Sealing member for prosthetic heart valve

Abstract

To fulfill, while covers used on an external surface of an endovascular prosthesis to prevent paravalvular leaking are well known, a remaining need for improved coverings that provide enhanced sealing while still providing a small profile suitable for percutaneous delivery to a patient.SOLUTION: A prosthetic heart valve includes an annular frame, which has an inflow end and an outflow end and is radially compressible and expandable between a radially compressed configuration and a radially expanded configuration. The prosthetic heart valve further includes a leaflet structure positioned within and secured to the frame, and an outer sealing member mounted outside the frame and adapted to seal against a surrounding tissue when the prosthetic heart valve is implanted in a native heart valve annulus of a patient. The outer sealing member can include a mesh layer and a pile layer comprising a plurality of pieces of pile yarn extending outwardly from the mesh layer.SELECTED DRAWING: Figure 2

Description

[Technical Field]

[0001] FIELD OF THE DISCLOSURE The present disclosure relates to implantable, expandable prosthetic devices, as well as methods and devices for such prosthetic devices. [Background technology]

[0002] The human heart can suffer from a variety of valvular diseases. These valvular diseases can result in significant cardiac dysfunction and ultimately require replacement of the native valve with a prosthetic valve. There are several known prosthetic valves and several known methods for implanting these prosthetic valves in humans. Due to the drawbacks associated with traditional open-heart surgery, percutaneous, minimally invasive surgical approaches have attracted significant attention. In one technique, prosthetic valves are configured to be implanted in a much less invasive procedure via catheterization. For example, a collapsible transcatheter prosthetic heart valve can be crimped into a compressed state, introduced percutaneously onto a catheter in the compressed state, and expanded to a functional size at a desired location by inflation of a balloon or by utilization of a self-expanding frame or stent.

[0003] Prosthetic valves used in such procedures may include a radially collapsible and expandable frame to which the leaflets of the prosthetic valve may be coupled. For example, U.S. Patent Nos. 6,730,118, 7,393,360, 7,510,575, and 7,993,394 describe exemplary collapsible transcatheter heart valves (THVs).

[0004] A challenge with catheter-implanted prosthetic valves is the process of crimping such prosthetic valves into a profile suitable for percutaneous delivery into a subject. Another challenge is controlling paravalvular leakage around the valve, which can occur for some time after initial implantation.

[0005] Paravalvular leakage has been a known problem since the introduction of the first replacement valves. The earliest prosthetic heart valves, surgically implanted, included a circumferential sewing ring configured to extend into the space within the tissue surrounding the implanted prosthesis to prevent paravalvular leakage. For example, U.S. Patent No. 3,365,728 describes a surgically implanted prosthetic heart valve including a rubber "cushion ring" that conforms to tissue irregularities to form an effective seal between the valve and the surrounding tissue. From there, vascular stents or stent-grafts, which can be implanted via non-surgical catheterization techniques, were developed. These stents included fabric coverings that allowed the stent to separate and reinforce the vessel wall from the vessel lumen. These fabric coverings essentially served the same purpose as the sealing rings on surgical heart valves, reducing the risk of blood leakage between the prosthesis and the surrounding tissue. Several graft designs have been developed that further strengthen the external seal to prevent blood from flowing between the graft and the surrounding cardiovascular tissue. For example, U.S. Patent No. 6,015,431 to Thornton discloses a seal secured to the outer surface of a stent, which is configured to conform to the irregular surface of the surrounding tissue to seal against outward leakage around the stent wall between the outer surface and the endolumenal wall when the stent is deployed. U.S. Patent Application Publication No. 2003 / 0236567 to Elliot similarly discloses a tubular prosthesis having a stent and one or more fabric "skirts" that seal against endoleaks. U.S. Patent Application Publication No. 2004 / 0082989 to Cook et al. also recognizes the possibility of endoleaks and describes a stent graft having a cuff portion with an external sealing zone extending around the body of the stent to prevent leakage. The cuff portion can be folded to create a pocket that collects blood passing around the leading edge of the graft and prevents endoleaks.

[0006] Building on this technology, the first permanent bioprosthetic heart valve was implanted in the late 1980s using a transcatheter technique. U.S. Patent No. 5,411,552 to Andersen describes a THV that includes a valve mounted within a collapsible and expandable stent structure. Certain embodiments have additional graft material applied along the outer and inner surfaces of the THV. Similar to stent grafts, the coverings proposed for use with THVs are designed to conform to the surface of the surrounding tissue to prevent paravalvular leakage.

[0007] As with stents, a "cuff" or other outer seal was used on the THV. Bessler, U.S. Patent No. 5,855,601, describes a self-expanding THV with a cuff portion that extends along the outside of the stent. When the stent is folded for delivery, the outer seal folds to form pleats and then expands with the stent to provide a seal between the THV and the surrounding tissue.

[0008] A different THV design was subsequently described by Pavcnik in U.S. Patent Application Publication No. 2001 / 0039450. Pavcnik's enhanced sealing structure was in the form of corner "flaps" or "pockets" that were secured to the stent at the edges of each "flap" or "pocket" and positioned at distinct locations around the prosthesis. The corner flaps were designed to capture retrograde blood flow, providing a better seal between the THV and the vessel wall, as well as providing an improved substrate for autologous tissue ingrowth.

[0009] Thus, fabrics and other materials used to cover and seal both the inner and outer surfaces of THVs and other endovascular prostheses, such as stents and stent-grafts, are well known. These covers can be made of low-porosity woven materials, for example, as described in U.S. Patent No. 5,957,949 to Leonhardt et al., which describes a valve stent having an outer covering that can conform to the surrounding anatomy upon implantation to help prevent blood leakage.

[0010] Some more recent THV designs include THVs with an outer covering. U.S. Patent No. 7,510,575 to Spenser discloses a THV with a cuff portion wrapped around the outer surface of a supporting stent at the inlet. The cuff portion is rolled up over the edge of the frame to provide a "sleeve-like" portion at the inlet, forming a cuff over the inlet that helps prevent blood leakage. U.S. Patent No. 8,002,825 to Letac and Cribier describes an inner cover that extends from the base of the valve to the lower end of the stent and then up the outer wall of the stent to form an outer cover. The integral cover can be made of any of the materials disclosed for making the valve structure, including fabrics (e.g., Dacron), biomaterials (e.g., pericardium), or other synthetic materials (e.g., polyethylene). [Prior art documents] [Patent documents]

[0011] [Patent Document 1] U.S. Patent No. 6,730,118 [Patent Document 2] U.S. Patent No. 7,393,360 [Patent Document 3] U.S. Patent No. 7,510,575 [Patent Document 4] U.S. Patent No. 7,993,394 [Patent Document 5] U.S. Patent No. 3,365,728 [Patent Document 6] U.S. Patent No. 6,015,431 [Patent Document 7] US Patent Application Publication No. 2003 / 0236567 [Patent Document 8] US Patent Application Publication No. 2004 / 0082989 [Patent Document 9] U.S. Patent No. 5,411,552 [Patent Document 10] U.S. Patent No. 5,855,601 [Patent Document 11] US Patent Application Publication No. 2001 / 0039450 [Patent Document 12] U.S. Patent No. 5,957,949 [Patent Document 13] U.S. Patent No. 8,002,825 [Patent Document 14] U.S. Patent Application Serial No. 14 / 704,861 [Patent Document 15] US Patent Application Publication No. 2012 / 0123529 [Patent Document 16] U.S. Provisional Patent Application No. 62 / 449,320 [Patent Document 17] U.S. Patent Application Serial No. 15 / 876,053 [Patent Document 18] US Patent Application Publication No. 2013 / 0030519 Summary of the Invention [Problem to be solved by the invention]

[0012] While covers used on the outer surface of endovascular prostheses to prevent paravalvular leakage are well known, there remains a need for improved coverings that provide an enhanced seal while still providing a small profile suitable for percutaneous delivery to a patient. [Means for solving the problem]

[0013] Disclosed herein are embodiments of a radially collapsible and expandable prosthetic valve including an improved outer skirt that reduces paravalvular leakage, as well as related methods and devices including such a prosthetic valve. In some embodiments, the disclosed prosthetic valve is configured as a replacement heart valve implanted in a subject.

[0014] In one exemplary embodiment, the prosthetic heart valve includes an annular frame including an inflow end and an outflow end, the annular frame being radially compressible and expandable between a radially compressed configuration and a radially expanded configuration. The prosthetic heart valve further includes a leaflet structure positioned within and secured to the frame, and an outer seal member attached to the exterior of the frame and configured to seal against surrounding tissue when the prosthetic heart valve is implanted in a patient's native heart valve annulus. The seal member may include a mesh layer and a pile layer including a plurality of pile yarns extending outward from the mesh layer.

[0015] In some embodiments, the mesh layer comprises a knitted or woven fabric.

[0016] In some embodiments, the pile yarns are arranged to form a looped pile.

[0017] In some embodiments, the pile yarns are cut to form cut pile.

[0018] In some embodiments, the height of the pile yarns varies along the height and / or circumference of the outer skirt.

[0019] In some embodiments, the pile yarns include a first group of yarns along an upstream portion of the outer skirt and a second group of yarns along a downstream portion of the outer skirt, the first group of yarns having a height that is less than the height of the second group of yarns.

[0020] In some embodiments, the pile yarns include a first group of yarns along an upstream portion of the outer skirt and a second group of yarns along a downstream portion of the outer skirt, the first group of yarns having a height greater than the height of the second group of yarns.

[0021] In some embodiments, the pile yarns include a first group of yarns along an upstream portion of the outer skirt, a second group of yarns along a downstream portion of the outer skirt, and a third group of yarns between the first and second group of yarns, wherein the first and second group of yarns have a height greater than the height of the third group of yarns.

[0022] In some embodiments, the prosthetic heart valve further includes an inner skirt mounted on an inner surface of the frame, the inner skirt having an inflow end portion secured to the inflow end portion of the outer seal member.

[0023] In some embodiments, the inlet end portion of the inner skirt wraps around the inlet end of the frame and overlaps the inlet end portion of the outer seal member on the outside of the frame.

[0024] In some embodiments, the mesh layer includes a first mesh layer, and the outer seal member further includes a second mesh layer disposed radially outward of the pile layer.

[0025] In some embodiments, the outer seal member is configured to expand axially when the frame is radially compressed to the radially compressed state.

[0026] In some embodiments, the mesh layer includes warp yarns and weft yarns woven with the warp yarns, and the pile layer includes the warp yarns or weft yarns of the mesh layer woven or knitted to form the pile yarns.

[0027] In some embodiments, the mesh layer comprises a woven fabric layer and the pile layer comprises a separate pile layer sewn to the woven fabric layer.

[0028] In some embodiments, the mesh layer has a first height extending axially along the frame and the pile layer includes a second height extending axially along the frame, the first height being greater than the second height.

[0029] In some embodiments, the mesh layer extends closer to the outflow end of the frame than the pile layer.

[0030] In another exemplary embodiment, a prosthetic heart valve includes an annular frame including an inflow end and an outflow end, the prosthetic heart valve being radially compressible and expandable between a radially compressed configuration and a radially expanded configuration. The prosthetic heart valve further includes a leaflet structure positioned within and secured to the frame, and an outer seal member attached to the exterior of the frame and configured to seal against surrounding tissue when the prosthetic heart valve is implanted in a patient's native heart valve annulus. The seal member may include a fabric having a variable thickness.

[0031] In some embodiments, the thickness of the fabric layer varies along the height and / or circumference of the outer seal member.

[0032] In some embodiments, the fabric comprises a plush fabric.

