Techniques for percutaneous mitral valve replacement and sealing

Abstract

Apparatus is provided for use with a native valve of a heart of a subject, the apparatus including (1) an annular upstream support portion, configured to be transluminally placed against an atrial surface of the native valve; (2) a tissue-engaging element that includes a coupling portion configured to be transluminally coupled to tissue in a ventricle of the heart; (3) an elastically-stretchable holding element, configured to secure the upstream support portion against the atrial surface by elastically coupling the coupling portion to the upstream support portion; and (4) a prosthetic valve, configured to be transluminally delivered to the native valve and intracorporeally coupled to the upstream support portion subsequently to the securing of the upstream support portion against the atrial surface. Other embodiments are also described.

1 - 25 . (canceled) 
     
     
         26 . Apparatus for use with a native valve of a heart of a subject, the apparatus comprising:
 an annular upstream support portion, configured to be transluminally placed against an atrial surface of the native valve;   a tissue-engaging element, comprising a coupling portion configured to be transluminally coupled to tissue in a ventricle of the heart;   an elastically-stretchable holding element, configured to secure the upstream support portion against the atrial surface by elastically coupling the coupling portion to the upstream support portion; and   a prosthetic valve, configured to be transluminally delivered to the native valve and intracorporeally coupled to the upstream support portion subsequently to the securing of the upstream support portion against the atrial surface.   
     
     
         27 . The apparatus according to  claim 26 , wherein the upstream support portion is configured to be transluminally advanced to the heart while coupled to the tissue-engaging element via the holding element. 
     
     
         28 . The apparatus according to  claim 26 , wherein the holding element has a contracted configuration in which the holding element has a length, and wherein the holding element is configured to couple the coupling portion to the upstream support portion such that a distance between the coupling portion and the upstream support portion is reversibly increasable to be greater than the length, by stretching of the holding element. 
     
     
         29 . The apparatus according to  claim 26 , wherein the holding element comprises nitinol. 
     
     
         30 . The apparatus according to  claim 26 , wherein the holding element comprises a spring. 
     
     
         31 . The apparatus according to  claim 30 , wherein the spring comprises a tension spring. 
     
     
         32 . The apparatus according to  claim 30 , wherein the spring is shaped to define a coil. 
     
     
         33 . The apparatus according to  claim 30 , wherein the spring is shaped to define a zigzag. 
     
     
         34 . The apparatus according to  claim 26 , wherein the holding element comprises a plurality of telescopically-slidable cylinders. 
     
     
         35 . The apparatus according to  claim 26 , wherein the holding element comprises a limiting wire, configured to limit stretching of the holding element. 
     
     
         36 . A method, comprising:
 securing an annular upstream support portion against an atrial surface of a native valve of a heart of a subject by:
 transluminally placing the upstream support portion against the atrial surface of the native valve of the heart, and 
 anchoring a coupling portion of a tissue-engaging element to tissue in a ventricle of the heart, the tissue-engaging element being elastically couplable to the upstream support portion via an elastically-stretchable holding element; 
   transluminally delivering a prosthetic valve to the native valve; and   intracorporeally coupling the prosthetic valve to the upstream support portion subsequently to the securing of the upstream support portion against the atrial surface.   
     
     
         37 . The method according to  claim 36 , further comprising advancing the upstream support portion to the native valve while the upstream support portion is coupled to the tissue-engaging element via the holding element. 
     
     
         38 . The method according to  claim 36 , wherein anchoring the coupling portion of the tissue-engaging element comprises anchoring a coupling portion of a tissue-engaging element that is elastically couplable to the upstream support portion via an elastically-stretchable holding element that includes nitinol. 
     
     
         39 . The method according to  claim 36 , wherein anchoring the coupling portion of the tissue-engaging element comprises anchoring a coupling portion of a tissue-engaging element that is elastically couplable to the upstream support portion via an elastically-stretchable holding element that includes a spring. 
     
     
         40 . The method according to  claim 39 , wherein anchoring the coupling portion of the tissue-engaging element comprises anchoring a coupling portion of a tissue-engaging element that is elastically couplable to the upstream support portion via an elastically-stretchable holding element that includes a spring that is shaped to define a coil. 
     
     
         41 . Apparatus for use at a heart of a subject, the apparatus comprising:
 a self-expanding prosthetic valve having a compressed state in which the prosthetic valve is transluminally advanceable, and an expanded state; and   a delivery tube:
 comprising a flexible material, and 
 configured to house the prosthetic valve in a manner in which the tube (1) retains the prosthetic valve in the compressed state, and (2) conforms to a shape of the prosthetic valve in the compressed state. 
   
     
     
         42 . The apparatus according to  claim 41 , wherein the flexible material is a fabric. 
     
     
         43 . The apparatus according to  claim 41 , wherein the delivery tube is flaccid without the prosthetic valve housed therewithin. 
     
     
         44 . The apparatus according to  claim 41 , wherein the delivery tube is configured to release the prosthetic valve by at least part of the delivery tube being intracorporeally opened into a sheet of the flexible material. 
     
     
         45 . The apparatus according to  claim 44 , further comprising a pullstring, wherein the delivery tube comprises the sheet of the flexible material held in a generally cylindrical shape by the pullstring, and is configured to be opened by the pullstring being pulled out of the delivery tube. 
     
     
         46 . The apparatus according to  claim 45 , wherein the pullstring holds the flexible material in the generally cylindrical shape by being woven between parts of the flexible material. 
     
     
         47 . The apparatus according to  claim 45 , wherein the pullstring holds the flexible material in the generally cylindrical shape by being coupled to the flexible material via a weakened join.