Heart valve sealing devices and delivery devices therefor

Abstract

To improve devices and methods for treating valvular regurgitation.SOLUTION: Implantable prosthetic devices are disclosed herein. One implantable prosthetic device has a coaptation element and at least one anchor. The coaptation element is configured to be positioned within the native heart valve orifice to help fill a space where the native valve is regurgitant and form a more effective seal. The coaptation element can have a structure that is impervious or resistant to blood and that allows the native leaflets to close around the coaptation element during ventricular systole to block blood from flowing from the left and right ventricles back into the left and right atriums, respectively. The coaptation element can be connected to the leaflets of the native valve by the anchor. The coaptation element may have cutouts to facilitate compression of the coaptation element.SELECTED DRAWING: Figure 105

Description

[Technical field]

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS This application claims the benefit of U.S. Provisional Application No. 62 / 915,589, filed October 15, 2019, entitled "Heart Valve Sealing Devices and Delivery Devices Therefor," which is incorporated herein by reference in its entirety. [Background technology]

[0002] The natural heart valves (i.e., aortic, pulmonary, tricuspid, and mitral) play a vital role in ensuring proper forward flow of blood supply through the cardiovascular system. These heart valves can be damaged and therefore less effective due to congenital malformations, inflammatory processes, infectious conditions, disease, etc. Damage to such valves can lead to serious cardiovascular danger and death. Damaged valves can be surgically repaired or replaced in open heart surgery. However, open heart surgery is highly invasive and can lead to complications. Transvascular techniques can be used to introduce and implant prosthetic devices in a much less invasive manner than open heart surgery. As an example, a transseptal technique can be used, including, for example, inserting a catheter into the right femoral vein, advancing up the inferior vena cava, and feeding into the right atrium, puncturing the septum, and threading the catheter into the left atrium.

[0003] A healthy heart has a generally conical shape that tapers toward the inferior apex. The heart is provided with four chambers, including the left atrium, the right atrium, the left ventricle, and the right ventricle. The left and right sides of the heart are separated by a wall commonly referred to as the septum. The natural mitral valve of the human heart connects the left atrium to the right ventricle. The mitral valve has a very different anatomical form than other natural heart valves. The mitral valve includes an annular portion, which is a circular portion of natural valve tissue that surrounds the mitral orifice, and a pair of cusps, or leaflets, that extend downward from the annulus into the left ventricle. The mitral annulus may form a "D"-shaped, oval, or other cross-sectional shape that is not a perfect circle with long and short axes. The anterior leaflets are larger than the posterior leaflets, and may form a generally "C"-shaped boundary between the abutting sides of each leaflet when they close together.

[0004] When functioning properly, the anterior and posterior leaflets together function as a one-way valve, allowing blood to flow only from the left atrium to the left ventricle. The left atrium receives oxygenated blood from the pulmonary veins. When the left atrial muscle contracts and the left ventricle expands (also called "ventricular diastole" or "diastole"), the oxygenated blood collected in the left atrium flows into the left ventricle. When the left atrial muscle relaxes and the left ventricle muscle contracts (also called "ventricular systole" or "systole"), the increased blood pressure in the left ventricle forces the sides of the two leaflets together, thereby closing the one-way mitral valve, so that blood cannot flow back into the left atrium, but instead is expelled from the left ventricle through the aortic valve. To prevent the leaflets from prolapsing under pressure and folding back from the mitral annulus toward the left atrium, multiple fibrous cords called chordae tendineae tether the leaflets to the papillary muscles of the left ventricle.

[0005] Mitral regurgitation occurs when the native mitral valve fails to close properly and blood flows from the left ventricle into the left atrium during the systolic phase of heart contraction. Mitral regurgitation is one of the most common forms of valvular heart disease. Mitral regurgitation can have a number of different causes, such as leaflet prolapse, papillary muscle insufficiency, mitral annulus stretching, or multiple of these resulting from left ventricular dilation. Mitral regurgitation in the center of the leaflets can be referred to as central jet mitral regurgitation, and mitral regurgitation closer to the commissure of one of the leaflets (i.e., where the leaflets meet) can be referred to as eccentric jet mitral regurgitation. Central jet mitral regurgitation occurs when the edges of the leaflets do not meet in the middle, thus preventing the valve from closing and allowing regurgitation to exist.

[0006] Techniques for treating mitral and other valvular regurgitation in patients may involve directly fastening the edges of the native valve leaflets together. For example, catheter-delivered clips may be used to attempt to fasten the sides of the leaflets together at their ends. However, significant problems exist. For example, multiple clips may be required to eliminate or reduce regurgitation to an acceptable level, which in some circumstances may increase the length of the procedure, overly restrict flow, or place undesirable stress on the native anatomy.

[0007] Despite these conventional techniques, there is a continuing need for improved devices and methods for treating valvular regurgitation. [Prior art documents] [Patent documents]

[0008] [Patent Document 1] International Application No. PCT / US2018 / 028171 [Patent Document 2] International Application No. PCT / US2019 / 028041 [Patent Document 3] U.S. Patent Application Serial No. 16 / 123,105 [Patent Document 4] International Application No. PCT / US2018 / 031959 [Patent Document 5] International Application No. PCT / US2018 / 028189 [Patent Document 6] International Application No. PCT / US2018 / 045985 [Patent Document 7] U.S. Provisional Patent Application No. 62 / 744031 [Patent Document 8] U.S. Provisional Patent Application No. 62 / 803854 [Patent Document 9] U.S. Provisional Patent Application No. 62 / 809856 [Patent Document 10] U.S. Provisional Patent Application No. 62 / 808377 [Patent Document 11] U.S. Provisional Patent Application No. 62 / 805847 [Patent Document 12] International Application No. PCT / US16 / 32462 [Patent Document 13] U.S. Patent No. 8,449,599 [Patent Document 14] US Patent Application Publication No. 2014 / 0222136 [Patent Document 15] US Patent Application Publication No. 2014 / 0067052 [Patent Document 16] US Patent Application Publication No. 2016 / 0331523 Summary of the Invention [Means for solving the problem]

[0009] This Summary is intended to provide some examples and is not intended to limit the scope of the present invention in any way. For example, none of the features included in the Examples of this Summary are required in the claims unless they are explicitly characterized in the claims. Also, features, components, steps, concepts, etc. described in the Examples in this Summary and elsewhere in this disclosure may be combined in various ways. Various features and steps as described elsewhere in this disclosure may be included in the Examples summarized here.

[0010] An exemplary implantable prosthetic device has a coaptation element and at least one anchor. The coaptation element is configured to be placed in the orifice of the native heart valve to fill the space where the native valve is regurgitant and help form a more effective seal. The coaptation element can have a blood-impermeable (or otherwise blood-blocking) structure that allows the native leaflets to close around the coaptation element during ventricular contraction to block blood from flowing back from the left or right ventricle into the left or right atrium, respectively. The coaptation element can be coupled to the leaflets of the native valve by an anchor.

[0011] In one exemplary embodiment, a valve repair device for repairing a patient's native valve includes a coaptation element and one or more anchor portions. The coaptation element may be formed from a solid or hollow piece of material by a variety of different processes, such as molding, three-dimensional printing, casting, etc. The one or more anchor portions are movable between an open position and a closed position.

[0012] In one exemplary embodiment, a valve repair device for repairing a patient's native valve includes a main shaft, a mating member, at least one paddle, at least one fastener, a drive shaft, and a cap. An attachment protrusion extends outwardly from the main shaft.

[0013] In some embodiments, the interface member includes a central opening, a groove along the central opening, and at least one engagement recess. The central opening can be configured to receive the main shaft. The groove along the central opening can be configured to allow an attachment protrusion of the main shaft to pass through the interface.

[0014] In some embodiments, the at least one engagement recess receives a mounting protrusion of the main shaft.

[0015] In some embodiments, the drive shaft extends through the main shaft.

[0016] In some embodiments, the cap is attached to a drive shaft such that the cap can be moved by the drive shaft away from the main shaft.

[0017] The paddle portions are movable between an open position and a closed position.

[0018] In some embodiments, at least one fastener is attached to each of the plurality of paddle portions.

[0019] In some embodiments, movement of the cap towards the main shaft causes the paddle portion to move to a closed position, and movement of the cap away from the main shaft causes the paddle portion to move to an open position.

[0020] In one exemplary embodiment, a valve repair device for repairing a patient's native valve includes a main shaft, a joint member, a drive shaft, a cap, and one or more paddles. In some embodiments, the main shaft has at least one paddle opening.

[0021] In some embodiments, the attachment protrusion extends outwardly from the main shaft.

[0022] In some embodiments, the drive shaft extends through the main shaft.

[0023] In some embodiments, the cap is attached to a drive shaft such that the cap can be moved by the drive shaft away from the main shaft.

[0024] In some embodiments, the cap comprises one or more paddle openings.

[0025] In some embodiments, the plurality of paddle portions are movable between an open position and a closed position.

[0026] In some embodiments, the proximal end of each paddle is inserted into one of a plurality of paddle openings in the main shaft.

[0027] In some embodiments, the distal end of each paddle is inserted into a paddle opening in the cap.

[0028] In some embodiments, movement of the cap towards the main shaft causes the paddle portion to move to a closed position, and movement of the cap away from the main shaft causes the paddle portion to move to an open position.

[0029] In one exemplary embodiment, a valve repair device for repairing a patient's native valve includes a main shaft, an abutment member, one or more paddles, a drive shaft, and a spreader member. The drive shaft extends through the main shaft. The spreader member is movable between an engaged position and a disengaged position. The one or more paddles are movable between an open position and a closed position. The cam portion is movable which causes the cam portion to engage the paddles and spread them apart.

[0030] In one exemplary embodiment, the valve repair device comprises a coaptation element and an anchor portion. The coaptation element includes a plurality of notches or openings that allow the coaptation element to be compressed to fit within a delivery catheter.

[0031] A further understanding of the nature and advantages of the present invention will become apparent from the following description and claims, particularly when considered in conjunction with the accompanying drawings, in which like parts are marked with like reference numerals and in which:

[0032] In order to further clarify various aspects of the embodiments of the present invention, some embodiments will be described more specifically with reference to various aspects of the accompanying drawings. It should be understood that these drawings show only typical embodiments of the present disclosure and therefore should not be considered as limiting the scope of the present disclosure. Furthermore, the figures may be drawn to scale in some embodiments, but not all embodiments. The embodiments and features and advantages of the present disclosure will be described and explained with more specificity and detail by using the accompanying drawings. [Brief description of the drawings]

[0033] [Figure 1] FIG. 1 is a cutaway view of a human heart during diastole. [Diagram 2] FIG. 1 is a cutaway view of a human heart during systole. [Diagram 3] FIG. 2 is another cut-away view of the human heart during systole, showing mitral regurgitation. [Figure 4] FIG. 4 is a cutaway view of FIG. 3 annotated to show the natural shape of the mitral valve leaflets during systole. [Diagram 5] FIG. 1 illustrates a healthy mitral valve with the leaflets closed, viewed from the atrial side of the mitral valve. [Figure 6] FIG. 1 shows a dysfunctional mitral valve with visible gaps between the leaflets as viewed from the atrial side of the mitral valve. [Figure 7] FIG. 2 is a diagram of the tricuspid valve as seen from the atrial side of the tricuspid valve. [Figure 8] 1A-1D depict an exemplary embodiment of an implantable prosthetic device at different stages of deployment. [Figure 9] 1A-1D depict an exemplary embodiment of an implantable prosthetic device at different stages of deployment. [Figure 10] 1A-1D depict an exemplary embodiment of an implantable prosthetic device at different stages of deployment. [Figure 11] 1A-1D depict an exemplary embodiment of an implantable prosthetic device at different stages of deployment. [Figure 12]1A-1D depict an exemplary embodiment of an implantable prosthetic device at different stages of deployment. [Figure 13] 1A-1D depict an exemplary embodiment of an implantable prosthetic device at different stages of deployment. [Figure 14] 1A-1D depict an exemplary embodiment of an implantable prosthetic device at different stages of deployment. [Figure 15] 15A-15C show an exemplary embodiment of an implantable prosthetic device similar to the device shown in FIGS. 8-14, but in which the paddles are independently controllable. [Figure 16] FIG. 15 illustrates the implantable prosthetic device of FIGS. 8-14 being delivered and implanted into a native mitral valve. [Figure 17] FIG. 15 illustrates the implantable prosthetic device of FIGS. 8-14 being delivered and implanted into a native mitral valve. [Figure 18] FIG. 15 illustrates the implantable prosthetic device of FIGS. 8-14 being delivered and implanted into a native mitral valve. [Figure 19] FIG. 15 illustrates the implantable prosthetic device of FIGS. 8-14 being delivered and implanted into a native mitral valve. [Figure 20] FIG. 15 illustrates the implantable prosthetic device of FIGS. 8-14 being delivered and implanted into a native mitral valve. [Figure 21] FIG. 15 illustrates the implantable prosthetic device of FIGS. 8-14 being delivered and implanted into a native mitral valve. [Figure 22] FIG. 1 is a perspective view of an exemplary implantable prosthetic device in a closed state. [Diagram 23] FIG. 23 is a front view of the implantable prosthetic device of FIG. 22. [Figure 24] FIG. 23 is a side view of the implantable prosthetic device of FIG. 22. [Diagram 25] 23 is a front view of the implantable prosthetic device of FIG. 22 with a cover covering the paddles and coaptation elements. [Figure 26] 23 is a top perspective view of the implantable prosthetic device of FIG. 22 in an open position. [Figure 27]23 is a bottom perspective view of the implantable prosthetic device of FIG. 22 in an open position. [Figure 28] 1A-1D show a barbed fastener for use in an implantable prosthetic device. [Figure 29] FIG. 13 illustrates a portion of native valve tissue captured by a barbed fastener. [Diagram 30] FIG. 2 is a side view of an exemplary implantable prosthetic device in a partially open state with the barbed fasteners in a closed position. [Diagram 31] FIG. 2 is a side view of an exemplary implantable prosthetic device in a partially open state with a barbed fastener in an open position. [Diagram 32] FIG. 2 is a side view of an exemplary implantable prosthetic device in a semi-open position with the barbed clasp in a closed position. [Diagram 33] FIG. 2 is a side view of an exemplary implantable prosthetic device in a semi-open position with the barbed fasteners in an open position. [Diagram 34] FIG. 2 is a side view of an exemplary implantable prosthetic device in a three-quarters open position with the barbed clasp in a closed position. [Diagram 35] FIG. 2 is a side view of an exemplary implantable prosthetic device in a three-quarters open position with the barbed fasteners in an open position. [Diagram 36] FIG. 2 is a side view of an exemplary implantable prosthetic device in a fully escaped position with the barbed clasp in a closed position. [Figure 37] FIG. 2 is a side view of an exemplary implantable prosthetic device in a fully ejected position with a barbed fastener in an open position. [Figure 38] FIG. 39 shows the implantable prosthetic device of FIGS. 30-38, including a cover, delivered and implanted within a native mitral valve. [Figure 39] FIG. 39 shows the implantable prosthetic device of FIGS. 30-38, including a cover, delivered and implanted within a native mitral valve. [Diagram 40] FIG. 39 shows the implantable prosthetic device of FIGS. 30-38, including a cover, delivered and implanted within a native mitral valve. [Diagram 41] FIG. 39 shows the implantable prosthetic device of FIGS. 30-38, including a cover, delivered and implanted within a native mitral valve. [Diagram 42] FIG. 39 shows the implantable prosthetic device of FIGS. 30-38, including a cover, delivered and implanted within a native mitral valve. [Diagram 43] FIG. 39 shows the implantable prosthetic device of FIGS. 30-38, including a cover, delivered and implanted within a native mitral valve. [Diagram 44] FIG. 39 shows the implantable prosthetic device of FIGS. 30-38, including a cover, delivered and implanted within a native mitral valve. [Diagram 45] FIG. 39 shows the implantable prosthetic device of FIGS. 30-38, including a cover, delivered and implanted within a native mitral valve. [Diagram 46] FIG. 39 shows the implantable prosthetic device of FIGS. 30-38, including a cover, delivered and implanted within a native mitral valve. [Figure 47] FIG. 39 shows the implantable prosthetic device of FIGS. 30-38, including a cover, delivered and implanted within a native mitral valve. [Figure 48] FIG. 39 shows the implantable prosthetic device of FIGS. 30-38, including a cover, delivered and implanted within a native mitral valve. [Figure 49] FIG. 39 shows the implantable prosthetic device of FIGS. 30-38, including a cover, delivered and implanted within a native mitral valve. [Figure 50] FIG. 13 is a schematic diagram showing the passage of the natural leaflets along each side of the coaptation element of the valve repair device. [Figure 51] 1A is a schematic top view illustrating the passage of the native leaflets around the coaptation elements of a valve repair device. [Figure 52] FIG. 1 shows the coaptation elements of the mitral valve gap as viewed from the atrial side of the mitral valve. [Diagram 53] FIG. 13 shows a valve repair device attached to the mitral valve leaflets by coaptation elements in the mitral valve gap, viewed from the ventricular side of the mitral valve. [Figure 54]FIG. 1 is a perspective view of a valve repair device applied to the mitral valve leaflets, showing the coaptation elements of the mitral valve gap from the ventricular side of the mitral valve. [Figure 55] FIG. 1 is a perspective view of an exemplary implantable prosthetic device in a closed state. [Figure 56] FIG. 2 is a perspective view of an exemplary barbed clasp of an exemplary implantable prosthetic device in a closed state. [Figure 57] 13A-13D illustrate the movement of paddles of an implantable prosthetic device. [Figure 58] 13A-13D illustrate the movement of paddles of an implantable prosthetic device. [Figure 59] 13A-13D illustrate the movement of paddles of an implantable prosthetic device. [Figure 60] 13A-13D illustrate the movement of paddles of an implantable prosthetic device. [Figure 61] 13A-13D illustrate the movement of paddles of an implantable prosthetic device. [Figure 62] 13A-13D illustrate the movement of paddles of an implantable prosthetic device. [Figure 63] 13A-13D illustrate the movement of paddles of an implantable prosthetic device. [Figure 64] 13A-13D illustrate the movement of paddles of an implantable prosthetic device. [Figure 65] FIG. 2 is a top perspective view of an exemplary implantable prosthetic device in a closed state. [Figure 66] FIG. 66 is a bottom perspective view of the implantable prosthetic device of FIG. 65. [Figure 67] FIG. 66 is a front view of the implantable prosthetic device of FIG. 65. [Figure 68] FIG. 66 is a side view of the implantable prosthetic device of FIG. 65. [Figure 69] FIG. 66 is a top view of the implantable prosthetic device of FIG. 65. [Figure 70] FIG. 66 is a bottom view of the implantable prosthetic device of FIG. 65. [Figure 71] FIG. 66 is an exploded perspective view of the components of the implantable prosthetic device of FIG. 65. [Figure 71A]1A-1D are perspective views of components of an exemplary implantable prosthetic device. [Figure 72] 66 is a top perspective view of the implantable prosthetic device of FIG. 65 in an open position. [Figure 73] FIG. 73 is a bottom perspective view of the implantable prosthetic device of FIG. 72. [Figure 74] FIG. 73 is a front view of the implantable prosthetic device of FIG. 72. [Figure 75] FIG. 73 is a side view of the implantable prosthetic device of FIG. 72. [Figure 76] FIG. 73 is a top view of the implantable prosthetic device of FIG. 72. [Figure 77] FIG. 73 is a bottom view of the implantable prosthetic device of FIG. 72. [Figure 78] FIG. 73 is a top perspective view of the paddles and drive components of the implantable prosthetic device of FIG. 72. [Figure 79] FIG. 79 is a bottom perspective view of the implantable prosthetic device of FIG. 78. [Figure 80] FIG. 79 is a front view of the implantable prosthetic device of FIG. 78. [Figure 81] FIG. 1 is a top perspective view of an exemplary implantable prosthetic device attached to a delivery system. [Figure 82] 82 is a top perspective view of the implantable prosthetic device of FIG. 81 with the delivery system in an open, retracted position. [Figure 83] FIG. 82 is a bottom perspective view of the exemplary implantable prosthetic device of FIG. 81. [Figure 84] FIG. 83 is a bottom perspective view of the implantable prosthetic device of FIG. 82. [Figure 85] FIG. 82 is a front view of the exemplary implantable prosthetic device of FIG. 81. [Figure 86] FIG. 83 is a front view of the implantable prosthetic device of FIG. 82. [Figure 87] FIG. 82 is a front view of the exemplary implantable prosthetic device of FIG. 81. [Figure 88] FIG. 83 is a front view of the implantable prosthetic device of FIG. 82. [Figure 89] FIG. 2 is a top perspective view of the main shaft of an exemplary implantable device. [Figure 90] FIG. 90 is a bottom perspective view of the main shaft of FIG. [Figure 91] FIG. 89 is a front view of the main shaft of FIG. [Figure 92] FIG. 90 is a side view of the main shaft of FIG. [Figure 93] FIG. 89 is a top view of the main shaft of FIG. [Figure 94] FIG. 90 is a bottom view of the main shaft of FIG. [Figure 95] FIG. 13 is a top perspective view of a coaptation element of an exemplary implantable device. [Figure 96] FIG. 96 is a bottom perspective view of the coaptation element of FIG. 95. [Figure 97] FIG. 96 is a front view of the interface element of FIG. 95. [Figure 98] FIG. 96 is a side view of the coaptation element of FIG. 95. [Figure 99] FIG. 96 is a top view of the interface element of FIG. 95. [Figure 100] FIG. 96 is a bottom view of the coaptation element of FIG. 95. [Figure 101] 1A-1C are diagrams of an exemplary interface element and main shaft assembly. [Figure 102] 1A-1C are diagrams of an exemplary interface element and main shaft assembly. [Figure 103] 1A-1C are diagrams of an exemplary interface element and main shaft assembly. [Figure 104] 1A-1C are diagrams of an exemplary interface element and main shaft assembly. [Figure 105] 1A-1C are diagrams of an exemplary interface element and main shaft assembly. [Fig. 106] FIG. 2 is a top perspective view of a paddle of an exemplary implantable prosthetic device. [Figure 107] FIG. 107 is a bottom perspective view of the paddle of FIG. 106. [Figure 108] FIG. 107 is a left side view of the paddle of FIG. 106. [Fig. 109] FIG. 107 is a front view of the paddle of FIG. 106. [Figure 110] FIG. 107 is a right side view of the paddle of FIG. 106. [Figure 111] FIG. 107 is a top view of the paddle of FIG. 106. [Figure 112] FIG. 107 is a bottom view of the paddle of FIG. 106. [Figure 113] FIG. 107 is a diagram of the paddle of FIG. 106 laser cut from a flat sheet of material. [Fig. 114] FIG. 107 is a diagram of the paddle of FIG. 106 laser cut from a flat sheet of material. [Figure 115] FIG. 2 is a top perspective view of a paddle of an exemplary implantable prosthetic device. [Fig. 116] FIG. 107 is a bottom perspective view of the paddle of FIG. 106. [Figure 117] FIG. 107 is a left side view of the paddle of FIG. 106. [Fig. 118] FIG. 107 is a front view of the paddle of FIG. 106. [Figure 119] FIG. 107 is a right side view of the paddle of FIG. 106. [Figure 120] FIG. 107 is a top view of the paddle of FIG. 106. [Figure 121] FIG. 107 is a bottom view of the paddle of FIG. 106. [Figure 122] FIG. 2 is a top perspective view of a spreading member of an exemplary implantable device. [Figure 123] FIG. 123 is a bottom perspective view of the spreader member of FIG. [Figure 124] FIG. 123 is a side view of the spreader member of FIG. 122. [Fig. 125] FIG. 123 is a front view of the spreader member of FIG. 122. [Fig. 126] FIG. 123 is a top view of the spreader member of FIG. [Figure 127] FIG. 123 is a bottom view of the spreader member of FIG. 122. [Figure 128] 1A-1C are top perspective exploded views of components of a distal nut assembly of an exemplary implantable device. [Figure 129] FIG. 219 is a view of the distal nut assembly of FIG. 218 in an assembled state. [Fig. 130] FIG. 13 is a top perspective exploded view of a drive element, a spreading member, and a distal nut assembly of an exemplary implantable device. [Fig. 131]FIG. 131 is a bottom perspective view of the components of FIG. 130. [Fig. 132] FIG. 131 is a front view of the components of FIG. 130. [Fig. 133] FIG. 131 is a side view of the components of FIG. 130. [Fig. 134] FIG. 13 is a top perspective view of an assembled state of the drive element, spreader member and distal nut assembly of an exemplary implantable device. [Fig. 135] FIG. 135 is a bottom perspective view of the components of FIG. 134. [Fig. 136] FIG. 135 is a front view of the components of FIG. 134. [Fig. 137] FIG. 135 is a side view of the components of FIG. 134. [Figure 138] FIG. 13 is a top perspective exploded view of a drive element, a spreading member, and a distal nut assembly of an exemplary implantable device. [Figure 139] FIG. 139 is a bottom perspective view of the components of FIG. 138. [Fig. 140] FIG. 139 is a front view of the components of FIG. 138. [Fig. 141] FIG. 139 is a side view of the components of FIG. 138. [Fig. 142] FIG. 13 is a top perspective view of an assembled state of the drive element, spreader member and distal nut assembly of an exemplary implantable device. [Fig. 143] FIG. 143 is a bottom perspective view of the components of FIG. 142. [Fig. 144] FIG. 143 is a front view of the components of FIG. 142. [Fig. 145] FIG. 143 is a side view of the components of FIG. 142. [Fig. 146] FIG. 13 is a top perspective exploded view of a paddle frame and distal nut assembly of an exemplary implantable device. [Fig. 147] FIG. 147 is a bottom perspective view of the components of FIG. 146. [Fig. 148] FIG. 147 is a side view of the components of FIG. 146. [Figure 149] FIG. 13 is a top perspective view of an assembled state of the paddle frame and distal nut assembly of an exemplary implantable device. [Fig. 150] FIG. 150 is a bottom perspective view of the components of FIG. 149. [Fig. 151] FIG. 150 is a side view of the components of FIG. 149. [Fig. 152] FIG. 150 is a top perspective view of the components of FIG. 149 with the paddle frame in a shape-setting position. [Fig. 153] FIG. 13 is a top perspective view of the paddle, paddle frame, and distal nut assembly in an assembled state. [Fig. 154] FIG. 154 is a bottom perspective view of the components of FIG. 153. [Fig. 155] FIG. 154 is a side view of the components of FIG. 153. [Fig. 156] FIG. 2 is a top perspective, partially cut-away view of components of an exemplary implantable device. [Fig. 157] FIG. 157 is a bottom perspective, partially cut-away view of the components of the implantable device of FIG. 156. [Fig. 158] 157 is a partial cross-sectional side view of components of the implantable device of FIG. 156. [Fig. 159] FIG. 157 is an enlarged detail of area 159 of FIG. 156. [Fig. 160] FIG. 158 is an enlarged detail of area 160 of FIG. 157. [Fig. 161] FIG. 2 is a top perspective view of a paddle of an exemplary implantable prosthetic device. [Fig. 162] FIG. 162 is a bottom perspective view of the paddle of FIG. 161. [Fig. 163] FIG. 13 is an exploded, top perspective view of the bottom of the paddle, paddle frame and distal nut assembly of an exemplary implantable device. [Fig. 164] FIG. 13 is a top perspective view of the bottom, assembled state of the paddle, paddle frame and distal nut assembly of an exemplary implantable device. [Fig. 165] FIG. 13 is a top perspective view of a barbed fastener of an exemplary implantable device. [Fig. 166] FIG. 166 is a top perspective view of a laser cut blank for the barbed fastener of FIG. 165; [Fig. 167]FIG. 167 is a top view of the barbed fastener blank of FIG. 166; [Fig. 168] FIG. 13 is a top perspective view of the deployment of a spreading member of an exemplary implantable device. [Fig. 169] FIG. 13 is a top perspective view of the deployment of a spreading member of an exemplary implantable device. [Fig. 170] FIG. 13 is a top perspective view of the deployment of a spreading member of an exemplary implantable device. [Fig. 171] FIG. 13 is a top perspective view of the deployment of a spreading member of an exemplary implantable device. [Fig. 172] FIG. 13 is a bottom perspective view of the deployment of a spreading member of an exemplary implantable device. [Fig. 173] FIG. 13 is a bottom perspective view of the deployment of a spreading member of an exemplary implantable device. [Fig. 174] FIG. 13 is a bottom perspective view of the deployment of a spreading member of an exemplary implantable device. [Fig. 175] FIG. 13 is a bottom perspective view of the deployment of a spreading member of an exemplary implantable device. [Fig. 176] FIG. 2 is a front view of an exemplary implantable device with the spreading member in a retracted position. [Fig. 177] FIG. 1 is a front view of an exemplary implantable device with a spreading member in a deployed state. [Fig. 178] FIG. 177 is a side view of the exemplary implantable device of FIG. 176. [Fig. 179] FIG. 178 is a side view of the exemplary implantable device of FIG. 177. [Fig. 180] FIG. 1 is a front view of an exemplary implantable device with some of the components removed and with the paddle and barb fastener in a capture-ready state. [Fig. 181] 181 is a front view of the exemplary implantable device of FIG. 180 with the paddles engaged by the deployed spreading members. [Fig. 182] FIG. 181 is a front view of the exemplary implantable device of FIG. 180 with the barbed clasps closed and the paddles partially closed to capture the native valve leaflets. [Fig. 183]FIG. 181 is a front view of the exemplary implantable device of FIG. 180 in a fully closed position with the spreader member in a retracted position. [Fig. 184] FIG. 2 is a top perspective view of an exemplary compressible interface element. [Fig. 185] FIG. 185 is a side view of the compressible joint element of FIG. 184. [Fig. 186] FIG. 185 is a front view of the compressible joint element of FIG. 184. [Fig. 187] FIG. 185 is a top view of the compressible joint element of FIG. 184. [Fig. 188] FIG. 186 is a schematic front view of the compressible joint element of FIG. 185 in a compressed state. [Fig. 189] FIG. 2 is a top perspective view of an exemplary compressible interface element. [Fig. 190] FIG. 189 is a side view of the compressible joint element of FIG. [Fig. 191] FIG. 189 is a front view of the compressible joint element of FIG. [Fig. 192] FIG. 189 is a top view of the compressible joint element of FIG. [Fig. 193] FIG. 189 is a schematic front view of the compressible joint element of FIG. 189 in a compressed state. [Fig. 194] FIG. 2 is a top perspective view of an exemplary compressible interface element. [Fig. 195] FIG. 195 is a side view of the compressible joint element of FIG. 194. [Fig. 196] FIG. 195 is a front view of the compressible joint element of FIG. 194. [Figure 197] FIG. 195 is a top view of the compressible joint element of FIG. 194; [Figure 198] FIG. 195 is a schematic front view of the compressible joint element of FIG. 194 in a compressed state. [Figure 199] FIG. 2 is a top perspective view of an exemplary compressible interface element. [Figure 200] FIG. 201 is a side view of the compressible joint element of FIG. 199; [Figure 201] FIG. 199 is a front view of the compressible joint element of FIG. [Fig. 202] FIG. 201 is a top view of the compressible joint element of FIG. 199; [Fig. 203] FIG. 199 is a schematic front view of the compressible joint element of FIG. 199 being moved into a compressed state. [Fig. 204] FIG. 2 is a top perspective view of an exemplary compressible interface element. [Fig. 205] FIG. 205 is a side view of the compressible joint element of FIG. 204. [Fig. 206] FIG. 205 is a front view of the compressible joint element of FIG. 204. [Fig. 207] FIG. 205 is a top view of the compressible joint element of FIG. 204. [Fig. 208] FIG. 205 is a schematic front view of the compressible joint element of FIG. 204 being moved into a compressed state. [Fig. 209] FIG. 2 is a top perspective view of an exemplary compressible interface element. [Fig. 210] FIG. 210 is a side view of the compressible joint element of FIG. 209. [Fig. 211] FIG. 210 is a front view of the compressible joint element of FIG. 209. [Fig. 212] FIG. 210 is a top view of the compressible joint element of FIG. 209. [Fig. 213] FIG. 210 is a schematic top view of the compressible joint element of FIG. 209 being moved into a compressed state. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0034] DETAILED DESCRIPTION In the following description, reference is made to the accompanying drawings which illustrate specific embodiments of the present disclosure. Other embodiments which differ in structure and operation do not depart from the scope of the present disclosure.