[0033] In some embodiments, the fabric comprises a plurality of pile yarns, the height of the pile yarns varying along the height and / or circumference of the outer skirt.

[0034] In some embodiments, the pile yarns include a first group of yarns along an upstream portion of the outer skirt and a second group of yarns along a downstream portion of the outer skirt, the first group of yarns having a height that is less than the height of the second group of yarns.

[0035] In some embodiments, the pile yarns include a first group of yarns along an upstream portion of the outer skirt and a second group of yarns along a downstream portion of the outer skirt, the first group of yarns having a height greater than the height of the second group of yarns.

[0036] In some embodiments, the pile yarns include a first group of yarns along an upstream portion of the outer skirt, a second group of yarns along a downstream portion of the outer skirt, and a third group of yarns between the first and second group of yarns, wherein the first and second group of yarns have a height greater than the height of the third group of yarns.

[0037] In another exemplary embodiment, a prosthetic heart valve includes an annular frame including an inflow end and an outflow end, the prosthetic heart valve being radially compressible and expandable between a radially compressed configuration and a radially expanded configuration. The prosthetic heart valve further includes a leaflet structure positioned within and secured to the frame, and an outer seal member attached to the exterior of the frame and configured to seal against surrounding tissue when the prosthetic heart valve is implanted in a patient's native heart valve annulus. The seal member may include a pile fabric including a plurality of pile yarns, the density of the pile yarns varying axially and / or circumferentially along the seal member.

[0038] In some embodiments, the pile yarns are arranged in rows extending in the circumferential direction of the pile yarns, with the density of the pile yarns varying from row to row.

[0039] In some embodiments, the pile yarns are arranged in rows extending in the axial direction of the pile yarns, and the density of the pile yarns varies from row to row.

[0040] In some embodiments, the seal member includes a mesh layer and a pile layer including pile yarns. In some embodiments, the weave density of the mesh layer varies axially and / or circumferentially along the seal member. In some embodiments, the mesh layer includes one or more rows of higher density mesh portions and one or more rows of lower density mesh portions. The one or more rows of higher density mesh portions and the one or more rows of lower density mesh portions may be circumferentially extending rows and / or axially extending rows.

[0041] In another exemplary embodiment, a prosthetic heart valve includes an annular frame including an inflow end and an outflow end, the prosthetic heart valve being radially compressible and expandable between a radially compressed configuration and a radially expanded configuration. The prosthetic heart valve further includes a leaflet structure positioned within the frame and secured to the frame, and an outer seal member attached to the outside of the frame and configured to seal against surrounding tissue when the prosthetic heart valve is implanted in a patient's native heart valve annulus. The seal member includes a fabric formed from a plurality of fibers arranged in multiple axially extending rows of higher stitch densities interleaved with multiple axially extending rows of lower stitch densities. The seal member is configured to axially stretch between a first, substantially relaxed, axially contracted configuration when the frame is in the radially expanded configuration and a second, axially elongated configuration when the frame is in the radially compressed configuration.

[0042] In some embodiments, each of the higher stitch density rows can extend in an undulating pattern when the seal member is in the axially contracted configuration, and the higher stitch density rows move from an undulating pattern toward a straight pattern when the seal member is in the axially elongated configuration.

[0043] In another exemplary embodiment, a prosthetic heart valve includes an annular frame including an inflow end and an outflow end, the prosthetic heart valve being radially compressible and expandable between a radially compressed configuration and a radially expanded configuration. The prosthetic heart valve further includes a leaflet structure positioned within the frame and secured to the frame, and an outer seal member attached to the outside of the frame and configured to seal against surrounding tissue when the prosthetic heart valve is implanted in a patient's native heart valve annulus. The seal member includes a fabric including a plurality of axially extending filaments and a plurality of circumferentially extending filaments. The seal member is configured to stretch axially when the frame is radially compressed from the radially expanded configuration to the radially compressed configuration. The axially extending filaments move from a deformed or twisted state when the frame is in the radially expanded configuration to a less deformed or twisted state when the frame is in the radially compressed configuration.

[0044] In some embodiments, the axially extending filaments are heat set in a deformed or twisted state.

[0045] In some embodiments, the thickness of the seal member decreases when the axially extending filaments move from a deformed or twisted state to a less deformed or twisted state. [Brief explanation of the drawings]

[0046] [Figure 1] FIG. 1 is a perspective view of a prosthetic heart valve according to one embodiment. [Figure 2] FIG. 2 is an enlarged perspective view of the inflow end portion of the prosthetic heart valve of FIG. 1. [Figure 3] FIG. 2 is a cross-sectional view of the prosthetic heart valve of FIG. 1, showing the attachment of the outer skirt to the inner skirt and frame. [Figure 4] 2 illustrates an exemplary frame for the prosthetic heart valve of FIG. 1. [Figure 5] 2 illustrates an exemplary frame for the prosthetic heart valve of FIG. 1. [Figure 6]2 illustrates an exemplary frame for the prosthetic heart valve of FIG. 1. [Figure 7] 2 illustrates an exemplary frame for the prosthetic heart valve of FIG. 1. [Figure 8] 2 illustrates an exemplary frame for the prosthetic heart valve of FIG. 1. [Figure 9] 2 illustrates an exemplary frame for the prosthetic heart valve of FIG. 1. [Figure 10] 2 illustrates an exemplary frame for the prosthetic heart valve of FIG. 1. [Figure 11] 2 illustrates an exemplary inner skirt of the prosthetic heart valve of FIG. 1. [Figure 12] 2 illustrates an exemplary inner skirt of the prosthetic heart valve of FIG. 1. [Figure 13] 12 shows the assembly of the inner skirt of FIG. 11 with the frame of FIG. 4. [Figure 14] 12 shows the assembly of the inner skirt of FIG. 11 with the frame of FIG. 4. [Figure 15] 12 shows the assembly of the inner skirt of FIG. 11 with the frame of FIG. 4. [Figure 16] 1 illustrates an exemplary leaflet structure assembly. [Figure 17] 1 illustrates an exemplary leaflet structure assembly. [Figure 18] 10 shows the assembly of the commissure portion of the leaflet structure and the window frame portion of the frame. [Figure 19] 10 shows the assembly of the leaflet structure and inner skirt along the inferior edge of the leaflet. [Figure 20] 10 shows the assembly of the leaflet structure and inner skirt along the inferior edge of the leaflet. [Figure 21] 2A-2C are different views of an exemplary outer skirt of the prosthetic heart valve of FIG. 1. [Figure 22] 2A-2C are different views of an exemplary outer skirt of the prosthetic heart valve of FIG. 1. [Figure 23] 2A-2C are different views of an exemplary outer skirt of the prosthetic heart valve of FIG. 1. [Figure 24] 4 is a cross-sectional view similar to FIG. 3 but showing a different embodiment of the outer skirt. [Figure 25]4 is a cross-sectional view similar to FIG. 3 but showing a different embodiment of the outer skirt. [Figure 26] 4 is a cross-sectional view similar to FIG. 3 but showing a different embodiment of the outer skirt. [Figure 27] 10 illustrates an alternative method of securing the outer skirt to the inner skirt and / or frame of the prosthetic heart valve. [Figure 28] 10 illustrates an alternative method of securing the outer skirt to the inner skirt and / or frame of the prosthetic heart valve. [Figure 29] 10 illustrates another method of securing the outer skirt to the inner skirt and / or frame of the prosthetic heart valve. [Figure 30] 10 illustrates another method of securing the outer skirt to the inner skirt and / or frame of the prosthetic heart valve. [Figure 31] 10 illustrates another method of securing the outer skirt to the inner skirt and / or frame of the prosthetic heart valve. [Figure 32] 10 illustrates another method of securing the outer skirt to the inner skirt and / or frame of the prosthetic heart valve. [Figure 33] 10 shows another embodiment of an outer sealing member of a prosthetic heart valve. [Figure 34] 10 shows another embodiment of an outer sealing member of a prosthetic heart valve. [Figure 35] 10 shows another embodiment of an outer sealing member of a prosthetic heart valve. [Figure 36] 10 illustrates another embodiment of an outer seal member shown mounted on the frame of a prosthetic heart valve. [Figure 37] FIG. 37 is a flattened view of the woven mesh layer of the seal member of FIG. 36. [Figure 38] FIG. 37 is a plan view of the pile layer of the sealing member of FIG. 36. [Figure 39] FIG. 10 is a plan view of the outer surface of an outer sealing member of a prosthetic heart valve according to another embodiment. [Figure 39A] FIG. 40 is an enlarged view of a portion of the seal member of FIG. 39. [Figure 40] FIG. 40 is a plan view of the inner surface of the seal member of FIG. 39. [Figure 40A] FIG. 41 is an enlarged view of a portion of the seal member of FIG. 40. [Figure 41] 10 is a plan view of an outer sealing member of a prosthetic heart valve shown in a relaxed state when the prosthetic heart valve has been radially expanded to its functional size, according to another embodiment. FIG. [Figure 42] 42 is a plan view of the outer seal member of FIG. 41 shown in an axially elongated tensioned state when the prosthetic heart valve is in a radially compressed state for delivery. [Figure 43A] FIG. 10 is an enlarged view of a portion of another embodiment of an outer sealing member of a prosthetic heart valve, the sealing member shown in a relaxed state when the prosthetic heart valve has been radially expanded to its functional size. [Figure 43B] FIG. 43B is an enlarged view of the seal member of FIG. 43A shown in an axially elongated tensioned state when the prosthetic heart valve is in a radially compressed state for delivery. [Figure 44A] FIG. 43B is a cross-sectional view of the seal member fabric of FIG. 43A in a relaxed state. [Figure 44B] FIG. 43C is a cross-sectional view of the seal member fabric of FIG. 43B in a tensioned state. DETAILED DESCRIPTION OF THE INVENTION

[0047] FIG. 1 illustrates a prosthetic heart valve 10 according to one embodiment. The illustrated prosthetic valve is configured for implantation in a native aortic valve annulus, but in other embodiments, it may be configured for implantation in other native valve annulus of the heart (e.g., the pulmonary, mitral, and tricuspid valves). The prosthetic valve may also be configured for implantation in other tubular organs or passageways of the body. The prosthetic valve 10 may have four main components: a stent or frame 12, a valve structure 14, an inner skirt 16, and a perivalvular outer sealing member or outer skirt 18. The prosthetic valve 10 may have an inflow end portion 15, an intermediate portion 17, and an outflow end portion 19.

[0048] The valve structure 14 may include three leaflets 40 ( FIG. 17 ), which collectively form a leaflet structure that may be arranged to fold in a tricuspid valve configuration. The lower edge of the leaflet structure 14 desirably has an undulating, curved, fan-shaped configuration (the suture line 154 shown in FIG. 20 follows the fan-shaped configuration of the leaflet structure). Forming the leaflets with this fan-shaped configuration reduces stress on the leaflets, thereby improving the durability of the prosthetic valve. Furthermore, the fan-shaped configuration may eliminate or at least minimize folds and corrugations in the belly (central region of each leaflet) of each leaflet, which can cause premature calcification in those areas. The fan-shaped configuration also reduces the amount of tissue material used to form the leaflet structure, thereby allowing for a smaller, more uniform crimp profile at the inflow end of the prosthetic valve. The valve leaflets 40 may be formed from pericardial tissue (e.g., bovine pericardial tissue), a biocompatible synthetic material, or a variety of other suitable natural or synthetic materials known in the art and as described in U.S. Pat. No. 6,730,118.

