# Patent

## Title
Adjustable height focal tissue deflector

## Abstract

A tissue shaping device adapted to reshape target tissue adjacent to a lumen. In some embodiments, the device includes an expandable and contractable anchor, with the anchor having an adjustable height anchoring portion adapted to engage a wall of the lumen in at least first and second anchor heights, the anchoring portion being further adapted to be changed from the first anchor height to the second anchor height by a substantially proximally or a substantially distally directed actuation force. The invention is also a tissue shaping system including a tissue shaping device and a tool for adjusting the height of an anchor of the device. The invention also includes methods of using such tissue shaping devices and systems.

## Background
CROSS-REFERENCE
This application is a continuation-in-part of U.S. patent application. Ser. No. 10/003,910, filed Nov. 1, 2001, now U.S. Pat. No. 6,949,122, the disclosure of which is incorporated by reference. This application is also a continuation-in-part of U.S. patent application Ser. No. 10/429,204, filed May 2, 2003 now U.S. Pat. No. 7,311,729, which is a continuation-in-part of U.S. patent application. Ser. No. 10/142,637, filed May 8, 2002, now U.S. Pat. No. 6,824,562, the disclosures of which are incorporated by reference. This application also claims the benefit of U.S. Provisional Application No. 60/476,666, filed Jun. 5, 2003, which application is incorporated herein by reference.


