AU2017200732B2 - Prosthetic insert for improving heart valve function - Google Patents

Abstract

A method for treating a mtral valve ndudes inserting a delivery sheath through anision through cardiac tissue along an apex of a heart into a left ventricle: advancing an insert member 02) in a collapsed configuration through the delvery sheath into the eft ventnIde, the insert member (102) including a biocompatible fabric outer ayera passageway extending therethrough along a longitudinal axis extending from a left atrium to the left ventrice and a valve member disposed within the passageway the valve member including one or more flap members defining a one-way valve allowing the insert number (102) to expand t an expanded configuration aligning a crosssectional profile of the insert member ( t02ltoconfrm to a curvature of native mitral valveleaflets; positioning the insert member (102) between natiVe leaflets of a mitral valve such that the native leaflets create a tight sea! against a layer of fabric disposed over an outerurface of the insert member;extending a first end of an anchorng member (704) through the incision, the anchoring member (704) including a second end coupled to an outflow end of the insert member (102) an elongate body porion, the first end including a penetration member (708) extending through the cardiac tissue; contacting a plate with an outer surface of the hartand locking the plate (709) to the eeration member (7)8 ' K~C 7/1 7102

Description

INVENTORS: 2017200732 03 Feb 2017

AUSTRALIA Patents Act, 1990 ORIGINAL COMPLETE SPECIFICATION APPLICANT/S:

Edwards Lsfescisnees Corporation HAUSER, David L SOLEM, Jan Otto ALON, David ADDRESS FOR SERVICE : Peter Maxwell and Associates

Level 6 60 Pitt Street SYDNEY NSW 2000

INVENTION TITLE: PROSTHETIC INSERT FOR IMPROVING

HEART VALVE FUNCTION DIVISIONAL OF AU - 2013 245 451- 15 October 2013 which is a divisional of AU - 2007 266 448 - 31 May 2007

The following statement is a full description of this invention including the best method of performing it known to us:- 1 m:\docs\20071213\455873.doc 2017200732 03 Feb 2017 -1

PROSTHETIC INSERT FOR IMPROVING HEART VALVE

FUNCTION

CROSS REFERENCE TO RELATED APPLICATION 10001] This application claims the benefit of U.S. Provisional Patent 5 Application No. 60/810,085, filed June 1, 2006, which is incorporated herein by reference in its entirety.

FIELD OF THE DISCLOSURE

[0002] The disclosure relates to the field of implantable cardiac prosthetics and in particular, to a cardiac prosthetic insert for reducing regurgitation 10 through a heart valve, such as the aortic valve, and to methods of implanting the cardiac prosthetic insert.

BACKGROUND

[0003] Heart valve regurgitation, or leakage from the outflow to the inflow side of a heart valve, is a condition that occurs when a heart valve fails to close 15 properly. Heart valve regurgitation decreases the efficiency of the heart, reduces blood circulation and adds stress to the heart. In early stages, heart valve regurgitation leaves a person fatigued and short of breath, if left unchecked, the problem can lead to congestive hear!: failure, arrythmias or death. 20 [0004] Regurgitation through the aortic valve, sometimes referred to as aortic insufficiency, is a serious problem that affects the health of millions of adults. The aortic valve is positioned on the left side of the heart between the left ventricle and the aorta. A healthy aortic valve opens to allow blood to flow from the left ventricle into the aorta during ventricular systole and then 2017200732 03 Feb 2017 closes to prevent blood from flowing backward from the aorta into the left ventricle during ventricular diastole. However, over time, changes in the gebm<pic configurations of the aortic annulus* or other causes such as calcification, infection and injury, may affect the functionality of the aortic 5 valve. As a result, the aortic valve may not close completely during ventricular diastole, thereby leading to regurgitation.

[0005] Aortic insufficiency is typically treated by replacing the defective native valve with a prosthetic valve during open heart, surgery. However, open-heart surgery is highly invasive and is therefore not an option for many 10 high risk patients. Accordingly, in recent years, less invasive methods, such as percutaneous valve replacement, have been developed for replacing aortic valves. In an example, a prosthesis including a stent and a valve is crimped into a small profile and then delivered into the heart via a percutaneous route. Once located at tile treatment site, foe prosthesis is expanded to replace the 15 funcion of the nati ve aortic valve. Although percutaneous valve replacement has shown gpat promise, there are still challenges with respect to delivery techniques, perivalvular leakage -and durability of the valve. Furthermore, When possible, it may be desirable to repair, rather than replace, the native valve.

20 SUMMARY

[0006] Accordingly, disclosed herein is a device and method of use for treating heart valve disease, involving: in exemplary embodiments, a minimally invasive procedure that does not require extracorporeal: circulation. Certain embodiments of such a dev ice and method desirably are capable of reducing e»r -fo eliminating regurgitation through a heart valve. It is also desirable that embodiments of such a device arid method be well-suited for delivery in a 2017200732 03 Feb 2017 percutaneous or minimally-hmrsive procedure. It is also desirable that embodiments of such a device and method be well-sailed for repairing an aortic valve. It is also desirable that :Suefl a device be safe, reliable and easy to deliver. It is also desirable that embodiments of such a device and method be 5 applicable for improving heart valve function for a wide variety of heart valve defects. It is also desirable that embodiments of such a device and method be capable of improving valve function without replacing the native valve.

[0007] Various embodiments of the present disclosure provide improved devices and methods for improving the function of a defective heart valve. 10 Particular embodiments can be configured to be implanted in a heart using a percutaneous or minimally invasive procedure wherein extracorporeal circulation is not required.

