37 in FIG. [Figure 38] FIG. 38 illustrates a side view of the clip. [Figure 39] FIG. 39 illustrates a side view of a strip of plugs. [Diagram 40] FIG. 40 illustrates a side view of the plug. [Diagram 41] FIG. 41 illustrates a perspective view of the first and second jaws. [Diagram 42] FIG. 42 illustrates a side view of the jaws. [Diagram 43] FIG. 43 illustrates an enlarged view of the distal end portion of the jaws. [Diagram 44] FIG. 44 illustrates an end view of the jaw shown in FIG. [Diagram 45] FIG. 45 illustrates an end view of the jaws. [Figure 46] FIG. 46 illustrates a side view of the clip. [Figure 47] FIG. 47 illustrates a side view of the clip. [Figure 48] FIG. 48 illustrates a side view of the spring. [Figure 49] FIG. 49 illustrates a side view of the clip. [Figure 50] FIG. 50 illustrates a perspective view of a portion of the jaw. [Figure 51] FIG. 51 illustrates a perspective view of the jaws. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0017] FIG. 1 illustrates a cross-sectional view of the left atrium 10 and left ventricle 12 of an individual's heart 14. The left atrium 10 is configured to fill with blood passing through the mitral valve 16 into the left ventricle 12 during the cardiac cycle. A left atrial appendage (LAA) 18 projects from an outer wall 20 of the left atrium 10 and includes an inlet 22 and a cavity 24 extending from the inlet 22. An LAA wall 26 may surround the cavity 24 and form an outer surface 28 of the LAA 18. The LAA 18 has a pouch shape extending from the left atrium 10. The cavity 24 may be configured to fill with blood, allowing the LAA to function as a reduced pressure chamber during systole and when pressure is otherwise elevated within the left atrium 10.

[0018] In some individuals, blood may back up and form clots within the LAA 18. Clots or other unwanted material from the LAA 18 may travel through the bloodstream and cause a variety of illnesses, including stroke. Thus, it may be beneficial to close the LAA 18 to reduce the likelihood of clots or other unwanted material causing such illnesses.

[0019] Figure 2 illustrates one example of a clip 30 that may be utilized in relation to a portion of the heart. Figure 3 illustrates a side perspective view of the clip 30 from the opposite side from that shown in Figure 2. With reference to Figures 2 and 3, the clip 30 may be configured to occlude the LAA 18 to reduce the likelihood that clots or other undesirable material originating from the LAA 18 will become dislodged in the bloodstream.

[0020] The clip 30 may include a first jaw 32 and a second jaw 34. The first jaw 32 may extend from a first end portion 36 to a second end portion 38 and may have an elongated shape. The first jaw 32 may be configured as an elongated beam. The first jaw 32 may have a central portion 40 between the first end portion 36 and the second end portion 38.

[0021] The first jaw 32 may include four sides, including an outer surface 42, a compression surface (facing away from the outer surface 42 and facing the second jaw 34), and two side surfaces 44, 46 (side surface 46 is shown in FIG. 3), each extending from the compression surface to the outer surface 42.

[0022] The first jaw 32 may extend along a longitudinal axis 48 (shown in FIGS. 4 and 6) and may have a rectangular cross-section when viewed perpendicular to the longitudinal axis 48 (as shown in the cross-sectional view of FIG. 4).

[0023] In an example, a first end portion 36 of the first jaw 32 may be tapered to provide a rounded tip 51 of the first jaw 32. The rounded tip 51 of the first jaw 32 may allow the first jaw 32 to be atraumatic to the patient's body upon insertion into the body and upon deployment to a desired location. In an example, a second end portion 38 of the first jaw 32 may be tapered.

[0024] The exterior surface 42 of the first jaw 32 may include a channel 50. FIG. 4 illustrates a cross-sectional view of the clip 30 taken along line 4-4 in FIG. 2, FIG. 5 illustrates an assembled view of the clip 30, and FIG. 6 illustrates a cross-sectional view of the clip 30 taken along line 6-6 in FIG. 2. Referring to FIGS. 4-6, the channel 50 may include a first side wall 52, a second side wall 54, and a bottom wall 56 of the channel 50. The top of the channel 50 may be left open to allow a spring 60 to pass through. The channel 50 may extend from the central portion 40 of the first jaw 32 to the second end portion 38 of the first jaw 32.

[0025] The channel 50 may include a first end 62 and a second end 64, with the second end 64 being open to allow the spring 60 to pass therethrough.

[0026] A coupling member 66 may be positioned at the first end 62 of the channel 50, and the coupling member 66 may be configured to receive an end of the spring 60. The coupling member 66 may include a cavity in the first jaw 32, or may have another configuration as desired.

[0027] In an example, the first jaw 32 may include a recess 68 for receiving a device that applies an expansive force to the spring 60. The recess 68 may be positioned between a first end 70 of the spring 60 and the second end portion 38 of the first jaw 32, as shown in FIG. 2. The recess 68 may be positioned on one or more of the sides 44, 46 and may extend through the first jaw 32, in a desired example.

[0028] The second jaw 34 may extend from a first end portion 72 to a second end portion 74 and may have an elongated shape. The second jaw 34 may be configured as an elongated beam. The second jaw 34 may have a central portion 79 between the first end portion 72 and the second end portion 74.

[0029] The second jaw 34 may include four sides, including an outer surface 76 (shown in FIG. 3), a compression surface 77 (shown in FIG. 5, facing away from the outer surface 76 and toward the first jaw 32), and two side surfaces 78, 80, each extending from the compression surface to the outer surface 76. The compression surface 77 of the second jaw 34 faces the compression surface of the first jaw 32.

[0030] The second jaw 34 may extend along a longitudinal axis 82 (shown in FIGS. 4 and 6) and may have a rectangular cross-section when viewed perpendicular to the longitudinal axis 82 (as shown in the cross-sectional view of FIG. 4).

[0031] In an example, the first end portion 72 of the second jaw 34 may be tapered to provide a rounded tip 84 of the second jaw 34. The rounded tip 84 of the second jaw 34 may allow the second jaw 34 to be atraumatic to the patient's body upon insertion into the body and upon deployment to a desired location. In an example, the second end portion 74 of the second jaw 34 may be tapered.

[0032] The exterior surface 76 of the second jaw 34 may include a channel 86. With reference to Figures 4-6, the channel 86 may include a first side wall 88, a second side wall 90, and a bottom wall 92 of the channel 86. The top of the channel 86 may be left open to allow the spring 60 to pass through. The channel 86 may extend from a central portion 79 of the second jaw 34 to the second end portion 74 of the second jaw 34.

[0033] The channel 86 may include a first end 94 and a second end 96, with the second end 96 being open to allow the spring 60 to pass therethrough.

[0034] A coupling member 99 may be positioned at the first end 94 of the channel 86, and the coupling member 99 may be configured to receive an end of the spring 60. The coupling member 99 may include a cavity in the second jaw 34, or may have another configuration as desired.

[0035] In examples, the second jaw 34 may include a recess 97 for receiving a device that applies an expansive force to the spring 60. The recess 97 may be positioned between the second end 71 of the spring 60 and the second end portion 74 of the second jaw 34, as shown in FIG. 2. The recess 97 may be positioned on one or more of the sides 78, 80 and may extend through the second jaw 34, in desired examples.

[0036] In the example, the recess 97 in the second jaw 34 and the recess 68 in the first jaw 32 may be positioned to distribute the compressive load from the spring 60 evenly to each end portion 36, 38, 72, 74 of the first jaw 32 and second jaw 34.

[0037] In an example, the recess 97 of the second jaw 34 and the recess 68 of the first jaw 32 may be configured such that the clip 30 may be variably positioned relative to a device that applies an expansion force to the spring 60. For example, referring to FIG. 8A, the device that applies an expansion force to the spring 60 may include extendable arms 101, 103 having corresponding protrusions 105, 107, respectively. The arms 101, 103 may be clamped relative to one another or otherwise configured to expand. The protrusions 105, 107 may be configured to be received within the corresponding recesses 68, 97, respectively, to apply an expansion force to the spring 60 (to drive the clip 30 to an open state by driving the protrusions 105, 107 in the opposite direction).

[0038] As shown in FIG. 8A, with protrusions 105, 107 both inserted into recesses 68, 97 at the same longitudinal position along recesses 68, 97, clip 30 may be held parallel to expandable arms 101, 103.

[0039] With projection 105 located at a first end 109 of recess 68 and projection 107 located at an opposite second end 111 in recess 97, as shown in Figure 8B, clip 30 may be pivoted and held at an angle relative to arms 101, 103. This angle may be a 45 degree angle or other angle as desired.

[0040] With the projection 105 located at the second end 113 of the recess 68 and the projection 107 located at the opposite first end 115 of the recess 97 as shown in FIG. 8C, the clip 30 may be pivoted and held at an angle relative to the arms 101, 103. This angle may be at a 45 degree angle or at another angle as desired, and this angle may be the opposite of the angle shown in FIG. 8B. For example, the angle shown in FIG. 8B may be at a 45 degree upward angle and the angle shown in FIG. 8C may be at a 45 degree downward angle. Thus, the clip 30 may be pivoted in an arc relative to the arms 101, 103 and held at an angle relative to the arms 101, 103 as desired.

[0041] In examples, the compression surfaces of the jaws 32, 34 may be coated with a soft medical grade material to make the compression surfaces of the jaws 32, 34 atraumatic, if desired.