[0035] Exemplary embodiments of the present disclosure are directed to devices and methods for repairing defective heart valves. It should be noted that various embodiments of native valve repair devices and systems for delivery are disclosed herein, and any combination of these options can be obtained, unless specifically excluded. In other words, the individual components of the disclosed devices and systems can be combined, unless they are mutually exclusive or physically impossible.

[0036] As described herein, when one or more components are described as being connected, joined, affixed, coupled, attached, or otherwise interconnected, such interconnection may be direct, such as between the components, or indirect, such as through the use of one or more intermediate components. Also, as described herein, references to a "member," "component," or "portion" are not limited to a single structural member, component, or element, but may include an assembly of components, members, or elements. Further, as described herein, the terms "substantially" and "about" are defined as at least near (and including) a given value or condition (preferably within 10%, more preferably within 1%, and most preferably within 0.1%).

[0037] The implantable prosthetic devices disclosed herein can take a wide variety of forms, including, but not limited to, International Application No. PCT / US2018 / 028171, filed April 18, 2018; International Application No. PCT / US2019 / 028041, filed April 18, 2019; U.S. Patent Application No. 16 / 123,105, filed September 6, 2018; International Application No. PCT / US2018 / 031959, filed May 10, 2018; International Application No. PCT / US2018 / 028189, filed April 18, 2018; International Application No. PCT / US2018 / 028200, filed August 9, 2018; No. 62 / 744031, filed October 10, 2018, U.S. Provisional Patent Application No. 62 / 803854, filed February 11, 2019, U.S. Provisional Patent Application No. 62 / 809856, filed February 25, 2019, U.S. Provisional Patent Application No. 62 / 808377, filed February 21, 2019, U.S. Provisional Patent Application No. 62 / 805847, filed February 14, 2019, and International Application No. PCT / US16 / 32462, filed May 13, 2016, may incorporate a wide variety of features and methods of operation of the implantable prosthetic devices shown and described in US2018 / 045985, U.S. Provisional Patent Application No. 62 / 744031, filed October 10, 2018, U.S. Provisional Patent Application No. 62 / 803854, filed February 11, 2019, U.S. Provisional Patent Application No. 62 / 809856, filed February 25, 2019, U.S. Provisional Patent Application No. 62 / 808377, filed February 21, 2019, U.S. Provisional Patent Application No. 62 / 805847, filed February 14, 2019, and International Application No. PCT / US16 / 32462, filed May 13, 2016.

[0038] 1 and 2 are cutaway views of a human heart H during diastole and systole, respectively. The right ventricle RV and left ventricle LV are separated from the right atrium RA and left atrium LA, respectively, by the tricuspid valve TV and the mitral valve MV, i.e., the atrioventricular valves. In addition, the aortic valve AV separates the left ventricle LV from the ascending aorta AA, and the pulmonary valve PV separates the right ventricle from the pulmonary artery. Each of these valves has flexible leaflets (e.g., leaflets 20, 22 shown in Figs. 3-7) that extend inward across their respective openings, and these leaflets come together, or "coapt," in the flow stream to form a one-way fluid blocking surface. The native valve repair system of the present application is described primarily with respect to the mitral valve MV. Thus, the anatomy of the left atrium LA and the left ventricle LV are described in great detail. It should be understood that the device described herein can also be used to repair other native valves, for example, the device can be used to repair the tricuspid valve TV, the aortic valve AV, and the pulmonary valve PV.

[0039] The left atrium LA receives oxygenated blood from the lungs. During diastolic phase or diastole, as seen in FIG. 1, blood previously collected in the left atrium LA (during systole) passes through the mitral valve MV into the left ventricle LV as the left ventricle LV expands. During systolic phase or systole, as seen in FIG. 2, the left ventricle LV contracts, forcing blood through the aortic valve AV and the ascending aorta into the body. During systole, the leaflets of the mitral valve MV close to prevent blood from flowing back from the left ventricle LV into the original left atrium LA, and blood is collected from the pulmonary veins into the left atrium. In one exemplary embodiment, the device described by the present application is used to restore the function of a defective mitral valve MV. That is, the device is configured to help prevent the leaflets of the mitral valve from closing to prevent blood from flowing back from the left ventricle LV into the original left atrium LA. The devices described in this application are designed to easily grasp and secure the native valve leaflets around an optional coaptation element or spacer that acts as a filler for the regurgitant opening to prevent or inhibit backflow or regurgitation during systole. In this application, the terms coaptation element, spacer, spacer element, and coaptation element refer to components that fill a portion of the space between a native heart valve, such as the mitral valve or tricuspid valve.

[0040] Referring now to Figures 1-7, the mitral valve MV includes two leaflets, an anterior leaflet 20 and a posterior leaflet 22. The mitral valve MV also includes an annulus 24, which is a fibrous ring of tissue of variable density surrounding the leaflets 20, 22. Referring now to Figures 3 and 4, the mitral valve MV is anchored to the wall of the left ventricle LV by chordae tendineae CT. The chordae tendineae CT are cord-like tendons that connect the papillary muscles PM (i.e., muscles at the base of the chordae tendineae CT and within the wall of the left ventricle LV) to the leaflets 20, 22 of the mitral valve MV. The papillary muscles PM serve to limit the movement of the leaflets 20, 22 of the mitral valve MV and to keep the mitral valve MV from retracting. The mitral valve MV opens and closes in response to relative pressure changes within the left atrium LA and the left ventricle LV. The papillary muscles PM do not open or close the mitral valve MV. Rather, the papillary muscles PM support or anchor the leaflets 20, 22 against the high pressures required to circulate blood throughout the body. Together, the papillary muscles PM and the chordae tendineae CT are known as the subvalvular apparatus and function to prevent herniation of the mitral valve MV into the left atrium LA when the mitral valve is closed. As can be seen from the left ventricular outflow tract (LVOT) diagram shown in Figure 3, the anatomy of the leaflets 20, 22 is such that the inner sides of the leaflets coapt at their free end portions and the leaflets 20, 22 begin to retract or splay away from each other. The leaflets 20, 22 splay toward the atrium until each leaflet meets the mitral annulus.

[0041] Various disease processes may impair the proper function of one or more of the native valves of the heart H. These disease processes include degenerative processes (e.g., Barlow's disease, fibroelastic deficiency), inflammatory processes (e.g., rheumatic heart disease), and infectious processes (e.g., endocarditis). In addition, damage to the left ventricle LV or right ventricle RV from a previous heart attack (i.e., myocardial infarction following coronary artery disease) or other heart diseases (e.g., cardiomyopathy) may deform the geometry of the native valve, causing the native valve to malfunction. However, the majority of patients who undergo valve surgery, such as surgery on the mitral valve MV, suffer from a degenerative disease that causes malfunction of the leaflets (e.g., leaflets 20, 22) of the native valve (e.g., mitral valve MV), resulting in prolapse and regurgitation.

[0042] In general, natural valves can fail to function normally in two different conditions: (1) valve stenosis, and (2) valve regurgitation. Valve stenosis occurs when a natural valve does not open completely, thereby causing impaired blood flow. Typically, valve stenosis results from the accumulation of calcified material on the leaflets of the valve, which thickens the leaflets and impairs their ability to fully open to allow forward blood flow. A second type of valve dysfunction, valve regurgitation, occurs when the leaflets of the valve do not close completely, thereby allowing blood to leak back into the anterior chamber (e.g., blood leaking from the left ventricle into the left atrium).

[0043] There are three main mechanisms by which native valves become regurgitant, i.e., incompetent, including Carpentier's types I, II, and III insufficiency. Carpentier's type I insufficiency involves dilatation of the valve annulus such that normally functioning leaflets diverge from one another to form a tight seal, i.e., the leaflets do not coapt properly. Type I insufficiency includes perforation of the leaflets, as in endocarditis. Carpentier's type II insufficiency involves prolapse of one or more leaflets of the native valve on the coaptation plane. Carpentier's type III insufficiency involves restriction of the movement of one or more leaflets of the native valve, such that the leaflets are abnormally restrained below the plane of the annulus. Leaflet restriction can be caused by rheumatic disease (Ma) or ventricular dilation (IIIb).

[0044] With reference to FIG. 5, when a healthy mitral valve MV is in a closed state, the anterior leaflet 20 and the posterior leaflet 22 coapt, thereby preventing blood from leaking from the left ventricle LV into the left atrium LA. With reference to FIGS. 3 and 6, mitral regurgitation MR occurs when the edges of the leaflets 20, 22 are not in contact with one another. This failure to coapt creates a gap 26 between the anterior leaflet 20 and the posterior leaflet 22, which allows blood to flow back from the left ventricle LV into the left atrium LA during systole, as illustrated by the mitral regurgitation MR flow path shown in FIG. 3. The gap 26 may have a width W of between about 2.5 mm and about 17.5 mm, between about 5 mm and about 15 mm, between about 7.5 mm and about 12.5 mm, or about 10 mm. In some circumstances, the gap 26 may have a width W greater than 15 mm. As previously discussed, there are a variety of different ways that a valve leaflet (eg, the leaflets 20, 22 of the mitral valve MV) can malfunction, thereby resulting in regurgitation.

[0045] In any of the above situations, a valve repair device is desired that can engage the anterior leaflets 20 and posterior leaflets 22 to close the gap 26 and prevent backflow of blood through the mitral valve MV. As can be seen in Figure 4, an abstract representation of the valve repair device 10 is shown implanted between the leaflets 20, 22 such that no backflow occurs during systole (compare Figure 4 with Figure 3). In particular, the coaptation elements of the device 10 have a generally tapered or triangular shape, which naturally matches the geometry of the native valve and its propensity for expanding leaflets (towards the annulus).

[0046] Although stenosis or regurgitation can affect any valve, stenosis is primarily found to affect the aortic valve AV or pulmonary valve PV, and regurgitation is primarily found to affect the mitral valve MV or tricuspid valve TV. Both valve stenosis and regurgitation increase the workload of the heart H and, if left untreated, can lead to very serious medical conditions such as endocarditis, congestive heart failure, permanent heart damage, cardiac arrest, and ultimately death. Because the left side of the heart is primarily responsible for circulating blood flow throughout the body, the left-sided cardiac structures (i.e., the left atrium LA, left ventricle LV, mitral valve MV, and aortic valve AV) are subject to substantially higher pressures. Accordingly, insufficiency of the mitral valve MV or aortic valve AV can be particularly problematic and often life-threatening.

[0047] A malfunctioning native heart valve can be repaired or replaced. Repair usually involves preserving and correcting the patient's native valve. Replacement usually involves replacing the patient's native valve with a biological or mechanical substitute. Usually, the aortic valve AV and pulmonary valve PV are more prone to stenosis. Because the stenotic damage sustained by the leaflets is irreversible, the most common treatment for a stenotic aortic valve or pulmonary valve is to remove the valve and replace it with a surgically implanted heart valve, or to replace the valve with a transcatheter heart valve. The mitral valve MV and tricuspid valve TV (FIG. 7) are more prone to deformation of the leaflets, which, as described above, can prevent the mitral valve MV or tricuspid valve TV from closing properly, allowing blood to flow regurgitantly or backflow from the ventricle to the atrium (e.g., a deformed mitral valve MV can allow mitral regurgitation MR or backflow from the left ventricle LV to the left atrium LA, as shown in FIG. 3). Regurgitation or backflow of blood from the ventricle to the atrium leads to valvular insufficiency. Deformations in the structure or shape of the mitral valve MV or tricuspid valve TV are often repairable. In addition, regurgitation can occur due to dysfunctional chordae tendineae CT (e.g., the chordae tendineae CT can stretch or tear), which cause the anterior and posterior leaflets 20 and 22 to turn back, allowing blood to flow back into the left atrium LA. These problems caused by dysfunctional chordae tendineae CT can be repaired by repairing the structures of the chordae tendineae CT or the mitral valve MV (e.g., by fixing the leaflets 20, 22 in the affected portion of the mitral valve).