[0049] The bare frame 12 is shown in FIG. 4 . The frame 12 may be formed with a plurality of circumferentially spaced slots, or commissural windows 20 (three in the illustrated embodiment), configured to attach the commissures of the valve structure 14 to the frame, as described in further detail below. The frame 12 may be made of any of a variety of suitable plastically expandable materials (e.g., stainless steel, etc.) or self-expanding materials (e.g., nickel-titanium alloys (NiTi) such as Nitinol) as known in the art. If constructed of a plastically expandable material, the frame 12 (and thus the prosthetic valve 10) may be crimped into a radially collapsed configuration onto a delivery catheter and then expanded inside the patient by an inflatable balloon or equivalent expansion mechanism. If constructed of a self-expandable material, the frame 12 (and thus the prosthetic valve 10) may be crimped into a radially collapsed configuration and constrained in the collapsed configuration by insertion of the delivery catheter into a sheath or equivalent mechanism. Once inside the body, the prosthetic valve may be advanced from the delivery sheath, causing it to expand to its functional size.

[0050] Suitable plastically expandable materials that can be used to form the frame 12 include, but are not limited to, stainless steel, biocompatible high-strength alloys (e.g., cobalt-chromium or nickel-cobalt-chromium alloys), polymers, or combinations thereof. In certain embodiments, the frame 12 is made of a nickel-cobalt-chromium-molybdenum alloy, such as MP35N® alloy (SPS Technologies, Jenkintown, Pennsylvania), which is equivalent to UNS R30035 alloy (covered by ASTM F562-02). MP35N® alloy / UNS R30035 alloy contains 35% nickel, 35% cobalt, 20% chromium, and 10% molybdenum by weight. The use of MP35N® alloy to form the frame 12 has been found to provide superior structural results compared to stainless steel. Specifically, when MP35N® alloy is used as the frame material, less material is needed to achieve the same or better performance in radial and crush force resistance, fatigue resistance, and corrosion resistance. Furthermore, because less material is needed, the crimp profile of the frame can be reduced, thereby providing a lower-profile prosthetic valve assembly for percutaneous delivery to a treatment location within the body.

[0051] 4 and 5, the frame 12 of the illustrated embodiment is arranged end-to-end and includes a first lower row I of circumferentially extending angled struts 22 at the inflow end of the frame; a second row II of circumferentially extending angled struts 24; a third row III of circumferentially extending angled struts 26; a fourth row IV of circumferentially extending angled struts 28; and a fifth row V of circumferentially extending angled struts 32 at the outflow end of the frame. A plurality of substantially straight, axially extending struts 34 may be used to interconnect the struts 22 of the first row I with the struts 24 of the second row II. The fifth row V of circumferential struts 32 are connected to the fourth row IV of circumferential struts 28 by a plurality of axially extending window frame portions 30 (defining the commissural windows 20) and a plurality of axially extending struts 31. Each axial strut 31 and each frame section 30 extends from a location defined by the convergence of the lower ends of two inclined struts 32 to another location defined by the convergence of the upper ends of two inclined struts 28. Figures 6, 7, 8, 9, and 10 are enlarged views of portions of frame 12 identified by the letters A, B, C, D, and E, respectively, in Figure 5.

[0052] Each commissure window frame segment 30 mounts a respective commissure of the leaflet structure 14. As shown, each frame segment 30 has its upper and lower ends secured to adjacent rows of struts, providing a sturdy configuration that enhances fatigue resistance under cyclic loading of the prosthetic valve compared to known cantilever-type struts for supporting the commissures of the leaflet structure. This configuration allows for a reduction in the wall thickness of the frame, achieving a smaller crimp diameter for the prosthetic valve. In certain embodiments, the thickness T of the frame 12 (FIG. 4), measured between the inner and outer diameters, is about 0.48 mm or less.

[0053] The frame struts and frame portions collectively define a plurality of open cells in the frame. At the inflow end of frame 12, struts 22, 24, and 34 define a lower row of cells that define opening 36. The second row of struts 24, the third row of struts 26, and the fourth row of struts 28 define the middle two rows of cells that also define opening 38. The fourth row of struts 28 and the fifth row of struts 32, together with frame portion 30 and struts 31, define an upper row of cells that define opening 40. Opening 41 is relatively large and sized to allow portions of leaflet structure 14 to protrude or bulge into and / or through opening 40 when frame 12 is crimped to minimize the crimp profile.

[0054] As best shown in FIG. 7 , the lower end of strut 31 connects to two struts 28 at nodes or junctions 44, and the upper end of strut 31 connects to two struts 32 at nodes or junctions 46. Strut 31 may have a thickness S1 that is less than thickness S2 at junctions 44, 46. Junctions 44, 46, along with junction 64, prevent opening 40 from completely closing. The geometry of strut 31 and junctions 44, 46, and 64 helps create sufficient space in opening 41 in the collapsed configuration to allow some of the prosthetic leaflets to protrude or bulge outward through the opening. This allows the prosthetic valve to be crimped to a relatively small diameter compared to when all of the leaflet material is constrained within the crimped frame.

[0055] The frame 12 is configured to reduce, prevent, or minimize potential overexpansion of the prosthetic valve at a given balloon pressure, particularly at the outflow end portion of the frame that supports the leaflet structure 14. In one aspect, the frame is configured with relatively large angles 42a, 42b, 42c, 42d, and 42e between the struts, as shown in FIG. 5. The larger the angle, the greater the force required to open (expand) the frame. Thus, the angles between the struts of the frame can be selected to limit the radial expansion of the frame at a given opening pressure (e.g., balloon inflation pressure). In certain embodiments, these angles are at least 110° or greater when the frame is expanded to its functional size, and more specifically, these angles are up to about 120° when the frame is expanded to its functional size.

[0056] Furthermore, the inflow and outflow ends of the frame generally tend to overexpand more than the central portion of the frame due to the "dog-boning" effect of the balloon used to expand the prosthetic valve. To protect the leaflet structure 14 from overexpansion, the leaflet structure is desirably secured to the frame 12 below the upper row of struts 32, as best shown in FIG. 1. Thus, if the outflow end of the frame overexpands, the leaflet structure will be positioned below the level at which overexpansion would occur, thereby protecting the leaflet structure from overexpansion.

[0057] In known prosthetic valve structures, portions of the valve leaflets may protrude longitudinally beyond the outflow end of the frame when the prosthetic valve is crimped if the leaflets are mounted too close to the distal end of the frame. If the delivery catheter onto which the crimped prosthetic valve is mounted includes a pressing mechanism or stop member that presses against or abuts the outflow end of the prosthetic valve (e.g., to maintain the position of the crimped prosthetic valve on the delivery catheter), the pressing or stop member may damage the exposed portion of the leaflet that extends beyond the outflow end of the frame. Another advantage of mounting the leaflets away from the outflow end of the frame is that when the prosthetic valve is crimped onto the delivery catheter, the outflow end of the frame 12, rather than the leaflets 40, becomes the most proximal component of the prosthetic valve 10. Thus, if the delivery catheter includes a pressing mechanism or stop member that presses against or abuts the outflow end of the prosthetic valve, the pressing mechanism or stop member contacts the outflow end of the frame and not the leaflets 40, avoiding damage to the leaflets.

[0058] Also, as can be seen in FIG. 5 , openings 36 in the bottom row of openings in the frame are relatively larger than openings 38 in the middle two rows of openings. This allows the frame, when crimped, to assume an overall tapered shape, tapering from a maximum diameter at the outflow end of the prosthesis to a minimum diameter at the inflow end of the prosthesis. When crimped, frame 12 has a reduced diameter region extending along a portion of the frame adjacent the inflow end of the frame that generally corresponds to the area of ​​the frame covered by outer skirt 18. In some embodiments, the reduced diameter region is reduced relative to the diameter of the upper portion of the frame (not covered by the outer skirt), such that outer skirt 18 does not increase the overall crimp profile of the prosthesis. When the prosthesis is deployed, the frame can expand to the generally cylindrical shape shown in FIG. 4 . In one example, the frame of a 26 mm prosthetic valve, when crimped, had a first diameter of 14 French at the outflow end of the prosthesis and a second diameter of 12 French at the inflow end of the prosthesis.

[0059] The primary function of the inner skirt 16 is to help secure the valve structure 14 to the frame 12 and to help form a good seal between the prosthetic valve and the native annulus by blocking blood flow through the open cells of the frame 12 below the lower edges of the valve leaflets. The inner skirt 16 desirably comprises a tough, tear-resistant material such as polyethylene terephthalate (PET), although various other synthetic or natural materials (e.g., pericardial tissue) can be used. The skirt thickness is desirably less than about 0.15 mm (about 6 mils), desirably less than about 0.1 mm (about 4 mils), and even more desirably about 0.05 mm (about 2 mils). In certain embodiments, the skirt 16 may have a variable thickness; for example, the skirt may be thicker at at least one of its edges than its center. In one implementation, the skirt 16 may comprise a PET skirt having a thickness of about 0.07 mm at the edges and about 0.06 mm at the center. A thinner skirt can provide better crimp performance while still providing a good perivalvular seal.

[0060] The inner skirt 16 may be secured to the inside of the frame 12 via sutures 70, as shown in FIG. 20. The valve structure 14 may be attached to the skirt via one or more reinforcing strips 72, discussed below (which may collectively form a sleeve), such as thin PET reinforcing strips, which allow for secure suturing and protect the pericardial tissue of the leaflet structures from tearing. The valve structure 14 may be sandwiched between the skirt 16 and the thin PET strips 72, as shown in FIG. 19. The sutures 154, which secure the PET strips and leaflet structure 14 to the skirt 16, may be any suitable suture, such as Ethibond Excel® PET suture (Johnson & Johnson, New Brunswick, NJ). The sutures 154 desirably follow the curvature of the bottom edge of the leaflet structure 14, as described in more detail below.

[0061] Known fabric skirts may include a weave of warp and weft fibers that extend perpendicular to one another, with a series of these fibers extending longitudinally between the upper and lower edges of the skirt. When the metal frame to which the fabric skirt is secured is radially compressed, the overall axial length of the frame increases. Unfortunately, fabric skirts with limited elasticity cannot stretch with the frame, and therefore tend to deform the frame's struts and prevent uniform crimping.

[0062] 12 , in contrast to known fabric skirts, skirt 16 is desirably woven from a first set of fibers, or threads or strands 78, and a second set of fibers, or threads or strands 80, neither of which are perpendicular to upper and lower edges 82, 84 of the skirt. In certain embodiments, first set of fibers 78 and second set of fibers 80 extend at an angle of approximately 45° (or 15-75°, or 30-60°) relative to upper and lower edges 82, 84. For example, skirt 16 may be formed by weaving the fibers at a 45° angle relative to the upper and lower edges of the fabric. Alternatively, skirt 16 may be diagonally cut (cut at an angle) from a vertically woven fabric (with the fibers extending perpendicular to the edges of the material), whereby the fibers extend at a 45° angle relative to the cut upper and lower edges of the skirt. 12, the opposing short edges 86, 88 of the skirt are desirably not perpendicular to the upper and lower edges 82, 84. For example, the short edges 86, 88 desirably extend at an angle of about 45° relative to the upper and lower edges, and are therefore aligned with the first set of fibers 78. The overall shape of the skirt is therefore a rhomboid or parallelogram.