[0008] In one representative embodiment of the present disclosure, a prosthetic device includes an anchoring member and an insert member 15 configured for deployment between the leaflets of a native valve, such as the aortic valve. The insert member is desirably shaped to fill the gap(s) between the leaflets for creating a tight seal during ventricular diastole and thereby minimizing or preventing regurgitation through the aortic valve. The insert member is desirably sized such that the native leaflets engage the surfaces of 20 the insert member. When configured for use with a typical aortic valve, the insert member desirably includes three arms eit|nding: radially outward flour a central region. Each of the :arms Is shaped for placement between adjacent leaflets of the aortic valve. The anchoring member is provided for securing the insert member in its deployed position. In exemplary embodiments, the 25 anchoring member takes the form, of a stent configured for deployment in the ascending aorta. In one variation, the insert member can be coniignred |e.g., with two arms) for use with an aortic valve having only two leaflets, fh 2017200732 03 Feb 2017 another variation, the insert member can be configured for use in a pulmonary valve for treating pulmonary insufficiency. (00091 h> another representative embodiment of the present disclosure, a prosthetic device includes an anchoring member formed of a stent and an insert 5 member configured for deployment between the leaflets of a native aortic valve. The anchoring member desirably includes a valve member for providing iinidirectional low- The anchoring member is desirably configured for delivery into an ascending aorta. The stent is expanded, either by self-expansion or by balloon expansion, such that the stent is anchored in the aorta. 1Θ After deployment, the valve member in the stent prevents or minimizes blood from flowing backward through the aorta. The insert member is delivered into t|e native aortic valve to improve the native; valve function. Accordingly, two; separate valves (e,g., stented Valve and native valVe| work in tandem for τη even ring regurgitation through the aortic annulus. By; deploying: the insert 15 member in the native Valve, the naive valve is allowed to function as it should and blood enters the coronary arteries in a substantially natural manner. The Stented valve supplements the function of the native valve. If desired^ the stented valve could be constructed to close before Or after (desirably after) fie native valve to further influence and improve the native valve function and 20 also to improve hemodynamics. pOlft] In a representative embodiment, a system and method are provided far framing a defective heart valve, The system includes a prostheie device including an anchoring member and an insert member. The system further includes a delivery catheter for delivering the prosthetic device into the heart 25 via a percutaneous approach. The delivery catheter desirably includes an elongate sheath having a lumen sized to receive the prosthetic device, in exemplary embodiments, the prosthetic device is held within the sheath in a WO 2007/140470 2017200732 03 Feb 2017 PCT/US20Q7/070141 collapsed configuration daring advancement through the subject’s vasculatuil In one variation, the sheath is configured for retrograde advancement and may be configured with a deflectable end portion for facilitating navigation around the aortic arch. After reaching the treatment site, the sheath is moved proximally relative to the prosthetic device to eject the device from the sheath. The device is then allowed to expand such that the insert conforms to the gaps in the aortic valve and the anchoring member engages the; inner wall of the aorta, [0011] In another representative embodiment of the present disclosure, a J 0 prosthetic device includes an anchoring member and an insert: member having three expandable alms configured for deployment between the g&amp;ps in an insufficient aortic valve. Mach arm desirably includes m. expandable region that opens in a manner somewhat similar to a parachute for preventing regurgitation. During ventricular systole, each expandable region collapses 15 such that the flow of blood through the aortic valve is not impeded.

[0012] In a certain representative embodiment of the present disclosure, a prosthetic device includes an insert member configured for deployment within an aprtic valve and an anchoring member configured for securement within the left ventricle. An elongate body portion is provided for coupling the insert 20 member to the anchoring member. If one variation, the prosthetic device can fee delivered in multiple stages. In a first stage, the anchoring member is delivered and is then allowed to grow into the heart wail. After sufficient ingrowth has occuned in a second stage, the insert member is attached to the anchoring member. 25 [0013] In another representative embodiment of fee present disclosure, a prosthetic device includes an anchoring member and an insert: member 2017200732 03 Feb 2017 6 ·· configured for deployment between anterior and posterior leaflets of a mitral vafve. The insert member is desirably shaped to ill the gap between native leaflets: for preventing regurgitation through the mitral valve. The insert member is sized such that the mitral, valve leaflets engage the surfaces of the 5 insert member to create a tight seal during ventricular systole. In a variation of this; embodiment, one or more passageways are provided through tie insert member for allowing blood to flow through the device in one direction to further improve valve function. 10014) The foregoing and other features will become more apparent from 10 die following detailed description of several embodiments, which proceeds with reference to the accompanying figures.

BRIEF DESCRIPTION OF THE DRAWINGS

[0015J FIG. 1 illustrates a cross-sectional view of a heaft.

[0016] FIG. 2 Is a perspective view of a prosthetic device including an 15 anchoring member and an insert member configured for deployment between leaflets of a native aortic valve.

[0017¾ FIG. 3 is a cross-sectional view of an insert member with an outer coating of bidcoinpatible material.

[0018] FIG. 4 is a cross^secfional view of the insert member of FIG. 2 20 positioned in an aortic valve.

[0019] FIG. 5 is a paid a) cut-away view of the aorta illustrating the prosthetic device of FIG. 2 deployed within a subject to treat aortic insufficiency·:. 2017200732 03 Feb 2017 {0020] FIG. 6 is a perspective view illustrating an embodiment of a prosthetic device wherein the insert member is directly attached to the anchoring member. 10021] FIG. 7 is a cross-sectional view of the insert ntember of FIG. 6 .7 contained within a sheath in a contracted condition for delivery to a treatment site. |0O22] FIG. 8 illustrates the insert member of FIG. 6 after being ejected horn the sheath and expanding into an expanded condition. 10023] FIG. 9A is a perspective view of a prosthetic device including an 10 insert member for deployment in the aortic valve and an anchoring member with engagement members for securement to the left ventricle. 10024] : Fi!G. 9B is an exploded view of an exemplary embodiment df a plurality of engagement members shown in an expanded state. pii2S] FIG. 9C is a perspective view of the plurality of engagement 15 members of FIG 9B shown in a compressed state for delivery to the heart. 10026} FIG. W is a variation of the embodiment shown in ilG. 9A wherein aii alternative anchoring member is provided. {0027] FIG. 11 is a perspective view of a prosthetic device similar to the embodiment illustrated in FIG. 2 wherein the anchoring member includes a 20 stent and a valve member for deployment in the ascending aorta, [0028] FIG. 11 is a perspective view of a prosthetic device similar to the embodiment illustrated in FIG. 2 in which the insert member is formed with two arms. 2017200732 03 Feb 2017 8 - FIG- 13 is a perspective view of a prosthetic device including an anchoring member and an insert member deployed in a heart for treating an insufficient mitral valve.

[0030] FIG. 14 is a cross-sectional view of the insert member of FIG. 13. 5 [003.1] FIG. 15 is g cross-sectional view illustrating ail insert member formed with a passageway and valve member for allowing blood to low through the insert member in one direction.

