Abstract:
A biologically implantable prosthesis is disclosed. The prosthesis can have a circumferentially expandable wall and elements that prevent the wall from collapsing once the wall is expanded. Methods of making and using the prosthesis are also disclosed.

Description:
BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     The present invention relates generally to a device for fixturing a prosthesis to a first mass and methods of making and using the same. 
     2. Description of the Related Art 
     Prosthetic heart valves can replace defective human valves in patients. Prosthetic valves commonly include sewing rings or suture cuffs or rings that are attached to and extend around the outer circumference of the prosthetic valve orifice. 
     In a typical prosthetic valve implantation procedure, the aorta is incised and the defective valve is removed leaving the desired placement site that may include a fibrous tissue layer or annular tissue. Known heart valve replacement techniques include individually passing sutures through the fibrous tissue or desired placement site within the valve annulus to form an array of sutures. Free ends of the sutures are extended out of the thoracic cavity and laid, spaced apart, on the patient&#39;s body. The free ends of the sutures are then individually threaded through a flange of the sewing ring. Once all sutures have been run through the sewing ring (typically 12 to 18 sutures), all the sutures are pulled up taught and the prosthetic valve is slid or “parachuted” down into place adjacent the placement site tissue. The prosthetic valve is then secured in place by traditional knot tying with the sutures. This procedure is time consuming as doctors often use three to ten knots per suture. 
     The sewing ring is often made of a biocompatible fabric through which a needle and suture can pass. The prosthetic valves are typically attached to the sewing rings which are sutured to a biological mass that is left when the surgeon removes the existing valve from the patient&#39;s heart. The sutures are tied snugly, thereby securing the sewing ring to the biological mass and, in turn, the prosthetic valve to the heart. 
       FIG. 1  illustrates a valve prosthesis  2  fixed to a vessel  4  with sutures  6 . The vessel  4  has a supra-annular space  8 , an intra-annular or trans-annular space  10  and an infra-annular space  12 . The natural valve that existed in the vessel has been removed. The placement site of the valve prosthesis  2  can be in the supra-annular space  8 , an intra-annular or trans-annular space  10 . The placement site is limited to being inferior to, and therefore not blocking, openings of the coronary arteries and superior to a plane defined by the insertion of the anterior leaflet of the mitral valve and the highest portion of the intraventricular septum. In the example shown in  FIG. 1 , the valve prosthesis  2  is on the shoulder between the supra-annular and trans-annular spaces  8  and  10 . The valve prosthesis  2  has a sewing cuff or ring  14  that presses or rests against the supra-annular vessel wall. 
       FIG. 1  also illustrates two common types of suturing. On the left, the suture  6  can be fed into the vessel wall in the trans-annular or infra-annular space  10  or  12 . The trailing end of the suture  6  can be secured to a pledget  16  by a knot  18  in the suture  6  behind the pledget  16 . As illustrated in  FIG. 2 , the suture assembly consists of two curved needles  400  attached by a common length of suture  6 . A pledget  16  is typically preloaded onto the suture  6 . The pledget  16  braces the trailing end of the suture loop  6  against the vessel wall. The suture  6  then feeds through the vessel wall and exits the vessel wall in the supra-annular space  8 . The surgeon passes the suture  6  through the sewing ring  14  and ties a knot  18  behind the sewing ring  14  to secure the sewing ring  14  to the vessel wall. 
     On the right side of  FIG. 1 , the suture  6  feeds into the vessel wall in the supra-annular space  8 . The suture  6  is then attached to the pledget  16  and fed as described for the suture on the left side of  FIG. 1 . As the view of the vessel is often from the supra-annular or trans-annular space  8  or  10 , this method provides the medical professional a better view of the initial insertion of the suture  6  into the vessel wall. 
       FIG. 3  illustrates a close-up of a mattress stitch of the suture  6 . The two ends of the suture  6  feed separately through the same side of the pledget  16 . Both ends of the suture  6  then feed into the vessel wall in the trans-annular or infra-annular space  10  or  12 . The pledget  16  braces the suture  6  against the vessel wall. Both ends of the suture  6  then feed through the vessel wall and exit the vessel wall in the supra-annular space  8 . Both ends of the suture  6  then pass through the sewing ring  14 . The ends of the suture  6  are then tied to each other in the knot  18  behind the sewing ring  14 , securing the sewing ring  14  to the vessel wall. 
     During heart valve replacement procedures, the patient is on heart-lung bypass which reduces the patient&#39;s oxygen level and creates non-physiologic bloodflow dynamics. The longer a patient is on heart-lung bypass, the greater the risk for complications including permanent health damage. Existing suturing techniques extend the duration of bypass and increase the health risks due to heart-lung bypass. Furthermore, the fixturing force created by suturing varies significantly because the pre-tensioning of the suture just prior to knot tying is difficult to consistently maintain, even for the same medical professional. 
     There is a need for a fixturing device to minimize the time required to fix a valve prosthesis to a first mass, which can be the surrounding tissue or a second prosthesis. There is also a need for a fixturing device to use a technique familiar to the users of existing devices. Furthermore, there is a need for a device that complements existing suturing devices and methods and reduces fixturing times. Also, there is a need for a fixturing device that does not require visual contact with, or suture access to, the infra-annular space. There also exists a need to provide a fixturing device that can provide a consistent fixturing force. The is also a need for a technique that could reduce the duration of the bypass procedure and minimize the associated health risks. 
     BRIEF SUMMARY OF THE INVENTION 
     A heart valve device is disclosed. The heart valve device has a gasket body and a receptacle located on an outer radial side of the gasket body. The receptacle can be, for example, a fenestration (e.g., window, gap, port, hole, slot), can, wireframe, hollow channel, collet, plate, eyelet, guide blocks, slide rod, guide blocks and slide rod with inner and outer walls or wall segments, high-friction channel, passage between cams, other complementary fixturing, or complementary attachment, device or other appropriate structure or any combination thereof. The receptacle is configured to receive an attachment or fixturing device. The attachment device can be knotless and the receptacle can have a friction lock. The friction lock can employ friction and/or an interference fit to fixedly attach the receptacle to the attachment device, for example, a plug or obstacles within a the receptacle. The receptacle can have a first cam, and the first cam can be rotatably attached to the gasket body. The receptacle can be in a flange. The flange can be an integral part of the gasket body, or the receptacle can be separate from, but attached to, the gasket body. 
     The receptacle can be formed into a cylinder. The cylinder can be a crimpable cylinder. The cylinder can be fixedly attached or rotatably attached to the gasket body. The cylinder can have a sidewall port or slit. 
     An attachment device for connecting a heart valve to a first mass is also disclosed. The attachment device has a base, a first connecting protrusion, and a second connecting protrusion. The base has a first side, a second side and a bendable joint. The first connecting protrusion is fixedly attached to the first side of the base at a first attachment area. The second connecting protrusion is fixedly attached to the first side of the base at a second attachment area. 
     The first connecting protrusion can be curved. The second connecting protrusion can be curved. The bendable joint can be between the first attachment area and the second attachment area. The bendable joint can be a fold in the base. 
     Another attachment device for connecting a heart valve to a first mass is also disclosed. This attachment device has a base and a curved shaft. The base has a sphere and a base diameter. The curved shaft has a first end, a second end and a shaft diameter. The first end is sharpened, and the second end is attached to the base. The base diameter is larger than the shaft diameter. 
     A heart valve is also disclosed. The heart valve has a gasket body, a first tab, and a second tab. The gasket body has a top surface and a bottom surface. The first tab is bendably attached to the top surface. The second tab is bendably attached to the bottom surface. The first tab can be pre-deployed in a bent position. 
     Another heart valve is disclosed. This heart valve has a gasket body and a first tab. The gasket body has a top surface, a bottom surface, and a middle area between the top surface and the bottom surface. The first tab is bendably attached to the middle area. 
     Another disclosed aspect is to use the disclosed devices to secure devices previously known to one having ordinary skill in the art, such as stents, grafts, stent-grafts, heart valves, annuloplasty rings and combinations thereof. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is not the invention and illustrates a cut-away view of vessel having a heart valve ring with a sewing ring attached to a biological annulus. 
         FIG. 2  is not the invention and illustrates a pledget and suture attached to two needles. 
         FIG. 3  is not the invention and illustrates a close-up view of a section of  FIG. 1 . 
         FIGS. 4 and 5  illustrate various fixturing devices. 
         FIGS. 6 and 7  illustrate top views of various fixturing devices. 
         FIGS. 8 and 9  illustrate front views of  FIGS. 6 and 7 , respectively. 
         FIGS. 10 and 11  illustrate side views of various embodiments of the devices of  FIGS. 6-9 . 
         FIG. 12  illustrates various fenestrations on a gasket body. 
         FIG. 13  illustrates tabs on a gasket body. 
         FIG. 14  illustrates an embodiment of section A-A. 
         FIGS. 15-20  illustrate various tabs. 
         FIG. 21  illustrates tabs on a gasket body. 
         FIGS. 22-25  illustrate various complementary fixturing devices on gasket bodies. 
         FIGS. 26 and 27  illustrate sections B-B of various embodiments of gasket bodies. 
         FIGS. 28-36  illustrate various complementary fixturing devices. 
         FIG. 37  is a front view of the complementary fixturing device of  FIG. 36 . 
         FIGS. 38-42  illustrate various complementary fixturing devices. 
         FIGS. 43-45  illustrate various complementary fixturing devices with fixturing devices therein. 
         FIGS. 46-48  illustrate various directing elements. 
         FIG. 49  illustrates a complementary fixturing device. 
         FIG. 50  illustrates section C-C. 
         FIG. 51  illustrates a complementary fixturing device. 
         FIGS. 52-55  illustrate various sutures. 
         FIG. 56  illustrates complementary fixturing devices with a gasket body. 
         FIG. 57  is a top view of the gasket body of  FIG. 56  after being straightened for illustrative purposes. 
         FIG. 58  illustrates complementary fixturing devices with a gasket body. 
         FIG. 59  is a top view of the gasket body of  FIG. 58  after being straightened for illustrative purposes. 
         FIG. 60  illustrates complementary fixturing devices with a gasket body. 
         FIG. 61  is a top view of the gasket body of  FIG. 60  after being straightened for illustrative purposes. 