[0063] 13 and 14 show the inner skirt 16 after the opposing short edge portions 90, 92 have been sewn together to form the annular shape of the skirt. As shown, edge portion 90 may be positioned in overlapping relation relative to the opposite edge portion 92, and the two edge portions may be sewn together with a diagonally extending seam 94 that is parallel to the short edges 86, 88. The upper edge portion of the inner skirt 16 may be formed with a plurality of protrusions 96 that define an undulating shape that generally follows the shape or contour of the fourth row of struts 28 immediately adjacent the lower ends of the axial struts 31. In this manner, as best shown in FIG. 15, the upper edge of the inner skirt 16 may be rigidly secured to the struts 28 with the sutures 70. The inner skirt 16 may also be formed with slits 98 to facilitate attachment of the skirt to a frame. The slits 98 are dimensioned to allow the upper edge portion of the inner skirt 16 to be partially wrapped around the posts 28, reducing stress on the skirt during the attachment procedure. For example, in the illustrated embodiment, the inner skirt 16 is placed inside the frame 12, and the upper edge portion of the skirt is wrapped around the top of the posts 28 and secured in place with sutures 70. Wrapping the upper edge portion of the inner skirt 16 around the posts 28 in this manner provides a stronger and more durable attachment of the skirt to the frame. The inner skirt 16 can also be secured to the first row of posts 22, the second row of posts 24, and / or the third row of posts 26 with sutures 70, respectively.

[0064] By orienting the fibers at an angle relative to the upper and lower edges, the skirt can undergo greater axial elongation (i.e., from the upper edge 82 to the lower edge 84). Thus, when the metal frame 12 is crimped, the inner skirt 16 elongates axially along with the frame, thus providing a more uniform and predictable crimp profile. Each cell of the metal frame in the illustrated embodiment includes at least four angled struts, which rotate axially during crimping (e.g., the angled struts are more aligned with the length of the frame). The angled struts in each cell act as a mechanism to rotate the skirt fibers in the same direction as the struts, allowing the skirt to elongate along the length of the struts. This allows for greater skirt elongation and avoids undesirable strut deformation when the prosthetic valve is crimped.

[0065] Additionally, the spacing between the woven fibers or yarns can be increased to facilitate axial skirt elongation. For example, in a PET inner skirt 16 formed from 20 denier yarn, the yarn density may be about 15% to about 30% lower than a typical PET skirt. In some embodiments, the yarn spacing of the inner skirt 16 may be about 60 threads per cm (about 155 threads per inch) to about 70 threads per cm (about 180 threads per inch), e.g., about 63 threads per cm (about 160 threads per inch), while in a typical PET skirt, the yarn spacing may be about 85 threads per cm (about 217 threads per inch) to about 97 threads per cm (about 247 threads per inch). The beveled edges 86, 88 promote even and uniform distribution of the fabric material along the inner circumference of the frame during crimping, reducing or minimizing bunching of the fabric and promoting uniform crimping to the smallest possible diameter. Additionally, cutting diagonal sutures perpendicularly can leave loose fringes along the cut edges. The angled edges 86, 88 help minimize this from happening. Compared to a typical skirt design (fibers extending perpendicular to the upper and lower skirt edges), the construction of the inner skirt 16 avoids undesirable deformation of the frame struts and results in a more uniform crimp of the frame.

[0066] In alternative embodiments, the skirt may be formed from woven elastic fibers that can stretch axially during crimping of the prosthetic valve. The warp and weft fibers may extend perpendicular and parallel to the upper and lower edges of the skirt, or, as previously described, may extend at an angle between 0 and 90 degrees relative to the upper and lower edges of the skirt.

[0067] The inner skirt 16 may be sewn to the frame 12 at a location away from the suture line 154, allowing the skirt to be more flexible in that area. This configuration avoids stress concentrations at the suture line 154, which attaches the lower edge of the leaflet to the inner skirt 16.

[0068] As previously mentioned, the leaflet structure 14 of the illustrated embodiment includes three flexible leaflets 40 (although a greater or lesser number of leaflets may be used). Additional information regarding leaflets and skirt materials may be found, for example, in U.S. Patent Application No. 14 / 704,861, filed May 5, 2015.

[0069] The leaflets 40 may be secured to one another at their adjacent sides to form commissures 122 ( FIG. 20 ) of the leaflet structure. Multiple flexible connectors 124 (one of which is shown in FIG. 16 ) may be used to interconnect pairs of adjacent sides of the leaflets and attach the leaflets to the commissure window frame portion 30 ( FIG. 5 ). FIG. 16 shows adjacent sides of two leaflets 40 interconnected by flexible connectors 124. Three leaflets 40 may be secured to one another laterally using three flexible connectors 124, as shown in FIG. 17 . Additional information regarding connecting leaflets to one another and to a frame can be found, for example, in U.S. Patent Application Publication No. 2012 / 0123529.

[0070] As previously described, the inner skirt 16 may be used to aid in sewing the leaflet structure 14 to the frame. The inner skirt 16 may have contoured temporary marking sutures to guide the attachment of the lower edge of each leaflet 40. The inner skirt 16 itself may be sewn to the struts of the frame 12 with sutures 70, as previously described, before securing the leaflet structure 14 to the skirt 16. The struts that intersect the marking sutures desirably are not attached to the inner skirt 16. This allows the inner skirt 16 to be more flexible in areas not secured to the frame and minimizes stress concentrations along the suture lines securing the lower edges of the leaflets to the skirt. As previously described, once the skirt is secured to the frame, the fibers 78, 80 (see FIG. 12 ) of the skirt generally align with the angled struts of the frame to promote uniform crimping and expansion of the frame.

[0071] FIG. 18 illustrates one specific approach to securing the commissure portions 122 of the leaflet structure 14 to the commissure window frame portion 30 of the frame. The flexible connectors 124 ( FIG. 17 ) securing the two adjacent sides of the two leaflets are folded laterally, and the upper tab portions 112 are folded downwardly relative to the flexible connectors. Each upper tab portion 112 is folded longitudinally (vertically) to assume an L-shape, with an inner portion 142 folded against the inner surface of the leaflet and an outer portion 144 folded against the connector 124. The outer portions 144 may then be sewn to the connector 124 along suture lines 146. Next, the commissure tab assemblies are inserted through the commissure windows 20 of the corresponding window frame portion 30, and the outer fold of the window frame portion 30 may be sewn to the portions 144.

[0072] FIG. 18 also illustrates that the folded upper tab portion 112 can form a double layer of leaflet material at the commissure. The inner portion 142 of the upper tab portion 112 lies flat against the layers of the two leaflets 40 that form the commissure, such that each commissure includes four layers of leaflet material immediately inward of the window frame 30. This four-layer portion of the commissure can be more resistant to bending or articulation than the portion of the leaflet 40 immediately radially inward from the relatively more rigid four-layer portion. This allows the leaflets 40 to articulate primarily at the inner edge 143 of the folded inner portion 142 in response to blood flowing through the prosthetic valve during operation in the body, as opposed to articulating around or proximal to the axial struts of the window frame 30. Because the leaflets articulate at a location spaced radially inward from the window frame 30, the leaflets can avoid contact with and damage from the frame. However, under high forces, the four-layered portions of the commissures can spread apart about the longitudinal axis adjacent the window frame 30, with each inner portion 142 folding outward relative to its respective outer portion 144. For example, this can occur when the prosthetic valve 10 is compressed and loaded onto a delivery shaft, allowing for a smaller crimp diameter. The four-layered portions of the commissures can also spread apart about the longitudinal axis when the balloon catheter is inflated during expansion of the prosthetic valve, which can relieve some of the pressure on the commissures caused by the balloon and reduce potential damage to the commissures during expansion.

[0073] After all three commissure tab assemblies are secured to their respective window frame portions 30, the lower edges of the leaflets 40 between the commissure tab assemblies may be sewn to the inner skirt 16. For example, as shown in FIG. 19, each leaflet 40 may be sewn to the inner skirt 16 along suture lines 154 using, for example, Ethibond Excel® PET thread. The sutures may be in-and-out sutures that extend through each leaflet 40, the inner skirt 16, and each reinforcement strip 72. Each leaflet 40 and each reinforcement strip 72 may be separately sewn to the inner skirt 16. In this manner, the lower edges of the leaflets are secured to the frame 12 via the inner skirt 16. As shown in FIG. 19, the leaflets may be sewn with overlock stitches that extend through each reinforcement strip 72, the leaflet 40, and the inner skirt 16 and loop around the edges of the reinforcement strips 72 and leaflets 40. The leaflet structure 14 may be further secured to the skirt with blanket sutures 156. The overlock sutures 156 may be formed from PTFE suture material. Figure 20 shows a side view of the frame 12, the leaflet structure 14, and the inner skirt 16 after they have been secured to the frame 12 and the leaflet structure 14 has been secured to the inner skirt 16.

[0074] FIG. 21 is a plan view of the outer skirt 18 before attachment to the frame 12, showing the outer surface of the skirt. FIG. 22 is a plan view of the outer skirt 18 before attachment to the frame 12, showing the inner surface of the skirt. FIG. 23 is a perspective view of the outer skirt before attachment to the frame 12. The outer skirt 18 may be laser cut or otherwise formed from a strong, durable material, such as PET or various other suitable synthetic or natural materials, configured to restrict and / or prevent blood flow therethrough. The outer skirt 18 may include a substantially straight lower (inflow or upstream) edge portion 160 and an upper (outflow or downstream) edge portion 162 that defines a plurality of alternating protrusions 164 and notches 166, or castellations, that generally follow the shape of a row of struts on the frame. The lower and upper edge portions 160, 162 may have other shapes in alternative embodiments. For example, in one implementation, the lower edge portion 160 may be formed with a plurality of protrusions that generally match the shape of a row of posts of the frame 12, and the upper edge portion 162 may be straight.

[0075] In certain embodiments, the outer skirt 18 may include at least one soft, plush surface 168 directed radially outward to cushion and seal against the natural tissue surrounding the prosthetic valve. In certain examples, the outer skirt 18 may be made of any of a variety of woven, knitted, or crocheted fabrics, with the surface 168 being a plush nap or pile surface of the fabric. Exemplary fabrics having pile include velour, velvet, bettine, corduroy, terry cloth, fleece, and the like. As best shown in FIG. 23 , the outer skirt may have a base layer 170 (first layer) from which extends a pile layer 172 (second layer). The base layer 170 may include warp and weft yarns that are woven or knitted into a mesh-like structure. For example, in a typical construction, the yarns of the base layer 170 may be flat yarns, may have a denier range of about 7 dtex to about 100 dtex, and may be braided at a density of about 20 to about 100 wales per inch and about 30 to about 110 courses per inch. The yarns may be made from, for example, a biocompatible thermoplastic polymer such as PET, PTFE (polytetrafluoroethylene), nylon, or any other suitable natural or synthetic fiber.

[0076] The pile layer 172 may include pile yarns 174 woven or knitted into loops. In certain configurations, the pile yarns 174 may be warp or weft yarns of the base layer 170, woven or knitted to form loops. The pile yarns 174 may also be separate yarns incorporated into the base layer, depending on the particular characteristics desired. In a typical configuration, the pile yarns 174 may be flat yarns, have a denier range of about 7 dtex to about 100 dtex, and may be knitted at a density of about 20 to about 100 wales per inch and about 30 to about 110 courses per inch. The pile yarns may be made from, for example, biocompatible thermoplastic polymers such as PET, PTFE, nylon, etc., or any other suitable natural or synthetic fibers.

[0077] In certain embodiments, the loops may be cut so that the pile layer 172 is cut pile, such as in a velour fabric. Figures 1 and 21 show an exemplary embodiment of the outer skirt 18 configured as a velour fabric. In other embodiments, the loops may be left intact to form a looped pile, such as in a terry cloth. Figure 23 shows an exemplary embodiment of the outer skirt 18 in which the pile yarns 174 are knitted to form loops 176.

[0078] The height of the pile yarns 174 (e.g., loops 176) may be the same for all pile yarns throughout the extent of the outer skirt to provide an outer skirt with a constant thickness. In alternative embodiments, the height of the pile yarns 174 may vary along the height and / or circumference of the outer skirt to vary the thickness of the outer skirt along its height and / or circumference, as described further below.