BACKGROUND OF THE INVENTION
U.S. patent application Ser. No. 10/003,910, “Focused Compression Mitral Valve Device and Method;” U.S. patent application Ser. No. 10/142,637, “Body Lumen Device Anchor, Device and Assembly;” U.S. patent application Ser. No. 10/331,143, “System and Method to Effect the Mitral Valve Annulus of a Heart;” and U.S. patent application Ser. No. 10/429,172, “Device and Method for Modifying the Shape of a Body Organ,” filed May 2, 2003; which are assigned to Cardiac Dimensions Inc., (the assignee of the present invention) and are herein incorporated by reference, disclose a variety of tissue deflecting mechanisms. In one application, the deflecting mechanisms engage a vessel wall in a coronary sinus and great cardiac vein to aid the closure of a regurgitating mitral valve. These devices generally include a connector (such as a cable or support wire) extending between a proximal anchor and a distal anchor engaging the lumen wall. The devices can be deployed to reshape the coronary sinus and the adjacent mitral valve annulus.
The purpose of a support device in a lumen such as a vein or artery is to reshape a particular tissue area adjacent to the lumen. In order to be minimally invasive, the reshaping should be limited to the target tissue, such as the mitral valve annulus, and any reshaping of other tissue adjacent to the lumen should be minimized or avoided. For example, to treat mitral valve regurgitation, the device is placed in the coronary sinus to reshape the mitral valve annulus. Care should be taken to minimize the reshaping of other adjacent tissue, such as nearby arteries. See, e.g., the following applications (the disclosures of which are incorporated herein by reference): U.S. patent application Ser. No. 09/855,945, “Mitral Valve Therapy Device, System and Method” (published Nov. 14, 2002, as U.S. 2002/0169504 A1); U.S. patent application Ser. No. 09/855,946, “Mitral Valve Therapy Assembly and Method” (published Nov. 14, 2002, as U.S. 2002/0169502 A1). It is also advisable to monitor cardiac perfusion during and after such mitral valve regurgitation therapy. See, e.g., U.S. patent application Ser. No. 10/366,585, “Method of Implanting a Mitral Valve Therapy Device,” the disclosure of which is incorporated herein by reference.
Tissue shaping devices that apply force to a localized, discrete portion of the vessel wall surrounding a lumen have been described. See, e.g., U.S. patent application Ser. No. 10/003,910, “Focused Compression Mitral Valve Device and Method,” which describes the use of such devices disposed in the coronary sinus to treat mitral valve regurgitation. Other therapies deploy one or more rigid devices in the lumen to change the shape of the lumen and adjacent tissue. See, e.g., Lashinski et al. U.S. patent application Ser. No. 10/066,302 (published as U.S. 2002/0151961 A1); Taylor et al. U.S. patent application Ser. No. 10/068,264 (published as U.S. 2002/0183835 A1); Liddicoat et al. U.S. patent application Ser. No. 10/112,354 (published as U.S. 2002/0183838 A1); the disclosures of which are incorporated herein by reference. Still other tissue shaping devices utilize an “anchor and cinch” method to modify tissue adjacent a lumen, i.e., by anchoring a distal anchor, placing a proximally-directed force on a connector extending proximally from the distal anchor, and anchoring a proximal anchor to maintain the configuration.
SUMMARY OF THE INVENTION
The present invention is a mechanism for selectively controlling the anchor height of an anchor to be used as a proximal anchor, a distal anchor, or a focal tissue deflector. As with other tissue shaping devices, one particular application is the treatment of mitral valve regurgitation by deploying a device in the coronary sinus to reshape the mitral valve annulus.
One aspect of the invention provides a tissue shaping device adapted to reshape target tissue adjacent to a lumen. In some embodiments, the device has an expandable and contractable anchor. The anchor in these embodiments has an adjustable height anchoring portion adapted to engage a wall of the lumen in at least first and second anchor heights, the anchoring portion being further adapted to be changed from the first anchor height to the second anchor height by a substantially proximally or a substantially distally directed actuation force. In some embodiments the adjustable height anchoring portion includes a bent wire portion (formed, e.g., in a figure 8 configuration) adapted to change its shape in response to the actuation force. The anchor may also include a plurality of locks each adapted to lock the anchoring portion in an anchoring height, and the bent wire portion may include a locking portion adapted to cooperate with each lock to maintain the bent wire portion's shape.
In some embodiments the tissue shaping device has an anchor height adjustment tool interface. In some embodiments the device has a second anchor and a connector disposed between the first and second anchor.
The device may be part of a system including an anchor height adjustment mechanism adapted to register the adjustable height anchoring portion in a plurality of predetermined anchor heights. In some embodiments the anchor height adjustment mechanism may include locks locking the adjustable height anchoring portion in each of the predetermined anchor heights. In some embodiments the anchor height adjustment mechanism may include a plurality of points of connection between the adjustable height anchoring portion and a base portion of the anchor. For example, where the adjustable height anchoring portion includes a bent wire portion and the anchor's base portion includes a tube, the anchor height adjustment mechanism may include slots formed in the tube and shaped to receive at least a portion of the anchor's bent wire portion. As another example, the anchor height adjustment mechanism may include shape changeable locks adapted to cooperate with a locking portion of the bent wire portion.
Another aspect of the invention is a tissue shaping system including an anchor height adjustment tool; and a tissue shaping device adapted to reshape target tissue adjacent to a lumen. In this aspect of the invention, the tissue shaping device includes an expandable and contractable anchor, with the anchor including an adjustable height anchoring portion adapted to engage a wall of the lumen in at least first and second anchor heights; and a tool interface adapted to receive a proximally or distally directed actuation force from the anchor height adjustment tool to change the adjustable height anchoring portion from the first anchor height to the second anchor height. In some embodiments the adjustable height anchoring portion includes a bent wire portion adapted to change its shape in response to the actuation force. The anchor may also include a plurality of locks each adapted to lock the anchoring portion in an anchoring height, and the bent wire portion may include a locking portion adapted to cooperate with each lock to maintain the bent wire portion's shape. In some embodiments the device has a second anchor and a connector disposed between the first and second anchor.
In some embodiments the tissue shaping device the tool interface is part of an anchor height adjustment mechanism, the anchor height adjustment mechanism being adapted to register the adjustable height anchoring portion in a plurality of predetermined anchor heights. The anchor height adjustment mechanism may have locks locking the adjustable height anchoring portion in each of the predetermined anchor heights. In embodiments in which the device's anchor has a base portion, the anchor height adjustment mechanism may have a plurality of points of connection between the adjustable height anchoring portion and the base portion.
Yet another aspect of the invention is a method of shaping target tissue adjacent to a lumen. In some embodiments the method includes the steps of delivering a tissue shaping device comprising an expandable and contractable anchor to a site in the lumen adjacent the target tissue; and applying a substantially distally or a substantially proximally directed actuation force on the anchor to change anchor height from a first lockable height to a second lockable height. For example, a substantially distally directed force may be used to increase anchor height, and a substantially proximally directed force may be used to decrease anchor height.
The anchor may have a height adjustment tool interface, in which case the applying step may include the step of engaging an anchor height adjustment tool with the height adjustment tool interface. The method may also include the step of unlocking the anchor from the first anchor height and locking the anchor in the second anchor height. The step of locking or unlocking the anchor may include the step of changing a shape of an anchor lock.
In some embodiments in which the anchor has an anchoring portion adapted to engage a wall of the lumen, the steps of locking and/or unlocking may include the step of changing a shape of at least a portion of the anchor.
Other aspects of the invention will be apparent from the following detailed description.



BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a superior view of a human heart with the atria removed.
FIG. 2 shows a tissue shaping device and system according to one embodiment of the invention deployed within a coronary sinus of the heart.
FIG. 3 is a side view with portions cut away illustrating a first step in deploying the anchor of the device shown in FIG. 2.
FIG. 4 is a side view similar to FIG. 3 illustrating a further step in the deployment of the anchor of the device shown in FIG. 2.
FIG. 5 is a side view similar to FIG. 3 illustrating a further step in the deployment of the device shown in FIG. 2 showing the anchor is an expanded but not yet locked configuration.
FIG. 6 is a side view similar to FIG. 3 illustrating a further step in the deployment of the device shown in FIG. 2 showing the anchor is an expanded locked configuration.
FIG. 7 is a perspective view of a tissue shaping device according to another embodiment of the invention.
FIG. 8 is a perspective view of a tissue shaping device according to yet another embodiment of the invention.
FIG. 9 is a side view of an adjustable height anchor of a tissue shaping device according to still another embodiment of the invention.
FIG. 10 is a perspective view of a tissue shaping system according to yet another embodiment of the invention.
FIG. 11 is a side view of the tissue shaping device of claim 10 as deployed in a coronary sinus.
FIG. 12 is a perspective view of a tissue shaping system according to yet another embodiment of the invention.



