# Patent

## Title
Transcatheter valve with paravalvular leak sealing ring

## Abstract

A prosthetic heart valve includes a collapsible and expandable stent extending from an inflow end to an outflow end and a plurality of prosthetic valve leaflets coupled to the stent. The prosthetic heart valve may also include a sealing ring coupled to the inflow end of the stent, the sealing ring comprising a tube extending circumferentially around the inflow end of the stent. The tube may be formed from a wire coiled into a repeating shape, such as a rectangle or a diamond, so that the tube is collapsible. A covering may at least partially surround the tube. The sealing ring may include a first filler positioned within the tube and/or a second filler positioned between the tube and the covering.

## Background
CROSS-REFERENCE TO RELATED APPLICATIONS
The present application claims the benefit of the filing date of U.S. Provisional Patent Application No. 61/994,253, filed May 16, 2014, the disclosure of which is hereby incorporated by reference herein.


BACKGROUND
The present disclosure relates to heart valve replacement and, in particular, to collapsible prosthetic heart valves. More particularly, the present disclosure relates to collapsible prosthetic transcatheter heart valves which minimize or reduce paravalvular leaks.
Prosthetic heart valves that are collapsible to a relatively small circumferential size can be delivered into a patient less invasively than valves that are not collapsible. For example, a collapsible valve may be delivered into a patient via a tube-like delivery apparatus such as a catheter, a trocar, a laparoscopic instrument, or the like. This collapsibility can avoid the need for a more invasive procedure such as full open-chest, open-heart surgery.
Collapsible prosthetic heart valves typically take the form of a valve structure mounted on a stent. There are two common types of stents on which the valve structures are ordinarily mounted: a self-expanding stent and a balloon-expandable stent. To place such valves into a delivery apparatus and ultimately into a patient, the valve is first collapsed or crimped to reduce its circumferential size.
When a collapsed prosthetic valve has reached the desired implant site in the patient (e.g., at or near the annulus of the patient's heart valve that is to be replaced by the prosthetic valve), the prosthetic valve can be deployed or released from the delivery apparatus and re-expanded to full operating size. For balloon-expandable valves, this generally involves releasing the valve, assuring its proper location, and then expanding a balloon positioned within the valve stent. For self-expanding valves, on the other hand, the stent automatically expands as a sheath covering the valve is withdrawn.
After implantation, imperfect sealing between the cuff and the site of implant may cause complications such as paravalvular leakage (“PV leak”), or blood flowing through a channel between the structure of the implanted valve and cardiac tissue as a result of the imperfect sealing.
BRIEF SUMMARY
According to an embodiment of the disclosure a prosthetic heart valve includes a collapsible and expandable stent extending from an inflow end to an outflow end, and a plurality of prosthetic valve leaflets coupled to the stent. Each leaflet may have a leaflet belly. The prosthetic heart valve may include a sealing ring coupled to the inflow end of the stent, the sealing ring comprising a tube extending circumferentially around the inflow end of the stent, wherein the tube is formed from a wire coiled into a repeating shape such that the tube is collapsible. The sealing ring may be axially offset from the leaflet belly when the stent is in a collapsed condition.
According to another embodiment of the disclosure, a prosthetic heart valve includes a collapsible and expandable stent extending from an inflow end to an outflow end and a plurality of prosthetic valve leaflets coupled to the stent. Each leaflet may have a leaflet belly. The prosthetic heart valve may include a sealing ring coupled to the inflow end of the stent, the sealing ring comprising a tube extending circumferentially around the inflow end of the stent, a covering at least partially surrounding the tube, and at least one of a first filler positioned within the tube and a second filler positioned between the tube and the covering. The sealing ring may be axially offset from the leaflet belly when the stent is in a collapsed condition.
According to a further embodiment of the disclosure, a prosthetic heart valve includes a collapsible and expandable stent extending from an inflow end to an outflow end and a plurality of prosthetic valve leaflets coupled to the stent. Each leaflet may have a leaflet belly. The prosthetic heart valve may also include a sealing ring coupled to the inflow end of the stent, the sealing ring comprising a tube extending circumferentially around the inflow end of the stent and a covering at least partially surrounding the tube, wherein the covering has a first end and a second end, the first end coupled to the stent by a first thread. The sealing ring may be axially offset from the leaflet belly when the stent is in a collapsed condition.



BRIEF DESCRIPTION OF THE DRAWINGS
Various embodiments of the presently disclosed prosthetic heart valve may be more fully understood with reference to the following detailed description when read with the accompanying drawings, in which:
FIG. 1 is a front view of a collapsible prosthetic heart valve according to the prior art;
FIG. 2 is a top cross-sectional view of the prosthetic heart valve of FIG. 1 implanted in a patient taken along line 2-2;
FIG. 3A is a highly schematic side view of one embodiment of a heart valve having a sealing ring intended to fill irregularities between the heart valve and the native valve annulus;
FIG. 3B is a highly schematic cross-sectional view of the sealing ring of FIG. 3A;
FIG. 3C is a highly schematic side view of the heart valve of FIG. 3A implanted into a native valve annulus with unresected native valve leaflets;
FIG. 3D is a highly schematic side view of the heart valve of FIG. 3A implanted into a native valve annulus with resected native valve leaflets;
FIG. 4A is a front view of a rectangular coil of a sealing ring;
FIG. 4B is a front view of a diamond coil of a sealing ring;
FIGS. 5A-5F are highly schematic cross sectional views of a portion of a prosthetic heart valve with a sealing ring comprising a tube and a covering;
FIGS. 6A-D are highly schematic cross sectional views of a portion of a prosthetic heart valve with a sealing ring comprising a tube, a covering, and an outer filler;
FIGS. 6E-H are highly schematic cross sectional views of a portion of a prosthetic heart valve with a sealing ring comprising a tube, a covering, an outer filler, and an inner filler;
FIGS. 6I-N are highly schematic cross sectional views of a portion of a prosthetic heart valve with a sealing ring comprising a tube, a covering, and an inner filler;
FIG. 6O is a highly schematic cross sectional view of a portion of a prosthetic heart valve with a sealing ring comprising a tube and an inner filler;
FIGS. 7A-P are highly schematic cross sectional views of a portion of a prosthetic heart valve with a sealing ring having a tacking stitch;
FIGS. 8A-P are highly schematic cross sectional views of a portion of a prosthetic heart valve with a sealing ring having an expandable stitch; and
FIGS. 9A-E illustrate a prosthetic heart valve at different stages of resheathing into a delivery device.



