Patent Publication Number: US-2023147741-A1

Title: Device, system, and method for transcatheter treatment of valvular regurgitation

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     The present application is a continuation application of U.S. application Ser. No. 15/931,181 filed May 13, 2020, which is a continuation application of U.S. application Ser. No. 16/129,194 filed Sep. 12, 2018, which is a continuation-in-part application of U.S. application Ser. No. 15/918,988 filed Mar. 12, 2018, which claims priority under 35 U.S.C. § 119(e) to U.S. Provisional Application No. 62/470,684, filed on Mar. 13, 2017. Each of the foregoing applications of which are hereby incorporated by reference in their entireties. Any and all applications for which a foreign or domestic priority claim is identified in the Application Data Sheet as filed with the present application, are hereby incorporated by reference in their entirety under 37 CFR 1.57. 
    
    
     BACKGROUND 
     Field 
     The present disclosure generally provides improved medical devices, systems, and methods, typically for treatment of heart valve disease and/or for altering characteristics of one or more valves of the body. Embodiments include implants for treatment of mitral valve regurgitation. 
     The human heart receives blood from the organs and tissues via the veins, pumps that blood through the lungs where the blood becomes enriched with oxygen, and propels the oxygenated blood out of the heart to the arteries so that the organ systems of the body can extract the oxygen for proper function. Deoxygenated blood flows back to the heart where it is once again pumped to the lungs. 
     The heart includes four chambers: the right atrium (RA), the right ventricle (RV), the left atrium (LA) and the left ventricle (LV). The pumping action of the left and right sides of the heart occurs generally in synchrony during the overall cardiac cycle. 
     The heart has four valves generally configured to selectively transmit blood flow in the correct direction during the cardiac cycle. The valves that separate the atria from the ventricles are referred to as the atrioventricular (or AV) valves. The AV valve between the left atrium and the left ventricle is the mitral valve. The AV valve between the right atrium and the right ventricle is the tricuspid valve. The pulmonary valve directs blood flow to the pulmonary artery and thence to the lungs; blood returns to the left atrium via the pulmonary veins. The aortic valve directs flow through the aorta and thence to the periphery. There are normally no direct connections between the ventricles or between the atria. 
     The mechanical heartbeat is triggered by an electrical impulse, which spreads throughout the cardiac tissue. Opening and closing of heart valves may occur primarily as a result of pressure differences between chambers, those pressures resulting from either passive filling or chamber contraction. For example, the opening and closing of the mitral valve may occur as a result of the pressure differences between the left atrium and the left ventricle. 
     At the beginning of ventricular filling (diastole) the aortic and pulmonary valves are closed to prevent back flow from the arteries into the ventricles. Shortly thereafter, the AV valves open to allow unimpeded flow from the atria into the corresponding ventricles. Shortly after ventricular systole (i.e., ventricular emptying) begins, the tricuspid and mitral valves normally shut, forming a seal, which prevents flow from the ventricles back into the corresponding atria. 
     Unfortunately, the AV valves may become damaged or may otherwise fail to function properly, resulting in improper closing. The AV valves are complex structures that generally include an annulus, leaflets, chordae and a support structure. Each atrium interfaces with its valve via an atrial vestibule. The mitral valve has two leaflets; the analogous structure of the tricuspid valve has three leaflets, and apposition or engagement of corresponding surfaces of leaflets against each other helps provide closure or sealing of the valve to prevent blood flowing in the wrong direction. Failure of the leaflets to seal during ventricular systole is known as malcoaptation, and may allow blood to flow backward through the valve (regurgitation). Heart valve regurgitation can have serious consequences to a patient, often resulting in cardiac failure, decreased blood flow, lower blood pressure, and/or a diminished flow of oxygen to the tissues of the body. Mitral regurgitation can also cause blood to flow back from the left atrium to the pulmonary veins, causing congestion. Severe valvular regurgitation, if untreated, can result in permanent disability or death. 