DETAILED DESCRIPTION OF SEVERAL EMBODIMENTS 10 [0032] I. Explanation of Terms [0033] Unless otherwise noted, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this disclosure belongs, in order to facilitate review of the various embodiments of the disclosure, tlu* following explanation of terms 15 is provided: [0034] The singular terms “a”, “an”, and “foe” include plural referents unless context dearly indicates otherwise. The term “or” refers to a single dement of stated alternative dements or a combination of two or more dements, unless context dearly indicates otherwise. 2Θ [0035] The term “includes” means “comprises.” For example, a device that includes or comprises A and B contains A and B, but may optionally contain C or other components other than A and B. Moreover, a device that:: 2017200732 03 Feb 2017 9 includes or comprises Λ or Bmay con lain A or B or A and B, and optionally one or more other components, such as C.

[0036] The term ‘proximal- refers to a portion of an instrument closer to an operator, while “distal” refers to a portion of the instrument farther away 5 from the operator.

[0037] I he term “subject” refers to both human arid other animal subjects. Ih certain embodiments^ the subject is a human or other mammal, such as a primate, cat, dog, cow, horSe, rodent, sheen, goat, or pig* In a particular example, the subject is a human patient. 1Θ [0038] Although methods and materials similar or equivalent to those described herein can be used in the practice or testing of the present disclosure, suitable methods and materials are described below. In case of conflict, the present specification, including terms, will control. In addition, tire materials, methods, and examples are illustrative only and not intended to be limiting. 15 [0039] 11 An anatomical overview of the Ifutncii.heari [0040] With reference to FIG. 1, a cress-sectional view of a heart 1 is provided, pood flows through the superior vena cava 2 and the inferior vena cava 4 into the: right atrium 6 of tlf heart 1. The tricuspid valve: 8 controls 20 blood flow between the right atrium 6 and the right: ventricle 15. The tricuspid valve 8 is closed when blood is pumped out fom the right ventricle 15 to the lungs. Tiereafter, the tricuspid valve 8 is opened to refill "the right ventricle 15 with blood froth the right atrium 6, Free edges of leaflets of the: tricuspid1 valve 8 are connected via the chordae tendinac 10 to the papillary muscles 12 in the 2017200732 03 Feb 2017 1:0 - right ventricle 15 for controlling the movements of the tricuspid valve 8. Blood from the right ventricle 15 is pumped through the pulmonary valve 20 to the pulmonary artery 22, which branches into arteries leading to the lungs.

[0041] Alter exiting the lungs, the oxygenated blood flows through Ihc 5 pulmonary veins 28 and enters the left atrium 26 of the heart 1. The mitral valve 30 controls blood flow between the left atrium 26 and the left ventricle 17. The mitral valve 30 is closed during ventricular systole when blood is ejected from the left ventricle 17 into the aorta 34. Thereafter, the mitral valve 30 is opened to refill the left ventricle 17 wifi blood from the left atrium 26. |0 Free edges of leaflets of the mitral valve 30«re connected via Lite chordae tendinae 11 to the papillary muscles 13 in the left ventricle for controlling the movements of the mitral valve 30. Blood from the left ventricle 17 is pumped through the aortic valve 32 into the aorta 34 which branches into arteries leading to all parts of the body. The aortic valve 32 includes three leaflets 15 (also known as flaps or cusps) collectively denoted by reference numeral 36. 1 -eaflets 36 open and close to control the flow of blood into the aorta 34 from the left ventricle 17 of the heart as it beats. 11)0421 ///. Prosthetic Device for reducing regurgitation through a heart valve 20 pM3j The efficiency of the heart may be seriously impaired if any of the heart valves is hot ftjm&amp;foning properly. For example, heart valves may lose their ability to: close properly due to dilation pf an annulus around the valve or a flaccid, prolapsed leaflet. The leaflets may also have shrunk due to disease, such as rheumatic disease, thereby leaving a gap in the valve between the 25 leaflets. The inability of the heart valve to close will cause blood to leak backwards (opposite to the normal low of blood), commonly referred to as 2017200732 03 Feb 2017 - Π reiprgjlaiion. through the aortic valve into tiie left ventricle. Regurgitation may seriously impair the function of the heart since more blood will have to be pumped through the regurgitating valve to maintain adequate circulation.

[0044] Embodiments of the present disclosure provide devices and 5 methods for improving the function of a defective heart valve, such as an aortic valve. The devices and methods disclosed herein are desirably delivered into a subject’s heart using percutaneous or minimally invasive surgical methods. Accordingly, desirable delivery methods described herein do not require extracorporeal circulation (e.g., blood from a subject’s circulation being routed 10 outside the body to have a process applied to and then, returned of the subject’s circulation). For example, in one embodiment, a delivery catheter (or similar delivery device) is inserted through an incision in the chest wall and then through the cardiac tissue (esg., through the apex of the heart) into a chamber of the patient’s beating heart. The delivery catheter can allow a prosthetic l! device to he delivered into the heart in a collapsed configuration and then expanded within the heart for treating a defective heart valve. Because the desired delivery methods do not require extracorporeal circulation, complications are greatly reduced as compared with traditional open-heart surgery. 20 [0045] EI6® 2 illustrates an example of a prosthetic device 100 which can be employed to reduce or eliminate regurgitation through a heart valve, such as the aortic valve. The prosthetic device 100 includes an insert member 102 and an anchoring member i 10. The insert, member 102 desirably includes a solid outer surface for contacting native Valve leaflets, such as the native aorlic v§ve 25 leaflets:. As used herein, a “solid” surface refers to a non-perforated surface that does not include a|y opeliftgs through which blood can pass. As illustrated in FIG. 2, thesinsert member 102 includes a first extension portion, 2017200732 03 Feb 2017 5 , 12 m arm, 104, a second extension portion, or arm, 106 and a third extension portion, or arm, 108. The extension portions 104, 106, 108 desirably are equally angularly-spaced about a central portion 112 of the insert member 102 and extend radially outwardly therefrom. The prosthetic device 100 can include a plurality of spacers or connecting members 120 for mounting the insert member 102 at a position spaced from the anchoring member 110. As shown in FIG. 2, three such spacers or connecting members 120 are provided in the illustrated embodiment for coupling the insert member 102 to the anchoring member HO. 10 [0046] In the illustrated embodiment, the anchoring member 110 takes the form of a self-expanding or balloon-expandable stent having an open-frame construction as depicted in FIG. 2. The anchoring member can be made of various suitable expandable and/or elastic materials, such as stainless steel, titanium, shape memory alloys, or other biocompatible metals. In one 15 example, the anchoring member 110 is sell-expanding and formed of shape memory alloys, such as nickel titanium (NiTi) shape memory alloys, as marketed, for example, under the trade name Nitinol. In another example, the anchoring member 110 is balloon-expandable and formed of stainless steel or oilier suitable materials. 20 [004 7] In particular embodiments, the anchoring member 110 comprises a stent having a plurality of |ngul|riy-spaced axial struts, or support members* that extend axially (longitudinally) of die member. The anchoring member 110 can also include a plurality of axially-spaeed, circumferential bands, or struts, attached to the axial struts. The circumferential struts are formed with 25 multiple bends that allow the anchoring member 110 to be compressed to a smaller diameter for delivery to an implantation site and expanded to its functional size for anchoring the insert member 102 to the heart. The 2017200732 03 Feb 2017 13 : circumferential stmts can include a plurality of linear strut members arranged in a zig-zag or saw-tooth configuration defining bends between adjacent strut members. In other examples, one or more of the circumferential bands can have a Curved or serpentine1 shape rather than a zig-zag: s|ape. In variations, 5 the anchoring member 110 may further include fixation or attachment members, sttch as barbs, staples, flangfg* hooks* and the (ike along the exterior of the anchoring member 110 for enhancing the ability of the anchoi'ifig member 11| to anchor insert member within the aorta. Further details of exemplary stents that can be employed iri tile embodiments disclosed herein 10 are disclosed in U.S. latent 'No. 6,730,118, U.S. Patent No. 6,767,362. and U.S. Patent No. 6,90f|4Sl, each of which is incorporated herein by reference:: in its entirety.