[0042] 2, the spring 60 may extend onto the exterior surface 42 of the first jaw 32 and onto the exterior surface 76 of the second jaw 34 and may be configured to bias the first jaw 32 and the second jaw 34 together to compress a portion of the heart between the compression surface of the first jaw 32 and the compression surface 77 of the second jaw 34 (shown in FIG. 5). For example, the spring 60 may have a "C" shape and have a first end 70, a second end 71, and a loop 98 coupled to the first end 70 and the second end 71. The loop 98 may include a straight portion 95 and a curved portion 93 coupled to the straight portion 95 and forming a curvature of the "C" shape. A first end 70 of the spring 60 may be coupled to a central portion 40 of the first jaw 32, a second end 71 of the spring 60 may be coupled to a central portion 79 of the second jaw 34, and the loop 98 may extend toward the second end portion 38 of the first jaw 32 and toward the second end portion 74 of the second jaw 34.

[0043] The loop 98 may extend into the channel 50 of the first jaw 32 and into the channel 86 of the second jaw 34. The loop 98 may protrude from the second end portion 38 of the first jaw 32 and from the second end portion 74 of the second jaw 34. The loop 98 may be positioned within the channel 50 of the first jaw 32 between the corresponding side walls 52, 54 of the channel 50 and may be positioned within the channel 86 of the second jaw 34 between the side walls 88, 90 (shown in FIG. 4 ) of the channel 86. The loop 98 may be spaced apart from the corresponding bottom walls 56, 92 of the channels 50, 86 such that the loop 98 may be driven toward the corresponding bottom walls 56, 92 when the clip 30 is in the open position. For example, the spring 60 may pivot relative to the bottom walls 56, 92 when the clip 30 is in the open position.

[0044] The position of loop 98 within channel 50, 86 may allow for expansion of clip 30. The position of loop 98 within channel 50, 86 may reduce the likelihood of spring 60 twisting when clip 30 is opened or closed. The position of loop 98 within channel 50, 86 may allow jaws 32, 34 to open more widely than, for example, the example shown in Figures 9-11.

[0045] The loop 98 may reside continuously within the channels 50, 86 to reduce the likelihood of distal or side-to-side movement of the jaws 32, 34.

[0046] The spring 60 may extend within the plane of movement of the first and second jaws 32 and 34 .

[0047] The spring 60 may be configured to allow the clip 30 to move from the open state to the closed state, and may be configured to bias the clip 30 toward the closed state. The spring 60 may thus provide a force to urge the compression surfaces of the first and second jaws 32, 34 toward each other, thereby compressing a portion of the heart therebetween. The spring 60 may be configured to maintain the jaws 32, 34 in a positive compression state at all times, even when stationary.

[0048] The spring 60 may have a "C" shape such that the corresponding first end portions 36, 72 of the first and second jaws 32, 34, respectively, can form an axial opening 100 (shown in FIG. 7A) for a space 102 (shown in FIG. 7A) between the first and second jaws 32, 34 to receive a portion of the heart. The clip 30 may be positioned in an open state, in which a portion of the heart is slid through the axial opening 100 and into the space 102. In examples, other methods for introduction into the space 102 may be provided (e.g., along the axis of the LAA).

[0049] The loop 98 may form a boundary of a space 102 between the first jaw 32 and the second jaw 34. The loop 98 may protrude from the second end portion 38 of the first jaw 32 and from the second end portion 74 of the second jaw 34. Thus, the loop 98 may prevent the clip 30 from sliding distally relative to the LAA 18 during deployment and may prevent tissue of the LAA 18 from protruding beyond the loop 98 during compression of the LAA 18.

[0050] The spring 60 may be configured to pivotally couple to the connecting members 66, 99. Thus, when the clip 30 is positioned in an open state, the compression surfaces of the first and second jaws 32, 34 may be inclined relative to one another with the tips 51, 84 positioned closer to one another as compared to the second end portions 38, 74 of the jaws 32, 34, as shown in FIG. 7A. Thus, when the clip 30 is closed, the tips 51, 84 may be configured to close earlier as compared to the second end portions 38, 74 of the jaws 32, 34. The spring 60 may be pivotally coupled to the connecting members 66, 99 such that the second end portions 38, 74 of the first and second jaws 32, 34 open before the tips 51, 84 when the clip 30 is opened. The spring 60 may be pivotally coupled to the connecting members 66, 99, in examples, without the need for pins and without gluing or welding.

[0051] In operation, the clip 30 may be utilized to close the LAA 18 .

[0052] 7A and 7B illustrate an exemplary deployment of clip 30. Features of clip 30 may be omitted in the illustrations in FIGS. 7A and 7B. In FIG. 7A, clip 30 may be placed in an open position and driven toward LAA 18 transverse to the major axis of LAA 18. In examples, other approaches (e.g., along the major axis of LAA 18) may be utilized as desired. Access may be provided to LAA 18 in a variety of ways, including transcatheter access, or including surgical access, such as a thoracotomy, mini-thoracotomy, or other access methods.

[0053] The clip 30 may be disposed on the exterior surface 28 of the LAA 18. In examples, a delivery device may be utilized to drive the clip 30 toward the LAA 18, or in examples, a user (e.g., a medical professional such as a surgeon or other form of medical professional) may manually place the clip 30. For example, the delivery device may include a device that applies an expansion force against the spring 60 and may be inserted into the corresponding recesses 68, 97 of the first and second jaws 32, 34, respectively, to hold the clip 30 open. The device may include extendable arms for introduction into the corresponding recesses 68, 97, among other forms of devices, in examples.

[0054] The clip 30, in an open state, may be placed onto the exterior surface 28 of the LAA 18. The user may confirm the desired placement of the clip 30 on the LAA 18.

[0055] In FIG. 7B, the clip 30 may be driven to an occluded state in which the LAA 18 is compressed between the first jaw 32 and the second jaw 34. The device exerting an expansion force on the spring 60 may reduce the expansion force to allow the clip 30 to close, and the device may be removed from the clip 30. The spring 60 may bias the clip 30 to an occluded state. The entire area of ​​the LAA 18 may be closed at the entrance, as desired, or another portion of the LAA 18 may be closed. The clip 30 may be occluded in such a manner that the tips 51, 84 occlude earlier than the second end portions 38, 74 of the jaws 32, 34. This feature may reduce the likelihood that tissue of the LAA 18 will protrude from the tips 51, 84 of the jaws 32, 34 during occlusion. The jaws 32, 34 may be rotated relative to the spring 60 to position the jaws 32, 34 parallel to one another. The springs 60 may slide outwardly within the corresponding channels 50, 86 upon rotation of the jaws 32, 34, respectively.

[0056] In an example, the clip 30 may be released and removed or repositioned during the deployment procedure or another procedure, as desired. The clip 30 may be grasped and the force of the spring 60 may be overcome to release the clip 30.

[0057] Although clip 30 may be utilized to close LAA 18, in examples, other portions of the heart may be clipped or closed using clip 30. In examples, other portions of the body, such as tubular organs or other portions of the body, may be closed using clip 30. Deployment may occur via a delivery device or via another method, as desired.

[0058] Variations regarding the configuration of clip 30 may be made as desired.

[0059] 9 illustrates an example of a clip 110 in which the spring 112 extends completely outside of the first and second jaws 114, 116 rather than extending into a channel. The spring 112 is coupled to corresponding central portions 118, 120 of the first and second jaws 114, 116, respectively. The first jaw 114 may include one or more recesses 122, 124 for receiving a device that applies an expansive force to the spring 112, and the second jaw 116 may include one or more recesses 126, 128 for receiving a device that applies an expansive force to the spring 112. By utilizing the device, the clip 110 may be held open.

[0060] 10 illustrates an example of a clip 130 in which the spring 132 extends completely outside of the first and second jaws 134, 136 rather than extending into a channel. The spring 132 is coupled to corresponding central portions 138, 140 of the first and second jaws 134, 136, respectively. The spring 132 may include one or more recesses 142, 144 for receiving a device that applies an expansive force to the spring 132. By utilizing the device, the clip 130 may be held in an open state.

[0061] 11 illustrates an example of a clip 150 in which the spring 152 extends completely outside the first and second jaws 154, 156 rather than extending into a channel. The spring 152 is coupled to corresponding central portions 158, 160 of the first and second jaws 154, 156, respectively. The first jaw 154 may include a recess 162 for receiving a device that applies an expansive force to the spring 112. The recess 162 may extend partially through a side of the first jaw 154. The second jaw 156 may include a recess 164 for receiving a device that applies an expansive force to the spring 112. The recess 164 may extend partially through a side of the second jaw 156. The device may be utilized to hold the clip 150 open.

[0062] In the examples shown in Figures 2-11, the jaws may be preloaded by associated springs. The jaws may be configured to be stationary in the closed position and a force may be required to open the jaws.

[0063] Various other modifications of the clips disclosed herein may be made. Various other methods of deployment and use of the clips may be provided as desired.

[0064] 12-17 illustrate an example of a clip 170 for a portion of the heart. Clip 170 may include similar features to clip 30 shown in FIGS. 2-8C. Features of clip 30 may apply to clip 170 shown in FIGS. 12-17 unless otherwise noted. Clip 170 may include a first jaw 172, a second jaw 174, and a spring 176. Spring 176 may be configured to bias first jaw 172 and second jaw 174 together to compress a portion of the heart between a compression surface of first jaw 172 and a compression surface of second jaw 174.