     Description of the Related Art 
     A variety of therapies have been applied for treatment of mitral valve regurgitation, and still other therapies may have been proposed but not yet actually used to treat patients. While several of the known therapies have been found to provide benefits for at least some patients, still further options would be desirable. For example, pharmacologic agents (such as diuretics and vasodilators) can be used with patients having mild mitral valve regurgitation to help reduce the amount of blood flowing back into the left atrium. However, medications can suffer from lack of patient compliance. A significant number of patients may occasionally (or even regularly) fail to take medications, despite the potential seriousness of chronic and/or progressively deteriorating mitral valve regurgitation. Pharmacological therapies of mitral valve regurgitation may also be inconvenient, are often ineffective (especially as the condition worsens), and can be associated with significant side effects (such as low blood pressure). 
     A variety of surgical options have also been proposed and/or employed for treatment of mitral valve regurgitation. For example, open-heart surgery can replace or repair a dysfunctional mitral valve. In annuloplasty ring repair, the posterior mitral annulus can be reduced in size along its circumference, optionally using sutures passed through a mechanical surgical annuloplasty sewing ring to provide coaptation. Open surgery might also seek to reshape the leaflets and/or otherwise modify the support structure. Regardless, open mitral valve surgery is generally a very invasive treatment carried out with the patient under general anesthesia while on a heart-lung machine and with the chest cut open. Complications can be common, and in light of the morbidity (and potentially mortality) of open-heart surgery, the timing becomes a challenge—sicker patients may be in greater need of the surgery, but less able to withstand the surgery. Successful open mitral valve surgical outcomes can also be quite dependent on surgical skill and experience. 
     Given the morbidity and mortality of open-heart surgery, innovators have sought less invasive surgical therapies. Procedures that are done with robots or through endoscopes are often still quite invasive, and can also be time consuming, expensive, and in at least some cases, quite dependent on the operator&#39;s skill. Imposing even less trauma on these sometimes frail patients would be desirable, as would be providing therapies that could be successfully implemented by a significant number of physicians using widely distributed skills. Toward that end, a number of purportedly less invasive technologies and approaches have been proposed. These include devices which seek to re-shape the mitral annulus from within the coronary sinus; devices that attempt to reshape the annulus by cinching either above to below the native annulus; devices to fuse the leaflets (imitating the Alfieri stitch); devices to re-shape the left ventricle, and the like. 
     Perhaps most widely known, a variety of mitral valve replacement implants have been developed, with these implants generally replacing (or displacing) the native leaflets and relying on surgically implanted structures to control the blood flow paths between the chambers of the heart. While these various approaches and tools have met with differing levels of acceptance, none has yet gained widespread recognition as an ideal therapy for most or all patients suffering from mitral valve regurgitation. 
     Because of the challenges and disadvantages of known minimally invasive mitral valve regurgitation therapies and implants, still further alternative treatments have been proposed. Some of the alternative proposals have called for an implanted structure to remain within the valve annulus throughout the heart beat cycle. One group of these proposals includes a cylindrical balloon or the like to remain implanted on a tether or rigid rod extending between the atrium and the ventricle through the valve opening. Another group relies on an arcuate ring structure or the like, often in combination with a buttress or structural cross-member extending across the valve so as to anchor the implant. Unfortunately, sealing between the native leaflets and the full perimeter of a balloon or other coaxial body may prove challenging, while the significant contraction around the native valve annulus during each heart beat may result in significant fatigue failure issues during long-term implantation if a buttress or anchor interconnecting cross member is allowed to flex. Moreover, the significant movement of the tissues of the valve may make accurate positioning of the implant challenging regardless of whether the implant is rigid or flexible. 