[0048] Although the: anchoring member is primarily described in the form of a stent,, it will be appreciated that a wide variety of anchoring mechanisms 15 may be used while remaining within the scope of the present disclosure. For example, the anchoring member can be formed by one or more retainers; In a particular example, the anchoring member can be a plurality of spaced-apart retainers that extend outwardly to contact tissue near or within the heart valve annulus. The retainers are sized and configured to secure the body to the heart 21 valve annulus. For instance, the one or more retainers can be circular bands formed of polyethylene, polypropylene, polycarbonate, nylon, polytetrajluoroethylene, polyurethane, stainless steel, Nitinol, titanium, polyimide, polyester, shape-memory material, or a mixture thereof The one or more retainers can include protrusions, barbs, needles, hooks, and like W engagement members for assisting with anchoring the prosthetic device within the heart valve. 2017200732 03 Feb 2017 10 14 f0Θ49] The insert member 102 is configured for insertion between the leaflets of an insufficient aortic valve so as to fill the gap between the leaflets.

In one specific example, the insert member 102 exhibits sufficient rigidity to substantially maintain its deployed shape and is resilient apdfor flexible enough to be compressed to a reduced diameter for delivery in a delivery sheath. The insert member can be formed from plastic, metal (e.g., shape memory metal) or oilier biocompatible material suitable for implantation into a subject. In particular examples* as illustrated in FIG. 3, the insert member 102 can include an inner support layer 127 and an outer layer or sheath IW, The outer layer 128 can be formed of a biocompatible material, Such as a cloth-like Of fabric materia If natural or synthetic) or a biological material, such as collagen or biological tissue material in order to protect the native leaflets from dimage (e.g., to inhibit abrasion that: could occur in response to engagement and disengagement of the leaflets). For instance, Smooth animal pericardium 15 such as equine, bovine, porcine another animal pericardial tissue which is compatible with the native leaflets may be included within the outer layer 128. Such tissue may he tanned or fixed by a suitable tanning environment or the pericardium can be cross-1 inked with glutaraldchyde and heparin bonded by a detoxification process. In a certain example, the biological tissue material can 20 be one of the hlO-REACf® natural tissue products exhibit improved biocompatibility and mitigate calcification and thrombus formation. The outer layer 128 can cover the entire outer surface of the inner layer 127 or selected portions of the outer surface, such as those portions that come into contact with the native leaflets.

[0050] In certain: examples, the diameter of the insert member 102 is similar to the diameter of the native aortic valve such that each of ihe extension portions extends into: a cusp between leaflets iris the aortic valve. As a result, 2017200732 03 Feb 2017 10 15 the insert member 102 of the device 100 remains centered within the aortic valve after deployment. In certain examples, the diameter of {he insert member is about 18 inm to about 26 mm, with about: 22 mm being a speciSe example. The diameter of the insert member 102 call be slightly smaller as compared to the diameter of the anchoring member 110. This configuration allows the insert member to collapse or fold-down to a reduced diameter for delivery in a delivery sheath Additionally, the length of the insert member can vary. For example, in ope embodiment, the length; of the insert member is approximately the sane size as the length of the anchoring member. In other examples, the length of the insert member is greater or smaller than that of (he anchoring member. In certain examples, fhe length of the insert member is about 20 mm to about 30 mm, with about 25 mm being a specific example.

[0051] As illustrated in FIG. 4, the cross-sectional profile of the insert member 1.02 can be shaped such that the native leaflets 36a, 36b, 36c are 15 capable of contacting the sides of the insert member 102 to create a tight seal during ventricular diastole. For example, the three spaced apart extensions or arms 104, 106 and 108 extend radially outward from a central region 112 of the insert member 102. In certain examples, the arms taper in width from the central portion to the outer ends of the extension portions. For example, each 20 arm includes a first end 114 and a second end 116. The first end 114 is of a greater width than the second end 116. The arms each include a first side 1.22 and a second side 124, each of which side is configured for contact with a native leaflet. The ends 114, 116 and the sides 122, 124 can be configured with smooth edges to minimize or eliminate hemolytic effects. Further, each 25 of the arms is configured to fill a. gap between adjacent leaflets of an aortic valve, thereby preventing regurgitation through the aortic valve. The contact surfaces of the arms can exhibit sufficient compliancy and/or flexibility to 2017200732 03 Feb 2017 25 filed on April 16- allow tie native leaflets to eftgage the insert member 112 and create a tight seal without damaging the leaflets. For example, as described above, each arm can include biocompalible material, such as collagen or pericardial tissue to inhibit abrasion that could occur in response to engagement or coaptation of the arms 5 with the native leaflets.

