Abstract:
Devices for attaching a first mass and a second mass and methods of making and using the same are disclosed. The devices can be made from an resilient, elastic or deformable materials. The devices can be used to attach a heart valve ring to a biological annulus. The devices can also be used for wound closure or a variety of other procedures such as anchoring a prosthesis to surrounding tissue or another prosthesis, tissue repair, such as in the closure of congenital defects such as septal heart defects, tissue or vessel anastomosis, fixation of tissue with or without a reinforcing mesh for hernia repair, orthopedic anchoring such as in bone fusing or tendon or muscle repair, ophthalmic indications, laparoscopic or endoscopic tissue repair or placement of prostheses, or use by robotic devices for procedures such as those above performed remotely.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application is a continuation of co-pending application Ser. No. 12/498,195, filed on Jul. 6, 2009, which is a continuation of application Ser. No. 10/681,700, filed Oct. 8, 2003, now U.S. Pat. No. 7,556,647. 
     
    
     BACKGROUND OF THE INVENTION 
       [0002]    1. Field of the Invention 
         [0003]    The present invention relates generally to a device for attaching a first mass to a second mass and methods of making and using the same. 
         [0004]    2. Description of the Related Art 
         [0005]    Prosthetic heart valves can replace defective human valves in patients. Prosthetic valves commonly include sewing rings, suture cuffs or rings that are attached to and extend around the outer circumference of the prosthetic valve orifice. 
         [0006]    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. 
         [0007]    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. 
         [0008]    During heart valve replacement procedures, the patient is on heart-lung bypass which reduces the patient&#39;s oxygen level and creates non-physiological blood flow dynamics. The longer a patient is on heat-lung bypass, the greater the risk for 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 from suture to suture, even for the same medical professional. 
         [0009]    In addition, sutures and other attachment devices are used in a variety of medical applications where the use of the device of the present invention would provide an advantage in fixing a first mass to a second mass, where the first mass is a tissue or a device or prosthesis, and the second mass is a tissue or a device or prosthesis. These applications include anchoring a prosthesis such as a synthetic or autologous graft to surrounding tissue or another prosthesis, tissue repair such as in the closure of congenital defects such as septal heart defects, tissue or vessel anastomosis, fixation of tissue with or without a reinforcing mesh for hernia repair, orthopedic anchoring such as in bone fusing or tendon or muscle repair, ophthalmic indications, laparoscopic or endoscopic tissue repair or placement of prostheses, or use by robotic devices for procedures performed remotely. 
         [0010]    For these indications and others, there is a need for a fixturing device to minimize the time spent fixturing certain devices or conduits, such as a valve prosthesis and a second mass, a vessel to another vessel or anatomical structure, tissue to tissue, surrounding tissue to a second prosthesis, and the like as described above. Furthermore, there is a need for a device that compliments existing suturing or attachment devices and methods and reduces fixturing times. Also, there is a need for a fixturing device that can be easily removed. There also exist a need to provide a fixturing device that can provide a consistent fixturing force. 
       BRIEF SUMMARY OF THE INVENTION 
       [0011]    A device for connecting a first mass to a second mass is disclosed. The device has a base and a first leg. The base has a base axis, a first end and a second end. The first leg extends from the first end of the base. The device has a first configuration and a second configuration. When the base is rotated with respect to the base axis, the device is in the first configuration. The device can also have a second leg extending from the second end of the base. 
         [0012]    Another device for connecting a first mass to a second mass is disclosed. The device has a base, a first leg and a second leg. The base has a base axis, a first end and a second end. The first leg has a first longitudinal axis and a first leg length. The first leg extends from the first end of the base. The second leg has a second longitudinal axis and a second leg length. The second leg extends from the second end of the base. The first leg length is substantially longer than the second leg length. 
         [0013]    The device can have a first configuration and a second configuration. When the base is rotated with respect to the base axis, the device is in the first configuration. 
         [0014]    Yet another device for connecting a first mass to a second mass is disclosed. The device has a base, a first leg and a second leg. The base is curved. The base has a base diameter, a first end and a second end. The first leg has a first longitudinal axis and a first leg length. The first leg extends from the first end of the base. The second leg has a second longitudinal axis and a second leg length. The second leg extends from the second end of the base. The device has a relaxed configuration. In the relaxed configuration the first leg crosses the second leg at a leg angle. The leg angle is less than 180 degrees. 