     In light of the above, it would be desirable to provide improved medical devices, systems, and methods. It would be particularly desirable to provide new techniques for treatment of mitral valve regurgitation and other heart valve diseases, and/or for altering characteristics of one or more of the other valves of the body. The need remains for a device which can directly enhance leaflet coaptation (rather than indirectly via annular or ventricular re-shaping) and which does not disrupt leaflet anatomy via fusion or otherwise, but which can be deployed simply and reliably, and without excessive cost or surgical time. It would be particularly beneficial if these new techniques could be implemented using a less-invasive approach, without stopping the heart or relying on a heart-lung machine for deployment, and without relying on exceptional skills of the operator to provide improved valve and/or heart function. 
     SUMMARY 
     The disclosure generally provides improved medical devices, systems, and methods. New coaptation assistance elements, systems, and methods for treatment of mitral valve regurgitation and other valve diseases are disclosed. The coaptation assistance element may remain within the blood flow path as the valve moves back and forth between an open-valve configuration and a closed valve configuration. The coaptation assistance elements may be relatively thin, elongate (along the blood flow path), and/or conformable structures which extend laterally across some, most, or all of the width of the valve opening, allowing coaptation between at least one of the native leaflets and the coaptation assistance element. The devices described herein can be used with any valve of the human body, including valves with two leaflets or three leaflets. 
     In some embodiments, an advantage is the ability to retrieve the coaptation assistance element. In some embodiments, the coaptation assistance element has a single anchor, which can engage or disengage tissue. In some embodiments, the anchor is captive within an annular hub of the coaptation assistance element. In some embodiments, the captive anchor is removed simultaneously with the removal of the coaptation assistance element. In some embodiments, the coaptation assistance element can include secondary anchors. In some embodiments, the coaptation assistance element can include passive anchors. In some embodiments, engagement of the anchor with the tissue positions one or more passive anchors into engagement with tissue. In some embodiments, an advantage is to retrieve the coaptation assistance element during a procedure. In some embodiments, the coaptation assistance element can be repositioned during a surgical procedure. In some embodiments, the coaptation assistance element can be removed from the patient during a subsequent surgical procedure. In some embodiments, the coaptation assistance element can be replaced by another device during a subsequent surgical procedure. In some embodiments, a single annular anchor facilitates the ability to retrieve the coaptation assistance element. In some embodiments, the location of the annular anchor facilitates the ability to retrieve the coaptation assistance element. In some embodiments, the ability to collapse the coaptation assistance element with the purse-string suture as described herein facilitates the ability to retrieve the coaptation assistance element. 
     In some embodiments, an advantage is the connection between the coaptation assistance element and the delivery catheter. In some embodiments, the coaptation assistance element includes an annular hub with features to engage the delivery catheter. In some embodiments, the coaptation assistance element and the delivery catheter are removably coupled such that the coaptation assistance element can be released from the delivery catheter during a procedure. In some embodiments, one or more secondary structures couples the coaptation assistance element and the delivery catheter after the coaptation assistance element is released from the delivery catheter. In some embodiments, the one or more secondary structures include the purse-string suture as descried herein. In some embodiments, the one or more secondary structures facilitate the collapse and/or expansion of the coaptation assistance element. In some embodiments, the coaptation assistance element and the delivery catheter are rotationally fixed relative to each other when coupled. In some embodiments, relative motion of the delivery catheter causes motion of the coaptation assistance element. 
     In some embodiments, an advantage is the coaptation assistance element can be delivered with a hub-leading orientation. In some methods of use, the annular hub can be moved into position relative to the anatomical structures. In some methods of use, the ventricular end of the coaptation assistance element can be retained within the delivery catheter until the annular hub is positioned. In some methods of use, once the annular hub and/or the annular anchor are engaged with the tissue, the coaptation assistance element can be expanded. In some methods of use, once the annular hub and/or the annular anchor are engaged with the tissue, the ventricular end of the coaptation assistance element can be positioned. 
     In some embodiments, an advantage is the coaptation assistance element can be delivered with a strut-leading orientation. In this method of use, one or more of the struts of the coaptation assistance element can be moved into position relative to the anatomical structures prior to the positioning of the annular hub. In some methods of use, the coaptation assistance element can be expanded or partially expanded prior to the engagement of the annular anchor. In some methods of use, the annular hub can be retained within the delivery catheter until one or more of the struts are positioned. In some methods of use, once the struts are positioned, the annular anchor can be engaged with the tissue. 