         FIG. 62  illustrates complementary fixturing devices with a gasket body. 
         FIGS. 63 and 64  are top views of embodiments of the gasket body of  FIG. 62  after being straightened for illustrative purposes. 
         FIGS. 65 and 66  illustrate various complementary fixturing devices with gasket bodies. 
         FIGS. 67 and 68  illustrate a complementary fixturing device in a first and a second configuration, respectively. 
         FIGS. 69 and 70  illustrate various methods of attaching a complementary fixturing device to a gasket body. 
         FIG. 71  illustrates complementary fixturing devices in or on a flattened and expanded gasket body or sheet. 
         FIG. 72  is a close-up cross-sectional view of complementary fixturing devices in a sheet attached to a gasket body. 
         FIG. 73  is a top view of a trilobular gasket body. 
         FIG. 74  is a front perspective view of a trilobular scalloped gasket body. 
         FIG. 75  illustrates assembly of a complementary fixturing device onto a gasket body. 
         FIG. 76  illustrates a mold for making a part to hold complementary fixturing devices. 
         FIG. 77  illustrates a fixturing device deployment assembly with a fixturing device. 
         FIG. 78  illustrates a method of using the fixturing device deployment assembly of  FIG. 78  with a fixturing device and a gasket body. 
         FIGS. 79 and 80  illustrate a method of using the cartridge of the fixturing device deployment assembly of  FIGS. 77 and 78 . 
         FIGS. 81-83  illustrate a method of using a fixturing device. 
         FIG. 84  illustrates a method of using two fixturing devices. 
         FIGS. 85-87  illustrate a method of using fixturing devices attached to a gasket body. 
         FIG. 88  illustrates snares loaded into complementary fixturing devices on a gasket body. 
         FIG. 89  illustrates a method of using snares loaded into complementary fixturing devices on a gasket body. 
         FIG. 90  illustrates a gasket body attached to a first mass with complementary fixturing devices. 
         FIGS. 91 and 92  illustrate various devices for and methods of crimping a complementary fixturing device. 
         FIG. 93  illustrates a device for implanting a gasket body having complementary fixturing devices. 
         FIG. 94  is a bottom view of the device of  FIG. 93 . 
         FIG. 95  illustrates a method of using the device of  FIG. 93 . 
         FIG. 96  illustrates the engagement device about to engage the complementary fixturing device. 
         FIG. 97  illustrates section D-D as the engagement device begins to engage the complementary fixturing device. 
         FIG. 98  illustrates section D-D while the engagement device is engaged with the complementary fixturing device. 
         FIG. 99  illustrates the engagement device engaged with the complementary fixturing device. 
         FIG. 100  illustrates the complementary fixturing device secured between the retention devices and the lip. 
         FIG. 101  illustrates section E-E. 
         FIG. 102  illustrates the complementary fixturing device secured between the retention devices and the lip. 
         FIG. 103  illustrates section F-F. 
         FIG. 104  illustrates the complementary fixturing device secured between two parts of the tube end. 
         FIG. 105  illustrates section G-G. 
         FIG. 106  illustrates the complementary fixturing device secured with an engagement rod to the tube. 
         FIG. 107  illustrates section H-H. 
         FIG. 108  illustrates section I-I. 
         FIG. 109  illustrates various methods of using the sutures. 
         FIG. 110  illustrates section J-J. 
         FIG. 111  illustrates an embodiment of section J-J before the plug is completely deployed. 
         FIG. 112  illustrates an embodiment of section J-J after the plug is completely deployed. 
         FIG. 113  illustrates an embodiment of section J-J before the complementary fixturing device is crushed. 
         FIG. 114  illustrates an embodiment of section J-J after the complementary fixturing device is crushed. 
         FIG. 115  illustrates the engagement device disengaging the complementary fixturing device. 
         FIG. 116  illustrates section K-K of  FIG. 115 . 
         FIG. 117  illustrates the engagement device disengaged from the complementary fixturing device. 
         FIG. 118  illustrates section L-L of  FIG. 117 . 
         FIGS. 119 and 120  illustrate a method of deploying a gasket body with complementary fixturing devices. 
         FIGS. 121 and 122  illustrate a method of using a complementary fixturing device. 
         FIG. 123  illustrates an expanded complementary fixturing device. 
         FIG. 124  illustrates a method of using the complementary fixturing device of  FIG. 33 . 
         FIG. 125  illustrates a method of using the complementary fixturing devices of  FIG. 65 . 
         FIG. 126  illustrates a method of using the complementary fixturing devices of  FIG. 21 . 
         FIG. 127  illustrates a method of using the complementary fixturing devices of  FIG. 22 . 
         FIGS. 128-130  illustrate methods of using the gasket body with multiple-piece heart valve assemblies. 
     
    
    
     DETAILED DESCRIPTION 
     Fixturing Devices 
       FIG. 4  illustrates an attachment or fixturing device  20 , for example a brad (e.g., single brad, double-brad, quadruple brad), stud, spike, staple, barb, hook or any combination thereof. The fixturing device  20  can have a base  22  and a connector, for example a connecting protrusion  24 . The base  22  can be solid and/or substantially spherical. The base  22  can have a radially expandable portion, as described in in U.S. patent application Ser. No. 10/327,821 filed 20 Dec. 2002, which is herein incorporated by reference in its entirety. The protrusion  24  can have a first end  26  and a second end  28 . The first end  26  can be fixedly attached to the base  22 . The second end  28  can be sharpened or pointed. 
     The fixturing device  20  can be used to attach a prosthesis to a first mass. The prosthesis can be, for example, stents, grafts, stent-grafts, heart valves, annuloplasty rings autografts, allografts, xenografts or any combination thereof. The first mass can be, for example, tissues such as vessels, valves, organs (e.g., intestine, heart, skin, liver, kidney) or any combination thereof. 
       FIG. 5  illustrates the fixturing device  20  having a protrusion  24  that can be curved. The protrusion  24  can have a center line  30 . The center line  30  can have a radius of curvature  32 . The base  22  can have a base diameter  34 . The base  22  can be configured to be a substantially flat square, rectangular, circular or ellipse, or a sphere, cylinder or cube. The protrusion  24  can be configured to be flat, square, or cylindrical, and can be straight, curved or angled. The protrusion  24  can have a protrusion diameter  36 . The fixturing device  20  can have a pledget  16  slidably or fixedly attached to the protrusion  24  near or against the base  22 . The pledget  16  can be fixedly or rotatably attached to the base  22 . 
     The fixturing device  20  can be made from stainless steel alloys, nickel titanium alloys (e.g., Nitinol), cobalt-chrome alloys (e.g., ELGILOY® from Elgin Specialty Metals, Elgin, Ill.; CONICHROME® from Carpenter Metals Corp., Wyomissing, Pa.), polymers such as polyester (e.g., DACRON® from E. I. Du Pont de Nemours and Company, Wilmington, Del.), polypropylene, polytetrafluoroethylene (PTFE), expanded PTFE (ePTFE), polyether ether ketone (PEEK), nylon, polyether-block co-polyamide polymers (e.g., PEBAX® from ATOFINA, Paris, France), aliphatic polyether polyurethanes (e.g., TECOFLEX® from Thermedics Polymer Products, Wilmington, Mass.), polyvinyl chloride (PVC), polyurethane, thermoplastic, fluorinated ethylene propylene (FEP), extruded collagen, silicone, radiopaque materials or combinations thereof. Examples of radiopaque materials are barium sulfate, titanium, stainless steel, nickel-titanium alloys, tantalum and gold. 
     The fixturing device  20  can have multiple connectors, for example the protrusions  24 , as illustrated in  FIGS. 6-11 . The protrusions  24  can be aligned with one another. The protrusions  24  can be deformable or non-deformable. The fixturing device  20  can have four protrusions  24 , where two protrusions  24  are on each side of a joint, for example a straight bendable fold  38  in the base  22 , a thinned and/or annealed portion of the base  22 , a mechanical hinge in the base  22  or combinations thereof. The protrusions  24  can be attached to the outer edge of the base  22 , as shown in  FIGS. 7 and 9 . The protrusions  24  of  FIGS. 7 and 9  can be cut from the same piece of material as the base  22 , and deformably folded into position. The protrusions  24  can be attached to base  22  away from the outer edge of the base  22 , as shown in  FIGS. 6 and 8 . 
     The base  22  can extend away from the fold  38  and beyond the protrusions  24  to form a retention pad  402 . An alignment hole  404  can be formed in the base  22 , for example in the middle of the base  22  along the fold  38 , to align a deployment tool or applicator assembly with the fixturing device  20 . 
       FIG. 10  illustrates protrusions  24  that can be substantially straight.  FIG. 11  illustrates protrusions  24  that can be substantially sickle or scimitar-shaped. The base  22  can have a base height  406 . The base height  406  can be from about 1.27 mm (0.050 in.) to about 12.7 mm (0.500 in.), for example about 3.18 mm (0.125 in.). 
     Prostheses 
       FIG. 12  illustrates a heart valve gasket body  40 , for example a ring, that can have various openings, receptacles or windows  42 . The windows  42  can be configured, for example, as squares, rectangles, ovals or circles. The windows  42  can all be the same shape or the windows  42  can be different shapes. The gasket body  40  can be any configuration conforming to the annulus shape of the patient, including a shape conforming to irregularities (e.g., a lobular annulus). The gasket body  40  can be, for example, circular, ovular, elliptical, bi-lobular or tri-lobular. The gasket body  40  can have any of the features of the device described in U.S. patent application Ser. No. 10/327,821 filed 20 Dec. 2002. The gasket body  40  can be made from any of the materials listed supra for the fixturing device  20  or combinations thereof. The gasket body  40  can be flexible and/or rigid. The gasket body  40  can have a gasket height  408  and a gasket diameter  410 . The gasket height  408  can be from about the length between the openings of the coronary arteries and the closest point on a plane defined by the insertion of the anterior leaflet of the mitral valve and the highest portion of the intraventricular septum to about 12.7 mm (0.500 in.), for example 5.08 mm (0.200 in.). The gasket diameter  410  can be from about 10 mm (0.39 in.) to about 50 mm (2.0 in.), more narrowly from about 30 mm (1.2 in.) to about 40 mm (1.6 in.). 