DETAILED DESCRIPTION
As used herein, the term “inflow end,” when used in connection with a prosthetic heart valve, refers to the end of the heart valve through which blood enters when the valve is functioning as intended. The term “outflow end,” when used in connection with a prosthetic heart valve, refers to the end of the heart valve through which blood exits when the valve is functioning as intended. As used herein, the terms “generally,” “substantially,” and “about” are intended to mean that slight deviations from absolute are included within the scope of the term so modified. Like numbers refer to similar or identical elements throughout. When used herein in the context of a prosthetic heart valve, or a component thereof, the lengthwise or axial direction refers to a direction along a longitudinal axis passing through the center of the stent or heart valve. When used herein in the context of a prosthetic heart valve, or a component thereof, the circumferential direction refers to a direction extending along the circumference of the prosthetic heart valve.
The sealing portions of the present disclosure may be used in connection with collapsible prosthetic heart valves. FIG. 1 shows one such collapsible stent-supported prosthetic heart valve 100 in an expanded condition. The prosthetic heart valve 100 is designed to replace the function of a native aortic valve of a patient. The prosthetic heart valve 100 includes a stent constructed as a frame 102. The stent 102 extends in a lengthwise or axial direction L from an inflow or annulus end 130 to an outflow or aortic end 132, and includes an annulus section 104 adjacent the inflow end 130 and an aortic section 142 adjacent the outflow end 132. The annulus section 104 has a relatively small cross section in the expanded condition, while the aortic section 142 has a relatively large cross section in the expanded condition. The annulus section 104 may be in the form of a cylinder having a substantially constant diameter along its length. A transition section 141 may taper outwardly from the annulus section 104 to the aortic section 142. Each of the sections of the stent 102 includes a plurality of cells 112 connected to one another in one or more annular rows around the stent 102. For example, as shown in FIG. 1, the annulus section 104 may have two annular rows of complete cells 112 and the aortic section 142 and the transition section 141 may each have one or more annular rows of complete or partial cells 112. The cells 112 in the aortic section 142 may be larger than the cells 112 in the annulus section 104. The larger cells 112 in the aortic section 142 may better enable the prosthetic valve 100 to be positioned without the stent structure 102 interfering with blood flow to the coronary arteries. At least partly due to the shape of cells 112, the stent 102 elongates in the lengthwise direction L as cells 112 collapse when the stent 102 is transitioned from the expanded condition to the collapsed condition.
The stent 102 may include one or more retaining elements 118 at the outflow end 132, the retaining elements 118 being sized and shaped to cooperate with retaining structures provided on a deployment device (not shown). The engagement of the retaining elements 118 with the retaining structures on the deployment device may help maintain the prosthetic heart valve 100 in assembled relationship with the deployment device, minimize longitudinal movement of the prosthetic heart valve relative to the deployment device during unsheathing or resheathing procedures, and help prevent rotation of the prosthetic heart valve relative to the deployment device as the deployment device is advanced to the target location and during deployment. One such deployment device is shown in U.S. Patent Publication No. 2012/0078352, the entire contents of which are hereby incorporated by reference herein.
The stent 102 may also include a plurality of commissure points 116 for mounting the commissures (not identified) of the valve assembly discussed below to the stent 102. As can be seen in FIG. 1, the commissure points 116 may lay at the intersection of four cells 112, two of the cells 112 being adjacent one another in the same annular row, and the other two cells 112 being in different annular rows and lying in end to end relationship. The commissure points 116 may be positioned entirely within the annulus section 104 or at the juncture of annulus section 104 and the transition section 141. The commissure points 116 may include one or more eyelets which facilitate the suturing of the leaflet commissure to the stent.
The prosthetic heart valve 100 includes a valve assembly 140 positioned in the annulus section 104. In the particular embodiment depicted, the valve assembly includes three leaflets 108. Two leaflets join one another at each of three commissures. When implanted at the native aortic valve annulus, blood flows from the inflow end 130, past leaflets 108, and toward the outflow end 132. This occurs when pressure in the left ventricle is greater than the pressure in the aorta, forcing the leaflets 108 to open. When pressure in the aorta is greater than pressure in the left ventricle, the leaflets 108 are forced closed and coapt with one another along free edges of the leaflet 108, blocking blood from flowing in a retrograde fashion from the outflow end 132 to the inflow end 130. The valve assembly 140 may be mounted to the stent 102 by suturing the commissures of the leaflets 108 to the commissure points 116 and suturing other portions of the valve assembly 140 to the stent 102, or by other methods known in the art. The valve assembly 140 may include a cuff 106 and a plurality of leaflets 108 which collectively function as a one way valve by coapting with one another. FIG. 1 illustrates a prosthetic heart valve for replacing a native tricuspid valve, such as the aortic valve. Accordingly, the prosthetic heart valve 100 is shown in FIG. 1 with three leaflets 108, as well as three commissure points 116. However, it will be appreciated that the prosthetic heart valves according to aspects of the disclosure may have a greater or lesser number of leaflets 108 and commissure points 116.
The leaflets 108 may define a leaflet belly B, indicated with broken lines in FIG. 1. The leaflet belly B is the portions of valve assembly 140 above which leaflets 108 are free to move radially inwardly to coapt with one another along their free edges. With this configuration, the valve assembly 140 is particularly thick at points at or above leaflet belly B. As such, any additional material axially aligned with valve assembly 140 above (or distal to) leaflet belly B may add significantly to the crimp profile of the valve 100.
Although the cuff 106 is shown in FIG. 1 as being disposed on the lumenal or inner surface of the annulus section 104, the cuff 106 may be disposed on the ablumenal or outer surface of annulus section 104, or may cover all or part of either or both of the lumenal and ablumenal surfaces of the annulus section 104. As is shown in FIG. 1, in one example the entirety of the valve assembly 140, including the leaflet commissures, is positioned in the annulus section 104 of the stent 102. When opened, the leaflets may extend further into the transition region 141 or may be designed such that they remain substantially completely within the annulus region 104. In this embodiment, substantially the entirety of the valve assembly 140 is positioned between the proximal end 130 of stent 102 and the commissure points 116, and none of the valve assembly is positioned between the commissure points 116 and the distal end 132 of the stent 102.
In operation, the embodiments of the prosthetic heart valve 100 described above may be used to replace a native heart valve, such as the aortic valve, a surgical heart valve, or a heart valve that has undergone a surgical procedure. The prosthetic heart valve 100 may be delivered to the desired site (e.g., near a native aortic annulus) using any suitable delivery device. During delivery, the prosthetic heart valve 100 is disposed inside the delivery device in the collapsed condition. The delivery device may be introduced into a patient using any known procedures, such as a transfemoral, transapical, or transseptal approach. Once the delivery device has reached the target site, the user may deploy the prosthetic heart valve 100. Upon deployment, the prosthetic heart valve 100 expands into secure engagement within the native aortic annulus. When the prosthetic heart valve 100 is properly positioned inside the heart, it works as a one-way valve, allowing blood to flow in one direction and preventing blood from flowing in the opposite direction.
