Prosthetic valve

Abstract

The prosthetic valve includes an annular frame and a skirt. The frame is radially expandable and compressible between a radially compressed configuration and a radially expanded configuration. The skirt has a fold around the inflow end of the frame to cover at least a portion of the outer surface of the frame and at least a portion of the inner surface of the frame. When the frame is in the radially expanded configuration, the outer portion of the skirt fits snugly against the outer surface of the frame, and the inflow end of the frame is axially spaced from the fold to form an axially extending gap between the frame and the fold. When the frame is in the radially compressed configuration, the inflow end of the frame extends axially to at least partially fill the axially extending gap.

Description

[Technical field]

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS This application claims the benefit of U.S. Provisional Patent Application No. 62 / 797,837, filed Jan. 28, 2019, which is incorporated herein by reference.

[0002] The present disclosure relates to embodiments of prosthetic valves for implantation in a body conduit, such as a native heart valve annulus, and methods of implanting the prosthetic valve. [Background technology]

[0003] The human heart can suffer from a variety of valvular diseases. These valvular diseases can result in significant dysfunction of the heart and ultimately require replacement of the natural valve with an artificial valve. There are several known artificial valves and several known methods of implanting these artificial valves in a person. Due to the drawbacks associated with traditional open-heart surgery, percutaneous minimally invasive surgical methods have attracted considerable attention. In one technique, a prosthetic heart valve is configured to be implanted in a much less invasive procedure using catheter techniques. For example, the prosthetic heart valve can be loaded in a crimped state at the distal end of a delivery device and advanced through the patient's vascular system (e.g., through the femoral artery and aorta) until the prosthetic valve reaches the implantation site in the heart. The prosthetic valve is then expanded to its functional size, for example by inflating a balloon on which the prosthetic valve is loaded, or by deploying the prosthetic valve from a sheath of the delivery device so that the prosthetic valve can self-expand to its functional size, or by other means. Despite recent advances in percutaneous valve technology, there remains a need for improved prosthetic valves and methods for the delivery of such valves.

[0004] Known prosthetic valves may be radially compressible and expandable between a radially compressed state and a radially expanded state, such that the prosthetic valve may be crimped in a radially compressed state in an implant delivery device during delivery and then expanded to a radially expanded state once the prosthetic valve reaches the implantation site.

[0005] A prosthetic valve typically comprises a frame on which the valve structure (e.g., the leaflets) are mounted, an inner skirt secured to the inside of the frame, and optionally an outer skirt secured to the outside of the frame. The inner skirt can serve several functions. For example, the inner skirt can function as a sealing member to prevent (or reduce) paravalvular leakage and to anchor the leaflets to the frame. The outer skirt can cooperate with the inner skirt to further reduce or avoid paravalvular leakage after implantation of the valve. The inner and outer skirts can be secured to the frame by sewing or stitching the fabric of the respective skirts to the frame.

[0006] The inner skirt desirably comprises a tough, tear-resistant material such as polyethylene terephthalate (PET), although a variety of other synthetic or natural materials can be used. Skirts formed from conventional woven PET or similar fabrics are substantially inelastic and therefore offer little stretch. The lack of elasticity of the skirt can make it difficult to retract the prosthetic valve. For example, retracting the prosthetic valve tends to lengthen the frame axially while reducing the diameter of the frame. Because the skirt is typically sewn to the frame, the inelasticity of the skirt can restrict the axial extension of the frame. In some circumstances, retraction can create substantial stresses in the fabric at the suture locations, which can result in tearing of the sutures, tearing of the fabric, or distortion of the frame. Furthermore, depending on how the skirt is sewn to the frame, the constraint of the skirt during retraction can be localized, such that some areas of the skirt fit the frame tighter than others. Such uneven tightening can result in undesirable uneven attachment of the skirt to the frame and can further cause tearing of the sutures and / or fabric, or distortion of the frame. One possible solution to this problem is to size the skirt so that there is radial slack when the prosthetic valve is in a radially expanded state. The slack allows axial elongation of the prosthetic valve during the shortening process without being restricted or constrained by the skirt. However, the use of excess fabric can increase the radial profile of the prosthetic valve, which is detrimental to transcatheter implantation of the valve. Also, loose fabric can protrude through the frame sections and contact the valve leaflets, causing undesirable wear of the leaflets. Therefore, improvements to skirts for prosthetic valves are desired. [Prior art documents] [Patent documents]

[0007] [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. Pat. No. 7,993,394 [Patent Document 5] U.S. Pat. No. 8,652,202 [Patent Document 6] U.S. Patent Application Serial No. 15 / 978,459 [Patent Document 7] U.S. Patent Application Serial No. 62 / 548,855 [Patent Document 8] U.S. Patent Application Serial No. 62 / 430,810 [Patent Document 9] U.S. Patent Application No. 15 / 831,197 (U.S. Patent Application Publication No. 2018 / 0153689) [Patent Document 10] U.S. Patent Application Serial No. 15 / 995,528 [Patent Document 11] US Patent Application Publication No. 2015 / 0135506 [Patent Document 12] US Patent Application Publication No. 2014 / 0296962 [Patent Document 13] US Patent Application Publication No. 2013 / 0030519 [Patent Document 14] US Patent Application Publication No. 2010 / 0049313 [Patent Document 15] US Patent Application Publication No. 2009 / 0281619 [Patent Document 16] US Patent Application Publication No. 2008 / 0065011 [Patent Document 17] US Patent Application Publication No. 2007 / 0005131 Summary of the Invention [Means for solving the problem]

[0008] Described herein are examples of prosthetic valves and associated methods of implanting the prosthetic valves. The prosthetic valves disclosed herein can be implanted into any of the heart's native valves (aortic, mitral, tricuspid, and pulmonary valves). In some embodiments, the prosthetic valves can be delivered through the vascular system using a delivery device and implanted into the patient's heart.

[0009] Certain embodiments of the present disclosure relate to a prosthetic valve having an annular frame, a valve structure, and an annular skirt. The annular frame may be radially expandable and compressible between a radially compressed configuration and a radially expanded configuration. The valve structure may be positioned within the frame and configured to permit blood flow through the prosthetic valve in one direction and block blood flow in the opposite direction. The annular skirt may have an outer portion covering at least a portion of an outer surface of the frame and an inner portion covering at least a portion of an inner surface of the frame. The skirt may be folded about an inflow end of the frame to define a fold between the inner and outer portions. The skirt may be sized such that when the frame is in the expanded configuration, the outer portion of the skirt conforms to the outer surface of the frame and the inflow end of the frame is axially spaced from the fold to form an axially extending gap between the frame and the fold, and such that when the frame is radially compressed from the expanded configuration to the compressed configuration, the inflow end of the frame moves axially closer to the fold within the gap.

[0010] In some embodiments, an outer portion of the skirt may be secured to a row of posts that define the outflow end of the frame.

[0011] In some embodiments, an outer portion of the skirt may be circumferentially stretched when the frame is in the expanded configuration.

[0012] In some embodiments, the skirt may comprise a non-elastic fabric.

[0013] In some embodiments, the fabric may be woven with polyethylene terephthalate fibers in both the warp and weft directions.

[0014] In some embodiments, the skirt can be woven from a first set of fibers oriented in a first direction and a second set of fibers oriented in a second direction, neither of which is perpendicular to the fold.

[0015] In some embodiments, the first direction may be generally perpendicular to the second direction, and the second direction may form an angle of about 45 degrees with respect to the fold.

[0016] In some embodiments, the valve structure may comprise a plurality of leaflets, each leaflet having an inflow edge portion. The inflow edge portions of the leaflets may define an undulating shape.

[0017] In some embodiments, the inner portion of the skirt may have a contoured outflow edge that is sutured to the inflow edge portion of the leaflet.

[0018] In some embodiments, the prosthetic valve may include a tether coupled to the skirt. The tether may be configured to prevent the fold from migrating inwardly of the frame when the frame is radially expanded from the compressed configuration to the expanded configuration.