[0048] The devices and procedures disclosed herein often refer to repairing the mitral valve for illustrative purposes. However, it should be understood that the devices and concepts presented herein can be used to repair any native valve, as well as any component of a native valve. For example, such devices can be used between the leaflets 20, 22 of the mitral valve MV to prevent or block the backflow of blood from the left ventricle to the left atrium. With respect to the tricuspid valve TV (FIG. 5), such devices can be used between any two of the anterior leaflet 30, the septal leaflet 32, and the posterior leaflet 34 to prevent or block the backflow of blood from the right ventricle to the right atrium. In addition, any of the devices and concepts presented herein can be used on all three of the leaflets 30, 32, 34 together to prevent or block the backflow of blood from the right ventricle to the right atrium. That is, the valve repair device presented herein can be placed centrally between the three leaflets 30, 32, 34.

[0049] An exemplary implantable prosthetic device has a coaptation element and at least one anchor. The coaptation element is configured to be placed in the natural heart valve orifice to fill the space between the leaflets and help form a more effective seal, thereby reducing or preventing the above-mentioned backflow. The coaptation element can have a blood-impermeable structure that also allows the natural leaflets to close around the coaptation element during ventricular contraction to prevent or resist blood from flowing back from the left or right ventricle into the left or right atrium, respectively. The prosthetic device can be configured to seal two or three natural leaflets. That is, the device can be used for natural mitral (bicuspid) and tricuspid valves. The coaptation element is sometimes referred to herein as a spacer, because it can fill the space between the improperly functioning native mitral valve leaflets 20, 22 or tricuspid valves 30, 32, 34 without completely closing.

[0050] The coaptation elements (e.g., spacers, coaptation forming elements, etc.) can have a variety of shapes. In some embodiments, the coaptation elements can have an elongated cylindrical shape with a circular cross-sectional shape. In some embodiments, the coaptation elements can have an elliptical cross-sectional shape, a crescent cross-sectional shape, a rectangular cross-sectional shape, or various other non-cylindrical shapes. The coaptation elements can have an atrial portion disposed in or near the left atrium, a ventricular or inferior portion disposed in or near the left ventricle, and lateral sides extending between the native leaflets. In embodiments configured for use with a tricuspid valve, the atrial or superior portion is disposed in or near the right atrium, the ventricular or inferior portion is disposed in or near the right ventricle, and the lateral sides extend between the native tricuspid valve leaflets.

[0051] The anchors can be configured to secure the device to one or both of the native leaflets such that the coaptation element is disposed between two native leaflets. In embodiments configured for use with tricuspid valves, the anchors are configured to secure the device to one, two, or three of the tricuspid leaflets such that the coaptation element is disposed between three native leaflets. In some embodiments, the anchors can attach to the coaptation element at a location adjacent to the ventricular portion of the coaptation element. In some embodiments, the anchors can be attached to a drive element, such as a shaft or drive wire to which the coaptation element is also attached. In some embodiments, the anchors and coaptation elements can be positioned separately from one another by moving each of the anchor and coaptation element separately along the longitudinal axis of the drive element (e.g., drive shaft, drive wire, etc.) or drive wire. In some embodiments, the anchors and coaptation elements can be positioned simultaneously by moving the anchor and coaptation element together along the longitudinal axis of the drive element, e.g., shaft or drive wire. The anchors can be configured to be positioned behind the native leaflets when implanted such that the leaflets are gripped by the anchors.

[0052] The prosthetic device can be configured to be implanted through a delivery sheath. The coaptation elements and anchors can be compressible to a radially compressed state and can be self-expandable to a radially expanded state when the compressive pressure is released. The device can be configured such that the anchors are initially radially expanded from a rest compressed coaptation element to create a gap between the coaptation element and the anchor. The native leaflets are then positioned in the gap. The coaptation elements can radially expand to close the gap between the coaptation element and the anchor, capturing the leaflets between the coaptation element and the anchor. In some embodiments, the anchors and coaptation elements are optionally configured to self-expand. The implantation methods of the various embodiments may vary, and each embodiment is discussed more fully below. Further information regarding these and other delivery methods can be found in U.S. Pat. No. 8,449,599, U.S. Pat. App. Pub. No. 2014 / 0222136, U.S. Pat. App. Pub. No. 2014 / 0067052, and U.S. Pat. App. Pub. No. 2016 / 0331523, each of which is incorporated herein by reference in its entirety. These methods may be performed in live animals or in simulated experiments, such as cadavers, cadaver hearts, simulated experimental devices (eg, simulated body parts, tissues, etc.).

[0053] The disclosed prosthetic device can be configured such that anchors are coupled to the leaflets to utilize tension from the natural axons to withstand high contractile pressures that urge the device toward the left atrium. During diastole, the device can rely on compressive and retaining forces on the leaflets that are gripped by the anchors.

[0054] 8-15, a schematic representation of an implantable prosthetic device 100 (e.g., a prosthetic spacer device, etc.) is shown in various stages of deployment. Device 100 may include any other features of the implantable prosthetic devices discussed in this application, and device 100 may be positioned to engage valve tissues 20, 22 as part of any suitable valve repair system (e.g., any of the repair systems disclosed in this application).

[0055] The device 100 is deployed from a delivery sheath or means for delivery 102 and includes a coaptation or coaptation forming portion 104 and an anchor portion 106. The coaptation forming portion 104 of the device 100 is adapted to be implanted between the leaflets of a native valve (e.g., native mitral valve, tricuspid valve, etc.) and comprises a coaptation element or means for coaptation 110 slidably attached to an actuation element 112 (e.g., a drive wire, drive shaft, drive tube, etc.). The anchor portion 106 is actuable between an open position and a closed position and can take a wide variety of forms, e.g., a paddle, a gripping element, etc. Actuation of the actuation element or means for actuation 112 opens and closes the anchor portion 106 of the device 100 to grip the native leaflets upon implantation. The actuation element 112 (e.g., a wire, shaft, tube, screw, line, etc.) can take a wide variety of different forms. For example, the drive element can be threaded such that when the drive element (e.g., a wire, shaft, tube, screw, etc.) is rotated, the anchor portion 106 moves relative to the joint 104. Alternatively, the drive element can be unthreaded such that when the drive element 112 is pushed or pulled, the anchor portion 106 moves relative to the joint 104.

[0056] The anchor portion 106 and / or anchor 108 of the device 100 includes an outer paddle 120 and an inner paddle 122 connected by portions 124, 126, 128 between the cap 114 and the joining element or means for joining 110. The connections 124, 126, 128 can be bonded and / or flexible to move between all positions described below. By interconnecting the outer paddle 120, the inner paddle 122, the joining element or means for joining 110, and the cap 114 by portions 124, 126, and 128, the device can be constrained to the positions and movements shown herein.

[0057] In some implementations, the drive element or means for driving 112 (e.g., drive wire, drive shaft, etc.) extends through the delivery sheath and the joining element or means for joining 110 to a cap 114 at the distal connection of the anchor portion 106. Extending and retracting the drive element or means for driving 112 increases and decreases the spacing, respectively, between the joining element or means for joining 110 and the cap 114. A collar or other attachment element removably attaches the joining element or means for joining 110 to the delivery sheath or means for delivery 102, such that the drive element or means for driving 112 slides through the collar or other attachment element and the joining element or means for joining 110 when actuated to open and close the paddles 120, 122.

[0058] The anchor portion 106 and / or anchor 108 include an attachment portion or gripping member. The illustrated gripping member comprises a barbed fastener 130 including a base or fixed arm 132, a movable arm 134, an optional barb or other means for fastening 136, and a coupling portion 138. The fixed arm 132 is attached to the inner paddle 122, and the coupling portion 138 is disposed adjacent to the joining element or means for joining 110. The barbed fastener 130 has a flat surface and does not fit into a recess in the inner paddle 122. Rather, the flat surface of the barbed fastener 130 is disposed against a surface of the inner paddle 122. The coupling portion 138 provides a spring force between the fixed arm 132 and the movable arm 134 of the barbed fastener 130. The coupling portion 138 can be any suitable coupling, such as a flexible coupling, a spring coupling, a pivot coupling, or the like. In some embodiments, coupling 138 is a flexible piece of material formed integrally with fixed arm 132 and movable arm 134. Fixed arm 132 is attached to inner paddle 122 and remains stationary relative to inner paddle 122 when movable arm 134 is opened to open barbed catch 130 and expose barb or means for securing 136.

[0059] The barbed fastener 130 is opened by applying tension to the drive line 116 attached to the movable arm 134, which allows the movable arm 134 to rotate, bend, or pivot about a joint 138. The drive line 116 extends through the delivery sheath or means for delivery 102. The drive line 116 can take a wide variety of forms, such as a line, suture, wire, rod, catheter, etc. The barbed fastener 130 can be spring loaded so that in the closed position, the barbed fastener 130 continuously exerts a pinching force on the grasped native leaflet. This pinching force remains constant regardless of the position of the inner paddle 122. The barbs or means for fixation 136 of the barbed fastener 130 can pierce the native leaflet to further secure the native leaflet.

[0060] During implantation, the paddles 120, 122 can be opened and closed to grip the native leaflets or native mitral leaflets, for example, between the paddles 120, 122 and the coaptation elements or means for coaptation 110. The barbed fasteners 130 can be used to grip and / or further secure the native leaflets by engaging the leaflets with the barbs or means for fixation 136 and by pinching the leaflets between the movable arms 134 and the fixation arms 132. The barbs or means for fixation 136 of the barbed fasteners 130 can increase friction with the leaflets or partially or completely pierce the leaflets. The drive lines 116 can be actuated separately, such that each barbed fastener 130 can be opened and closed separately. Separate operation allows leaflets to be gripped one at a time or allows the barbs 130 of a poorly gripped leaflet to be repositioned without altering the successful grip of the other leaflet. The barbed catch 130 can be opened and closed relative to the position of the inner paddle 122 (as long as the inner paddle is in the open position), thereby allowing the leaflets to be grasped in a variety of positions as required by a particular situation.

[0061] Referring now to FIG. 8, the device 100 is shown in an elongated or fully open state for deployment from a delivery sheath. The device 100 is loaded into the delivery sheath in the fully open state because it takes up the least amount of space, allowing the smallest catheter to be used (or the largest device 100 for a given catheter size). In the elongated state, the cap 114 is spaced from the joining element or means for joining 110 such that the paddles 120, 122 are fully extended. In some embodiments, the angle formed between the inside of the outer paddle 120 and the inside of the inner paddle 122 is about 180 degrees. The barbed fastener 130 is held closed during deployment by the delivery sheath or means for delivery 102, so that the barbs or means for fastening 136 (FIG. 9) do not snag or damage the tissue of the sheath or the patient's heart.

[0062] 9, device 100 is shown in an elongated and entangled state similar to that of FIG. 8, but with barbed clasp 130 in a fully open position and in a range of about 140 degrees to about 200 degrees, to about 170 degrees, to about 190 degrees, or to about 180 degrees between fixed position 132 and movable position 134 of barbed clasp 130. It has been found that fully opening paddles 120, 122 and clasps 130 improves the ease of disentanglement or detachment from a patient's anatomical structures, such as chordae tendineae CT, upon implantation of device 100.

[0063] 10, the device 100 is shown in a shortened or fully closed state. The compact size of the device 100 in the shortened state allows for easier manipulation and placement inside the heart H. To move the device 100 from the elongated state to the shortened state, the driving element or means for driving 112 is retracted to pull the cap 114 towards the interface element or means for connecting 110. The connection 126 (e.g., bond, flexible connection, etc.) between the outer paddle 120 and the inner paddle 122 is constrained in motion such that the paddles 120, 122 move radially outward due to the compressive force on the outer paddle 120 from the cap 114 being retracted towards the interface element or means for connecting 110. During movement from the open position to the closed position, the outer paddle 120 maintains an acute angle with the driving element or means for driving 112. The outer paddle 120 can be optionally biased towards the closed position. During the same movement, the inner paddle 122 moves through a significantly larger angle as it faces away from the joining element or means for joining 110 in the open position and folds along the side of the joining element or means for joining 110 in the closed position. In some embodiments, the inner paddle 122 can be thinner and / or narrower than the outer paddle 120 and the links 126, 128 (or bonds, flexible links, etc.) connected to the inner paddle 122 can be thinner and / or more flexible. For example, this increased flexibility allows for a greater movement than the link 124 connecting the outer paddle 120 to the cap 114. In some embodiments, the outer paddle 120 is narrower than the inner paddle 122. The links 126, 128 connected to the inner paddle 122 can be more flexible to allow for a greater movement than the link 124 connecting the outer paddle 120 to the cap 114. In some embodiments, the inner paddle 122 may be the same width or substantially the same width as the outer paddle 120 .

[0064] 11-13, the device 100 is shown in a partially open, gripping-ready state. To move from the fully closed state to the partially open state, the actuation element or means for actuation 112 is extended to push the cap 114 away from the coaptation element or means for coaptation 110, thereby pulling the outer paddle 120, which in turn pulls the inner paddle 122, causing the anchors 108 of the anchoring portion 106 to partially unfold. The actuation line 116 is also pulled to open the catch 130, which can grip the leaflets. The position of the catch 130 is also dependent on the position of the paddles 122, 120. For example, referring to FIG. 10, closing the paddles 122, 120 also closes the catch 130.

[0065] 12, one of the drive lines 116 is stretched to allow one of the catches 130 to close. Now referring to FIGURE 13, the other drive line 116 is stretched to allow the other catch 130 to close. Either or both of the drive lines 116 can be repeatedly driven to repeatedly open and close the barbed catch 130.

[0066] 14, the device 100 is shown in a fully closed and deployed state. The delivery sheath or means for delivering 102 and the drive element or means for driving 112 are retracted, and the paddles 120, 122 and catches 130 remain in the fully closed position. Once deployed, the device 100 can be maintained in the fully closed position by a mechanical latch, or can be biased to remain closed by using a spring material such as steel, other metals, plastics, composites, or a shape memory alloy such as Nitinol. For example, the links 124, 126, 128, the couplings 138, and / or the inner and outer paddles 122, and / or additional biasing components (not shown) can be formed of a metal such as steel, or a shape memory alloy such as Nitinol (produced as a wire, sheet, tube, or laser sintered powder) and are biased to keep the outer paddle 120 closed around the coaptation element or means for coaptation 110 and the barbed clasp 130 clamped around the native leaflets. Similarly, the fixed arm 132 and the movable arm 134 of the barbed clasp 130 are biased to clamp the leaflets. In some embodiments, the links 124, 126, 128, the couplings 138, and / or the inner and outer paddles 122, and / or additional biasing components (not shown) can be formed of a metal or any other suitable resilient material, such as a polymeric material, to maintain the device in a closed state after implantation.

[0067] Figure 15 illustrates an exemplary embodiment in which the paddles 120, 122 are independently controllable. The device 101 illustrated in Figure 15 is similar to the device illustrated in Figure 11, except that the device 101 of Figure 15 includes two independent actuation elements or actuation wires 111, 113 coupled to two independent caps 115, 117. To move the first inner paddle 122 and the first outer paddle 120 from a fully closed state to an incompletely open state, the actuation element or means for actuating 111 is extended to push the cap 115 away from the joining element or means for joining 110, thereby pulling the outer paddle 120, which in turn pulls the inner paddle 122, incompletely spreading the first anchor 108. To move the second inner paddle 122 and the second outer paddle 120 from a fully closed state to an incompletely open state, the driving element or means for driving 113 is extended to push the cap 115 away from the joining element or means for joining 110, thereby pulling the outer paddle 120, which in turn pulls the inner paddle 122, incompletely spreading the second anchor 108. The independent paddle control shown in FIG. 15 can be implemented in any of the devices disclosed by this application. For comparison, in the example shown in FIG. 11, the pair of inner paddle 122 and outer paddle 120 move in unison, rather than separately, by a single driving element or means for driving 112.

[0068] 16-21, the implantable device 100 of FIGS. 8-14 is shown delivered and implanted into the native mitral valve MV of a heart H, although similar steps may be used with other valves. The methods and steps shown and / or described may be performed in a live animal or in a simulated experiment, such as a cadaver, a cadaver heart, a simulated experimental device (e.g., a simulated body part, heart, tissue, etc.).

[0069] Referring now to FIG. 16, the delivery sheath is inserted through the septum into the left atrium LA and the device 100 is deployed from the delivery sheath in a fully open state. The actuating element or means for actuating 112 is then retracted, thereby moving the device 100 to a fully closed state shown in FIG. 17. As seen in FIG. 18, the device 100 is placed in position within the mitral valve MV into the ventricle LV and partially opens, thereby allowing it to grasp the leaflets 20, 22. Referring now to FIG. 19, the actuating line 116 is extended to close one of the catches 130, thereby capturing the leaflet 20. FIG. 20 shows the other actuating line 116, which is then extended to close the other catch 130, thereby capturing the remaining leaflet 22. As seen in FIG. 21, the delivery sheath or means for delivery 102 and the actuating element or means for actuating 112 and the actuating line 116 are then retracted, causing the device 100 to be fully closed and deployed within the native mitral valve MV.

[0070] 22-27, an exemplary embodiment of an implantable prosthetic spacer device 200 is shown. Implantable device 200 is one of many different forms that device 100, shown generally in Figures 8-14, can take. Device 200 can include any other feature of the implantable prosthetic devices discussed in this application, and device 200 can be positioned to engage valve tissue 20, 22 as part of any suitable valve repair system (e.g., any of the valve repair systems disclosed in this application).

[0071] The implantable prosthetic spacer device 200 comprises a coaptation portion 204, a proximal or attachment portion 205, an anchor portion 206, and a distal portion 207. The coaptation portion 204 of the device includes a coaptation element 210 for implantation between the leaflets 20, 22 of the native mitral valve MV. The anchor portion 206 includes a plurality of anchors 208, each of which includes an outer paddle 220, an inner paddle 222, a paddle extension or frame 224, and a fastener 230. The attachment portion 205 includes a first, or proximal collar 211 for engaging a capture mechanism 213 (FIGS. 43-49) of a delivery sheath or system 202 (FIGS. 38-42 and 49).

[0072] The joint elements 210 and paddles 220, 222 may be formed from a flexible material, which may be a metal fabric, such as a woven, knitted, or any other suitable formed mesh, or a laser cut or otherwise cut flexible material. The material may also be a cloth, a shape memory alloy wire (such as Nitinol) to provide a shape setting function, or any other flexible material suitable for implantation in the human body.

[0073] An element 212 (e.g., a drive wire, shaft, etc.) extends from the delivery sheath or system 202 to engage and enable actuation of the implantable prosthetic device 200. The drive element 212 extends through the capture mechanism 213, the proximal collar 211, and the interface element 210 to engage a cap 214 on the distal portion 207. The drive element 212 can be configured to releasably engage the cap 214 with a threaded connection, or similar means, such that the drive element 212 can be disengaged and removed from the device 200 after implantation.

[0074] The coaptation element 210 extends from the proximal collar 211 to the inner paddle 222. The coaptation element 210 has a generally elongated round shape. In particular, the coaptation element 210 has an oval shape or cross-section when viewed from above (FIG. 51), a tapered shape or cross-section when viewed from the front (e.g., FIG. 23), and a round shape or cross-section when viewed from the side (e.g., FIG. 24). A mixture of these three geometries can result in the illustrated three-dimensional shape of the coaptation element 210 that achieves the benefits described herein. It can be seen that the round shape of the coaptation element 210 also substantially follows or approximates the shape of the paddle frame 570 when viewed from above.

[0075] The size of the coaptation element 210 may be selected to minimize the number of implants required per patient (preferably one) while simultaneously maintaining a low in-out gradient. In one exemplary embodiment, the anterior-posterior distance of the top of the spacer is about 5 mm, and the central lateral distance of the spacer is about 10 mm at its widest point. In one exemplary embodiment, the overall geometry of the device 200 may be based on these two dimensions and the overall shape strategy described above. It should be readily apparent that using different anterior-posterior and central lateral distances as a starting point for the device will result in devices of different dimensions. Additionally, using other dimensions and the shape strategies described above will also result in devices of different dimensions.

[0076] Outer paddle 220 is seamably attached to cap 214 of distal portion 207 by connector 221 and to inner paddle 222 by connector 223. Inner paddle 222 is seamably attached to the joint element by connector 225. In this manner, anchor 208 is configured similar to a leg, in that inner paddle 222 resembles the upper part of a leg, outer paddle 220 resembles the lower part of a leg, and connector 223 resembles the knee of a leg.

[0077] The inner paddle 222 is stiff, relatively stiff, rigid, has a rigid portion, and / or is rigidified by a fastener 232 of a rigidifying member or fastener 230. The stiffening of the inner paddle allows the device to move to a variety of different positions as shown and described herein. The inner paddle 222, outer paddle 220, and interface elements can all be interconnected as described herein such that the device 200 is constrained to the movements and positions shown and described herein.

[0078] The paddle frame 224 is attached to the cap 214 at the distal portion 207 and extends to a junction 223 between the inner paddle 222 and the outer paddle 220. In some embodiments, the paddle frame 224 is formed from a material that is stiffer and more rigid than the material forming the paddles 222, 220, such that the paddle frame 224 provides support for the paddles 222, 220.