DETAILED DESCRIPTION OF THE INVENTION
FIG. 1 is a superior view of a human heart 10 with the atria removed to expose the mitral valve 12, the coronary sinus 14, the coronary artery 15, and the circumflex artery 17 of the heart 10. As used herein, “coronary sinus” includes the venous system associated with the coronary sinus including the great cardiac vein.
The mitral valve 12 includes an anterior cusp 16, a posterior cusp 18 and an annulus 20. The annulus encircles the cusps 16 and 18 and maintains their spacing to provide a complete closure during a left ventricular contraction. As is well known, the coronary sinus 14 partially encircles the mitral valve 12 adjacent to the mitral valve annulus 20. As is also known, the coronary sinus is part of the venous system of the heart and extends along the AV groove between the left atrium and the left ventricle. This places the coronary sinus essentially within the same plane as the mitral valve annulus making the coronary sinus available for placement of a mitral valve therapy device, such as described below.
FIG. 2 shows a tissue shaping device 30 deployed in the coronary sinus 14 of the heart 10 adjacent the mitral valve annulus 20 for reshaping the mitral valve annulus, the target tissue for this use of the device. Also shown in FIG. 2 is a deployment system 50 that deploys the device 30 in the coronary sinus 14. The device 30 takes the form of an elongated body 32 which includes a distal anchor 34 and a proximal anchor 36.
Anchors 34 and 36 are shown in FIG. 2 in their deployed configuration. As described below, upon deployment of the device 30 in the coronary sinus, the distal anchor 34 is transitioned from a first configuration to a locked second configuration. In the process, it is expanded outwardly to anchor the device in the coronary sinus against both bidirectional longitudinal and rotational movement. The proximal anchor in this embodiment, however, is configured to permit proximal movement when deployed. This allows the device 30 to be tightened within the coronary sinus by proximal pulling of the anchor 36 after the distal anchor 34 is deployed. The device 30 may be formed from Nitinol or stainless steel, for example.
The deployment system 50 illustrated in FIG. 2 includes an elongated catheter 52, an elongated pusher 54, and a tether 56. In deploying the device 30, the tether 56 is first looped about the proximal anchor 36 of the device 30 as illustrated and the device is then loaded into the catheter 50. The tether 56 is then threaded through an internal lumen 58 of the pusher 54 and looped around the proximal anchor 36 of the device 30 as illustrated. The pusher 54 is then advanced along the tether 56 for engaging the device 30 and pushing the device distally down the catheter to a predetermined position at the distal end of the catheter 50. The catheter with the device 30 loaded therein is then fed into the heart and through the coronary sinus ostium 31 into the coronary sinus to place the catheter in a position such that the device 30 is adjacent the mitral valve annulus 20. Thereafter, the device is maintained in a stationary position by the pusher 54 as the catheter 50 is partially withdrawn-to expose the distal anchor 34.
Once the distal anchor is exposed, it is deployed by the catheter in a manner to be described more particularly with respect to FIGS. 3-6. Once the distal anchor 34 is deployed, the catheter 50 is then retracted proximally of the proximal anchor 36. This exposes the proximal anchor 36 and permits the proximal anchor to self deploy. Once the proximal anchor is deployed, the tether 56 is pulled proximally to move the proximal anchor 36 in a proximal direction for tightening the device within the coronary sinus and to an extent which results in the desired effect on the geometry of the mitral valve annulus 20. During this adjustment process, mitral regurgitation may be monitored and the device adjusted for optimal results. When the device 30 is in its final position within the coronary sinus 14, the pusher 54 and catheter 50 may be removed from the heart. The tether 56 may be permitted to remain in the heart during an acute phase to ascertain the effectiveness of the device 30. Should further adjustment of the device be necessary, the tether 56 may then be used as a guide for guiding the introduction of the catheter 50 back into the heart.
FIGS. 3-6 illustrate the manner in which the distal anchor 34 may be deployed in the coronary sinus 14 for anchoring the device 30. In each of FIGS. 3-6 a portion of the coronary sinus has been removed and the pusher has not been illustrated so as to not unduly complicate the figures. FIG. 3 shows the catheter 50 disposed within the coronary sinus 14 with most of the device 30 and part of distal anchor within the catheter 50. To that end, the catheter includes a lumen 60 which is dimensioned to receive the device 30 and the distal anchor 34 when the distal anchor 34 is in a first configuration. The distal anchor 34 includes an anchoring portion 38 connected to a base portion 44 at distal and proximal points 40 and 46. In this embodiment, base portion 44 includes a crimp 70 holding the distal end of anchoring portion 38 as well as the distal portion of a connector 42. The proximal connection point 46 of anchoring portion 38 is formed as a loop extending around connector 42 to serve as an element of the anchor's lock, as explained below. The wire forming anchoring portion 38 is bent into a figure 8 configuration whose height may be changed and locked by moving the proximal connection point 46 distally or proximally, as described below.
A lock bump 48 is formed in connector 42 to form another portion of the anchor's lock. The shape of lock bump 48 may be changed elastically to permit loop 46 slide to slide over it in a proximal or distal direction. When the loop 46 is located distally of lock bump 48, it will be held by the enlarged portion 48 for locking the device in the second configuration.