[0079] The pile layer 172 has a much larger surface area than a similarly sized skirt formed from flat or woven material and may therefore promote tissue ingrowth compared to known skirts. Promoting tissue growth into the pile layer 172 may reduce perivalvular leakage, increase valve retention at the implantation site, and contribute to the long-term stability of the valve. In some configurations, the surface area of ​​the pile yarns 174 may be further increased by using textured yarns with increased surface area, for example, for a wavy or undulating structure. In configurations such as the looped pile embodiment of FIG. 23 , the loop structure and increased surface area provided by the textured yarns of the loops 176 allow the loops to act as a scaffold for tissue growth into and around the pile loops.

[0080] The embodiments of the outer skirt described herein can also contribute to improved compressibility and shape memory properties of the outer skirt compared to known valve coverings and skirts. For example, the pile layer 172 may be flexible so that it compresses under load (e.g., when in contact with tissue, another implant, etc.) and returns to its original size and shape when the load is removed. This can help improve the seal between the outer skirt and the tissue of the native annulus or surrounding support structure into which the prosthetic valve is deployed. Embodiments of implantable support structures configured to receive and retain a prosthetic valve within a native mitral valve are disclosed in co-pending application Ser. No. 62 / 449,320, filed Jan. 23, 2017, and application Ser. No. 15 / 876,053, filed Jan. 19, 2018. The compressibility provided by the pile layer 172 of the outer skirt 18 is also beneficial in reducing the crimp profile of the valve. Additionally, the outer skirt 18 can prevent the leaflets 40, or portions thereof, from extending through the spaces between the struts of the frame 12 when the prosthetic valve is crimped, thereby protecting the leaflets from damage due to being pinched between the struts.

[0081] In alternative embodiments, the outer skirt 18 may be made of a nonwoven fabric such as felt, or a fabric such as nonwoven cotton fabric. The outer skirt 18 may also be made of a porous or spongy material, such as any of a variety of flexible polymer foam materials, or a woven fabric such as woven PET.

[0082] Various techniques and configurations may be used to secure the outer skirt 18 to the frame 12 and / or inner skirt 16. As best shown in FIG. 3 , the lower edge portion 180 of the inner skirt 16 may be wrapped around the inflow end 15 of the frame 12, and the lower edge portion 160 of the outer skirt 18 may be attached to the lower edge portion 180 of the inner skirt 16 and / or frame 12 by one or more sutures or stitches 182 (best shown in FIG. 2 ), adhesive, or the like. Instead of, or in addition to, sutures, the outer skirt 18 may be attached to the inner skirt 16 by, for example, ultrasonic welding. In the embodiment shown, the lower edge portion 160 of the outer skirt 18 may be loop-free, and the lower edge portion 180 of the inner skirt 16 may overlap and be secured to the base layer 170 of the outer skirt 18. In other embodiments, the lower edge portion 180 of the inner skirt 16 can extend over one or more rows of loops 176 in the pile layer 172 (see FIG. 27), as described further below. In other embodiments, the lower edge portion 180 of the inner skirt 16 can be wrapped around the inflow end of the frame and extend between the outer surface of the frame and the outer skirt 18 (i.e., the outer skirt 18 is radially outward of the lower edge portion 180 of the inner skirt 16).

[0083] As shown in FIG. 1, each projection 164 of the outer skirt 18 may be attached to a post 26 (FIG. 5) in the third row III of the frame 12. The projections 164 may, for example, be wrapped over each of the posts 26 in row III and secured with sutures 184. The outer skirt 18 may be further secured to the frame 12 by sewing a middle portion of the outer skirt (the portion between the lower and upper edge portions) to a post of the frame, for example, a post 24 in the second row II of the posts.

[0084] The height of the outer skirt (measured from the lower edge to the upper edge) may vary in alternative embodiments. For example, in some embodiments, the outer skirt may cover the entire outer surface of the frame 12, with the lower edge portion 160 secured to the inflow end of the frame 12 and the upper edge portion secured to the outflow end of the frame. In another embodiment, the outer skirt 18 may extend from the inflow end of the frame to the second row II support 24, or to the fourth row IV support 28, or to a location along the frame between two rows of support posts. In still other embodiments, the outer skirt 18 need not extend to the inflow end of the frame; instead, the inflow end of the outer skirt may be secured elsewhere on the frame, for example, to the second row II support 24.

[0085] The outer skirt 18 is desirably sized and shaped relative to the frame so that when the prosthetic valve 10 is in its radially expanded state, the outer skirt 18 fits snugly (tightly) against the outer surface of the frame. When the prosthetic valve 10 is radially compressed to a compressed state for delivery, the portion of the frame to which the outer skirt is attached can stretch axially. The outer skirt 18 desirably has sufficient elasticity to stretch axially upon radial compression of the frame, thereby not interfering with full radial compression of the frame or deforming the struts during the crimping process.

[0086] Known skirts that have slack or folds in material when the prosthetic valve is expanded to its functional size are difficult to assemble because the material must abut when sewn to the frame. In contrast, because the outer skirt 18 is sized to fit snugly around the frame in its fully expanded state, the assembly process of securing the skirt to the frame is greatly simplified. During the assembly process, the outer skirt can be placed around the frame, and when the valve is fully functional, the frame is in its fully expanded state and the outer skirt is in its final shape and position. In this position, the skirt can then be sewn to the frame and / or inner skirt. This simplifies the suturing process compared to skirts designed to have slack or folds when radially expanded.

[0087] As shown in FIG. 3 , the height of the loops of the pile layer 172 may be constant throughout the extent of the outer skirt, thereby causing the outer skirt 18 to have a constant thickness except along the upper and lower edge portions, which may be free of loops to facilitate attachment of the outer skirt to the frame and / or inner skirt 16. The "height" of the loops is measured radially when the skirt is attached to the frame. In another embodiment, as shown in FIG. 24 , the loops may include lower loops 176 a along the lower or upstream portion of the skirt that are relatively shorter in height (as indicated by a thinner cross-sectional area) than upper loops 176 b (as indicated by a thicker cross-sectional area) along the upper or downstream portion of the skirt. The skirt 18 may further include a group of intermediate loops 176 c that gradually increase in height from the lower loops 176 a to the upper loops 176 b. Thus, in the embodiment of FIG. 24 , the thickness of the outer skirt 18 increases from a minimum thickness along the lower portion to a maximum thickness along the upper portion.

[0088] Figure 25 shows another embodiment in which the loops of the outer skirt include lower loops 176d along a lower portion of the skirt that are relatively taller or longer than upper loops 176e along an upper portion of the skirt. The skirt 18 may further include a group of intermediate loops 176f that gradually decrease in height from the lower loops 176d to the upper loops 176e. Thus, in the embodiment of Figure 25, the thickness of the outer skirt 18 decreases from a maximum thickness along the lower portion to a minimum thickness along the upper portion.

[0089] FIG. 26 shows another embodiment in which the loops include lower loop 176g, upper loop 176h, and intermediate loop 176i, which is relatively shorter in height than the lower and upper loops. As shown, lower loop 176g may gradually decrease in height from the lower edge of the skirt toward intermediate loop 176i, and upper loop 176h may gradually decrease in height from the upper edge of the skirt toward intermediate loop 176i. Thus, in the embodiment of FIG. 26, the thickness of the outer skirt decreases from a maximum thickness along the lower portion to a minimum thickness along the middle portion, and then increases from the middle portion to a maximum thickness along the upper portion. In the illustrated embodiment, the upper portion of the skirt, including upper loop 176h, has the same thickness as the lower portion of the skirt, including lower loop 176g. In other embodiments, the thickness of the upper portion of the skirt, including upper loop 176h, may be greater than or less than the same thickness of the lower portion of the skirt, including lower loop 176g.

[0090] Furthermore, in any of the previously described embodiments in which the loop height varies along the height of the skirt, the loop height need not vary gradually from one section of the skirt to another section of the skirt. Thus, an outer skirt can have loops of varying heights, with the loop heights changing abruptly at locations along the skirt. For example, in the embodiment of FIG. 24, the lower portion of the skirt, including lower loop 176a, can extend to the upper portion of the skirt, including upper loop 176g, without intermediate loop 176c forming a transition between the upper and lower portions.

[0091] Instead of, or in addition to, having loops that vary in height along the height of the skirt, the height of loop 176 (and thus the thickness of the outer skirt) may vary along the circumference of the outer skirt. For example, the height of the loop may be increased along circumferential sections of the skirt where a larger gap between the outer skirt and the native annulus may be expected, such as those aligned with the commissures of the native valve.

[0092] 27 and 28 show an alternative configuration for attaching the outer skirt 18 to the frame 12. In this embodiment, as best shown in FIG. 27, the lower edge portion 180 of the inner skirt 16 is wrapped around the inflow end of the frame and extends over one or more rows of loops along the lower edge portion 160 of the outer skirt. The lower edge portion 180 of the inner skirt 16 may then be secured to the lower edge portion 160 of the outer skirt by sutures or stitching 186 ( FIG. 28 ), adhesive, and / or welding (e.g., ultrasonic welding), etc. The stitching 186 may also extend around selected struts adjacent the inflow end of the frame. The lower edge portion 180 of the inner skirt is effective to partially compress the loops of the pile layer 172, thereby creating a tapered edge at the inflow end of the prosthetic valve. The tapered edge reduces the insertion force required to push the prosthetic valve through an introducer sheath during insertion into a patient's body. In one particular implementation, stitching 186 secures the lower edge portion 180 of the inner skirt to the outer skirt 18 at a distance of at least 1 mm from the bottom edge of the outer skirt. The upper edge portion 162 and middle portion of the outer skirt may then be secured to the frame as previously described.

[0093] 29-32 show another configuration for attaching the outer skirt 18 to the frame 12. In this embodiment, the outer skirt 18 is initially positioned in a tubular configuration with the base layer 170 facing outward, and the lower edge portion 160 (which may lack the loops 176) may be positioned between the inner surface of the frame 12 and the lower edge portion 180 of the inner skirt 16, as depicted in FIG. 30. The lower edge portions of the outer and inner skirts may be secured to one another by stitching, adhesive, and / or welding (e.g., ultrasonic welding), etc. In one implementation, the lower edge portions of the outer and inner skirts are secured to one another with in-and-out stitches and lock stitches. The outer skirt 18 is then inverted and pulled upward around the outer surface of the frame 12, so that the base layer 170 is positioned against the outer surface of the frame, as depicted in FIG. 29, with the pile layer 172 facing outward. In this assembled configuration, the lower edge portion 160 of the outer skirt wraps around the inflow end of the frame and is secured to the inner skirt inside the frame. The upper edge portion 162 and middle portion of the outer skirt can then be secured to the frame as previously described.

[0094] The prosthetic valve 10 may be configured for and mounted on a suitable delivery device for implantation into a subject. Several catheter-based delivery devices are known, and non-limiting examples of suitable catheter-based delivery devices include those disclosed in U.S. Patent Application Publication No. 2013 / 0030519 and U.S. Patent Application Publication No. 2012 / 0123529.

[0095] To implant the plastically expandable prosthetic valve 10 inside a patient, the prosthetic valve 10, including the outer skirt 18, can be crimped onto the elongate shaft of a delivery instrument. The prosthetic valve, together with the delivery instrument, can form a delivery assembly for implanting the prosthetic valve 10 into the patient's body. The shaft can include an inflatable balloon for expanding the prosthetic valve inside the body. With the balloon deflated, the prosthetic valve 10 can then be delivered percutaneously to a desired implantation location (e.g., in the area of ​​the native aortic valve). Once the prosthetic valve 10 is delivered to the implantation site inside the body (e.g., the native aortic valve), the prosthetic valve 10 can be radially expanded to its functional state by inflating the balloon or equivalent expansion mechanism.