[0079] The paddle frame 224, as seen in FIG. 51, provides additional pinching force between the inner paddle 222 and the coaptation element 210, helping to wrap the leaflets around the sides of the coaptation element 210 for a better seal between the coaptation element 210 and the leaflets. That is, the paddle frame 224 can be configured with a rounded three-dimensional shape and extends from the cap 214 to the linkage 223 of the anchor 208. The linkages between each paddle frame 224, the outer paddle 220 and the inner paddle 222, the cap 214, and the coaptation element 210 can constrain each of these portions to the movements and positions described herein. In particular, the linkage 223 is constrained by its connection between the outer paddle 220 and the inner paddle 222, and by its connection to the paddle frame 224. Similarly, the paddle frame 224 is constrained by its attachment to the linkage 223 (and thus the inner paddle 222 and the outer paddle 220) and the cap 214.

[0080] Configuring the paddle frame 224 in this manner provides an increased surface area compared to the outer paddle 220 alone. This increased surface area facilitates gripping and securing the native leaflets. The increased surface area also allows the clamping force of the paddles 220 and paddle frame 224 against the native leaflets to be distributed over a larger surface area of ​​the native leaflets to further protect the native leaflet tissue. Referring again to FIG. 51, the increased surface area of ​​the paddle frame 224 may also allow the native leaflets 20, 22 to be secured to the implantable prosthetic spacer device 200 such that the native leaflets 20, 22 coapt generally around the coaptation member 210. This may, for example, improve sealing of the native leaflets 20, 22 and thus prevent or further reduce valvular regurgitation.

[0081] The barbed catch 230 includes a base or fixed arm 232, a movable arm 234, a barb 236, and a coupling portion 238. The fixed arm 232 is attached to the inner paddle 222 and the coupling portion 238 is disposed adjacent to the interface element 210. The coupling portion 238 is spring loaded such that the fixed arm 232 and the movable arm 234 are biased toward one another when the barbed catch 230 is in a closed state.

[0082] The fixed arm 232 is attached to the inner paddle 222 with sutures (not shown) through holes or slots 231. The fixed arm 232 may be attached to the inner paddle 222 by any suitable means, such as screws or other fasteners, locking sleeves, mechanical hooks or clasps, welding, adhesives, etc. The fixed arm 232 remains substantially fixed relative to the inner paddle 222 when the moveable arm 234 is opened to open the barbed clasp 230 and expose the barb 236. The barbed clasp 230 is opened by applying tension to the drive line 216 (FIGS. 43-48) attached to a hole 235 in the moveable arm 234, which causes the moveable arm 234 to move, pivot, bend, etc. on the joint 238.

[0083] 29, a close-up view of one of the leaflets 20, 22 being gripped by a barbed fastener, such as fastener 230, is shown. The leaflets 20, 22 are gripped between a movable arm 234 and a fixed arm 232 of the fastener 230. The tissue of the leaflets 20, 22 is not perforated by the barbs 236, although in some embodiments the barbs 236 may partially or completely perforate the leaflets 20, 22. The angle and height of the barbs 236 relative to the movable arms 234 aid in securing the leaflets 20, 22 within the fastener 230. In particular, the force of pulling the implant away from the native leaflets 20, 22 encourages the barbs 236 to further engage the tissue, thereby ensuring a better retention. Retention of the leaflets 20, 22 on the barbs 230 is further improved by the positioning of the fixed arms 232 near the barbs 236 when the fastener 230 is closed. In this arrangement, the tissue is forced into an S-shaped, serpentine path by the fixed and movable arms 232, 234 and the barbs 236. Thus, the force pulling the leaflets 20, 22 away from the catch 230 will encourage the tissue to further engage the barbs 236 before the leaflets 20, 22 can escape. For example, leaflet tension during diastole may encourage the barbs 236 to be pulled towards the end portions of the leaflets 20, 22. Thus, in an S-shaped path, leaflet tension during diastole can be utilized to force the leaflets 20, 22 into closer engagement with the barbs 236.

[0084] 25, the prosthetic spacer device 200 may also include a cover 240. In some embodiments, the cover 240 may be disposed on the joint members 210, the outer and inner paddles 220, 222, and / or the paddle frame 224. The cover 240 may be configured to prevent or reduce blood flow through the prosthetic spacer device 200 and / or to promote natural tissue ingrowth. In some embodiments, the cover 240 may be a cloth or fabric such as PET, velour, or other suitable fabric. In some embodiments, instead of or in addition to a fabric, the cover 240 may include a coating (e.g., polymer, silicone, etc.) applied to the implantable prosthetic spacer device 200.

[0085] During implantation, the paddles 220, 222 of the anchor 208 are opened and closed to grip the native leaflets 20, 22 between the paddles 220, 222 and the coaptation element 210. The anchor 208 is moved between a closed position (FIGS. 22-25) and various open positions (FIGS. 26-37) by extending and retracting the actuation element, wire, or shaft 212. Extending and retracting the actuation element 212 increases and decreases the spacing between the coaptation element 210 and the cap 214, respectively. The proximal collar 211 and coaptation element 210 slide along the actuation element 212 during actuation, thereby changing the spacing between the coaptation element 210 and the cap 214 to move the paddles 220, 220 between different positions to grip the native leaflets 20, 22 during implantation.

[0086] When device 200 is opened and closed, the pair of inner and outer paddles 222, 220 move in unison, rather than independently, via a single actuation element 212. Also, the position of catch 230 depends on the positions of paddles 222, 220. For example, catch 230 is positioned such that catch 230 closes at the same time that anchor 208 closes. In one exemplary embodiment, device 200 can be fabricated such that paddles 220, 222 are independently controllable in the same manner as device 100 illustrated in FIG. 15.

[0087] The barbed fasteners 230 further secure the native leaflets 20, 22 by engaging the leaflets 20, 22 with the barbs 236 and by pinching the leaflets 20, 22 between the movable arm 234 and the fixed arm 232. The barbs 236 of the barbed fasteners 230 may increase friction with the leaflets 20, 22 or partially or completely pierce the leaflets 20, 22. The drive lines 216 (FIGS. 43-48) can be separately actuated, such that each barbed fastener 230 can be opened and closed separately. Separate actuation allows the leaflets 20, 22 to be grasped one at a time, or allows the fastener 230 on a poorly grasped leaflet 20, 22 to be repositioned without altering the successful grip of the other leaflet 20, 22. The barbed catch 230 can be fully opened and closed when the inner paddle 222 is not closed, thereby allowing the leaflets 20, 22 to be grasped in a variety of positions as required by a particular situation.

[0088] 22-25, the device 200 is shown in a closed configuration. When closed, the inner paddle 222 is positioned between the outer paddle 220 and the coaptation element 210. The catch 230 is disposed between the inner paddle 222 and the coaptation element 210. Upon successful capture of the native leaflets 20, 22, the leaflets 20, 22 are secured within the device 200 by the catch 230 and the device 200 is moved to and held in a closed position such that the paddles 220, 222 press the leaflets 20, 22 against the coaptation element 210. The outer paddle 220 has a wide curved shape that fits around the curved shape of the coaptation element 210 to more securely grip the leaflets 20, 22 when the device 200 is closed, as can be seen in FIG. 51. The curved shape and rounded edges of the outer paddle 220 also prevent tearing of the leaflet tissue.

[0089] 30-37, the implantable prosthetic device 200 described above is shown in various positions and configurations ranging from a partially open to a fully open position. The paddles 220, 222 of the device 200 transition between each of the positions shown in FIGS. 30-37, from the closed position shown in FIGS. 22-25 to the fully open position, after the drive element 212 (e.g., wire, shaft, etc.) is extended from a fully retracted position to a fully extended position of the drive element.

[0090] 30-31, the device 200 is shown in a partially open state. The device 200 is moved to the partially open position by extending the drive element 212. Extending the drive element 212 pulls down the bottom of the outer paddle 220 and the paddle frame 224. The outer paddle 220 and the paddle frame 224 pull down the inner paddle 222, which is coupled to the outer paddle 220 and the paddle frame 224. The proximal collar 212 and the coaptation element 210 are held in place by the capture mechanism 213, causing the inner paddle 222 to move in an open direction, pivot, bend, etc. The inner paddle 222, the outer paddle 220, and the paddle frame all bend to the state shown in FIGS. 30-31. Opening the paddles 222, 220 and frame 224 creates a gap between the coaptation element 210 and the inner paddle 222 to receive and grip the native leaflets 20, 22. This movement also exposes a barbed catch 230 that can move between a closed position (FIG. 30) and an open position (FIG. 31) to form a second gap for gripping the native leaflets 20, 22. The expansion of the gap between the fixed arm 232 and the movable arm 234 of the catch 230 is limited to the extent that the inner paddle 222 expands away from the coaptation element 210.

[0091] 32-33, the device 200 is shown in a laterally extended or open state. The device 200 is moved to the laterally extended or open state by continuing to extend the actuation element 212 described above, thereby increasing the distance between the interface element 210 and the cap 214 of the distal portion 207. Continued extension of the actuation element 212 pulls the outer paddle 220 and the paddle frame 224 down, thereby causing the inner paddle 222 to open further away from the interface element 210. In the laterally extended or open state, the inner paddle 222 extends horizontally to a greater extent than in other states of the device 200, forming an angle of approximately 90 degrees with respect to the interface element 210. Similarly, the paddle frame 224 is in its maximum extended state when the device 200 is in the laterally extended or open state. The increased gap between the interface element 210 and the inner paddle 222 formed in the laterally stretched, i.e., open, state allows the catch 530 to open further before the catch 230 engages the interface element 210 (FIG. 33), thereby increasing the size of the gap between the fixed arm 232 and the movable arm 234.

[0092] 34-35, the device 200 is shown in a three-quarters extended state. The device 200 is moved to the three-quarters extended state by continuing to extend the drive element 212 as described above, thereby increasing the distance between the interface element 210 and the cap 214 of the distal portion 207. Continued extension of the drive element 212 pulls the outer paddle 220 and the paddle frame 224 down, which causes the inner paddle 222 to open further away from the interface element 210. In the three-quarters extended state, the inner paddle 222 opens beyond 90 degrees to approximately 135 degrees relative to the interface element 210. The paddle frame 224 spreads less than in the laterally extended or open state and begins to move inwardly toward the drive element 212 as the drive element 212 extends further. The outer paddle 220 also bends back toward the drive element 212. Similar to the laterally stretched or open state, the increased gap between the interface element 210 and the inner paddle 222 formed in the laterally stretched or open state allows the fastener 230 to open even further (FIG. 35), thereby increasing the size of the gap between the fixed arm 232 and the movable arm 234.

[0093] 36-37, the device 200 is shown in a fully extended state. The device 200 is moved to a fully extended position by continuing to extend the drive element 212 described above, which increases the distance between the joint element 210 and the cap 214 of the distal portion 207 to the maximum distance allowable by the device 200. Continued extension of the drive element 212 pulls the outer paddle 220 and the paddle frame 224 down, which causes the inner paddle 222 to spread further away from the joint element 210. The outer paddle 220 and the paddle frame 224 move to a position closer to the drive element. In the fully extended state, the inner paddle 222 opens to about 180 degrees relative to the joint element 210. The inner paddle 222 and the outer paddle 220 are stretched straight out in the fully extended state, forming an angle of about 180 degrees between the paddles 222, 220. The fully extended state of the device 200 provides the maximum size of the gap between the coaptation element 210 and the inner paddle 222, and in some embodiments, the clasp 230 is also allowed to fully open to approximately 180 degrees ( FIG. 37 ) between the fixed arm 232 and the movable arm 234 of the clasp 230. The state of the device 200 is in its longest and thinnest configuration. That is, the fully extended state of the device 200 may be the desired state for allowing the device 200 to escape from an attempted implantation or for loading the device into a delivery catheter.

[0094] Configuring the prosthetic spacer device 200 such that the anchors 208 can extend to a straight or substantially straight configuration (e.g., about 120-180 degrees relative to the coaptation elements 210) can provide several advantages. For example, this configuration can reduce the radial pleat profile of the prosthetic spacer device 200. It can also facilitate grasping the native leaflets 20, 22 by providing a larger opening between the coaptation elements 210 and the inner paddle 222 for grasping the native leaflets 20, 22. Additionally, the relatively thin, straight configuration can prevent or reduce the likelihood that the prosthetic spacer device 200 will become entangled with native anatomical structures (e.g., chordae tendineae CT shown in FIGS. 3 and 4) when the prosthetic spacer device 200 is placed and / or retrieved from the delivery apparatus 202.

[0095] 38-49, implantable device 200 is shown delivered and implanted into the native mitral valve MV of heart H, although similar steps may be used with other valves. The methods and steps shown and / or described may be performed in a live animal or in a simulated experiment, such as a cadaver, a cadaver heart, a simulated experimental device (e.g., a simulated body part, heart, tissue, etc.).

[0096] As mentioned above, the device 200 shown in FIGS. 38-49 includes an optional cover 240 (e.g., FIG. 25) over the joint element 210, the catch 230, the inner paddle 222 and / or the outer paddle 220. The device 200 is deployed from the delivery sheath 202 and is held by a capture mechanism 213 (see FIGS. 43-49) and driven by extending or retracting a drive element, wire or shaft 212. Fingers of the capture mechanism 213 removably attach the collar 211 to the delivery sheath 202. In some embodiments, the capture mechanism 213 is held closed around the collar 211 by the drive element 211, such that removal of the drive element 211 after successful implantation of the device 200 allows the fingers of the capture mechanism 213 to open to release the collar 212 and decouple the capture mechanism 213 from the device 200.

[0097] 38, for the reasons described above with respect to device 100, a delivery sheath 202 is inserted transseptally into the left atrium LA and device 200 is deployed from delivery sheath 202 in a fully open position. Drive element 212 is then retracted to move device 200 through a partially closed position (FIG. 39) to a fully closed position as shown in FIGS. 40-41, and then steered towards the mitral valve MV as shown in FIG. 41. Referring now to FIG. 42, once device 200 is aligned with the mitral valve MV, drive element 212 is extended to open paddles 220, 222 to a partially open position and drive line 216 (FIGS. 43-48) is retracted to open barbed catch 230 in preparation for leaflet grasping. The partially open device 200 is then inserted into the mitral valve MV until the leaflets 20, 22 are properly positioned between the inner paddle 222 and the coaptation element 210 and inside the open barbed catches 230, as shown in Figures 43-44. Figure 45 shows the device 200 with both catches 230 closed, but the barbs 236 of one catch 230 have missed one leaflet 22. As can be seen in Figures 45-47, the out-of-place catch 230 is again opened and closed to properly grasp the missed leaflet 22. Once both leaflets 20, 22 are properly grasped, the actuation element 212 is retracted to move the device 200 to the fully closed position shown in Figure 48. 49, with the device 200 fully closed and implanted within the native mitral valve MV, the actuation element 212 can be disengaged and withdrawn from the cap 214 to release the capture mechanism 213 from the proximal collar 211, thereby retracting the capture mechanism 213 into the delivery sheath 202. Once deployed, the device 200 can be maintained in the fully closed position using mechanical means such as a latch, or biased to remain closed through the use of a spring material such as steel and / or a shape memory alloy such as Nitinol.For example, the paddles 220, 222 can be formed of steel or Nitinol shape memory alloy (produced as a wire, sheet, tube, or laser sintered powder), and the paddles are also biased such that the outer paddle 220 is held closed around the inner paddle 222, the coaptation element 210, and the barbed clasp 230 is held clamped around the native leaflets 20, 22.

[0098] 50-54, after the device 200 is implanted within the native mitral valve MV, the coaptation element 210 functions as a gap filler for a valve regurgitation opening, such as the gap 26 of the mitral valve MV shown in FIG. 6. With the device 200 deployed between the two opposing leaflets 20, 22, the leaflets 20, 22 no longer coapt to one another in the region of the coaptation element 210, but instead coapt to the coaptation element 210. This reduces the distance that the leaflets 20, 22 must be approximated to close the mitral valve MV during systole, thereby facilitating the treatment of functional valve disease that may be the cause of mitral regurgitation. Several other benefits may also result as a result of the reduced leaflet proximity. For example, the reduced required proximity of the leaflets 20, 22 reduces or minimizes the stresses experienced by the native valve. The closer the leaflets 20, 22 are brought together, the less approximation force may be required, resulting in less tension on the leaflets 20, 22 and less reduction in the diameter of the annulus. Less annular shrinkage--or no shrinkage at all--may result in less reduction in valve orifice area compared to a device without a spacer. In this manner, the coaptation element 210 may reduce transvalvular gradients.

[0099] In order to adequately fill the gap 26 between the leaflets 20, 22, the device 200 and its components can have a wide variety of different shapes and sizes. For example, the outer paddle 220 and paddle frame 224 can be configured to match the shape or geometry of the coaptation element 210 as shown in FIGS. 50-54. As a result, the outer paddle 220 and paddle frame 224 can fit over both the coaptation element 210 and the native leaflets 20, 22. That is, when the leaflets 20, 22 are coapted to the coaptation element 210, the leaflets 20, 22 completely surround or "embrace" the coaptation element 210 in its entirety, thus preventing or inhibiting small amounts of leakage on the lateral and medial surfaces 201, 203 of the coaptation element 210. The interaction of the leaflets 20, 22 with the device 200 is made clear in Figure 51, which shows a schematic atrial or surgical view showing a paddle frame 224 (which would not actually be visible from a true atrial view, e.g., Figure 52) that conforms to the geometry of the coaptation element 210. The opposing leaflets 20, 22 (whose ends also would not be visible in a true atrial view, e.g., Figure 52) brought together by the paddle frame 224 completely surround or "embrace" the coaptation element 210.

[0100] This coaptation of the leaflets 20, 22 to the lateral and medial surfaces 201, 203 of the coaptation element 210 (shown from the atrial side in FIG. 52 and the ventricular side in FIG. 53) may appear to contradict what was stated above about the distance the leaflets must approximate being minimized by the presence of the coaptation element 210. However, the distance the leaflets 20, 22 must approximate is still minimized when the coaptation element 210 is positioned exactly in the regurgitation gap 26, which is smaller than the width (medial-lateral) of the coaptation element 210.

[0101] 50 illustrates the geometry of the coaptation element 210 and paddle frame 224 from an LVOT perspective. As can be seen in this figure, the coaptation element 210 has a tapered shape that is smaller in size in the area near where the inner surfaces of the leaflets 20, 22 must coapt and increases in size as the coaptation element 210 extends toward the atrium. Thus, the illustrated native valve geometry is accommodated by the tapered coaptation element geometry. With further reference to FIG. 50, the tapered coaptation element geometry, along with the illustrated expanding (toward the annulus) paddle frame 224 shape, may help achieve coaptation to the lower ends of the leaflets, reduce stress, and minimize transvalvular gradients.

[0102] 54, the shapes of the coaptation element 210 and the paddle frame 224 can be defined based on the native valve and the commissure view of the device 200. Two elements of these shapes are leaflet coaptation to the coaptation element 210 and reduction of stress on the leaflets due to coaptation. With reference to FIG. 54 and FIG. 24, the coaptation element 210 can have a round or rounded shape and the paddle frame 224 can have a full radius that spans almost the entirety of the paddle frame 224 to coapt both the leaflets 20, 22 to the coaptation element 210 and reduce stress applied to the leaflets 20, 22 by the coaptation element 210 and / or the paddle 224. The round shape of the coaptation element 210 and / or the illustrated fully rounded shape of the paddle frame distributes stress on the leaflets 20, 22 over a wide curved engagement area 205'. For example, in FIG. 54, as the leaflets 20 attempt to open during the diastolic cycle, the force applied by the paddle frame to the leaflets 20, 22 is spread along the entire rounded length of the paddle frame 224.

[0103] 55, an exemplary embodiment of an implantable prosthetic spacer device 300 is shown. The implantable device 300 is one of many different forms that the device 100, shown generally in Figures 8-14, can take. The device 300 can include any other features of the implantable prosthetic devices discussed in this application, and the device 300 can be positioned to engage valve tissue 20, 22 as part of any suitable valve repair system (e.g., any of the valve repair systems disclosed in this application).

[0104] The implantable prosthetic spacer device 300 comprises a joint portion 304, a proximal or attachment portion 305, an anchor portion 306, and a distal portion 307. The joint portion 304 of the device includes a joint element 310 for implantation between the leaflets 20, 22 of the native valve. The anchor portion 306 includes a plurality of anchors 308, each of which includes an outer paddle 320, an inner paddle 322, a paddle extension or frame 324, and a fastener 330. The attachment portion 305 includes a first or proximal collar 311 for engaging a capture mechanism (e.g., a capture mechanism such as capture mechanism 213 shown in FIGS. 43-49) of a delivery sheath or system (e.g., a delivery sheath or system such as delivery sheath or system 202 shown in FIGS. 38-42 and 49).

[0105] The anchor 308 is attached to the joining member 310 by a link 325 and to the cap 314 by a link 321. The anchor 308 may include a first portion or outer paddle 320 and a second portion or inner paddle 322 separated by a link 323. The link 323 may be attached to a paddle frame 324 that is hingedly attached to the cap 314. In this manner, the anchor 308 is configured similar to a leg in that the inner paddle 322 resembles the top of a leg, the outer paddle 320 resembles the bottom of a leg, and the link 323 resembles the knee of the leg.

[0106] The junction members 310 and anchors 308 can be coupled together in a wide variety of ways. For example, as shown in the illustrated embodiment, the junction members 310 and anchors 308 can be coupled together by integrally forming the junction members 310 and anchors 308 as a single, unitary component. This can be accomplished, for example, by forming the junction members 310 and anchors 308 from a continuous strip 301 of braided or woven material, such as braided or woven Nitinol wire. In some embodiments, such as in the illustrated example, the junction members 310, outer paddle portion 320, inner paddle portion 322, and linking portions 321, 323, 325 are formed from a continuous strip of material.