FIG. 2 is a highly schematic cross-sectional illustration of the prosthetic heart valve 100 having leaflets 108 disposed within the native valve annulus 250, taken along line 2-2 shown in FIG. 1. As seen in FIG. 2, the substantially circular annulus section 104 of the stent 102 is disposed within a non-circular native valve annulus 250. At certain locations around the perimeter of the prosthetic heart valve 100, gaps 200 form between the heart valve 100 and the native valve annulus 250. Blood flowing through these gaps and around the valve assembly 140 of the prosthetic heart valve 100 can result in PV leak or regurgitation and other inefficiencies which can reduce cardiac performance. Such improper fitment may be due to suboptimal native valve annulus geometry due, for example, to calcification of the native valve annulus 250 or due to unresected native leaflets.
FIG. 3A illustrates a heart valve 300 according to one embodiment of the disclosure intended to reduce the likelihood and severity of PV leak between the heart valve and a native valve annulus. Heart valve 300 may have a stent 302 which extends between inflow end 330 and outflow end 332, a valve assembly 340 having a plurality of leaflets 308, and a cuff 306. Heart valve 300 may be formed of any of the materials and in any of the configurations described above with reference to FIG. 1.
The stent 302 may be wholly or partly formed of any biocompatible material, such as metals, synthetic polymers, or biopolymers capable of functioning as a stent. Suitable biopolymers include, but are not limited to, elastin, and mixtures or composites thereof. Suitable metals include, but are not limited to, titanium, nickel, stainless steel, and alloys thereof, including nitinol. Other metals that have elastic and/or memory properties may also be suitable, such as spring stainless steel, trade named alloys such as Elgiloy®, and Hastelloy®, CoCrNi alloys (e.g., trade name Phynox), MP35N®, CoCrMo alloys, mixtures of such alloys or mixtures of metal and polymer fibers. Suitable synthetic polymers for use as a stent include, but are not limited to, thermoplastics, such as polyolefins, polyesters, polyamides, polysulfones, acrylics, polyacrylonitriles, polyetheretherketone (PEEK), and polyaramides. Furthermore, the stent 302 need not be cylindrically shaped. For example, stent 302 may take the shape of an ellipse or other shapes, such as a general “D” shape with a substantially straight section and an arcuate section extending from one end of the straight section to the other. Such a “D” shape may better conform to particular anatomies, such as the mitral valve, the tricuspid valve, or a diseased bicuspid valve. Other portions of the valve, such as the sealing ring 350, described in greater detail below, may take similar shapes, for example depending on the stent 302 on which they are positioned.
The valve assembly 340 may be wholly or partly formed of any suitable biological material or polymer. Examples of biological materials suitable for the valve assembly 340 include, but are not limited to, porcine or bovine pericardial tissue. Examples of polymers suitable for the valve assembly 340 include, but are not limited to, polyurethane, silicone, PTFE, and polyester. In at least some examples, portions of valve assembly 340, a cuff and the suture used may include an ultra-high molecular weight polyethylene. An example of one such valve assembly 340 is disclosed in U.S. Patent Publication No. 2010/0185277, the entire contents of which are hereby incorporated by reference herein. Although valve assembly 340 typically includes one or more leaflets, other suitable valve assemblies without leaflets that work as one-way valves may be alternately used.
Similar to cuff 106, cuff 306 may be disposed on the lumenal side of stent 302, the ablumenal side of stent 302, or both. Both the cuff 306 and the leaflets 308 may be wholly or partly formed of any suitable biological material or polymer, including those, such as PTFE, described above in connection with the prosthetic heart valve 300. Additionally, the cuff 306 may be formed from polyurethane copolymers or include ultra-high molecular weight polyethylene.
It should be noted that while the disclosure herein is predominately discussed in terms of a tricuspid valve, i.e., a valve having three distinct mutually coapting leaflets, and a stent having a shape as illustrated in FIG. 3A, the valve and stent may take other forms. For example, the valve could be a bicuspid valve, i.e., a valve having two coapting leaflets, or other types of valves, including valves with greater or fewer leaflets as well as non-leaflet valves. Similarly, the stent could have different shapes, such as a flared or conical annulus section, a more or less bulbous aortic section, a differently shaped transition section between the aortic section and the annulus section, any other suitable shape, and may or may not be collapsible.
Heart valve 300 may include a sealing element, such as sealing ring 350, at or near inflow end 330 of stent 302 to help mitigate PV leak, as illustrated in FIG. 3A. FIG. 3B illustrates an enlarged cross-sectional view of sealing ring 350 taken along a cutting plane P transverse to the circumferential direction of sealing ring 350. Generally, sealing ring 350 may comprise tube 400 with or without a covering 500, with optional outer filler 610 between the covering 500 and the tube 400, and with optional inner filler 620 inside the tube 400. Unless stated otherwise, the term filler, as used herein, refers to the outer filler 610 and/or the inner filler 620. Sealing ring 350 may include any combination of tube 400, covering 500, and filler. If outer filler 610 is used, covering 500 may be required to contain outer filler 610 within sealing ring 350. Prior to describing sealing ring 350 in greater detail, the function of sealing ring 350 is briefly explained.
FIGS. 3C-D illustrate heart valve 300 disposed within a native valve annulus 250 adjacent unresected native leaflets 203 and adjacent resected leaflets, respectively. When implanted within native valve annulus 250, sealing ring 350 may be disposed, for example, below the native valve annulus 250 (i.e., in a sub-annular position) or below native leaflets 203 (i.e., in a sub-leaflet position). As shown in FIG. 3C, sealing ring 350 is disposed such that it is in contact with the left ventricular outflow tract (“LVOT”) 204, although it may be disposed within the native annulus 250, or at the juncture between native annulus 250 and LVOT 204. Such positioning helps to provide a seal between heart valve 300 and the native heart tissue. For example, as illustrated in FIG. 3D, despite gaps 200 between heart valve 300 and native valve annulus 250, sealing ring 350 helps prevent retrograde blood flow around the outer circumference of valve 300. Sealing ring 350 may additionally help prevent heart valve 300 from migrating into the aorta when implanted at the native aortic valve annulus. It should be noted that the sealing ring 350 may be flexible such that it conforms to the geometry in which it is positioned. For example, sealing ring 350 may conform to the LVOT 204, native annulus 250, or any other structure to a greater degree than illustrated in FIG. 3C. Also, as should be understood, sealing ring 350 may be positioned below the native annulus 250, at the native annulus 250, above the native annulus 250, or any combination thereof, for example being in contact with the native annulus 250 and extending slightly below the native annulus 250 as well.
As noted above, sealing ring 350 may include elements such as tube 400, covering 500, and filler material. Generally, tube 400 may provide a structural support onto which covering 500 may be attached and into which outer filler 610 or inner filler 620 may be inserted. Tube 400 alone may provide sealing of prosthetic valve 300, although such sealing may be enhanced with the addition of covering 500 and/or filler.
While the intent of sealing ring 350 is to mitigate and/or prevent PV leak, there is generally a correlation between the amount of material forming valve 300 and the size of the valve when crimped to a collapsed condition. When using a collapsible and expandable prosthetic valve, such as valve 300, the valve 300 is generally crimped into a collapsed condition for loading within a sheath of a delivery device that is delivered through the body, such as through the vasculature, to the site of implantation. As such, a large crimp profile for valve 300 generally requires the delivery device to incorporate a correspondingly large diameter sheath. As used herein, the term “crimp profile” generally refers to the largest diameter of a prosthetic valve when it is in a collapsed condition. A large diameter delivery system may be incapable of being passed through the patient's vasculature, while a delivery system having a smaller diameter and housing a heart valve with a smaller crimp profile may be easier to navigate through the patient's body and may also reduce the operation time.