[0019] Certain embodiments of the present disclosure also relate to a prosthetic valve having an annular frame, a valve structure, and an annular skirt. The annular frame can have an inflow end and an outflow end, and the frame can be radially expandable and compressible between a radially compressed configuration and a radially expanded configuration. The valve structure can be positioned within the frame and configured to permit blood flow through the prosthetic valve in one direction and block blood flow in the opposite direction. The annular skirt can have a fold extending around the inflow end of the frame to cover at least a portion of an outer surface of the frame and at least a portion of an inner surface of the frame. When the frame is in the radially expanded configuration, the outer portion of the skirt can fit tightly against the outer surface of the frame, and the inflow end of the frame can be axially spaced from the fold to form an axially extending gap between the frame and the fold. When the frame is in the radially compressed configuration, the inflow end of the frame can extend axially to at least partially fill the axially extending gap.

[0020] In certain embodiments, the valve structure can include a plurality of leaflets each having an inflow edge portion, which can define an undulating, curved wave shape that circumferentially follows a plurality of interconnected strut segments of the frame when the frame is in a radially expanded configuration.

[0021] In certain embodiments, the outer portion of the skirt may be axially longer than the inner portion of the skirt.

[0022] In certain embodiments, an outer portion of the skirt may be circumferentially stretched when the frame is in the expanded configuration.

[0023] In certain embodiments, the prosthetic valve may include a tether coupled to the skirt that extends at an oblique angle relative to the longitudinal axis of the frame such that the tether can apply tension to the skirt to prevent the folds from migrating inwardly into the frame as the frame is radially expanded from a compressed configuration to an expanded configuration.

[0024] Also disclosed herein is a method of implanting a prosthetic valve mounted on a delivery device. The method may include delivering a prosthetic valve in a radially compressed configuration to a target location, the prosthetic valve comprising an annular frame and an annular skirt having a fold about an inflow end of the frame to cover at least a portion of an outer surface of the frame and at least a portion of an inner surface of the frame. The method further includes expanding the prosthetic valve to a radially expanded configuration such that the outer portion of the skirt fits snugly against the outer surface of the frame and the inflow end of the frame moves axially away from the fold, thereby forming an axially extending gap between the frame and the fold.

[0025] In certain embodiments, the prosthetic valve may further comprise a valve structure. The valve structure may comprise a plurality of leaflets each having an inflow edge portion, the inflow edge portions of the leaflets may define an undulating curved wave shape that circumferentially follows the plurality of interconnected strut segments of the frame when the frame is in the radially expanded configuration.

[0026] In certain embodiments, an outer portion of the skirt may be circumferentially stretched when the frame is in the expanded configuration.

[0027] In certain embodiments, when the frame is in a radially compressed configuration, the inflow end of the frame can extend axially to a fold to completely fill the axially extending gap.

[0028] In certain embodiments, the prosthetic valve may include a tether coupled to the skirt, the tether may be configured to prevent the folds from migrating inwardly of the frame when the frame is radially expanded from the compressed configuration to the expanded configuration.

[0029] Further disclosed herein are embodiments of a prosthetic valve comprising an annular frame and an annular skirt covering at least a portion of an outer surface of the frame. The annular frame can have an inflow end and an outflow end, and the frame can be radially expandable and compressible between a radially compressed configuration and a radially expanded configuration. A lower edge of the skirt can extend over the inflow end of the frame. The skirt can be attached to the frame by a plurality of sutures. The sutures can be positioned on selected struts of the frame such that the sutures form undulating, wavy suture lines. Each of the suture lines can form an angle of about 45 degrees with respect to a longitudinal axis of the frame when the frame is in the radially expanded configuration. The skirt can be woven from a first set of inelastic fibers oriented in a first direction and a second set of inelastic fibers oriented in a second direction. The first direction can be generally perpendicular to a second direction that can form an angle of about 45 degrees with respect to the lower edge of the skirt. The skirt can be sized to fit tightly against the outer surface of the frame without slack when the frame is in the radially expanded configuration.

[0030] In some embodiments, the skirt can be folded about the inflow end of the frame such that a lower edge of the skirt defines the fold. When the frame is in the radially expanded configuration, the inflow end of the frame can be axially spaced from the fold to form an axially extending gap between the frame and the fold. When the frame is radially compressed from the expanded configuration to the compressed configuration, the inflow end of the frame can move axially closer to the fold within the gap.

[0031] In some embodiments, when the frame is radially compressed, the skirt can ripple to form folded flaps between the rippled seams.

[0032] In some embodiments, each flap may be folded circumferentially over its adjacent flap to maintain the low crimped profile of the prosthetic valve.

[0033] Certain embodiments of the present disclosure relate to a prosthetic valve comprising an annular frame having an inflow end and an outflow end, at least one actuator mounted to the frame, and an annular skirt having a fold extending around the inflow end of the frame to cover at least a portion of an outer surface of the frame and at least a portion of an inner surface of the frame. The actuator may be configured to radially expand or compress the frame between a radially compressed configuration and a radially expanded configuration. When the frame is in the radially expanded configuration, an outer portion of the skirt may fit tightly against the outer surface of the frame, and the inflow end of the frame may be axially spaced from the fold to form an axially extending gap between the frame and the fold. When the frame is in the radially compressed configuration, the inflow end of the frame may extend axially to at least partially fill the axially extending gap.

[0034] In some embodiments, the at least one actuator may be one of a plurality of actuators mounted to an inner surface of the frame and equally spaced around the inner surface of the frame.

[0035] In some embodiments, the at least one actuator may include a first tether attached to a first location on the frame, a second tether secured to a second location on the frame, and a bar extending through the first tether and the second tether. The second location may be closer to the inflow end of the frame than the first location. The bar may be configured to increase or decrease a distance between the first and second locations to radially compress or radially expand the frame, respectively.

[0036] In some embodiments, the bar may include male threads configured to matingly engage with the female threads of the second anchor portion.

[0037] In some embodiments, the first location can be a joint between two overlapping posts of the frame, and the first tether can be hinged to the joint by a fastener.

[0038] In some embodiments, the at least one actuator can comprise a bar at least partially received in the sleeve, such that axial movement of the bar relative to the sleeve can cause radial expansion or compression of the frame.

[0039] In some embodiments, the at least one actuator may include a locking mechanism configured to lock the frame in the radially expanded configuration.

[0040] In some embodiments, the at least one actuator may include an attachment member configured to form a releasable coupling with a corresponding actuation member of the delivery device such that the actuation member of the delivery device can apply a force to the at least one actuator to radially compress or expand the frame.

[0041] In some embodiments, the prosthetic valve may further comprise a valve structure positioned within the frame and configured to permit blood flow through the prosthetic valve in one direction and prevent blood flow in the opposite direction.

[0042] In some embodiments, the valve structure can include a plurality of leaflets each having an inflow edge portion that can define an undulating, curved wave shape that circumferentially follows a plurality of interconnected strut segments of the frame when the frame is in a radially expanded configuration.

[0043] In some embodiments, the outer portion of the skirt may be axially longer than the inner portion of the skirt.

[0044] In some embodiments, the outer portion of the skirt may have approximately the same axial length as the inner portion of the skirt.

[0045] In some embodiments, the outer portion of the skirt may be axially shorter than the inner portion of the skirt.

[0046] In some embodiments, an outer portion of the skirt may be circumferentially stretched when the frame is in the expanded configuration.

[0047] In some embodiments, the top edge of the outer portion of the skirt may be generally straight before being attached to the frame.

[0048] In some embodiments, the upper edge of the outer portion of the skirt may be attached to the frame at a number of swivel joints formed by overlapping posts of the frame.

[0049] In some embodiments, the upper edge of the outer portion of the skirt may have a contoured shape and is sewn along the row of strut sections of the frame.

[0050] In some embodiments, the prosthetic valve may further comprise a tether coupled to the skirt and extending at an oblique angle to the fold such that the tether applies tension to the skirt to prevent the fold from moving inwardly to the frame when the frame is radially expanded from the compressed configuration to the expanded configuration.

[0051] In some embodiments, the oblique angle may range from about 10° to about 80°. In some embodiments, the oblique angle may range from about 30° to about 60°. In some embodiments, the oblique angle may be about 45°.

[0052] In some embodiments, a first end of the tether can be located at the outflow edge of the outer portion of the skirt and a second end of the tether can be located adjacent the fold.

[0053] In some embodiments, the tether may include a suture that is sewn to the outer portion of the skirt using a skewer stitch.

[0054] In some embodiments, the tether may comprise an elastic material.

[0055] In some embodiments, the tether can be one of multiple tethers that can each form an oblique angle to the fold.