       FIG. 13  illustrates a gasket body  40  that can have a top edge or side  44  and a bottom edge or side  46 . Tines, prongs or tabs  48  can be attached to the top and/or bottom edges  44  and/or  46 . The tabs  48  can have a tab length  50 . The tab length  50  can be sufficiently sized to mechanically engage the annular tissue without damaging other organs or tissues (e.g., ventricles). 
       FIG. 14  illustrates cross-section A-A of the gasket body  40  that can have pre-deployed tabs  48  attached to the top edge  44 . The tabs  48  attached to the top edge  44  can extend substantially perpendicular from a wall  52  of the gasket body  40 . The tabs  48  attached to the top edge  44  can point radially outward and/or downward. The tabs  48  attached to the bottom edge  46  can extend substantially parallel from a wall  52  of the gasket body  40 . The tabs  48  attached to the bottom edge  46  can point straight downward or be angled radially inward or outward. 
       FIG. 15  illustrates the tab  48  that can have a rectangular configuration.  FIG. 16  illustrates the tab  48  that can have a rounded configuration.  FIG. 17  illustrates the tab  48  that can have a sharp spiked configuration.  FIG. 18  illustrates the tab  48  that can have a forked, “V”-shaped, or “Y”-shaped configuration.  FIG. 19  illustrates the tab  48  that can have pores or holes  54 .  FIG. 20  illustrates the tab  48  that can have micro-engagement devices, for example studs, spikes, hooks and/or barbs  56 . Any of the aforementioned tab configurations and elements can be used in combination. 
       FIG. 21  illustrates the gasket body  40  that can have tabs  48  between the top edge  44  and the bottom edge  46 . The tabs  48  can be substantially deformable sections of the wall  52  of the gasket body  40 . 
       FIG. 22  illustrates the gasket body  40  that can have tabs  48  with side wings  58  extending from the sides of the tabs  48 . The tabs  48  can be between the top edge  44  and the bottom edge  46  and/or the tabs  48  can be at the top edge  44 , and/or the tabs can be at the bottom edge  46 . The side wings  58  can be substantially deformable sections of the wall  52  of the gasket body  40 . Some, none or all of the tabs  48  can have receptacles or windows  42  therein, thereby enabling the tabs  48  to function as deformable receptacles or windows  42 . 
       FIG. 23  illustrates the gasket body  40  that can have cooperative or complementary fixturing (or attachment) devices, for example receptacles, such as friction-lock or mechanical interference-lock devices, configured to receive a fixturing device, for example the suture  6  (suture  6  refers herein to sutures  6  and other similar attachment mechanisms). Cooperative or complementary fixturing devices are devices or features that engage the fixturing device and assist the fixturing device to fix or attach to the prosthesis, for example the gasket body. The suture  6  can be 2-0 suture, 0 suture, another suture known to one having ordinary skill in the art or any combinations thereof. The receptacles can be discrete, meaning that each receptacle can be not directly connected to other receptacles. The receptacle can be, for example, cans  60  such as deformable cylinders. (“Can”  60  refers to cylinders and non-cylinders throughout the specification.) The can  60  can be annealed or otherwise treated to make the can  60  more easily deformable. The can  60  can have a can diameter  412  and a can height  414 . The inner can diameter  412  can be from about 0.838 mm (0.033 in.) or to about 2.54 mm (0.100 in), for example about 0.838 mm (0.033 in.). The outer can diameter  412  can be from about 1.3 mm (0.050 in.) to about 3.18 mm (0.125 in), for example about 1.3 mm (0.050 in). The can height  414  can be from about 1.3 mm (0.050 in.) to about 6.35 mm (0.250 in.), for example about 3.18 mm (0.125 in.). 
     Each can  60  can have a hollow channel  62 . The hollow channel  62  can be on the inside and/or outside of the can  60 . The hollow channel  62  can be a path for the suture  6 . The complementary fixturing devices can be attached to the outer radial side (as shown in  FIG. 22 ), inner radial side or within the wall  52  of the gasket body  40 . The complementary fixturing devices and their associated parts can be made from any of the same materials listed above for the fixturing device  20 . 
     The gasket body  40  can have a gasket longitudinal axis  534  through the center of the gasket body  40 . An inner complementary attachment device radius  536  can be measured from the gasket longitudinal axis  534  to the closest part of the can  60  from the gasket longitudinal axis  534 . An outer complementary attachment device radius  538  can be measured from the gasket longitudinal axis  534  to the farthest part of the can  60  from the gasket longitudinal axis  534 . A gasket body radius  540  can extend from the gasket longitudinal axis  534  to the gasket body  40 . Inner and outer gasket body radii (not shown) can be measured from the gasket body radius  540  to the closest and farthest parts, respectively, of the gasket body  40  from the gasket longitudinal axis  534 . 
     When the outer complementary attachment device radius  538  is greater than the outer gasket body radius  540 , the inner complementary attachment device radius  536  can be greater than, about equal to or less than the outer gasket body radius  540 , or the inner complementary attachment device radius  536  can be greater than, about equal to or less than the inner gasket body radius  540 . When the outer complementary attachment device radius  538  is less than the outer gasket body radius  540  (when the can  60  is on the radial inside of the gasket body  40 ), the inner complementary attachment device radius  536  can be greater than, about equal to or less than the outer gasket body radius  540 , or the inner complementary attachment device radius  536  can be greater than, about equal to or less than the inner gasket body radius  540 . 
       FIG. 24  illustrates the gasket body  40  of  FIG. 23  that can have flanges  64 , for example soft pads. The flanges  64  can partially and/or completely circumferentially surrounding the gasket body  40 . The flanges  64  can be solid or porous. The flanges  64  can be fabric, for example, polyester (e.g., DACRON® from E. I. du Pont de Nemours and Company, Wilmington, Del.), polypropylene, PTFE, ePTFE, nylon, extruded collagen, silicone or combinations thereof. The flanges  64  can be a matrix for cell ingrowth during use. The flanges  64  and/or any other parts of the invention can be filled and/or coated with an agent delivery matrix known to one having ordinary skill in the art and/or a therapeutic and/or diagnostic agent. These agents can include radioactive materials; radiopaque materials; cytogenic agents; cytotoxic agents; cytostatic agents; thrombogenic agents, for example polyurethane, cellulose acetate polymer mixed with bismuth trioxide, and ethylene vinyl alcohol; lubricious, hydrophilic materials; phosphor cholene; anti-inflammatory agents, for example non-steroidal anti-inflammatories (NSAIDs) such as cyclooxygenase-1 (COX-1) inhibitors (e.g., acetylsalicylic acid, for example ASPIRIN® from Bayer AG, Leverkusen, Germany; ibuprofen, for example ADVIL® from Wyeth, Collegeville, Pa.; indomethacin; mefenamic acid), COX-2 inhibitors (e.g., VIOXX® from Merck &amp; Co., Inc., Whitehouse Station, N.J.; CELEBREX® from Pharmacia Corp., Peapack, N.J.; COX-1 inhibitors); immunosuppressive agents, for example Sirolimus (RAPAMUNE®, from Wyeth, Collegeville, Pa.), or matrix metalloproteinase (MMP) inhibitors (e.g., tetracycline and tetracycline derivatives) that act early within the pathways of an inflammatory response. Examples of other agents are provided in Walton et al, Inhibition of Prostoglandin E 2  Synthesis in Abdominal Aortic Aneurysms,  Circulation , Jul. 6, 1999, 48-54; Tambiah et al, Provocation of Experimental Aortic Inflammation Mediators and Chlamydia Pneumoniae,  Brit. J Surgery  88 (7), 935-940; Franklin et al, Uptake of Tetracycline by Aortic Aneurysm Wall and Its Effect on Inflammation and Proteolysis,  Brit. J. Surgery  86 (6), 771-775; Xu et al, Sp1 Increases Expression of Cyclooxygenase-2 in Hypoxic Vascular Endothelium,  J. Biological Chemistry  275 (32) 24583-24589; and Pyo et al, Targeted Gene Disruption of Matrix Metalloproteinase-9 (Gelatinase B) Suppresses Development of Experimental Abdominal Aortic Aneurysms,  J. Clinical Investigation  105 (11), 1641-1649 which are all incorporated by reference in their entireties. 
     The flanges  64  can have a circular, oval or square cross-section. The flanges  64  can be attached to the wall  52  and/or to the cans  60 . The flanges  64  can be above and/or below the cans  60 . The flanges  64  can cover sharp edges exposed on the gasket body  40 , cans  60  or other parts. The flanges  64  can surround the perimeter of the gasket body  40  and/or can be in a segment or segments (as shown) that do not surround the perimeter of the gasket body  40 . The flanges  64  can have cannulated suture ports  66  that can be aligned with the cans  60  and/or no suture port can be aligned with the cans  60 . The cans  60  can be partially or completely inside the flanges  64 . A suture for a specific can  60  can be passed through a suture port  66 , and/or through and/or around the flange  64  during use. 
       FIG. 25  illustrates the gasket body  40  that can be surrounded by a flange configured as sewing ring  14 . The sewing ring  14  can be solid or porous. The sewing ring  14  can be fabric and can be made from any material listed above for the flanges  64 . The sewing ring  14  can be a matrix for cell ingrowth during use. 
     The sewing ring  14  can be attached to the wall  52  and/or to the cans  60 . The sewing ring  14  can extend from about the bottom edge  46  to about the top edge  44 . The sewing ring  14  can cover exposed edges and/or metal on the gasket body  40 , cans  60  or other parts. The sewing ring  14  can surround the perimeter (as shown in  FIG. 25 ) of the gasket body  40  and/or can be in a segment or segments that do not surround the perimeter of the gasket body  40 . The sewing ring  14  can have cannulated suture ports  66  that can be aligned with the cans  60  and/or no suture port can be aligned with the cans  60 . A suture for a specific can  60  can be passed through an access or suture port  66 , and/or through and/or around the sewing ring  14  during use. The access or suture port  66  can be pre-formed, before deployment of the gasket body  40 . The gasket body  40  can have the sewing ring  14  and can be devoid of cans  60 . 