As illustrated in FIGS. 3A, 3C, and 3D, sealing ring 350 may be attached to inflow end 330 of valve 300. In particular, sealing ring 350 may be positioned such that it does not overlap in the axial direction, or only minimally overlaps, the region of the valve having prosthetic leaflets 308 when the prosthetic heart valve 300 is in the collapsed condition. In particular, the sealing ring 350 may be axially offset from the belly regions of the prosthetic leaflets 308. There may also be little or no axial overlap when the prosthetic heart valve 300 is in the expanded condition, as shown in FIGS. 3A, 3C and 3D. As used herein, “axial overlap” refers to portions of two structures being within the same radial line extending perpendicularly from the lengthwise direction L. With this configuration, when prosthetic valve 300 is crimped into a collapsed condition, such as for loading onto a delivery device, there is little or no axial overlap between sealing ring 350 and the region of valve 300 at which prosthetic leaflets 308 are positioned. As a result, valve 300 may have a smaller crimp profile compared to another prosthetic valve having the same sealing ring located closer toward the region at which prosthetic leaflets 308 are positioned.
In one example, sealing ring 350 is positioned such that approximately half of the sealing ring is positioned above (i.e. circumferentially overlapping) the stent 302 at its inflow end 330 and approximately half of the sealing ring is positioned below (i.e. not circumferentially overlapping) the stent at its inflow end when valve 300 is in the expanded condition. In another example, sealing ring 350 may be nearly completely positioned below the stent 302 at its inflow end 330 when valve 300 is in the expanded condition. In a further example, the proximalmost end of the sealing ring 350 may substantially align with the proximal most portion of the inflow end 330 of the stent 302 when valve 300 is in the expanded condition. When used herein in the context of a prosthetic heart valve, the term proximal refers to a direction closer to the inflow end of the valve, while the term distal refers to a direction closer to the outflow end of the valve.
In addition to the positioning of sealing ring 350 with respect to other components of valve 300, the material and structure of the components of sealing ring 350 may have an effect on the effectiveness of mitigating PV leak while maintaining a relatively small crimp profile.
Tube 400 of sealing ring 350 may be formed of various materials. In addition, the material forming tube 400 may have one or more of a variety of structures. For example, the material of tube 400 may be individual strands braided into a generally tubular mesh structure, or may be an individual strand formed into a coil. For a braided tube 400, the strands forming the braid may have a particular relative orientation with respect to one another (e.g., a helical braid).
Covering 500 may be formed of one or more materials having low permeability or no permeability to water and/or blood. For example, covering 500 may be formed of tissue, including but not limited to pericardium or other sheet-like tissue obtained from animals or by tissue engineering. The covering 500 may be formed of a fabric-type material, such as a fabric formed of polytetrafluoroethylene (PTFE), polyethylene terephthalate (PET), or ultra-high molecular weight polyethylene (UHMWPE). The covering 500 may also be formed of synthetic or natural polymers, such as silicones, polyvinyl alcohol (PVA), or collagen sheets. The covering 500 may be formed of any one or any combination of the above-listed materials.
The filler may be formed of any of a variety of materials. For example, the filler may be composed of the same material described in connection with tube 400, such as a coil or mesh braid formed of Nitinol. The filler may also be composed of any material described in connection with covering 500, such as fabrics, tissues, and synthetic or natural polymers. Furthermore, the filler may be composed of a water swellable material, such natural sea sponge or beads, or other materials that expand upon exposure to body conditions. This may include, for example, PVA microspheres that expand upon contact with blood. Other materials that expand after exposure to temperatures found in the body or components of the blood may also be suitable for the filler. Another potential material for filler is a highly compressible sponge, for example one made from alginate cross-linked at low temperatures. Such a highly compressible sponge may collapse to a large extent when shear forces are applied, while being able to return to an original shape upon removal of the forces. Such a property may contribute to a smaller valve crimp profile while retaining the ability to “spring back” to an original shape upon deployment of the valve. Further, a single filler composed of a single material or a combination of materials described above may be used, or multiple fillers each composed of one or a combination of any of the above materials may be used.
In one embodiment, prosthetic valve 300 may include sealing ring 350 that includes tube 400 formed of braided mesh of a shape-memory material, of a super-elastic material, of a bio-compatible polymer, or of another material that is capable of being collapsed and expanded into a desired shapes. Generally, tube 400 takes the shape of a hollow annulus wrapped around a portion of stent 302, such that tube 400 generally forms a hollow torus. It should be understood that tube 400 need not meet the precise mathematical definition of a torus or other toroid. Tube 400 may comprise a braided metal fabric that is both resilient and capable of heat treatment to substantially set a desired shape, such as Nitinol, or any other metal suitable for use of stent 302 described above. However, it should be understood that other materials, such as braided polymers, including polypropylene, may be used for the braided mesh version of tube 400. Depending on the individual material selected, the strand diameter, number of strands, and pitch may be altered to achieve the desired properties for tube 400. If sealing ring 400 comprises only braided mesh, the braided tube 400 may help in reducing PV leak, for example by creating a seal as blood clots form in the braid. PV leak may be further mitigated to the extent tissue in-growth occurs on the sealing ring 350, such as by endothelialization and/or epithelialization. Such sealing by clotting and/or thrombus formation may take up to an hour or more to form, with tissue in-growth occurring over a longer time. However, faster sealing may be a desirable result. For example, faster sealing may provide a physician with immediate or near immediate feedback that PV leak is not occurring at unacceptable levels, regardless of the fact that PV leak may be appropriately mitigated given the amount of time required for clotting in the braided tube 400. As is described in greater detail below, a covering 500 and/or filler may be used in combination with a braided tube 400 (or a coiled tube 400 as described below) to accelerate sealing and enhance tissue in-growth.
One of the advantages of using braided Nitinol for tube 400 is that the structure relatively easily undergoes a transition into different shapes. For example, it may be easily collapsible for delivery, easily expandable upon implantation, and may change shape as appropriate to fill in gaps 200 in native annulus 250. However, as noted above, it may be desirable to add a covering 500 and/or filler if tube 400 is formed of braided mesh. The addition of such material may change the way the braided mesh changes shapes. For example, if the braid is covered tightly with a covering 500, the braid may not behave the same as it would without such a covering. One possible solution to this challenge is the choice of material for covering 500 and/or filler material, as well as the way the covering 500 is attached to tube 400, which is described in greater detail below. Another possible solution is to use a different structure for tube 400.
Instead of forming tube 400 of a braided mesh, it may be desirable to form tube 400 from a coiled material, such as coiled Nitinol (or any other material suitable for use in forming stent 302). In particular, tube 400 may be formed of a single strand of material, or single stands of material attached end-to-end, coiled into a desired shape. For example, tube 400 may be formed of a strand of Nitinol coiled into a circular shape, a rectangular shape, or a diamond shape. The strand of material forming the coil may have various cross-sectional shapes, such as round, flat (e.g. a ribbon), or rectangular. Still further, the coiled wire may take the form of a coil, multiple wires wound together in different directions (e.g., a braid), two or more wires wound together in the same direction (e.g., two wires wound as a double helix). The coiled wire may be later cut from a tube and may have varying diameters along the length of the coil. In addition, the coil need not be a closed coil, but may be an open coil having, for example, a “U” or “C” shape.