         [0015]    The leg angle can be less than or equal to 90 degrees. The leg angle can be less than or equal to 60 degrees. The base diameter can be less than or equal to 0.13 inches. The base diameter can be greater than or equal to 0.08 inches. 
         [0016]    A method of attaching a first mass to a second mass is disclosed. The method uses an attachment device having a base, a first leg, and a second leg. The base has a first end and a second end. The first leg extends from the first end of the base. The second leg extends from the second end of the base. The attachment device has a first configuration and a second configuration. The method includes holding the attachment device in the first configuration. The method also includes twisting the base of the attachment device to force the attachment device into the second configuration. Further, the method includes inserting the attachment device into the first mass and the second mass. The method also includes releasing the attachment device. 
         [0017]    Twisting the base of the attachment device can occur before inserting the attachment device into the first mass. Inserting the attachment device, at least partially, into the first mass can occur before twisting the base of the attachment device. 
         [0018]    Another method of attaching a first mass to a second mass is disclosed. The method includes forcibly holding an attachment device in a second configuration. The attachment device has a first configuration and the second configuration. The method also includes inserting the attachment device into the first mass and the second mass. The method also includes releasing the attachment device into the first configuration. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0019]      FIG. 1  is a front view of an embodiment of the attachment device. 
           [0020]      FIG. 2  is a side view of an embodiment of the attachment device. 
           [0021]      FIG. 3  is a bottom view of an embodiment of the attachment device. 
           [0022]      FIGS. 4-10  illustrate embodiments of section A-A of the attachment device. 
           [0023]      FIG. 11  is a front view of an embodiment of the attachment device. 
           [0024]      FIGS. 12 and 13  are bottom views of various embodiments of the attachment device shown in  FIG. 11 . 
           [0025]      FIGS. 14 and 15  are front views of various embodiments of the attachment device. 
           [0026]      FIG. 16  is a front perspective view of an embodiment of the attachment device. 
           [0027]      FIG. 17  is a top view of the embodiment of the attachment device shown in  FIG. 16 . 
           [0028]      FIG. 18  is a side perspective view of an embodiment of the attachment device. 
           [0029]      FIG. 19  is a side view of the attachment device shown in  FIG. 18 . 
           [0030]      FIGS. 20 and 21  are front views of various embodiments of the attachment device. 
           [0031]      FIG. 22  is a front perspective view of an embodiment of the attachment device. 
           [0032]      FIG. 23  is a top view of the embodiment of the attachment device shown in  FIG. 22 . 
           [0033]      FIG. 24  is a front view of an embodiment of the attachment device. 
           [0034]      FIGS. 25  illustrates an embodiment of a mandrel for manufacturing the attachment device. 
           [0035]      FIGS. 26 and 27  illustrate methods of changing the attachment device from a first configuration to a second configuration. 
           [0036]      FIGS. 28-30  are cross-sections illustrating an embodiment of a method of using the attachment device. 
           [0037]      FIGS. 31-33  are cross-sections illustrating an embodiment of a method of using the attachment device with the pledget shown in full perspective for  FIGS. 31 and 32 . 
           [0038]      FIGS. 34-36  are cross-sections illustrating an embodiment of a method of using the embodiment of the attachment device shown in  FIG. 14 . 
           [0039]      FIGS. 37-39  are cross-sections illustrating an embodiment of a method of using the embodiment of the attachment device shown in  FIGS. 18 and 19 . 
           [0040]      FIGS. 40-42  are cross-sections illustrating an embodiment of a method of using the attachment device. 
           [0041]      FIG. 43  is a cross-section illustrating a method of using the flag. 
           [0042]      FIG. 44  illustrates an embodiment of the tool for deploying the attachment device. 
           [0043]      FIG. 45  illustrates the end of a tool for deploying the attachment device. 
           [0044]      FIGS. 46 and 47  illustrate using the tip of an embodiment of the tool to deploy the attachment device. 