     The sewing ring  14  can incorporate a flare or skirt  70 . The skirt  70  can surround the perimeter (as shown) of the sewing ring  14  or can be in a segment or segments that do not surround the perimeter of the sewing ring  14 . The skirt  70  can extend radially from the sewing ring  14 . The skirt  70  can be placed near or at the bottom edge  46 . 
       FIG. 26  illustrates an embodiment of cross-section B-B. The can  60  can be within the sewing ring  14 . The can  60  can be placed near or at the top edge  44 . The suture port  66  can stay the same size or enlarge as the suture port  66  extends away from the can  60 . The sewing ring  14  can close over the suture port  66 . The sewing ring can form an eyelet, buttonhole or gusset  416  adjacent to the suture port  66 . The gusset  416  can be self-closing. The sewing ring  14  can have a reinforcement  418  that can encircle the gusset  416 . The reinforcement  418  can be made of any of the materials listed herein, for example a metal or plastic ring. The reinforcement  418  can also be a thickened or additionally dense portion of the material of the sewing ring  14 . 
       FIG. 27  illustrates an embodiment of cross-section B-B. The sewing ring  14  can have a sewing ring height  420 . The can height  414  can be less than, equal to, or greater than the sewing ring height  420 . The sewing ring height  420  can be from about 1.3 mm (0.050 in.) to about 6.35 mm (0.250 in.), for example about 3.18 mm (0.125 in.), also for example about 5.08 mm (0.200 in.), for another example about 6.35 mm (0.250 in.). The can  60  can be placed near of at the bottom edge  46 . The cross-section of the suture port  66  can enlarge, stay the same, or reduce in size as the suture port  66  extends away from the can  60 . The can  60  can have attachment prongs  71 . The can  60  can be attached to the sewing ring  14  at the attachment prongs  71  or by other attachment methods known in the art, for example by suturing methods known in the art. The outer radial side of the skirt  70  or the remainder of the sewing ring  14  can be shaped, sized, coated, otherwise treated or any combination thereof to alter the stiffness as desired. For example, the skirt  70  can have relief grooves  422  formed therein. The relief grooves  422  can be semicircular, rectangular, semi-oval, star-shaped or a combination thereof. 
     The sewing ring  14  can suspend the cans  60  from the gasket body  40 . The cans  60  can rotate and translate with a reduced resistance from the gasket body  40  thereby allowing snug fixturing of the gasket body  40  to the first mass without unnecessary deformation of the annulus by the wall  52 . 
       FIG. 28  illustrates the can  60  adapted to receive a suture  6 , snare or other element for fixation. The can  60  can have passive internal obstacles, for example offset internal obstacles  72 , defining a hollow channel  62  that can have a tortuous path within the can  60 . The internal obstacles  72  can be made from a polymer that can provide increased friction against the suture  6  compared to the friction from the can  60 . The internal obstacles  72  can be made from any of the materials listed herein for any other elements or any combination thereof. The can  60  can be fixedly or rotatably attached to an axle  74 . 
       FIG. 29  illustrates the can  60  that can have aligned internal obstacles  72 . The can  60  can be fixedly or rotatably attached to a frame  76 . The internal obstacles  72  can be configured to collapse or crush when the can  60  is crushed, for example, the internal obstacles  72  can be hollow. 
       FIG. 30  illustrates a can  60  and an elastic space-occupying element, for example a plug  78 , sized to sealingly fit a can end  80 . The space-occupying element can be made of, for example, an elastomer and/or any of the other materials listed herein for any other elements or any combination thereof. The plug  78  can be removably attached to an engagement element, for example a breakaway line  82 . The breakaway line  82  can be pulled (as shown by the arrow) through the can  60  to engage and fix the plug  78  in the can end  80 . The breakaway line  82  can be configured to separate from the plug  78  when a maximum tension is exceeded. The plug  78  can be engaged and fixed into the other can end  80 . Two space-occupying elements can be used, one space-occupying element for each can end  80 . The space-occupying elements can be self-engaging, engaging and fixing into the can end  80  when the suture  6  is deployed and/or pulled through and/or near the space-occupying element. 
       FIG. 31  illustrates a can  60  and a plug  78  sized to fit the can end  80 . The plug can have a plug height  84 . The plug height  84  can be from about 1.3 mm (0.050 in.) to about 6.35 mm (0.250 in.), for example about 3.18 mm (0.125 in.). The plug height  84  can be substantially equal to the can height  414  or sized to sufficiently engage the suture  6  against the can  60 . The insertion force that pushes the plug  78  into the can  60  can be from about enough to secure the plug  78  in the can  60  to about equal to the retention force securing the gasket body  40  to the implantation site. For example, for the can  60  having an inner can diameter  412  of about 8.4 mm (0.33 in.), the insertion force for the plug  78  having a diameter of about 0.64 mm (0.025 in.) can be about 11 N (2.5 lbs.). In another example, for the can  60  having an inner can diameter  412  of about 8.4 mm (0.33 in.), the insertion force for the plug  78  having a diameter of about 0.66 mm (0.026 in.) can be about 19 N (4.3 lbs.). 
       FIG. 32  illustrates a resilient can  60  that can be biased to remain closed. The can  60  can be made from a resilient material, for example, a polymer, any other materials listed herein or any combinations thereof. The can  60  can have slots  88  in the sides of the can  60 . 
       FIG. 33  illustrates a can  60  that can have an active internal obstacle, for example an expandable obstacle  100 . The expandable obstacle  100  can be, for example, a deformably expandable (e.g., balloon-expandable) or resiliently-expandable (e.g., self-expandable) space-occupying element, such as a deformable cylinder, stent or balloon. The hollow channel  62  can be between the expandable obstacle  100  and the can  60 . The hollow channel  62  can form an annular space for passing the suture  6 . The can  60  can have a can longitudinal axis  424 . The expandable obstacle  100  or the can  60  can have longitudinally-retaining members  426  at either or both ends that extend perpendicularly to the can longitudinal axis  424  and longitudinally restrain the expandable obstacle  100  with respect to the can  60 . 
     The can  60  can also be radially compressible and the obstacle  100  can be radially non-compressible. During use, the can  60  can compress onto the obstacle  100 . 
       FIG. 34  illustrates a collet  102  and a can  60  that can have a splayed end  104 . The collet  102  can have a can port  106  sized to receive the splayed end  104 . The can  60  can have a can body  108  and extensions  110  at the splayed end  104 . The extensions  110  can be resiliently or deformably attached to the can body  108 . The extensions  110  can be biased radially inward as the extensions  110  extend away from the can body  108 . During use, the can  60  can be moved toward the collet  102 , shown by arrows  112 , and/or the collet  102  can be moved toward the can  60 , shown by arrows  114 . The splayed end  104  can move into the can port  106  and continue to move through the can port  106  until the splayed end  104  radially contracts, shown by arrows  116 , to a desired position. 
       FIG. 35  illustrates the can  60  that can have a first fenestration or window  118  and a second fenestration or window  120 . The can  60  can have a first can end  122  nearer the first window  118 . The can  60  can have a second can end  124  nearer the second window  120 . The can  60  can have a first can segment  126  between the first can end  122  and the first window  118 . The can  60  can have a second can segment  128  between the first window  118  and the second window  120 . The can  60  can have a third can segment  130  between the second window  120  and the second can end  124 . 
     The hollow channel  62  can be outside the radius of the can  60  in the area of the first can segment  126 . The hollow channel  62  can pass through the first can window. The hollow channel  62  can be inside the radius of the can  60  in the area of the second can segment  128 . The hollow channel  62  can pass through the second window  120 . The hollow channel  62  can be outside the radius of the can  60  in the area of the third can segment  130 . 
     The hollow channel  62  can pass into, and/or out of, the radius of the can  60  in any combination for the first, second, and third can segments  126 ,  128  and  130 . The hollow channel  62  does not have to pass through a fenestration or window when the hollow channel  62  goes from one can segment to an adjacent can segment. 
     The first and second windows  118  and  120  can be circular, as shown in  FIG. 35 , rectangular, as shown in  FIG. 36 , ovular, square or combinations thereof. The windows can also have an angular width up to about 360°, as shown in  FIG. 37 . If the angular width of the windows  118  and/or  120  is 360° the can segments  126 ,  128 , and  130  can be completely separated from each other. 
       FIG. 38  illustrates the can  60  that can have the first can segment  126  and the third can segment  130  that can be substantially misaligned with the second can segment  128 . For example, the first and third can segments  126  and  130  can be substantially flat. The second can segment  128  can be curved, for example, in a semi-circular shape. 
     A first direction  132  can be substantially opposite of a second direction  134 . The hollow channel  62  can pass on the first direction side of the first can segment  126 . The hollow channel  62  can pass through the first window  118 . The hollow channel  62  can pass on the second direction side of the second can segment  128 . The hollow channel  62  can pass through the second window  120 . The hollow channel  62  can pass on the first direction side of the third can segment  130 . 
       FIGS. 39 and 40  illustrate the can  60  that can be a cylinder that has been crushed into a shape analogous to the shape of the can  60  shown in  FIG. 38 . The can  60  can have front panels  136  and rear panels  138 . The can  60  can have a gaps  140  between the can segments  126 ,  128  and  130 . The gaps  140  can be formed by removing a portion of the panels  136  and/or  138  next to the adjacent can segment  126 ,  128  or  130 . For example, a portion of the front panel  136  on the first and/or third can segments  126  and/or  130  can be removed, and/or a portion or portions of the rear panel  138  on the second can segment  128  can be removed. During use, the gaps  140  can reduce the shearing force applied to the suture  6  passed through the hollow channel  62  if the second can segment  128  is pressed into a position substantially parallel to the first and/or third can segments  126  and/or  130 . 
       FIG. 41  illustrates a can  60  that can be made from a wire or wires. The wire or wires can be deformable or resilient. The can  60  can have a first loop  142 , a second loop  144  and a chassis  146 . The first loop  142  can be fixedly attached to the chassis  146 . The second loop  144  can be fixedly attached to the chassis  146 . Additional loops can be attached to the chassis  146 . The chassis  146  can be a single wire between the first loop  142  and the second loop  144 . 
       FIG. 42  illustrates a can  60  that can be made from a plate  148 . The plate  148  can be formed, for example by wrapping or otherwise hot or cold forming, into a substantially cylindrical shape. A first plate end  150  can overlap a second plate end  152 . 
