Adjustable Tether And Epicardial Pad System For Prosthetic Heart Valve

Abstract

Apparatus and methods are described herein for repositioning a tether attached to a prosthetic heart valve. In some embodiments, a method includes inserting a distal end portion of a snare device through an incision at a first location in a ventricular wall of a heart and within the left ventricle of the heart. A tether extending from a prosthetic mitral valve, through the left ventricle and out an incision at a second location on the ventricular wall of the heart is snared with the snare device. The tether is pulled with the snare device such that a proximal end of the tether is moved back through the incision at the second location on the ventricular wall and into the left ventricle. The snare device is pulled proximally such that the tether is pulled proximally through the incision at the first location in the ventricular wall of the heart.

What is claimed is: 
     
         1 . A method, comprising:
 inserting a distal end of a catheter through an incision at a first location in a ventricular wall of a heart, through a left ventricle of the heart and through the ventricular septum of the heart such that the distal end of the catheter is disposed within the right ventricle, a portion of the catheter extending through the incision at the first location with the proximal end of the catheter disposed outside the heart;   moving a snare device distally within a lumen of the catheter until a distal end of the snare device is disposed within the right ventricle;   snaring with the snare device a portion of a tether disposed within the right ventricle, the tether extending from a prosthetic tricuspid valve implanted within the heart, the tether extending through an incision at a second location in the ventricular wall of the heart with a proximal end of the tether disposed outside of the heart; and   pulling the tether with the snare device through the lumen of the catheter such that the proximal end of the tether is pulled out the proximal end of the catheter outside of the heart.   
     
     
         2 . The method of  claim 1 , further comprising:
 after the pulling the tether, adjusting a tension on the tether between the prosthetic tricuspid valve and the incision at the first location in the ventricular wall of the heart.   
     
     
         3 . The method of  claim 1 , further comprising:
 after the pulling the tether, removing the catheter from the heart leaving the tether extending through the incision at the first location in the ventricular wall of the heart.   
     
     
         4 . The method of  claim 1 , further comprising:
 after the pulling the tether, adjusting a tension on the tether between the prosthetic tricuspid valve and the incision at the first location in the ventricular wall of the heart; and   after the adjusting, removing the catheter from the heart leaving the tether extending through the incision at the first location in the ventricular wall of the heart.   
     
     
         5 . The method of  claim 1 , further comprising:
 securing the tether at the first location on the ventricular wall of the heart with an epicardial pad device.   
     
     
         6 . The method of  claim 1 , further comprising:
 after the pulling the tether, adjusting a tension on the tether between the prosthetic tricuspid valve and the incision at the first location in the ventricular wall of the heart; and   securing the tether at the first location on the ventricular wall of the heart with an epicardial pad device.   
     
     
         7 . A method, comprising:
 inserting a distal end portion of a catheter through an incision at a first location in a ventricular wall of a heart such that a distal end portion is disposed within a left ventricle of the heart;   inserting a snare device through an incision at a second location in the ventricular wall of the heart such that a distal end portion of the snare device is disposed with the left ventricle of the heart, a tether extending from a prosthetic mitral valve, extend through the left ventricle out through the incision at the second location in the ventricular wall of the heart;   snaring the distal end portion of the catheter with the snare device;   pulling the snare device with the snared distal end portion of the catheter through the incision at the second location in the ventricular wall while a proximal end of the catheter remains outside the incision at the first location;   threading a distal end of the tether through a distal opening defined by the catheter, through a lumen defined by the catheter and out a proximal opening defined by the catheter;   removing the catheter leaving the tether extending through the incision at the first location in the ventricular wall of the heart; and   adjusting a tension on the tether between the prosthetic mitral valve and the incision at the first location in the ventricular wall of the heart.   
     
     
         8 . The method of  claim 7 , further comprising:
 securing the tether at the first location on the ventricular wall of the heart with an epicardial pad device.   
     
     
         9 . The method of  claim 7 , wherein the catheter is flexible such that the catheter can bend to extend between the incision at the first location in the ventricular wall of the heart and the incision at the second location in the ventricular wall of the heart. 
     
     
         10 . The method of  claim 7 , wherein the catheter includes a bend formed in the catheter such that the catheter can extend between the incision at the first location in the ventricular wall of the heart and the incision at the second location in the ventricular wall of the heart.