[0056] Certain embodiments of the present disclosure also relate to a prosthetic valve comprising an annular frame radially expandable and compressible between radially compressed and radially expanded configurations, an annular skirt having an outer portion covering at least a portion of an outer surface of the frame and an inner portion covering at least a portion of an inner surface of the frame, and a tether coupled to the skirt to prevent the fold from moving inwardly to the frame when the frame is radially expanded from the compressed configuration to the expanded configuration. The skirt may be folded about an inflow end of the frame to define a fold between the inner and outer portions. The skirt may be sized such that when the frame is in the expanded configuration, the outer portion of the skirt can conform to the outer surface of the frame, and the inflow end of the frame can be axially spaced from the fold to form an axially extending gap between the frame and the fold, and such that when the frame is radially compressed from the expanded configuration to the compressed configuration, the inflow end of the frame can be axially moved closer to the fold within the gap.

[0057] In some embodiments, the prosthetic valve may further comprise a valve structure positioned within the frame and configured to permit blood flow through the prosthetic valve in one direction and prevent blood flow in the opposite direction.

[0058] In some embodiments, the valve structure may comprise a plurality of leaflets, each having an inflow edge portion, the inflow edge portions of the leaflets may define an undulating shape.

[0059] In some embodiments, the inner portion of the skirt may have a contoured outflow edge that is sutured to the inflow edge portion of the leaflet.

[0060] In some embodiments, an outer portion of the skirt may be secured to a row of posts that define the outflow end of the frame.

[0061] In some embodiments, an outer portion of the skirt may be circumferentially stretched when the frame is in the expanded configuration.

[0062] In some embodiments, the skirt may comprise a non-elastic fabric.

[0063] In some embodiments, the fabric may include polyethylene terephthalate fibers.

[0064] In some embodiments, the polyethylene terephthalate fibers may have a thickness of about 20 denier.

[0065] In some embodiments, the polyethylene terephthalate fibers can have an inter-fiber spacing ranging from about 155 fibers per inch to about 180 fibers per inch. In some embodiments, the polyethylene terephthalate fibers can have an inter-fiber spacing of about 160 fibers per inch.

[0066] In some embodiments, the skirt can be woven from a first set of fibers oriented in a first direction and a second set of fibers oriented in a second direction, neither of which is perpendicular to the fold.

[0067] In some embodiments, the first direction may be generally perpendicular to the second direction that forms an angle of about 45 degrees to the fold.

[0068] In some embodiments, when the frame is in the expanded configuration, a first set of fibers can extend generally parallel to a first set of struts of the frame, a second set of fibers can extend generally parallel to a second set of struts of the frame, and the second set of struts can overlap the first set of struts to form a frame joint.

[0069] In some embodiments, the tether can extend at an oblique angle to the fold, and the tether can be configured to apply tension to the skirt when the frame is in the expanded configuration.

[0070] In some embodiments, the oblique angle may be about 45°.

[0071] In some embodiments, a first end of the tether can be located at the outflow edge of the outer portion of the skirt and a second end of the tether can be located adjacent the fold.

[0072] In some embodiments, the tether may include a suture that is sewn to the outer portion of the skirt using a skewer stitch.

[0073] In some embodiments, the tether may comprise an elastic material.

[0074] Certain embodiments of the present disclosure also relate to a prosthetic valve comprising an annular frame radially expandable and compressible between radially compressed and radially expanded configurations, and an annular outer skirt covering at least a portion of an outer surface of the frame, wherein when the frame is in the radially compressed configuration, a portion of the outer skirt can undulate to form a longitudinally extending folded flap.

[0075] In some embodiments, each flap may be further folded circumferentially to maintain the low crimped profile of the prosthetic valve.

[0076] In some embodiments, each flap can at least partially overlap an adjacent flap in the circumferential direction.

[0077] In some embodiments, the outer skirt may be connected to the frame posts along zig-zag attachment lines.

[0078] In some embodiments, the outer skirt may be connected to the frame posts with stitching along zigzag attachment lines.

[0079] In some embodiments, the outer skirt may not be connected to any of the struts of the frame or other components of the prosthetic valve at locations that are not along the zigzag attachment lines.

[0080] In some embodiments, the outer skirt may be connected to the frame only along the zigzag attachment lines.

[0081] In some embodiments, the prosthetic valve may further comprise a plurality of leaflets, each leaflet having an inflow edge portion attached to a post of the frame along a zigzag attachment line.

[0082] In some embodiments, the flap may be V-shaped.

[0083] In some embodiments, the prosthetic valve may further comprise an annular inner skirt covering at least a portion of the inner surface of the frame, and the outer skirt may be connected to the inner skirt via a fold extending around the inflow end of the frame.

[0084] In some embodiments, when the frame is in the radially expanded configuration, the outer skirt can be configured to fit tightly against an outer surface of the frame, and the inflow end of the frame can be axially spaced from the fold to form an axially extending gap between the frame and the fold, and when the frame is in the radially compressed configuration, the inflow end of the frame can be configured to extend axially to at least partially fill the axially extending gap.

[0085] In some embodiments, the axial length of the gap can range from about 4 mm to about 8 mm when the frame is in the radially expanded configuration. In some embodiments, the axial length of the gap can be about 6 mm when the frame is in the radially expanded configuration.

[0086] In some embodiments, when the frame is in a radially compressed configuration, the inflow end of the frame can extend axially into the gap to completely fill the gap.

[0087] In some embodiments, when the frame is in a radially compressed configuration, the inner skirt can fold inwardly toward the interior of the frame.

[0088] In some embodiments, the prosthetic valve may further comprise a tether coupled to the outer skirt and extending at an oblique angle to the fold such that the tether applies tension to the outer skirt to prevent the fold from moving inwardly of the frame when the frame is radially expanded from the compressed configuration to the expanded configuration.

[0089] In some embodiments, the tether may include a suture that is sewn to the outer skirt using a skewer stitch.

[0090] In some embodiments, the tether may comprise an elastic material.

[0091] Certain embodiments of the present disclosure further relate to a method of assembling a prosthetic valve. The method may include receiving an annular frame that is radially expandable and compressible between a radially compressed configuration and a radially expanded configuration, and attaching the annular skirt to the frame such that the skirt has an outer portion covering at least a portion of an outer surface of the frame and an inner portion covering at least a portion of an inner surface of the frame. The skirt may be folded about the inflow end of the frame to define a fold between the inner and outer portions. The skirt may be sized such that when the frame is in the expanded configuration, the outer portion of the skirt can conform to the outer surface of the frame, and the inflow end of the frame can be axially spaced from the fold to form an axially extending gap between the frame and the fold, and such that when the frame is radially compressed from the expanded configuration to the compressed configuration, the inflow end of the frame can be axially moved closer to the fold within the gap.

[0092] In some embodiments, attaching the annular skirt to the frame may include sewing an upper edge of an inner portion of the skirt to a selected row of strut sections of the frame from the inside of the frame.

[0093] In some embodiments, attaching the annular skirt to the frame may include sewing an outer portion of the skirt to a row of posts that define the outflow end of the frame.

[0094] In some embodiments, the method may further include attaching a valve structure to the frame. The valve structure may be configured to permit blood flow through the prosthetic valve in one direction and prevent blood flow in the opposite direction.

[0095] In some embodiments, the valve structure can include a plurality of leaflets, each having an inflow edge portion. The inflow edge portions of the leaflets can define an undulating shape. Attaching the valve structure to the frame can include suturing the inflow edge portions of the leaflets circumferentially from an inner side of the frame to a row of interconnected strut segments of the frame.

[0096] In some embodiments, the method may further include coupling a tether to the skirt at an oblique angle to the fold to prevent the fold from migrating inwardly of the frame when the frame is radially expanded from the compressed configuration to the expanded configuration.

[0097] Certain embodiments of the present disclosure further relate to a method including receiving a prosthetic valve having an annular frame radially expandable and compressible between a radially compressed configuration and a radially expanded configuration, and an annular skirt covering at least a portion of an outer surface of the frame, compressing the frame into the radially compressed configuration such that a portion of the skirt undulates to form a longitudinally extending folded flap, and folding the flap circumferentially.

[0098] In some embodiments, the skirt may be sewn to the frame posts along zigzag attachment lines.

[0099] In some embodiments, the prosthetic valve can include multiple leaflets, each of which can have an inflow edge portion that is attached to a post of the frame along a zig-zag attachment line.