[0065] The first jaw 172 may extend from a first end portion 177, or distal end portion, to a second end portion 179, or proximal end portion, of the first jaw 172. The first jaw 172 may include a central portion 173 between the first end portion 177 and the second end portion 179 of the first jaw 172. The second end portion 179 of the first jaw 172 may be tapered, in examples.

[0066] First jaw 172 may include a first side 178 configured to face a first lateral direction of first jaw 172 and may include a second side 180 (shown in FIG. 15 ) that faces a second lateral direction opposite the first lateral direction. First jaw 172 may include a compression surface 184 (shown in FIG. 16 ) and an outer surface 182 that faces opposite compression surface 184. First side 178 may extend from compression surface 184 to outer surface 182 of first jaw 172.

[0067] One or more of the sides 178, 180 may include a recess 181 for receiving a device that applies an expansive force to the spring 176, as disclosed herein.

[0068] The first side 178 of the first jaw 172 may have a curvature. The first side 178 may be concavely curved relative to the first jaw 172, for example as shown in FIG. 12 . The first side 178 may be concavely curved from a proximal tip 186 at the second or proximal end portion 179 of the first jaw 172 to a distal tip 190 at the first or distal end portion 177 of the first jaw 172. In examples, the concave curvature may be a constant curvature from the proximal tip 186 to the distal tip 190 of the first jaw 172. For example, the curvature of the first side 178 may include a constant radius of curvature (e.g., about 5 inches, about 6 inches, about 7 inches, or a larger or smaller radius of curvature as desired). In examples, other configurations of the first side 178 or other curvatures may be provided. For example, various curvatures may be provided, or portions without curvature (eg, flat portions), among other configurations.

[0069] The second side 180 of the first jaw 172 may have a curvature. The second side 180 may be convexly curved relative to the first jaw 172, for example as shown in FIG. 13. The first side 178 may be convexly curved from a proximal tip 186 at the second or proximal end portion 179 of the first jaw 172 to a distal tip 190 at the first or distal end portion 177 of the first jaw 172. In an example, the convex curvature may be a constant curvature from the proximal tip 186 at the second or proximal end portion of the first jaw 172 to the distal tip 190 at the first or distal end portion of the first jaw 172. For example, the curvature of the second side 180 may include a constant radius of curvature (e.g., about 5 inches, about 6 inches, about 7 inches, or a larger or smaller radius of curvature as desired). In examples, other configurations or other curvatures of second side 180 may be provided. For example, various curvatures may be provided or portions without curvature (e.g., flat portions), among other configurations.

[0070] In an example, the first side 178 may have a concave curvature relative to the first jaw 172, and the second side 180 may have a convex curvature relative to the first jaw 172. In an example, the curvatures of the first side 178 and the second side 180 may match one another such that the arcs of the first side 178 and the second side 180 remain parallel as in FIG. 13. In an example, different curvatures may be provided for the first side 178 and the second side 180 (e.g., both sides are concave or convex, or both sides have different curvatures from one another).

[0071] The curvature of the first side 178 and the second side 180 may lie in a plane 194 (shown in FIG. 14 ), which may be transverse or perpendicular to the plane of closure of the clip 170. The first jaw 172 may be curved in a lateral direction that is transverse to the longitudinal extent of the first jaw 172.

[0072] The second jaw 174 may extend from a first end portion 201, or distal end portion, to a second end portion 203, or proximal end portion, of the second jaw 174. The second jaw 174 may include a central portion 195 between the first end portion 201 and the second end portion 203 of the second jaw 174. The second end portion 203 of the second jaw 174 may be tapered, in examples.

[0073] The second jaw 174 may include a first side 196 configured to face a first side direction of the second jaw 174 and may include a second side 198 (shown in FIG. 15 ) that faces a second side direction opposite the first side direction. Considering the side of the first jaw 172, the side 196 may be referred to as a third side and the side 198 may be referred to as a fourth side. The second jaw 174 may include a compression surface 202 (shown in FIG. 16 ) and an outer surface 200 that faces opposite the compression surface 202. The first side 196 may extend from the compression surface 202 to the outer surface 200 of the second jaw 174.

[0074] One or more of the sides 196, 198 may include a recess 191 for receiving a device that applies an expansive force to the spring 176, as disclosed herein.

[0075] The first side 196 of the second jaw 174 may have a curvature. The first side 196 may be concavely curved relative to the second jaw 174, for example as shown in FIG. 12 . The first side 196 may be concavely curved from a proximal tip 204 at the second end portion 203 or proximal end portion of the second jaw 174 to a distal tip 206 at the first end portion 201 or distal end portion of the second jaw 174. In examples, the concave curvature may be a constant curvature from the proximal tip 204 to the distal tip 206 of the second jaw 174. For example, the curvature of the first side 196 may include a constant radius of curvature (e.g., about 5 inches, about 6 inches, about 7 inches, or a larger or smaller radius of curvature as desired). In examples, other configurations of the first side 196 or other curvatures may be provided. For example, various curvatures may be provided, or portions without curvature (eg, flat portions), among other configurations.

[0076] The second side 198 of the second jaw 174 may have a curvature. The second side 198 may be convexly curved relative to the second jaw 174, for example as shown in FIG. 15 . The second side 198 may be convexly curved from a proximal tip 204 at the second or proximal end portion 203 of the second jaw 174 to a distal tip 206 at the first or distal end portion 201 of the second jaw 174. In examples, the convex curvature may be a constant curvature from the proximal tip 204 to the distal tip 206 of the second jaw 174. For example, the curvature of the second side 198 may include a constant radius of curvature (e.g., about 5 inches, about 6 inches, about 7 inches, or a larger or smaller radius of curvature as desired). In examples, other configurations of the second side 198 or other curvatures may be provided. For example, various curvatures may be provided, or portions without curvature (eg, flat portions), among other configurations.

[0077] In an example, the first side 196 may be concavely curved relative to the second jaw 174 and the second side 198 may be convexly curved relative to the second jaw 174. In an example, the curvatures of the first side 196 and the second side 198 may match one another such that the arcs of the first side 196 and the second side 198 remain parallel as shown in FIG 13. In an example, different curvatures may be provided for the first side 196 and the second side 198 (e.g., both sides are concave or convex, or both sides have different curvatures relative to one another).

[0078] The curvature of the first side 196 and the second side 198 may lie in a plane 210 (shown in FIG. 14 ), which may be transverse or perpendicular to the plane of closure of the clip 170. The second jaw 174 may be curved in a lateral direction that is transverse to the longitudinal extent of the second jaw 174.

[0079] The clip 170 may be beneficially curved toward the side to allow the curvature of the clip 170 to conform to the shape of the left atrium 10 (as shown in FIG. 1 ) upon closure of the ostium 22 of the LAA 18. Thus, the concave curvature of the first side 178, 196 of the jaws 172, 174 may face toward the left atrium 10 upon deployment relative to the ostium 22 of the LAA 18. Such a feature may reduce the likelihood of a pouch or other undesirable region forming along the line of closure of the clip 170. The curved clip may provide other advantages. In an example, the curvature of the clip 170 may conform to the curvature of the left atrium 10.

[0080] The exterior surface 182 of the first jaw 172 may include a first channel 212 (shown in FIG. 16) into which the loop 213 of the spring 176 extends. The exterior surface 200 of the second jaw 174 may include a second channel 214 (shown in FIG. 16) into which the loop 213 of the spring 176 extends. The loop 213 of the spring 176 may extend toward the corresponding second end portions 179, 203 of the first and second jaws 172, 174, respectively. The first channel 212 may be bounded by side walls 216, 218 and a bottom wall 220 (shown in FIG. 16) of the first channel 212. The second channel 214 may be bounded by side walls 222, 224 and a bottom wall 226 (shown in FIG. 16) of the second channel 214.

[0081] The first channel 212 may be curved in a plane 194 (shown in FIG. 14 ), which may be transverse or perpendicular to the plane of closure of the clip 170. The first channel 212 may be curved in a lateral direction transverse to the longitudinal extent of the first jaw 172. In an example, the curvature of the first channel 212 may match the curvature of the first side 178 or second side 180 of the first jaw 172 (e.g., as shown in FIG. 13 ).

[0082] The second channel 214 may be curved in a plane 210 (shown in FIG. 14 ), which may be transverse or perpendicular to the closure plane of the clip 170. The second channel 214 may be curved in a lateral direction transverse to the longitudinal extent of the second jaw 174. In an example, the curvature of the second channel 214 may match the curvature of the first side 196 or the second side 198 of the second jaw 174.

[0083] The curvature of the first channel 212 may, in examples, be matched to the curvature of the second channel 214 .

[0084] 18, the spring 176 may include a distal end portion 228 and a proximal end portion 230. The distal end portion 228 may include ends 232, 234 of the spring 176 which may be coupled to corresponding central portions 173, 195 (shown in FIG. 12) of the first and second jaws 172, 174, respectively. The ends 232, 234 may be coupled to corresponding coupling members 236, 238 (shown in FIG. 16) of the first and second jaws 172, 174, respectively. The proximal end portion 230 may include the loop 213 and curved portion 240 of the spring 176.

[0085] The spring 176 may include an outer surface 242 (shown in FIG. 19) and an inner surface 244 (shown in FIG. 18) facing opposite the outer surface 242. The inner surface 244 may face the opening 254 that the spring 176 surrounds. The spring 176 may further include a first side 246 (shown in FIG. 18) facing a first lateral direction and a second side 248 (shown in FIG. 19) facing a second lateral direction opposite the first lateral direction. Each of the first side 246 and the second side 248 may extend from the outer surface 242 to the inner surface 244.