Generally, tube 400 may have different qualities when formed from a coil compared to a braided mesh. For example, a tube 400 formed from a coil may collapse to a smaller profile than a similar tube formed of a braided mesh. On the other hand, if sealing ring 350 is formed solely of tube 400 comprising a coil, sealing via clotting may be slower or may never occur at all compared to the braided mesh version. But when a covering 500 and/or filler is included with a tube 400 formed of a coil, the sealing ring 350 may seal against PV leak rapidly. However, it should be clear that a covering 500 and/or filler may similarly be used in conjunction with a braided mesh version of tube 400.
As noted above, when tube 400 is formed of a coil, the coil may take different general shapes, such as that of a circle (not illustrated), of a rectangle (FIG. 4A), or a diamond (FIG. 4B). The coils shown in FIG. 4A-B are viewed along the same cutting plane P shown in FIG. 3B. As such, multiple turns or iterations of each coil shape are visible in FIGS. 4A-B. Stated more precisely, the shape of the coil is a rectangle (FIG. 4A) or a diamond (FIG. 4B) when an individual turn of the coiled wire is projected onto a plane. The use of a rectangular coil 410 or diamond coil 420 for tube 400 may have an advantage in that the respective coils are more readily collapsible than, for example, a circular coil or braided mesh. In particular, the corners 415 of rectangular coil 410 and the peaks 425 of diamond coil 420 facilitate the respective coils collapsing during loading, delivery, and/or resheathing of valve 400. Benefits of the tube 400 being readily collapsible may include a reduced overall delivery profile, as well the requirement of relatively little force to load and/or resheath prosthetic valve 300 prior to being fully released in the native annulus 250. It should be noted that rectangular coil 410 is shown in FIG. 4A (and diamond coil 420 in FIG. 4B) not in the form of tube 400, but rather a segment thereof. In stent 300, rectangular coil 410 or diamond coil 420 would extend along a circumferential path around inflow end 330 of valve 300, forming tube 400. As should be clear from the above, the term “tube” does not solely refer to an elongated cylindrical structure, as the rectangular coil 410 and diamond coil 420 extended circumferentially around stent 300 is still considered herein as a tube 400. In fact, although shown throughout this disclosure as a torus, the tube 400 need not be a toroid at all. For example, tube 400 of sealing ring may undulate such that points on the proximal (or distal) surface do not lie in the same plane as other points on the proximal (or distal) surface. As such sealing ring 350 may have an undulating quality as well.
Varying the geometry of the shape of the coil may provide for different effects in terms of profile and sealing. For example, when using a diamond coil 420, the lengths of the major axis XMAJOR and minor axis XMINOR may be, respectively, approximately 3 mm by approximately 2 mm, approximately 4 mm by approximately 2 mm, or approximately 4 mm by approximately 3 mm. The lengths of the major and minor axes should be understood to be examples, and not requirements. The examples given above may be useful for achieving a bulge in the sealing ring 350 of approximately 2-3 mm from the outer circumference of the stent 302, which may be particularly effective at reducing PV leak. Further, as noted above, wires having cross-sections other than circular, including flat and/or rectangular, may be used to form coil tube 400. Generally, the goal is to decrease the collapsed profile of the valve 300 including sealing ring 350, while retaining enough strength within the sealing ring 350 to push or abut against the native valve annulus 250 to eliminate or reduce any gaps 200 between the native valve annulus 250 and the prosthetic valve 300. While the thickness of the coil forming tube 400 may vary in size, particularly depending upon the shape of the coil, one exemplary range of thicknesses is between approximately 0.05 mm and approximately 0.175 mm. The term thickness in the context of a coiled wire refers to a cross-sectional dimension of the wire. For example, a coil having a circular cross-section has a thickness equal to the diameter of the cross-section. It should be noted that the above dimensions provided in relation to components of tube 400, as well as any other dimensions provided herein, are for illustrative purposes. Varying dimensions may be used without departing from the scope of this disclosure.
Other features of the braids and/or coiled wires forming tube 400 may be modified and optimized to achieve a better seal against PV leak, including, for example, the wire or braid density, shape, and stiffness. Also, when tube 400 is formed of a coiled wire, the ratio of thickness of the coil to the spacing between adjacent iterative shapes of the coil (i.e., pitch) may have an effect on PV leak sealing. For example, a relatively large pitch may lead to kinking or tenting (i.e., a deviation from a smooth circumference) in the tube 400, which may reduce the effectiveness of sealing against PV leak. In some embodiments, it may be preferable that the ratio of coil thickness to the pitch is between approximately 1:6 and approximately 1:32.
As noted above, when tube 400 is formed of a coiled material, rather than a braided mesh, it may be advantageous to include a covering 500 that at least partially surrounds tube 400. It may also be advantageous to include a filler material inside and/or outside the tube 400. However, it should be understood that a covering 500 and filler may be used regardless of whether tube 400 is formed of a coil or a braided mesh. For example, if tube 400 is formed of either a metallic coil or a metallic braided mesh, a covering 500 may be desired to reduce the likelihood and/or severity of abrasion from metal-on-metal contact between tube 400 and stent 302.
FIGS. 5A-F are highly schematic cross-sectional drawings of an inflow portion 330 of valve 300 with a sealing ring 350 taken along the same cutting plane P illustrated in FIG. 3B. In these embodiments, sealing ring 350 comprises tube 400 and covering 500. In particular, tube 400 may take any form described above, such as a braided mesh or coil. The addition of covering 500 to tube 400, in particular a covering 500 with low or no permeability to water and/or blood, may facilitate creating a better seal between sealing ring 350 and the native valve annulus 250. In addition to physically blocking blood from flowing past the sealing ring 350, covering 500 may accelerate clotting within sealing ring 350 to the extent clotting occurs, and may further facilitate tissue ingrowth to create a better seal over time. Although some materials may have greater porosity than others, and thus greater permeability to water, those materials may be advantageous if, for example, they have relatively small thickness, relatively good tissue ingrowth, or other properties that help reduce the crimp profile of sealing ring 350 with valve 300.
Each embodiment of sealing ring 350 shown in FIGS. 5A-5F includes tube 400, covering 500, and one or more connections 510 connecting covering 500 to tube 400 and/or the stent 302 of valve 300. It should be noted that although connections 510 are described as being connected to the stent 302, connections may alternatively be connected to other portions of the prosthetic heart valve 300, such as the cuff 306, in addition or alternatively to the stent 302. Connections may be, for example, sutures or other strand-like material. Various stitch patterns, such as running stitches and whip stitches, may be used for connections 510. It should further be noted that, although tube 400 is generally described as being connected to valve 300 with stitching and/or sutures, other methods of connection, including welding, adhesives, etc. may be suitable in addition or in the alternative to stitching.
