Flexible commissure frame

Abstract

To provide stents and prosthetic valves that can have a high degree of flexibility, without compromising mechanical integrity or functionality.SOLUTION: Prosthetic devices and frames to be implanted in a cardiac valve annulus include an annular frame (having an inflow end and an outflow end), and a plurality of axial frame members as bridges between two circumferentially extending rows of angled struts. The axial frame members can include a plurality of axially extending leaflet attachment members and a plurality of axial struts in a 1:1 ratio. Along each of the two rows, the frame can have at least three angled struts between adjacent axial frame members.SELECTED DRAWING: Figure 1

Description

[Technical Field]

[0001] The present disclosure is in the field of prosthetic heart valves, stents for use with prosthetic heart valves, and methods for delivering prosthetic heart valves. [Background technology]

[0002] Existing frames for prosthetic heart valves typically include a row of diagonal struts and multiple axial frame members spaced around the circumference of the frame. The multiple axial frame members may include multiple leaflet attachment members (for coupling to the commissures of the supported valve-like structure) extending between the rows of diagonal struts and multiple axially oriented struts. Frames typically have three or more axially oriented struts per leaflet attachment member, and typically no more than two diagonal struts between adjacent struts or between other axial frame members. In practice, a large number of axially oriented struts has been found to be necessary to maintain the structural stability of the stent and / or valve. Unfortunately, a large number of axial struts can compromise valve flexibility. [Prior art documents] [Patent documents]

[0003] [Patent Document 1] U.S. Patent No. 6,730,118 [Patent Document 2] U.S. Patent Application Publication No. 2011 / 0123529 Summary of the Invention [Problem to be solved by the invention]

[0004] Therefore, there is a need for stents and prosthetic valves that can have a high degree of flexibility without compromising their mechanical integrity or function. [Means for solving the problem]

[0005] In one aspect of the present disclosure, a prosthetic device for implantation into a heart valve annulus has an annular frame with an inflow end, an outflow end, and a plurality of axial frame members bridging two circumferentially extending rows of diagonal struts, wherein the plurality of axial frame members comprises a plurality of axially extending leaflet attachment members and a plurality of axial struts in a one-to-one ratio.

[0006] In some embodiments, the device can further comprise a leaflet structure located within the frame having a plurality of commissures secured to the frame at the leaflet attachment members.

[0007] In some embodiments, at least three diagonal struts separate adjacent axial frame members along each of two rows of diagonal struts.

[0008] In some embodiments, exactly six diagonal struts separate adjacent leaflet attachment members along each of two rows of diagonal struts, and exactly three diagonal struts separate adjacent axial frame members along each of two rows of diagonal struts, such that each axial strut is located at a midpoint between adjacent leaflet attachment members.

[0009] In some embodiments, each axial frame member extends between locations defined by the converging points of adjacent diagonal struts.

[0010] In some embodiments, the apparatus further comprises an inner skirt secured to an inner portion of the annular frame, and an outer skirt secured to an outer portion of the annular frame.

[0011] In some embodiments, the frame comprises exactly four rows of diagonal struts.

[0012] In some embodiments, the valve members comprise exactly three leaflets arranged in a tricuspid configuration, in which case the frame comprises exactly three axial struts and exactly three leaflet attachment members, with exactly three diagonal struts separating adjacent axial frame members along each of two rows of diagonal struts.

[0013] In another aspect of the present disclosure, an annular frame for a prosthetic heart valve can include an inflow end, an outflow end, and a plurality of axial frame members angularly spaced about the circumference of the frame. The plurality of axial frame members can bridge two circumferentially extending rows of diagonal struts, each of the two rows including at least three diagonal struts between adjacent axial frame members.

[0014] In some embodiments, each of the two rows comprises exactly three diagonal struts between adjacent axial frame members.

[0015] In some embodiments, the plurality of axial frame members comprises a plurality of axially extending leaflet attachment members, with two rows each comprising exactly six diagonal struts between adjacent leaflet attachment members.

[0016] In some embodiments, the plurality of axial frame members comprises a plurality of axially extending leaflet attachment members, where two rows each comprise four diagonal struts between adjacent axial frame members and eight diagonal struts between adjacent leaflet attachment members.

[0017] In some embodiments, the plurality of axial frame members comprises exactly three leaflet attachment members and exactly three axial struts.

[0018] In some embodiments, the leaflet attachment members extend between positions defined by the confluence of the upper ends of adjacent diagonal struts in each row of diagonal struts, and the axial struts extend between positions defined by the confluence of the lower ends of adjacent diagonal struts in each row of diagonal struts.

[0019] In some embodiments, the two rows of diagonal struts may comprise a first row and a second row, where the first row is closer to the outflow end than the second row.

[0020] In some embodiments, the leaflet attachment members extend from a position defined by the confluence of the upper ends of adjacent diagonal struts along the first row of diagonal struts to a position defined by the confluence of the lower ends of adjacent diagonal struts along the second row of diagonal struts, and the axial struts extend between a position defined by the confluence of the lower ends of adjacent diagonal struts along the first row of diagonal struts and a position defined by the confluence of the upper ends of adjacent diagonal struts along the second row of diagonal struts.