[0086] The first side 246 may face a first lateral direction and may have a curvature. The first side 246 may be concavely curved relative to the spring 176, in an example. The concave curvature may match the curvature of the first side 178 of the first jaw 172 or the curvature of the first side 196 of the second jaw 174, in an example, or may have a different curvature. The second side 248 may face a second lateral direction opposite the first lateral direction and may have a curvature. The second side 248 may be convexly curved relative to the spring 176, in an example. The convex curvature may match the curvature of the second side 180 of the first jaw 172 or the curvature of the second side 198 of the second jaw 174, in an example, or may have a different curvature.

[0087] The spring 176 may have a curvature in a plane that is transverse or perpendicular to the plane of closure of the clip 170. The spring 176 may be curved in a lateral direction that is transverse to the longitudinal extent of the clip 170.

[0088] In an example, the spring 176 may be curved to be received within the first channel 212 of the first jaw 172 and within the second channel 214 of the second jaw 174. The curved spring 176 may extend within the curved channels 212, 214.

[0089] 18 , the proximal end portion 230 of the spring 176 may have a height 250 in the closure plane of the clip 170 that is greater than a height 252 of the distal end portion 228 of the spring 176 in the closure plane of the clip 170. Thus, the spring 176 may taper downwardly in a direction from the proximal end portion 230 to the distal end portion 228 of the spring 176.

[0090] The spring 176 may be a C-shaped spring that may surround an aperture 254 positioned within an inner surface 244 of the spring 176. The aperture 254 may have a greater height or diameter 256 in the closure plane of the clip 170 at a proximal end portion 230 of the spring 176 compared to a height or diameter 258 in the closure plane of the clip 170 at a distal end portion 228 of the spring 176.

[0091] The tapered profile of the spring 176 may enable a distal end portion 228 of the spring 176 to be positioned at or within the outer surfaces 182, 200 of the corresponding first and second jaws 172, 174, respectively, as shown, for example, in the cross-sectional view of Figure 16 (taken along line 16-16 in Figure 13) and the side view of Figure 14. The corresponding outer surfaces 182, 200 of the first and second jaws 172, 174, respectively, may be located at the distal end portion 228 of the spring 176 or may be disposed above the distal end portion 228 of the spring 176.

[0092] The proximal end portion 230 of the spring 176 may be positioned above the outer surfaces 182, 200 of the corresponding first and second jaws 172, 174, respectively, as shown, for example, in the cross-sectional view of FIG. 17 (taken along line 17-17 in FIG. 13) and in the side view of FIG. 14.

[0093] 18, the tapered profile of the spring 176 and the increased height or diameter of the opening 254 at the proximal end portion 230 of the spring 176 may allow the clip 170 to open with the spring 176 forming a "U" shape, thereby increasing the amount of tissue that may be received between the jaws 172, 174. For example, the jaws 172, 174 may extend parallel to one another in the fully open state, although other configurations may be used.

[0094] 13, in an example, the proximal tip 186 of the first jaw 172 and the second jaw 174 may be positioned at or may protrude proximally from the proximal end portion 230 of the spring 176. The loop 213 of the spring 176 may extend proximally toward the second end portion 179 of the first jaw 172 and toward the second end portion 203 of the second jaw 174. The corresponding second end portions 179, 203 of the first jaw 172 and the second jaw 174, respectively, may protrude proximally from or may be positioned at the loop 213. Thus, the likelihood of tissue getting pinched between the spring 176 and the proximal tip 186 at the fulcrum of the clip 170 may be reduced.

[0095] The spring 176 may extend onto an outer surface 182 of the first jaw 172 and onto an outer surface 200 of the second jaw 174 and may be configured to bias the first jaw 172 and the second jaw 174 together to compress a portion of the heart between a compression surface 184 of the first jaw 172 and a compression surface 202 of the second jaw 174. The ends 232, 234 (shown in FIG. 18) of the spring 176 may be positioned such that the recess 181 shown in FIG. 12 is located between the first end 232 of the spring 176 and the second end portion 179 or proximal end portion of the first jaw 172. The recess 191 shown in FIG. 12 may be positioned between the second end 234 of the spring 176 and the second end portion 203 or proximal end portion of the second jaw 174.

[0096] Various other modifications of the clips disclosed herein may be made. Various other methods of deployment and use of the clips may be provided as desired.

[0097] Figure 20 illustrates a perspective view of a first jaw 260 of a clip 261 (shown in Figure 22), which may be configured similarly to clip 170 shown in Figures 12-17 unless otherwise noted. First jaw 260 may include a first side 262 that may be concavely curved relative to first jaw 260. First jaw 260 may include a second side 264 facing opposite first side 262 and that may be concavely curved relative to first jaw 260. Thus, sides 262, 264 may both be concavely curved relative to first jaw 260 and may have opposite curvatures.

[0098] The distal end portion 266 of the first jaw 260 may include a first sidewall 268, a second sidewall 270, and a gap 272 between the first sidewall 268 and the second sidewall 270. The sidewalls 268, 270 may diverge from one another in a direction toward a distal tip 274 of the first jaw 260 such that the size of the gap 272 increases in a direction toward the distal tip 274. For example, FIG. 21 illustrates a triangular shaped gap 272 that increases in width in a direction toward the distal tip 274. The sidewalls 268, 270 may comprise a flared distal end of the first jaw 260.

[0099] In examples, the gap 272 may retain tissue between the side walls 268, 270 when the clip 261 is closed, which may stabilize the position of the clip 261 during deployment and reduce the likelihood of the clip 261 moving after deployment.

[0100] The proximal end portion 276 of the first jaw 260 may include a first sidewall 278, a second sidewall 280, and a gap 282 between the first sidewall 278 and the second sidewall 280. The sidewalls 278, 280 may diverge from one another in a direction toward a proximal tip 284 of the first jaw 260 such that the size of the gap 282 increases in a direction toward the proximal tip 284. For example, FIG. 21 illustrates a triangular shaped gap 282 that increases in width in a direction toward the proximal tip 284. The sidewalls 278, 280 may comprise a flared proximal end of the first jaw 260.

[0101] In examples, the gap 282 may retain tissue between the side walls 278, 280 when the clip 261 is closed, which may stabilize the position of the clip 261 during deployment and reduce the likelihood of the clip 261 moving after deployment.

[0102] FIG. 21 illustrates a top view of the first jaw 260.

[0103] 22, a second jaw 286 may be provided which may be configured similarly to the first jaw 260. For example, the curvature of the sides of the second jaw 286 may match the curvature of the corresponding sides 262, 264 of the first jaw 260.

[0104] The clip 261 may include a spring 288 that may compress the first jaw 260 toward the second jaw 286. The spring 288 may be a straight spring 288 that may lack curvature in a lateral direction transverse to the closure plane of the clip 261. For example, with reference to FIG. 23, the spring 288 may be aligned with respect to the longitudinal axis of the clip 261.

[0105] 24 illustrates a proximal end view of clip 261. FIG. 25 illustrates a distal end view of clip 261.

[0106] Various other modifications of the clips disclosed herein may be made. Various other methods of deployment and use of the clips may be provided as desired.

[0107] In examples, a cushioning layer may be provided relative to one or more of the first and second jaws of the clip. The cushioning layer may include a compression surface relative to one or more of the first and second jaws of the clip. The cushioning layer may be provided over other components of the clip (e.g., a spring) in examples. The cushioning layer may have a variety of configurations.

[0108] For example, FIG. 26 illustrates a first jaw 300 that may be utilized in the examples herein and may include a cushioning layer 302 as a compression surface of the first jaw 300. The cushioning layer 302 may include an elongated strip of material and may include an engagement portion 304 configured to slide into a receiving portion 306 of the first jaw 300. The engagement portion 304 may include a dovetail protrusion. The receiving portion 306 may include an elongated track configured to receive the dovetail protrusion and may extend along the length of the first jaw 300. The engagement portion 304 may slide into the receiving portion 306.

[0109] For example, Fig. 27 illustrates an end view of the first jaw 300 showing the engagement portion 304 received into the receiving portion 306 in the form of a track. Fig. 28 illustrates a perspective view of the cushion layer 302 separated from the body of the first jaw 300.

[0110] In assembly, the cushioning layer 302 may be molded or otherwise formed separately and then slid into the receiving portion 306 to hold the cushioning layer 302 against the body of the first jaw 300.

[0111] In an example, the cushioning layer 302 may include a soft material and may be configured to flex when compressed with the portion of the heart that is to be compressed. The soft material may include an elastomeric material, such as silicone or rubber, or may include other forms of elastomeric material. The soft material may be formed separately from the body of the first jaw 300 and then engaged to the body of the first jaw 300.

[0112] The cushioning layer may have a variety of configurations, in examples. For example, FIG. 29 illustrates a configuration of a cushioning layer 308 having an elongated channel 310. The elongated channel 310 may include an interior cavity that extends along the length of the elongated cushioning layer 308. For example, FIG. 30 illustrates an end view of the cushioning layer 308. The receiving portion 306 may include an elongated track similar to the receiving portion 306 shown in FIG. 26. FIG. 31 illustrates a perspective view of the cushioning layer 308.

[0113] In an example, one or more of the first jaw and the second jaw may include a cushioning layer. For example, FIG. 32 illustrates second jaw 312 including cushioning layer 314. Cushioning layer 314 may have a similar configuration as cushioning layer 308. In an example, the cushioning layer of second jaw 312 may have a different configuration than the cushioning layer of first jaw 300.