[0107] Like the anchor 208 of the implantable prosthetic device 200 described above, the anchor 308 can be configured to transition to various configurations by axially moving the cap 314 relative to the proximal collar 311, and thus the anchor 308 relative to the joint element 310, along a longitudinal axis extending between the cap 314 and the proximal collar 311. For example, the anchor 308 can be positioned as a fully extended or straightened configuration (e.g., similar to the configuration of the device 200 shown in FIG. 36) by moving the cap 314 away from the joint element 310. In the straightened configuration, the paddle portions 320, 322 are aligned or straightened along the longitudinal axis of the device, and the bond portion 323 of the anchor 308 is adjacent to the longitudinal axis of the joint element 310 (e.g., similar to the configuration of the device 200 shown in FIG. 36). From the straightened configuration, the anchor 308 can transition to a fully collapsed configuration (e.g., FIG. 55) by moving toward the joint element 310. Initially, as cap 314 moves toward junction member 310, anchor 308 bends at links 321, 323, 325, with link 323 moving radially outward relative to the longitudinal axis of device 300 and axially toward junction member 310 (e.g., similar to the configuration of device 200 shown in FIG. 34). As cap 314 continues to move toward junction member 310, link 323 moves radially inward relative to the longitudinal axis of device 300 and axially toward the proximal end of junction member 310 (e.g., similar to the configuration of device 200 shown in FIG. 30).

[0108] The barbed catch 330 (shown in detail in FIG. 56) includes a base or fixed arm 332, a movable arm 334, a barb 336, and a coupling portion 338. The fixed arm 332 is attached to the inner paddle 322 and the coupling portion 338 is disposed adjacent the interface element 310. The coupling portion 338 is spring loaded such that the fixed arm 332 and the movable arm 334 are biased toward each other when the barbed catch 330 is in a closed state.

[0109] The fixed arm 332 is attached to the inner paddle 322 with sutures (not shown) through holes or slots 331. The fixed arm 332 may be attached to the inner paddle 322 by any suitable means, such as screws or other fasteners, locking sleeves, mechanical hooks or clasps, welding, adhesives, etc. The fixed arm 332 remains substantially fixed relative to the inner paddle 322 when the movable arm 334 is opened and the barbed clasp 330 opens, exposing the barb 336. The barbed clasp 330 is opened by applying tension to a drive line (e.g., drive line 216 shown in FIGS. 43-48) attached to a hole 335 in the movable arm 334, which causes the movable arm 334 to move, pivot, bend, etc. on the coupling 338.

[0110] In summary, the implantable prosthetic device 300 is similar in construction and operation to the implantable prosthetic device 200 described above, except that the joint elements 310, the outer paddle 320, the inner paddle 322, and the links 321, 323, 325 are formed from a single strip of material 301. The strip of material 301 is attached to the proximal collar 311, the cap 314, and the paddle frame 324 by weaving or inserting through openings in the proximal collar 311, the cap 314, and the paddle frame 324 that are configured to receive the continuous strip of material 301. The continuous strip 301 can be a single layer of material or can include two or more layers. In some embodiments, one portion of the device 300 has a single layer of the strip of material 301 and another portion is formed from multiple overlapping or overlying layers of the strip of material 301. For example, Figure 55 shows a joining member 310 and inner paddle 322 formed from multiple overlapping layers of strip of material 301. The single continuous strip of material 301 may begin and end at various locations on the device 300. The ends of the strip of material 301 may be at the same or different locations on the device 300. For example, in the illustrated embodiment of Figure 55, the strip of material 301 begins and ends at the location of the inner paddle 322.

[0111] As with implantable prosthetic device 200 described above, the size of coaptation element 310 may be selected to minimize the number of implants required per patient (preferably one) while simultaneously maintaining a low in-out gradient. Notably, by forming multiple components of device 300 from strips of material 301, device 300 may be made smaller than device 200. For example, in one exemplary embodiment, the anterior-posterior distance of the apex of coaptation element 310 is less than 2 mm, and the median lateral distance of device 300 at its widest point (width of paddle frame 324 wider than coaptation element 310) is approximately 5 mm.

[0112] 57-64, an implantable device 400 is shown. The implantable device 400 has a paddle 402 that opens and closes to grip the leaflets 20, 22 against a barbed catch or gripping device 404. The paddle 402 moves to create an opening 406 between the paddle 402 and the gripping device 404 through which the leaflets 20, 22 can be gripped. The device 400 can be configured to close the gap 26 (FIG. 6) of the native heart valves MV, TV. In addition, the implantable device 400 can include any other features of the devices discussed in this application, and the device 400 can be positioned to engage the leaflets 20, 22 as part of any suitable valve repair system (e.g., any of the valve repair systems disclosed in this application). Device 400 may include any other features of the implantable prosthetic devices discussed in this application, and device 400 may be positioned to engage valve tissue 20, 22 as part of any suitable valve repair system (e.g., any of the valve repair systems disclosed in this application).

[0113] 57, the paddle 402 of the device 400 moves, bends, rotates or pivots outwardly in a rotational or pivotal direction 410 to create an opening 406 of a first width 420 between the paddle 402 and the gripping member 404. The first width 420 can be between about 5 mm and about 15 mm, such as about 10 mm, for example, between 7.5 mm and about 12.5 mm. In some embodiments, the first width 420 can be less than 5 mm or greater than 15 mm.

[0114] 58, the paddle 402 of the device 400, instead of being rotated as shown in FIG. 57, is moved outward in a translation direction 412 such that the opening 406 reaches a first width 420. Similar to the rotated paddle 402 described above, the first width 420 can be between about 5 mm and about 15 mm, such as about 10 mm, for example, between 7.5 mm and about 12.5 mm. In some embodiments, the first width 420 can be less than 5 mm or more than 15 mm. In this example, the translated paddle can then be moved outward, bent, rotated, or pivoted to be wider than width 420.

[0115] 59-61, in one exemplary embodiment, the device 400 can be configured such that the paddle 402 is moved, bent, rotated, or pivoted outward in a rotational or pivotal direction 410 and then moved outward in a translational direction 412 to form an opening 406 having a second width 422 between the paddle 402 and the gripping member 404. The second width 422 can be, for example, between about 10 mm and about 25 mm, such as between about 10 mm and about 20 mm, such as between about 12.5 mm and about 17.5 mm, such as about 15 mm. In some embodiments, the second width 422 can be less than 10 mm or greater than 25 mm. In some embodiments, the ratio of the second width 422 to the first width 420 can be about 5:1 or less, such as about 4:1 or less, such as about 3:1 or less, such as about 2:1 or less, such as about 1.5:1 or less, such as about 1.25:1 or less, such as about 1:1. Optionally, the device 400 can be configured such that the paddles are moved outward in a translational direction 412 and then rotated or pivoted outward in a rotational or pivotal direction 410 to form an opening 406 having a second width 420 between the paddles 402 and the gripping member 404. Additionally, the device 400 can be configured such that the paddles 402 move, bend, rotate, or pivot outward in the rotational or pivotal direction 410 while simultaneously moving outward in the translational direction 412 to create the second width 422 between the paddles 402 and the gripping member 404.

[0116] 59-61 show the implantable device 400 with the paddles 402 moved outward, bent, rotated or pivoted in a rotational or pivotal direction 410, followed by moving outward in a translational direction 412 to create a wider opening 406. FIG. 59 shows the implantable device 400 in a closed state with the paddles 402 engaged with the gripping members 404. Referring to FIG. 60, the paddles 402 moved outward, bent, rotated or pivoted in a rotational or pivotal direction 410 to create an opening 406 of a first width 420 for receiving valve tissue. Referring to FIG. 61, after the paddles 402 moved outward, bent, rotated or pivoted in a rotational or pivotal direction 410, the paddles 402 moved outward in a translational direction 412 such that the opening 406 is of a second width 422. After the valve tissue is received in the openings 406 between the paddles 402 and the gripping members 404, the valve repair device is returned to the closed state (shown in FIG. 59 ) to secure the valve repair device 400 to the valve tissue. The implantable device 400 can include any other features of the implantable devices discussed in this application, and the implantable device 400 can be positioned to engage the valve tissue 20, 22 as part of any suitable valve repair system (e.g., any of the valve repair systems disclosed in this application).

[0117] 62-64 show the implantable device 400 with the paddles 402 moving outward in a translational direction 412 and then moving outward, bending, rotating or pivoting in a rotational or pivoting direction 410 to create a wider opening 406. FIG. 62 shows the implantable device 400 in a closed state such that the paddles 402 are engaged with the gripping members 404. With reference to FIG. 63, the paddles 402 move outward in a translational direction 412 to create an opening 406 of a first width 420 for receiving valve tissue. With reference to FIG. 64, after the paddles 402 move outward in the translational direction 412, the paddles 402 move outward, bending, rotating or pivoting in a rotational or pivoting direction 410 such that the opening 406 is of a second width 422. After the valve tissue is received in the openings 406 between the paddles 402 and the gripping members 404, the implantable device 400 is returned to the closed state (shown in FIG. 62) to secure the implantable device 400 to the valve tissue. The implantable device 400 may include any other features of the implantable devices discussed in this application, and the implantable device 400 may be positioned to engage the valve tissue 20, 22 as part of any suitable valve repair system (e.g., any of the valve repair systems disclosed in this application).

[0118] 59-61 illustrate a device 400 in which the paddles 402 are rotated or pivoted and then spread apart (e.g., translated away from one another), and FIGS. 62-64 illustrate a device 400 in which the paddles 402 are spread apart and then rotated or pivoted. In some embodiments, the device 400 can include paddles 402 that can spread and rotate or pivot simultaneously. Additionally, in some embodiments, the paddles 402 can spread, rotate or pivot independently of one another. That is, in the embodiments of the valve repair device 400 illustrated in FIGS. 59-61 and 62-64, as well as in embodiments in which each paddle 402 completes spreading and rotating or pivoting simultaneously, the paddles 402 can be controlled independently of one another.

[0119] 65-183, an exemplary embodiment of an implantable prosthetic spacer device 500 is shown. The implantable prosthetic spacer device 500 is one of many different forms that the device 100, shown generally in FIGS. 8-15, can take. The device 500 can include any other features of an implantable prosthetic device described in this application or any of the applications incorporated herein by reference, and the device 500 can be positioned to engage valve tissue 20, 22 as part of any suitable valve repair system (e.g., any valve repair system disclosed in this application or any of the applications incorporated herein by reference). The various components of the implantable prosthetic spacer device 500 can be made in any suitable size to accommodate different sized patient anatomies.

[0120] The implantable prosthetic spacer device 500 extends from a proximal portion 501 to a distal portion 502 and includes a commissure portion 504 and an anchor portion 506. The commissure portion 504 of the device 500 includes a central or main shaft 510 and a commissure element 520 for implantation between the leaflets 20, 22 of the native valve. The anchor portion 506 includes a plurality of anchors 508, each anchor 508 comprising a paddle 530, a paddle extension member or paddle frame 570, and a fastener 580. The anchor portion 506 may also include an optional spreading member 550 that may be actuated to adjust the position of a portion of the paddle 530 and the fastener 580.

[0121] The implantable prosthetic spacer device 500 is implanted into the native valve in a manner similar to the implantable prosthetic spacer device 200 described above. That is, during implantation, the paddles 530 of the anchor 508 are opened and closed to grip the native valve leaflets 20, 22 between the paddles 530 and the coaptation elements 520. The anchor 508 is moved between a closed position (FIGS. 65-70) and various open positions (FIGS. 72-80) by extending and retracting a drive element 591 (e.g., a wire, shaft, rod, line, etc.) extending from a delivery system 590 through a main shaft 510 and to a spreader member 550 which is coupled to a distal cap assembly 560. Referring to FIG. 72, the drive element 591 releasably engages the spreader member 550 by a threaded connection, or similar means, such that the drive element 591 may be disengaged and removed from the device 500 after implantation. In embodiments without the spreading member 550, the drive element extends to and is removably attached to the distal cap assembly 560. In these embodiments, the device illustrated by Figures 65-183 can be operated in substantially the same manner as any of the non-spreading devices described herein.

[0122] Extending and retracting an actuating element 591 attached to the spreading member 550 increases and decreases, respectively, the spacing between the main shaft 510 and the distal cap assembly 560. The main shaft 510 slides along the spreading member 550 and actuating element 591 during actuation, thereby changing the spacing between the main shaft 510 and the distal cap assembly 560 to move the paddles 530 between different positions to grip the native leaflets 20, 22 during implantation.

[0123] In an exemplary embodiment, as device 500 is opened and closed, paddles 530 move in unison rather than independently via a single drive element or drive wire 591. Also, the position of catch 580 depends on the position of paddle 530. For example, catch 580 is positioned such that catch 580 closes at the same time that anchor 508 closes. In any of the embodiments disclosed herein, catch 580 can be omitted and the native leaflets captured directly between paddle 530 and the coaptation element.

[0124] In one exemplary embodiment, device 500 can be fabricated such that paddles 530 are independently controllable in the same manner as device 100 illustrated in FIG.

[0125] The barbed fasteners 580 further secure the native leaflets 20, 22 by engaging the leaflets 20, 22 with the barbs 586 and pinching the leaflets 20, 22 between the fixed arm 582 and the movable arm 584. The barbs 586 of the barbed fasteners 580 may increase friction with the leaflets 20, 22 or partially or completely pierce the leaflets 20, 22. The drive lines 596 (FIGS. 72-75) may be separately actuated, allowing each barbed fastener 580 to open and close separately. The separate operation of the barbed fasteners 580 allows the leaflets 20, 22 to be grasped one at a time, or allows the fastener 580 on a poorly grasped leaflet 20, 22 to be repositioned without altering the successful grasp of the other leaflet 20, 22. The barbed catches 580 can be fully opened and closed when the paddles 530 are not closed, thereby allowing the leaflets 20, 22 to be grasped in a variety of positions as required by a particular situation.

[0126] 65-70, the implantable prosthetic device 500 is shown in a closed position. When closed, the inner portion 538 of the paddle 530 is disposed between the outer portion 540 of the paddle 530 and the coaptation element 520. The catch 580 is disposed between the inner portion 538 and the coaptation element 520. Upon successful capture of the native leaflets 20, 22, the leaflets 20, 22 are secured within the device 500 by the catch 580 and the device 500 is moved to and held in the closed position such that the paddle 530 and / or paddle frame 570 press against the coaptation element 520. In the example shown, the outer portion 540 of the paddle has a wider curved shape that fits around the curved shape of the coaptation element 520 to more securely grip the leaflets 20, 22 when the device 500 is closed, similar to that shown in FIG. 51 for the device 200. The curved shape and rounded edges of the outer portion 540 also inhibit tearing of the leaflet tissue.The various components of the implantable prosthetic device 500 in the closed position are shown in an exploded view in FIG.

[0127] 71, the implantable prosthetic device 500 includes an optional spreading member 550, as described above. However, the implantable prosthetic device 500 may have other configurations. For example, as shown in FIG. 71A, the implantable prosthetic device does not include the optional spreading member 500.

[0128] 72-77, the implantable prosthetic device 500 is shown in a partially or approximately three-quarters extended position. Similar to the device 200 described above, the device 500 may be driven from a closed position, to a partially open position, to a fully open position, and any position in between, if circumstances require. The paddles 530 of the device 500 transition between the closed position shown in FIGS. 65-70 and the open position shown in FIGS. 72-80 after the drive elements 591 are fully retracted or extended from the closed position to the three-quarters extended position. The implantable prosthetic device 500 is shown in FIGS. 78-80 with various components removed and the main shaft 510 and distal cap assembly 560 cut away to better illustrate how the paddles 530 couple to other components to facilitate opening and closing of the device 500.

[0129] Extending the actuation element 591 pulls down the distal end 532 of the paddle 530, which is attached to the distal cap assembly 560. The paddle 530 includes an inner paddle portion 538 and an outer paddle portion 540. A paddle frame 570 is coupled to the paddle 530 between the inner paddle portion 538 and the outer paddle portion 540 and to the distal cap assembly 560 by a connector 579 (as shown diagrammatically in FIGS. 72-74). The coupling portion 579 can take a wide variety of different forms. For example, the coupling portion 579 can be formed on the inner paddle portion 538, the outer paddle portion 540, or the transition between the inner and outer paddle portions. Pulling down the distal end 532 pulls down the outer paddle portion 540 and the paddle frame 570. The outer paddle portion 540 and the paddle frame 570 then pull down the inner paddle portion 538, which is connected to the proximal attachment interface 533, which is fixedly attached to the main shaft 510. The main shaft 510 is held in place by the capture mechanism 592, causing the inner paddle portion 538 to move in an opening direction, pivot, bend, etc. When the drive element 591 is fully extended, the inner paddle portion 538, the outer paddle portion 540, and the paddle frame 570 all bend to the positions shown in Figures 72-77. That is, the opening of the paddle 530 and frame 570 creates a gap 505 between the coaptation element 520 and the inner paddle portion 538 that can receive the native leaflets 20, 22. This movement also exposes the barbed catch 580, which can move between a closed position (Figure 65) and an open position (Figure 72) to create another gap 507 for gripping the native leaflets 20, 22. The extent of the gap 507 in the fastener 580 is limited to the extent that the inner paddle portion 538 extends away from the interface element 520 .

[0130] Continued extension of the drive element 591 pulls the paddle 530 and paddle frame 570 down, causing the inner paddle portion 538 to spread further away from the interface element 520. At full extension, the outer paddle portion 540 and paddle frame 570 move closer to the drive element 591. At full extension, the inner paddle portion 538 opens to an angle of approximately 180 degrees relative to the interface element 520 (see Figures 36 and 37). At full extension, the inner paddle portion 538 and the outer paddle portion 540 are stretched straight out, forming an angle of approximately 180 degrees between the paddle portions 538 and 540 (see Figures 36 and 37). The fully extended state of the device 500 provides the maximum size of the gap between the coaptation element 520 and the inner paddle portion 530, and in some embodiments, the catch 580 is also allowed to fully open to about 180 degrees (e.g., FIG. 37) between the fixed arm 584 and the movable arm 234 of the catch 580. The state of the device 500 is in its longest and thinnest configuration. That is, the fully extended state of the implantable prosthetic device 500 may be a position for loading the device into a delivery catheter, or the like, a position for initial deployment of the device into the atrium (see FIG. 38), and / or a position for expulsion of the device 500 from an attempted implantation.

[0131] Configuring the implantable prosthetic spacer device 500 such that the anchors 508 can extend to a straight or substantially straight configuration (e.g., about 120-180 degrees relative to the coaptation elements 520) can provide several advantages. For example, this configuration can reduce the radial pleat profile of the prosthetic spacer device 500. It can also facilitate grasping the native leaflets 20, 22 by providing a larger opening between the coaptation elements 520 and the inner paddle portion 538 for grasping the native leaflets 20, 22. Additionally, the relatively thin, straight configuration can prevent or reduce the likelihood that the prosthetic spacer device 500 will become entangled with native anatomical structures (e.g., chordae tendineae CT shown in FIGS. 3 and 4) when the prosthetic spacer device 500 is placed and / or retrieved from the delivery system 590. The fasteners can be fully open while the prosthetic spacer device is in a fully extended position facilitating disentanglement from the native anatomical structures.

[0132] The implantable prosthetic spacer device 500 is similar in many respects to the devices 200, 300 described above. As with the implantable prosthetic spacer device 200, the implantable prosthetic spacer device 500 can include a cover (not shown). In some embodiments, the cover can be disposed on the joint members 520, the paddles 530, and / or the paddle frame 570. The cover can be configured to prevent or reduce blood flow through the prosthetic spacer device 500 and / or promote natural tissue ingrowth. In some embodiments, the cover can be a cloth or fabric, such as PET, velour, or other suitable fabric. In some embodiments, instead of or in addition to a fabric, the cover can include a coating (e.g., a polymer) applied to the implantable prosthetic spacer device 500. In some embodiments, instead of or in addition to a fabric, the joint members can be made from any of the cover materials described above.

[0133] 81-88, the implantable prosthetic device 500 is held by a capture mechanism 592 of a delivery system 590. The capture mechanism 592 can be opened and / or closed in a variety of different ways. In one exemplary embodiment, the capture mechanism is opened by retracting a drive element, wire, or shaft 591. A movable portion 594 of the capture mechanism 592 removably attaches the main shaft 510 to the delivery system 590. With reference to FIGS. 81, 83, 85, and 87, in the illustrated embodiment, the capture mechanism 592 is held closed about the main shaft 510 by the drive element 591. For example, the drive element can engage an eyelet or other structure attached to the inside of the movable portion 594 to hold the movable portion closed. 82, 84, 86, and 88, removal of the drive element 591 in a removal direction 593 causes a movable portion 594 of the capture mechanism 592 to spring open in an opening direction 597, releasing the main shaft 510 and allowing the capture mechanism 592 to be decoupled from the implantable prosthetic device 500 after the device 500 is successfully implanted. The movable portion 594 includes an opening 595 that receives a portion of the attachment protrusion 515 near the proximal end 512 of the main shaft 510.

[0134] 89-94, various views of the central or main shaft 510 are shown with the main shaft 510 separated from the other components of the implantable prosthetic device 500. The main shaft 510 extends from a first or proximal end 511 to a second or distal end 512. A central opening 513 extends through the main shaft 510 from the proximal end 511 to the distal end 512. The central opening 513 has a rounded shape for receiving and sliding along the optional spreader member 550 and drive element 591. Parallel paddle slots 514 extend opposite each other from the proximal end 511 to the distal end 512 for receiving the ribbon paddles 530. The paddle slots 514 may open into the central opening 513 to form larger, irregularly shaped central openings 513 that can be formed in a single manufacturing operation. A spacer link protrusion 503 and a pair of delivery attachment protrusions 515 extend outwardly from opposite sides of the main shaft 510 near the proximal end 511. A gap 516 between each pair of spacer link protrusions 503 and attachment protrusions 515 can be shaped to receive at least a portion of a movable portion 594 of the attachment mechanism 592. The gap is sized such that at least a portion of the attachment protrusion 515 protrudes into an opening 595 in the movable portion 594.