       FIG. 43  illustrates the gasket body  40  that can be made from a laminate of a first gasket layer  428  and a second gasket layer  430 . The first and second gasket layers  428  and  430  can be fixedly or slidably attached to a slide rod  432 , and fixedly attached to a first guide block  434  and a second guide block  436 . The first and second guide blocks  434  and  436  can be adjacent to the bottom edge  46 . The fixturing device  20  can have an elongated slide port  438 . The fixturing device  20  can be slidably attached at the slide port  438  to the slide rod  432 . A sharpened tip  440  of the fixturing device  20  can be slidably placed in a complementary fixturing device, for example a receptacle formed between the first and second guide blocks  434  and  436 . Because the fixturing device  20  is limitedly slidable on the slide rod  432 , the fixturing device  20  can be prevented from completely escaping or being removed from the gasket body  40 . The fixturing device  20  can be loaded onto the gasket body  40  before the gasket body  40  is deployed and selectively activated or deployed into tissue depending on the condition and/or placement of the fixturing device  20  relative to the first mass. 
       FIG. 44  illustrates two fixturing devices  20 , as shown in  FIG. 43 , that can be placed adjacent to each other. The fixturing devices  20  can be turned opposite directions so to face each other, resulting in overlapping and/or adjacent placement of the two fixturing devices  20  after deployment, as shown. 
       FIG. 45  illustrates the configuration of  FIG. 43  without the second gasket layer  430 . The slide rod  432  can be fixedly or rotatably attached at a first end to the gasket body  40 . The slide rod  432  can be fixedly or rotatably attached at a second end to a radial directing element  442 . The radial directing element  442  can be circular and can have a larger diameter than the slide rod  432 . 
       FIGS. 46-48  illustrate radial directing elements  442 .  FIG. 46  illustrates a radial directing element  442  that can be oval, rectangular or otherwise elongated.  FIG. 47  illustrates a radial directing element  442  that can be thin and can be bent radial toward the gasket body  40  (not shown).  FIG. 48  illustrates a radial directing element  442  that can be fixedly attached to the first and/or second guide blocks  434  and/or  436 . 
       FIG. 49  illustrates a can  60  that can have cross-section C-C.  FIG. 50  illustrates cross-section C-C. The can  60  can have teeth  154 . The teeth  154  can be internal to the can  60 . The teeth  154  can have shelves  156  and slopes  158 .  FIG. 51  illustrates a can  60  that can be made from a resilient material, for example, any polymer or metal listed herein. The can  60  can have slots  88  in the sides of the can  60 . 
       FIGS. 52 to 55  illustrate sutures  6  that can be used with, for example, the cans  60  illustrated in  FIGS. 49 to 51 . The suture  6  can have one or more digitations, detents or pawls  160  fixedly attached to a filament  162 . The pawls  160  can be conical (shown in  FIG. 52 ), angled or straight tabs (shown in  FIG. 53 ), substantially droplet-shaped (shown in  FIG. 54 ), spherical (shown in  FIG. 55 ) or a combination thereof. The tops of the droplet-shaped pawls  160  can be concave inward toward the filament  162 . The sutures  6  illustrated in  FIGS. 52 to 55  can be self-fixturingly ratcheted through a suitable can  60  and finitely adjusted as desired. 
       FIGS. 56 and 57  illustrate a portion of a sheet or the gasket body  40  that can have integral complementary fixturing devices. The complementary fixturing devices can be second wall segments  164 . The second wall segments  164  can be raised portions of the wall  52 . The wall  52  can have first wall segments  166  between the second wall segments  164  and the top edge  44 . The wall  52  can have third wall segments  168  between the second wall segments  164  and the bottom edge  46 . The hollow channel  62  can pass along the wall analogous to the hollow channel  62  for the can  60  shown in  FIGS. 38 to 40 . 
       FIGS. 58 and 59  illustrate a portion of a sheet  170  that can have raised sheet segments  172  and has voids  173  above and below the raised sheet segments  172 . During use, the sheet  170  can be attached to a prosthesis  2 , for example the gasket body  40  or any available prosthesis to enable reduced implantation time. 
     The sheet  170  can be used in lieu of, or in addition to, sewing rings for multiple-piece heart valve assemblies, for example, heart valve assemblies disclosed by Griffin et al. in U.S. Pat. No. 6,241,765 and by Ritz in U.S. Pat. No. 5,976,183, both of which are hereby incorporated in their entireties. Other heart valve assemblies that can be used with the sheet  170  include, for example, the Advantage Bileaflet heart valve, Parallel valve, Freestyle stentless aortic valve, Hancock Porcine heart valve, Hancock apical left ventricular connector model  174 A, Hancock valved conduit models  100 ,  105 ,  150 , Hall Medtronic heart valve, Hall Medtronic valved conduit, MOSAIC® heart valve and Intact porcine tissue valve (by Medtronic, Inc. Minneapolis, Minn.); Angelini Lamina-flo valve (by Cardio Carbon Company, Ltd., England); Bjork-Shiley single-disk, monostrut and caged-disk valves (Shiley, Inc., now-defunct, previously of CA); Wada-Cutter valve and Chitra Cooley-Cutter valve (by Cutter Biomedical Corp., San Diego, Calif.); Angioflex trileaflet polyurethane valve (by Abiomed, Inc., Danvers, Mass.); ATS AP Series heart valve and ATS Standard heart valve (by ATS Medical, Inc., Minneapolis, Minn.); ANNULOFLO® annuloplasty ring, ANNUFLEX® annuloplasty ring, CARBSEAL® valved conduit, ORBIS® Universal aortic and mitral valve, pediatric/small adult valve, R series valve, SUMIT® mitral valve, TOP HAT® aortic valve, OPTIFORM® mitral valve, MITROFLOW SYNERGY® PC stented aortic pericardial bioprosthesis and the SYNERGY® ST stented aortic and mitral porcine bioprosthesis (by CarboMedics, Inc., Austin, Tex.); ON-X® prosthetic heart valve (by MCRI®, LLC, Austin, Tex.); Starr-Edwards SILASTIC® ball valve, Starr-Edwards 1000, Starr-Edwards 1200, Starr-Edwards 1260, Starr-Edwards 2400, Starr-Edwards 6300, Starr-Edwards 6500, Starr-Edwards 6520, Carpentier-Edwards porcine tissue valve, Carpentier-Edwards pericardial prosthesis, Carpentier-Edwards supra-annular valve, Carpentier-Edwards annuloplasty rings, Duromedics valve and PERIMOUNT® heart valve (by Edwards Lifesciences Corp., Irvine, Calif.); Cross-Jones Lenticular disc valve (by Pemco, Inc.); Tissuemed stented porcine valve (by Tissuemed, Ltd., Leeds, England); Tekna valve (by Baxter Healthcare, Corp., Deerfield, Ill.); Komp-01 mitral retainer ring (by Jyros Medical Ltd., London, England); SJM® Masters Series mechanical heart valve, SJM® Masters Series aortic valved graft prosthesis, ST. JUDE MEDICAL® mechanical heart valves, ST. JUDE MEDICAL® mechanical heart valve Hemodynamic Plus (HP) series, SJM REGENT® valve, TORONTO SPV® (Stentless Porcine Valve) valve, SJM BIOCOR® valve and SJM EPIC® valve (St. Jude Medical, Inc., St. Paul, Minn.); Sorin Bicarbon, Sorin Carbocast, Sorin Carboseal Conduit, Sorin Pericarbon and Sorin Pericarbon Stentless (by Snia S.p.A., Italy). The gasket body  40  described herein can also be used in lieu of the gasket bodies in any of the heart valve assemblies listed supra. 
       FIGS. 60 and 61  illustrate a sheet or gasket body  40  that can have undulations forming cans  60 . The cans  60  can be substantially cylindrical. The cans  60  can be unclosed cylinders. 
       FIGS. 62 to 64  illustrate a sheet or gasket body  40  that can have substantially closed, substantially cylindrical cans  60 . The sheet or gasket  40  can be made from a single layer, or can be made from a laminate that can have a first gasket layer  428  and a second gasket layer  430 . 
       FIG. 65  illustrates the gasket body  40  that can have the complementary fixturing devices that can be pairs of cams  174 . The cams  174  can be rotatably attached to the gasket body  40  by the axles  74 . The cams  174  can be oval or elliptical. The cams  174  can be biased to open upward or downward, and lock when the major axis of one cam  174  approaches parallel with the major axis of the other cam  174  in the pair of cams  174  (as shown in  FIG. 27 ). A spool (not shown) can be located in or adjacent to the cam  174  to intake and/or roll-up the additional length of the suture  6  during deployment of the gasket body  40 . 
       FIG. 66  illustrates the gasket body  40  that can have the complementary fixturing devices that can be a static receptacle  444 . The static receptacle  444  can be on the outside of the gasket body  40 . The static receptacle  444  can be resiliently elastic. The static receptacle  444  can be made of an elastomer. The static receptacle  444  can have a high friction channel  446  passing through the static receptacle  444 . The high friction channel  446  can be formed by a tortuous path through the static receptacle  444 . The diameter of the high friction channel  446  can be larger, smaller or equal to the diameter of the suture  6 . 
       FIG. 67  illustrates a complementary fixturing device, for example a spindle lock  176 , that can have an active internal obstacle in a first configuration. The spindle lock  176  can be attached to the wall  52 . The spindle lock  176  can have a first seating block  178  and a second seating block  180 . The hollow channel  62  can be between the first and second seating blocks  178  and  180 . A seat  182  can be defined above the first and second seating blocks  178  and  180 . The seat  182  can be angular or flat. The spindle lock  176  can have a spindle  183 . The spindle  183  can be triangular or another shape that conforms to the seat  182 . The spindle  183  can be fixedly attached to a pin  184 . The pin  184  can be slidably attached to a slide hole, slot or groove  186  behind the spindle  183 . During use, the suture (not shown) can be wrapped around the spindle  183 . The suture  6  can be pulled up, in turn, pulling the spindle  183  up, shown by the arrow. In a configuration with the spindle  183  up and out of the seat  182 , the suture  6  can be free to slide around the spindle  183 . 