[0021] In some embodiments, the leaflet attachment members extend from a position defined by the confluence of the upper ends of adjacent diagonal struts along a first row of diagonal struts to a position defined by the confluence of the upper ends of adjacent diagonal struts along a second row of diagonal struts, and the axial struts extend between a position defined by the confluence of the lower ends of adjacent diagonal struts along the first row of diagonal struts and a position defined by the confluence of the lower ends of adjacent diagonal struts along the second row of diagonal struts.

[0022] In some embodiments, the frame comprises exactly four rows of diagonal struts.

[0023] Another aspect of the present disclosure provides a prosthetic device for implantation into a heart valve annulus, comprising an annular frame having an inflow end, an outflow end, at least four rows of circumferentially extending diagonal struts, and exactly six axial frame members bridging two of the four rows of circumferentially extending diagonal struts. The plurality of axial frame members may comprise exactly three axially extending leaflet attachment members and exactly three axial struts, with each of the two rows comprising exactly three diagonal struts between each adjacent pair of leaflet attachment members and axial struts, and exactly six diagonal struts between adjacent leaflet attachment members. The device may further comprise a tri-leaflet valve member positioned within the frame, with commissures secured to the frame at the leaflet attachment members.

[0024] The foregoing and other objects, features, and advantages of the present invention will become more apparent from the following detailed description taken in conjunction with the accompanying drawings. [Brief explanation of the drawings]

[0025] [Figure 1] FIG. 1 is a side view of one exemplary embodiment of a prosthetic heart valve. [Figure 2] 1 is a perspective view of one exemplary embodiment of a prosthetic heart valve. [Figure 3] FIG. 2 is a side view of an exemplary frame of the prosthetic heart valve of FIG. 1. [Figure 4] 2 is a perspective view of an exemplary frame of the prosthetic heart valve of FIG. 1. [Figure 5] FIG. 2 is a flattened view of an exemplary frame of the prosthetic heart valve of FIG. 1. [Figure 6] FIG. 1 is a perspective view of another exemplary prosthetic heart valve. [Figure 7] 7 is a perspective view of an exemplary frame of the prosthetic heart valve of FIG. 6. [Figure 8] FIG. 7 is a flattened view of an exemplary frame of the prosthetic heart valve of FIG. 6. [Figure 9] FIG. 10 is a flattened view of another exemplary frame for a prosthetic heart valve. [Figure 10] FIG. 10 is a flattened view of a portion of another exemplary frame for a prosthetic heart valve. [Figure 11] FIG. 10 is a flattened view of a portion of another exemplary frame for a prosthetic heart valve. [Figure 12] FIG. 10 is a flattened view of a portion of another exemplary frame for a prosthetic heart valve. [Figure 13] FIG. 10 is a flattened view of a portion of another exemplary frame for a prosthetic heart valve. DETAILED DESCRIPTION OF THE INVENTION

[0026] Disclosed herein are prosthetic heart valves and highly flexible stents for use with such valves. This flexibility can be useful for delivery to the valve annulus (e.g., to crimp / expand a transcatheter heart valve (THV)) and / or to accommodate valve motion during the cardiac cycle. In certain embodiments, the frame lacks axial struts at strategically selected locations around its circumference, resulting in increased flexibility. In various embodiments, the increased distance between each commissure and the nearest axial frame member (other than any support member at the commissure, such as a commissure support or window frame member) results in increased commissure flexibility. The frame can have one or more circumferentially extending rows of struts with three consecutive diagonal struts between one or more pairs of axial support. In some embodiments, these one or more rows of struts are near the outflow end of the frame. In some embodiments, the frame can have two rows of circumferentially extending struts (near the outflow end of the valve) with three consecutive diagonal struts between pairs of axial support. In some embodiments, the frame has three consecutive diagonal struts separating each commissural support (at each commissure) from the nearest axial support, while in other embodiments there are four such diagonal struts separating each commissural support from the nearest axial support.

[0027] As used herein, an "axial support" refers to a junction where at least three struts are connected, such as two diagonal struts and a single axial strut to which they are connected, or a junction between two diagonal struts and another axial member, such as a commissural support. As used herein, an "axial frame member" refers to any axially extending support member that connects two (or more) circumferentially extending rows of diagonal struts. Thus, an axial frame member can be an axial support member, such as a commissural support, that is associated with one or more leaflets. An axial frame member can also be a simple axial strut or other axial member that is not associated with a leaflet. As used herein, a "commissural support" (also referred to as a "leaflet attachment member") refers to an axially extending support member shaped to support each commissure of a prosthetic valve member. The commissural support can be a commissure "window frame member" shaped to receive the commissure of a prosthetic valve member through an opening in the frame member, as described further below. The commissural support can also be an axial strut or other axial support member that does not include a window or other opening sized to receive a commissure. Thus, the commissures can be supported by the leaflet attachment members using a variety of techniques or mechanisms, for example, by extending sutures through suture openings in the leaflet attachment members to secure the commissures to their respective leaflet attachment members.

[0028] 1-2 illustrate a prosthetic heart valve 100 according to one embodiment, in side and perspective views, respectively. The illustrated prosthetic valve is adapted to be implanted within a native aortic valve annulus; however, in other embodiments, it may be adapted to be implanted within other native valve annulus of the heart (i.e., native mitral, pulmonary, and tricuspid valves) or within other tubular passageways within the body. The valve 100 may have four main components: a stent or frame 102, a valve-like structure 104, an inner skirt 106, and an outer skirt 108. The frame 102 may have an inflow end 103 and an outflow end 105.