In FIG. 5A, one edge of covering 500 is stitched to stent 302, tube 400 is stitched to stent 302, and covering 500 does not surround the entire cross-section of tube 400. In FIG. 5B, one stitch 510 connects a first edge of covering 500 to stent 302, another stitch 510 connects the other edge of covering 500 to tube 400, and covering 500 does not surround the entire cross-section of tube 400. In FIG. 5C, one edge of covering 500 is connected to both stent 302 and tube 400 by a single stitch 510, and the covering 500 does not surround the entire cross-section of tube 400. In FIG. 5D, one edge of covering 500 is connected to both stent 302 and tube 400 with a first stitch 510, the other edge of covering 500 is connected to tube 400 with a second stitch 510, and the covering 500 does not cover the entire cross-section of tube 400. In FIG. 5E, covering 500 surrounds the entire cross-section of tube 400, and one stitch 510 connects each edge of covering 500 to stent 302. In FIG. 5F, covering 500 surrounds the entire cross-section of tube 400 and one stitch 510 connects each edge of covering 500 to both stent 302 and tube 400.
In each of the embodiments described in connection with FIGS. 5A-F, a number of stitches 510 may be used to connect covering 500 to tube 400 and/or stent 302 along the circumference of the inflow end 330 of the stent 302. It should be noted that there may be a benefit of using few or no sutures attaching covering 500 directly to tube 400. For example, particularly when tube 400 comprises braided Nitinol, tight and/or frequent stitches 510 connecting covering 500 directly to tube 400 may reduce the ability of tube 400 to predictably undergo a transition in shape to fill gaps 200 in native valve annulus 250. Additionally, allowing little or no slack between tube 400 and covering 500 may restrict the ability of tube 400 to change shape appropriately to fill in any gaps 200 between native valve annulus 250 and prosthetic valve 300. For example, the configurations illustrated in FIGS. 5A-D leave a proximal end of tube 400 exposed. If tube 400 is comprised of a wire coiled in a diamond shape 425, during expansion (or during collapsing), the diamond shape may grow in a lengthwise dimension as the peaks 425 of the minor axis XMINOR come together and the peaks 425 of the major axis XMAJOR move apart. The exposed proximal end of tube 400 may facilitate such change in shape. It should further be noted that, particularly in embodiments in which both edges of covering 500 are connected to the stent 302 and/or tube 400, the position of the covering 500 with respect to the tube 400 may be reversed. Taking the embodiment illustrated in FIG. 5D as an example, the covering 500 may be positioned to surround the proximal end of tube 400 leaving the distal end of tube 400 exposed. If the covering 500 takes this reverse position, it may be desirable to connect the covering to the valve 300 in a way to reduce the possibility of the covering 500 sliding with respect to the connection point, for example because of the force of gravity. Such connection may be made, for example, by attaching the covering 500 to an eyelet, groove, or other structure on stent 302, where the possibility of such sliding motion is limited. This reverse orientation may be applicable to remaining embodiments described below.
As should be clear from the above description, covering 500 need not surround the entire cross-section of tube 400, and may cover only the portion facing the direction of retrograde blood flow when implanted in an intended position. As illustrated in FIGS. 5A-F, this surface of tube 400 is oriented on the proximal end of tube 400, facing away from inflow end 330. Using a partial covering 500 may reduce the amount of material, and thus reduce the bulk and profile of valve 300 when in the collapsed condition, while covering 500 still is in contact with any retrograde blood flow contacting sealing ring 350. Covering 500 may still contact any retrograde blood flow contacting sealing ring 350 if oriented on the distal end of tube 400. Similarly, the greater the number of stitches 510 used, both in terms of the points of connection of covering 500 to tube 400 and stent 302, as well as the frequency of those stitches along the length of the circumference of stent 302, may effect the crimp profile of valve 300. Generally, as more stitches 510 are used, the crimp profile of valve 300 increases and the covering 500 is more tightly attached to tube 400. Although not described above, other combinations of stitch locations and configurations of covering 500 with respect to tube 400 and stent 302 may be suitable.
FIGS. 6A-0 are highly schematic cross-sectional drawings of an inflow portion 330 of valve 300 with a sealing ring 350 taken along the same cutting plane P as shown in FIG. 3B. In these embodiments, sealing ring 350 comprises tube 400 and filler, with some embodiments also including covering 500. In particular, tube 400 may take any form described above, such as a braided mesh or coil. Covering 500, if used, may take any suitable form, such as those described above. The filler may be positioned completely or substantially within tube 400 (inner filler 620), between tube 400 and covering 500 (outer filler 610, if covering 500 is present), or both. The filler may help accelerate sealing against PV leak, for example by reducing clotting time, particularly if covering 500 is permeable to water. As described above in connection with FIGS. 5A-F, a variety of stitches 510 and configurations of covering 500 may be used for sealing ring 350. It should be noted that if the filler takes the form of a metal or other abrasive material, a buffer material (such as fabric) may be appropriate to include to reduce the possibility that the filler will the tube 400 will fret against one another.
Each embodiment of sealing ring 350 shown in FIGS. 6A-6D includes tube 400, covering 500, outer filler 610, and one or more connections 510 connecting covering 500 and/or outer filler 610 to tube 400 and/or the stent 302 of valve 300. Outer filler 610 refers to filler that is positioned between tube 400 and covering 500. In FIG. 6A, covering 500 surrounds the entire cross-section of tube 400 and one stitch 510 connects each edge of covering 500 to the stent 302. Outer filler 610 is positioned between tube 400 and covering 500 and surrounds the cross-section of tube 400. In FIG. 6B, covering 500 surrounds the entire cross-section of tube 400, and one stitch 510 connects each edge of covering 500 to stent 302 and tube 400. Outer filler 610 is positioned between tube 400 and covering 500 and surrounds the cross-section of tube 400. In FIG. 6C, one edge of covering 500 is connected to both stent 302 and tube 400 with a first stitch 510, the other edge of covering 500 is connected to tube 400 with a second stitch 510, and the covering 500 does not cover the entire cross-section of tube 400. Similarly, the outer filler 610 is positioned between tune 400 and covering 500 and does not surround the entire cross-section of tube 400. In FIG. 6D, one stitch 510 connects a first edge of covering 500 to stent 302, another stitch 510 connects the other edge of covering 500 to tube 400, and covering 500 does not surround the entire cross-section of tube 400. Similarly, outer filler 610 is positioned between tube 400 and covering 500 and does not surround the entire cross-section of tube 400.
FIGS. 6E-H correspond to FIGS. 6A-D, respectively, with the exception that in addition to an outer filler 610, the sealing rings 350 of FIGS. 6E-H include an inner filler 620. Inner filler 620 refers to filler that is positioned substantially or completely within tube 400. Otherwise, the patterns of covering 500 and stitches 510 are identical between FIGS. 6A-D and 6E-H, respectively.
FIGS. 6I-L correspond to FIGS. 6E-H, respectively, with the exception that outer filler 610 is absent and only inner filler 620 is present. Otherwise, the patterns of covering 500 and stitches 510 are identical between FIGS. 6E-H and 6I-L, respectively.
In FIG. 6M, one edge of covering 500 is stitched to stent 302, and covering 500 does not surround the entire cross-section of tube 400. Inner filler 620 is positioned within tube 400. This generally corresponds to sealing ring 350 of FIG. 5A with an inner filler 620. In FIG. 6N, one edge of covering 500 is connected to both stent 302 and tube 400 by a single stitch 510, and the covering 500 does not surround the entire cross-section of tube 400. Inner filler 620 is positioned within tube 400. This generally corresponds to sealing ring 350 of FIG. 5C with an inner filler 620. In FIG. 6O, covering 500 is absent and a single stitch 510 attaches tube 400 to stent 300, with inner filler 620 positioned within tube 400. In this embodiment, it is important that inner filler 620 and tube 400 be chosen such that inner filler 620 cannot escape tube 400.
As described in connection with sealing rings 350 illustrated in FIGS. 5A-F, any covering 500 used in connection with filler may surround the entire cross-section of tube 400 or only a portion thereof. The same is true of outer filler 610. Further, as described above with reference to FIGS. 5A-F, the orientation of covering 500 may be reversed so that the covering 500 covers only a distal portion of tube 400. In embodiments in which covering 500 has this reverse orientation, outer filler 610 may also have a similar reverse orientation.