     In some embodiments, an advantage is the annular anchor can be rotated independently of the coaptation assistance element. As described herein, the coaptation assistance element is coupled to one portion of the delivery catheter. As described herein, the annular anchor is independently coupled to another portion of the delivery catheter, such as a driver disposed with the delivery catheter. The annular anchor can be rotated independently of the annular hub. The annular hub can remain stationary as the annular anchor is rotated to engage tissue. The annular anchor can be driven into the tissue while the delivery catheter retains the position of the annular hub. 
     In some embodiments, an advantage is the ability to collapse the coaptation assistance element. In some embodiments, the coaptation assistance element is fully collapsed. The fully collapsed configuration can be the insertion configuration or a low profile configuration. In some embodiments, the coaptation assistance element is partially collapsed. The partially collapsed configuration can be a partially deployed configuration. The partially collapsed configuration can allow the coaptation assistance element to be selectively deployed within the heart. The partially collapsed configuration can allow the coaptation assistance element to be moved into position within the heart. The configurations of the coaptation assistance element can be monitored such as by imaging to ensure proper deployment. In some embodiments, one or more purse-string sutures, or portions thereof, are tensioned to collapse or partially collapse the coaptation assistance element. In some embodiments, the partially collapsed configuration can allow rotation of the coaptation assistance element. In some embodiments, the fully collapsed configuration can allow rotation of the coaptation assistance element. In some embodiments, the coaptation assistance element can be rotated with a delivery catheter or portion thereof. In some embodiments, the coaptation assistance element can be rotated about a central location such as the annular hub. 
     In some embodiments, an advantage is the ability to expand the coaptation assistance element. In some embodiments, one or more purse-string sutures, or portions thereof, are released to expand the coaptation assistance element. In some embodiments, release of the purse-string suture allows one or more struts to assume a neutral configuration. In some embodiments, the release of the purse-string suture allows one or more struts to assume a pre-shaped curve. In some embodiments, the one or more struts comprise NiTi. In some embodiments, the purse-string suture can be repeatedly tensioned and/or released. In some embodiments, the purse-string suture is captive within the coaptation assistance element. In some embodiments, the purse-string suture is tensioned to remove the coaptation assistance element from a patient. In some embodiments, the purse-string suture is released to deploy the coaptation assistance element within the heart of a patient. In some embodiments, the purse-string suture can be selective deployed to expand a portion of coaptation assistance element while another portion of the coaptation assistance element remains collapsed or partially collapsed. 
     In some embodiments, an advantage is the ability to adjust the coaptation assistance element. In some embodiments, the coaptation assistance element can be held by a central location. In some embodiments, the central location is the anchor. In some embodiments, the central location is the hub. In some embodiments, the hub and/or the anchor are located generally near a mid-point of the diameter of the coaptation assistance element. In some embodiments, the hub and/or the anchor are generally located near a mid-point and/or central location of the annular portion of the coaptation assistance element. In some embodiments, the coaptation assistance element can be held at a neutral position. In some embodiments, the coaptation assistance element can be rotated by rotating a delivery catheter connected to the annular hub. In some embodiments, the coaptation assistance element can be moved longitudinally by corresponding longitudinal motion of a delivery catheter connected to the annular hub. 
     In some embodiments, an advantage is the coaptation assistance element can be retained by a delivery catheter after the coaptation assistance element is positioned. In some embodiments, the coaptation assistance element can be fully deployed within the mitral valve but still tethered to a delivery catheter. In some embodiments, the coaptation assistance element can be adjusted after the coaptation assistance element is fully deployed within the mitral valve. In some embodiments, the coaptation assistance element can be rotated about the hub after the coaptation assistance element is fully deployed. In some embodiments, the anchor can be disengaged and/or reengaged with the tissue after the coaptation assistance element is fully deployed. In some embodiments, the purse-string sutures can collapse and/or expand the coaptation assistance element or a portion thereof after the coaptation assistance element is fully deployed. In some embodiments, the coaptation assistance element can be recaptured after the coaptation assistance element is fully deployed. In some embodiments, the coaptation assistance element can be removed after the coaptation assistance element is fully deployed. 