       
    
    
     DETAILED DESCRIPTION 
       [0045]      FIGS. 1 through 3  illustrate an attachment device  2 . The attachment device  2  can have a base  4 , legs  6 , and a tip  8  at the end of each leg  6 . (Phantom lines delineate the base  4 , legs  6  and tips  8 .) The base  4 , legs  6  and tips  8  can be separate or integral elements. A flag  10  can be attached to, and extend from, the base  4 . The base  4  and/or the legs  6  can be straight or curved. 
         [0046]    The attachment device  2  can be made from a deformable or elastic material or a combination of materials having resulting deformable or elastic properties. The material can be, for example, 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, echogenic, radioactive, radiopaque materials or combinations thereof Examples of radiopaque materials are barium sulfate, titanium, stainless steel, nickel-titanium alloys, tantalum and gold. 
         [0047]    Any or all elements of the attachment device  2  can be a matrix for cell ingrowth or used with a fabric, for example a covering (not shown) that acts as a matrix for cell ingrowth. The fabric can be, for example, polyester (e.g., DACRON® from E. I. duPont de Nemours and Company, Wilmington, Del.), polypropylene, PTFE, ePTFE, nylon, extruded collagen, silicone or combinations thereof 
         [0048]    The attachment device  2  and/or the fabric 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-I (COX-I) 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-I 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 E2 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, Spi Increases Expression ofCyclooxygenase-2 Hypoxic Vascular Endothelium.  J Biological Chemistry  275 (32) 24583-245S9; and Pyo et al, Targeted Gene Disruption of Matrix Metalloproteinase- 9  (Gelatinase B) Suppresses Development of Experimental Abdominal Aortic Aneurysms,  J Clinical investigation  105 (II), I64I-I649 which are all incorporated by reference in their entireties. 
         [0049]    A base axis  12  can extend longitudinally through the transverse cross-sectional center of the base  4 . As shown in  FIG. 2 , when viewed from the side, the base axis  12  can form a base plane angle  14  from about 0° to about 30°, for example about 10°. The base  4  can have a base inner radius  16  from about 0.25 mm (0.010 in.) to about 19.1 mm (0.750 in.), for example about 1.91 mm (0.075 in.). The proximal end of the base  4  can be formed into a table  17 . The table  17  can be a flat surface that tapers to the base  4 . 
         [0050]    The base  4  and legs  6  can have a shaft diameter  18  from about 0.03 mm (0.001 in.) to about 6.35 mm (0.250 in.), for example, about 0.51 mm (0.020 in.). The base  4  and legs  6  can have the same or different shaft diameters  18 . A base neutral radius  19  can be the base inner radius  16  and half the shaft diameter  18 . As shown in  FIG. 1 , the legs  6  can intersect at a leg angle  20  in or near the plane of the attachment device  2  or in or near the approximate plane of the base  4 . An approximate plane is a plane that can be used whether the base  4  does or does not fall on a flat plane. If the base  4  is a straight line or a point, the approximate plane of the base  4  can be calculated using the points of the legs  6  that are nearest the base  4  and out of line with the base  4 . The leg angle  20  can be from about 180° to about 10°, more narrowly from about 90° to about 60°, for example about 45° or, for example, about 60°. 
         [0051]    The length from an end of the base  4  to a longitudinal leg axis  24  can be a body length  22 . The body length  22  can be from about 0.25 mm (0.010 in.) to about 12.7 mm (0.500 in.), for example about 2.913 mm (0.1147 in.). The length between the distal end of one tip  8  and the distal end of the opposite tip  8  can be a tip distance  26 . The tip distance  26  can be from about 0.03 mm (0.001 in.) to about 25.4 mm (1.000 in.), more narrowly about 1.3 mm (0.050 in.) to about 3.18 mm (0.125 in.), for example about 2.3 mm (0.090 in.). 
         [0052]    The tip  8  can have a tip length  28  from about 0.05 mm (0.002 in.) to about 12.7 mm (0.500 in.), for example about 1.0 mm (0.040 in.). The tip  8  can have a tip angle  30  from about 5° to about 90°, for example about 30°. The tips  8  can be straight, pointed ends, curve out of line (shown by alternative tips  8   a  and  8   b , drawn in phantom lines in  FIGS. 2 and 3 ) from the nearest end of the leg  6 , or combinations thereof. 