[0114] In examples, the cushioning layer may be coupled to the jaws in a variety of other manners. For example, FIG. 33 illustrates a first jaw 320 including a receiving portion 322 including a number of openings for receiving a cushioning layer 324. The cushioning layer 324 may include an engagement portion 326 including a number of pins configured to be inserted into the number of openings to couple with the first jaw 320.

[0115] For example, Figure 34 illustrates the cushion layer 324 engaged against the first jaw 320. Figure 35 illustrates a bottom perspective view of the first jaw 320, showing the configuration of the cushion layer 324 as a compression surface of the first jaw 320.

[0116] The cushioning layer 324 may be formed or molded separately from the first jaw 320 and inserted into the opening in the first jaw 320 .

[0117] In examples, the cushioning layer may be coupled to the jaws in a variety of other manners.

[0118] In an example, the cushioning layer may include one or more sleeves that cover one or more of the first and second jaws or cover other portions of the clip. For example, FIGS. 36 and 37 illustrate an example where the cushioning layer includes a single sleeve 330 configured to cover the first and second jaws 332, 334, and spring 336 of the clip 338. The sleeve 330 may include a single elongated tube that may extend over the first jaw 332 and may be curved around a proximal end portion 342 of the clip 338 to cover the second jaw 334. A fold 344 of the sleeve 330 may be positioned at the proximal end portion 342 of the clip 338, where the sleeve 330 extends from around the first jaw 332 to the second jaw 334 at the fulcrum of the clip 338. The sleeve or sleeves may include a soft material that may be configured to flex when compressed with the portion of the heart that is to be compressed. The soft material may include an elastomeric material such as silicone or rubber, or may include other forms of elastomeric material. The sleeve or sleeves may include polytetrafluoroethylene (PTFE). In an example, expanded PTFE (ePTFE) may be utilized.

[0119] The ends 346, 348 of the sleeve 330 may be closed in a variety of ways. In examples, the ends 346, 348 may be closed by using adhesive or heating the ends 346, 348, among other methods.

[0120] Figure 37 illustrates a cross-sectional view of clip 338 taken along line 37-37 in Figure 36. Sleeve 330 is shown covering first jaw 332 and second jaw 334, and further forming a cushioning layer 350 of first jaw 332 and a cushioning layer 352 of second jaw 334. Cushioning layer 350 may include a compression surface of first jaw 332. Cushioning layer 352 may include a compression surface of second jaw 334.

[0121] In examples, cushioning layers of various configurations may be provided.

[0122] 38 illustrates an example where a first sleeve 360 ​​can cover a first jaw 362 and a second sleeve 364 can cover a second jaw 366. Thus, separate sleeves may be utilized for the first jaw 362 and the second jaw 366. In an example, the spring 368 may be left uncovered by a sleeve. In an example, one or more sleeves (e.g., a third sleeve) may cover the spring 368.

[0123] In an example, the end of a sleeve may be coupled to the first or second jaw by using a coupling member. For example, FIG. 39 illustrates a forming string of coupling members including plugs 370. The plugs 370 may be removed from a strip 372 of plugs 370. For example, FIG. 40 illustrates a plug 370 including an insert portion 374 or stem and a relatively wide head 376. The plugs 370 may be utilized to couple to one or more ends of a sleeve or to couple to one or more jaws.

[0124] One or more plugs may be positioned at the first or distal end portion of the first or second jaw and may be coupled to the one or more sleeves.

[0125] For example, Figure 41 illustrates a first plug 370 utilized to connect the end of sleeve 360 ​​to the end of first jaw 362. Similarly, a second plug 370' may be utilized to connect the end of sleeve 364 to the end of second jaw 366. One or more plugs may be utilized for the end of a single sleeve (e.g., as shown in Figure 36) or for the ends of multiple sleeves (e.g., in a configuration as shown in Figure 38).

[0126] The plug 370 may be inserted into the jaws 362, 366 such that an insertion portion 374 of the plug 370 is inserted into the jaws 362, 366. A relatively wide head 376 may overlap a portion of the end of the sleeve for mating with the jaws 362, 366.

[0127] Additionally, the head 376 of the plug 370 may have a smooth surface so as to be atraumatic to the tissue of an individual's body upon insertion into the individual's body.

[0128] In examples, if desired, an adhesive may be applied to secure the plug in place.

[0129] In some examples, other forms of attachment to the jaws may be provided. For example, FIG. 42 illustrates an example of a jaw 380 that includes a suture receiving portion 382 at a distal end portion 384 of the jaw 380. The suture receiving portion 382 may include a channel that extends around the circumference of the jaw 380.

[0130] 43 illustrates an enlarged view of a distal end portion 384 of jaw 380. A suture receiving portion 382 is shown positioned proximal to a distal tip 386. The suture receiving portion 382 may include an opening 388 through which a suture may be passed and then wrapped around a channel 390.

[0131] FIG. 44 illustrates an end view of the first jaw 380.

[0132] 45, in examples, the compression surface 391 of the first jaw 392 may be curved about an axis extending parallel to the longitudinal axis of the first jaw 392. Such a curvature may enhance the conformity of the jaw against the closed portion of the heart.

[0133] 46 illustrates a configuration of a clip 400 utilizing a first jaw 380. A sleeve 402 may extend over the first jaw 380 and may have a distal end 404 over which a suture 406 may extend. One or more sutures 406 may be positioned at a first end portion of the first jaw 380 and may be coupled to the one or more sleeves. The sutures 406 may couple the distal end 404 of the sleeve 402 to the first jaw 380.

[0134] The clip 400 may also include a second jaw 410. A sleeve 412 may extend over the second jaw 410 and may have a distal end 414 over which a suture 415 may extend. The suture 415 may connect the distal end 414 of the sleeve 412 to the second jaw 410.

[0135] In examples, adhesive may be applied over the sutures if desired.

[0136] 46, one or more of the sleeves 402, 412 may extend over the spring 416 associated with the clip 400. In an example, a single sleeve may extend over the first jaw 380, the second jaw 410, and the spring 416. In the example shown in FIG. 47, the spring 416 may not be covered by the sleeves 418, 420.

[0137] In examples, the spring may be encased by a cushioning layer. For example, referring to FIG. 48, the spring 422 may be encased by a layer of cushioning material 424, such as polytetrafluoroethylene (PTFE). PTFE tape may be wrapped around the spring 422. In examples, expanded PTFE (ePTFE) may be utilized. In examples, other forms of cushioning material 424 may be utilized.

[0138] In examples, one or more of the first and second jaws may be encased by a layer of cushioning material. For example, FIG. 49 illustrates a first jaw 430 and a second jaw 432 each encased by a layer of cushioning material 434 including polytetrafluoroethylene (PTFE). A PTFE tape may be wrapped around the first jaw 430 or the second jaw 432. In examples, expanded PTFE (ePTFE) may be utilized. In examples, other forms of cushioning material 434 may be utilized. The spring 422 may be encased by the same cushioning material as the first jaw 430 or the second jaw 432, or may have another form in examples.

[0139] In an example, a layer of cushioning material may be overmolded or insert molded onto a portion of the first or second jaw. For example, FIG. 50 illustrates a first portion 440 of a first jaw 442 that may be formed by molding or other process. With reference to FIG. 51 , an overmold 444 of cushioning material may be provided over the first portion 440 to form a cushioning layer for the first jaw 442. The compression surface of the first jaw 442 may include the overmold 444. The second jaw may be formed in a similar manner.

[0140] The cushioning layer may include a medical grade soft material that may render the compression surface of the jaws atraumatic, as desired. The cushioning layer may include an elastomeric material, such as silicone, rubber, or other forms of material that may deform under applied pressure. PTFE or ePTFE (e.g., PTFE or ePTFE tubing) may be utilized as desired. Other configurations for the cushioning layer may be provided on other portions of the clip as desired. The body of the jaws may include a relatively hard plastic, such as polyetheretherketone (PEEK), or may be formed from other materials (e.g., metal or softer materials). The spring may be formed from a shape memory material, such as Nitinol, or may be formed from other materials (e.g., stainless steel or cobalt chrome, among others). The features disclosed with respect to the cushioning layer may be utilized in any example clip disclosed herein.

[0141] The clips disclosed with respect to Figures 12-51 may be deployed and utilized in a manner similar to the clips disclosed with respect to Figures 2-11, or may be deployed and utilized in another manner as desired. Repositioning or redeployment may be performed in a manner similar to the clips disclosed with respect to Figures 2-11, or may be performed in another manner as desired.

[0142] Various other modifications of the clips disclosed herein may be made. Various other methods of deployment and use of the clips may be provided as desired.

[0143] The clips disclosed herein may be used to close the LAA or may be used to close other parts of the heart. In examples, clips may be used to close other parts of the body, including other tubular vessels or other parts of the body. Deployment may be via a delivery device or via another method, as desired. Deployment may be via a surgical method, a transcatheter method, or a non-invasive surgical method.

[0144] Variations on the clips and methods disclosed herein may be provided. Features may be combined across examples. Features may be omitted or added in various examples disclosed herein. Combinations of features in examples may be provided. The clips may be used alone or in the methods disclosed herein, or in combination with other devices disclosed herein.