[0135] The first cam slot 517 extends from the front to the rear of the main shaft 510 between the paddle slots 514 and has a width that is approximately the same as or slightly greater than the width of the cam portion 556 of the spreader member 550. The first slot 517 receives the cam portion 556 of the spreader member 550 when the spreader member 550 is in a stowed position and orientation. The second cam slot 518 extends from the distal end 512 on each side of the main shaft 510 and intersects with the paddle slots 514. The second cam slot 518 is perpendicular to the first cam slot 517 and narrows near the center of the main shaft 510 - having approximately the same width as the first cam slot 517 - and widens to the width of the paddle slots 514 to provide space for the paddles 530 to open and spread apart. The second cam slot 518 receives the cam portion 556 of the spreader member 550 when the spreader member 550 is in a deployed position and orientation. The first cam slot 517 and the second cam slot 518 receive the cam portion 556 of the spreading member 550 when the spreading member 550 is retracted into the main shaft 510 to fully close the implantable prosthetic device 500. The distal protrusion 519 extends between the first cam slot 517 and the second cam slot 518 and engages the cam portion 556 to limit the rotation of the spreading member 550 between the active and inactive rotation positions.

[0136] 89-94, optional cutout 610 forms an optional flange 612 at the proximal end 511 of the central shaft. An optional recapture tether passage 614 extends through flange 612. An optional recapture tether may be routed through passage 614 to allow the device to be recaptured after an initially unsuccessful deployment.

[0137] 89-94, the main shaft 510 can be made from a wide variety of different materials. For example, the main shaft can be made from plastics such as PET, PTFE, ePTFE, metal, foam, fabric, braided material, and the like.

[0138] 95-100, various views of the coaptation member or element 520 are shown with the coaptation element 520 separated from the other components of the implantable prosthetic device 500. The coaptation element 520 extends from a proximal end 521 to a distal end 522 and has a generally elongated round shape. In particular, the coaptation element 520 has an oval shape or cross-section when viewed from above (FIG. 99), a tapered shape or cross-section when viewed from the front (e.g., FIG. 97), and a round shape or cross-section when viewed from the side (e.g., FIG. 98). A mixture of these three geometries can result in the three-dimensional shape of the illustrated coaptation element 520 that achieves the benefits described herein. In order to adequately fill the gap 26 between the leaflets 20, 22, the device 500 and its components can have a wide variety of different shapes and sizes. For example, paddle 530 and paddle frame 570 may be configured to match the shape or geometry of interface element 520 as shown in Figures 50-54. With respect to device 500, it can be seen that the round shape of interface element 520 also substantially follows or approximates the shape of paddle frame 570 when viewed from above.

[0139] The size of the coaptation elements 520 may be selected to minimize the number of implants required per patient (preferably one) while simultaneously maintaining a low in-out gradient. In one exemplary embodiment, the anterior-posterior distance of the top of the spacer is about 5 mm, and the central lateral distance of the spacer is about 10 mm at its widest point. In one exemplary embodiment, the overall geometry of the separate coaptation elements 520 may be based on these two dimensions and the overall shape strategy described above. It should be readily apparent that by using different anterior-posterior and central lateral distances as a starting point for the device, coaptation elements 520 of different dimensions may be obtained. Additionally, coaptation elements 520 of different dimensions may also be obtained by using other dimensions and the shape strategies described above.

[0140] A central opening 523 extends through the interface member 522 from the proximal end 521 to the distal end 522. The central opening 523 has a diameter approximately the same as or slightly larger than the diameter of the main shaft 510 so that the main shaft 510 can be received within the central opening 523 of the interface element 520. The central opening 523 includes an assembly slot or groove 524 routed along the entire length of the central opening 523. The assembly groove 524 allows the interface element 520 to slide over the projections 503, 515 upon assembly from the proximal end 511 to the main shaft 510, as shown in FIGS. 101-105, which will be described below. The assembly groove 524 is also of sufficient width and length to receive the cam portion 556 of the spreading member 550 so that the spreading member 550 can be fully retracted proximally without interference with the interface element 520. An engagement or locking recess 525 is located at the proximal end 521 of the interface element 520 approximately 90 degrees offset from the assembly groove 524. The locking recess 525 receives the distal end of the projection 503 of the main shaft 510 to complete assembly of the interface element 520 to the main shaft 510 and "lock" the two components together by inhibiting rotation of the interface element 520. The distal end 522 of the interface element 520 includes a tapered cut 526 that intersects the central opening 523 and is perpendicular to the assembly groove 524 to form a rounded slot or clearance opening 527 that passes laterally through the interface element. The tapered cut 526 provides the interface element 520 with the tapered shape described above, and the clearance opening 527 provides space for the paddle 530 and the spreader member 550, as shown in FIGS. 155-168, which will be described below.

[0141] In some embodiments, the interface element 520 is a solid or hollow body instead of being formed from a braided material. Forming the interface element 520 as a hollow or solid body also allows the interface element 520 to be formed by injection molding, casting, machining, additive manufacturing, such as 3D printing or the like, rather than being braided from strands of material. The interface element 520 may be formed from any suitable material for use in the human body, such as, for example, various plastic, rubber, foam, and / or metal materials. Forming the interface element 520 by a molding process also facilitates creating a custom shaped interface element 520 based on a particular patient's cardiac anatomy. In some cases, the interface element 520 may also be removed and replaced with a different interface element 520 having a different size or shape. In one exemplary embodiment, additive manufacturing techniques are used to form a custom shaped interface element shaped in response to a scan of the patient's natural anatomy to receive the implant. Additive manufacturing techniques such as 3D printing allow custom shaped interface elements to be rapidly manufactured, even during surgery, based on images of the patient. The interface element 520 may also be made, shaped, or otherwise configured to be compressible. The interface element 520 may be made to be compressible in a variety of different ways, such as those described below.

[0142] 101-105, there is shown the step of assembling the interface element 520 to the main shaft 510 of the implantable prosthetic device 500. When the implantable prosthetic device 500 is fully assembled, the paddle 530 extends from the distal end 512 of the main shaft 510, thereby preventing the interface element 520 from being assembled from the distal end 512 of the main shaft. Thus, assembly of the interface element 520 to the main shaft 510 is accomplished by placing the distal end of the interface element 520 over the proximal end 511 of the shaft 510.

[0143] In some embodiments, prior to assembly, as seen in FIGS. 101 and 102, the interface element 520 is placed on the proximal end 511 of the main shaft 510 and oriented such that the assembly groove 524 of the interface element 520 is aligned with the attachment protrusion 515 of the main shaft 510. Then, as seen in FIG. 103, the interface element 520 is moved downward on the main shaft 510 until the proximal end 521 of the interface element 520 is below the distal end of the attachment protrusion 515. Next, as seen in FIG. 104, the interface element 520 is rotated 90 degrees until the engagement recess 525 is aligned with the attachment protrusion 503. Finally, the interface element 520 is moved proximally such that the distal end of the attachment protrusion 503 is inserted into the engagement recess 525 of the interface element 520. Optionally, the attachment protrusion 503 can be latched or otherwise secured or locked within the engagement recess, thereby preventing the main shaft 510 from disengaging from the interface element.

[0144] Assembly of the coaptation element 520 to the main shaft 510 may be performed prior to or during implantation. As such, for example, the native leaflets 20, 22 may be captured by the catches 580, but the paddles 530 are not yet closed. In some embodiments, the coaptation element 520 may be removed after implantation and replaced with a new coaptation element 520. A recapture system (not shown) may be used to recapture an already implanted device 500 that can later be opened, where the coaptation element would be removed while the implanted device remains attached to the native leaflets, a new coaptation element would be attached, and the device would then be closed around the new coaptation element.

[0145] A wide variety of different coupling arrangements can be used to couple the coaptation element 520 to the main shaft 510. The illustrated quarter turn coupling mechanism is only one of many coupling arrangements that can be used. The illustrated quarter turn locking mechanism used to couple the coaptation element 520 to the main shaft 510 allows for quick exchange of different coaptation elements 520. Quick changeover between different coaptation elements 520 can allow the physician to adapt to new information learned during the implantation procedure. For example, it may be discovered that the size or shape of the gap 26 in a native valve, such as a native mitral valve, is different than expected or has changed, and now requires a spacer device of a different size than originally planned. By providing the physician with a package or kit containing different sizes and shapes of coaptation elements 520 along with the implantable prosthetic device 500, the physician can select which size or shape of coaptation element 520 is needed based on all available information. Alternatively, one or more custom molded coaptation elements 520 can also be pre-planned and provided with the device 500, and each tested for fit. Rather than creating an entire device with different sized joints, a single implantable prosthetic device 500 can be configured with any number of joint elements 520 having a wide variety of sizes and shapes, thereby improving the fit of the implanted device and reducing manufacturing costs.

[0146] 106-121, various views of one of a pair of paddles 530 are shown with the paddle 530 separated from the other components of the implantable prosthetic device 500. The paddle 530 has a ribbon-like configuration extending from a proximal end 531 to a distal end 532 and includes three main segments, namely, a link portion 534, an inner paddle portion 538, and an outer paddle portion 540. The inner paddle portion 538 and the outer paddle portion 540 of the paddle 530 are configured similar to a leg in that the inner paddle portion 538 resembles an upper part of a leg, the outer paddle portion 540 resembles a lower part of a leg, and an intermediate link portion 539 between the inner paddle portion 538 and the outer paddle portion 540 resembles the knee portion of a leg. The inner paddle portion 538 is stiff, relatively stiff, rigid, rigid, has a rigid portion, and / or is stiffened by a fastening portion 582 of a stiffening member or fastener 580. As shown, the inner paddle portion 538 can include more material, and therefore be stiffer, than other portions of the paddle 530. Stiffening the inner paddle portion 538 allows the device 500 to be moved to a variety of different positions as shown and described herein.

[0147] The proximal end 531 includes a proximal attachment contact surface 533 that engages the main shaft 510 to secure the proximal end 531 of the paddle 530 near the proximal end 511 of the main shaft 510. A fastening or coupling portion 534 extends from the proximal end 531 to a flexible or widening portion 535 that is engaged by a cam portion 556 of a widening member 550. In embodiments where a widening member 550 is not included, the portion 535 can be rigid or substantially rigid. A hinge or coupling portion 536 connects the widening portion 535 to an inner paddle portion 538. The inner paddle portion 538 can include an optional opening 537 for securing a barbed fastener 580 via a suture or some other attachment means. A hinge or linkage 539 connects the inner paddle portion 538 to an outer paddle portion 540 which is connected to the distal end 532 via a lower hinge or linkage 546. Like the proximal end 531, the distal end 532 includes a mounting contact surface 547 that engages the distal cap assembly 560.

[0148] The paddle 530 can be made from a wide variety of different materials and can be made in a wide variety of different ways. In one exemplary embodiment shown in Figs. 113 and 114, the paddle 530 is laser cut from a flat layer of shape memory material, such as Nitinol. The various portions of the paddle 530 lie flat in the same plane when cut from the layer of material. With reference to Figs. 106-112, the flat paddle 530 is bent into a desired shape in a shape setting fixture and then undergoes a shape setting process. After shape setting, deforming the paddle 530 by bending or stretching its various components creates a spring force that tends to return the components of the paddle 530 to their shape set position. Because the paddle 530 is shape set in a substantially closed state, the various linkages act as spring-loaded hinges that tend to close the paddle 530.

[0149] Outer paddle portion 540 includes upper and lower flexible members 542 and 544 that allow outer paddle portion 540 to extend to a longer, narrower extended state as shown in Figures 115-121. Upper and lower flexible members 542 and 544 are connected by various hinges or links, where a first link 541 connects upper flexible member 542 to middle link 539, a second link 543 connects upper flexible member 542 to lower flexible member 544, and a third link 545 connects lower flexible member 544 to lower link 546. As the outer paddle portions 540 are extended, the upper flexible members 542 move, pivot or bend towards one another and the lower flexible members 544 also move, pivot or bend towards one another such that the outer paddle portions 540 lengthen and narrow. This lengthening and narrowing occurs when the device is moved from a closed state to an open and / or fully extended position. In particular, pulling down on the mounting contact surface 547 to open and / or elongate the device 500 applies a tensile force to the outer paddle portions 540, allowing them to lengthen and narrow in the illustrated configuration of the outer paddle portions.

[0150] When a force is applied to the implantable prosthetic device 500 to stretch the outer paddle portion 540, the angle between the various components connected by each of the first, second, and third links 541, 543, 545 increases. This increase in angle is resisted by a resilient spring force due to the shape memory properties of the material of the paddle 530 which resists the expansion of the links 541, 543, 545. Thus, when the stretching force is removed, the outer paddle portion 540 contracts to its original length and expands to its original width.

[0151] In some embodiments, links 536, 539, 546 are formed by multiple springs or linking segments arranged in a repeating pattern of cutouts formed when paddle 530 is laser cut from a flat sheet of material. The thinner portions of the segments provide flexibility along the mid-plane of paddle 530, and the symmetrical shape of each segment resists bending moments that might twist paddle 530 outside the mid-plane during bending. These linking segments allow links 536, 539, 546 to undergo significant bending while avoiding plastic deformation of the material as the individual linking segments are bent.

[0152] 122-127, various views of an embodiment of an optional spreading member 550 are shown with the spreading member 550 separated from other components of the implantable prosthetic device 500. The spreading member 550 extends from a proximal end 551 that attaches to the drive element 591 to a distal end 552 that attaches to the distal cap 560. A central rod 553 of the spreading member 550 includes a threaded opening 554 at the proximal end 551 of the spreading member 550. The central rod 553 extends from the proximal end 551 to the distal end 552 that includes an attachment portion 555. A cam portion 556 extends laterally in the lower half of the spreading member 550. The cam portion 556 has a rounded triangular shape and includes an external rounded cam surface 558 that engages the paddle 530. Although the spreading member 550 is shown as an elongated body having a laterally extending ramp-like portion, the spreading member 550 may be any device or mechanism that spreads the paddle 530 laterally.

[0153] The cam portion 556 can take on a wide variety of different shapes and sizes. Additionally, the cam portion 556 may be formed from a solid piece of material or may be expandable by inflation or other suitable means such that the cam portion 556 can change size, shape, and / or position. In some embodiments, the cam portion 556 is expandable or inflatable such that rotation of the spreader member 550 is not required to engage the paddle 530 with the cam surface 558. That is, expanding the cam portion 556 engages the paddle 530 and deflating the cam portion 556 disengages the paddle 530.

[0154] 128-129, an exemplary distal cap assembly 560 is shown in exploded (FIG. 128) and assembled (FIG. 129) views. The distal cap assembly 560 holds the distal end 502 of the device 500 and allows the device 500 to be opened and closed, for example, by extending and retracting a drive element 591. The base of the distal cap assembly 560 is a threaded bolt 561 extending from a rounded head. A washer 562 fits over the bolt 561 and includes a square shaped central opening 563 for receiving a distal retention nut 566 and a rectangular side opening 564 for receiving a paddle frame 570. The washer 562 also includes a paddle slot 565 for receiving the distal end 532 of the paddle 530. A retaining nut 566 includes a square or locking end 567 that fits within central opening 563 and closes side opening 564 to retain paddle frame 570. A threaded opening 568 extends through the length of retaining nut 566 (the threads may be all or part of the length of the opening) and engages bolt 561, thereby holding distal cap assembly 560 together. A side slot 569 aligns with side opening 564 of washer 562, providing further engagement with paddle frame 570.

[0155] 130-137, various views of an exemplary assembly of a spreading member 550, a distal cap assembly 560, and a drive element 591 are shown in disassembled (FIGS. 130-133) and assembled (FIGS. 134-137) states. The two connections of the assembly--between the spreading member 550 and the distal cap assembly 560, and between the spreading member 550 and the drive element 591--differ in nature and purpose. That is, the connection between the distal cap assembly 560 and the spreading member 550 allows the two components to rotate relative to one another without disengaging, as is the case with a typical threaded connection. A wide variety of different rotatable couplings between the distal cap assembly 560 and the spreading member 550 may be used. In contrast, the connection between the spreading member 550 and the drive element 591 is a fixed connection, such as a threaded connection, that secures the spreading member 550 to the drive element but is disassembled when the drive element 591 is rotated in the counter-clamping direction while the spreading member 550 is held in a fixed position. However, any fixed but releasable connection between the drive element 591 and the spreading member 550 could be used.

[0156] In the example shown, the rotatable coupling between the spreading member 550 and the distal cap assembly 560 is made by inserting the mounting portion 555 of the spreading member 550 into an aperture 568 of the distal nut 566. The aperture 568 includes a radially inwardly extending protrusion that engages a radially outwardly extending end of the mounting portion. The mounting portion 555 engages an internal protrusion of the aperture 568, coupling the spreading member 550 to the distal nut 566 and allowing the spreading member 550 to rotate freely relative to the distal nut 566. The mounting portion 555 engages the aperture 568 by snapping the two components together with a cam surface on the end of the mounting portion 555 that engages an internal protrusion of the aperture 568. The coupling between the spreading member 550 and the distal nut 566 allows the spreading member 550 to rotate freely relative to the distal nut 566 without coming apart, as opposed to a fixed threaded coupling. Thus, the spreading member 550 can be rotated between a stationary position and an engaged position by the wire 591, as described below.

[0157] In one exemplary embodiment, the connection between the spreading member 550 and the drive element 591 is made by threading the drive element 591 into the threaded opening 568 of the distal cap assembly 560. When fully installed, the connection between the spreading member 550 and the drive element 591 is rotatably fixed such that rotation of the drive element 591 also rotates the spreading member 550. The connection between the spreading member 550 and the drive element 591 can be unscrewed when the spreading member 550 is fully retracted into the main shaft 510 and prevented from rotating by the protrusions 519. For example, once implantation of the device 500 is complete, the drive element 591 can be unscrewed from the spreading member 550 and retracted into the delivery system 590.

[0158] 138-145, various views of an exemplary assembly of the spreader member 650, distal cap assembly 560, drive element 591, and drive tube 691 are shown in disassembled (FIGS. 138-141) and assembled (FIGS. 142-145) states. The spreader member 650 is similar in form and function to the spreader member 550, but can be actuated independently of the distal cap assembly 560, thereby providing increased control over the lateral position of the paddles 530 independent of the open state of the paddles 530. That is, the spreader member 650 can be actuated when the implantable prosthetic device 500 is partially open, half open, three-quarters open, fully open, or any other amount of open.

[0159] In some embodiments, the spreading member 650 extends from a proximal end 651 that attaches to the drive tube 691 to a distal end 652. The drive element 591 extends through the drive tube 691 and attaches to an opening 568 in the distal cap assembly 560. A central rod 653 of the spreading member 650 includes a central opening 654 that extends through the spreading member 650. The drive element 591 extends through the central opening 654 to allow the spreading member 650 to slide along the drive element 591. The central rod 653 extends from the proximal end 651 to the distal end 652. A cam portion 656 extends laterally in the lower half of the spreading member 650. The cam portion 656 has a rounded triangular shape and includes an external rounded cam surface 658 that engages the paddle 530.

[0160] The two connections of the assembly--between the drive element 591 and the distal cap assembly 560, and between the spreading member 650 and the drive tube 691--are similar in nature and purpose. That is, both connections are fixed connections that allow the drive element 591 and the tube 691 to extend and retract the connected components--i.e., the distal cap assembly 560 and the spreading member 650, respectively. For example, threaded connections may be used between the drive element 591 and the distal cap assembly 560, and between the spreading member 650 and the drive tube 691, and the connections may be released by rotating the drive element 591 or the tube 691 in a counter-tightening direction while the distal cap assembly 560 or the spreading member 650 is held in a fixed position. However, any fixed but releasable connection may be used between the drive element 591 and the distal cap assembly 560, and between the drive tube 691 and the spreading member 650.

[0161] 146-152, various views of an exemplary distal cap assembly 560 and paddle frame 570 are shown separated from other components of the implantable prosthetic device 500. The paddle frame 570 extends from a cap attachment portion 571 to a paddle connector portion 572. The paddle frame 570 is formed from a piece of material, such as Nitinol, or any other suitable material, that extends from a first end 573 at the cap attachment portion 571, through a middle or loop portion 574 at the paddle connector portion 572, and back to a second end 575 at the cap attachment portion 571. The first end 573 and the second end 575 of the paddle frame 570 each include a mounting notch or recess 576 that aids in securing the paddle frame 570 to the distal cap assembly 560. The paddle frame 570 also includes a mounting hole 577 in the loop portion 574 for securing the paddle 530 to the paddle frame 570. In some embodiments, the paddle frame 224 is formed from a material that is stiffer and more rigid than the material forming the paddles 222, 220, such that the paddle frame 224 provides support for the paddles 222, 220. The paddle frame 570 can be formed from a flat blank that is cut from a flat sheet of material, for example, by laser cutting. The cut blank can then be bent to form the three-dimensional shape of the paddle frame 570.

[0162] The paddle frame 570, as seen in FIG. 51, provides additional pinching force between the paddle 530 and the coaptation element 520 and helps wrap the leaflets 20, 22 around the sides of the coaptation element 520 for a better seal between the coaptation element 520 and the leaflets 20, 22. That is, the paddle frame 570 can be configured with a rounded three-dimensional shape that extends from the distal cap assembly 560 to the mid-hinge portion 539 between the inner paddle portion 538 and the outer paddle portion 540. The connections between the main shaft 510, the paddle 530, the distal cap assembly 560, and the paddle frame 570 can constrain each of these portions to the movements and positions described herein. In particular, the mid-hinge portion 539 is constrained by its connection between the inner paddle 538 and the outer paddle 540 and by its connection with the paddle frame 570. Similarly, the paddle frame 570 is constrained by its attachment to the paddle 530 (using the intermediate hinge portion 539 ) and the distal cap assembly 560 .