         [0053]    The tips  8  and/or legs  6  can have retention devices  29 . The retention devices  29  can be barbs, spikes, hooks, threads, ribs, splines, a roughened surface, a sintered surface, a covered surface (e.g., with DACRON® from E. I. duPont de Nemours and Company, Wilmington, Del.) or combinations thereof. A retention coating  31 , for example a biodegradable coating or filler such as gel or gelatin or otherwise removable, can be on and/or around and/or near the retention devices  29 . The retention coating  31  (shown in phantom lines) can be configured to render the retention device  29  substantially ineffective until a substantial amount of the retention coating  31  has been biodegraded or otherwise removed. 
         [0054]    The legs  6  can have mechanical interfaces  33 , for example, a slot, snap, protrusion, latch, catch or combinations thereof. The interfaces  33  can be aligned so the interface on one leg  6  meets the interface  33  on the other leg  6  at the point where the legs  6  cross. The interfaces  33  can removably attach to each other. 
         [0055]      FIGS. 4 through 10  illustrate examples of cross-section A-A of the legs  6  and/or the base  4 . The cross-section A-A of the legs  6  can be the same or different as the cross-sections of the base  4 . The cross-sections of the base  4  and/or legs  6  can be constant or vary along their respective lengths.  FIGS. 4 through 8 , respectively, illustrate circular, rectangular (including square), triangular, substantially flat, and star-shaped or irregular cross-sections A-A.  FIG. 9  illustrates an oval cross-section A-A. A ratio of the shaft diameter  18  to the length of a minor axis  32  can be from about 1:1 to about 20:1, for example 10:1. 
         [0056]      FIG. 10  illustrates a cavity  36  inside the cross-section A-A. The cavity  34  can be hollow or can be filled completely or partially. The cavity  34  can be filled with an agent delivery matrix known to one having ordinary skill in the art and/or a therapeutic and/or diagnostic agent and/or echogenic and/or radioactive and/or radiopaque materials, for example, the agents and/or materials listed supra. The type and amount of filling can vary along the length of the base  4  and/or legs  6 . The ratio of the shaft diameter  18  to a cavity diameter  36  can be from about 1:1 to about 50:1, for example, about 2:1. 
         [0057]      FIG. 11  illustrates an attachment device  2  that can have a leg  6  that can have a first leg segment  38  and a second leg segment  40 . The first leg segment  38  can extends from the base  4 . The second leg segment  40  can extend on a proximal end from the first leg segment  38 . The tip  8  can extend from a distal end of the second leg segment  40 . The second leg segment  40  can have a different radius of curvature than the first leg segment  38  and/or form an angle with respect to the first leg segment  40 .  FIG. 12  illustrates that the second leg segment  40  can form an angle (shown by arrows) with the approximate plane of the base  4 .  FIG. 13  illustrates that the first leg segment  38  can form an angle (shown by arrows) with the approximate plane of the base  4 . The second leg segments  40  can be substantially parallel with the approximate plan of the base  4 . 
         [0058]      FIG. 14  illustrates an attachment device  2  that can have a first leg  6   a  that can be substantially longer than a second leg  6   b . The ratio of a first leg-tip length  22   a  to a second leg-tip length  22   b  can be from about 1:1 to about 10:1, for example, about 3:1. 
         [0059]      FIG. 15  illustrates an attachment device that can have a first leg radius  42  and a second leg radius  44 . The ratio of the first leg radius  42  to the second leg radius  44  can be from about 1:1 to about 50:1, for example about 10:1. 
         [0060]      FIGS. 16 and 17  illustrate an attachment device  2  that can have a “flat top.” The approximate plane of the second leg  6   b  can form an angle, for example about 90°, with the approximate plane of the base  4 . When in use, the flat top can further anchor the attachment device  2  against the first mass and/or second mass.  FIGS. 18 and 19  illustrate an attachment device  2  that can have arms  6  that can wrap around the base axis  12 . 