[0145] For purposes of this specification, certain aspects, advantages, and novel features of the examples of the disclosure are described herein. The disclosed methods, devices, and systems should not be construed as limiting in any manner. Instead, the disclosure is directed to all novel and non-obvious features and aspects of the various disclosed examples, alone and in various combinations and subcombinations with each other. The methods, devices, and systems are not limited to any particular aspect or feature, or combination thereof, and the disclosed examples do not require that any one or more particular advantages exist or problems be solved. Features, elements, or components of one example can be combined into other examples herein. EXAMPLES

[0146] Example 1: 1. A clip for a portion of the heart, the clip comprising: a first jaw extending from a first end portion to a second end portion, the first jaw including a compression surface and an outer surface facing opposite the compression surface; a second jaw extending from the first end portion to the second end portion, the second jaw including a compression surface opposing the compression surface of the first jaw and an outer surface facing opposite the compression surface of the second jaw; and a spring extending over the outer surface of the first jaw and over the outer surface of the second jaw, the spring configured to urge the first and second jaws together to compress the portion of the heart between the compression surface of the first jaw and the compression surface of the second jaw.

[0147] Example 2: A clip as described in any embodiment herein, particularly as described in embodiment 1, wherein the first jaw includes a central portion between the first and second end portions of the first jaw, the second jaw includes a central portion between the first and second end portions of the second jaw, and the spring includes a first end coupled to the central portion of the first jaw and a second end coupled to the central portion of the second jaw.

[0148] Example 3: The clip as described in any embodiment herein, particularly embodiment 2, wherein the spring includes a loop extending toward the second end portion of the first jaw and toward the second end portion of the second jaw.

[0149] Example 4: A clip as described in any embodiment herein, particularly embodiment 3, wherein an outer surface of the first jaw includes a channel, an outer surface of the second jaw includes a channel, and a loop extends into the channel of the first jaw and into the channel of the second jaw.

[0150] Example 5: The clip as described in any embodiment herein, particularly as described in embodiment 3 or 4, wherein the loop protrudes from the second end portion of the first jaw and from the second end portion of the second jaw.

[0151] Example 6: A clip as described in any embodiment herein, particularly any one of embodiments 1 to 5, wherein a first end portion of the first jaw is tapered and a second end portion of the first jaw is tapered.

[0152] Example 7: A clip as described in any embodiment herein, particularly any one of embodiments 1-6, wherein the first jaw includes a side extending from the compression surface to the outer surface of the first jaw, the side including a recess for receiving a device that applies an expansion force to the spring.

[0153] Example 8: The clip as described in any embodiment herein, particularly embodiment 7, wherein the recess is positioned between the first end of the spring and the second end portion of the first jaw.

[0154] Example 9: A clip as described in any embodiment herein, particularly embodiment 7 or 8, wherein the second jaw includes a side extending from the compression surface to the outer surface of the second jaw, the side including a recess for receiving a device that applies an expansion force to the spring.

[0155] Example 10: The clip as described in any embodiment herein, particularly any one of embodiments 1-9, wherein the spring includes a recess for receiving a device that applies an expansive force to the spring.

[0156] Example 11: A clip as described in any embodiment herein, particularly any one of embodiments 1-10, wherein the spring includes a loop extending proximally toward the second end portion of the first jaw and toward the second end portion of the second jaw, the second end portion of the first jaw protruding proximally from the loop or positioned at the loop, and the second end portion of the second jaw protruding proximally from the loop or positioned at the loop.

[0157] Example 12: A clip as described in any embodiment herein, particularly any one of embodiments 1-11, wherein the first jaw includes a side extending from the compression surface to the outer surface of the first jaw, the side being concavely curved relative to the first jaw, and the second jaw includes a side extending from the compression surface to the outer surface of the second jaw, the side of the second jaw being concavely curved relative to the second jaw.

[0158] Example 13: A clip as described in any embodiment herein, particularly as described in embodiment 12, wherein the side of the first jaw includes a first side facing in the first lateral direction, the first jaw includes a second side facing opposite the first side and curved convexly relative to the first jaw, the side of the second jaw includes a third side facing in the first lateral direction, and the second jaw includes a fourth side facing opposite the third side and curved convexly relative to the second jaw.

[0159] Example 14: A clip as described in any embodiment herein, particularly as described in embodiment 12, wherein the side of the first jaw includes a first side facing in the first lateral direction, the first jaw includes a second side facing opposite the first side and curved concavely relative to the first jaw, the side of the second jaw includes a third side facing in the first lateral direction, and the second jaw includes a fourth side facing opposite the third side and curved concavely relative to the second jaw.

[0160] Example 15: A clip as described in any embodiment herein, particularly any one of embodiments 12-14, wherein the side of the first jaw has a constant curvature and the side of the second jaw has a constant curvature.

[0161] Example 16: A clip as described in any embodiment herein, particularly any one of embodiments 12-15, wherein the side of the first jaw is concavely curved toward the first jaw from the proximal tip of the first jaw to the distal tip of the first jaw.

[0162] Example 17: A clip as described in any embodiment herein, particularly any one of embodiments 1 to 16, wherein the spring has an outer surface, an inner surface, a first side extending from the outer surface to the inner surface and facing a first side direction, and a second side extending from the outer surface to the inner surface and facing a second side direction opposite the first side direction, the first side being concavely curved toward the spring.

[0163] Example 18: The clip as described in any embodiment herein, particularly embodiment 17, wherein the second side is convexly curved relative to the spring.

[0164] Example 19: A clip as described in any embodiment herein, particularly any one of embodiments 1-18, wherein the outer surface of the first jaw includes a channel curved in a plane transverse to the closure plane of the clip, the outer surface of the second jaw includes a channel curved in a plane transverse to the closure plane of the clip, and the spring is curved in a plane transverse to the closure plane of the clip and extends into the channel of the first jaw and into the channel of the second jaw.

[0165] Example 20: A clip as described in any embodiment herein, particularly any one of embodiments 1-19, wherein the spring includes a distal end portion having a height in the closure plane of the clip and including a first end portion attached to the first jaw and a second end portion attached to the second jaw, and a proximal end portion having a height in the closure plane of the clip and including a loop extending toward the second end portion of the first jaw and toward the second end portion of the second jaw, wherein the height of the proximal end portion of the spring is greater than the height of the distal end portion of the spring.

[0166] Example 21: A clip as described in any embodiment herein, particularly embodiment 20, wherein the spring includes a C-shaped spring surrounding an opening, and the diameter of the opening at the proximal end portion of the spring is larger than the diameter of the opening at the distal end portion of the spring.

[0167] Example 22: A clip as described in any embodiment herein, particularly embodiment 20 or 21, wherein the proximal end portion of the spring is positioned above the outer surface of the first jaw and above the outer surface of the second jaw.

[0168] Example 23: A clip as described in any embodiment herein, particularly any one of embodiments 20-22, wherein the outer surface of the first jaw is located at the distal end portion of the spring or is positioned above the distal end portion of the spring, and the outer surface of the second jaw is located at the distal end portion of the spring or is positioned above the distal end portion of the spring.

[0169] Example 24: A clip as described in any embodiment herein, particularly any one of embodiments 1 to 23, wherein the second end portion of the first jaw is tapered and the second end portion of the second jaw is tapered.

[0170] Example 25: A clip as described in any embodiment herein, particularly any one of embodiments 1-24, wherein the first end portion of the first jaw includes a distal tip, a first side wall, a second side wall, and a gap between the first side wall and the second side wall, the first side wall and the second side wall diverging away from each other in a direction toward the distal tip.

[0171] Example 26: A clip as described in any embodiment herein, particularly as described in embodiment 25, wherein the width of the gap increases in a direction toward the distal tip.

[0172] Example 27: A clip as described in any embodiment herein, particularly any one of embodiments 1 to 26, wherein the second end portion of the first jaw includes a proximal tip, a first side wall, a second side wall, and a gap between the first side wall and the second side wall, the first side wall and the second side wall diverging away from each other in a direction toward the proximal tip.

[0173] Example 28: A clip as described in any embodiment herein, particularly as described in embodiment 27, wherein the width of the gap increases in a direction toward the proximal tip.

[0174] Example 29: The clip as described in any embodiment herein, particularly any one of embodiments 1-28, wherein the compression surface of the first jaw comprises a cushioning layer.

[0175] Example 30: The clip as described in any embodiment herein, particularly embodiment 29, wherein the cushioning layer is received in the track of the first jaw.

[0176] Example 31: The clip as described in any embodiment herein, particularly embodiment 29 or 30, wherein the first jaw includes one or more openings for receiving the cushioning layer.

[0177] Example 32: The clip as described in any embodiment herein, particularly any one of embodiments 29-31, wherein the cushioning layer comprises an elongate channel extending along the cushioning layer.

[0178] Example 33: The clip as described in any embodiment herein, particularly any one of embodiments 29-32, wherein the cushioning layer comprises an overmolded or insert molded over a portion of the first jaw.

[0179] Example 34: The clip according to any embodiment herein, particularly any one of embodiments 1-33, further comprising one or more sleeves covering the first jaw and the second jaw.

[0180] Example 35: The clip as described in any embodiment herein, particularly embodiment 34, wherein a single sleeve covers the first jaw and the second jaw.

[0181] Example 36: The clip as described in any embodiment herein, particularly embodiment 34, wherein a first sleeve covers the first jaw and a second sleeve covers the second jaw.

[0182] Example 37: The clip according to any embodiment herein, particularly any one of embodiments 34-36, wherein one or more sleeves cover the spring.