[0052J When used to treat an aortic valve, the cross-sectional, profile of the insert member can be minimized to limit resistance to blood flow from the left ventricle into the aorta when the aortic valve is fully open. Furthermore, one or both ends of the insert member may be tapered or rounded such that there 10 are no flat surfaces toeing perpendicular to the flow of blood. With respect to the illustrated embodiment, if will be appreciated that the prosthetic device is capable of minimizing or preventing regurgitation without utilizing any moving parts. The device can therefore achieve greater durability as compared with alternative heart valve repair and replacement techniques that utilize 15 moving parts.

[01)53] The insert member 102 can be configured with expandable structures, such as moveable flaps, to further impede regurgitation through the aortic valve. Each expandable structure can be configured to fill a gap between adjacent native valve leaflets, ip ope example, the movable flaps can 20 be configured to open in a manner similar to that of a parachute to block regurgitation of blood between the leaflets of the native aortic valves During ventricular systole, the moveable flaps collapse to allow blood to flow from the left ventricle, through the native aortic valve and into the aorta in a substantially unimpeded manner. Additional details regarding an expandable insert member (mg, valve portion) can be found in Applicant’s co-pending U.S. Appication FJo. f 1/407,582 (U.S. Pa lent Publication Me. 2006/0241745), 19, 2006, which is hereby incorporated by reference in its 2017200732 03 Feb 2017 , 1.7 - entirety. Principles and features of fie expandable prosthetic devices described in the ’5:82: Application, which are configured for use with a mitral valve, tp a||p applicable to the devices described herein for use in the aortic valve.

[0054] As mentioned above a|d dS illustrated in PIG. 1, the prosthetic 5 device ISO includes: a plurality of spacers or connecting members 120. Each connecting member can |e generally cylindrical in shape, although any other suitable shape may be employed, In certain examples, the length of each connecting member is about 6 rnm to about 14 mm, with about 10 mm being a specific example. Each connecting member preferably couples an arm of the 10 insert member 102 to the anchoring member 110. The connecting members 120 can assist in stabilizing the insert member 102. Each connecting member desirably exhibits sufficient rigidity to substantially maintain the insert member in a fixed position relative to the anchoring member. The connecting members can be formed of plastic, metal or other biocompatible material 15 suitable for implantation into a subject. The connecting members 120 also minimize interference of the prosthetic device with blood flow to the coronary arteries by allowing the anchoring member 110 to be positioned above the coronary ostia and the insert member 102 positioned in the native aortic valve.

[0055] As best illustrated in FIG. 4, the native leaflets 36a, 36b, 36c of the 20 aortic valve 32 contact the insert member 102 during ventricular diastole to create a tight seal. By allowing the aortic valve 32 to create a tight seal, regurgitation from the: aorta into the left ventricle is mim.miied or prevented. During ventricular systole* the native leaflets open as they do naturally to allow blood to be pumped from the left ventricle into the aorta. As can be seen in 25 FIG. % the crossasectional area of the insert member 102 is relatively small as compared with the flow area through the aortic annulus. Accordingly, in the 2017200732 03 Feb 2017 10 18 - illustrated embodiment, the insert member 102 will not substantially impede the flow of blood through the aortic valve during ventricular systole.

[0056) With reference to FIG, 5. the .prosthetic device 100 is illustrated after deployment within a subject. As illustrated in FIG. 5, the anchoring member 110 is deployed in the aorta above the aortic valve, such as above the ostia o| the coronary arteries 38 such as to not interfere with the flow of blood through the coronary arteries. The insert, member 102 is deployed: within the native aortic valve to: improve the function of the aortic valve. For example, the insert member 102 is positioned within the native aortic valve with each arm 104, 106 and 108 extending between adjacent edges of two leaflets such that the leaflets of the aortic valve 32 coapt with the arms 104, 106 and 108. The connecting members 120 extend from the anchoring member 110 to the insert member 102 for maintaining the insert member 102 in a substantially fixed position. During ventricular diastole, the leaflets of the aortic valve 32 close and press against the walls of the insert member to create a tight seal, Although the native leaflets in an insufficient or defective aortic valve may not be able to close completely, the arms of the insert member 102 fill the gaps such that little or no blood is allowed to pass from the aorta bade into the left ventricle. 20 [0057) As shown, the native aortic valve is not excised and continues to function in a substantially normal manner. As a result, over time, it may be possible to remove the prosthetic device if the native Valve is $bf| to heal itself or if an alternative treatment is found.

[0058] With reference to FIG. 6, a prosthetic device 200 according to 23 another embodiment is shown. Prosthetic device 200 includes an insert member 102 and an anchoring member 110, The insert member 102 in the 2017200732 03 Feb 2017 illustrated embodiment 15 20 -19 directly couplet! to Ihe anchoring member ! 10 rather than via the connecting members 120, For example, the insert member can be coupled to the anchoring member 110 via the proximal end 118 of the insert member 102, for example with the proximal end Of the insert member 102 received partially within and surrounded by an end portion of the anchoring member 110. The diameter of the insert member 102 in the illustrated embodiment is less than the diameter of the anchoring member 110, This configuration allows the insert member 102 to be collapsed or folded dining implantation, and then deployed within the valve, [0059] The disclosed prosthetic devices can be configured to be delivered in a percutaneous or minimally invasive procedure in which only a small access incision is required, In one example, the prosthetic device can be con figured so that I can be crimped or otherwise collapsed into a smaller profile and then placed in a delivery sheath for advancement to the treatment site. FICT 7. for example, illustrates a prosthetic device 200 in a collapsed condition within a sheath 142. As shown, the insert member 102 can be configured to be sufficiently flexible such that the arms can be folded or caused to assume a curved profile to temporarily reduce the profile of the insert during delivery. After being ejected from the sheath 142, the anchoring member 110 and insert member 102. expand to a fully expanded condition as shown in FIG. 8. When delivered to the aortic valve in a percutaneous procedure, it may be desirable to utilize a delectable sheath to facilitate navigation through the patient’s vasculature and around the; sortie; arch. Details; regarding various embodiments of a deflectable sheath configured to deliver a therapy device to an aortic valve can be found in Applicant’s copending U.S. Application No. 11/152,288, filed June 13, 2005, entitled “Heart 2017200732 03 Feb 2017 10 20:

Valve Deliver)' System,’5 which is hereby incorporated by reference in its entirety::: [0060] FIG. 9A illustrates a prosthetic device 300 that can be used to reduce or eliminate heart valve regurgitation, such as aortic valve regurgitation. In this embodiment, the prosthetic device includes an insert member 102 configured for insertion into the aortic valve and an anchoring member 302 configured for securement to the muscular wall in the left ventricle. The anchoring member 302 can include a plurality of engagement members 304, such as hooks dir lingers, that penetrate tissue along the muscular wall for securing the insert member 102 to the heart. The engagement members 304 can be formed of any biocompatible material, such as biocompatible metals or plastics, which is capable of penetrating the left ventricle muscular wall to secure the insert member 102 to the heart without substantially impairing the wall. The anchoring member 302 can include an 15 elongate body portion, or shaft, 306 which couples the engagement members 304 to the itipit member 102. In one example, the elongate body portion 306 and the engagement members 304 can be formed1 from a angle piece of material, In another example, the elongate body portion 306 and the engagement members 304 can be separately formed and subsequently coupled 20 to one another by any suitable means, such: as welding. The elongate body portion 306 and the engagement members 304 can be formed of the same dr different materials depending on the material properties (elasticity, rigidity, resilience and the like) desired for each part of the device 300. 10061 \ The prosthetic device 300 can be positioned within the heart to 25 minimize aortic valve regurgitation by positioning the plurality of engagement nfombers 304 in the left ventricle near the left ventricular apex. In the illustrated embodiment, a plurality of fingers or hooks penetrates tissue along 2017200732 03 Feb 2017 20 21 the left ventricle muscular wall near tile lei! \canicular apex. I'he insert member 102 is positioned in the aortic valve annulus such that an upper portion and lower portion extend above and below the native aortic valve and the arms of the insert member 102 are aligned with eoaptions of the three cusps 5 of aortic valve so each leaflet moves up and down between the insert arms.

[0062] FIGS. 9B and 9C illustrate the lower end portion of an anchor member 302 with a plurality of engagement members 304 in the form of elongated prongs. The elongated prongs 304 are desirably configured to self-expand flout the impressed configuration of FIG. 9C to a “flowered” or 10 expanded configuration of FIG. 9S when advanced out of a delivery sheath. This flowering is desirably achieved with a self curving area 304a that deflects the prongs 104 radially outward from tlfe center of the body 502 and rearward toward: the second end of the body. The prongs 304 arc desirably pointed or barbed to facilitate penetration and engagement with the muscular wall of the 15 heart.

[0063] The anehor member III can be formed from a single tube of shape memory material, such as, for example, Nitinol. During: manufacture, the shape memory material may be cut using a mechanical or laser cutting tool. After cutting the lube, the expanded or flowered shape can be imparted to the memory of the shape memory material with techniques known in the art (e.g. heal: setting the shape). Methods for manufeeturing the anchor member are described in detail in Applicant's co-pending U.S. Application No. 11 /750,272 (hereinafter “the '272 application”), which is incorporated herein by reference. In one preferred embodiment, the anchor member iss formed: to have an expanded configuration that conforms to the contours of the particular surface area of the heart where the anchor member is to: be deployed, as: described in the 7272 application. 2017200732 03 Feb 2017 -22 - [0064] The si si face ot (he anchor member 302, including the prongs 304, is desirably configured to promote tissue growth onto and even into its surface.

In one example this growth is achieved by providing the anchor member with a relatively rough and/or porous surface. Additionally, biological coatings of the 5 types known in the art can be included on the surface of the anchor member 302 to promote healing and tissue growth.

[0065.1 FIG. 10 illustrates another variation of an anchoring member 402 wherein one or more anchors, such as the illustrated plates 404, are located on opposite sides of the muscular wall of the heart for anchoring the prosthetic 10 device 400 to the heart. The plates 404 can be formed of any biocompatible material, such as biocompatible metals or plastics. The anchoring member 402 includes a shaft 406 having an upper end portion connected to the insert member 102 and a lower-end portion that extends through the wall of the heart. One plate 404 is disposed on the shaft inside the left ventricle and another plate IS 404 is disposed on the shaft outside the ldft ventricle to secure the shaft in place.

[0066] 11 desired* the prosthetic device may be deployed in multiple stages wherein, in a first stage, the anchoring member is attached to the aorta (or ventricular wall) before tire insert member is delivered. In a second stage, the 20 insert member of the device is connected to the anchoring member at a later time (e.g., hours, days or weeks later). The time between the first and second stages advantageously allows tissue to heal and even grow over the anchoring member, thereby further embedding the anchoring member in the heart. Without tire added stress that the insert member of the device may impart on 25 the tissue, the healing and over-growth may proceed more rapidly with less adverse affects (e.g., unwanted scarring). Additional details regarding 2017200732 03 Feb 2017 23 exemplary:: anchoring members, expandable insert members aid dwo^stage deployment can be found in the '272 application.

[0067] MG. 11 shows another alternative embodiment of a prosthetic device, indicated at 500. The anchoring member 110 can be a stent and can 5 include a valve member 130 mounted inside the stent. In the illustrated embodiment, the valve member 130 is a three-leaflet bioprosthetic valve. In particular examples*: the anchoring member and valve member may take the: form of the Cribier-Edwards valve manufactured by Edwards Lifosciences Irvine, California. Additional details regarding exemplary embodiments: of a: 10 stented valve can be found in UJ. Patent No. 6,893,460, which is hereby incorporated by reference in its entirety.