         [0061]      FIG. 20  illustrates an attachment device  2  that can have arms  46  that can extend from the base  4  and/or the legs  6 . When deployed, the arms  46  can squeeze tissue between the arms  46  and the legs  6  and/or base  4  for additional retention force. Anchors  48  can extend from the arms  46 , for example at the distal ends of the arms  46 . The anchors  48  can be, for example, hooks, barbs, spikes, staples or combinations thereof. The anchors  48  can extend directly from the base  4  and/or legs  6  with or without arms  46  separately attached to the base  4  and/or legs  6 .  FIG. 21  illustrates an attachment device  2  that can have a straight base  4  and can have the arms  46  extending from the base  4 . 
         [0062]      FIGS. 22 and 23  illustrate an attachment device that can have first, second and third legs  6   a ,  6   b  and  6   c . The base  4  can be a platform, wireframe, or point attachment which can be spot-welded or brazed, tube crimped or otherwise mechanically connected. The planes of the legs  6   a ,  6   b  and  6   c  can intersect at substantially equal angles, about 120°, or unequal angles. 
         [0063]      FIG. 24  illustrates an attachment device that can have a first loop  49  and a second loop  51 . The first loop  49  can be formed from the base  4  and a proximal portion of the first leg segments  38 . The second loop  51  can be formed from a distal portion of the first leg segments  38  and a proximal portion of the second leg segments  40 . 
       Method of Making 
       [0064]      FIG. 25  illustrates a mandrel  50  that can be used to form the attachment device  2 , for example during heat treatment. The base  4  and/or legs  6  can be held on the mandrel  50  by a single cylinder  52 , a formed path  54 , a pressure plate  56 , for example a washer under a screw or combinations thereof Methods for forming shape memory alloys (e.g., Nitinol) are known to those having ordinary skill in the art. The tips  8  can be formed, for example, by grinding, electropolishing, or precision sharpening (e.g., polishing services from Point Technologies, Inc., Boulder, Colo.) to a satisfactory geometry, including a trocar point, beveled, rounded, tapered, pointed or flattened. 
         [0065]    Other methods known to one having ordinary skill in the art can be used to manufacture the attachment device  2  and/or its elements. 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), etching or combinations thereof. 
         [0066]    Any elements, sub-assemblies, or the attachment device  2  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, utilizing materials such as PTFE (e.g., TEFLON® from E. I. duPont de Nemours and Company, Wilmington, Del.), polyester (e.g., DACRON® from E. I. duPont de Nemours and Company, Wilmington, Del.), gelatin, gel, other polymers or combinations thereof. 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. 
         [0067]    The attachment device  2 , or any element thereof (e.g., the base  4 ) can be covered with a fabric, for example polyester (e.g., DACRON® from E. I. duPont de Nemours and Company, Wilmington, Del.), polypropylene, PTFE (e.g., TEFLON® from E. I. duPont de Nemours and Company, Wilmington, Del.), ePTFE, nylon, extruded collagen, gel, gelatin, silicone or combinations thereof. Methods of covering an implantable device with fabric are known to those having ordinary skill in the art, for example, sintering, spray coating, adhesion, loose covering, dipping or combinations thereof. 
       Methods of Using 
       [0068]    The attachment device  2  can have a first configuration (e.g., the configuration shown in  FIGS. 26 and 27 ) and a second configuration (e.g., the configuration shown in  FIGS. 1 through 3 ). The attachment device  2  can have the second configuration when the attachment device is in a relaxed state, with no external forces applied (e.g., prior to insertion or use). The attachment device  2  can have the first configuration when external forces are applied, such as by a delivery tool prior to delivery. When external forces are removed from the attachment device  2 , the attachment device  2  can revert from the first configuration to the second configuration. 
         [0069]    The attachment device can substantially revert to the second configuration even when some permanent hysteresis deformation occurs and/or when a foreign object (e.g., a first and/or second mass) is obstructing the attachment device  2 . When the attachment device  2  has the first configuration, one or both legs  6  can be rotated with respect to the base  4  (e.g., by rotating the base  4  around the base axis  12 , one or both legs  6  splay or separate as they are torqued by the twisting or rotating around of the base). 