[0183] Example 38: A clip as described in any embodiment herein, particularly any one of embodiments 34-37, further comprising one or more plugs positioned at a first end portion of the first jaw and coupled to the one or more sleeves.

[0184] Example 39: A clip as described in any embodiment herein, particularly any one of embodiments 34-38, further comprising one or more sutures positioned at a first end portion of the first jaw and attached to one or more sleeves.

[0185] Example 40: The clip as described in any embodiment herein, in particular any one of embodiments 1 to 39, wherein the clip is configured to close the left atrial appendage.

[0186] Example 41: 11. The method, comprising: deploying a clip to close a portion of the heart, the clip comprising: a first jaw extending from a first end portion to a second end portion, the first jaw including a compression surface and an outer surface facing opposite the compression surface; a second jaw extending from the first end portion to the second end portion, the second jaw including a compression surface opposing the compression surface of the first jaw and an outer surface facing opposite the compression surface of the second jaw; and a spring extending on the outer surface of the first jaw and on the outer surface of the second jaw, the spring configured to bias the first and second jaws together to compress the portion of the heart between the compression surface of the first jaw and the compression surface of the second jaw.

[0187] Example 42: The method as described in any embodiment herein, particularly embodiment 41, wherein the portion of the heart is the left atrial appendage.

[0188] Example 43: The method of any embodiment herein, particularly embodiment 41 or 42, wherein the first jaw includes a central portion between the first and second end portions of the first jaw, the second jaw includes a central portion between the first and second end portions of the second jaw, and the spring includes a first end coupled to the central portion of the first jaw and a second end coupled to the central portion of the second jaw.

[0189] Example 44: The method of any embodiment herein, particularly embodiment 43, wherein the spring includes a loop extending toward the second end portion of the first jaw and toward the second end portion of the second jaw.

[0190] Example 45: The method of any embodiment herein, particularly embodiment 44, wherein an outer surface of the first jaw includes a channel and an outer surface of the second jaw includes a channel, and the loop extends into the channel of the first jaw and into the channel of the second jaw.

[0191] Example 46: The method of any embodiment herein, particularly embodiment 44 or 45, wherein the loop protrudes from the second end portion of the first jaw and from the second end portion of the second jaw.

[0192] Example 47: The method of any embodiment herein, particularly any one of embodiments 41-46, wherein a first end portion of the first jaw is tapered and a second end portion of the first jaw is tapered.

[0193] Example 48: The method of any embodiment herein, particularly any one of embodiments 41-47, wherein the first jaw includes a side extending from the compression surface to the outer surface of the first jaw, the side including a recess for receiving a device that applies an expansion force to the spring.

[0194] Example 49: The method as described in any embodiment herein, particularly embodiment 48, wherein the recess is positioned between the first end of the spring and the second end portion of the first jaw.

[0195] Example 50: The method of any embodiment herein, particularly embodiment 48 or 49, wherein the second jaw includes a side extending from the compression surface to the outer surface of the second jaw, the side including a recess for receiving a device that applies an expansion force to the spring.

[0196] Example 51: The method of any embodiment herein, particularly any one of embodiments 41-50, wherein the spring includes a loop extending proximally toward the second end portion of the first jaw and toward the second end portion of the second jaw, the second end portion of the first jaw protruding proximally from the loop or positioned at the loop, and the second end portion of the second jaw protruding proximally from the loop or positioned at the loop.

[0197] Example 52: The method of any embodiment herein, particularly any one of embodiments 41-51, wherein the first jaw includes a side extending from a compression surface to an outer surface of the first jaw, the side being concavely curved relative to the first jaw, and the second jaw includes a side extending from a compression surface to an outer surface of the second jaw, the side of the second jaw being concavely curved relative to the second jaw.

[0198] Example 53: The method of any embodiment herein, particularly embodiment 52, wherein the side of the first jaw includes a first side facing in the first lateral direction, the first jaw includes a second side facing opposite the first side and curved convexly relative to the first jaw, the side of the second jaw includes a third side facing in the first lateral direction, and the second jaw includes a fourth side facing opposite the third side and curved convexly relative to the second jaw.

[0199] Example 54: The method of any embodiment herein, particularly embodiment 52, wherein the side of the first jaw includes a first side facing in the first lateral direction, the first jaw includes a second side facing opposite the first side and curved concavely relative to the first jaw, the side of the second jaw includes a third side facing in the first lateral direction, and the second jaw includes a fourth side facing opposite the third side and curved concavely relative to the second jaw.

[0200] Example 55: The method of any embodiment herein, particularly any one of embodiments 52-54, wherein a side of the first jaw has a constant curvature and a side of the second jaw has a constant curvature.

[0201] Example 56: The method of any embodiment herein, particularly any one of embodiments 52-55, wherein the side of the first jaw is concavely curved relative to the first jaw from the proximal tip of the first jaw to the distal tip of the first jaw.

[0202] Example 57: The method of any embodiment herein, particularly any one of embodiments 41-56, wherein the spring has an outer surface, an inner surface, a first side extending from the outer surface to the inner surface and facing a first lateral direction, and a second side extending from the outer surface to the inner surface and facing a second lateral direction opposite the first lateral direction, the first side being concavely curved relative to the spring.

[0203] Example 58: The method of any embodiment herein, particularly embodiment 57, wherein the second side is convexly curved relative to the spring.

[0204] Example 59: The method of any embodiment herein, particularly any one of embodiments 41-58, wherein the outer surface of the first jaw includes a channel curved in a plane transverse to the closure plane of the clip, the outer surface of the second jaw includes a channel curved in a plane transverse to the closure plane of the clip, and the spring is curved in a plane transverse to the closure plane of the clip and extends into the channel of the first jaw and into the channel of the second jaw.

[0205] Example 60: The method of any of the embodiments herein, particularly any one of embodiments 41-59, wherein the spring comprises a distal end portion having a height in the closure plane of the clip and including a first end portion attached to the first jaw and a second end portion attached to the second jaw, and a proximal end portion having a height in the closure plane of the clip and including a loop extending toward the second end portion of the first jaw and toward the second end portion of the second jaw, wherein the height of the proximal end portion of the spring is greater than the height of the distal end portion of the spring.

[0206] Example 61: The method of any embodiment herein, particularly embodiment 60, wherein the spring comprises a C-shaped spring surrounding an aperture, and a diameter of the aperture at the proximal end portion of the spring is larger than a diameter of the aperture at the distal end portion of the spring.

[0207] Example 62: The method of any embodiment herein, particularly embodiment 60 or 61, wherein the proximal end portion of the spring is positioned above the outer surface of the first jaw and above the outer surface of the second jaw.

[0208] Example 63: The method of any embodiment herein, particularly any one of embodiments 60-62, wherein the outer surface of the first jaw is located at or above the distal end portion of the spring, and the outer surface of the second jaw is located at or above the distal end portion of the spring.

[0209] Example 64: The method of any embodiment herein, particularly any one of embodiments 41-63, wherein the second end portion of the first jaw is tapered and the second end of the second jaw is tapered.

[0210] Example 65: The method of any embodiment herein, particularly any one of embodiments 41-64, wherein the first end portion of the first jaw includes a distal tip, a first side wall, a second side wall, and a gap between the first side wall and the second side wall, the first side wall and the second side wall diverging away from each other in a direction toward the distal tip.

[0211] Example 66: The method of any embodiment herein, particularly embodiment 65, wherein the width of the gap increases in a direction toward the distal tip.

[0212] Example 67: The method of any embodiment herein, particularly any one of embodiments 41-66, wherein the second end portion of the first jaw includes a proximal tip, a first side wall, a second side wall, and a gap between the first side wall and the second side wall, the first side wall and the second side wall diverging away from each other in a direction toward the proximal tip.

[0213] Example 68: The method of any embodiment herein, particularly embodiment 67, wherein the width of the gap increases in a direction toward the proximal tip.

[0214] Example 69: The method of any embodiment herein, particularly any one of embodiments 41-68, wherein the compression surface of the first jaw comprises a cushioning layer.

[0215] Example 70: The method of any embodiment herein, particularly embodiment 69, wherein the cushioning layer is received in the track of the first jaw.

[0216] Example 71: The method of any embodiment herein, particularly embodiment 69 or 70, wherein the first jaw includes one or more openings for receiving the cushioning layer.

[0217] Example 72: The method of any embodiment herein, particularly any one of embodiments 69-71, wherein the cushioning layer comprises an elongated channel extending along the cushioning layer.

[0218] Example 73: The method of any embodiment herein, particularly any one of embodiments 69-72, wherein the cushioning layer comprises an overmolding or insert molding over the portion of the first jaw.

[0219] Example 74: The method of any embodiment herein, particularly any one of embodiments 69-73, wherein the compression surface of the second jaw comprises a cushioning layer.

[0220] Example 75: The method of any embodiment herein, particularly any one of embodiments 41-74, further comprising one or more sleeves covering the first and second jaws.

[0221] Example 76: The method of any embodiment herein, particularly embodiment 75, wherein a single sleeve covers the first jaw and the second jaw.

[0222] Example 77: The method of any embodiment herein, particularly embodiment 75, wherein a first sleeve covers the first jaw and a second sleeve covers the second jaw.

[0223] Example 78: The method of any embodiment herein, particularly any one of embodiments 75-77, wherein one or more sleeves cover the spring.

[0224] Example 79: The method described in any embodiment herein, particularly any one of embodiments 75-78, further comprising one or more plugs positioned at the first end portion of the first jaw and coupled to the one or more sleeves.