[0100] In some embodiments, the skirt may cover at least a portion of the inner surface of the frame and form a fold around the inflow end of the frame.

[0101] In some embodiments, the skirt can be sized such that when the frame is in an expanded configuration, the inflow end of the frame can be axially spaced from the fold to form an axially extending gap between the frame and the fold, and such that when the frame is radially compressed from the expanded configuration to the compressed configuration, the inflow end of the frame can move axially closer to the fold within the gap.

[0102] In some embodiments, the prosthetic valve may further comprise a tether coupled to the skirt at an oblique angle to the fold to prevent the fold from moving inwardly into the frame when the frame is radially expanded from the compressed configuration to the expanded configuration.

[0103] In some embodiments, the method may further include loading the prosthetic valve into a sheath of a delivery device, inserting the prosthetic valve into the patient, advancing the prosthetic valve through the patient's vasculature to an implantation site, and radially expanding the prosthetic valve at the implantation site.

[0104] In some embodiments, radially expanding the prosthetic valve may cause the flaps to spread apart.

[0105] In some embodiments, the skirt can fit tightly against the outer surface of the frame when the frame is in the radially expanded configuration.

[0106] The foregoing and other objects, features and advantages of the present invention will become more apparent from the following detailed description which proceeds with reference to the accompanying drawings. [Brief description of the drawings]

[0107] [Figure 1] FIG. 1 is a perspective view of a prosthetic valve according to one embodiment. [Figure 2A] 2 is a diagram of the frame of the prosthetic valve of FIG. 1 shown in a radially compressed configuration. [Figure 2B] 2 is a diagram of the frame of the prosthetic valve of FIG. 1 shown in an incomplete radially expanded configuration. [Figure 2C] 2 is a frame diagram of the prosthetic valve of FIG. 1 shown in a fully radially expanded configuration. [Diagram 3] 2 is a side elevational view of the prosthetic valve depicted in FIG. 1 in a radially compressed configuration, the valve further comprising a skirt attached to the frame. [Figure 4] FIG. 4 is a side elevational view of the prosthetic valve depicted in FIG. 3 in a radially expanded configuration. [Diagram 5] FIG. 2 is a side cross-sectional view of the prosthetic valve when it is fully expanded. [Figure 6] FIG. 2 is a cross-sectional side view of the prosthetic valve when it is incompletely expanded. [Figure 7] FIG. 2 is a side cross-sectional view of the outermost portion of the prosthetic valve when it is fully expanded. [Figure 8] FIG. 2 is a flattened view of the skirt. [Figure 9] 1 is a perspective view of a prosthetic valve according to an alternative embodiment. [Figure 10] FIG. 13 is a perspective view of a radially expanded frame of a prosthetic valve according to another embodiment. [Figure 11] FIG. 11 shows the frame of FIG. 10 incompletely compressed, with the outer portion of the skirt folded outward. [Figure 12A] FIG. 10 shows the prosthetic valve of FIG. 9 fully compressed, with the outer portion of the skirt waving to form a folded flap. [Figure 12B] FIG. 12B is a view of the fully compressed prosthetic valve of FIG. 12A with the flaps folded circumferentially. [Figure 12C] FIG. 12C is a cross-sectional view of the fully compressed prosthetic valve depicted in FIG. 12B. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0108] 1 illustrates an exemplary prosthetic valve 10 according to one embodiment. In a specific embodiment, the prosthetic valve 10 may be implanted in the native aortic valve annulus, but may also be implanted elsewhere in the heart, including in the native mitral valve, the native pulmonary valve, and the native tricuspid valve. The prosthetic valve 10 may include an annular stent or frame 12 having an inflow end 14 and an outflow end 16. The prosthetic valve 10 may also include a valve structure 18 coupled to and supported within the frame 12. The valve structure 18 is configured to regulate the flow of blood through the prosthetic valve 10 from the inflow end 14 to the outflow end 16.

[0109] The prosthetic valve 10 may further include one or more actuators 50 mounted to and equally spaced about an inner surface of the frame 12. Each of the actuators 50 may be configured to form a releasable connection with one or more respective actuators of a delivery device, as described further below.

[0110] The valve structure 18 may, for example, comprise a leaflet assembly including one or more leaflets 20 made from a flexible material. The leaflets 20 may be made in whole or in part from a biological material, a biocompatible synthetic material, or other such material. A suitable biological material may include, for example, bovine pericardium (or pericardium from other sources). The leaflets 20 may be secured to one another at their adjacent sides to form joints 22, each of which may be secured to a respective actuator 50 or frame 12.

[0111] In the depicted embodiment, the valve structure 18 comprises three leaflets 20 that may be arranged to collapse in a three-tip configuration. Each leaflet 20 may have an inflow edge portion 21. As shown in FIG. 1, the inflow edge portion 21 of the leaflets 20 may define an undulating, curved wave shape that follows or traces the interconnected strut segments of the frame 12 in the circumferential direction when the frame 12 is in the radially expanded configuration. The inflow edge of the leaflets may be referred to as a "wavy line." In some embodiments, the inflow edge portion 21 of the leaflets 20 may be sutured to the struts generally along the wavy line. Forming the leaflets 20 with this wavy shape reduces stress on the leaflets 20, which further improves the durability of the valve 10. Furthermore, thanks to the wave shape, folds and ripples in the bulge of each leaflet 20 (the central region of each leaflet), which may cause early stiffening in those regions, may be eliminated or at least minimized. The corrugated shape also reduces the amount of tissue material used to form the valve structure 18 , thereby allowing for a smaller, more uniformly foreshortened profile at the inflow end 14 of the valve 10 .

[0112] Further details regarding transcatheter prosthetic heart valves, including the manner in which the valve structures may be coupled to the frame 12 of the prosthetic valve 10, can be found, for example, in U.S. Pat. Nos. 6,730,118, 7,393,360, 7,510,575, 7,993,394, 8,652,202, and U.S. patent application Ser. No. 15 / 978,459, all of which are incorporated by reference herein in their entireties.

[0113] The prosthetic valve 10 may be radially compressible and expandable between a radially compressed configuration and a radially expanded configuration. Figures 2A-2C show a bare (without leaflets or other components) frame 12 of the prosthetic valve 10 for purposes of illustrating the expansion of the prosthetic valve 10 from a radially compressed configuration to a radially expanded configuration. Figure 2A shows the frame 12 in a radially compressed configuration, Figure 2B shows the frame 12 in a partially expanded configuration, and Figure 2C shows the frame 12 in a fully radially expanded configuration.

[0114] In the illustrated embodiment, the prosthetic valve 10 may be mechanically expanded from a radially compressed configuration to a radially expanded configuration. For example, the prosthetic valve 10 may be radially expanded by applying an axial force (F) to the outflow end 16 toward the inflow end 14 while maintaining the inflow end 14 of the frame 12 in a fixed position. Alternatively, the prosthetic valve 10 may be expanded by applying an axial force to the inflow end 14 while maintaining the outflow end 16 in a fixed position, or by applying opposing axial forces to the inflow end 14 and outflow end 16, respectively.

[0115] In the illustrated embodiment, the expansion and compression forces are applied to the frame by actuators 50. Referring again to FIG. 1, each of the actuators 50 may comprise a screw or threaded rod 52, a first anchor in the form of a cylinder or sleeve 54, and a second anchor in the form of a threaded nut 56. The rod 52 extends through the sleeve 54 and the nut 56. The sleeve 54 may be secured to the frame 12 with a fastener or the like that forms a hinge at the joint between the two posts. Each actuator 50 is configured to increase the distance between the mounting locations of the respective sleeve 54 and nut 56, thereby lengthening the frame 12 axially and compressing it radially, and to decrease the distance between the mounting locations of the respective sleeve 54 and nut 56, thereby shortening the frame 12 axially and expanding it radially.

[0116] For example, each bar 52 may have male threads that engage female threads on a nut 56 such that rotation of the bar causes corresponding axial movement of the nut 56 either toward or away from the sleeve 54 (depending on the direction of rotation of the bar 52). This causes the hinges supporting the sleeve 54 and nut 56 to move closer together, causing a radial expansion of the frame, or move farther away from each other, causing a radial compression of the frame, depending on the direction of rotation of the bar 52.