         [0070]      FIG. 26  illustrates a method of forcing the attachment device to have the first configuration. The attachment device  2  can be forced to have the first configuration by the application of a base torque, shown by arrows  58 , applied about the base axis  12 . The base torque can be directly applied to the base  4 . The base torque indirectly becomes, or can be applied as, a leg torque, as shown by arrows  60   a  and  60   b , to the legs  6   a  and/or  6   b  about the leg axes  24   a  and  24   b . If approximately two times the base neutral radius  19  is less than the tip distance  26 , the legs  6  will splay outward when entering the first mass  68 . If approximately two times the base neutral radius  19  is greater than or equal to the tip distance  26 , the legs  6  will splay inward or stay vertical when deploying into the first mass  68 . 
         [0071]      FIG. 27  illustrates a method of forcing the attachment device to have the first configuration. The attachment device  2  can be forced to have the first configuration by the application of a pivot torque, shown by arrows  62 , applied about the area where the base  4  attaches to the legs  6 , so that the legs  6  are forced to pivot radially outward from each other. The pivot torque can be applied by applying outward translational forces, as shown by arrows  64 , to one or both legs  6 . The pivot torque can be applied by applying translational forces to the base  4 , as shown by arrows  66 . 
         [0072]    As illustrated in  FIGS. 28 through 30 , the attachment device  2  can be deployed to attach a first mass  68  to a second mass  70 . The first mass  68  and/or the second mass  70  can be a prosthesis and/or a tissue, or both tissue or both prostheses. The prosthesis can be, for example, cardiac leads, markers, stents, grafts, stent-grafts, heart valves, annuloplasty rings, autografts, allografts, xenografts or any assemblies thereof or combination thereof. The tissue can be, for example, vessels, valves, organs (e.g., intestine, heart, skin, liver, kidney, urethra, bone mass, tendon, nerve, muscle), calcified soft tissue or any combination thereof. 
         [0073]    Heart valve assemblies disclosed by Griffin et al. in U.S. Pat. No. 6,241,765, by Lane in U.S. Pat. No. 6,371,983 and by Ritz in U.S. Pat. No. 5,976,183, both of which are hereby incorporated in their entireties, can be placed with the use of the device of the present invention. Other heart valve assemblies that can be used 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 Calif.); 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 attachment devices of the present invention may be deployed to implant these various devices in the supra-annular position, or infrannular, depending on the geometry and preferred placement of a particular device. Similarly, it may be advantageous to use the attachment devices  2  of the present invention to secure a sewing ring, or first prosthesis by placing them horizontally or vertically within or around the annulus of such ring, prior to placing a second prosthesis including a valve structure, as provided in U.S. application Ser. No. 10/646,639 filed, 22 Aug. 2003, hereby incorporated by reference in its entirety. 
         [0074]      FIG. 28  illustrates that the attachment device  2  can be held in the first configuration. The attachment device  2  can be fed through a pledget  71  before the attachment device  2  is forced into the first mass  68 . The pledget  71  can be a piece of fabric, for example, a fabric listed supra. The pledget  71  can be loaded onto the attachment device  2  before use.  FIG. 29  illustrates that the attachment device  2  can be forced, as shown by arrow  72 , into and through the first mass  68  and part of the second mass  70 .  FIG. 30  illustrates that the attachment device  2  can be released from having the first configuration. The attachment device  2  can revert to having substantially the second configuration. A pinching force, shown by arrows, can be applied to the attachment device  2  to encourage additional reversion of the attachment device  2  to having the second configuration. The attachment device  2  shown in  FIG. 24  can be deployed in the same manner as described supra, except that the attachment device  2  shown in  FIG. 24  can be rotated sufficiently to straighten the first and second loops, before or during deployment. 
         [0075]    The attachment device  2  can be removed and redeployed at any stage of deployment supra, for example, if the surgeon is unsatisfied with the position of the attachment device  2 , or if the prosthesis need replacing or “redoing” at a point in the future. If the attachment device  2  has a retention device  29 , when the retention coating  31  sufficiently biodegrades or is otherwise removed, the retention devices  29  will become exposed and can substantially prevent the removal of the attachment device  2  from the deployment site. Removal may still be achieved however, by apply sufficient force (by a tool or other device) to overcome the strength of the secondary retention element. 