FIG. 4 illustrates the anchor 34 after the catheter 50 has been moved proximal to the anchor 34. More specifically, it will be noted that the distal end of the catheter 50 is now proximal to the loop 46 at the proximal end of the anchor 34. The shape memory of the anchor has caused the anchor to expand and is now partially transitioned from the first configuration of FIG. 3 to the second and final configuration to be described with reference to FIG. 6.
FIGS. 5 and 6 further illustrate anchor 34 being moved from the first configuration to the second configuration by using catheter 50 as a tool to adjust and lock the anchor's height. FIG. 5 shows anchor 34 prior to locking. Distal end of catheter 50 may be used to apply an actuation force to push distally on an interface portion at the proximal end of the anchor 34 while the tether (not shown) holds the device 30 against distal movement, thereby expanding anchor 34 and increasing its anchor height.
As the catheter 50 is moved distally, it forces the loop 46 of the anchor 34 over the lock bump 48 to lock anchor 34 in the expanded second configuration. This provides for anchoring within the coronary sinus of the device 30 against both bidirectional longitudinal and rotational movement. Once the anchor 34 is deployed as illustrated in FIG. 6, the catheter 50 may then be moved proximally and/or removed as indicated by the arrow 72.
One of the many features of the anchor of the instant invention is that it may be moved within or removed from the body lumen in which it is deployed. More specifically, and making reference to FIG. 6, the anchor 34 may be removed by grabbing the proximal side of anchoring portion 38 and pulling the loop 46 proximally over lock bump 48 to collapse the anchor to enable removal of the device within the catheter 50.
Further details of the construction and operation of the device described with respect to FIGS. 2-6 may be found in U.S. patent application Ser. No. 09/142,637.
FIG. 7 shows an embodiment of a tissue shaping device 100 in which both distal anchor 120 and proximal anchor 140 are expandable and lockable. Device 100 includes a connector such as support wire 102 having a proximal end 104 and a distal end 106. Connector 102 is made of a biocompatible material such as stainless steel or a shape memory material such as nitinol wire.
In this embodiment, connector 102 comprises a double length of nitinol wire that has both ends positioned within a distal crimp tube 108. To form the connector 102, the wire extends distally from the crimp tube 108 where it is bent to form a distal stop loop having a diameter that is larger than the lumens within the distal crimp tube 108. After forming the distal stop loop, the wire returns proximally through the crimp tube 108 towards the proximal end of the device 100. Proximal to the proximal end of the crimp tube 108 is a distal lock bump 110 that is formed by the connector bending away from the longitudinal axis of the device 102 and then being bent parallel to the longitudinal axis of the support before being bent again towards the longitudinal axis of the support. Therefore, the bends in the connector form a half 110a of the distal lock bump that is used to secure the distal anchor in the manner described below. From the distal lock bump 110, the wire continues proximally through a proximal crimp tube 112. On exiting the proximal end of the proximal crimp tube 112, the wire is bent to form an arrowhead-shaped proximal lock bump 114. The wire of the connector 102 then returns distally through the proximal crimp tube 112 to a position just proximal to the proximal end of the distal crimp tube 108 wherein the wire is bent to form a second half 110b of the distal lock bump 110.
At the distal end of connector 102 is a distal anchor 120 that is formed of a flexible wire such as nitinol or some other shape memory material. The wire forming the distal anchor has one end positioned within the distal crimp tube 108. After exiting the distal end of the crimp tube 108, the wire forms a figure eight configuration whereby it bends upward and radially outward from the longitudinal axis of the crimp tube 108. The wire then bends back proximally and crosses the longitudinal axis of the crimp tube 108 to form one leg of the figure eight. The wire is then bent to form a double loop eyelet or loop 122 around the longitudinal axis of the connector 102 before extending radially outwards and distally back over the longitudinal axis of the crimp tube 108 to form the other leg of the figure eight. Finally, the wire is bent proximally into the distal end of the crimp tube 108 to complete the distal anchor 120.
As in the embodiment described above with respect to FIGS. 2-6, the distal anchor is expanded moving the delivery catheter distally to engage the proximal portion of anchor 120 and double eyelet 122 and move it from a position that is proximal to the distal lock bump 110 on the connector to a position that is distal to the distal lock bump 110. The bent-out portions 110a and 110b of connector 102 are spaced wider than the width of double eyelet 122 and provide camming surfaces for the locking action. Distal movement of eyelet 122 pushes these camming surfaces inward to permit eyelet 122 to pass distally of the lock bump 110, then return to their original spacing to keep eyelet 122 in the locked position.
At the proximal end of the device is a proximal anchor 140 that is preferably formed of a biocompatible, elastic wire such as stainless steel or a shape memory material such as nitinol. Proximal anchor 140 is made of a single length of wire having a first end positioned within a proximal crimp tube 112. The wire extends distally from the crimp tube 112 and bends radially outward and away from the longitudinal axis of the crimp tube 112 before being bent proximally and crossing the longitudinal axis of the crimp tube 112 in order to form a first leg of a figure eight configuration. The wire then is bent to form a double eyelet or loop 142 around the longitudinal axis of the connector 102 wherein the eyelet 142 has a diameter that allows it to be forced over the proximal lock 114. After forming the eyelet 142, the wire extends outwardly and away from the longitudinal axis of the crimp tube 112 before being bent distally over and across the longitudinal axis of the crimp tube 112 to form the second leg of a figure eight. Finally, the wire is bent proximally and extends into the distal end of the crimp tube 112.