[0068] The valve member 130 in the stent ensures unidirectional flow through the stent. The stent is desirably configured for delivery into an ascending aortas The stent is expanded, either by self-expansion or by balloon 15 expansion, such that the stent is anchored in the aorta. After depfoyment, the vaivc member in the stent prevents blood from flowing backward through the aorta. The insert member is delivered into the native aortic valve to improve the native valve function. Accordingly, two separate valves (i.e., the stented valve and the native valve) work in tandem for inhibiting regurgitation through 20 the aortic annulus. By deploying the insert member in the native valve, tire native valve is allowed to function as it should and blood is allowed to flow into the coronary arteries in a substantially natural manner. The stented valve supplements the function of the native valve. ¥ desired, the stented valve could be constructed to close before or after the native valve to further 25 influence and improve the native valve function and also to improve hemodynamics and/or perfusion into the coronary arteries. 2017200732 03 Feb 2017 24 · [0069J With reference to I*IG. 12, a prosthetic device 600 according to yet another embodiment is provided. The prosthetic device 600 is configured for use in an abnormal aortic valve having only two leaflets. To treat this portion of the population, an insert member 602 is provided with two arms 604, 606 5 for filling the gaps between the leaflets. In addition, in certain aortic valves having three leaflets, it may not be necessary to fill gaps between each of the three leaflets. Accordingly, it may be desirable to use an insert member of the type shown in FIG. 12 for preventing or reducing regurgitation in a three leaflet valve. 10 (0070] For purposes of illustration, desirable embodiments of a prosthetic device have been described above for use in a valve normally having three leaflets, such as an aortic valve. However, it will be recognized by those of ordinary skill in the art that variations of the devices may also be used to treat nnother valve with three leaflets, such as a pulmonary valve, in an analogous 15 mariner. When used to treat the pulmonary valve, the anchoring member (e.g., stent) can be configured for deployment in the pulmonary trunk Or a pulmonary artery. Alternatively, the anchoring member may be secured within the right ventricle. 10071] With reference now to FIGS. 13 through 15, a prosthetic device 700 20 is configured for treating a bicuspid valve, such as a defective mitral valve. As illustrated in FIG. 13, the prosthetic device 700 includes an insert member 702 and an anchoring member 704. The insert member 702 comprises a body sized and shaped to fill the gap between the anterior and posterior leaflets of an insufficient mitral valve. 25 [0072] 1§ ppe specific example. the insert member 10| exhibits sufficient rigidity to substantially maintain its deployed shape and is resilient and/or 2017200732 03 Feb 2017 -· 25 ^ flexible enough to be compressed to a reduced diameter for delivery in a delivery sheath. The insert member mn be formed from plastic* metal or other biocompatible material suitable lor implantation into a subject. In particular examples* as described previously, the insert member can include an outer 5 layer or sheath substantial ly formed of a bio compatible material, such as a cloth- like or fabric material (natural or synthetic) or a biological material, such as collagen or biological tissue material in order to protect the native leaflets from damage to inhibit abrasion that could occur in response to engagement and disengagement of the leaflets). For instance, smooth animal |0 pericardium such as equine, bovine, porcine or other animal pericardial tissue which is compatible with the native leaflets may be included within the outer layer. Such tissue may be tanned or fixed by a suitable tanning environment or the pericardium can be cross-linked with glutar aldehyde arid heparin bonded by a detoxification process. In a certain example, the biological tissue material 15 can be one of the MO-RpACT® natural tissue products exhibit improved bioeompatifeility and mitigate calcification and thrombus formation. The outer layer can cover the entire outer surface of |he insert member 1.02 or selected portions of the outer surface, such as those portions that come into contact with the native leaflets. The Insert member 702 can be shaped with tapered andfor 20 smooth edges to minimize or eliminate hemolytic effects. 100731 The cross-sectional profile of the insert member 702 is shaped such that the native leaflets are capable of contacting the sides 703a and 703b of the insert member 702 to create a tight seal. As illustrated in FIGS. 13-15, the insert member 702 preferably has a crescent-shape cross-sectional profile to 25 better conform to the curvature of the native leaflets. The surface of the insert member 702 can be of a compliancy that allows the native leaflets to engage the insert member 702 to create a tight seal without damaging the leaflets. For 2017200732 03 Feb 2017 - 26 v example, as described above, the surface can comprise a biocompatible material, such as collagen or pericardial tissue to inhibit abrasion that could occur in response to engagement or coaptation of the insert member surface with the native leaflets. In operation, the native leaflets of the mitral valve 5 press against the walls of the insert member during ventricular systole to create a tight seal and prevent regurgitation of blood from the left ventricle into the left atrium.

[0074] In the illustrated embodiment, the anchoring member 704 of the prosthetic device 7BB includes a shaft or elongated body portion 7Θ6, the lower 10 end portio! of which fortes a penetration member 708. PIai.es 709 can be disposed m the penetration member 708 on opposite sides of the heart wall to secure the shaft in place. The body portion 706 and penetration member 708 of the anchoring member 704 may be of any suitable shape and material that Imparts the material properties (elasticity* rigidity, resilience and the lilee) 15 desired for each part of device 700. For example, the penetration member 708 can be formed of any biocompatible material, such as bioeompatible metals or plastics, which is capable of penetrating the left ventricle muscular wall to secure the insert member 702 to the heart without substantially impairing the wall. 20 [0075] In one example, the anchoring member 704 may be configured for deployment in the left ventricle. PI©. 14 is a inoss-sectiomal view of the insert member 702 shown in Pi©. 13. In this embodiment the insert, member 702 can have a substantially solid cross-section. In a variation, as shown in FI©. 15, the insert member 702 may include a passageway extending along a 25 longitudinal axis. The passageway can be adapted to allow blood to flow through the insert member in one direction. A valve member can be included within tile insert to ensure that blood flows in only one direction. In a 2017200732 03 Feb 2017 [0076] valve particular example, the valve member ep comprise one or more lip members 712 defining a slit or opening 730. The valve member mimics the function of the target valve by allowing blood flow in only one direction. Thus, blood flow passing into the passage from one direction opens the flaps and thereby 5 passes through the insert member while Blood moving into the passage from the opposite direction is stopped by the valve.