[0117] In other embodiments, the actuators 50 may be reciprocating actuators configured to apply an axially directed force to the frame to create radial expansion and compression of the frame. For example, the bar 52 of each actuator may be axially fixed relative to a nut 56 and slidable relative to a sleeve 54. Thus, in this approach, moving the bar 52 distally relative to the sleeve 54 and / or moving the sleeve 54 proximally relative to the bar 52 radially compresses the frame. Conversely, moving the bar 52 proximally relative to the sleeve 54 and / or moving the sleeve 54 distally relative to the bar 52 radially expands the frame.

[0118] If a reciprocating actuator is used, the prosthetic valve may also include one or more locking mechanisms to hold the frame in the expanded state. The locking mechanism may be a separate component mounted to the frame separate from the actuator, or may be a subordinate component of the actuator itself.

[0119] Each rod 52 may include an attachment member 58 along a proximal end portion thereof that is configured to form a releasable connection with a corresponding actuator of a delivery device. The actuator of the delivery device can apply a force to the rod to radially compress or expand the prosthetic valve 10. The attachment member 58 in the illustrated configuration includes a notch 60 and a protrusion 62 that can engage with a corresponding protrusion of the actuator of the delivery device.

[0120] In the illustrated embodiment, the prosthetic valve 10 includes three such actuators 50, although a greater or lesser number of actuators may be used in other embodiments. The leaflets 20 may have a seam attachment member 64 that wraps around the sleeve 54 of the actuator 50. Further details of the actuators, locking mechanisms, and delivery devices for actuating the actuators may be found in U.S. Patent Application Nos. 62 / 548,855, 62 / 430,810, 15 / 831,197 (published as U.S. Patent Application Publication No. 2018 / 0153689), and 15 / 978,459, each of which is incorporated herein by reference in its entirety. Any of the actuators and locking mechanisms disclosed in the earlier-filed patent applications may be incorporated into any of the prosthetic valves disclosed herein. Additionally, any of the delivery devices disclosed in the earlier-filed patent applications may be used to deliver and implant any of the prosthetic valves disclosed herein.

[0121] The frame 12 can be made from any of a variety of suitable materials, such as stainless steel, cobalt chromium alloy, or nickel titanium alloy ("NiTi"), e.g., Nitinol. As shown, the frame 12 can include a plurality of interconnected struts 24 arranged in a lattice-type pattern. The struts 24 are shown as being positioned diagonally, or offset at an angle relative to and radially offset from a longitudinal axis 26 of the prosthetic valve 10 when the prosthetic valve 10 is in an expanded configuration. In other implementations, the struts 24 may be offset by a different amount than depicted in Figures 2B and 2C, or some or all of the struts 24 may be positioned parallel to the longitudinal axis 26 of the prosthetic valve 10.

[0122] In the depicted embodiment, the struts 24 are pivotally coupled to one another at one or more swivel joints along the length of each strut. For example, in the illustrated configuration, each of the struts 24 may be formed with openings at opposite ends of the strut and with openings spaced apart along the length of the strut. Respective hinges may be formed where the struts 24 overlap one another via fasteners, such as rivets or pins 28 that extend through the openings. The hinges allow the struts 24 to pivot relative to one another as the frame 12 is radially expanded or compressed, such as during assembly, preparation, or implantation of the prosthetic valve 10.

[0123] In the depicted embodiment, the struts 24 are arranged in five rows (I, II, III, IV, and V) from the inflow end 14 to the outflow end 16. Each row is defined by strut segments that extend in a zigzag pattern between adjacent perimeter rows of hinges 28. For example, a first row I is defined by strut segment 25 that extends between a first row of hinges 28a at the inflow end of the frame and the adjacent row of hinges 28b. In other embodiments, the segments of the struts 24 may be arranged in different numbered rows.

[0124] In some embodiments, the frame 12 may be constructed by forming individual components (e.g., the struts and frame fasteners) and then mechanically assembling and connecting the individual components. In other embodiments, the struts 24 are not connected to each other at respective hinges, but are pivotable or bendable relative to each other to allow radial expansion and contraction of the frame 12. For example, the frame 12 may be formed (e.g., via laser cutting, electroforming, or physical vapor deposition) from a single piece of material (e.g., a metal tube). Further details regarding the construction of the frame and prosthetic valves are described in U.S. Patent Application Nos. 15 / 831,197, 15 / 995,528, and 62 / 548,855, all of which are incorporated herein by reference. Additional examples of expandable prosthetic valves that can be used with the delivery devices disclosed herein are described in U.S. Patent Application Publication Nos. 2015 / 0135506 and 2014 / 0296962, which are incorporated by reference herein.

[0125] In other embodiments (not shown), the frame may be made from any of a variety of suitable plastically expandable materials known in the art (e.g., stainless steel, cobalt-chromium alloy, etc.) or self-expanding materials (e.g., Nitinol). If constructed from a plastically expandable material, the frame (and thus the valve) may be crimped to a radially compressed configuration in a delivery device and then expanded inside the patient by an inflatable balloon or other suitable expansion mechanism. If constructed from a self-expandable material, the frame (and thus the valve) may be crimped to a radially compressed configuration and restrained in the compressed configuration by insertion into a sheath or equivalent mechanism of the delivery device. Once inside the body, the valve may be advanced from the delivery sheath, thereby allowing the valve to expand to its functional size.

[0126] 3-7, the prosthetic valve 10 may further include an annular skirt 30 attached to the frame 12. A flattened view of the skirt 30 is shown in FIG.

[0127] The skirt 30 in the illustrated embodiment can have an inner portion 32 and an outer portion 34. Specifically, the skirt 30 can extend along the inner surface of the frame 12 around the inflow end 14 of the frame 12 and then along the outer surface of the frame to define a fold 36 between the inner portion 32 and the outer portion 34. When attached to the frame 12, the inner portion 32 can cover at least a portion of the inner surface of the frame 12 and the outer portion 34 can cover at least a portion of the outer surface of the frame 12.

[0128] The inner portion 32 of the skirt 30 can function as a sealing member to prevent or reduce paravalvular leakage and to anchor the leaflets 20 to the frame 12. The outer portion 34 of the skirt 30 can function as a sealing member for the prosthetic valve 10 by sealing against the tissue of the native annulus and helping to reduce paravalvular leakage from the prosthetic valve 10.

[0129] 8, the upper edge 38 of the inner portion 32 (which in the illustrated embodiment is the outflow edge of the inner portion) may have a contoured shape that generally follows the shape of a selected row of strut sections 25 of the frame 12 when the frame 12 is in the expanded configuration. In this manner, the upper edge 38 of the inner portion 32 may be tightly secured to the selected row of strut sections 25 by stitching. For example, in some embodiments, the upper edge 38 of the inner portion 32 may be sewn to row II of the strut sections. In other embodiments, the upper edge 38 of the inner portion 32 may be sewn to row III of the strut sections.

[0130] In specific embodiments, the sutures used to secure the upper edge 38 extend only around the strut segments that are aligned with the wavy line defined by the leaflet 20 (a line that follows the inflow edge portion 21 of the leaflet). In some embodiments, the upper edge 38 of the inner portion 32 is "sandwiched" between the frame 12 and the leaflet 20. For example, the inflow edge portion 21 of the leaflet can overlap a portion of the inner surface of the inner portion 32 along the upper edge 38, and the leaflet can be secured to the inner portion 32 with sutures that extend through the inner surface of the inner portion 32.

[0131] In the depicted embodiment, the upper edge 40 of the outer portion 34 (which in the illustrated embodiment is the outflow edge of the outer portion) is generally straight and may be attached to the frame at a swivel joint just below row V of strut segments (see, e.g., FIG. 4). In an alternative embodiment (not shown), the upper edge 40 of the outer portion 34 may have a contoured shape (similar to the upper edge of the inner portion 32) so that it may be sewn along the strut segments of a selected row (e.g., row V of strut segments).

[0132] In the depicted embodiment, the outer portion 34 of the skirt 30 is axially longer than the inner portion 32 of the skirt 30, i.e., the upper edge 40 of the outer portion 34 extends closer to the outflow end 16 of the frame than the upper edge 38 of the inner portion 32.

[0133] Although not shown, in alternative embodiments, the axial length of the outer portion 34 may be the same or substantially the same as the axial length of the inner portion 32. Alternatively, the outer portion 34 may be axially shorter than the inner portion 32, i.e., the upper edge 38 of the inner portion 32 may extend closer to the outflow end 16 of the frame than the upper edge 40 of the outer portion 34.