Like the distal anchor, the proximal anchor is expanded and locked by advancing the delivery catheter distally to engage the proximal side of anchor 140 to move the double eyelet 142 from a position that is proximal to the proximal lock bump 114 to a position that is distal to the proximal lock bump 114 in the manner described above with respect to FIGS. 2-6. As can be seen in FIG. 7, the proximal lock bump 114 has an arrowhead shape whereby the proximal end of the lock is bent away from the longitudinal axis of the connector at an angle that is less steep than the distal end of the proximal lock bump. The less steep section makes it easier to advance the eyelet 142 over the lock bump 114 in the distal direction than to retrieve the eyelet 142 over the lock bump in the proximal direction. Distal movement of eyelet 142 cams the less steep proximal surfaces inward to permit eyelet 142 to pass distally of the lock bump 114, then return to their original spacing to keep eyelet 142 in the locked position. Further details of the construction and operation of device 100 may be found in U.S. patent application Ser. No. 10/429,172.
FIG. 8 is a perspective view a focused compression mitral valve device 180, also known as a focal deflector. The device has an elongated semi-tubular base 182 having cut-out portions 184 to allow bending of the base 182. Between the cut-out portions 184 are semi-cylindrical surfaces 186 arranged to continuously contact the pericardial wall of the coronary sinus when the device 180 is implanted in the coronary sinus to distribute the applied force.
The device 180 further includes a force applying member 188 which extends from opposed sidewalls 190 and 192 intermediate the ends of the base 182. The member 188 has an end 194 for engaging a discrete portion of the atrial wall of the coronary sinus to apply the applied force to a discrete portion of the mitral valve annulus to reshape the mitral valve annulus. Further details of device 180 may be found in U.S. patent application Ser. No. 10/003,910.
FIG. 9 shows an anchor design that may be used in place of anchors 34 or 36 of device 30 in FIGS. 2-6, anchors 120 or 140 of device 100 in FIG. 7, or focal deflector 180 in FIG. 8. As in the devices shown in FIGS. 2-7, adjustable height anchor 234 is formed from a wire 202 bent into a figure 8 configuration. Wire 202 is held by a base, such as crimp tube 270. Wire 202 has an eyelet 246 on its proximal side that cooperates with a series of lock bumps 248. To expand the anchor, an actuation tool such as the delivery catheter (not shown) applies a distally directed force on anchor 234 to move eyelet 246 distally over one or more lock bumps. The lock bumps change shape to capture and lock the anchor, as described above. The series of lock bumps register the anchor in discrete and predetermined anchor heights so that the anchor height and the anchoring force can be adjusted. Likewise, a proximally directed force on the anchor will move eyelet 246 proximally over the lock bumps to decrease anchor height and the anchoring force.
FIGS. 10 and 11 show yet another embodiment of a tissue shaping device with an adjustable height anchor, such as an anchor used as a focal tissue deflector. Anchor 300 includes a cylindrical tube 310 having a central slot 312 that extends along a length of the tube and a series of opposing slots 314 that extend in a direction that is perpendicular to the length of the slot 312. Anchor 300 also has anchoring portion made up of a pair of legs 316 each having a fixed end secured to the tube 310 and a free end that is positioned in one of the series of opposing slots 314. Preferably, the legs 316 are made of a superelastic material such as Nitinol or other biocompatible elastic material. By selecting a different slot for the free ends of the legs, the height of the legs can be readily adjusted.
To adjust the height of anchor 300, a tool 320 having a funnel or other shaped end is inserted into the tube 310 to engage the free ends of the legs and move them to the center slot 312 to allow them to be placed in another pair of opposing slots 314. Preferably, the legs 316 are biased radially outward such that when positioned adjacent to a slot 314 and released, they will be biased towards the ends of the slots 314. The series of slots register the anchor in discrete and predetermined anchor heights so that the anchor height and the anchoring force can be adjusted.
FIG. 11 shows the anchor of FIG. 10 within a vessel 325, such as the coronary sinus. The legs 316 engage a vessel wall 332 and press the tube 310 on the side of the vessel wall adjacent tissue to be reshaped. In the example shown, the anatomy comprises a mitral valve 330 that is urged closed by the presence of the tissue shaping device in the vessel.
This anchor embodiment could also be used as the proximal or distal anchor of a tissue deflecting device, such as the devices described above. The anchor's variable height permits the user to provide the appropriate minimum amount of expansive force to securely anchor the tissue deflecting device, thereby minimizing any effects of over-expansion of an anchor.
An alternative embodiment is shown in FIG. 12, in which the legs 316A of the anchor are provided with barbs 322 to facilitate anchoring. This geometry would also facilitate collapse of the legs by tool 320 by placing a tensile load on tool 320. Other geometries for the legs are possible, of course, without departing from the invention.