[0029] The valve-like structure 104 can include three leaflets 110 that collectively form a valve structure, which can be arranged to fold in a tricuspid configuration. The leaflets 110 can be secured to each other at their adjacent sides to form commissures. The leaflets 110 can 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 described in U.S. Patent No. 6,730,118.

[0030] The bare frame 102 is shown in side view, perspective view, and unfolded flat configuration in Figures 3-5, respectively. The frame 102 may be formed with a plurality of circumferentially spaced slots or commissural windows 120 (three in the illustrated embodiment), which are adapted to attach the commissures of the valve-like structure 104 to the frame, as described in more detail below. The frame 102 may be made from any of a variety of suitable plastically expandable materials (such as stainless steel) or self-expandable materials (such as nitinol) known in the art.

[0031] Suitable plastically expandable materials that can be used to form the frame 102 can include, but are not limited to, stainless steel, nickel-based alloys (e.g., cobalt-chromium or nickel-cobalt-chromium alloys), polymers, or combinations thereof. In certain embodiments, the frame 102 can be made from a nickel-cobalt-chromium-molybdenum alloy, such as MP35N® alloy (SPS Technologies), which is equivalent to UNS R30035 alloy (covered by ASTM F562-02). MP35N® / UNS R30035 alloy contains 35% nickel, 35% cobalt, 20% chromium, and 10% molybdenum by weight. It has been found that using MP35N® alloy to form the frame 102 can provide superior structural results over stainless steel. Specifically, using MP35N® alloy as the frame material requires less material to achieve the same or better performance in radial and crush force resistance, fatigue resistance, and corrosion resistance. Furthermore, requiring less material allows the retracted profile of the frame 102 to be reduced, thereby providing a smaller profile valve assembly for percutaneous delivery to a treatment location within the body.

[0032] When constructed from a plastically expandable material, the frame 102 (and thus the valve 100) can be contracted to a radially compressed state on a delivery catheter and then expanded inside the patient by an inflatable balloon or equivalent expansion mechanism. When constructed from a self-expanding material, the frame 102 (and therefore the valve 100) can be contracted to a radially compressed state and held in the compressed state by insertion into a delivery catheter sheath or equivalent mechanism. Once inside the body, the valve is advanced out of the delivery sheath, allowing the valve to expand to its functional size.

[0033] 5, the frame 102 in the illustrated embodiment (shown in a flattened configuration) comprises a first lower row I of circumferentially extending diagonal struts 112 arranged end-to-end at the inflow end of the frame, a second lower row II of circumferentially extending diagonal struts 114, a third lower row III of circumferentially extending diagonal struts 116, a fourth lower row IV of circumferentially extending diagonal struts 118, and a fifth lower row V of circumferentially extending diagonal struts 122 at the outflow end 105. A plurality of generally straight, axially extending struts 124 may be used to interconnect the struts 112 of the first row I with the struts 114 of the second row II. The fifth row V of diagonal struts 122 is connected to the fourth row IV of diagonal struts 118 by a plurality of axially extending window frame portions 130 (which define the commissural windows 120 ) and a plurality of axially extending struts 132 .

[0034] Each commissure window frame segment 130 attaches a corresponding commissure to a respective leaflet-like structure 104. As can be seen, each window frame segment 130 is secured at its upper and lower ends to adjacent rows of diagonal struts, providing a robust configuration that enhances fatigue resistance under cyclic valve loading compared to known frames that use cantilevered struts to support the commissures of the leaflet structures. This configuration allows for a reduced frame wall thickness, achieving a smaller diameter after contraction of the valve. In certain embodiments, the thickness of the frame 102, measured between the inner and outer diameters, is about 0.48 mm or less.

[0035] As best shown in Figures 3-4, the struts and frame portion of the frame collectively define a plurality of open cells in the frame. At the inflow end of frame 102, struts 112, 114, and 124 define a lower row of cells that define opening 136. The second row of struts 114, the third row of struts 116, and the fourth row of struts 118 define two middle rows of cells that define opening 138. The fourth row of struts 118 and the fifth row of struts 122, together with window frame portion 130 and struts 132, define an upper row of cells that define opening 140. Opening 140 is relatively large and sized to allow a portion of valve-like structure 104 to protrude or overhang into and / or through opening 140 to minimize the contracted profile when frame 102 is contracted.

[0036] In some embodiments, there are fewer than three axially extending struts 132 along the length of the row between adjacent frame sections 130, such as only two axially extending struts 132 or only one axially extending strut 132. In some embodiments, there is only one axially extending strut 132 between adjacent frame sections 130, and that axially extending strut 132 may be located at the midpoint between the frame sections 130. Thus, in various embodiments, the frame may be specifically constructed to incorporate a one-to-one ratio of frame sections 130 and axially extending struts 132.

[0037] In one embodiment shown in Figures 3-5, there are exactly three window frame segments 130 and exactly three axial struts 132. Minimizing or reducing the number of axially extending struts 132 between the window frame segments 130 promotes a more compact collapse of the prosthetic valve. This also maximizes or increases the size of the opening 140, which is advantageous, for example, when the outflow end 105 of the prosthetic valve extends above the level of the coronary ostia. In such cases, the larger opening 140 allows access to the coronary arteries for subsequent procedures, such as those requiring coronary catheterization.