[0096] The outer skirt 18 can fill the gap between the frame 12 and the surrounding native annulus and help form a good fluid-tight seal between the prosthetic valve 10 and the native annulus. Thus, the outer skirt 18 cooperates with the inner skirt 16 to avoid perivalvular leakage after implantation of the prosthetic valve 10. Additionally, as previously mentioned, the pile layer of the outer skirt further strengthens the perivalvular seal by promoting tissue ingrowth by surrounding tissue.

[0097] Alternatively, the self-expanding prosthetic valve 10 can be crimped into a radially collapsed configuration and constrained in the collapsed configuration by inserting the prosthetic valve 10, including the outer skirt 18, into a delivery catheter sheath or equivalent mechanism. The prosthetic valve 10 can then be delivered percutaneously to the desired implantation site. Once inside the body, the prosthetic valve 10 can be advanced from the delivery sheath, allowing the prosthetic valve to expand to its functional state.

[0098] 33 shows a seal member 200 for a prosthetic valve according to another embodiment. The seal member 200 of the shown embodiment is formed from a spacer fabric. The seal member 200 may be positioned around the outer surface of the frame 12 of the prosthetic valve (instead of the outer skirt 18) and secured to the inner skirt 16 and / or frame using stitching, adhesive, and / or welding (e.g., ultrasonic welding).

[0099] As best shown in FIG. 34 , the spacer fabric may include a first inner layer 206, a second outer layer 208, and an intermediate spacer layer 210 extending between the first and second layers to create a three-dimensional fabric. The first and second layers 206, 208 may be woven or mesh layers. In certain configurations, one or more of the first and second layers 206, 208 may be woven to define a plurality of openings 212. In some examples, openings such as opening 212 may promote tissue in-growth into the seal member 200. In other embodiments, the layers 206, 208 need not define openings but may be porous, as desired.

[0100] The spacer layer 210 can include a plurality of pile yarns 214. The pile yarns 214 can be, for example, monofilament yarns arranged to form a scaffold-like structure between the first layer 206 and the second layer 208. For example, Figures 34 and 35 show an embodiment in which the pile yarns 214 extend between the first layer 206 and the second layer 208 in a sinusoidal or loop pattern.

[0101] In certain examples, the pile yarns 214 may have a stiffness greater than the stiffness of the fabric of the first layer 206 and the second layer 208, allowing the pile yarns 214 to extend between the first layer 206 and the second layer 208 without collapsing under the weight of the second layer 208. The pile yarns 214 may be sufficiently elastic so that the pile yarns can bend or flex under a load, compressing the fabric, and return to their undeflected state when the load is removed. For example, when the prosthetic valve is radially compressed for delivery into a patient's body and placed within a delivery sheath of a delivery device or advanced through an introducer sheath, the pile yarns 214 can be compressed to reduce the overall crimp profile of the prosthetic valve, and then return to their undeflected state upon deployment from the delivery sheath or introducer sheath, as the case may be.

[0102] The spacer fabric may be warp knitted or weft knitted, as desired. Some configurations of the spacer fabric may be made on a double-bar knitting machine. In an exemplary embodiment, the yarns of the first and second layers 206, 208 may have a denier range of about 10 dtex to about 70 dtex, and the yarns of the monofilament pile yarns 214 may have a denier range of about 2 mil to about 10 mil. The pile yarns 214 may have a knit density of about 20 to about 100 wales per inch and about 30 to about 110 courses per inch. Additionally, in some configurations (e.g., warp knit spacer fabrics), materials with various flexibility properties may be incorporated into the spacer fabric to improve the overall flexibility of the spacer fabric.

[0103] FIG. 36 shows an outer seal member 18' mounted on the outside of the frame 12 of a prosthetic heart valve 10 according to another embodiment. FIG. 37 shows the base layer 170 of the seal member 18' in a flat configuration. FIG. 38 shows the pile layer 172 of the seal member 18' in a flat configuration. The outer seal member 18' is similar to the seal member 18 of FIGS. 1 and 21-23, except that the height (H1) of the base layer 170 is greater than the height (H2) of the pile layer 172. As with the previously described embodiments, the seal member 18' is desirably sized and shaped relative to the frame 12 so that both layers 170, 172 of the seal member 18 fit snugly (tightly) around the outer surface of the frame when the prosthetic valve is in its radially expanded state.

[0104] In the configuration shown, the base layer 170 extends axially from the inlet end of the frame 12 to the posts 26 of the third row III of the frame 12. The upstream and downstream edges of the base layer 170 may be sewn to the posts 22 of the first row I and the posts 26 of the third row III with sutures 182 and 184, respectively, as previously described. The pile layer 172 in the configuration shown extends from the inlet end of the frame 12 to a plane that intersects the frame at a node formed at the intersection of the upper ends of the posts 24 of the second row II and the lower ends of the posts 26 of the third row III, this plane being perpendicular to the central axis of the frame.

[0105] The pile layer 172 may be formed separately from the base layer 170 and then attached to the base layer 170, such as by stitching, adhesive, and / or welding. Alternatively, the pile layer 172 may be formed from yarns or fibers woven into the base layer 170. The pile layer 172 may have any of the configurations shown in Figures 24-26.

[0106] In certain embodiments, the height H1 of the base layer 170 may be about 9 mm to about 25 mm or about 13 mm to about 20 mm, with about 19 mm being a specific example. The height H2 of the pile layer 172 may be at least 2 mm less than H1, at least 3 mm less than H1, at least 4 mm less than H1, at least 5 mm less than H1, at least 6 mm less than H1, at least 7 mm less than H1, at least 8 mm less than H1, at least 9 mm less than H1, or at least 10 mm less than H1. The height of the frame 12 in the radially expanded state may be about 12 mm to about 27 mm or about 15 mm to about 23 mm, with about 20 mm being a specific example.

[0107] The relatively short pile layer 172 reduces the crimp profile along the central section of the prosthetic valve 10, while still enhancing the perivalvular seal along most of the prosthetic valve's landing zone. The base layer 170 also provides a sealing function downstream of the downstream edge of the pile layer 172.

[0108] 39-40 show an outer seal member 300 for a prosthetic heart valve (e.g., prosthetic heart valve 10) according to another embodiment. FIGS. 39A and 40A are enlarged views of a portion of the seal member shown in FIGS. 39 and 40, respectively. Seal member 300 may be attached to the outside of frame 12 of prosthetic valve 10 in place of seal member 18, for example, using sutures, ultrasonic welding, or any other suitable attachment method. As with the previously described embodiment, seal member 300 is desirably sized and shaped relative to frame 12 so that seal member 300 conforms closely (tightly) against the outer surface of the frame when the prosthetic valve is in its radially expanded state.

[0109] The seal member 300, like seal members 18, 18', may be a double layer fabric including a base layer 302 and a pile layer 304. Figure 39 shows the outer surface of the seal member 300 defined by the pile layer 304. Figure 40 shows the inner surface of the seal member 300 defined by the base layer 302. The base layer 302 in the shown configuration includes a mesh weave having circumferentially extending rows or stripes 306 of higher density mesh portions interspersed with rows or stripes 308 of lower density mesh portions.

[0110] In certain embodiments, the yarn count of the circumferentially extending (laterally or horizontally in FIGS. 40 and 40A ) yarns is higher in the higher density row 306 than in the lower density row 308. In other embodiments, the yarn count of the circumferentially extending yarns and the yarn count of the axially extending (vertically in FIGS. 40 and 40A ) yarns is higher in the higher density row 306 than in the lower density row 308.

[0111] The pile layer 304 may be formed from yarns woven into the base layer 302. For example, the pile layer 304 may include a velour weave formed from yarns incorporated into the base layer 302. The pile layer 304 may include circumferentially extending rows or stripes 310 of pile formed at axially spaced locations along the height of the seal member 300, thereby providing axially extending gaps between adjacent rows 310. In this manner, the density of the pile layer varies along the height of the seal member. In an alternative embodiment, the pile layer 304 may be formed without gaps between adjacent rows of pile, but the pile layer may include circumferentially extending rows or stripes of higher density pile interspersed with rows or stripes 312 of lower density pile.

[0112] In an alternative embodiment, the base layer 302 may comprise a uniform mesh weave (where the density of the weave pattern is uniform) and the pile layer 304 has a varying density.

[0113] Varying the density of the pile layer 304 and / or base layer 302 along the height of the seal member 300 is advantageous in that it facilitates axial elongation of the seal member 300 caused by axial elongation of the frame 12 when the prosthetic heart valve is crimped to a radially compressed state for delivery. The varying density also reduces the bulk of the seal member in the radially collapsed state, thus reducing the overall crimp profile of the prosthetic heart valve.

[0114] In alternative embodiments, the density of the seal member 300 may vary along the circumference of the seal member to reduce the bulk of the seal member in its radially folded state. For example, the pile layer 304 may include multiple axially extending, circumferentially spaced rows of pile yarns, or alternating axially extending rows of higher density pile interspersed with axially extending rows of lower density pile. Similarly, the base layer 302 may include multiple axially extending rows of higher density mesh interspersed with rows of lower density mesh.

[0115] In other embodiments, the seal member 300 may include a base layer 302 and / or a pile layer 304 that vary in density along the circumference and along the height of the seal member.

[0116] In other embodiments, the seal member can be knitted, crocheted, or woven to have rows or sections of higher stitch density and rows or sections of lower stitch density without two separate layers. FIG. 41 , for example, shows a seal member 400 including a fabric having multiple axially extending rows 402 of higher density stitching alternating with axially extending rows 404 of lower density stitching. The seal member 400 can be formed, for example, by knitting, crocheting, or weaving a single-layer fabric having rows 402, 404 formed by increasing the stitch density along rows 402 and decreasing the stitch density along rows 404 during fabric formation. The seal member 400 can be attached to the exterior of the frame 12 of the prosthetic valve 10 in place of the seal member 18, for example, using sutures, ultrasonic welding, or any other suitable attachment method. As in the previously described embodiment, the sealing member 400 is desirably sized and shaped relative to the frame 12 so that the sealing member 400 conforms closely (tightly) against the outer surface of the frame when the prosthetic valve is in its radially expanded state.

[0117] The seal member 400 can be elastically stretchable between a first, substantially relaxed, axially contracted configuration ( FIG. 41 ), corresponding to a radially expanded state of the prosthetic valve, and a second, axially elongated or tensioned configuration ( FIG. 42 ), corresponding to a radially compressed state of the prosthetic valve. As shown in FIG. 41 , when the prosthetic valve is radially expanded and the seal member 400 is in the first configuration, the denser rows 402 extend in an undulating pattern from the lower (upstream edge) to the upper (downstream edge) of the seal member 400. In the illustrated embodiment, for example, the denser rows 402 each include a plurality of straight, angled sections 406 a, 406 b arranged end-to-end in a zigzag or herringbone pattern extending from the lower (upstream edge) to the upper (downstream edge) of the seal member 400. In an alternative embodiment, the rows 402 can be sinusoidal rows with curved longitudinal edges.

[0118] When the prosthetic valve is crimped to its radially compressed state, the frame 12 expands, causing the seal member to stretch axially to its second configuration, as shown in FIG. 42. The lower density rows 404 facilitate the stretching of the seal member and allow the higher density rows 402 to straighten. FIG. 42 depicts the higher density rows 402 as straight sections extending from the inflow edge to the outflow edge of the seal member. However, it should be understood that the higher density rows 402 do not need to form perfectly straight rows when the prosthetic valve is in the radially compressed state. Instead, the "straightening" of the higher density rows 402 occurs when the angle 408 of adjacent angled segments 406 a, 406 b of each row increases during axial stretching of the seal member.