     In some embodiments, an advantage is the coaptation assistance element does not require ventricular attachment. In some embodiments, the coaptation assistance element only requires annular attachment. In some embodiments, the coaptation assistance element only requires attachment of an annular anchor through an annular hub. In some embodiments, the coaptation assistance element only requires attachment of an annular anchor through an annular hub and annular barbs. In some embodiments, the coaptation assistance element only requires attachment of an annular anchor through an annular hub, annular barbs, and/or commissural barbs. 
     In some embodiments, an advantage is the radially extending frame. In some embodiments, the frame comprises an annular hub and one or more struts. In some embodiments, the struts extend radially from the annular hub. In some embodiments, the frame is constructed from a single, planar sheet of material. In some embodiments, the frame is precisely cut using water jet, laser etching or similar technology. In some embodiments, the frame is constructed by forming the annular hub with an edge of the frame. In some embodiments, the planar sheet of material is formed into a loop which becomes the annular hub. In some embodiments, the struts are bent to the desired configuration. In some embodiments, the struts are equally spaced about the circumference of the annular hub. In some embodiments, the struts are unequally spaced about the circumference of the annular hub. In some embodiments, the struts extending along a portion of the circumference of the annular hub are different than struts extending along another portion of the circumference of the annular hub. In some embodiments, one or more designated portions of the struts are designed to be placed near the annular region of the heart. In some embodiments, one or more designated portions of the struts are designed to be placed near the commissure region of the heart. In some embodiments, one or more designated portions of the struts are designed to be placed near the ventricular region of the heart. In some embodiments, the struts of the radially outward frame do not intersect. In some embodiments, the struts of the radially outward frame do not form a mesh. In some embodiments, the struts of the radially outward frame extend in a line from the hub to an edge of the coaptation assistance element. In some embodiments, the struts of the radially outward frame have a sharpened edge. In some embodiments, the sharpened edge extends in a straight line from the edge of the coaptation assistance element. In some embodiments, the sharpened edge is integrally formed in the strut. In some embodiments, a strut of the radially outward frame has one or more radii of curvature. In some embodiments, a strut of the radially outward frame can be concave or convex or both concave and convex along the length of the strut. In some embodiments, a strut of the radially outward frame has one or more inflection points. 
     In some embodiments, an advantage is the curvature of the frame. In some embodiments, the annular hub is radially extending. In some embodiments, the annular hub extends from the coaptation assistance element away from the annulus. In some embodiments, the annular hub extends from a surface of the coaptation assistance element above a planar surface of the struts. In some embodiments, an edge of the coaptation assistance element is curved. In some embodiments, one or more struts may curve laterally from the annular hub toward the superior edge. In some embodiments, the superior edge of the coaptation assistance element can curve upward from the annulus. In some embodiments, the superior edge of the coaptation assistance element can curve upward from the posterior leaflet. In some embodiments, the superior edge of the coaptation assistance element can curve downward toward the annulus. In some embodiments, the superior edge of the coaptation assistance element can curve downward toward the posterior leaflet. In some embodiments, one or more struts may curve laterally from the annular hub toward the inferior edge. In some embodiments, the inferior edge of the coaptation assistance element can curve away from the posterior leaflet. In some embodiments, the inferior edge of the coaptation assistance element can curve toward the posterior leaflet. 