As described above the tube 400 may not change shapes as expected if covering 500 is tightly wrapped around and connected to tube 400. This may be particularly true of a tube 400 formed of a braided mesh. One way of mitigating this potential problem is, as described above, reducing or eliminating the number of stitches 500 directly connecting covering 500 to tube 400. However, another solution is the use of tacking stitching 520 or expandable stitching 530. Tacking stitching 520, illustrated in FIGS. 7A-P, generally refers to the use of intermittent stitching along the circumference of stent 302 holding the stitched material loosely in place. Expandable stitching 530, illustrated in FIGS. 8A-P, generally refers to stitching that allows for seam expansion. Expandable stitching 530 may be accomplished, for example, with the use of a very loose stitch or with a stitch sewn with an elastic material, such as thread formed from silicone.
For example, FIGS. 7A-D illustrate sealing ring 350 with covering 500 attached at a first edge to stent 302 with a first stitch 510 and at a second edge to tube 500 with a tacking stitch 520, represented in the figures by a line with a cross through the line. The covering 500 does not fully cover the cross-section of tube 400, nor does the outer filler 610, where present. FIGS. 7A-D illustrate embodiments of sealing ring 350 with no filler (FIG. 7A), outer filler 610 (FIG. 7B), outer filler 610 and inner filler 620 (FIG. 7C), and inner filler 620 (FIG. 7D).
FIGS. 7E-H illustrate sealing ring 350 with covering 500 attached at a first edge to stent 302 with a stitch 510 and at a second edge to stent 302 with a tacking stitch 520. The covering 500 fully covers the cross-section of tube 400, as does the outer filler 610, where present. FIGS. 7E-H illustrate embodiments of sealing ring 350 with no filler (FIG. 7E), outer filler 610 (FIG. 7F), outer filler 610 and inner filler 620 (FIG. 7G), and inner filler 620 (FIG. 7H).
FIGS. 7I-L illustrate sealing ring 350 with covering 500 attached at a first edge to stent 302 and tube 400 with a stitch 510 and at a second edge to tube 400 with a tacking stitch 520. The covering 500 does not fully cover the cross-section of the tube 400, nor does the outer filler 610, where present. FIGS. 7I-L illustrate embodiments of sealing ring 350 with no filler (FIG. 7I), outer filler 610 (FIG. 7J), outer filler 610 and inner filler 620 (FIG. 7K), and inner filler 620 (FIG. 7L).
FIGS. 7M-P illustrate sealing ring 350 with covering 500 attached to stent 302 and tube 400 with a stitch 500, with both edges of covering 500 attached to one another and tube 400 with a tacking stitch 520. The covering 500 fully covers the cross-section of the tube 400, as does the outer filler 610, where present. FIGS. 7M-P illustrate embodiments of sealing ring 350 with no filler (FIG. 7M), outer filler 610 (FIG. 7N), outer filler 610 and inner filler 620 (FIG. 7O), and inner filler 620 (FIG. 7P).
FIGS. 8A-8P illustrate embodiments of sealing ring 350 using an expandable stitch 530. FIGS. 8A-D illustrate sealing ring 350 with covering 500 attached at a first edge to stent 302 with a stitch 510 and at a second edge to tube 500 with an expandable stitch 530, represented in the figures by a line with a zigzag pattern along the line. The covering 500 does not fully cover the cross-section of tube 400, nor does the outer filler 610, where present. FIGS. 8A-D illustrate embodiments of sealing ring 350 with no filler (FIG. 8A), outer filler 610 (FIG. 8B), outer filler 610 and inner filler 620 (FIG. 8C), and inner filler 620 (FIG. 8D).
FIGS. 8E-H illustrate sealing ring 350 with covering 500 with an expandable stitch 530 attaching both edges of the covering 500 to one another and the stent 302. The covering 500 fully covers the cross-section of tube 400, as does the outer filler 610, where present. FIGS. 8E-H illustrate embodiments of sealing ring 350 with no filler (FIG. 8E), outer filler 610 (FIG. 8F), outer filler 610 and inner filler 620 (FIG. 8G), and inner filler 620 (FIG. 8H).
FIGS. 8I-L illustrate sealing ring 350 with covering 500 attached at a first edge to stent 302 and tube 400 with a stitch 510 and at a second edge to tube 400 with an expandable stitch 530. The covering 500 does not fully cover the cross-section of the tube 400, nor does the outer filler 610, where present. FIGS. 8I-L illustrate embodiments of sealing ring 350 with no filler (FIG. 8I), outer filler 610 (FIG. 8J), outer filler 610 and inner filler 620 (FIG. 8K), and inner filler 620 (FIG. 8L).
FIGS. 8M-P illustrate sealing ring 350 with covering 500 attached to stent 302 and tube 400 with a stitch 500, with both edges of covering 500 attached to one another and tube 400 with an expandable stitch 530. The covering 500 fully covers the cross-section of the tube 400, as does the outer filler 610, where present. FIGS. 8M-P illustrate embodiments of sealing ring 350 with no filler (FIG. 8M), outer filler 610 (FIG. 8N), outer filler 610 and inner filler 620 (FIG. 8O), and inner filler 620 (FIG. 8P).
FIGS. 9A-E illustrate side views of prosthetic heart valve 300 being resheathed into a delivery device (heart valve 300 only labeled in FIG. 9A). Briefly, the delivery device includes an outer sheath 700, a distal tip 710, and an inner sheath 720 (inner sheath 720 labeled only in FIG. 9A). In this embodiment, sealing ring 350 takes the form of a tube 400 formed of a Nitinol coil with a diamond shape 420. The sealing ring 350 is on the left end of the prosthetic valve 300 as illustrated. As noted above, prosthetic heart valve may be resheathable. For example, during delivery, a user may first allow prosthetic heart valve 300 to partially expand outside of outer sheath 700 to test positioning and functioning of the valve (FIG. 9A) prior to fully releasing the valve. FIGS. 7A-E illustrate different levels of resheathing, with greater resheathing progressing from FIG. 9A to FIG. 9E. As described above with respect to FIGS. 4A-B, the rectangular shape 410 or diamond shape 420 of a coiled wire forming tube 400 may allow for the tube 400 to collapse to a reduced profile during loading or resheathing the valve 300 into the delivery device. As can be seen in the illustrations, particularly from FIG. 9B to FIG. 9D, during loading or resheathing, the tube rectangular shape 410 or diamond shape 420 of the coiled wire may allow the tube 400 to fold away from the remainder of valve 300 during the process. In addition to collapsing during resheathing (or loading), the sealing ring 350, and in particular the tube 400, may pivot or rotate with respect to inflow end 330 of the valve 300. This is best illustrated in FIGS. 9D-E, in which the inflow end 330 enters the outer sheath 700 as the sealing ring 350 is forced to pivot or rotate away from the end of distal sheath 700. For example, the entirety or nearly the entirety of inflow end 330 may be positioned within outer sheath 700 prior to any of sealing ring 350 entering outer sheath 700 during a resheathing (or loading) process. As such, when fully loaded into the delivery device, the tube 400 may be completely or substantially axially offset from the remainder of prosthetic heart valve 300, including the leaflet belly B regions, reducing the crimping profile even further.
Although certain embodiments of the prosthetic heart valve described herein may provide a single feature for reducing paravalvular leakage, it should be understood that multiple similar or dissimilar features may be utilized on a single prosthetic heart valve to reduce paravalvular leak. For example, one or more sealing rings may be used on a single prosthetic heart valve, including a first sealing ring disposed proximal to (or within) the native valve annulus and a second sealing ring disposed distal the first sealing ring. In other examples, a sealing ring may be disposed proximal to (or within) the native valve annulus, and one or more pockets expandable upon retrograde blood flow may be disposed distal the sealing ring. Prosthetic heart valves with expandable pockets are described in greater detail in U.S. Patent Publication No. 2011/0098802, the disclosure of which is hereby incorporated by reference herein.
In one embodiment of the disclosure, a prosthetic heart valve comprises: a collapsible and expandable stent extending from an inflow end to an outflow end; a plurality of prosthetic valve leaflets coupled to the stent, each leaflet having a leaflet belly; and a sealing ring coupled to the inflow end of the stent, the sealing ring comprising a tube extending circumferentially around the inflow end of the stent, the sealing ring being axially offset from the leaflet belly when the stent is in a collapsed condition, wherein the tube is formed from a wire coiled into a repeating shape such that the tube is collapsible; and/or