[0225] Example 80: The method described in any embodiment herein, particularly any one of embodiments 75-79, further comprising one or more sutures positioned at the first end portion of the first jaw and attached to the one or more sleeves.

[0226] Any feature in any of the above-referenced examples, including but not limited to any of the above-referenced examples 1 to 80, is applicable to all other aspects and examples specified herein, including but not limited to any of the above-referenced examples 1 to 80. Moreover, any feature in one of the above-referenced examples, including but not limited to any of the above-referenced examples 1 to 80, may be combined in any manner, independently, in part or in whole, with other examples described herein, for example, one, two, or more than two examples may be combined in part or in whole. Furthermore, any feature in the above-referenced examples, including but not limited to any of the above-referenced examples 1 to 80, may be optional with respect to other examples. Any of the above-referenced examples of the method may be performed by a system or device in another example, and any of the above-referenced examples of the system or device may be configured to perform the method of another of the above-referenced examples, including but not limited to any of the above-referenced examples 1 to 80.

[0227] Certain features that are described in the present disclosure in the context of separate implementations can also be implemented in combination in a single implementation. Conversely, various features that are described in the context of a single implementation can also be implemented in multiple implementations separately or in any suitable subcombination. Moreover, although features may be described above as functioning in a particular combination, in some cases one or more features from a claimed combination can be excluded from that combination, and the combination may be claimed as any subcombination or as a variation of any subcombination.

[0228] Moreover, although methods may be illustrated in the drawings or described in the specification in a particular order, such methods need not be performed in the particular order illustrated or in sequential order to achieve desirable results, and not all methods need to be performed. Other methods not illustrated or described can be incorporated into the illustrated methods and processes. For example, one or more additional methods can be performed before any of the described methods, after any of the described methods, simultaneously with any of the described methods, or between any of the described methods. Furthermore, in other implementations, the methods may be rearranged or reordered. Also, the separation between various system components in the above-described implementations should not be understood as requiring such separation in all implementations, and it will be understood that the described components and systems can generally be integrated together in a single product or packaged into multiple products. Additionally, other implementations are within the scope of the present disclosure.

[0229] Conditional language such as "may," "could," "could be," "might," and "could be" are generally intended to convey that a particular example includes or does not include certain features, components, and / or steps, unless specifically stated otherwise or understood otherwise within the context in which they are used. Thus, such conditional language is not generally intended to imply that the features, components, and / or steps are in any manner required with respect to one or more examples.

[0230] Conjunctive language such as the phrase "at least one of X, Y, and Z," unless specifically stated otherwise, is to be understood in context as being generally used to convey that an item, term, etc. can be either X, Y, or Z. Thus, such conjunctive language is not generally intended to imply the necessity for the presence of at least one X, at least one Y, and at least one Z in a particular instance.

[0231] As used herein, degree statements such as the terms "approximately", "about", "entirely", and "substantially" refer to a value, amount, or characteristic that is close to the stated value, amount, or characteristic while still performing a desired function or achieving a desired result. For example, the terms "approximately", "about", "entirely", and "substantially" may refer to an amount that is within 10%, within 5%, within 1%, within 0.1%, and within 0.01% of the stated amount. When the stated amount is 0 (e.g., none, having nothing), the ranges described above can be specific ranges, not within a specific percentage of the value. For example, within 10% by weight / volume, within 5% by weight / volume, within 1% by weight / volume, within 0.1% by weight / volume, and within 0.01% by weight / volume of the stated amount.

[0232] Some examples are described in connection with the accompanying drawings. Although the drawings are drawn to scale, such scale should not be considered limiting, as dimensions and proportions other than those illustrated are contemplated and are within the scope of the present disclosure. Distances, angles, etc. are merely illustrative and do not necessarily bear precise relationship to the actual dimensions and layout of the illustrated devices. Components can be added, removed, and / or rearranged. Furthermore, disclosures herein of specific features, aspects, methods, properties, attributes, qualities, attributes, members, or the like, associated with various examples can be used in all other examples described herein. Additionally, it will be recognized that any method described herein can be implemented using any device suitable for performing the described steps.

[0233] Although certain examples and variations thereof have been described in detail, other modifications and methods of use thereof will be apparent to those skilled in the art. It is therefore understood that various applications, modifications, materials, and substitutions may be made from equivalents without departing from the original and inventive disclosure herein or without departing from the scope of the claims.

Claims

1. A clip (261) for a portion of the heart, comprising: a first jaw (260) extending from a first end portion (266) to a second end portion (276), the first jaw (260) including a compression surface and an outer surface facing opposite the compression surface; a second jaw (286) extending from a first end portion (266) to a second end portion (276), the second jaw (286) including a compression surface opposing the compression surface of the first jaw (260) and an outer surface of the second jaw (286) facing away from the compression surface; a spring (288) extending over the outer surface of the first jaw (260) and over the outer surface of the second jaw (286), the spring (288) configured to urge the first jaw (260) and the second jaw (286) together to compress the portion of the heart between the compression surface of the first jaw (260) and the compression surface of the second jaw (286); the first jaw (260) extends from the compression surface to the outer surface of the first jaw (260) and includes a first side surface facing a first lateral direction and a second side surface facing opposite to the first side surface, the first side surface and the second side surface of the first jaw (260) being concavely curved relative to the first jaw (260); The second jaw (286) extends from the compression surface to the outer surface of the second jaw (286) and includes a third side surface facing the first side and a fourth side surface facing opposite the third side surface, and the third side surface and the fourth side surface of the second jaw (286) are concavely curved toward the second jaw (286).

2. the first jaw (260) includes a central portion between the first end portion (266) and the second end portion (276) of the first jaw (260); the second jaw (286) includes a central portion between the first end portion (266) and the second end portion (276) of the second jaw (286); 2. The clip (261) of claim 1, wherein the spring (288) includes a first end coupled to the central portion of the first jaw (260) and a second end coupled to the central portion of the second jaw (286).

3. 3. The clip (261) of claim 2, wherein the spring (288) includes a loop extending toward the second end portion (276) of the first jaw (260) and toward the second end portion (276) of the second jaw (286).

4. the outer surface of the first jaw (260) includes a channel; the outer surface of the second jaw (286) includes a channel; 4. The clip (261) of claim 3, wherein the loop extends into the channel of the first jaw (260) and into the channel of the second jaw (286).

5. 5. A clip (261) according to any one of claims 1 to 4, wherein the first end portion (266) of the first jaw (260) is tapered and the second end portion (276) of the first jaw (260) is tapered.

6. the spring (288) includes a loop extending proximally toward the second end portion (276) of the first jaw (260) and toward the second end portion (276) of the second jaw (286); the second end portion (276) of the first jaw (260) projects proximally from or is positioned at the loop; A clip (261) according to any one of claims 1 to 2, wherein the second end portion (276) of the second jaw (286) projects proximally from the loop or is positioned at the loop.

7. A clip (261) according to any one of claims 1 to 6, wherein the first side and the second side of the first jaw (260) have a constant curvature, and the third side and the fourth side of the second jaw (286) have a constant curvature.

8. A clip (261) according to any one of claims 1 to 7, wherein the first side and the second side of the first jaw (260) are concavely curved relative to the first jaw (260) from the proximal tip of the first jaw (260) to the distal tip of the first jaw (260).

9. A clip (261) as described in any one of claims 1 to 8, wherein the spring (288) has an outer surface, an inner surface, a first side surface extending from the outer surface to the inner surface and facing a first lateral direction, and a second side surface extending from the outer surface to the inner surface and facing a second lateral direction opposite the first lateral direction, and the first side surface is curved concavely relative to the spring (288).

10. the outer surface of the first jaw (260) includes a curved channel in a plane transverse to the plane of closure of the clip (261); the outer surface of the second jaw (286) includes a curved channel in a plane transverse to the plane of closure of the clip (261); A clip (261) according to any one of claims 1 to 9, wherein the spring (288) is curved in a plane transverse to the closure plane of the clip (261) and extends into the channel of the first jaw (260) and into the channel of the second jaw (286).

11. The spring (288) a distal end portion having a height in the plane of closure of the clip (261), the distal end portion including a first end connected to the first jaw (260) and a second end connected to the second jaw (286); a proximal end portion of the clip (261) having a height in the plane of closure and including a loop extending toward the second end portion (276) of the first jaw (260) and toward the second end portion (276) of the second jaw (286); A clip (261) according to any one of the preceding claims, wherein the height of the proximal end portion of the spring (288) is greater than the height of the distal end portion of the spring (288).

12. A clip (261) according to any one of claims 1 to 11, wherein the second end portion (276) of the first jaw (260) is tapered and the second end portion (276) of the second jaw (286) is tapered.

13. the first end portion (266) of the first jaw (260) includes a distal tip, a first side wall, a second side wall, and a gap between the first side wall and the second side wall, the first side wall and the second side wall diverging away from each other in a direction toward the distal tip; and / or A clip (261) according to any one of claims 1 to 12, wherein the second end portion (276) of the first jaw (260) includes a proximal tip, a first side wall, a second side wall, and a gap between the first side wall and the second side wall, the first side wall and the second side wall diverging away from each other in a direction towards the proximal tip.

14. The clip (261) of any one of claims 1 to 13, wherein the compression surface of the first jaw (260) comprises a cushion layer.

15. The clip (261) according to any one of claims 1 to 14, wherein the clip is configured to close the left atrial appendage.

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