[0038] Each window frame section 130 and / or each axially extending strut 132 may extend between a location 142 characterized by the meeting of the lower ends of two diagonal struts 122 (in row V at the outflow end 105) and a location or node 144 defined by the meeting of the upper ends of two diagonal struts 118 (in row IV). There may be two diagonal struts 122 along row V, from one location 142 to the next 142, and there may be two diagonal struts 118 along row IV, from one location 144 to the next 144.

[0039] Frame 102 may include axially extending frame members (i.e., frame segments 130 or struts 132) at every other such pair of such locations 142 along row V and such locations 144 along row VI. Frame 102 may have one window frame segment 130 at every four such locations, equally spaced around the circumference of frame 102, thereby providing a total of three window frame segments 130 (corresponding to the three commissures in a tri-leaflet valve). Thus, the frame 102 may comprise, in sequence along row V, a window frame portion 130 extending between a pair of such positions 142, 144, followed by a second pair of positions 142, 144 without axially extending posts or frame members extending therebetween, followed by an axially extending post 132 extending between a third pair of positions 142, 144, followed by a fourth pair of positions 142, 144 also without axially extending posts or frame members, followed by another window frame portion 130 extending between such pairs of positions 142, 144 (thus resuming the sequence of posts and frame portions). If there are two diagonal struts between each set of positions 142, 144 (along each of rows IV and V), this embodiment can have sets of eight diagonal struts along each row between adjacent window frame sections 130, and four consecutive diagonal struts between each window frame section 130 and its adjacent axial strut 132 (i.e., with no other axial frame members in between).

[0040] After the prosthetic heart valve 100 is properly implanted in the valve annulus, it can be cycled between open and closed states to allow or block blood flow. In various embodiments, the frame 102 of the prosthetic heart valve 100 flexes inward during diastole to provide some damping during valve closure, and this flexing reduces stress on the valve leaflets. For example, a force pulling the commissures of the leaflets 110 radially inward (e.g., during valve closure) can also pull regions of the frame directly adjacent the commissures (e.g., the window frame portion 130) radially inward, while the axial struts 132 can force them radially outward. In various embodiments, this braking effect (which involves pulling frame portion 130 radially inward and pushing axial struts 132 radially outward) can be enhanced by reducing the number of axial struts along the upper tier (between rows IV and V in valve 100) compared to frames having a greater number of axial frame members (e.g., a greater number of axial struts), as disclosed herein.

[0041] The primary function of the inner skirt 106 is to help secure the valve-like structure 104 to the frame 102 and to form a good seal between the valve 100 and the native annulus by preventing blood from flowing through the open cells of the frame 102 under the lower edges of the valve leaflets 110. The inner skirt 106 desirably comprises a tough, tear-resistant material such as polyethylene terephthalate (PET), although various other synthetic or natural materials may be used. The inner skirt 106 may be secured to the interior of the frame 102 with sutures. The valve-like structure 104 may be attached to the inner skirt 106 with the aid of one or more thin PET reinforcing strips (which may form a sleeve overall, not shown) that allow for secure suturing and protect the pericardial tissue of the valve leaflet structure from tearing. The valve-like structure 104 may be sandwiched between the inner skirt 106 and the thin PET strips.

[0042] An upper edge portion of the inner skirt 106 may be formed with a plurality of protrusions defining a wave shape that generally follows the shape of the fourth row (row IV) of struts 118 directly adjacent the lower ends of the axial struts 132. In this manner, the upper edge of the inner skirt 106 may be securely secured to the struts 118 with stitching 146, as best shown in FIG. 1 . The inner skirt 106 may also be secured to the first row of struts 112, the second row of struts 114, and / or the third row of struts 116 (rows I-III) with stitching 146.

[0043] The inner skirt 106 can be sutured to the frame 102 at a location away from the suture lines attaching the lower edges of the leaflets 110 to the inner skirt 106, thereby reducing stress concentrations at the leaflet suture lines and providing increased flexibility to the skirt in that region.

[0044] As shown in FIGS. 1-2 , multiple flexible connectors 125 can be used to interconnect each pair of adjacent edges of the leaflets 110 and attach the leaflets 110 to the commissure window frame portion 130. The flexible connectors 125 can be made from a single piece of woven PET fabric, although other synthetic and / or natural materials may also be used. Each commissure can include two tab portions for two adjacent leaflets. Each commissure can be secured to the frame, for example, by inserting the tab portions through the commissure windows 120 in the window frame portion 130 and suturing the tab portions to the connectors 125 on the outside of the frame 102.

[0045] The outer skirt 108 can be laser cut or otherwise formed from a piece of strong, durable material, such as woven PET, although other synthetic or natural materials may also be used. The outer skirt 108 can have a generally straight lower edge and an upper edge defining a plurality of alternating projections 150 and notches 152. The lower edge of the outer skirt 108 can be sewn to the lower edge of the inner skirt 106 at the inflow end of the valve 100. In other embodiments, the inner skirt 106 and outer skirt 108 are integrally fabricated as a single component. As shown in FIGS. 1-2 , each projection 150 can be secured to the second stage II of the strut 114 of the frame 102 with sutures 154.

[0046] Further details relating to securing the valve member 104, inner skirt 106, and outer skirt 108 to the frame 102 are described in U.S. Patent Application Publication No. 2011 / 0123529.

[0047] In various embodiments, the frame can be constructed with more or fewer rows of diagonal struts than are included in frame 102, such as four or six rows of diagonal struts. In various other frame embodiments, each window frame portion and / or each axially extending strut can extend between two positions, each defined by the upper ends of the diagonal struts converging at a point. In various embodiments, each window frame portion and / or each axially extending strut can extend between two positions, each defined by the lower ends of the diagonal struts converging at a point.