Bystemmnd Methods for reducing regurgitation through axhemt [0077] ©iplosed herein are a system and methods for nearing a defective Hi heart valve. In one embodiment, the system includes a prosthetic device including an anchoring member, such as a self-expandable anchoring member, and an insert member. The system can further include a delivery catheter for delivering the prosthetic device into the heart via* a percutaneous approach. Tor example* the catheter can be introduced percutaneously into the patient’s 15 vasculature (e.g., into a peripheral artery such as the femoral artery) and advanced to the implantation site. In certain embodiments, for example, the catheter is sized for insertion through a small incision in the groin and has a length of at least about 80 cm, usually about 90-100 cm, to allow transluminal positioning of the shaft from the femoral and iliac arteries to the ascending 20 aorta in a retrograde approach. Alternatively, the catheter may have a shorter length, e.g. about 20-60 cm, for introduction through other insertion points, such as. for example, the iliac artery, the brachial artery, the carotid or the subclavian arteries. In the femoral approach, the catheter desirably is long enough and flexible enough to traverse the path through the femoral artery, 25 iliac artery, descending aorta and aortic arch. At the same time, the catheter desirably has sufficient pushability to be advanced to the ascending aorta by pushing on the proximal end, and has sufficient axial, bending, and torsional 2017200732 03 Feb 2017 stiffness Lo allow the physician to control the position of the distal end, even when the catheter is in a tortuous vascular structure. Alternatively, the catheter may be passed through a port between ribs. In one technique, the catheter is advanced through the patient’s thorax above the heart and through an incision 5 in the aortic arch, in a so-called minimaily-invasive procedure. In another technique, the catheter is advanced through an incision in the heart wall, preferably along the apex of the heart. The prosthetic device is advanced to the heart valve that is to be treated, and it is positioned to extend across the valve with the arms of the device interposed between the leaflets such that the 10 leaflets of the valve close and press against the walls of the insert member to create a tight seal, [0078] In certain embodiments, the delivery catheter includes an elongated sheath having a lumen sized to receive the prosthetic device. The prosthetic device is held within the sheath in a collapsed configuration during 15 advancement through the subject’s vasculature. For example, during advancement to the left ventricle, the device is initially contained within the delivery sheath With the anchoring member retained in a ladiully compressed state. In one variation, the distal portion of the delivery sheath is configured for retrograde advancement and may be configured with a deflectable end 20 portion for facilitating navigation around the aortic arch. After reaching the treatment site, the sheath is moved proximaliy relative to the prosthetic device to eject the device from the sheath. The device is then allowed to expand such that die insert conforms to the gaps in the aortic valve and the anchoring member engages the inner wall of the aorta. 25 [0079] Although embodiments of the present invention are preferably configured for percutaneous or minimally-invasi ve delivery procedures, in certain situations, the insert miMbef may be deployed via an open-heart 2017200732 03 Feb 2017 - 29 - surgical procedure. In these embodiments, a delivery catheter may not be necessary since the defective native valve can be directly accessed.

[0080] Although the disclosure has been described in terms of particular embodiments and applications, one of ordinary skill in the art, in light of this teaching, can generate additional embodiments and modifications without departing from the spirit of or exceeding the scope of the claimed invention. Accordingly, it is to be understood that the drawings and descriptions herein are proffered by way of example to facilitate comprehension of the disclosure and should not be construed to limit the scope thereof.

Claims (14)

1. THE CLAIMS DEFINING THE INVENTION ARE AS FOLLOWS:-

   1. A method for treating a mitral valve, the method comprising: inserting a delivery sheath through an incision through cardiac tissue aiong an apex of a head into a left ventncle; advancing an inset member ih a coliapsed configuration through the delivery sheath into the left ventricle, the insert member inciuding a biocompatible fabric outer layer, a passageway extending therethrough aiong a longitudinal axis extending from a left atrium to the left ventricle, and a valve member disposed within the passageway, the valve member including one or more flap members dittoing a one-way valve; allowing the insert member to expand to an expanded configuration; aligning a cross-sectional profile of the insert member to conform to a curvature of native mitral valve leaflets; positioning the insert member between native leaflets of a mitral valve such that the native leaflets create a tight seal against a layer of fabric disposed over an outer surface of the insert member; extending a first end of an anchoring member through the incision, the anchoring member including a second end coupled to an outflow end of the Insert member, an elongate body portion and a first end including a penetration member, the penetration member extending through the cardiac tissue; contacting a plate with an outer surface of the heart; and locking the plate to the penetration member.
2. 2. The method of claim 1, whereto advancing the insert member comprises advancing an insert member including a crescent-shaped transverse cross-sectional profile.
3. 3. The method of claim 1 f wherein extending the first end of the anchoring member including the elongate body portion comprises extending a first end of an anchoring member including an elongate, elastic body portion.
4. 4. The method of claim 1, wherein the plate is a first plate; the method further comprising contacting a second plate with an inner surface of the heart; and locking the second plate to the penetration member,
5. 5. The method of claim 1, wherein advancing the insert member comprises advancing an insert member including at least one of plastic or metal.
6. 6. A method for treating a mitral valve, the method comprising: advancing an insert member in a collapsed configuration through a heart wall and into a left ventricle, the insert member including a passageway extending therethrough along a longitudinal axis extending from a left atrium to the left ventricle, a one-way valve member disposed within the passageway; allowing the insert member to expand to an expanded configuration; positioning the insert member between native leaflets of a mitral valve such that the native lllpets create a tight seal against an outer surface of the insert member; extending a first end portion of an anchoring member through the heart wall, the anchoring member including a second end portion coupled to an outflow end of the insert member; locking a plate to the first end portion of the anchoring member on an exterior wall of the heart.
7. 7. The method of claim 6, wherein advancing the insert member comprises advancing the insert member through an incision through cardiac tissue along an apex of a heart into a left ventricle,
8. 8. The method of claim 6, wherein advancing the insert member comprises advancing the insert member through a delivery sheath.
9. 9. The method of claim 6, wherein advancing the insert member Comprises advancing an insert memier including a biocompatible fabric outer layer. 1Q. The method of claim 6, wherein advancing the insert member comprises advancing an insert member including a biological tissue outer iayer.
10. 11. The method of eiilm 6, wherein advancing the insert member comprises advancing an insert member including at least one of plastic or metai.
11. 12. The method of claim 6, wherein advancing the insert member comprises advancing an insert member including a crescent-shaped transverse cross-sectional profile. 1:3. Tie method of claim 8, wherein positioning the insert member further comprises aligning a cross-sectional profile of the insert member to conform to a curvature of native mitral valve leaflets.
12. 14. The method of claim 6, wherein extending the first end portion of the anchoring member comprises extending a first end portion of an anchoring member including an elongate, elastic body portion.
13. 15. The method of claim 6, wherein locking the plate to the first end portion of the anchoring member further comprises contacting the plate with an outer surface of the heart.
14. 16. The method of claim 6, wherein the plate is a first plate, and wherein locking a plate to the first end portion of the anchoring member comprises locking the first plate to the first end portion of the anchoring member on the exterior wall of the heart and locking a second plate to the first end portion of the anchoring member on an inner surface of the heart.