[0163] In some embodiments, the loop portion 574 of the paddle frame 570 forms a generally rounded three-dimensional shape that generally matches the shape of the coaptation element 520--as described above and as seen in Figures 65 and 69. The sides of the paddle frame 570 between the cap attachment portion 571 and the paddle coupling portion 572 have a rounded, wing-like shape that engages the curved surface of the coaptation element 520 when gripping the native leaflets 20, 22 between the paddle 530 and the coaptation element 520 of the implantable device of the present invention, as seen in Figures 50 and 51. By configuring the paddle frame 570 in this manner, an increased surface area is achieved compared to the paddle 530 alone. This increased surface area allows the native leaflets 20, 22 to be more easily gripped and secured. The increased surface area may also allow the clamping force of the paddles 530 and paddle frame 570 against the native leaflets 20, 22 to be distributed over a relatively larger surface of the native leaflets 20, 22 to further protect the native leaflet tissue. Similar to the frame 224 shown in FIG. 51, the increased surface area of ​​the paddle frame 570 may also allow the native leaflets 20, 22 to be secured to the implantable prosthetic spacer device 500 such that the native leaflets 20, 22 coapt generally around the coaptation member 520. This may, for example, improve sealing of the native leaflets 20, 22 and thus prevent or further reduce valvular regurgitation.

[0164] 146-148, an exemplary distal cap assembly 560 and paddle frame 570 are shown in a disassembled state prior to being coupled together. To assemble the paddle frame 570 to the distal cap assembly 560, the first end 573 and the second end 575 are pressed together to reduce the width of the cap mounting portion 571 so that the first end 573 and the second end 575 can be inserted into the side opening 564 of the washer 562. When the paddle frame 570 is allowed to expand, the first end 573 and the second end 575 expand outwardly and the mounting recess 576 receives and hooks around a portion of the washer 562. The retaining nut 566 is then inserted into the opening 563 such that the locking end 567 fits between the ends 573, 575 of the paddle frame 570, thereby engaging and locking the paddle frame 570 with the washer 562. The bolt 561 is then threaded into the retaining nut 566 and tightened until the flange or cap of the bolt 561 engages the washer 562, as shown in Figures 149-151.

[0165] 152, the paddle frame 570 is shown assembled to the distal cap assembly 560. The paddle frame 570 can be configured to increase the clamping force against or toward the interface element 520 when the paddle 530 is in the closed configuration because the paddle frame 570 is configured for a closed position (e.g., FIG. 149) to a first position (e.g., FIG. 152), which is beyond where the paddle 530 engages the interface element 520, such as beyond a central plane of the device 500, such as beyond the opposite side of the interface element 520, such as beyond the outer paddle 570 on the opposite side of the interface element 520. In the first position, the loop portions 574 of the paddle frames 570 are intertwined in that the side of one paddle frame 570 moves slightly laterally to allow movement over the side of the other paddle frame 570 until the paddle connectors 572 of each frame 570 contact each other and the side, preventing further movement.

[0166] 153-155, the paddle 530 is shown spaced apart from the associated distal nut assembly that forms the distal cap 560 and paddle frame 570. To attach the paddle 530 to the distal cap assembly 560, the distal end 532 of the paddle 530 is aligned with the paddle slot 565 of the washer 562. The distal mounting contact surface 547 of the paddle 530 is laterally compressed to fit within the paddle slot 565 and then inserted into the paddle slot 565 until the mounting contact surface 547 bottoms out of the washer 562. The mounting contact surface 547 is then allowed to expand to secure the distal end 532 of the paddle 530 within the paddle slot 565, as shown in FIGS. 156-158 and 160.

[0167] 156-159, the paddle 530 and main shaft 510 are assembled by inserting the proximal attachment contact surface 533 through the slot 514 in the distal end 512 of the main shaft. The attachment contact surface 533 is threaded through the slot 514 until the attachment contact surface reaches the proximal end 511 of the main shaft 510. The proximal attachment contact surface 533 expands laterally to secure the proximal end 531 of the paddle 530 to the proximal end 511 of the main shaft 510. Although the proximal attachment contact surface 533 is shown protruding slightly from the proximal end 511 of the main shaft 510, the proximal attachment contact surface 533 may be flush with the proximal end of the main shaft 510 or may be recessed into the proximal end of the main shaft 510.

[0168] 156-159, the proximal end 551 of the shaft 553 of the spreading member 550 is inserted through the passage 513 in the distal end 512 of the main shaft 510. The shaft 553 of the spreading member 550 is advanced through the passage 513 toward the proximal end 511 of the main shaft 510.

[0169] 161-164, another exemplary embodiment of a paddle 630 for an exemplary implantable prosthetic element is shown. The paddle 630 is formed by joining together the distal ends 532 of two of the paddles 530 (described above) with a link 632. The link 632 includes an opening 634 for receiving a distal retaining nut 566 (FIG. 163) such that the paddle 630 is sandwiched between a bolt 561 and a washer 562 (FIG. 163). Optionally, the paddles 530 may be joined at their proximal ends 532 by a link (not shown). Attaching the paddles 630 in this manner allows both paddles 530 to be formed in one operation.

[0170] 165-167, various views of one of the barbed fasteners 580 are shown with the barbed fastener 580 separated from other components of the implantable prosthetic device 500. The barbed fastener 580 may be substantially similar to the barbed fastener 330 shown in FIG. 56, however, the size of the fastener 580 may differ from the size of the fastener 330, as the device 300 shown in FIG. 55 may be a different size than the device 500. However, a wide variety of different barbed fasteners may be used in the devices disclosed herein. Examples of barbed fasteners that may be used include, but are not limited to, the barbed fastener illustrated in FIG. 29 and / or any of the barbed fasteners disclosed in this application and any of the applications incorporated herein by reference and / or claiming priority from this application. The barbed fastener 580 grips the native leaflets 20, 22 in a manner similar to that shown in FIG. 29 and described above.

[0171] The barbed catch 580 includes a base or fixed arm 582, a movable arm 584, a barb 586, and a coupling or hinge portion 588. The fixed arm 582 is attached to the paddle 530, and the coupling portion 588 is located adjacent to the mating element 520. The coupling portion 588 is spring loaded such that the fixed arm 582 and the movable arm 584 are biased toward each other when the barbed catch 580 is in a closed state, as well as an open portion. The hinge portion 588 is formed from multiple spring segments arranged in a repeating pattern that extends between the fixed arm 582 and the movable arm 584. The multiple segments are coupled together to allow the hinge portion 588 to undergo a significant amount of bending while avoiding plastic deformation of the material when the individual spring segments are twisted. For example, in some embodiments, the fixed arm 582 may be moved, bent, rotated, or pivoted from a neutral position that is about 125 degrees beyond the movable arm 584 to a fully open position that is about 180 degrees from the movable arm 584 without plastically deforming the fastener material. In some embodiments, the fastener material plastically deforms during opening without reducing or substantially reducing the pinch force between the fixed arm and the movable arm in the closed position.

[0172] Fixed arm 582 is attached to opening 537 in paddle 530 with sutures (not shown) through holes or slots 581. Fixed arm 582 may be attached to paddle 530 by any suitable means, such as screws or other fasteners, locking sleeves, mechanical latches or clasps, welding, adhesives, etc. Fixed arm 582 remains substantially fixed relative to paddle 530 when movable arm 584 is opened to open barbed clasp 580 and expose barb 586. Barbed clasp 580 is opened by applying tension to drive line 596 (FIGS. 72-75) attached to hole 585 in movable arm 584, which causes movable arm 584 to move, pivot, bend, etc. on coupling 588.

[0173] In some embodiments, the barbed fastener 580 is laser cut from a layer of shape memory alloy, such as Nitinol. As shown in FIGS. 166-167, the barbs 586 lie flat in the same plane as the rest of the fastener 580 when cut from the layer of material. The movable arms 584 and barbs 586 are then bent and / or twisted and then subjected to a shape setting process. They may be formed in other ways as well.

[0174] 115-121, the outer paddle portion 540 of the paddle 530 may be stretched to extend the length and decrease the width of the implantable prosthetic device 500. Also, the paddle frame 570 may be stretched in length and decreased in width by stretching. In some embodiments, the width of the paddle frame 570 may decrease from about 10 millimeters to about 8 millimeters when stretched. Stretching the paddle 530 and paddle frame 570 may be accomplished by applying a force to the drive element 591 to move the distal cap assembly 560 away from the main shaft 510 while simultaneously maintaining tension on the drive line 596. The action of moving the distal cap assembly 560 away from the main shaft 510 pulls down the distal end 532 of the paddle 530, which in turn applies a tensile force to the outer paddle portion 540. The force applied to the drive line can be less than the force required to open the catch 580 while still being sufficient to maintain the position of the catch 580 as the drive element 591 is extended. As a result, the inner paddle portion 538 and the paddle linkage 572 of the paddle frame 570 attached to the catch 580 are also restrained from moving. Thus, the outer paddle portion 540 and the paddle frame 570 are stretched between the distal cap assembly 560 and the paddle linkage 572, and the outer paddle portion 540 is stretched from the rest position shown in FIGS. 106-112 to the extended position shown in FIGS. 115-121, and the paddle frame 570 is likewise extended (not shown). In an embodiment of the implantable prosthetic device 500 including a spreading member 650 (FIGS. 138-145) that can be actuated independently of the movement of the distal cap assembly 560, the paddle 530 and the paddle frame 570 can be spread apart while being maintained in the open position. That is, the position of the distal cap assembly 560 (which controls the opening and closing of the paddles) may be maintained by the control wires, while the spreading member 650 is moved into engagement with the paddle 530. While the position of the cap 560 is maintained, the engagement of the paddle 530 with the spreading member 650 may also increase tension along the outer paddle portion 540 and the paddle frame 570.This tension can stretch the outer paddle portion 540 and the paddle frame 570, allowing them to fit through small gaps in the patient's anatomy, such as between the chordae tendineae.

[0175] As described above, the upper and lower flexible members 542, 544 move together to reduce the overall width of the outer paddle portion 540 as the length of the outer paddle portion 540 increases. The paddle frame 570 similarly narrows in width as it is stretched. Thus, the width of the outer paddle portion 540 and the paddle frame 570 can be adjusted by stretching the outer paddle portion 540 and the paddle frame 570. In some embodiments, the outer paddle portion 540 is more flexible than the paddle frame 570, and the outer paddle portion 540 narrows before the paddle frame 570, so that the paddle frame 570 bears more of the load exerted on the device 500 from the stretching. Conversely, in some embodiments, the paddle frame 570 is more flexible than the outer paddle portion 540 and therefore the paddle frame 570 narrows more forward than the outer paddle portion 540, resulting in the outer paddle portion 540 bearing more of the load exerted on the device 500 from stretching.

[0176] During the implantation procedure, native heart structures (e.g., multiple and / or tightly packed chordae) may interfere with the capture of the leaflets. That is, portions of the implantable prosthetic device 500 may contact the chordae such that the associated leaflets are pushed aside when the surgeon attempts to move the implantable prosthetic device 500 toward the leaflets for capture. Allowing the implantable prosthetic device 500 to have an adjustable width improves the maneuverability of the implantable prosthetic device 500 when configured in a "ready to capture" configuration during the implantation procedure. When such native structures are encountered, the implantable prosthetic device 500 may be partially extended, thereby stretching the outer paddle portion 540 and the paddle frame 570 and reducing the width of the paddles 530 and the paddle frame 570, thereby avoiding the native heart structures and allowing the capture of the leaflets. The paddles 530 expand when the implantable prosthetic device 500 is closed to capture the leaflets, thereby increasing the pinching surface area for better securing the leaflets within the implantable prosthetic device 500 .

[0177] 168-183, various views of the deployment of the optional spreading member 550 are shown. The spreading member 550 may be selectively deployed to engage and spread the paddles 530 apart, thereby enabling the translational movement of the paddles 530 as shown in FIGS. 57-64 and described above. That is, deployment and actuation of the spreading member 550 causes the paddles 530 to translate outward to better position the catches 580 to grip the leaflets 20, 22 of the native valve at the larger gap 26. As discussed above, the translation of the paddles 530 may occur before, while, or after the paddles are rotated or pivoted in an open direction to prepare to capture the leaflets 20, 22. When the gap 26 is not large enough to require spreading, the device may be used as described above without using the spreading feature of the paddles. That is, the paddle 530 is simply opened and closed by translating the spreading member 550 without rotating the spreading member 550 to effect the spreading function of the paddle.

[0178] 168, 172, 176, and 178, when not needed to spread the paddles 530, the spreader member 550 is stowed in the distal end 512 of the main shaft 510 such that the cam portions 556 are disposed between and are limited in rotation by the distal projections 519 of the main shaft 510. In the stowed position, the spreader member 550 is also partially disposed within the central opening 523 and assembly groove 524 of the distal end 522 of the joint element 520. The drive element 591 is extended to deploy the spreader member 550 by first moving the spreader member 550 distally such that the cam portions 556 are free from the distal projections 519 of the main shaft as shown in FIGS. 169 and 173. This extension of the drive element 591 can partially open the paddles 530. Optionally, such partial opening may be limited or prevented entirely by applying tension to drive line 596 during extension of drive element 591, as described above. That is, the force exerted by extension of drive element 591 may be directed toward stretching outer paddle portion 540 and paddle frame 570 rather than opening paddle 530. In some embodiments, outer paddle portion 540 and paddle frame 570 are stretched and paddle 530 is partial opened by extension of drive element 591 to deploy spreader member 550.

[0179] 170 and 174, the extended drive element 591 is rotated, thereby rotating the spreading member 550 to a deployed orientation that is 90 degrees from the stowed orientation. This rotation aligns the cam portion 556 of the spreading member 550 with the second cam slot 518 of the main shaft 510, thereby allowing the spreading member 550 to retract to engage and spread the paddles 530 (see FIG. 181). The drive element 591 and spreading member 550 can be retracted into the second cam slot 518 between the distal projections 519 to engage the paddles 530. The spreading member 550 can be driven to any position between the extended position shown in FIGS. 170 and 174 and the retracted position shown in FIGS. 171, 175, 177, and 179 to effect translation of the paddles 530.

[0180] In one use example, the cam spreader 550 can be configured to remain in the cam spreader position after the leaflets are captured, the catches 580 are closed, and the paddles 530 are closed around the coaptation member 520 by retraction of the cam spreader. In another exemplary embodiment, the cam spreader 550 can be used to widen the spacing between the catches 580 by rotating the cam spreader 550 to capture the spacing leaflets. After the spacing leaflets are gripped by the catches 580, the cam spreader 550 can be used to return the spacing between the catches 580 (and the captured leaflets) to the original narrow spacing by rotating the cam spreader 550 back to the illustrated position. The paddles 530 can then be closed around the captured leaflets by retracting the cam spreader.

[0181] 180-183, portions of the paddles 530 and catches 580 are shown in addition to the components of the device 500 shown in FIGS. 168-179 to illustrate how the spreader members 550 engage the paddles 530 to facilitate the translational movement described above that spreads the paddles 530 to capture the leaflets 20, 22. To begin capturing the leaflets, the device 500 is opened to the ready-to-capture state shown in FIG. 180 with the paddles 530 and catches 580 only partially open (although any amount of opening may be used). The spreader members 550 are in a tucked or disengaged position such that the spreader members 550 fit between the paddles 530 and do not engage the paddles 530. In this position, the leaflets 20, 22 are likely to be spread apart and not captured by closing the catches 580.

[0182] To move the catches 580 to a more desirable capture position, the spreader member 550 can be used to rotate the spreader member 550 to the position illustrated in FIG. 181 to increase the spacing between the catches 580 and capture the spacing leaflets 20, 22. The spreader member 550 is extended (see FIG. 180), rotated, and retracted to move from the stowed position shown in FIG. 179 to the deployed position shown in FIG. 181. When stowed, the optional distal projection 519 of the main shaft 510 can inhibit rotation of the spreader member 550 from either the disengaged or engaged positions while retracting the spreader member 550 into the main shaft 510 and coaptation element 520. This retraction action causes the cam surface 558 of the cam portion 556 to engage the spreader portion 535 of the paddle 530 to spread the spreader portion 535 apart. The outward movement of the spreader portion 535 also moves the linkage portion 536 and the inner paddle portion 538 outward, and therefore the catch 580 attached to the inner paddle portion 538, in an outward translational manner. The illustrated ramp-like shape of the cam portion 556 allows the amount of lateral translation of the paddle 530 and catch 580 to be controlled by controlling the amount of extension and retraction of the drive element 591 and / or the spreader portion. That is, the maximum outward movement of the paddle 530 is reached when the spreader member 550 is retracted to the maximum extent possible. The cam portion 556 is shown in a triangular shape, but can have a wide variety of shapes that increase or decrease the amount and rate at which the paddle 530 is spread upon retraction of the spreader member 550 to aid in capture of the native valve leaflets 20, 22.

[0183] After the paddle 530 and catch 580 are spread apart, the leaflets 20, 22 are captured by closing the catch 580 and paddle 530. Closing the catch 580 pinches the leaflets 20, 22 between the fixed arm 582 and the movable arm 584, as can be seen in FIG. 182. The paddle 530 can also be partially closed to move the leaflets 20, 22 towards the coaptation element 520. After the leaflets 20, 22 are captured, the spreader member 550 can be used to return the spacing between the catch 580 (and the captured leaflets 20, 22) to the original narrower spacing by rotating the spreader member 550 back to the packed or disengaged position illustrated in FIG. 183. The paddle 530 is then fully closed to secure the leaflets 20, 22 against the coaptation element 520, as illustrated in FIG. 183. In another example of use, the spreading member 550 can remain in the spread position shown in FIGS. 181 and 182 after the leaflets 20, 22 are captured, the catches 580 are closed, and the paddle 530 is closed around the coaptation member 520 by retraction of the spreading member 550.

[0184] 184-213, the coaptation elements may be configured in a variety of ways to be compressible. For example, the coaptation elements 520 described above may be compressible to fit into, move through, and / or be deployed from a delivery catheter or the like. Each of the coaptation elements may incorporate any of the features previously described herein, such as the coaptation element 520 described in FIGS. 95-100. Additionally, each of the coaptation elements may be used with any of the implantable prosthetic spacer devices 100, 200, 300, 400, 500 previously described herein. Each of the coaptation elements may be made from a flexible and / or compressible material, such as, for example, rubber, foam, plastic, or other suitable material.

[0185] 184-188, an interface element 1520 is depicted according to one embodiment. The interface element 1520 extends from a proximal end 1521 to a distal end 1522 and has a generally elongated rounded shape. In particular, the interface element 1520 has an oval shape or cross-section when viewed from above (FIG. 187), a tapered shape or cross-section when viewed from the front (FIG. 186), and a rounded shape or cross-section when viewed from the side (FIG. 185). A central opening 1523 extends through the body portion 1528 of the interface member 1520 from the proximal end 1521 to the distal end 1522. The central opening 1523 has a diameter approximately the same as or slightly larger than the diameter of the main shaft 510 such that the main shaft 510 can be received within the central opening 1523 of the interface element 1520.

[0186] The joint element 1520 has one or more arms 1530 extending outwardly (front to back) from a body portion 1528. The one or more arms 1530 couple to the body portion 1528 near the proximal and distal ends 1521, 1522 of the body portion 1528, thereby defining one or more openings 1531 between the arms 1530 and the body portion 1528. The one or more arms 1530 may be made from a flexible and / or compressible material such as, for example, foam, rubber, plastic, or other suitable material.

[0187] Optionally, the interface element 1520 can also include a distal arm 1532 that defines a distal opening 1533 between the body portion 1528 and the distal arm 1532. The distal arm 1532 can be made from a flexible and / or compressible material such as, for example, foam, rubber, plastic, or other suitable material. In one exemplary embodiment, the entire interface element 1520 is a single molded component.

[0188] As shown in FIG. 188, a force is applied to one or more of the arms 1530 such that the arms 1530 bend, move, or otherwise flex inwardly or inwardly toward the body portion 1528, thereby reducing the size of one or more of the apertures 1531 or eliminating one or more of the apertures. As such, the arms 1530 are compressed toward the body portion 1528 and the overall size of the coaptation element 1520 is reduced. In the illustrated embodiment, a force is applied downward (distal) such that the arms 1530 are compressed toward the body portion 1528. However, it will be understood that the arms 1530 may be compressed toward the body portion 1528 in a variety of ways. For example, an inward force may be applied to the arms 1530 such that the arms 1530 are compressed toward the body portion 1528.

[0189] 189-193, an interface element 2520 is depicted according to one embodiment. The interface element 2520 extends from a proximal end 2521 to a distal end 2522 and has a generally elongated rounded shape. In particular, the interface element 2520 has an oval shape or cross-section when viewed from above (FIG. 192), a tapered shape or cross-section when viewed from the front (FIG. 191), and a rounded shape or cross-section when viewed from the side (FIG. 190). A central opening 2523 extends through the body portion 2528 of the interface member 2520 from the proximal end 2521 to the distal end 2522. The central opening 2523 has a diameter or size that is approximately the same as or slightly larger than the diameter of the main shaft 510 such that the main shaft 510 can be received within the central opening 2523 of the interface element 2520.