[0048] 6 shows a perspective view of another exemplary prosthetic valve 200 including an inner skirt 206, an outer skirt 208, and a valve member 204 mounted within a stent 202. The valve member 204 may have a set of three leaflets 210. Multiple flexible connectors 225 may be used to interconnect pairs of adjacent edges of the leaflets 210 and to attach the leaflets 210 to commissure window frame portions 230.

[0049] 7-8 show perspective and flattened views of a bare stent 202 having an inflow end 203, an outflow end 205, and four rows (I-IV) of struts 214, 216, 218, 222 (rather than the five rows shown in FIGS. 1-5). The fourth row IV of diagonal struts 222 can be connected to the third row III of diagonal struts 218 by a plurality of axially extending fenestration portions 230 (defining commissural fenestrations 220) and a plurality of axially extending struts 232.

[0050] Thus, each window frame portion 230 and each axially extending strut 232 can extend between the two rows of diagonal struts closest to the outflow end 205. Specifically, each window frame portion 230 can extend between a position 242 defined by the upper ends of two diagonal struts 222 meeting at a point and a position 244 defined by the upper ends of two diagonal struts 218 meeting at a point. Each axially extending strut 232 can extend between another position 246 defined by the lower ends of two diagonal struts 222 meeting at a point and another position 248 defined by the lower ends of two diagonal struts 218 meeting at a point.

[0051] The frame 202 may include three window frame sections 230 equally spaced around the circumference of the frame 202. As shown, the frame 202 may be constructed to have six diagonal struts (along each of columns III and IV) between the window frame sections 230 along each row. The frame may be constructed to have three diagonal struts between each window frame section 230 and an adjacent axial strut 232. Thus, each axial strut 232 may be located at the midpoint between adjacent window frame sections 230, and the frame 202 may be constructed to incorporate a one-to-one ratio of window frame sections and axially extending struts. In the illustrated embodiment, there are exactly three window frame sections 230 and exactly three axial struts 232.

[0052] Specifically, the frame 202 may include, in sequence along rows III and IV, a window frame portion 230 extending between a pair of positions 242, 244, followed by a pair of positions 246, 248 without an axially extending member, followed by a pair of positions 242, 244 without an axially extending member, followed by an axially extending strut 232 extending between the pair of positions 246, 248, followed by a pair of positions 242, 244 without an axially extending member, followed by a pair of positions 246, 248 without an axially extending member, followed by another window frame portion 230 extending between the pair of positions 242, 244 (thus resuming the arrangement of the window frame portion 230 and the axially extending strut 232).

[0053] After the prosthetic heart valve 200 is properly seated in the valve annulus, the valve 200 can be cycled between open and closed states to allow or block blood flow. As discussed with respect to the prosthetic valve 100, the forces that pull the commissures radially inward during cycling can also pull the window frame portions 230 radially inward, relieving stress on the leaflets during valve closure. Meanwhile, the axial struts 232 can be forced radially outward.

[0054] The frame 202 may be capable of assuming a collapsed configuration (e.g., for delivery on or within a catheter) and an expanded configuration (i.e., a configuration operable at the valve annulus). In various embodiments, in the collapsed configuration, a plurality of axial struts are positioned radially outward relative to the leaflet attachment members and / or commissures. In one embodiment, during transition from the expanded configuration to the collapsed configuration and / or from the collapsed configuration to the expanded configuration, the valve 200 may assume an intermediate configuration in which only the struts 222 adjacent to row IV of axially extending struts 232 are grouped together and extend axially (in approximate axial alignment with adjacent struts 232).

[0055] 9, the frame 302 can have an axial window frame member 330 extending between a position 342 defined by the convergence of the upper ends of the two diagonal struts 322 and a position 344 defined by the convergence of the lower ends of the two diagonal struts 318. The frame 302 can have an axially extending strut 332 extending between a position 346 defined by the convergence of the lower ends of the two diagonal struts 322 and a position 348 defined by the convergence of the upper ends of the two diagonal struts 318.

[0056] Frame 302 is similar to frame 202, except that the first three rows of diagonal struts (row I, row II, and row III) are shifted 20 degrees relative to the same rows in frame 202. Thus, each window frame member 330 is axially aligned with a location 344 defined by the convergence of the lower ends of the two diagonal struts 318 in row III. Each window frame member 330 may comprise a lower strut portion 334 below the level of the commissural fenestrae 320 (towards the inflow end of the stent 302). This lower strut portion 334 extends from the lower end of the window frame member 330 to a position 344 defined by the convergence of the lower ends of the two diagonal struts 318. The lower strut portion 334 adds length to the window frame member 330, allowing the frame member 330 to effectively bridge the greater distance between positions 342, 344 in this embodiment. Other features and components of the frame 302 may be similar to those described for frame 202 above.

[0057] FIG. 10 shows a portion of a frame 402 according to another embodiment. Only one-third of the circumference of the two upper rows of diagonal struts (the rows closest to the outflow end) is shown in FIG. 10. The frame 402 can have an axial window frame member 430 extending between a position 442 defined by the convergence of the lower ends of the two diagonal struts 422 and a position 444 defined by the convergence of the lower ends of the two diagonal struts 418. The frame 402 can have an axially extending strut 432 extending between a position 446 defined by the convergence of the upper ends of the two diagonal struts 422 and a position 448 defined by the convergence of the upper ends of the two diagonal struts 418.