## Claims

1. A tissue shaping device adapted to reshape target tissue adjacent to a lumen, the device comprising an expandable and contractable anchor, the anchor comprising an adjustable height anchoring portion adapted to engage a wall of the lumen in at least first and second anchor heights, the anchoring portion being further adapted to be changed from the first anchor height to the second anchor height by a substantially proximally or a substantially distally directed actuation force,
wherein the adjustable height anchoring portion comprises a bent wire portion which is adapted to change its shape in response to the actuation force
wherein the anchor further comprises a plurality of locks each adapted to lock the anchoring portion in an anchoring height.

2. The tissue shaping device of claim 1 wherein the bent wire portion comprises a locking portion adapted to cooperate with each lock to maintain the bent wire portion's shape.

3. A tissue shaping device adapted to reshape target tissue adjacent to a lumen, the device comprising
an expandable and contractable anchor, the anchor comprising an adjustable height anchoring portion adapted to engage a wall of the lumen in at least first and second anchor heights, the anchoring portion being further adapted to be changed from the first anchor height to the second anchor height by a substantially proximally or a substantially distally directed actuation force,
wherein the adjustable height anchoring portion comprises a bent wire portion, and
wherein the bent wire portion is formed in a figure 8 configuration.

4. A tissue shaping device adapted to reshape target tissue adjacent to a lumen, the device comprising an expandable and contractable anchor, the anchor comprising an adjustable height anchoring portion adapted to engage a wall of the lumen in at least first and second anchor heights, the anchoring portion being further adapted to be changed from the first anchor height to the second anchor height by a substantially proximally or a substantially distally directed actuation force,
the device further comprising an anchor height adjustment tool interface.

5. A tissue shaping device adapted to reshape target tissue adjacent to a lumen, the device comprising an expandable and contractable anchor, the anchor comprising an adjustable height anchoring portion adapted to engage a wall of the lumen in at least first and second anchor heights, the anchoring portion being further adapted to be changed from the first anchor height to the second anchor height by a substantially proximally or a substantially distally directed actuation force,
the device further comprising an anchor height adjustment mechanism adapted to register the adjustable height anchoring portion in a plurality of predetermined anchor heights.

6. The tissue shaping device of claim 5 wherein the anchor height adjustment mechanism comprises locks locking the adjustable height anchoring portion in each of the predetermined anchor heights.

7. The tissue shaping device of claim 5 wherein the anchor further comprises a base portion, the anchor height adjustment mechanism comprising a plurality of points of connection between the adjustable height anchoring portion and the base portion.

8. The tissue shaping device of claim 7 wherein the adjustable height anchoring portion comprises a bent wire portion.

9. The tissue shaping device of claim 8 wherein the base portion comprises a tube, the anchor height adjustment mechanism comprising slots formed in the tube and shaped to receive at least a portion of the anchor's bent wire portion.

10. The tissue shaping device of claim 8 wherein the anchor height adjustment mechanism comprises shape changeable locks adapted to cooperate with a locking portion of the bent wire portion.