[0134] As previously described, to deploy the prosthetic valve 10, the frame 12 is radially expanded to a larger diameter (i.e., deployed diameter). The deployed diameter can be within a working range of diameters defined between a minimum deployed diameter and a maximum deployed diameter. In one exemplary, but non-limiting, embodiment, the minimum deployed diameter is about 26 mm and the maximum deployed diameter is about 29 mm.

[0135] In a specific embodiment, when frame 12 is expanded radially (see, e.g., FIGS. 4-5), outer portion 34 of skirt 30 may be stretched slightly in the circumferential direction. In a specific embodiment, skirt 30 may be sized such that outer portion 34 of skirt 30 may be stretched to fit tightly or snugly against the outer surface of frame 12 when frame 12 is expanded to a diameter within the working range, i.e., such that no slack forms in outer portion 34 around the periphery of frame 12.

[0136] For example, during assembly of the prosthetic valve 10, the skirt 30 may be sutured to the frame 12 when expanded to its minimum deployed diameter. The skirt 30 may be sized such that the outer portion 34 fits tightly against the outer surface of the frame 12 without radial loosening when the frame 12 is expanded to its minimum deployed diameter. Such a tight fit of the skirt 30 against the outer surface of the frame 12 may prevent the skirt 30 from protruding through the frame sections, thereby preventing abrasion of the leaflets 20.

[0137] As the frame 12 is radially expanded to larger diameters within the working range of deployed diameters, the outer portion 34 of the skirt 30 can tighten further on the frame 12. Thus, in certain embodiments, it can be ensured that the outer portion 34 is radially tight when the frame 12 is expanded to any diameter within the working range. In some embodiments, the skirt 30 can be cut to a smaller size and mounted on the frame 12 (at its minimum deployed diameter) with some circumferential stretch to ensure that the outer portion 34 fits tightly around the frame 12 at its minimum deployed diameter.

[0138] In other embodiments, the skirt 30 may be sized such that when the frame 12 is expanded to its minimum deployed diameter, there is no stretching of the skirt in any direction, no slack in the radial direction, and a snug fit around the frame. When the frame is radially expanded to larger diameters within the working range, the skirt 30 may stretch slightly and tighten around the frame.

[0139] In some embodiments, the prosthetic valve may have only one deployed diameter. In such cases, the skirt 30 may be sized so that when the frame 12 is expanded to the deployed diameter, there is no stretching of the skirt in any direction, there is no slack in the radial direction, and it fits snugly around the frame. In other embodiments, the skirt 30 may be sized so that there is some stretching in the circumferential direction when the frame is expanded to the deployed diameter.

[0140] Additionally, when frame 12 is radially expanded, inflow end 14 of frame 12 may be axially spaced from fold 36 to form an axially extending gap 42 between inflow end 14 of frame 12 and fold 36 (see, e.g., FIG. 5). In some embodiments, gap 42 may have a length (L) ranging from about 4 mm to about 8 mm. In a specific embodiment, length L of gap 42 may be about 6 mm.

[0141] When frame 12 is radially compressed during shortening (see, e.g., FIGS. 6-7), inflow end 14 of frame 12 can move axially closer to fold 36 within gap 42. In some embodiments, when frame 12 is in a fully compressed configuration, inflow end 14 of frame 12 can extend to fold 36 such that frame 12 completely fills gap 42. Also, when frame 12 is in a radially compressed configuration, outer portion 34 of skirt 30 can form longitudinal pleats as shown in FIG. 3, while inner portion 32 of skirt 30 can fold inwardly toward the interior of frame 12.

[0142] The skirt 30 can be formed from any of a variety of suitable biocompatible materials, including any of a variety of synthetic materials (e.g., PET) or natural tissues (e.g., pericardial tissue). In certain embodiments, the skirt 30 is generally inelastic. For example, the skirt 30 can be woven using a plain weave design with PET fibers or yarns in both the warp (longitudinal) and weft (circumferential) directions. In specific embodiments, the skirt can be assembled to the frame such that the warp fibers extend axially of the frame and the weft fibers extend circumferentially of the frame. In alternative embodiments, the skirt can be assembled to the frame such that the weft fibers extend axially of the frame and the warp fibers extend circumferentially of the frame.

[0143] In other embodiments, the skirt 30 may be elongated to a particular angle in both the radial and axial directions, even though it is still woven with inelastic fibers. Such pseudoelasticity may be achieved, for example, by orienting the fibers at an angle relative to the height of the skirt and / or by increasing the spacing between the fibers. For example, as shown in FIG. 8, the skirt 30 may be woven from a first set of fibers (or yarns or threads) extending in a first direction 44 and a second set of fibers (or yarns or threads) extending in a second direction 46, neither of which is perpendicular to the fold 36.

[0144] In a particular embodiment, first direction 44 can be generally perpendicular to second direction 46, and second direction can extend at an angle α of about 45 degrees (e.g., between 15 and 75 degrees, or between 30 and 60 degrees) relative to fold 36. In a particular embodiment, first direction 44 extends parallel or substantially parallel to outer struts 24a, and second direction 46 extends parallel or substantially parallel to inner struts 24b when frame 12 is in its radially expanded state.

[0145] In some embodiments, the spacing between the woven fibers (or yarns or threads) may be increased to facilitate stretching of the skirt 30 in both the radial and axial directions. For example, for a PET skirt 30 formed from 20 denier yarns, the yarn density may be about 15% to about 30% less than a conventional PET skirt. In some examples, the yarn spacing of the skirt 30 may be about 155 yarns per inch to about 180 yarns per inch, such as about 160 yarns per inch, whereas in a conventional PET skirt, the yarn spacing may be about 217 yarns per inch to about 247 yarns per inch.

[0146] In some embodiments, the fibers may be oriented parallel or substantially parallel to the struts and / or the spacing between the fibers may be increased to lengthen the skirt 30 in the axial and / or circumferential directions by up to about 40%. For example, in some embodiments, rotating the fibers and / or increasing the spacing between the fibers may lengthen the skirt 30 in the circumferential direction from a minimum deployed diameter to a maximum deployed diameter.

[0147] Because only the upper edge 40 of the outer portion 34 of the skirt 30 is attached to the frame 12 in the illustrated embodiment, the outer portion 34 of the skirt 30 does not constrain the axial extension of the frame 12 when the frame is radially compressed. Thus, the frame 12 is free to move axially toward the fold 36 within the axially extending gap 42 during retraction. As a result, a relatively small retraction force is required to retract the prosthetic valve 10, and excessive stretching of the skirt 30 is avoided.

[0148] In some embodiments, a tether 48 may be coupled to the skirt 30 to prevent the folds 36 from migrating inwardly of the frame 12 when the frame 12 is radially expanded from the compressed configuration to the expanded configuration.

[0149] For example, the skirt 30 may include a tether 48 extending diagonally from a first end 48a to a second end 48b located at or near the fold 36 such that the tether 48 forms an oblique angle with the fold 36 (see, e.g., FIG. 3). In some embodiments, the angle between the tether 48 and the fold 36 may range from about 10° to about 80°. In some embodiments, the angle between the tether 48 and the fold 36 may range from about 30° to about 60°. In one particular embodiment, the angle between the tether 48 and the fold 36 may be about 45°.

[0150] In a particular embodiment, the first end 48a can be located at the top edge 40 of the outer portion 34. In other embodiments, the first end 48a can be spaced from the top edge 40. In alternative embodiments, the first end 48a can be attached to an upper portion of the frame 12. In some embodiments (not shown), two or more tethers 48 can be coupled to the skirt 30, with each tether 48 extending at an oblique angle relative to the fold 36.

[0151] In some embodiments, the tether 48 may be formed from a suture that is sewn to the outer portion 34 of the skirt, for example, using a skewer stitch, as depicted in Figures 3 and 4. Because of the skewer stitch, the length of the suture may be longer than the distance traveled by the stitch, such that the suture may be lengthened when stretched. In this approach, the suture may function similarly to a coil that returns to its original length after being stretched. In other embodiments, the tether 48 may be formed from an elastic material (e.g., an elastic fabric) that can be stretched longitudinally when tension is applied along its length and return to its original length when the tension is removed.