[0058] The two upper rows of diagonal struts include a total of three axial window frame members 430 and three axially-extending struts 432 equidistant between the frame members 430, with three diagonal struts 418 and three diagonal struts 422 extending between the frame members 430 and adjacent axially-extending struts 432. The frame 402 may also include three additional rows of diagonal struts (not shown in FIG. 10 ) at the inflow end of the frame, similar to the embodiment discussed above. The lower end of each window frame member 430 may be connected to the upper ends of two diagonal struts in the adjacent row (the third row from the outflow end of the frame) at location 444. Thus, in this embodiment, the lower end of each axially-extending strut 432 is not connected to any struts in the adjacent row.

[0059] FIG. 11 shows a portion of a frame 502 according to another embodiment. Only one-third of the circumference of the two upper rows of diagonal struts (the rows closest to the outflow end) is shown in FIG. 11 . The frame 502 can have an axial window frame member 530 extending between a position 542 defined by the convergence of the lower ends of the two diagonal struts 522 and a position 544 defined by the convergence of the upper ends of the two diagonal struts 518. The frame 502 can have an axially extending strut 532 extending between a position 546 defined by the convergence of the upper ends of the two diagonal struts 522 and a position 548 defined by the convergence of the lower ends of the two diagonal struts 518. The axially extending strut 532 in this embodiment can be longer than the window frame member 530 to compensate for the greater distance between positions 546 and 548 compared to the distance between positions 542 and 544.

[0060] The two upper rows of diagonal struts include a total of three axial window frame members 530 and three axially-extending struts 532 equidistant between the frame members 530, with three diagonal struts 518 and three diagonal struts 522 extending between the frame members 530 and adjacent axially-extending struts 532. The frame 502 may also include three additional rows of diagonal struts (not shown in FIG. 11 ) at the inflow end of the frame, similar to the embodiment discussed above. The lower end of each axially-extending strut 532 may be connected to the upper ends of two diagonal struts in the adjacent row (the third row from the outflow end of the frame) at location 548. Thus, in this embodiment, the lower end of each window frame member 530 is not connected to any diagonal struts in the adjacent row.

[0061] FIG. 12 shows a portion of a frame 602 according to another embodiment. Only one-third of the circumference of the two upper rows of diagonal struts (the rows closest to the outflow end) is shown in FIG. 12. The frame 602 can have an axial window frame member 630 extending between a position 642 defined by the convergence of the upper ends of the two diagonal struts 622 and a position 644 defined by the convergence of the upper ends of the two diagonal struts 618. The frame 602 can have an axially extending strut 632 extending between a position 646 defined by the convergence of the lower ends of the two diagonal struts 622 and a position 648 defined by the convergence of the lower ends of the two diagonal struts 618.

[0062] 12, there are two such axially-extending struts 632 spaced between each pair of window frame members 630. Specifically, for each pair of window frame members, there are three diagonal struts 618 and three diagonal struts 622 between each window frame member 630 and the nearest axially-extending strut 632, and two diagonal struts 618 and two diagonal struts 622 between two axially-extending struts 632. Thus, for the entire frame 602, the two top rows of diagonal struts include a total of three axial window frame members 630 and six axially-extending struts 632.

[0063] The frame 602 may also include three additional rows of diagonal struts (not shown in FIG. 12 ) at the inflow end of the frame, similar to the embodiment discussed above. The lower end of each axially extending strut 632 may be connected to the upper ends of two diagonal struts in the adjacent row (the third row from the outflow end of the frame) at location 648. Thus, in this embodiment, the lower end of each window frame member 630 is not connected to any struts in the adjacent row.

[0064] FIG. 13 shows a portion of a frame 702 according to another embodiment. Only one-third of the circumference of the two upper rows of diagonal struts (the rows closest to the outflow end) is shown in FIG. 13. The frame 702 can have an axial window frame member 730 extending between a position 742 defined by the convergence of the lower ends of the two diagonal struts 722 and a position 744 defined by the convergence of the upper ends of the two diagonal struts 718. The frame 702 can have an axially extending strut 732 extending between a position 746 defined by the convergence of the upper ends of the two diagonal struts 722 and a position 748 defined by the convergence of the lower ends of the two diagonal struts 718.

[0065] 13, there are two such axially-extending struts 732 spaced between each pair of window frame members 730. Specifically, for each pair of window frame members, there are three diagonal struts 718 and three diagonal struts 722 between each window frame member 730 and the nearest axially-extending strut 732, and two diagonal struts 718 and two diagonal struts 722 between two axially-extending struts 732. Thus, for the entire frame 702, the two top rows of diagonal struts include a total of three axial window frame members 730 and six axially-extending struts 732. Also, the struts 732 may be longer than the window frame members 730 to compensate for the greater distance between locations 746, 748 compared to the distance between locations 742, 744.

[0066] The frame 702 may also include three additional rows of diagonal struts (not shown in FIG. 13) at the inflow end of the frame, similar to the embodiment discussed above. The lower end of each axially extending strut 732 may be connected to the upper ends of two diagonal struts in the adjacent row (the third row from the outflow end of the frame) at location 748. Thus, in this embodiment, the lower end of each window frame member 730 is not connected to any struts in the adjacent row.

