Methods, systems and devices for cardiac valve repair

Abstract

Disclosed are methods, systems, and devices for the endovascular repair of cardiac valves, particularly the atrioventricular valves which inhibit back flow of blood from a heart ventricle during contraction. The procedures described herein can be performed with interventional tools, guides and supporting catheters and other equipment introduced to the heart chambers from the patient's arterial or venous vasculature remote from the heart. The interventional tools and other equipment may be introduced percutaneously or may be introduced via a surgical cut down, and then advanced from the remote access site through the vasculature until they reach the heart.

What is claimed is: 
     
         1 . A chordal replacement device comprising:
 a proximal anchor comprising a flexible patch and a leaflet attachment device, wherein the flexible patch is affixed to an upper surface of a portion of a flailing leaflet with the leaflet attachment device;   a distal anchor extending and affixed to a distal attachment site in a ventricle; and   a flexible tether coupled to and tensioned between the proximal and distal anchors.   
     
     
         2 . The device of  claim 1 , wherein the leaflet attachment device comprises a pair of expandable elements interconnected by a central attachment rod. 
     
     
         3 . The device of  claim 2 , wherein the pair of expandable elements sandwich the flexible patch and the leaflet. 
     
     
         4 . The device of  claim 1 , wherein the leaflet attachment device comprises an expandable element. 
     
     
         5 . The device of  claim 1 , wherein the expandable element is self-deploying. 
     
     
         6 . The device of  claim 5 , wherein the expandable element comprises a star-shaped barb, a mesh web, or a mesh ball. 
     
     
         7 . The device of  claim 1 , wherein the proximal anchor further comprises a mesh stent deployable within an atrium. 
     
     
         8 . The device of  claim 7 , wherein the mesh stent is coupled to a flexible rod that extends through a valve commissure into the ventricle. 
     
     
         9 . The device of  claim 8 , wherein a distal end of the flexible rod couples to the distal anchor and provides consistent tension on the tether during a heart cycle. 
     
     
         10 . The device of  claim 8 , wherein the flexible rod has a deflectable, spring-formed shape. 
     
     
         11 . The device of  claim 8 , wherein the flexible rod is jointed. 
     
     
         12 . The device of  claim 1 , wherein the distal anchor and tensioned flexible tether apply a downward force on the flailing leaflet. 
     
     
         13 . The device of  claim 1 , wherein the distal anchor comprises a weight, barb, adhesive, screw, or fluid-filled element. 
     
     
         14 . The device of  claim 1 , wherein the distal attachment site comprises a portion of the ventricle wall, ventricular septum or papillary muscle. 
     
     
         15 . The device of  claim 14 , wherein the distal anchor fine-tunes the tension of the tether after the distal anchor is affixed to the distal attachment site. 
     
     
         16 . The device of  claim 15 , wherein the distal anchor comprises a coil screw and wherein rotation of the coil screw fine-tunes the tension on the tether. 
     
     
         17 . The device of  claim 15 , wherein the distal anchor comprises a balloon and wherein infusion of fluid into the balloon increases tension on the tether. 
     
     
         18 . The device of  claim 1 , wherein the flexible tether has a length that can be adjusted to a desired tension to apply a downward force on the flailing leaflet. 
     
     
         19 . The device of  claim 1 , wherein the flexible tether comprises one or more loops of a flexible material. 
     
     
         20 . The device of  claim 19 , wherein the one or more loops are drawn together at a distal end region with an enclosed element. 
     
     
         21 . The device of  claim 20 , wherein the enclosed element couples the one or more loops to the distal anchor. 
     
     
         22 . The device of  claim 21 , wherein the one or more loops are coupled to the proximal and distal anchors such that the one or more loops self-equalize and evenly distribute tension on the flailing leaflets and on distal attachment site.