     In some embodiments, a coaptation assistance element for treating mal-coaptation of a heart valve in provided. The heart valve has an annulus. The coaptation assistance element can include a body that includes an annular section and a coaptation section. In some embodiments, the annular section is configured to be implanted within a heart superior to a valve annulus. In some embodiments, the coaptation zone configured to be implanted within a heart and traversing a plane of the valve annulus. The coaptation assistance element can include a first coaptation surface, and an opposed second surface. In some embodiments, each surface is bounded by a first lateral edge, a second lateral edge, an inferior edge, and a superior edge. In some embodiments, the superior edge forms a lip and cupped downward toward the inferior edge or upward from the annular section. The coaptation assistance element can include a hub and an anchor coupled to the hub and carried by the annular section. In some embodiments, the anchor is selectively deployable at a first target location. The coaptation assistance element can include a plurality of struts extending radially outward from the hub. In some embodiments, the plurality of struts comprise at least a first strut residing within the annular section and a second strut extending from the annular section to the coaptation section, wherein the second strut has a total length that is longer than that of the first strut, such as, for example, a total length that is about, or at least about 110%, 120%, 130%, 140%, 150%, 160%, 170%, 180%, 190%, 200%, 225%, 250% or more of the total length of the first strut. In some embodiments, the total length of the second strut is between about 125% and about 300%, or between about 125% and 200% of the total length of the first strut. 
     In some embodiments, at least one strut of the plurality of struts has a sharpened tip configured to engage tissue. In some embodiments, the plurality of struts comprises Nitinol. In some embodiments, the anchor is helical-shaped. The coaptation assistance element can include one or more additional anchors. In some embodiments, the one or more additional anchors are active anchors. In some embodiments, the hub comprises a cross-pin configured to extend through a helix of the anchor. In some embodiments, the hub is configured to mate with a delivery catheter, wherein the delivery catheter is configured to position the hub near the first target location. In some embodiments, the delivery catheter is configured to rotate the anchor independently of the hub. The coaptation assistance element can include a radiopaque marker. The coaptation assistance element can include a plurality of radiopaque markers near the superior edge. In some embodiments, the superior edge forming a lip is cupped downward toward the inferior edge. In some embodiments, the superior edge forming a lip is cupped upward from the annular section. In some embodiments, the hub extends upward from the annular section. In some embodiments, the inferior edge curves backwards toward the hub. 
     In some embodiments, a method for treating mal-coaptation of a heart valve in a patient is provided. The heart valve has an annulus. The annulus further defines a valve plane, the valve plane separating an atrium proximally and a ventricle distally. The method can include coupling a delivery catheter to a hub of a coaptation assistance element. The method can include positioning the hub near the annulus. The method can include rotating an anchor through the hub and into heart tissue distal to the annulus. The method can include expanding the coaptation assistance element by allowing a plurality of struts to expand radially outward from the hub. 
     In some embodiments, the coaptation assist body is suspended such that the coaptation surface coapts with a first leaflet and a leaflet surface of the coaptation assist body overlays a second leaflet such that mal-coaptation is mitigated. The method can include engaging a sharpened end of a strut of the plurality of struts with heart tissue distal to the annulus. The method can include monitoring the position of the coaptation assistance element with one or more markers. The method can include monitoring the position of the coaptation assistance element with a plurality of markers near a superior edge of the coaptation assistance element. In some embodiments, a tip of the anchor is recessed in the hub during positioning the hub near the annulus. 
     In some embodiments, a coaptation assistance element for treating mal-coaptation of a heart valve of a heart is provided. The coaptation assistance element can include a first coaptation surface and an opposed second surface. The coaptation assistance element can include a first lateral edge, a second lateral edge, an inferior edge, and a superior edge. The coaptation assistance element can include a superior zone and an inferior zone. In some embodiments, the superior zone is configured to reside in the plane of an annulus of the heart valve. In some embodiments, the inferior zone comprises the first coaptation surface and the opposed second surface. In some embodiments, the inferior zone comprises a laminate layer such that a thickness of the inferior zone is greater than a thickness of a portion of the superior zone. 