[0067] The prosthetic valve embodiments disclosed herein can be surgically implanted and / or delivered using a delivery device such as a catheter. The prosthetic valve can be mounted in a deflated state on or adjacent to an inflatable balloon or equivalent expansion mechanism of the delivery device. The delivery device and deflated prosthetic valve can be inserted into a patient's vascular system and advanced within the patient using well-known techniques.

[0068] In one implementation, the prosthetic valve is delivered via a transfemoral approach, in which a delivery device is inserted into the femoral artery and advanced through the aorta to the native aortic valve (or another native valve in the heart). In another implementation, the prosthetic valve can be delivered via a transventricular approach, in which the delivery device is inserted through a small surgical opening in the chest and another surgical opening in a wall of the heart, such as the left ventricular wall. In another implementation, the prosthetic valve can be delivered via a transaortic approach, in which the delivery device is inserted through a small surgical opening in the chest and another surgical opening in the ascending aorta above the aortic valve. In another implementation, the prosthetic valve is a replacement venous valve for implantation in a vein or a replacement for another valve with a lower flow rate than the aortic valve.

[0069] Once the prosthetic valve is positioned at a desired deployment location (e.g., within the native aortic valve), the balloon of the delivery device can be inflated to radially expand the prosthetic valve. In some embodiments, simultaneously with fully expanding the prosthetic valve, the outer skirt of the prosthetic valve can be forced into contact with the tissue surrounding the native valve to establish a seal between the outer surface of the frame and the surrounding tissue. The frame of the prosthetic valve can include an inflow end portion having an outer diameter smaller than the outer diameter of the outflow end portion of the frame when in a radially compressed, seated configuration.

[0070] When constructed from a self-expanding material, the prosthetic valve can be contracted to a radially compressed state and held in that compressed state by insertion into a delivery catheter sheath or equivalent mechanism. After the delivery device is inserted and advanced into the body to position the prosthetic valve at a desired deployment location, the prosthetic valve can be advanced out of the delivery sheath. Once deployed out of the delivery sheath, the prosthetic valve can self-expand radially to its functional size.

[0071] The prosthetic heart valve can include commissure portions of the leaflets that extend radially outward through corresponding window frame portions to locations exterior to the frame and are sutured to the lateral struts of the commissure window frame. To minimize the contracted profile of the prosthetic valve, the window frame portions can be recessed radially inward relative to surrounding portions of the frame, such as the frame portions extending between adjacent commissure windows, when the prosthetic valve is radially compressed onto the catheter into its collapsed configuration.

[0072] For example, when the prosthetic valve is radially compressed, the commissural windows of the frame can be recessed inward by a radial distance, such as between 0.2 mm and 1.0 mm, compared to the portion of the frame extending between adjacent commissural windows. In this way, the outer diameter of the outflow end portion of the prosthetic valve, including the commissural portions, can be generally uniform, as opposed to commissural portions protruding outward from the periphery of the prosthetic valve, which may interfere with delivery of the prosthetic valve into the body. Even with radially recessed commissural window frames, when the prosthetic valve is radially compressed onto a catheter, the outer diameter of the inflow end portion of the frame can still be smaller than or approximately equal to the outer diameter of the outflow end portion of the frame, thereby allowing for a minimum or reduced maximum overall diameter of the prosthetic valve. By minimizing or reducing the diameter of the prosthetic valve when mounted on a delivery catheter, the diameter of the delivery catheter through which the prosthetic valve is advanced can also be minimized or reduced. This allows the prosthetic valve to be delivered into the body through narrower blood vessels, generally resulting in a less invasive delivery procedure.

[0073] Further details relating to the delivery of the prosthetic heart valves disclosed herein are provided in U.S. Patent Application Publication No. 2011 / 0123529.

[0074] General Considerations In this description, certain aspects, advantages, and novel features of embodiments of the present disclosure are described herein. The disclosed methods, apparatus, and systems should not be construed as limiting in any way. Rather, the present disclosure is directed to all novel and unobvious 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 specific aspect or feature or combination thereof, nor are the disclosed embodiments required to have any specific advantage or advantages or to solve any specific problem or problems.

[0075] Although the operations of some of the disclosed methods are described in a particular order of occurrence for convenience of presentation, it should be understood that such description encompasses reordering unless a specific order is required by specific language. 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. As used herein, the terms "a," "an," and "at least one" encompass one or more of the specified elements. That is, where two specified elements are present, one of those elements is also present, and therefore "an" element is present. The terms "a plurality of" and "plural" mean two or more specified elements.

[0076] As used herein, the term "and / or" used between the last two of a list of elements means any one or more of the listed elements. For example, the phrase "A, B and / or C" means "A," "B," "C," "A and B," "A and C," "B and C," or "A, B and C."

