Reconfiguring heart features

Abstract

Among other things, a heart tissue support has gripping elements, each element having a free end that is sharp enough to penetrate heart tissue when pushed against the tissue, and a feature to resist withdrawal from the tissue after the sharp free end has penetrated the tissue. Among other things, the shape of a heart valve annulus is corrected in a catheter laboratory by orienting a tip of a catheter holding a heart tissue support that has gripping elements at the valve annulus, applying a radial force from the catheter against the annulus by opening a structure at the tip of the catheter, and while the structure is opened, forcing the support onto the annulus. Among other things, the shape of a heart valve annulus is corrected during a surgical procedure by pushing a heart tissue support that has gripping elements onto the annulus.

1 . An apparatus comprising:
 a heart tissue support having gripping elements,   each gripping element having a free end that is sharp enough to penetrate heart tissue when pushed against the tissue, and a feature to resist withdrawal of the gripping element from the tissue after the sharp free end has penetrated the tissue.   
   
   
       2 . The apparatus of  claim 1  in which the free ends of the gripping elements project away from a surface of the support. 
   
   
       3 . The apparatus of  claim 1  in which the feature that resists withdrawal of the gripping element from the tissue comprises a finger projecting laterally from the gripping element. 
   
   
       4 . The apparatus of  claim 1  in which the heart tissue support comprises an annular surface bearing the gripping elements. 
   
   
       5 . The apparatus of  claim 1  in which the support is expandable and contractible. 
   
   
       6 . The apparatus of  claim 5  in which the support has a native size that is configurable. 
   
   
       7 . The apparatus of  claim 6  in which a wire configures the native size. 
   
   
       8 . The apparatus of  claim 1  in which the support comprises at least one of stainless steel, gold, Nitinol, or a biologically compatible elastomer. 
   
   
       9 . The apparatus of  claim 1  in which the support comprises a torus. 
   
   
       10 . The apparatus of  claim 1  in which the support comprises a helically wound portion. 
   
   
       11 . The apparatus of  claim 1  in which some portions of the support bear no gripping elements. 
   
   
       12 . The apparatus of  claim 1  in which the gripping elements are organized in a pattern. 
   
   
       13 . The apparatus of  claim 12  in which the pattern comprises rows. 
   
   
       14 . The apparatus of  claim 12  in which the pattern comprises a group in which the gripping elements are more densely placed and a group in which the gripping elements are less densely placed. 
   
   
       15 . The apparatus of  claim 12  in which the pattern comprises arcs. 
   
   
       16 . The apparatus of  claim 12  in which the pattern comprises clusters. 
   
   
       17 . The apparatus of  claim 12  in which the pattern comprises random placement. 
   
   
       18 . The apparatus of  claim 1  in which at least some of the gripping elements comprise at least one of platinum, gold, palladium, rhenium, tantalum, tungsten, molybdenum, nickel, cobalt, stainless steel, Nitinol, and alloys of any combination of them. 
   
   
       19 . The apparatus of  claim 1  in which the gripping elements have the same size. 
   
   
       20 . The apparatus of  claim 1  in which some of the gripping elements are of different sizes. 
   
   
       21 . The apparatus of  claim 1  in which at least some of the gripping elements have more than one of the feature that resists withdrawal. 
   
   
       22 . The apparatus of  claim 2  in which at least some of the gripping elements project from the surface orthogonally. 
   
   
       23 . The apparatus of  claim 1  in which at least some of the gripping elements are curved. 
   
   
       24 . The apparatus of  claim 1  also including a sleeve through which tissue can grow. 
   
   
       25 . The apparatus of  claim 24  in which the sleeve comprises polyethylene terephthalate. 
   
   
       26 . The apparatus of  claim 1  in which there are between about 15 and a million gripping elements on the support. 
   
   
       27 . The apparatus of  claim 1  in which there are between about 100 and about 100,000 gripping elements. 
   
   
       28 . The apparatus of  claim 1  in which the gripping elements comprise burr hooks. 
   
   
       29 . The apparatus of  claim 1  in which the gripping elements comprise arrows. 
   
   
       30 . The apparatus of  claim 1  in which the gripping elements comprise hooks. 
   
   
       31 . A method comprising:
 correcting the shape of a heart valve annulus in a catheter laboratory by orienting a tip of a catheter holding a heart tissue support that has gripping elements at the valve annulus, applying a radial force from the catheter against the annulus by opening a structure at the tip of the catheter, and while the structure is opened, forcing the support onto the valve annulus.   
   
   
       32 . A method comprising:
 correcting the shape of a heart valve annulus during a surgical procedure by pushing a heart tissue support that has gripping elements onto the valve annulus.   
   
   
       33 . A method comprising
 attaching, to different sized heart valve annuli in different patients, supports that can be expanded in preparation for attachment and allowed to contract to a common relaxed, non-expanded native size when they are in place on the annuli, and   reducing the sizes of at least some of the in-place supports to be smaller than the common relaxed non-expanded native size, to accommodate the different sized heart valve annuli of different patients.   
   
   
       34 . A heart tissue support comprising:
 a large number of small grippers, each having a tissue penetration feature and a retention feature, and   the configuration of the grippers relative to a configuration of a given area of heart tissue to which the support is to be attached by force being such that   (1) the penetration features of a failed set of the grippers will fail to penetrate the tissue,   (2) the penetration features of a second set of the grippers will successfully penetrate the tissue,   (3) the retention features of a subset of the second set of grippers will fail to retain the grippers in the tissue, and   (4) the retention features of the remaining grippers of the second set will successfully retain the grippers in the tissue and hold the support in an intended configuration on the tissue.   
   
   
       35 . A method comprising:
 pushing a support onto a region of heart tissue to cause only a portion of a number of small grippers on the support to embed themselves and be retained in the tissue, the portion being sufficient to attach the support securely to the heart tissue.   
   
   
       36 . An apparatus comprising:
 an annular heart valve support that is expandable and contractible and bears gripping elements configured to penetrate heart tissue and to retain the elements in the tissue after penetration.   
   
   
       37 . A tool to attach a support to a heart valve annulus, the tool comprising mechanisms to hold the support in an expanded configuration prior to attachment, to expand the heart valve annulus prior to attachment, to enable the attachment of the support in its expanded configuration to the expanded valve annulus, and to release the expanded support to a contracted configuration after the attachment. 
   
   
       38 . The tool of  claim 37  attached to an end of a catheter. 
   
   
       39 . The tool of  claim 37  also comprising an inflatable balloon. 
   
   
       40 . The tool of  claim 39  in which the balloon plays a role in positioning the tool. 
   
   
       41 . The tool of  claim 37  also in which the mechanisms are also to remove the tool from the heart after attachment. 
   
   
       42 . A tool to attach a support to a heart valve annulus, the tool comprising a structure to expand the annulus of the heart to a predetermined shape under control of an operator. 
   
   
       43 . The tool of  claim 42  in which the structure has a conical outer surface at least a portion of which conforms to the predetermined shape. 
   
   
       44 . The tool of  claim 42  in which the structure has an outer surface that can be expanded to the predetermined shape.