[0152] Thus, when frame 12 is radially expanded from the compressed configuration to the expanded configuration, tether 48 can be stretched in the tether length due to the radial expansion of skirt outer portion 34. As a result, tether 48 is relatively taut and can hold fold 36 in place against blood flow forces. Thus, tether 48 can prevent fold 36 from migrating into frame 12 when frame 12 is in the expanded configuration, which could otherwise impede fluid flow through valve 10. When frame 12 is radially compressed, tether 48 can return to its original length.

[0153] The prosthetic valve 10 described above can be loaded onto a delivery device and delivered to a target location within a patient. Various embodiments of delivery devices and methods of delivering prosthetic valves are described, for example, in U.S. Patent Application Publication Nos. 2013 / 0030519, 2010 / 0049313, 2009 / 0281619, 2008 / 0065011, and 2007 / 0005131, and U.S. Patent Application No. 15 / 831,197, the disclosures of which are incorporated by reference.

[0154] To load the prosthetic valve 10 onto a delivery device, the prosthetic valve 10 can be retracted onto the shaft of the delivery device. During retraction, the diameter of the frame 12 decreases while the axial length of the frame 12 increases. By using fabrics with angled fibers and / or increased spacing between the fibers, the skirt 30 can lengthen axially. Furthermore, because the frame 12 is not constrained by the outer portion 34 of the skirt 30, the frame 12 is free to lengthen axially and the inflow end 14 of the frame 12 can extend into the gap 42 during retraction. As described above, when the frame 12 is radially compressed, the outer portion 34 of the skirt 30 can form longitudinal pleats and the inner portion 32 of the skirt 30 can fold inward.

[0155] After being delivered to the target location, the prosthetic valve 10 can be expanded until the diameter of the frame 12 is within its working range. During expansion, the diameter of the frame 12 increases while the axial length of the frame 12 decreases. When the prosthetic valve 10 is in the radially expanded configuration, the outer portion 34 of the skirt 30 in a specific embodiment can be stretched in the circumferential direction so as to fit tightly to the outer surface of the frame 12 without any radial loosening. Meanwhile, the inflow end 14 of the frame 12 can move away from the fold 36 to form an axially extending gap 42 between the frame 12 and the fold 36. In some embodiments, one or more tethers 48 can be coupled to the skirt 30 to prevent the fold 36 from moving inwardly of the frame 12 during valve expansion.

[0156] 9 illustrates a prosthetic valve 110 according to another embodiment. The prosthetic valve 110 includes a frame 112 that may be radially expandable and compressible between a radially compressed configuration and a radially expanded configuration. Similar to the prosthetic valve 10, the prosthetic valve 110 may include a valve structure 118 attached to the frame 112, which may include a plurality of leaflets 120 having a wave shape (three leaflets are shown in FIG. 9).

[0157] The prosthetic valve 110 may further include an outer skirt 130 that covers at least a portion of the outer surface of the frame 112. For example, a lower edge 136 (inflow edge in the illustrated embodiment) of the skirt 130 may extend from the inflow end 114 of the frame 112, while an upper edge 140 (outflow edge in the illustrated embodiment) of the skirt 130 may be offset from the outflow end 116 of the frame 112. In the depicted embodiment, the frame 112 has five rows of strut segments, and only the row of strut segments that defines the outflow end 116 is not covered by the skirt 130. In other embodiments, the skirt 130 may be sized to cover a portion of the outer surface of the frame different than that shown in FIG. 9 or may extend across the entire outer surface of the frame 112. In some embodiments, the skirt 130 may be folded around the inflow end 114 of the frame to form a gap similar to the axially extending gap 42 depicted in FIG. 5.

[0158] As shown in FIG. 9 , the skirt 130 may be sutured to the strut segments 124 of the frame 112 along wavy lines 121 defined by the inflow edges of the leaflets 120. In the illustrated embodiment, the wavy lines 121 are zigzag shaped attachment lines for the skirt 130 and the inflow edges of the leaflets 120. In some embodiments, the sutures 122 may be positioned to wrap around the struts such that the sutures 122 are positioned along a path that generally follows the wavy lines 121. As shown in FIG. 9 , each segment of the wavy lines 121 (where the inflow edges of the leaflets 120 attach to the frame 112) forms an approximately 45 degree angle with respect to the longitudinal axis 126 of the frame 112 when the frame 112 is in the expanded configuration. During contraction of the frame 112, the strut segments along the wavy lines 121 move inward. Thus, those sutures 122 along the wavy lines 121 do not stress the skirt 130. In some embodiments, some of the sutures 122 along the wavy lines 121 are configured to be able to slide along the struts. Such sliding sutures can further reduce stress on the skirt 130 when the frame 112 is radially compressed or expanded.

[0159] In a specific embodiment, the outer skirt 130 is connected to the frame only along the attachment line 121, i.e., the outer skirt is not connected to any of the frame's posts or other components of the prosthetic valve at locations other than along the attachment line 121.

[0160] In some embodiments, the outer skirt 130 is connected to the struts of the frame along the attachment line 121 , but the inflow edge portions of the leaflets 120 need not be connected to the frame along the attachment line 121 .

[0161] FIG. 10 illustrates a prosthetic valve 210 according to another embodiment. Similar to the valve 110 previously described, the valve 210 includes a radially compressible and expandable frame 212 and an outer skirt 230 covering at least a portion of the outer surface of the frame 212. As with the valve 110, the skirt 230 may be secured to the frame 212 with sutures 222 along predetermined wavy lines 221 (which in the illustrated embodiment are zigzag attachment lines for the skirt). The valve structure is not shown in FIG. 10 so that the suture lines 221 on the back of the frame 212 can be clearly seen. The frame 212 in the illustrated embodiment has four rows of strut segments, with the two rows of strut segments closest to the outflow end 216 not covered by the skirt 230.

[0162] Similar to the skirt 30 described above, the fabric of the skirt 130 or 230 can be woven with inelastic fibers that are rotated (e.g., 45 degrees) and optionally have increased spacing between the fibers, so that the skirt 130 or 230 can accommodate a certain degree of stretch in both the radial and axial directions. Similarly, the skirt 130 or 230 can be sized to fit tightly without slack against the outer surface of the respective frame 112 or 212 when the respective frame 112 or 212 is expanded to its minimum working diameter.

[0163] FIG. 12A shows that when the frame 112 is radially compressed, a portion of the skirt 130 can ripple to form a folded V-shaped flap 150 that extends longitudinally between adjacent sections of the wavy suture line 121. In some embodiments, each flap 150 can be further folded in the circumferential direction to maintain the low, crimped profile of the valve 110. As shown, depending on the number and size of each flap, each flap 150 can partially overlap an adjacent flap in the circumferential direction. For example, although FIGS. 12B-12C show the flaps 150 folded in a clockwise direction (as viewed from the outflow end), it should be understood that the flaps 150 can also be folded in a counterclockwise direction.

[0164] Similarly, when the frame 212 is radially compressed, as shown in Figure 11, the skirt 230 can ripple to form folded V-shaped flaps 250 extending longitudinally between adjacent sections of the suture line 221. To maintain a small crimped profile, it may be desirable to effect patterned folding of the flaps 250 by rolling the flaps 250 circumferentially, similar to the embodiment shown in Figures 12B-12C.

[0165] In the illustrated embodiment, the inflow and outflow edges of skirts 130 and 230 are not connected to the frame or other components of the prosthetic valve except along attachment lines 121, 221, which form a plurality of first V-shaped flaps opening toward the outflow end of the prosthetic valve alternating with a plurality of second V-shaped flaps opening toward the inflow end of the prosthetic valve around the circumference of the frame (as best shown in FIG. 11 ).

[0166] General Considerations The disclosed embodiments can be adapted to deliver and implant prosthetic devices in any of the heart's native annulus (e.g., the pulmonary, mitral, and tricuspid annulus) and can be used with any of a variety of delivery techniques (e.g., retrograde, antegrade, transseptal, transventricular, transatrial, etc.).

[0167] For the purposes of this description, certain aspects, advantages, and novel features of the disclosed embodiments are described herein. The disclosed methods, devices, and systems should not be construed as limiting in any way. Instead, the disclosure is directed to all novel and non-obvious features and aspects of the various disclosed embodiments, both alone and in various combinations and subcombinations with each other. The methods, devices, and systems are not limited to their particular aspects, features, or combinations, and the disclosed embodiments do not require that one or more particular advantages exist or problems be solved. Techniques from any example can be combined with techniques described in any one or more of the other examples. In view of the many possible embodiments to which the principles of the disclosed technology may be applied, it should be recognized that the illustrated embodiments are merely representative examples and should not be taken as limiting the scope of the disclosed technology.