[0077] In view of the many possible embodiments to which the principles of the disclosed invention may be applied, it is to be understood that the illustrated embodiments are merely preferred examples of the invention and should not be construed as limiting the scope of the invention. Rather, the scope of the invention is defined by the appended claims. The inventors therefore claim as their invention all that comes within the scope and spirit of such claims. [Explanation of symbols]

[0078] 100 Artificial heart valves, artificial valves 102 Stents, frames 103 Inflow end 104 Valve-like structure, valve member 105 Outlet end 106 Inner Skirt 108 Outer Skirt 110 Valve leaflet 112 Diagonal Support 114 Diagonal Support 116 Diagonal Support 118 Diagonal Support 120 Commissural window 122 Diagonal Support 124 Axial extension column 125 Flexible Connector 130 Axially extending window frame portion, commissure window frame portion 132 Axial extension column, axial column 136 Opening 138 Opening 140 Opening 142 positions 144 Position, Node 146 Suture 150 protrusions 152 Notch 154 Sutures 200 Artificial valves, artificial heart valves 202 Stents, frames 203 Inflow end 204 Valve member 205 Outlet end 206 Inner Skirt 208 Outer Skirt 210 Valve Leaflet 214 Post 216 Post 218 Diagonal Support 220 Commissural window 222 Diagonal Support 225 Flexible Connector 230 commissure window frame portion, axially extending window frame portion 232 Axial extension column, axial column 242 positions 244 positions 246 positions 248 positions 302 Frame, stent 318 Diagonal Support 320 Commissural window 322 Diagonal Support 330 Axial window frame members 332 Axial extension column 334 Lower support part 342 positions 344 position 346 position 348 positions 402 frames 418 Diagonal Support 422 Diagonal Support 430 Axial window frame member 432 Axial extension column 442 position 444 position 446 position 448 position 502 frames 518 Diagonal Support 522 Diagonal Support 530 Axial window frame member 532 Axial extension column 542 position 544 position 546 position 548 position 602 frames 618 Diagonal Support 622 Diagonal Support 630 Axial window frame members 632 Axial extension column 642 position 644 position 646 position 648 position 702 frames 718 Diagonal Support 722 Diagonal Support 730 Axial window frame members 732 Axial Extending Column 742 position 744 position 746 position 748 position I First Lower Row II. Second row, second column III. The Third Column IV. The Fourth Column V Fifth Column

Claims

1. A plastically expandable frame (102; 202; 302; 402; 502; 602; 702) for a prosthetic heart valve, said frame (102; 202; 302; 402; 502; 602; 702) comprising: an inlet end (103; 203) and an outlet end (105; 205), - an outflow cell row at the outflow end (105; 205), said outflow cell row comprising a first row of diagonal struts and a second row of diagonal struts, each arranged around the circumference of the stent; and - axial frame members (130, 132; 230, 232; 330, 332; 430, 432; 530, 532; 630, 632; 730, 732) bridging the first row of diagonal struts and the second row of diagonal struts; Equipped with the axial frame members (130, 132; 230, 232; 330, 332; 430, 432; 530, 532; 630, 632; 730, 732) bridging the first row of diagonal struts and the second row of diagonal struts extend only between the first row of diagonal struts and the second row of diagonal struts; A frame characterized in that the outflow side cells are formed by a total of 6, 8 or 10 pillars.

2. 2. The frame of claim 1, wherein the axial frame members (130, 132; 230, 232; 330, 332; 430, 432; 530, 532; 630, 632; 730, 732) are configured as axial struts.

3. 3. The frame of claim 1, wherein the axial frame member (130, 132; 230, 232; 330, 332; 430, 432; 530, 532; 630, 632; 730, 732) comprises at least two axially extending leaflet attachment members configured as axial struts having suture openings configured to support respective commissures of a prosthetic valve member.

4. 4. The frame of claim 3, wherein there are three or fewer axially extending struts (132; 232; 332; 432; 532; 632; 732) between adjacent leaflet attachment members (130; 230; 330; 430; 530; 630; 730).

5. The frame of any one of claims 1 to 4, wherein the frame is made of stainless steel, a nickel-based alloy, a polymer, or a combination thereof.

6. A prosthetic heart valve (100; 200) comprising a frame according to any one of claims 1 to 5, a valve-like structure (104; 204), an inner skirt (106; 206) and an outer skirt (108; 208).

7. 7. The prosthetic heart valve of claim 6, wherein the valve-like structure (104; 204) comprises three leaflets (110).

8. 8. The prosthetic heart valve of claim 7, wherein the leaflets (110) are made of pericardial tissue or a biocompatible synthetic material.

9. The prosthetic heart valve according to any one of claims 6 to 8, characterized in that the inner skirt (106; 206) comprises a tough, tear-resistant material.

10. 10. The prosthetic heart valve of claim 9, wherein the inner skirt (106; 206) comprises polyethylene terephthalate or a natural material.

11. 11. The prosthetic heart valve according to any one of claims 6 to 10, characterized in that the inner skirt (106; 206) is fixed to the inside of the frame (102; 202; 302; 402; 502; 602; 702) by means of sutures.

12. 12. The prosthetic heart valve according to any one of claims 6 to 11, characterized in that the upper edge of the inner skirt (106; 206) is formed with a plurality of projections defining a wave shape following the shape of the row of struts to which the inner skirt (106; 206) is fixed.

13. 13. The prosthetic heart valve of claim 6, wherein the inner skirt (106; 206) is sutured to the frame (102; 202; 302; 402; 502; 602; 702) at a position away from the suture line attaching the lower edge of the valve leaflet (110) to the inner skirt (106; 206).

14. 14. The prosthetic heart valve according to claim 6, wherein the lower edge of the outer skirt (108; 208) is sewn to the lower edge of the inner skirt (106; 206) at the inflow end (103; 203) of the prosthetic heart valve (100; 200).

15. 14. The prosthetic heart valve according to any one of claims 6 to 13, characterized in that the inner skirt (106; 206) and the outer skirt (108; 208) are integrally formed as a single component.

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