         [0076]      FIGS. 31  though  33  illustrate a method of deploying the attachment device  2  to attach a first mass  68  to a second mass  70 . The pledget  71  can be fed over the attachment device  2  before use. The pledget  2  can be formed as a rectangular container with an access opening  73 , for example a slit, hole, or aperture, to allow access to the base  4  of the attachment device  2 . The attachment device  2  can have the second configuration. The attachment device  2  can be forced, as shown by arrow, so the tips  8  engage the first mass  68 .  FIG. 32  illustrates that, with the tips  8  held by the first mass  68 , a longitudinal torque, shown by arrows, applied to the attachment device  2  about a longitudinal axis  74  can then force the attachment device  2  into the first configuration. As illustrated by  FIG. 33 , the attachment device  2  can be forced, shown by arrow, through the first mass  68  and part of the second mass  70 . The longitudinal torque (not shown in  FIG. 33 ) can be removed during deployment or after the attachment device  2  is completely deployed into the first and second masses  68  and  70 . The pledget  71  can be crushed during deployment. 
         [0077]      FIGS. 34 through 36  illustrate a method of deploying the attachment device shown in  FIG. 14 . The first leg  6   a  can be forced, as shown by arrow, into and through the first mass  68  and part of the second mass  70 . The first leg  6   a  can have a “paddle” (not shown). The paddle can be a flat oval or long rectangular cross-sectional shape on one leg. The paddle can increase resistive force with the first and/or second mass  68  and/or  70  when applying torque to the attachment device  2 . 
         [0078]      FIG. 35  illustrates that the attachment device  2  can be forced into the first configuration by applying a base torque, shown by arrows  58 . The second leg  6   b  can then rotate outwardly from the attachment device  2 , as shown by arrow  76 . 
         [0079]      FIG. 36  illustrates that the attachment device  2  can be forced, shown by arrow, through the first mass  68  and part of the second mass  70 , The base torque (not shown in  FIG. 36 ) can be removed during deployment or after the attachment device  2  is completely deployed into the first and second masses  68  and  70 . 
         [0080]      FIGS. 37 through 39  illustrate a method of deploying the attachment device  2  shown in  FIGS. 18 and 19 .  FIG. 37  illustrates that the base  4  and the tips  8  can be placed in contact with or near the first mass  68 .  FIG. 38  illustrates that the arms  6  can be rotated, as shown by arrows, about the base axis  12 . The arms  6  can be rotated to cause the arms  6  to be forced into the first mass  68 .  FIG. 39  illustrates that the arms  6  can be rotated, as shown by arrows, further about the base axis  12 . The arms  6  can be forced into and through the second mass  70 . The arms  6  can re-enter the first mass  68 . 
         [0081]      FIGS. 40 through 42  illustrate a method of deploying the attachment device  2  to attach a first mass  68  to a second mass  70 . The first mass  68  and the second mass  70  can be two sections of the same object, such as when the attachment device  2  is used to close a wound.  FIG. 40  illustrates that the attachment device  2  can be held in the first configuration.  FIG. 41  illustrates that the attachment device  2  can be forced, as shown by arrow  72 , so that the first leg  6   a  inserts into the first mass  68  and that the second leg  6   b  inserts into the second mass  70 .  FIG. 42  illustrates that the attachment device  2  can be released from having the first configuration. The attachment device  2  can revert to having substantially the second configuration, causing the legs  6   a  and  6   b  to rotate inward, shown by arrows  78 , applying force, shown by arrows  80 , to the first mass  68  and the second mass  70  such that the first and second masses  68  and  70  move toward each other. 
         [0082]    The attachment device  2  can be removed from the second mass  70  and/or the first mass  68 , when applicable, by reversing the steps of the deployment methods supra. 
         [0083]      FIG. 43  illustrates that, during use, the attachment device  2  can be covered by new tissue growth  82 . The flag  10  can extend outside of the new tissue growth  82  (as shown) or be located just below the surface but palpable. The flag  10  can act as a marker, palpable or visible by direct vision or imaging modalities known in the art (e.g., x-ray, magnetic resonance imaging (MRI), ultrasound, computed tomography (CT), echocardiogram) for example to locate the attachment device  2  in case of removal of the attachment device  2 . The flag  10  can be made of, for example, suture material (e.g., Nylon, polyglycolic acid, polyester such as DACRON® from E. I. duPont de Nemours and Company, Wilmington, Del., metals such as those used in the other elements of the attachment device  2 , other polymers or combinations thereof). The base  4  can also serve this function (e.g., of a marker) in some applications. 