       FIG. 68  illustrates the spindle lock  176  in a second configuration. The suture  6  can be pulled down, in turn, pulling the spindle  183  down, shown by the arrow. In a configuration with the spindle  183  down and in the seat  182 , the suture  6  can be constricted and fixed between the spindle  183  and the first and second seating blocks  178  and  180 . 
     Methods of Making 
       FIG. 69  illustrates a method of fixedly attaching the can  60  to a sheet or the gasket body  40 . The frame  76  can be inserted (as shown by the arrows) through holes  54  in the sheet or gasket body  40 . The frame  76  can then be attached to the sheet or gasket body  40  by crimping, stamping, melting, screwing, grommeting, snapping, bossing, gluing, welding or combinations thereof. The frame  76  can have one or more snap bosses  188  at the ends of the frame  76 . 
       FIG. 70  illustrates a method of rotatably attaching the can  60  and the sheet or gasket body  40 . The can  60  can have one axle  74 . The axle  74  can be inserted (as shown by the arrow) into the hole  54 . 
       FIG. 71  illustrates the sheet or gasket body  40  in an expanded and flattened view. The cans  60  can be attached to the sheet or gasket body  40  through the holes  54 . The holes  54  not being used to attach cans  60  to the sheet or gasket body  40  can be used to attach a second prosthesis, for example a heart valve, to the sheet or gasket body  40 . 
       FIG. 72  illustrates the sheet  170  that can be fixedly attached to the gasket body  40 . The sheet  170  can be made from, for example, any polymer listed herein. The cans  60  can be in or on the sheet  170 , or between the sheet  170  and the gasket body  40 . The sheet  170  can be attached to the gasket body  40 , for example, by sutures  6 , bosses  202  fit into the holes  54 , snap bosses  188  fit into the holes  54  or combinations thereof. 
       FIG. 73  illustrates the sheet or gasket body  40  wrapped or otherwise formed in a trilobular configuration. The gasket body  40  can have three lobes  204  and three cusps  206 .  FIG. 74  illustrates the sheet or gasket body  40  wrapped or otherwise formed in a scalloped, trilobular configuration. The gasket body  40  can have scallops  208  aligned with the lobes  204  or the cusps  206 . 
       FIG. 75  illustrates a method of rotatably attaching the cam  174  to the gasket body  40 . The axle  74  can be pressed, as shown by arrow  210 , into the hole  54  in the cam  174 . The cam  174  can be placed against or near the gasket body  40 , and the axle  74  can be pressed, as shown by arrow  212 , into the hole  54  in the gasket body  40 . 
       FIG. 76  illustrates a mold  214  that can be used to form a polymer, for example silicone, frame from which the sewing rings  14  having suture ports  66  can be made. The mold  214  can have cylindrical and/or conical protrusions  216  to form the suture ports  66 . A mold outer wall  448  can extend radially inward from the radial outer edge of a mold base  450 . The mold outer wall  448  can form the top of the flare or skirt  70 . A mold inner wall  452  can extend substantially vertically from the radial inner edge of the mold base  450 . One having an ordinary level of skill in the art can manufacture the sewing ring  14  using the mold  214 . 
     As shown in  FIG. 21 , the tabs  48  can be sections of the gasket body  40  around which an about 180° cut can be made to allow the section of the gasket body  40  forming the tab  48  to articulate. The cut can be made by any method described infra. 
     The fixturing devices  20 , pledget  16 , gasket body  40 , tabs  48 , cans  60 , plugs  58 , cams  174 , and other parts can be made from methods known to one having ordinary skill in the art. For example, manufacturing techniques include molding, machining, casting, forming (e.g., pressure forming), crimping, stamping, melting, screwing, gluing, welding, die cutting, laser cutting, electrical discharge machining (EDM) or combinations thereof. 
     Any parts, sub-assemblies, or the device as a whole after final assembly, can be coated by dip-coating or spray-coating methods known to one having ordinary skill in the art, for example to apply the agents described above. One example of a method used to coat a medical device for vascular use is provided in U.S. Pat. No. 6,358,556 by Ding et al. and hereby incorporated by reference in its entirety. Time release coating methods known to one having ordinary skill in the art can also be used to delay the release of an agent in the coating. The coatings can be thrombogenic or anti-thrombogenic. 
     Methods of Using 
       FIGS. 77 to 80  illustrate a method of using a fixturing device deployment assembly  454  to deploy fixturing device  20 . As shown in  FIGS. 77 and 78 , the fixturing device deployment assembly  454  can have a static rod  456  rotatably connected, shown by arrows in  FIG. 78 , to a brace rod  458 . The static rod  456  can be slidably connected to a dynamic rod  460 . The static rod  456  can be rotatably connected at a pivot pin  456  to a cartridge  464 . The dynamic rod  460  can be rotatably connected to the cartridge  464  at a driving pin  466 . The cartridge  464  can deploy the fixturing device  20  in a curvilinear path. The cartridge  464  can be removably attached to the fixturing device  20 . The cartridge  464  can have an ejection activator  468 . 
     An upward force, shown by arrow  470 , can be applied to the dynamic rod  460 . As the dynamic rod  460  moves upward, the cartridge  464  can rotate, shown by arrow  472 . The cartridge  464  can rotate to press the ejection activator  468  against an ejection pin  474 . The ejection pin  474  can be part of, or fixedly attached to, the static rod  456 . The fixturing device  20  can eject from the cartridge  464  when the ejection activator  468  is pressed into the ejection pin  474  with sufficient force. 
     A cover  476  can be slidably attached to the static rod  456 . The cover  476  can be slid down to cover the static rod  456  during use (the cover  476  is open in  FIGS. 77 and 78  for illustrative purposes). When the cover  476  covers the static rod  456 , the cover  476  can protect the elements of the fixturing device deployment assembly  454  and provide additional support for the dynamic rod  460  and the cartridge  464 . 
     The fixturing device deployment assembly  454  can be placed into a gasket body  40 . The static rod  456  can have a first deployment guide  478 . The brace rod  458  can have a second deployment guide  480 . The fixturing device deployment assembly  454  can self-align with the gasket body  40  by fitting the first and second deployment guides into appropriate grooves or notches on the gasket body  40 . The fixturing device deployment assembly  454  can be firmly held in place by applying pressure against the gasket body  40  with the static rod  456  and the brace rod  458 . Once the fixturing device deployment assembly  454  is aligned with the gasket body  40 , the fixturing device  20  can be deployed through the window  42 . 
       FIGS. 79 and 80  illustrate the cartridge  464  deploying the fixturing device  20 . The cartridge  464  can have a first outer panel  482 , a load panel  484  adjacent to the first outer panel  482  and a second outer panel (not shown for illustrative purposes) adjacent to the load panel  484 . The cartridge  464  can have a pivot port  486  to rotatably attach to the pivot pin  462 . The cartridge  464  can have a drive port  488  to rotatably attach to the driving pin  466 . 
     An ejection section  490  can be rotatably attached to the load panel  484  at a joint  492 . The ejection activator  468  can be a protruding portion of the ejection section  490 . A locking section  494  of the fixturing device  20  can be in a loading capsule  496 . The locking section  494  or another portion of the fixturing device  20  can be attached (not shown) to the suture  6 . The loading capsule  496  can be defined by the ejection section  490  and an ejection lip  498 . The ejection lip  498  can be part of the load panel  484 . 
     When the ejection pin  498  presses, shown by arrow  500 , against the ejection activator  468 , the ejection section  490  can rotate, shown by arrow  502 , releasing the fixturing device  20  from the cartridge  464 . After the ejection pin  474  begins to press against the ejection activator  468  and before the ejection section  490  rotates, an ejection force can be applied by the locking section  494  to the ejection lip  498 . The ejection force must be large enough to deform the locking section  494  and/or the ejection lip  498  and/or the ejection section  490  before the ejection section  490  can rotate. The large ejection force can cause the fixturing device  20  to jump or launch from the cartridge  464  when deployed. The jump or launch also provides tactile feedback of deployment of the fixturing device  20  to the user of the fixturing device deployment assembly  454 . 
     A second cartridge (not shown) can be attached to the dynamic rod  460  similar to the attachment of the cartridge  464 , but “upside down”. The fixturing device  20  of the second cartridge can be delivered overlapping the fixturing device  20  of the cartridge  464 , as shown in  FIG. 84 . The drive port (not shown) of the second cartridge can be rotatably attached to the second cartridge driving pin  504 . The pivot port (not shown) of the second cartridge can be rotatably attached to the ejection pin  474 . The pivot pin  462  can act as the ejection pin for the second cartridge. 
       FIGS. 81 to 83  illustrate a method of fixing a first mass, for example biological heart tissue  218 , to a second mass, for example the gasket body  40 . The gasket body  40  can be placed adjacent to the tissue  218 . An applicator assembly  220  can be placed adjacent to, and aligned with, the window  42 . The gasket body  40  can be covered by a fabric or the sewing ring  14 . 
     The applicator assembly  220  can have a top mount  222  that can be fixedly attached to a bottom mount  224 . The applicator assembly  220  can have a press  226  that can be slidably attached to the top mount  222  and/or the bottom mount  224 . The mounts  222  and  224  can each have a loading notch  228 . The fixturing device  20  can be loaded into the loading notches  228 , and the fixturing device  20  can be pressed against the press  226 , as shown in  FIG. 81 . The fixturing device  20  can fill the notches  228  completely when loaded, or the notches  228  can have available space for the expansion of the fixturing device  20 . The distance between the loading notches  228  can be a loading notch height  506 . The loading notch height  506  can be from about 1.27 mm (0.050 in.) to about 12.7 mm (0.500 in.), for example, about 3.20 mm (0.126 in.). 
     As illustrated by the arrow in  FIG. 82 , the press  226  can be slidably moved (as shown by the arrow) toward the tissue  218 , the press  226  can contact and push the fixturing device  20  on or near the fold  38 . The fixturing device  20  can expand to fill the notches  228  and/or the fixturing device  20  can deform. The protrusions  24  can move through the tissue  218 . 