[0119] The varying stitch density of the sealing member 400 reduces the overall bulk of the sealing member, minimizing the crimp profile of the prosthetic valve. The zigzag or undulating pattern of the denser rows 402 in the prosthetic valve's radially expanded state facilitates axial stretching of the sealing member when the prosthetic valve is radially compressed and allows the sealing member to return to a pre-stretched state in which the sealing member fits snugly around the frame when the prosthetic valve is radially expanded. Furthermore, the zigzag or undulating pattern of the denser rows 402 in the prosthetic valve's radially expanded state eliminates any straight flow path for blood between adjacent rows 402 extending along the outer surface of the sealing member from its outflow edge to its inflow edge, promoting tissue ingrowth by the seal and surrounding tissue.

[0120] In alternative embodiments, seal member 400 may have multiple circumferentially extending, higher density rows (similar to rows 402, but extending circumferentially) interspersed with multiple circumferentially extending, lower density rows (similar to rows 404, but extending circumferentially). In some embodiments, seal member 400 may have axially and circumferentially extending, higher density rows interspersed with axially and circumferentially extending, lower density rows.

[0121] 43A, 43B, 44A, and 44B show an outer seal member 500 for a prosthetic heart valve (e.g., prosthetic heart valve 10) according to another embodiment. The seal member 500 may have a plush outer surface 504. The seal member 500 may be secured to the frame 12 of the prosthetic valve using, for example, sutures, ultrasonic welding, or any other suitable attachment method as previously described herein. For illustrative purposes, an expanded or enlarged portion of the seal member 500 is shown in the drawings. It should be understood that the overall size and shape of the seal member 500 may be modified as needed to cover the entire outer surface of the frame 12 or a portion of the outer surface of the frame, as previously described herein.

[0122] The seal member 500 may comprise a woven or knitted fabric. The fabric may be elastically stretchable between a first, natural, or relaxed configuration ( FIG. 43A ) and a second, axially elongated, or tensioned configuration ( FIG. 43B ). When disposed on the frame 12, the relaxed configuration may correspond to the radially expanded functional configuration of the prosthetic valve, and the elongated configuration may correspond to the radially collapsed delivery configuration of the prosthetic valve. Thus, with reference to FIG. 43A , the seal member 500 may have a first axial length L1 when the prosthetic valve is in the radially expanded configuration, and a second axial length L2 ( FIG. 43B ) longer than L1 when the valve is crimped into the delivery configuration, as described in further detail below.

[0123] The fabric may include a plurality of circumferentially extending warp yarns 512 and a plurality of axially extending weft yarns 514. In some embodiments, the warp yarns 512 may have a denier of about 1D to about 300D, about 10D to about 200D, or about 10D to about 100D. In some embodiments, the warp yarns 512 may have a thickness t1 (FIG. 44A) of about 0.01 mm to about 0.5 mm, about 0.02 mm to about 0.3 mm, or about 0.03 mm to about 0.1 mm. In some embodiments, the warp yarns 512 may have a thickness t1 of about 0.03 mm, about 0.04 mm, about 0.05 mm, about 0.06 mm, about 0.07 mm, about 0.08 mm, about 0.09 mm, or about 0.1 mm. In an exemplary embodiment, the warp yarns 512 may have a thickness of about 0.06 mm.

[0124] The weft yarn 514 may be a texturized yarn including a plurality of texturized filaments 516. For example, the filaments 516 of the weft yarn 514 may be bulked, e.g., the filaments 516 are twisted, heat-set, and unwound, such that the filaments retain their deformed, twisted shape in a relaxed, untensioned configuration. The filaments 516 may also be bulked by crimping, coiling, etc. When the weft yarn 514 is in a relaxed, untensioned state, the filaments 516 may be loosely packed, providing compressible volume or bulk to the fabric and plush surface. In some embodiments, the weft yarn 514 may have a denier of about 1D to about 500D, about 10D to about 400D, about 20D to about 350D, about 20D to about 300D, or about 40D to about 200D. In certain embodiments, the weft yarns 514 may have a denier of about 150D. In some embodiments, the filament count of the weft yarns 514 may be between 2 filaments / yarn and 200 filaments / yarn, between 10 filaments / yarn and 100 filaments / yarn, between 20 filaments / yarn and 80 filaments / yarn, or between about 30 filaments / yarn and 60 filaments / yarn. Additionally, although the axially extending textured yarns 514 are referred to as weft yarns in the configuration shown, fabrics can also be manufactured such that the axially extending textured yarns are the warp yarns and the circumferentially extending yarns are the weft yarns.

[0125] 44A and 44B show cross-sectional views of a seal member with weft yarns 512 extending in the plane of the page. Referring to FIG. 44A, the fabric of seal member 500, when in a relaxed state and secured to a frame, can have a thickness t2 of about 0.1 mm to about 10 mm, about 1 mm to about 8 mm, about 1 mm to about 5 mm, about 1 mm to about 3 mm, about 0.5 mm, about 1 mm, about 1.5 mm, about 2 mm, about 2.5 mm, or about 3 mm. In some embodiments, seal member 500 can have a thickness of about 0.1 mm, about 0.2 mm, about 0.3 mm, about 0.4 mm, or about 0.5 mm when measured in a relaxed state with a weighted drop gauge having a presser foot. In a representative example, the seal member can have a thickness of about 1.5 mm when secured to a prosthetic valve frame in a relaxed state. The loosely packed, bulked filaments 516 of the weft yarns 514 in their relaxed state may also promote tissue ingrowth into the seal member 500 .

[0126] When the fabric is in a relaxed state, the textured filaments 516 of the weft yarns 514 may be widely dispersed so that individual weft yarns are not easily discernible, as depicted in FIG. 43A. When tension is applied axially, the filaments 516 of the weft yarns 514 may be pulled together as the weft yarns elongate and kinks, twists, etc. of the filaments are pulled straight out so that the fabric stretches and decreases in thickness. In certain embodiments, when sufficient tension is applied to the fabric in the axial direction (in the weft direction in the illustrated embodiment), for example, when a prosthetic valve is crimped onto the shaft of a delivery device, the textured fibers 516 may be pulled together so that individual weft yarns 514 can be discerned, as best shown in FIG. 43B.

[0127] Thus, for example, when fully stretched, the seal member may have a second thickness t3 that is less than thickness t2, as shown in FIG. 44B. In certain embodiments, the thickness of the tensioned weft yarns 514 may be the same as or approximately the same as the thickness t1 of the warp yarns 512. Thus, in certain examples, when stretched, the fabric may have a thickness t3 that is the same as or approximately the same as three times the thickness t1 of the warp yarns 512, depending, for example, on the amount of flattening of the weft yarns 514. Thus, in the example described above where the warp yarns 512 have a thickness of about 0.06 mm, the thickness of the seal member may vary between about 0.2 mm and about 1.5 mm as the fabric stretches and relaxes. In other words, the thickness of the fabric may vary by 750% or more as the fabric stretches and relaxes.

[0128] Furthermore, as shown in Figure 44A, the warp yarns 512 may be spaced apart from one another in the fabric by a distance y1 when the outer covering is in a relaxed state. As shown in Figures 43B and 44B, when tension is applied to the fabric in a direction perpendicular to the warp yarns 512 and parallel to the weft yarns 514, the distance between the warp yarns 512 may increase as the weft yarns 514 lengthen. In the example shown in Figure 44B, where the fabric is stretched such that the weft yarns 514 lengthen and narrow to approximately the diameter of the warp yarns 512, the distance between the warp yarns 512 may increase to a new distance y2 that is greater than distance y1.

[0129] In certain embodiments, distance y1 can be, for example, about 1 mm to about 10 mm, about 2 mm to about 8 mm, or about 3 mm to about 5 mm. In a representative example, distance y1 can be about 3 mm. In some embodiments, when the fabric is stretched as shown in FIGS. 43B and 44B, distance y2 can be about 6 mm to about 10 mm. Thus, in certain embodiments, the length of seal member 500 in the axial direction can vary by 100% or more between the relaxed length L1 and the fully stretched length (e.g., L2). This ability of the fabric to lengthen facilitates crimping of the prosthetic valve. Thus, seal member 500 can soften and volumize when the prosthetic valve is expanded to its functional size and can be relatively thin when the prosthetic valve is crimped to minimize the overall crimp profile of the prosthetic valve.

[0130] General theory It should be understood that the disclosed embodiments may be configured to deliver and implant a prosthesis in any of the heart's native annulus (e.g., pulmonary, mitral, and tricuspid annulus) and may be used in any of a variety of approaches (e.g., retrograde, antegrade, transseptal, transventricular, transatrial, etc.). The disclosed embodiments may also be used to implant prostheses in other lumens of the body. Furthermore, in addition to prosthetic valves, the delivery assembly embodiments described herein may be configured to deliver and implant a variety of other prosthetics, such as stents, and / or other artificial repair devices.

[0131] For purposes of this description, certain aspects, advantages, and novel features of the disclosed embodiments are described herein. The disclosed methods, apparatus, and systems should not be construed as limiting in any way. Instead, the present disclosure is directed to all novel and non-obvious features and aspects of the various disclosed embodiments, alone and in various combinations and subcombinations with one another. The methods, apparatus, and systems are not limited to any particular aspect or feature or combination thereof, and the disclosed embodiments do not require that any one or more particular advantages exist or problems be solved.

[0132] Although some operations of the disclosed embodiments are described in a particular order for convenient presentation, it should be understood that this method of description encompasses reordering unless a particular order is required by specific wording described below. For example, operations described sequentially may, in some cases, be reordered or performed simultaneously. Moreover, for simplicity, the accompanying drawings may not show the various ways in which the disclosed methods can be used in conjunction with other methods. Furthermore, the description sometimes uses terms such as "provide" or "achieve" to describe the disclosed methods. These terms are high-level abstractions of the actual operations that are performed. The actual operations corresponding to these terms may vary depending on the particular implementation and are readily discernible by those skilled in the art.

[0133] As used in this application and in the claims, the singular forms "a," "an," and "the" include the plural forms unless the context clearly dictates otherwise. Furthermore, the term "includes" means "comprises." Furthermore, the terms "coupled" and "associated" generally mean electrically, electromagnetically, and / or physically (e.g., mechanically or chemically) coupled or connected and do not exclude the presence of intermediate elements between coupled or associated items, unless specific language to the contrary is used.

[0134] As used herein, the term "proximal" refers to a position, direction, or portion of a device that is closer to the user and away from the implantation site. As used herein, the term "distal" refers to a position, direction, or portion of a device that is away from the user and closer to the implantation site. Thus, for example, proximal movement of a device is movement of the device toward the user, and distal movement of a device is movement of the device away from the user. The terms "longitudinal" and "axial" refer to axes extending in the proximal and distal directions, unless expressly defined otherwise.

[0135] As used herein, the terms "integrally formed" and "unitary structure" refer to a structure that does not include any welds, fasteners, or other means for securing separately formed pieces of material together.

[0136] As used herein, actions occurring "simultaneously" or "together" generally occur in conjunction with one another, but delays in the occurrence of one action relative to another due to spacing, play, or backlash between components of a mechanical linkage, e.g., threads, gears, etc., are expressly included within the scope of the term unless specifically phrased to the contrary.