         [0084]      FIG. 44  illustrates a tool  84  for deploying the attachment device  2 . The tool  84  can have a first lever  86  and a second lever  88 . The first lever  86  can be rotatably attached to the second lever  88  at a pivot  90 . The first and second levers  86  and  88  can have a handle  92  at each lever&#39;s first end and a pad  94  at each lever&#39;s second end. The pads  94  can be used to hold the attachment device  2 . When a force is applied to the handles  92 , shown by arrows  96 , the force is transmitted, shown by arrows  98 , to the pads  94 . 
         [0085]    A driver shaft  100  can have a driver handle  102  at a first end and grips  104  at a second end. The pivot  90  can have a longitudinal channel  106 . The driver shaft  100  can pass through the longitudinal channe 1106  and/or be rotatably mounted to a case (not shown) fixed to a lever  86  or  88 . The grips  104  can be releasably attached to the attachment device  2 . The attachment device  2  can be rotated about the longitudinal axis  2  by releasing the pads  94  and rotating, as shown by arrows  108 , the driver handle. 
         [0086]      FIG. 45  shows the end of a tool  84  for deploying the attachment device  2  before the attachment device  2  has been loaded into the tool  84 . The tool  84  can have a top part  110  and a bottom part  112 . The top part  110  can be removably attached to the bottom part, as shown by arrow  114 . 
         [0087]    The top part  110  and/or the bottom part  112  can have grooves  116  sized to fit the base  4  and a portion of one or more legs  6  when the attachment device  2  has the first configuration. The attachment device  2  can be forced to have the first configuration and be loaded into the tool  84 , as shown by arrow  118 . The top part  110  can be attached to the bottom part  112  with the attachment device  2  seated (not shown) in the grooves  116 . 
         [0088]    The attachment device  2  can be placed at a desired deployment site by the tool  84 . 
         [0089]    The device  2  can be deployed from the tool  84  by removing the top part  110  from the bottom part  112 , and removing the tool  84  from the deployment site. 
         [0090]      FIGS. 46  illustrates an end of a tool  84 . The tool  84  can have a case  120  with an anvil  122  and leg ports  124 . The case  120  can be slidably attached to a slide  126 . The attachment device  2  can be loaded around the anvil  122 . The legs  6  can protrude from the case  120  through the leg ports  124 . 
         [0091]      FIG. 47  illustrates a method of using the tool  84  of  FIG. 46  to deploy the attachment device  2 . The slide  126  can be forced, as shown by arrow  128 , toward the anvil  122 . The slide  126  can push the base  4  against the anvil  122 , causing the legs  6  to rotate outward, as shown by arrows  76 . The surface geometry of the anvil  122  and the slider  126  can match the surface geometry of the attachment device  2 , when the attachment device is fully strained, as shown in  FIG. 39 . The attachment device  2  can then be inserted into the desired deployment site (not shown). When the attachment device  2  is in place, the attachment device  2  can be deployed from the tool  84 , for example, by sliding the anvil  122  out of the way (perpendicular to the plane of  FIG. 47 ) and forcing the attachment device  2  out the end of the tool  84  with the slide  126 . 
         [0092]    The ends of the tools  84  shown in  FIGS. 45 through 47  can be pivoted to the remainder of the tool  84  by methods known to those having ordinary skill in the art. The pivotable end of the tool  84  can improve access to deployment sites not as easily accessible by a non-articulating tool  84 . The tool  84  can be non-articulatable. It would also be possible when access to the site of implantation allows, to employ a tool substantially similar to a needle driver tool known to those skilled in the art. 
         [0093]    Additional disclosure is included in U.S. patent application Ser. Nos. 10/327,821 and 10/646,639, filed 20 Dec. 2002 and 22 Aug. 2003, respectively, which are hereby incorporated by reference in their entireties. 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.