[0190] The joining element 2520 has a number of prongs or wings 2530 extending outward (front to back) from the body portion 2528. The prongs or wings 2530 are generally oriented perpendicular to the central opening 2523. The one or more prongs or wings 2530 are connected to the body portion 2528 at two points, thereby defining a longitudinal opening 2531 between the body portion 2528 and each of the wing portions 2530. The longitudinal openings 2531 on each side of the body portion 2528 can be at least partially aligned. In some embodiments, there are between 2 and 20 prongs / wings, and the prongs / wings are spaced anywhere between 0.1 mm and 3 mm apart. The one or more prongs / wings 2530 can be made of a flexible and / or compressible material, such as, for example, foam, rubber, plastic, silicone, or other suitable material.

[0191] As shown in FIG. 193, the coaptation element 2520 may be compressed. A force may be applied to the prongs / wings 2530 such that the prongs / wings 2530 angle downward or distally in the direction of the distal portion 2522. The outer portion of each prong / wing 2530 may be moved downward or distally such that the outer portion of each prong / wing 2530 nests or fits within the longitudinal opening 2531 defined by the distally lower prong / wing 2530. As such, the overall size of the coaptation element 2520 is reduced. In the illustrated embodiment, a force is applied downward (distal) and inward (inward) to each wing 2530 such that the prongs / wing 2530 are compressed toward the body portion 2528. However, it will be understood that the prongs / wing 2530 may be compressed toward the body portion 2528 in a variety of ways. For example, a downward or inward force may be applied to the protrusions / wings 2530 such that the protrusions / wings 2530 are compressed towards the body portion 2528 .

[0192] 194-198, an interface element 3520 is depicted according to one embodiment. The interface element 3520 extends from a proximal end 3521 to a distal end 3522 and has a generally elongated rounded shape. In particular, the interface element 3520 has an oval shape or cross-section when viewed from above (FIG. 197), a tapered shape or cross-section when viewed from the front (FIG. 196), and a rounded shape or cross-section when viewed from the side (FIG. 195). A central opening 3523 extends through the body portion 3528 of the interface member 3520 from the proximal end 3521 to the distal end 3522. The central opening 3523 has a diameter or shape that is approximately the same as or slightly larger than the diameter of the main shaft 510 such that the main shaft 510 can be received within the central opening 3523 of the interface element 3520.

[0193] The interface element 3520 has a number of protrusions or wing-like portions 3530 extending outward (front to back) from a body portion 3528. Similar to the interface element 2520 of FIGS. 189-193, the protrusions or wing-like portions 3530 are generally oriented perpendicular to the central opening 3523, and one or more of the wing-like portions 3530 connect to the body portion 3528 at two points, thereby defining a longitudinal opening 3531 between the body portion 3528 and each of the protrusions / wing-like portions 3530. However, the protrusions / wing-like portions 3530 are thinner and spaced further apart (e.g., 1-3 times further apart) than the protrusions / wing-like portions 2530 of the interface element 2520 shown in FIGS. 189-193. The one or more wing-like portions 3530 may be made of a flexible and / or compressible material, such as, for example, foam, rubber, plastic, or other suitable material. In some embodiments, there are between 2 and 20 prongs / wings, and the prongs / wings are spaced anywhere from 0.1 mm to 5 mm apart.

[0194] As shown in FIG. 198, the coaptation element 3520 may be compressed. A force may be applied to the prongs / wings 3530 such that the prongs / wings 3530 angle downward or distally. The outer portion of each prong / wing 3530 may be moved downward or distally such that the outer portion of each prong / wing 3530 nests or fits within the opening 3531 defined by the prong / wing 3530 below. Due to the configuration and spacing of the prongs / wing 3530, each prong / wing 3530 may extend outward (towards the front and rear) farther than the proximal prong / wing 3530 above. As such, the prongs / wing 3530 may nest more easily, which may facilitate the overall compression of the coaptation element 3520. In the illustrated embodiment, a downward (distal) and inward (inward) force is applied to each protrusion / wing 3530 such that the protrusion / wing 2530 is compressed toward the body portion 3528. However, it will be understood that the protrusion / wing 3530 may be compressed toward the body portion 3528 in a variety of ways. For example, a downward or inward force may be applied to the protrusion / wing 3530 such that the protrusion / wing 3530 is compressed toward the body portion 3528.

[0195] 199-203, an interface element 4520 is depicted according to one embodiment. The interface element 4520 is depicted as having a generally elongated rounded shape extending from a proximal end 4521 to a distal end 4522. In particular, the interface element 4520 is depicted as having an oval shape or cross-section when viewed from above (FIG. 202), a tapered shape or cross-section when viewed from the front (FIG. 201), and a rounded shape or cross-section when viewed from the side (FIG. 200), although variations and other shapes are possible. A central opening 4523 extends through the body portion 4528 of the interface member 4520 from the proximal end 4521 to the distal end 4522. The central opening 4523 has a diameter or shape that is approximately the same as or slightly larger than the diameter of the main shaft 510 such that the main shaft 510 can be received in the central opening 4523 of the interface element 4520.

[0196] The coaptation element 4520 has a number of protrusions or wing-like portions 4530 extending outward (front to back) from the body portion 4528. The protrusions / wing-like portions 4530 are angled distally and outwardly from the body portion 4528, with the distal protrusions / wing-like portions 4530 oriented more downwardly (i.e., toward the distal end 4522 of the coaptation element 4520). Optionally, one or more of the protrusions or wing-like portions 4530 are coupled to the body portion 4528 at two points, thereby defining an opening 4531 between the body portion 4528 and each of the protrusions / wing-like portions 4530. The coaptation element 4520 also includes grooves 4533 between its protrusions / wing-like portions 4530 that narrowly taper toward the body portion 4528. The distal grooves 4533 can be wider than the proximal grooves 4533. The protrusion / wing-like portion(s) 4530 may be made from a flexible and / or compressible material such as, for example, foam, rubber, plastic, or other suitable material.

[0197] As shown in FIG. 203, a force may be applied to the protrusions / wings 4530 such that the outer portions of the protrusions / wings 4530 are moved downward (distal) and inward (toward the body portion 4528). The grooves 4533 may be configured such that the longer protrusions / wings 4530 are moved further downward than the other protrusions / wings 4530. Optionally, a portion of the protrusions / wings 4530 may fit or nest within a longitudinal opening 4531 defined by the distally lower protrusions / wings 4530. As such, the overall size of the coaptation element 4520 may be compressed or otherwise reduced. In the illustrated embodiment, a force is applied downward (distal) and inward (inward) to each protrusion / wing 4530 such that the protrusions / wings 4530 are compressed toward the body portion 4528. However, it will be appreciated that the protrusions / wings 4530 may be compressed towards the body portion 4528 in a variety of ways. For example, a downward or inward force may be applied to the protrusions / wings 4530 such that the protrusions / wings 4530 are compressed towards the body portion 4528.

[0198] 204-208, an interface element 5520 according to one embodiment is depicted. The interface element 5520 extends from a proximal end 5521 to a distal end 5522 and has a generally elongated rounded shape. In particular, the interface element 5520 has an oval shape or cross-section when viewed from above (FIG. 207), a tapered shape or cross-section when viewed from the front (FIG. 206), and a rounded shape or cross-section when viewed from the side (FIG. 205). A central opening 5523 extends through the body portion 5528 of the interface member 5520 from the proximal end 5521 to the distal end 5522. The central opening 5523 has a diameter or size that is approximately the same as or slightly larger than the diameter of the main shaft 510 such that the main shaft 510 can be received within the central opening 5523 of the interface element 5520.

[0199] The coaptation element 5520 has a number of protrusions or wing-like portions 5530 extending outward (front to back) from the body portion 5528. The protrusions / wing-like portions 5530 are angled, or generally angled, distally and outwardly from a point substantially midway of the body portion 5528. The protrusions / wing-like portions 5530 closer to the proximal end 5521 may be angled upwardly away from the body portion 5528, and the protrusions / wing-like portions 5530 closer to the distal end 5522 may be angled downwardly away from the body portion 5528. Optionally, one or more of the protrusions or wing-like portions 5530 are coupled to the body portion 5528 at two points, thereby defining an opening 5531 between the body portion 5528 and each of the protrusions / wing-like portions 5530. The interface element 4520 also includes grooves 5533 between its prongs / wings 5530 that narrow and taper toward the body portion 5528. The grooves 5533 extend inward toward the center of the body portion 5528. The prongs / wings 5530 or more may be made from a flexible and / or compressible material such as, for example, foam, rubber, plastic, or other suitable material.

[0200] As shown in FIG. 208, a force can be applied to the protrusions / wings 5530, thereby compressing the coaptation element 5520. An upward (proximal), inward (toward the body portion 5528) force can be applied to the protrusions / wings 5530 near the proximal end 5521 and a downward (distal), inward (toward the body portion 5528) force can be applied to the protrusions / wings 5530 near the distal end 5522. The grooves 5533 can be configured to allow the protrusions / wings 5530 to move as far as possible toward the body portion 5528. Optionally, a portion of the protrusions / wings 5530 can fit or nest within a longitudinal opening 5531 defined by the protrusions / wings 5530, toward which the protrusions / wings 5530 are moved. As such, the overall size of the coaptation element 5520 can be compressed. In the illustrated embodiment, a force is applied upward (proximal) and inward to the protrusions / wings 5530 near the proximal end 5521 and a force is applied downward (distal) and inward to the protrusions / wings 5530 near the distal end 5522, thereby compressing the protrusions / wings 5530 toward the body portion 5528. However, the protrusions / wings 5530 may be compressed toward the body portion 5528 in a variety of ways. For example, the protrusions / wings 5530 may be oriented, shaped, and / or configured such that an inward force may be applied to all of the protrusions / wings 5530 to compress the protrusions / wings 5530 toward the body portion 5528.

[0201] 209-213, an interface element 6520 is depicted according to one embodiment. The interface element 6520 extends from a proximal end 6521 to a distal end 6522 and has a generally elongated rounded shape. In particular, the interface element 6520 has an oval shape or cross-section when viewed from above (FIG. 212), a tapered shape or cross-section when viewed from the front (FIG. 211), and a rounded shape or cross-section when viewed from the side (FIG. 210). A central opening 6523 extends through the body portion 6528 of the interface member 5520 from the proximal end 6521 to the distal end 6522. The central opening 6523 has a diameter or size that is approximately the same as or slightly larger than the diameter of the main shaft 510 such that the main shaft 510 can be received within the central opening 6523 of the interface element 6520.

[0202] The joining element 6520 has a number of protrusions or wing-like portions 6530 extending radially outward (back and forth) from the body portion 6528. The protrusions or wing-like portions 6530 are separated by one or more longitudinal grooves 6531 extending radially inward toward the body portion 6528. The longitudinal grooves 6531 may taper inward toward the body portion 6528. The protrusions or wing-like portions 6530 and the longitudinal grooves 6531 may be configured such that the protrusions or wing-like portions 6530 are thicker at their radially outer portions. The protrusion or wing-like portions 6530 may be made of a flexible and / or compressible material, such as, for example, foam, rubber, plastic, or other suitable material.

[0203] 213, a force can be applied to the protrusions / wings 6530, thereby compressing the coaptation element 6520. A radially inward force can be applied to the protrusions or wing portions 6530, thereby radially compressing the protrusions or wing portions 6530, thereby reducing the overall size of the coaptation element 6520. The longitudinal grooves 6531 can be configured to allow the protrusions / wings 6530 to move as far as possible toward the body portion 6528. As such, the overall size of the coaptation element 6520 can be compressed.

[0204] In the illustrated embodiment, an inward radial force is applied to the protrusions / wings 6530 such that the protrusions / wings 6530 are compressed towards the body portion 6528. However, it will be appreciated that the protrusions / wings 6530 may be compressed towards the body portion 6528 in a variety of ways. For example, either a forward or aft lateral force may be applied to the protrusions / wings 6530 such that the protrusions / wings 6530 are compressed towards the body portion 6528.

[0205] Although the interface elements have been described according to specific embodiments, the various features of any of the interface elements 520, 1520, 2520, 3520, 4520, 5520, 6620 can be used in many alternative embodiments, either individually or in various combinations and subcombinations thereof.

[0206] The interface element 7020 may be sized, shaped, and configured to fit the natural anatomy of the patient receiving the implant. For example, any of the interface elements 520, 1520, 2520, 3520, 4520, 5520, 6620, or interface elements incorporating any of the various features of any of the interface elements 520, 1520, 2520, 3520, 4520, 5520, 6620 may be employed. The interface element 520 may be sized, shaped, and configured specifically for the natural anatomy of the patient receiving the implant. Optionally, the person performing the procedure may have various interface elements available during the procedure, for example, in a kit that may include any of the associated tools and other elements. The person performing the procedure may select an interface element having a desired size, shape, and configuration that corresponds to the natural anatomy of the patient receiving the implant.

[0207] Although various inventive aspects, concepts, and features of the present disclosure are described and illustrated herein as being embodied in a combination of exemplary embodiments, these various aspects, concepts, and features can be used individually in many alternative embodiments or in various combinations and subcombinations thereof. Unless specifically excluded herein, all such combinations and subcombinations are intended to be within the scope of the present application. Furthermore, although various alternatives for various aspects, concepts, and features of the present disclosure (such as alternative materials, structures, forms, methods, devices, and components, and alternatives in terms of form, fit, and function) are described herein, such descriptions are not intended to be a complete or exhaustive list of alternative embodiments that may be used, whether currently known or developed in the future. Those skilled in the art will be able to readily incorporate one or more of the aspects, concepts, and features of the present invention into further embodiments and applications within the scope of the present application, even if such embodiments are not expressly disclosed herein.

[0208] In addition, even if some features, concepts, or aspects of the disclosure are described herein as preferred configurations or methods, such description does not imply that such features are required or necessary, unless specifically stated otherwise. Furthermore, while example or representative values ​​and ranges may be included to aid in understanding the present application, such values ​​and ranges should not be construed in a limiting sense, but rather should be the limiting values ​​or ranges only when expressly stated.

[0209] Furthermore, although various aspects, features and concepts may be expressly identified as being inventive or forming part of the disclosure, such identification is not intended to be exclusive; rather, there may be aspects, concepts and features of the invention that are fully described herein without being expressly identified as being part of such a specific disclosure or therein, which disclosure is instead set forth in the appended claims. Descriptions of exemplary methods and processes are not limited to including all steps as required in all cases, nor should they be construed as requiring or requiring the order in which the steps are presented, unless expressly stated. Furthermore, the therapeutic techniques, methods, operations, steps, etc. described or suggested herein may be performed in live animals or in non-vivo simulated experiments, such as cadavers, cadaver hearts, simulated experimental devices (e.g., simulated body parts, tissues, etc.). The terms used in the claims have their full ordinary meaning and are not limited in any way by the description of the embodiments herein. [Explanation of symbols]

[0210] 10 Valve Repair Devices 20, 22 leaflets 30 Anterior leaflet 32 Septal leaflet 34 Posterior leaflet 100 devices 100A Device 101 Devices 102 Delivery sheath or means for delivery 104 Joints or joint forming parts 106 Anchor part 108 Anchor 110 Joining elements or means for joining 111, 113 Drive element or drive wire 112 Driving elements or means for driving 114 Cap 115, 117 Cap 116 Drive Line 120 Outer Paddle 122 Inner Paddle 124, 126, and 128 Connections 130 Closure with bar 132 Base or fixed arm 134 Movable Arm 136 Barbs or other means of fastening 138 Joint 159 areas 160 areas 200 Prosthetic Spacer Device 201 Side 202 Delivery sheath or system 203 Central plane 204 Joint 205 Proximal or Attachment 206 Anchor section 207 Distal 208 Anchor 210 Joint elements 211 First or Proximal Collar 212 Driving Elements 213 Capture mechanism 214 Cap 220 Outer Paddle 221 Connecting part 222 Inner Paddle 223 Connecting part 224 Paddle extension member or paddle frame 230 Fasteners 231 Hole or slot 232 Base or fixed arm 234 Movable Arm 235 holes 236 Return 238 Joint 240 Cover 300 Implantable prosthetic spacer device 301 Material Strips 302 Spacer member 304 Joint 305 Proximal or Attachment 306 Anchor part 307 Distal 308 Anchor 310 Joint elements 311 First or Proximal Collar 314 Cap 320 Outer Paddle 321 Connection section 322 Inner Paddle 323 Connecting part 324 Paddle extension member or paddle frame 325 Connecting part 330 Fasteners 330 Closure with bar 332 Base or fixed arm 334 Movable Arm 336 Return 338 Joint 400 Implantable Prosthetic Devices 402 Paddle 404 Gripping member 406 Aperture 410 Rotation or turning direction 412 Translation direction 420 First Width 422 Second Width 500 Implantable prosthetic spacer device, implantable prosthetic device 501 Proximal 502 Distal 503 Spacer connecting protrusion 504 Joint 505 Gap 506 Anchor part 508 Anchor 510 Central or main shaft 511 Proximal end 512 Proximal end 513 Center opening 514 Parallel Paddle Slots 515 Mounting protrusion 516 Gap 517 First Cam Slot 518 Second Cam Slot 519 Protrusion 520 Joint elements 521 Proximal end 522 Distal end 523 Center opening 524 Assembly Slot or Groove 525 Engagement or locking recess 526 Tapered cut 527 Rounded Slots or Clearance Openings 530 Paddle 531 Proximal end 532 Distal end 533 Proximal mounting contact surface 534 Connecting part 535 Widening section 537 Aperture 538 Inner part 539 Intermediate connection 540 Outer part 541 First Connection 542 Upper flexible member 543 Second Connection 544 Lower flexible member 545 Third Connection 546 Connecting part 547 Mounting contact surface 550 Optional Spreader 551 Proximal end 552 Distal end 553 Center Rod 554 Threaded Aperture 555 Mounting part 556 Cam part 558 Cam surface 560 Distal Cap Assembly 561 Threaded Bolt 562 Washer 563 Square shaped central opening 564 Rectangular shaped side opening 565 Paddle Slot 566 Distal Retaining Nut 567 Lock End 568 Threaded Aperture 569 Side Slot 570 Paddle Frame 571 Cap attachment part 572 Paddle connection part 573 First End 574 Loop section 575 Second End 576 Depression 577 Mounting Hole 579 Connecting part 580 Fasteners 581 Slots 582 Fixed Arm 584 Movable Arm 585 holes 586 Return 588 Hinge part 590 Delivery System 591 Driving Elements 592 Capture mechanism 594 Moving parts 596 Drive Line 610 Cutout 612 Flange 614 Recapture Tether Passage 630 Paddle 632 Connecting part 634 Aperture 650 Spreading member 651 Proximal end 652 Distal end 653 Center Rod 654 Center opening 656 Cam part 658 Cam surface 691 Drive Tube 1520 Joint elements 1521 Proximal end 1522 Distal end 1523 Center opening 1528 Main body 1530 Arm section 1531 Aperture 1532 Distal Arm 1533 Distal opening 2520 Connection elements 2521 Proximal end 2522 Distal end 2523 Center opening 2528 Main body 2530 Projections or wing-like parts 2531 Aperture 3520 Joint elements 3521 Proximal end 3522 Distal end 3523 Center opening 3528 Main unit 3530 Projection or wing-like part 3531 Aperture 4520 Joint elements 4521 Proximal end 4522 Distal end 4523 Center opening 4528 Main body 4530 Protrusion / wing-like part 4531 Aperture 4533 Groove 5520 Joint elements 5521 Proximal end 5522 Distal end 5523 Center opening 5528 Main body 5530 Projection or wing-like part 5531 Aperture 5533 Groove 6520 Joint elements 6521 Proximal end 6522 Distal end 6523 Center opening 6528 Main unit 6530 Projection or wing-like part 6531 Groove 7020 Joint elements

Claims

1. 1. A valve repair device for repairing a native valve in a patient, comprising: a joining element formed from a solid or hollow piece of molding material; an anchor portion movable between an open position and a closed position and having a plurality of anchors configured to attach to a patient's native valve and hold leaflets of the native valve against the coaptation element; 1. A valve repair device comprising:

2. The valve repair device of claim 1 , wherein the interface element is formed by injection molding.

3. a main shaft extending from the anchor portion; The valve repair device of claim 1 or 2, characterized in that the coaptation element is removably attached to the main shaft.

4. 4. The valve repair device of claim 3, wherein the interface element is attached to the main shaft with a quarter turn connection.

5. The valve repair device according to any one of claims 1 to 4, characterized in that the coaptation element is made of solid or foamed plastic.

6. The valve repair device of claim 1 , wherein the coaptation element comprises a body portion and a plurality of wing-like portions.

7. 7. The valve repair device of claim 6, wherein the wing-like portions are separated by tapered grooves.

8. 1. A valve repair system for repairing a native valve in a patient, comprising: The main shaft, a mounting projection extending outwardly from the main shaft; A joint, a central opening for receiving the main shaft; a groove along the central opening that allows the attachment protrusion to pass through the interface; at least one engagement recess for receiving the mounting protrusion of the main shaft; A joint comprising: Equipped with A valve restoration system, characterized in that the interface element is formed from a solid or hollow molded piece of material.

9. The system of claim 8 , further comprising a drive element extending through the main shaft.

10. 10. The system of claim 8, further comprising a cap attached to the drive element, the cap being movable by the drive element away from the main shaft.

11. 11. The system of claim 9 or 10, further comprising a plurality of paddle portions movable between an open position and a closed position and configured for attachment to the patient's natural valve, the system preferably further comprising at least one fastener attached to each of the plurality of paddle portions.

12. 12. The system of claim 11, wherein movement of a cap toward the main shaft causes the paddle portion to move to a closed position, and movement of the cap away from the main shaft causes the paddle portion to move to an open position.

13. 13. The system according to claim 8, wherein the joining element is formed by injection molding.

14. 14. The system according to claim 8, wherein the joint element comprises a body portion and a plurality of wing-like portions.

15. 15. The system of claim 8, wherein the groove and the at least one engaging recess are spaced approximately 90 degrees apart about the central opening of the interface.

Images