     Before the press  226  forces the base  22  to form a straight plane, or before the base  22  can otherwise not resiliently return to the configuration shown in  FIG. 81 , the press  226  can be returned to the position shown in  FIG. 81  and the fixturing device  20  can be removed from the tissue  218 . In this way, portions of the tissue  218  can be tested with the protrusions  24  before the fixturing device  20  is completely deployed. 
       FIG. 83  illustrates completely deploying the fixturing device  20 . The press  226  can be slid (as shown by the arrow) far enough toward the tissue  218  to egress the fixturing device  20  from the notches  228 . The window  42  can be dimensioned to fix, for example by interference fitting or wedging, the fixturing device  20  into the gasket body  40  when the fixturing device  20  is completely deployed. 
     The protrusions  24  do not need to be curved, but if the protrusions  24  are curved and the protrusions  24  are deployed using the curvilinear motion shown in  FIGS. 81 to 83 , damage to the tissue  218  can be minimized. The fixturing device  20  can be oriented to any angle about the longitudinal axis of the press  226  before the fixturing device  20  is deployed. 
       FIG. 84  illustrates two fixturing devices  20  (similar to the fixturing device illustrated in  FIG. 5 ) that can be deployed in a window  42  to fix the gasket body  40  to the tissue  218 . The fixturing devices  20  can be placed to maximize the holding force, for example, the fixturing devices  20  can be placed at substantially the same position in the window  42  and deployed through the tissue  218  in substantially opposite directions. 
       FIGS. 85 to 87  illustrate a method of deploying the gasket body  40  that can have the pre-deployed tabs  48  attached to the top edge  44  and additional tabs  48  attached to the bottom edge  46 . The gasket body  40  can be lowered through the vessel  4 , as shown by the arrows in  FIG. 85 . As illustrated in  FIG. 86 , the gasket body  40  can be placed in the trans-annular space  10 . The tabs  48  attached to the top edge  44  can hook into the vessel wall, attaching the gasket body  40  to the vessel  4 . 
       FIG. 87  illustrates a method of deploying the tabs  48 , for example the tabs  48  attached to the bottom edge  46 . A tab deployment assembly  230  can be positioned adjacent to the gasket body  40 . 
     The tab deployment assembly  230  can have a first anvil  232  and a second anvil  234 . A cable, rods or line  236  (referred to hereafter as the line  236  for illustrative purposes) can be fixedly attached to the first anvil  232  at an anchoring point  238 . The line  236  can then pass through, and be slidably attached to, the second anvil  234 . The line  236  can then pass through, and be slidably attached to, the first anvil  232 . A free end  240  of the line  236  can extend into and beyond the supra-annular space  8 . 
     The anvils  232  and  234  can have curved faces  242 . The faces  242  can be positioned directly adjacent to the tabs  48 . When the free end  240  of the line  236  is pulled, as shown by arrow  244 , the first anvil  232  and the second anvil  234  move toward each other, as shown by arrows  246 . The anvils  232  and  234  can then reshape the tabs  48 . Reshaping the tabs  48  can include curving the tabs  48  and pushing the tabs  48  into the vessel wall. The anvils  232  and  234  can press into the vessel wall, if necessary, to complete the reshaping of the tabs  48 . 
       FIG. 88  illustrates the gasket body  40  shown in  FIG. 23  with looped snares  248  loaded into the cans  60 . (Only the snares  248  on the front half of the gasket body  40  are shown for illustrative purposes.) The snares  248  can be used with any gasket body  40  using complementary fixturing devices, for example cams  174 . The snares  248  can be any suitable snare known to one having ordinary skill in the art, for example a stainless steel snare having a diameter of about 0.2 mm (0.006 in.).  FIG. 89  illustrates the suture  6 , already passed through the vessel wall, passed through the snare  248 . Single stitches and mattress stitches, both known to those having ordinary skill in the art, can be used to attach the suture  6  to the vessel wall. The snare  248  can then be pulled, as shown by the arrow, through the can  60 , thereby feeding the suture  6  through the can  60 . 
     Once all the desired sutures  6  are fed through the cans  60 , the gasket body  40  can be parachuted down onto the shoulder between the supra-annular and trans-annular spaces  8  and  10 , as shown in  FIG. 90 . The parachuting can be done with the assistance of an aligning stick or valve holder (not shown) to align the gasket body  40 , as known by one having ordinary skill in the art. The cans  60  can be crimped, plugged or otherwise locked, and the excess suture  6  can be trimmed and removed. 
     As illustrated in  FIG. 91 , a remote crimping tool  250  can be used to crimp the cans  60 . The remote crimping tool  250  can have an arm  252  rotatably attached to a crushing member  254  at a pivot  256 . The can  60 , attached to the gasket body  40 , can be loaded between the crushing member  254  and the arm  252 . The crushing member  254  can have a crush head  508 . An actuator ball  258  can be fixedly attached to a pull line  260 . The actuator ball  258  can be in a ball cavity  262  between the arm  252  and the crushing member  254 . The crushing member  254  can block the ball  258  from exiting the ball cavity  262 . When the pull line  260  is pulled, as shown by arrow  264 , the ball  258  forces the crushing member  254  in the direction of arrow  266 . The crush head  508  can then crush the can  60 . 
       FIG. 92  illustrates another remote crimping tool  250  that can have an arm  252  that can be fixedly attached to the crushing member  254  at a proximal end (not shown). A slide tensioner  510  can be slidably attached to the arm  252  and the crushing member  254 . The slide tensioner  510  can be non-deformable. The slide tensioner  510  can constrain the bending strain of the arm and the crushing member  254 . The slide tensioner  510  can have a bending stresser  512  between the arm  252  and the crushing member  254 . The crushing member  254  can be resiliently biased to stay apart from the arm  252  and/or the bending stresser  512  can force a bending strain upon the arm  252  and/or the crushing member  254 . Bending strain over all or part of the length of the arm  252  and/or crushing member  254  can bend the crushing member  254  sufficiently to allow the can  60  to fit between the crush head  508  and the arm  252 . When the slide tensioner  510  is slid toward the can, shown by arrow  514 , the slide tensioner  510  forces the crushing member  254  in the direction of arrow  266 . 
       FIGS. 93 and 94  illustrate a deployment tool  268  that can be used to implant the gasket body  40  to the desired site. The deployment tool  268  can have a support  270 , for example a disc. The deployment tool  268  can have substantially parallel engagement devices, for example tubes  272 . The tubes  272  can be fixedly attached to the support  270  at an attachment area  516 . Some or all of the tubes  272  can be unattached to the support  270 . For example, about three of the tubes  272  can be unattached to the support  270 . The tubes  272  can be hollow. The tubes  272  can be substantially cylindrical. The tubes  272  can have tube ends  274 . The tube ends  274  can be open-ended. The tube ends  274  can be resilient. 
       FIG. 95  illustrates a method of using the deployment tool  268  with the gasket body  40 . The cans  60  can be engaged by the tube ends  274 . The tube ends  274  can fit over and hold the cans  60 . 
       FIG. 96  illustrates the deployment tool  268  and the can  60  and a portion of the gasket body  40  before the deployment tool  268  engages the can  60 . The edge of the tube end  274  of the deployment tool  268  can have a lip  276 . The tube end  274  can have an engagement hole  278  cut or formed along the side of the tube end  274 . The engagement hole  278  can be sized to slide around the snap bosses  188 . The tube end  274  can have a disengagement driver  280 , for example a hollow catheter, that can extend along the length of the tube  272 . The inside of the disengagement driver  280  can have an instrument port  282 . The tube end  274  can be moved adjacent to the can  60 , as shown by the arrow. 
       FIG. 97  illustrates section D-D as the tube end  274  begins to engage the can  60 . The lip  276  can have an engagement face  284  and a disengagement face  286 . As the tube end  274  contacts the can  60 , the can  60  can slide against the engagement face  284 . The tube end  274  can be pushed over the can, as shown by arrows  288 , and the tube end  274  can then flex outward, shown by arrows  300 . The radius of the can  60  can then be accommodated by the tube end  274  and the tube end  274  can be slid over the length of the can  60 . 
     The sewing ring  14  can be separated from the can  60  where the can  60  is engaged by the tube end  274  so that the sewing ring  14  does not substantially interfere with the tube end  274 . The tube end  274  can be fit (not shown) into the inner radius of the can  60  and the lips  276  can extend (not shown) radially outward from the tube end  274  and the sewing ring  14  can substantially attach to the can  60  around the entire perimeter of the can  60 . 
       FIGS. 98 and 99  illustrate when the tube end  274  engages the can  60 . When the lip  276  get to the end of the can  60 , the lip  276  can return to a relaxed, non-flexed position, shown by the arrows. 
       FIGS. 100 and 101  illustrate the can  60  secured during deployment between retention devices, for example flaps  302 , and the disengagement face  286  of the lip  276 . The flaps  302  can be cut out of the wall of the tube end  274 . The flaps  302  can be resilient. The flaps  302  can flex out of the way of the disengagement driver  280  during use. 
       FIGS. 102 and 103  illustrate the can  60  secured during deployment similar to the can  60  of  FIGS. 100 and 101  except the tube end  274  can be inside the diameter of the can  60 , and the lip  276  and the flaps  302  can face radially outward. The lip  276  can be flexible and/or have a notch, hole or slot to improve flexing during engagement and disengagement of the can  60 . 
       FIGS. 104 and 105  illustrate the tube ends  274  engaging the can  60  in multiple engagement ports  518  on the can  60 . The tube ends  274  can be integral portions of the tube  272  or separated from the tube  272 . The tube ends  274  can be biased radially outward from the tube and forced radially inward by an external force, or biased radially inward and forced radially outward by an external force. The engagement ports  518  can be shaped and sized to receive the lips  276  and restrain the motion of the lips in one or two dimensions. 
       FIGS. 106 to 108  illustrate the tube  272  side-engaging the can  60  substantially within a can gap  520 . The tube  272  can be held to the can  60  by an engagement rod  522 . The engagement rod  522  can be slidably attached to the can  60  and the tube  272 . When the engagement rod  522  is removed from the can  60 , the tube  272  and the can  60  can be separated. The tube  272  can have an engagement slope  524  to minimize contact with the can  60  during engagement and disengagement with the can  60 . When the tube  272  side-engages the can  60 , the tube  272  can stay substantially clear of the supra-annular volume directly above the gasket body  40 . 