    
    
        the wire is coiled into a rectangular shape; and/or
        the wire is coiled into a diamond shape having a major axis and a minor axis; and/or
        the major axis is approximately 3 mm and the minor axis is approximately 2 mm; and/or
        the major axis is approximately 4 mm and the minor axis is approximately 2 mm; and/or
        the major axis is approximately 4 mm and the minor axis is approximately 3 mm; and/or
        the wire has a thickness of between approximately 0.05 mm and approximately 0.175 mm; and/or
        the wire has a thickness and there is a distance between adjacent repeating shapes of the coiled wire, a ratio of the thickness to the distance being between approximately 1:6 and approximately 1:32.
    
    


In another embodiment of the disclosure, a prosthetic heart valve comprises: a collapsible and expandable stent extending from an inflow end to an outflow end; a plurality of prosthetic valve leaflets coupled to the stent, each leaflet having a leaflet belly; and a sealing ring coupled to the inflow end of the stent, the sealing ring comprising a tube extending circumferentially around the inflow end of the stent, a covering at least partially surrounding the tube, and at least one of a first filler positioned within the tube and a second filler positioned between the tube and the covering, the sealing ring being axially offset from the leaflet belly when the stent is in a collapsed condition; and/or

    
    
        the covering is formed from a material selected form the group consisting of tissues, fabrics, and polymers; and/or
        at least one of the first filler and the second filler is formed from a material selected from the group consisting of metals, tissues, fabrics, polymers, and water-swellable materials; and/or
        at least one of the first filler and the second filler is configured to expand upon exposure to blood.
    
    


In a further embodiment of the disclosure, a prosthetic heart valve comprises: a collapsible and expandable stent extending from an inflow end to an outflow end; a plurality of prosthetic valve leaflets coupled to the stent, each leaflet having a leaflet belly; and a sealing ring coupled to the inflow end of the stent, the sealing ring comprising a tube extending circumferentially around the inflow end of the stent and a covering at least partially surrounding the tube, the sealing ring being axially offset from the leaflet belly when the stent is in a collapsed condition, wherein the covering has a first edge and a second edge, the first end coupled to the stent by a first thread; and/or

    
    
        the first thread couples the first edge of the covering and the tube to the stent; and/or
        a second thread coupling the second edge of the covering to the tube; and/or
        the second thread is formed of an elastic material; and/or
        the first thread couples the second edge of the covering to the first edge of the covering and the stent; and/or
        the first thread is formed of an elastic material; and/or
        the elastic material is silicone.
    
    


Although the invention herein has been described with reference to particular embodiments, it is to be understood that these embodiments are merely illustrative of the principles and applications of the present invention. It is therefore to be understood that numerous modifications may be made to the illustrative embodiments and that other arrangements may be devised without departing from the spirit and scope of the present invention as defined by the appended claims. Such modification may include, for example, combining of certain elements of one embodiment of the disclosure with other elements of another embodiment of the disclosure.

## Claims

1. A prosthetic heart valve comprising:
a collapsible and expandable stent extending from an inflow end to an outflow end;
a plurality of prosthetic valve leaflets coupled to the stent, each leaflet having a leaflet belly; and
a sealing ring coupled stent adjacent the inflow end of the stent, the sealing ring comprising a tube extending circumferentially around the inflow end of the stent, the sealing ring being axially offset from the leaflet belly when the stent is in a collapsed condition,
wherein the tube includes a wire coiled into a repeating shape such that the tube is collapsible.

2. The prosthetic heart valve of claim 1, wherein the wire is coiled into a rectangular shape.

3. The prosthetic heart valve of claim 1, wherein the wire is coiled into a diamond shape having a major axis and a minor axis.

4. The prosthetic heart valve of claim 3, wherein the major axis is approximately 3 mm and the minor axis is approximately 2 mm.

5. The prosthetic heart valve of claim 3, wherein the major axis is approximately 4 mm and the minor axis is approximately 2 mm.

6. The prosthetic heart valve of claim 3, wherein the major axis is approximately 4 mm and the minor axis is approximately 3 mm.

7. The prosthetic heart valve of claim 1, wherein the wire has a thickness of between approximately 0.05 mm and approximately 0.175 mm.

8. The prosthetic heart valve of claim 1, wherein the wire has a thickness and there is a distance between adjacent repeating shapes of the coiled wire, a ratio of the thickness to the distance being between approximately 1:6 and approximately 1:32.

9. A prosthetic heart valve comprising:
a collapsible and expandable stent extending from an inflow end to an outflow end;
a plurality of prosthetic valve leaflets coupled to the stent, each leaflet having a leaflet belly; and
a sealing ring coupled to the inflow end of the stent, the sealing ring comprising a tube extending circumferentially around the inflow end of the stent, a covering at least partially surrounding the tube, and at least one of a first filler positioned within the tube and a second filler positioned between the tube and the covering, the sealing ring being axially offset from the leaflet belly when the stent is in a collapsed condition.

10. The prosthetic heart valve of claim 9, wherein the covering is formed from a material selected form the group consisting of tissues, fabrics, and polymers.

11. The prosthetic heart valve of claim 9, wherein at least one of the first filler and the second filler is formed from a material selected from the group consisting of metals, tissues, fabrics, polymers, and water-swellable materials.

12. The prosthetic heart valve of claim 9, wherein at least one of the first filler and the second filler is configured to expand upon exposure to blood.

13. A prosthetic heart valve comprising:
a collapsible and expandable stent extending from an inflow end to an outflow end;
a plurality of prosthetic valve leaflets coupled to the stent, each leaflet having a leaflet belly; and
a sealing ring coupled to the inflow end of the stent, the sealing ring comprising a tube extending circumferentially around the inflow end of the stent and a covering at least partially surrounding the tube, the sealing ring being axially offset from the leaflet belly when the stent is in a collapsed condition
wherein the covering has a first edge and a second edge, the first edge coupled to the stent by a first thread.

14. The prosthetic heart valve of claim 13, wherein the first thread couples the first edge of the covering and the tube to the stent.

15. The prosthetic heart valve of claim 13, further comprising a second thread coupling the second edge of the covering to the tube.

16. The prosthetic heart valve of claim 15, wherein the second thread is formed of an elastic material.

17. The prosthetic heart valve of claim 13, wherein the first thread couples the second edge of the covering to the first edge of the covering and the stent.

18. The prosthetic heart valve of claim 17, wherein the first thread is formed of an elastic material.

19. The prosthetic heart valve of claim 18, wherein the elastic material is silicone.