[0137] In view of the many possible embodiments to which the principles of the disclosed invention may be applied, it is recognized that the illustrated embodiments are merely preferred examples of the invention and should not be understood as limiting the scope of the invention. Rather, the scope of the invention is defined by the following claims. We therefore claim as our invention all that comes within the spirit and scope of these claims.

[0138] [Additional note 1] 1. A prosthetic heart valve, comprising: an annular frame including an inlet end and an outlet end, the annular frame being radially compressible and expandable between a radially compressed configuration and a radially expanded configuration; a leaflet structure positioned within the frame and secured to the frame; an outer sealing member attached to the outside of the frame and configured to seal against surrounding tissue when the prosthetic heart valve is implanted in the patient's native heart valve annulus, the outer sealing member including a mesh layer and a pile layer including a plurality of pile yarns extending outward from the mesh layer; 1. A prosthetic heart valve comprising: [Additional note 2] 2. The prosthetic heart valve of claim 1, wherein the mesh layer comprises a knitted or woven fabric. [Additional note 3] 3. The prosthetic heart valve according to claim 1 or 2, wherein the pile yarns are arranged to form looped pile yarns. [Additional note 4] 4. The prosthetic heart valve according to any one of claims 1 to 3, wherein the pile yarns are cut to form cut pile. [Additional note 5] 5. The prosthetic heart valve of any one of claims 1 to 4, wherein the height of the pile yarns varies along the height or circumference of the outer skirt, or both. [Additional note 6] 6. The prosthetic heart valve of claim 5, wherein the pile yarns include a first group of yarns along an upstream portion of the outer skirt and a second group of yarns along a downstream portion of the outer skirt, the first group of yarns having a height that is less than a height of the second group of yarns. [Additional note 7] 6. The prosthetic heart valve of claim 5, wherein the pile yarns include a first group of yarns along an upstream portion of the outer skirt and a second group of yarns along a downstream portion of the outer skirt, the first group of yarns having a height greater than a height of the second group of yarns. [Additional note 8] 6. The prosthetic heart valve of claim 5, wherein the pile yarns include a first group of yarns along an upstream portion of the outer skirt, a second group of yarns along a downstream portion of the outer skirt, and a third group of yarns between the first and second groups of yarns, and wherein the first and second groups of yarns have a height that is greater than a height of the third group of yarns. [Additional note 9] 9. The prosthetic heart valve of any one of claims 1 to 8, further comprising an inner skirt mounted on an inner surface of the frame, the inner skirt having an inflow end portion secured to the inflow end portion of the outer seal member. [Additional Note 10] 10. The prosthetic heart valve of claim 9, wherein the inflow end portion of the inner skirt is wrapped around the inflow end of the frame and overlaps the inflow end portion of the outer seal member outside the frame. [Additional Note 11] 11. The prosthetic heart valve according to any one of claims 1 to 10, wherein the mesh layer includes a first mesh layer, and the outer seal member further includes a second mesh layer disposed radially outward of the pile layer. [Additional Note 12] 12. The prosthetic heart valve of any one of claims 1 to 11, wherein the outer seal member is configured to expand axially when the frame is radially compressed to the radially compressed state. [Additional Note 13] 13. The prosthetic heart valve according to any one of claims 1 to 12, wherein the mesh layer comprises warp yarns and weft yarns woven together with the warp yarns, and the pile layer comprises the warp yarns or the weft yarns of the mesh layer woven or knitted to form the pile yarns. [Additional Note 14] 13. The prosthetic heart valve of any one of claims 1 to 12, wherein the mesh layer comprises a woven fabric layer and the pile layer comprises a separate pile layer sewn to the woven fabric layer. [Additional Note 15] 15. The prosthetic heart valve of any one of claims 1 to 14, wherein the mesh layer has a first height extending axially along the frame, and the pile layer includes a second height extending axially along the frame, the first height being greater than the second height. [Additional Note 16] 16. The prosthetic heart valve of claim 15, wherein the mesh layer extends closer to the outflow end of the frame than the pile layer. [Additional Note 17] 1. A prosthetic heart valve, comprising: an annular frame including an inlet end and an outlet end, the annular frame being radially compressible and expandable between a radially compressed configuration and a radially expanded configuration; a leaflet structure positioned within the frame and secured to the frame; an outer sealing member attached to the outside of the frame and configured to seal against surrounding tissue when the prosthetic heart valve is implanted in the patient's native heart valve annulus, the outer sealing member comprising a fabric having a variable thickness; and 1. A prosthetic heart valve comprising: [Additional Note 18] 18. The prosthetic heart valve of claim 17, wherein the thickness of the fabric layer varies along the height or circumference, or both, of the outer seal member. [Additional Note 19] 19. The prosthetic heart valve of claim 17 or 18, wherein the fabric comprises a plush fabric. [Additional Note 20] 20. The prosthetic heart valve of any one of clauses 17 to 19, wherein the fabric comprises a plurality of pile yarns, the height of the pile yarns varying along the height and / or circumference of the outer skirt. [Additional Note 21] 21. The prosthetic heart valve of claim 20, wherein the pile yarns include a first group of yarns along an upstream portion of the outer skirt and a second group of yarns along a downstream portion of the outer skirt, the first group of yarns having a height that is less than a height of the second group of yarns. [Additional note 22] 21. The prosthetic heart valve of claim 20, wherein the pile yarns include a first group of yarns along an upstream portion of the outer skirt and a second group of yarns along a downstream portion of the outer skirt, the first group of yarns having a height greater than a height of the second group of yarns. [Additional Note 23] 21. The prosthetic heart valve of claim 20, wherein the pile yarns include a first group of yarns along an upstream portion of the outer skirt, a second group of yarns along a downstream portion of the outer skirt, and a third group of yarns between the first and second groups of yarns, and wherein the first and second groups of yarns have a height that is greater than a height of the third group of yarns. [Explanation of symbols]

[0139] 10. Artificial Heart Valves 12 frames 14 Valve structure 15 Inlet end part 16 Inner skirt 17 Middle part 18 Outer Skirt 18' Sealing material 19 Outflow end part 22 Inclined support of the first lower row I 24 circumferentially extending inclined struts of the second row II 26 circumferentially extending inclined struts of the third row III 28 circumferentially extending inclined struts of the fourth row IV 30 Window frame part 31 Axial support 32 Circumferentially extending inclined struts of the fifth row V 36 Opening 38 Opening 40 leaflets 41 Opening 42a angle 42b angle 42c angle 42d angle 42e angle 44 Joint 46 Joint 64 Joint 70 sutures 72 Reinforcement strip 78 First set of fibers 80 Second set of fibers 82 Upper edge 84 Lower edge 86 Edge 88 Edge 90 Edge 92 Edge 94 Suture 96 Protrusion 98 Slit 112 Upper tab part 122 Commissure 124 Flexible Connector 142 Inner part 143 Inner edge 144 Outer part 146 Suture 154 Suture 156 Hemming suture 160 Lower edge 162 Upper edge 164 Protrusion 166 Notch 168 plush surface 170 Base layer 172 pile layer 174 pile yarn 176 Loops 176a Lower Loop 176b Upper Loop 176c Mid Loop 176d Lower Loop 176e Upper Loop 176f intermediate loop 176g lower loop 176h Upper Loop 176i mid loop 180 Lower edge 182 Sutures 184 Sutures 186 Stitching 200 sealing material 206 First inner layer 208 Second outer layer 210 Intermediate spacer layer 212 Opening 214 Pile yarn 300 outer seal member 302 Base layer 304 Pile layer 306 rows of denser mesh sections 308 Rows of lower density mesh sections 310 Circumferential row of piles 400 Sealing material 402 multiple axially extending rows of denser stitching 404 axially extending rows of less dense stitching 406a Straight Inclined Section 406b Straight Inclined Section 408 angle 500 outer seal member 504 Plush External Surface 512 Warp threads 514 Weft 516 Bulky processed filament L1 First length L2 Second length

Claims

1. 1. A prosthetic heart valve, comprising: an annular frame (12) with an inflow end and an outflow end, which is radially foldable and expandable between a radially folded configuration and a radially expanded configuration having a cylindrical shape, the annular frame (12) comprises a plurality of rows of struts (22) arranged end to end and extending circumferentially, with a first row of inclined struts (32) at the top and a second row of inclined struts (28) immediately adjacent to the first row of inclined struts (32) defining an upper row of cells which together with the frame portions (30) and struts (31) define openings (40); An annular frame; a leaflet structure (14) located within and fixed to said frame (12); an outer skirt (18) attached to the outside of the frame (12) and adapted to seal the prosthetic heart valve against the surrounding tissue when implanted in the patient's native heart annulus, the outer skirt (18) comprises an inlet end portion (160) and an outlet end portion (162) defining a plurality of alternating protrusions (164) and notches (166), the protrusions and the notches following the shape of a row of the angled struts (28, 26, 28, 32); the outer skirt (18) is sized and shaped relative to the frame (12) such that the outer skirt (18) fits snugly against the outer surface of the frame (12) when the prosthetic heart valve (10) is in the radially expanded configuration of the prosthetic heart valve; An outer skirt and an inner skirt (16) mounted on the inner surface of said frame (12) and having an inflow end portion fixed to the inflow end portion of said outer skirt (18), the outflow end portion of the inner skirt (16) is fixed to the inclined struts of the second row so that the openings (40) of the cells of the upper row are not covered by the inner skirt (16); With inner skirt, An artificial heart valve comprising:

2. 2. The prosthetic heart valve of claim 1, wherein the outer skirt is attached to the inner skirt.

3. 2. The prosthetic heart valve of claim 1, wherein the frame is configured to be crimped into the radially folded configuration onto a delivery catheter and subsequently expanded inside a patient by an inflatable balloon.

4. 2. The prosthetic heart valve of claim 1, wherein the inner skirt has slits formed therein sized to allow an upper edge portion of the inner skirt to partially wrap around the struts.

5. The lower edge portion of the inner skirt (16) is wrapped around the inflow end of the frame (12); 2. The prosthetic heart valve of claim 1, wherein the lower edge portion of the outer skirt (18) is attached to the lower edge portion of the inner skirt (16) and / or to the frame (12) with an adhesive.

6. 2. The prosthetic heart valve of claim 1, wherein the outer skirt (18) is attached to the inner skirt (16) by ultrasonic welding.

7. 2. The prosthetic heart valve of claim 1, wherein a lower edge portion (180) of the inner skirt (18) is wrapped around the inflow end of the frame (12) and extends between the outer surface of the frame (12) and the outer skirt (18).

8. 2. The prosthetic heart valve of claim 1, wherein the lower edges of the leaflets are fixed to the frame (12) via the inner skirt (16).

9. 10. The prosthetic heart valve of claim 1, wherein the inner skirt comprises a durable, tear-resistant material.

10. the leaflet structure (14) has at least two leaflets (40); 10. The prosthetic heart valve of claim 1, wherein the leaflets (40) comprise pericardial tissue, a biocompatible synthetic material, or a natural or synthetic material.

11. 2. The prosthetic heart valve of claim 1, wherein the lower edge of the leaflet structure (14) has a curved, sector-like shape.

12. the leaflet structure (14) comprises three leaflets (14); 10. The prosthetic heart valve of claim 1, wherein the leaflets are arranged to fold in a tricuspid configuration.

13. 2. The prosthetic heart valve of claim 1, wherein the leaflet structure (14) is attached to the skirt via one or more reinforcing strips (72).

14. 2. The prosthetic heart valve of claim 1, wherein the outer skirt (18) is made of a porous or spongy material.

15. 10. The prosthetic heart valve of claim 1, wherein the outer skirt (18) is laser cut from a strong, durable material configured to restrict and / or prevent blood flow therethrough.

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