11. A tissue shaping system comprising:
an anchor height adjustment tool; and
a tissue shaping device adapted to reshape target tissue adjacent to a lumen, the device comprising an expandable and contractable anchor, the anchor comprising:
an adjustable height anchoring portion adapted to engage a wall of the lumen in at least first and second anchor heights; and
a tool interface adapted to receive a proximally or distally directed actuation force from the anchor height adjustment tool to change the adjustable height anchoring portion from the first anchor height to the second anchor height.

12. The tissue shaping system of claim 11 wherein the adjustable height anchoring portion comprises a bent wire portion.

13. The tissue shaping system of claim 12 wherein the bent wire portion is adapted to change its shape in response to the actuation force.

14. The tissue shaping system of claim 13 wherein the anchor further comprises a plurality of locks each adapted to lock the anchoring portion in an anchoring height.

15. The tissue shaping system of claim 14 wherein the bent wire portion comprises a locking portion adapted to cooperate with each lock to maintain the bent wire portion's shape.

16. The tissue shaping system of claim 11 wherein the anchor is a first anchor, the tissue shaping device further comprising a second anchor and a connector disposed between the first and second anchor.

17. The tissue shaping system of claim 11 wherein the tissue shaping device comprises an anchor height adjustment mechanism comprising the tool interface, the anchor height adjustment mechanism being adapted to register the adjustable height anchoring portion in a plurality of predetermined anchor heights.

18. The tissue shaping device of claim 17 wherein the anchor height adjustment mechanism comprises locks locking the adjustable height anchoring portion in each of the predetermined anchor heights.

19. The tissue shaping device of claim 17 wherein the anchor further comprises a base portion, the anchor height adjustment mechanism comprising a plurality of points of connection between the adjustable height anchoring portion and the base portion.

20. A method of shaping target tissue adjacent to a lumen, the method comprising:
delivering a tissue shaping device comprising an expandable and contractable anchor to a site in the lumen adjacent the target tissue, wherein the anchor has an anchor height;
locking the anchor in a first height;
applying a substantially distally or a substantially proximally directed actuation force on the anchor to change the anchor height from the first height to a second height; and
locking the anchor in the second height.

21. The method of claim 20 wherein the second lockable height is greater than the first lockable height, the applying step comprising applying a substantially distally directed force on the anchor.

22. The method of claim 20 wherein the first lockable height is greater than the second lockable height, the applying step comprising applying a substantially proximally directed force on the anchor.

23. A method of shaping target tissue adjacent to a lumen, the method comprising:
delivering a tissue shaping device comprising an expandable and contractable anchor to a site in the lumen adjacent the target tissue, wherein the anchor has an anchor height;
locking the anchor in a first height;
applying a substantially distally or a substantially proximally directed actuation force on the anchor to change the anchor height from the first height to a second height; and
locking the anchor in the second height; and
wherein the anchor comprises a height adjustment tool interface, the applying step comprising engaging an anchor height adjustment tool with the height adjustment tool interface.

24. The method of claim 20 further comprising unlocking the anchor from the first anchor height and locking the anchor in the second anchor height.

25. The method of claim 24 wherein the step of unlocking the anchor comprises changing a shape of an anchor lock.

26. The method of claim 24 wherein the step of locking comprises changing a shape of an anchor lock.

27. The method of claim 24 wherein the anchor comprises an anchoring portion adapted to engage a wall of the lumen, the step of unlocking comprising changing a shape of at least a portion of the anchor.

28. The method of claim 24 wherein the anchor comprises an anchoring portion adapted to engage a wall of the lumen, the step of locking comprising changing a shape of at least a portion of the anchor.

29. A tissue shaping device adapted to reshape target tissue adjacent to a lumen, the device comprising an expandable and contractable anchor, the anchor comprising an adjustable height anchoring portion adapted to engage a wall of the lumen in at least first and second lockable anchor heights, the anchoring portion being further adapted to be changed from the first lockable anchor height to the second lockable anchor height by a substantially proximally or a substantially distally directed actuation force, wherein the device further comprises at least a first lock element to lock the anchoring portion in the first lockable anchor height and a second lock element to lock the anchoring portion in the second lockable anchor height.