       FIGS. 109 and 110  illustrate two methods of deploying the snares and/or sutures  6 . A first snare and/or suture  6   a  can be fed into the tube end  274  and through the can  60 . The first suture  6   a  can then be passed through a tube window  304  and out of the tube end  274 . The first suture  6   a  can be pulled, shown by arrow  306 , on the outside of the tube  272 . 
     A second snare and/or suture  6   b  can be fed into the tube end  274  and through the can  60 . The second suture  6   b  can then continue along the tube end  274  and through the instrument port  282  in the disengagement driver  280 . The second suture  6   b  can extend up the length of the tube  272 . The second suture  6   b  can be pulled, shown by arrow  308 , on the inside of the tube  272 . One or more sutures  6  can be deployed through a single can  60 . 
       FIG. 111  illustrates an embodiment of section J-J with the plug  78  in the process of being deployed. The plug  78  can be fed, shown by the arrow, through the instrument port  282  by an instrument driver  310 , for example a catheter. The plug  78  can flex to slide within the disengagement driver  280  and around the suture  6 . 
       FIG. 112  illustrates an embodiment of section J-J after the plug  78  has completely deployed. The instrument driver  310  can force the plug into the can  60 , thereby forming a tight seal around the can and pressure-fixing the suture  6  between the plug  78  and the can  60 . 
       FIGS. 113 and 114  illustrate an embodiment of section J-J showing a method of using the remote crimping tool  250  to crush the can  60 . A torque, shown by the arrows, can be applied to the crushing members  254 . After the torque is applied, as shown in  FIG. 114 , the can  60  can be crushed, pressing the internal obstacles  72  of one side of the can  60  against internal obstacles  72  of the other side of the can  60 , and can fix the suture  6  between the internal obstacles  72 . The can  60  can be deformable, thereby the can  60  can fix the suture  6  between the internal obstacles  72  after being crushed until the can  60  is deformed to release the suture  6  from between the internal obstacles  72 . 
     Once the suture  6  is deployed and fixed to the gasket body  40 , the suture  6  can be cut and the excess suture can be removed. The suture  6  can be cut by scissors, sheared by the deployment tool  264  (e.g., between the tube end  274  and the can  60 ) or any combination thereof.  FIGS. 115 to 118  illustrate a method of disengaging the can  60  from the deployment tool  268 .  FIGS. 115 and 116  illustrate pushing, shown by arrows  312 , the disengagement driver  280  against the can  60 . The tube end  274  can slide along the disengagement face  286 , flex outward, shown by arrows  300 , and can be retracted, shown by arrow  314 . The tube end  274  can then be slid along the can  60  and the disengagement driver  280 .  FIGS. 117 and 118  illustrate the can  60  disengaged from the deployment tool  268 . The lip  276  can be on the disengagement driver  280 . The deployment tool  268  can then be removed for the implantation site. 
       FIG. 119  illustrates an deployment tool  268  engaged with the gasket body  40 . The tube ends  274  can be removably attached to the cans  60 . The tube ends  274  can attach to the cans  60  via necks  316 . The necks  316  can be perforated or narrowed portions of the wall of the tube end  274 . The necks  316  can directly attach to the cans  60 . 
       FIG. 120  illustrates the deployment tool  268  of  FIG. 119  after disengaging from the gasket body  40 . To disengage the deployment tool  268  from the gasket body  40  the necks  316  can break and the tube ends  274  can be pulled off the cans  60 . The necks  316  can break by pulling the necks  316  against a resistive force. For example, the gasket body  40  can be secured to the implantation site with sutures  6  before pulling on the deployment tool  268 . In another example, electrical current can be sent down the tubes  272  to break the necks  316 . The necks  316  can be made of a conductive material that heats and breaks when sufficient current is applied. 
     Some tube ends  274  can be removed from the cans  60  while other tube ends  274  can remain attached to the cans  60  (not shown). The latter tube ends  274  that can still be attached to the cans  60  can be removed from the cans  60  at a later time. For example, several tube ends  274  can be removed from the cans  60  leaving tubes ends  274  still attached to the cans  60 . The tube ends  274  still attached to the cans  60  can be side-engaging tube ends  274 . The tube ends  274  still attached to the cans  60  can be unattached to the support  270 . The support  270  and the removed tube ends  274  can be removed completely from the supra-annular space  8 . The supra-annular space directly above the gasket body  40  can then be more easily accessible by medical professionals or other devices. The tube ends  274  still attached to the cans  60  can then be used as guide rods. For example, additional portions of the heart valve device, such as a connecting adapter, crown and/or leaflets, can be aligned and slid over and/or radially inside of any or all of the remaining tube ends  274 . The remaining attached tube ends  274  can be removed from the cans  60  when the gasket body  40  no longer needs to be engaged to the tubes  272 . 
       FIGS. 121 and 122  illustrate a method of using the fixturing device  20  of  FIG. 43 . The gasket body  40  can be placed in the supra-annular space  8 . A deployment force, shown by arrow in  FIG. 122 , can be applied to the fixturing device  20 . The fixturing device  20  can slide along the slide rod  432  and between the first and second guide blocks  434  and  436 . The tip  440  can secure the gasket body  40  to the heart tissue  218 . When the fixturing device  20  is deployed, the first and second guide blocks  434  and  436  can resiliently alter the shape of the fixturing device  20  to create a friction lock between the fixturing device  20  and the first and/or second guide blocks  434  and/or  436 . 
     Each fixturing device  20  on the gasket body  40  can be selectively deployed or left undeployed. Each deployed fixturing device  20  can be removed from the heart tissue  218  by reversing the deployment force. 
       FIG. 123  illustrates the resilient nature of the can  60  shown in  FIG. 32 . The can  60  can be opened by an external opening force (as shown by the arrows) to allow the suture  6  or the snare  248  to pass through the hollow channel  62 . Pulling the suture  6  or the snare  248  through the hollow channel  62  with more than a minimum necessary pulling force can be sufficient to open the hollow channel  62  without the external opening force. The can  60  will resiliently return to the configuration shown in  FIG. 32  when the external opening force is removed and/or the suture  6  or the snare  248  is no longer pulled by more than the minimum necessary pulling force. The minimum necessary pulling force can be determined by the dimensions and materials of the can  60 , as known by those having ordinary skill in the art. 
       FIG. 124  illustrates a method of using the can  60  shown in  FIG. 33 . The suture  6  can be fed between the can  60  and the expandable obstacle  100 . The expandable obstacle  100 . can then be radially expanded, shown by the arrows, for example, a balloon catheter can be deployed and/or a self-expandable stent can be released. 
       FIG. 125  illustrates the cams  174  with the snare  248  or the suture  6  (shown in  FIG. 125  as the suture  6  for illustrative purposes) between the cams  174 . The cams  174  can be self-locking cam cleats. The cams  174  shown in  FIG. 125  can be biased to open upward. When the suture  6  is pulled upward, as shown by arrow  318 , the cams  174  can rotate freely as shown by arrows  320 . When the suture  6  is pulled downward, as shown by arrow  322 , the cams  174  can rotate as shown by arrows  324  until the cams  174  contact each other, at which point the cams  174  will lock into place and prohibit further downward movement of the suture  6 . 
       FIG. 126  illustrates a method of using the gasket body  40  shown in  FIG. 21 . Once the gasket body  40  has been positioned at the implantation site, the tabs  48  can be turned outward, shown by arrows. The downward and/or outward turned tabs  48  can engage the implantation site. The engagement can be from increased friction, puncture of the implantation site, and/or ingrowth from the implantation site into the tabs  48 . 
       FIG. 127  illustrates a method of using the gasket body  40  shown in  FIG. 22 . Once the gasket body  40  has been positioned at the implantation site, the side wings  58  can be curled inward, shown by arrows  526 , to form a cylinder through which the suture  6  can be passed. After the suture  6  is passed through the newly formed cylinder, the side wings  58  can be crushed to fix the suture  6  to the gasket body  40 . 
     The tabs  48  can be turned outward, shown by arrow  528 , and engage the implantation site, similar to the tabs  48  of the gasket body  40  of  FIG. 126 . The tabs  48  can be turned inward, not turned, or any tab-by-tab combination of turned outward, turned inward and not turned. The suture  6  can be passed through the receptacles  42  in the tabs  48 , whether the tabs  48  have been turned inward, outward or not turned. 
       FIG. 128  illustrates a method for attaching, shown by arrows, the gasket body  40  to a connection adapter  326  and a heart valve crown  328  that can have leaflets  530 , for example, U.S. Pat. No. 6,371,983 to Lane which is herein incorporated by reference in its entirety. The gasket body  40  can be used, for example, with 1-piece valves, 2-piece valves, mechanical valves and/or biological valves. A flexible gasket body  40  and/or cans  60  that are suspended from the gasket body  40  (e.g., by housing the cans  60  entirely within the sewing ring  14 ) can minimize the stress on the connection adapter  326  and/or the heart valve crown  328  and maximize the quality of the engagement between the gasket body  40  and the connection adapter  326  and/or the heart valve crown  328 . 
     Examples of methods for attaching the gasket body  40  to the connection adapter  326  and/or the heart valve crown  328  are disclosed in U.S. patent application Ser. No. 10/327,821. The crown  328  and/or connection adapter  326  can be circumferentially resilient or otherwise circumferentially and/or radially adjustable. The crown  328  and/or connection adapter  326  can have an embodiment enabling circumferentially and/or radially adjustability by using elements similar to those employed by the first prosthesis disclosed in U.S. patent application Ser. No. 10/327,821. The gasket body  40  can be attached directly to the crown  328 , as shown in  FIG. 129 . The gasket body  40  can be attached directly to the leaflets  530 , as shown in  FIG. 130 . The leaflets  530  can be inserted alone into the gasket body  40  by a method known by one having an ordinary skill in the art. The leaflets  530  can have be inserted while the leaflets are held by a leaflet gasket  532 , as shown in  FIG. 130 . The gasket body  40  may not directly attach to the leaflets  530 . 
     It is apparent to one skilled in the art that various changes and modifications can be made to this disclosure, and equivalents employed, without departing from the spirit and scope of the invention. Elements shown with any embodiment are exemplary for the specific embodiment and can be used on other embodiments within this disclosure.