[0168] Although some operations of the disclosed embodiments are described in a particular sequential order for convenient presentation, it should be understood that the description of this technique encompasses rearrangements unless a particular order is required by explicit language subsequently set forth. For example, operations described in sequence may be rearranged in some cases or performed in parallel. Furthermore, for simplicity, the accompanying figures may not show the various ways in which the disclosed methods can be used in combination with other methods. Also, the description may use terms such as "provide" or "achieve" to describe the disclosed methods. These terms are high-level abstractions of actual operations that are performed. The actual operations that correspond to these terms may vary depending on the particular implementation and are readily discernible by those of ordinary skill in the art.

[0169] As used in this application and the claims, the singular forms "a," "an," and "the" include the plural unless the context clearly dictates otherwise. Also, the term "comprises" means "comprising." Furthermore, the terms "coupled" and "coupled" 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 specifically stated to the contrary.

[0170] Directions and other relative references (e.g., inside, outside, above, below, etc.) may be used herein to facilitate elaboration of the drawings and principles, but are not intended to be limiting. For example, specific terms such as "inside," "outside," "up," "down," "internal," "external," etc. may be used. Such terms are used, where applicable, to provide some clarity of description when dealing with relative relationships, particularly with respect to the illustrated embodiments. However, such terms are not intended to imply a sense of absolute relationship, position, and / or orientation. For example, with respect to an object, an "upper" portion may become a "lower" portion by simply flipping the object over. It is still the same portion and the object remains the same. As used herein, "and / or" means "and" or "or" and "and" and "or."

[0171] In view of the many possible embodiments to which the principles of the disclosed invention may be applied, it should be recognized that the illustrated embodiments are merely preferred examples of the invention and should not be taken as limiting the scope of the invention, which is rather defined by the following claims. [Explanation of symbols]

[0172] 10 Prosthetic valves 12 Stents, frames 14 Inlet end 16 Outlet end 18 Valve Structure 20 leaflets 21 Inlet edge 22 Seams 24 Posts 24a Outer support 24b Inner support 25 Pillar classification 26 Longitudinal Axis 28 Rivets, pins, hinges 28a, 28b hinge 30 Circular Skirt 32 Inner part 34 Outer part 36 Folds 38 upper edge of inner portion 32 40 upper edge of outer portion 34 42 Gap 44 First Direction 46 Second Direction 48 Tether 48a First end 48b Second end 50 Actuator 52 Screws, threaded rods 54 First mooring part, cylinder, sleeve 56 Second anchor, threaded nut 58 Mounting material 60 Notch 62 Protrusion 64 Joint mounting member 110 Prosthetic valves 112 frames 114 Inlet end 116 Outlet end 118 Valve Structure 120 Leaflets 121 Wavy lines, attachment lines, suture lines 122 Suture 124 Post division 126 Longitudinal Axis 130 Outer skirt, skirt 136 Lower edge 140 Upper edge 150 Flap 210 Prosthetic Valves 212 frames 216 Outlet end 221 Wavy lines, suture lines, attachment lines 222 Suture 230 Outer skirt, skirt 250 Flap I, II, III, IV, V column division rows F force L Length of gap 42 α Angle to Fold 36

Claims

1. A prosthetic valve, comprising: an annular frame having an inlet end and an outlet end; at least one actuator mounted to the frame, the actuator configured to radially expand or compress the frame between a radially compressed configuration and a radially expanded configuration; an annular skirt having a fold extending around the inflow end of the frame to cover at least a portion of an outer surface of the frame and at least a portion of an inner surface of the frame; Equipped with when the frame is in the radially expanded configuration, an outer portion of the skirt fits closely against the outer surface of the frame, and the inflow end of the frame is axially spaced from the fold to define an axially extending gap between the frame and the fold, and when the frame is in the radially compressed configuration, the inflow end of the frame extends axially to at least partially fill the axially extending gap; The prosthetic valve is configured such that the relative distance between the fold of the skirt and the inflow end of the frame changes depending on whether the frame is in its expanded configuration.

2. The prosthetic valve of claim 1 , wherein the at least one actuator is one of a plurality of actuators mounted to the inner surface of the frame and equally spaced about the inner surface of the frame.

3. 3. The prosthetic valve of claim 1 or 2, wherein the at least one actuator comprises a first anchor attached to a first location on the frame, a second anchor fixed to a second location on the frame, and a rod extending through the first anchor and the second anchor, the second location being closer to the inflow end of the frame than the first location, and the rod configured to increase or decrease the distance between the first location and the second location, respectively, to radially compress or expand the frame.

4. 4. The prosthetic valve of claim 3, wherein the rod comprises male threads configured to matingly engage with the female threads of the second anchor portion.

5. 5. The prosthetic valve of claim 3 or 4, wherein the first location is a junction between two overlapping struts of the frame, and the first anchoring portion is hinged to the junction by a fastener.

6. 3. The prosthetic valve of claim 1 or 2, wherein the at least one actuator comprises a rod at least partially received in a sleeve, and axial movement of the rod relative to the sleeve causes radial expansion or compression of the frame.

7. The prosthetic valve of claim 6 , wherein the at least one actuator comprises a locking mechanism configured to lock the frame in the radially expanded configuration.

8. 8. The prosthetic valve of claim 1, wherein the at least one actuator comprises an attachment member configured to form a releasable connection with a corresponding actuation member of the delivery device such that the actuation member of the delivery device can apply a force to the at least one actuator to radially compress or expand the frame.

9. 9. The prosthetic valve of claim 1, further comprising a valve structure positioned within the frame and configured to permit blood flow through the prosthetic valve in one direction and prevent blood flow in an opposite direction.

10. 10. The prosthetic valve of claim 9, wherein the valve structure comprises a plurality of leaflets each having an inflow edge portion, the inflow edge portions of the leaflets defining an undulating, curved wave shape that circumferentially follows a plurality of interconnected strut segments of the frame when the frame is in the radially expanded configuration.

11. 11. The prosthetic valve of claim 1, wherein the outer portion of the skirt is axially longer than the inner portion of the skirt.

12. 11. The prosthetic valve of claim 1, wherein the outer portion of the skirt has approximately the same axial length as the inner portion of the skirt.

13. 11. The prosthetic valve of claim 1, wherein the outer portion of the skirt is axially shorter than the inner portion of the skirt.

14. 14. The prosthetic valve of claim 1, wherein the outer portion of the skirt is circumferentially stretched when the frame is in the expanded configuration.

15. The prosthetic valve of claim 14 , wherein an upper edge of the outer portion of the skirt is generally straight prior to attachment to the frame.

16. 16. The prosthetic valve of claim 15, wherein the upper edge of the outer portion of the skirt is attached to the frame at a plurality of swivel joints formed by overlapping struts of the frame.

17. 15. The prosthetic valve of claim 14, wherein an upper edge of the outer portion of the skirt has an undulating shape and is sewn along a row of strut segments of the frame.

18. 18. The prosthetic valve of any one of claims 1 to 17, further comprising a tether coupled to the skirt and extending at an oblique angle to the fold such that the tether applies tension to the skirt to prevent the fold from moving inwardly of the frame when the frame is radially expanded from the compressed configuration to the expanded configuration.

19. 20. The prosthetic valve of claim 18, wherein the oblique angle ranges from about 10 degrees to about 80 degrees.

20. 20. The prosthetic valve of claim 19, wherein the oblique angle ranges from about 30 degrees to about 60 degrees.

21. 21. The prosthetic valve of claim 20, wherein the oblique angle is about 45 degrees.

22. 22. The prosthetic valve of claim 18, wherein a first end of the tether is positioned at an outflow edge portion of the outer portion of the skirt and a second end of the tether is positioned adjacent to the fold.

23. 23. The prosthetic valve of any one of claims 18 to 22, wherein the tether comprises a suture that is sewn to the outer portion of the skirt using a skewer stitch.

24. 24. The prosthetic valve of any one of claims 18 to 23, wherein the tether comprises an elastic material.

25. 25. The prosthetic valve of any one of claims 18 to 24, wherein the tether is one of a plurality of tethers each forming an oblique angle with respect to the fold.

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