     In some embodiments, the laminate layer comprises ePTFE. In some embodiments, the thickness of the inferior zone is at least about 25% thicker than the thickness of the portion of the superior zone. In some embodiments, the thickness of the inferior zone is at least about 50% thicker than the thickness of the portion of the superior zone. In some embodiments, the peripheral edge of the coaptation assistance element comprises a raised atraumatic edge surrounding only partially around the coaptation assistance element. In some embodiments, the peripheral edge of the coaptation assistance element comprises a raised atraumatic edge surrounding only the inferior zone of the coaptation assistance element. In some embodiments, the raised edge comprises a suture. In some embodiments, the peripheral edge of the coaptation assistance element comprises spaced apart barbs extending radially outwardly from the peripheral edge of only the superior zone of the coaptation assistance element. The coaptation assistance element can include a hub spaced inward from each of the first lateral edge, the second lateral edge, the inferior edge, and the superior edge. The coaptation assistance element can include an active anchor configured to couple to the hub and configured to be rotated relative to the hub to selectively deploy the active anchor at a first target location. The coaptation assistance element can include a plurality of struts spaced around the hub and extending outward from the hub, the plurality of struts comprising at least a first strut configured to be implanted within the heart and a second strut configured to be implanted within the heart such that the first coaptation surface coapts with a first leaflet of the heart valve and the opposed second surface overlays a second leaflet of the heart valve. In some embodiments, the coaptation assistance element comprises a layer of mesh. 
     In some embodiments, a coaptation assistance element delivery system for treating mal-coaptation of a heart valve is provided. In some embodiments, the heart valve has an annulus. The coaptation assistance element delivery system can include a coaptation assistance element comprising a first surface and an opposed second surface. In some embodiments, each surface bounded by a first lateral edge, a second lateral edge, an inferior edge, and a superior edge. The coaptation assistance element can include a hub. The coaptation assistance element delivery system can include a primary anchor disposed within a primary anchor housing. In some embodiments, the primary anchor is configured to extend through the hub to engage the annulus. The coaptation assistance element delivery system can include a release wire extending through the primary anchor housing and configured to be positioned adjacent to the annulus. 
     The coaptation assistance element delivery system can include a primary anchor driver disposed within the primary anchor housing. In some embodiments, the primary anchor driver is configured to rotate, but not translate, relative to the primary anchor housing. In some embodiments, the primary anchor driver comprises two extensions, wherein the two extensions are configured to engage a cross-bar of the primary anchor. The coaptation assistance element delivery system can include two release wires extending through the primary anchor housing. In some embodiments, the two release wires are configured to be positioned adjacent to the annulus, extending from the hub in opposite directions. In some embodiments, the two release wires cross. The coaptation assistance element delivery system can include a secondary anchor tether extending through the coaptation assistance element. In some embodiments, the secondary anchor tether extends around the release wire. The coaptation assistance element delivery system can include at least two secondary anchor tethers extending through the coaptation assistance element. In some embodiments, at least two secondary anchor tethers extend around the release wire. In some embodiments, at least one secondary anchor tether extends around the release wire and at least one secondary anchor tether extends around a second release wire. The coaptation assistance element delivery system can include a secondary anchor guide rail. In some embodiments, the secondary anchor guide rail is configured to lock a secondary anchor driver to a secondary anchor. In some embodiments, the secondary anchor guide rail is configured to prevent entanglement between a secondary anchor and an adjacent secondary anchor tether. In some embodiments, the secondary anchor guide rail is configured to slide along a secondary anchor tether to deliver a secondary anchor. The coaptation assistance element delivery system can include a secondary anchor driver. In some embodiments, the secondary anchor driver comprises at least one locking tab configured to engage a window of a secondary anchor. The coaptation assistance element delivery system can include a secondary anchor. In some embodiments, the secondary anchor is configured to be delivered by sliding the secondary anchor along a secondary anchor tether looped around the release wire. In some embodiments, the secondary anchor is configured to be rotated to engage the annulus. In some embodiments, the secondary anchor has a smaller diameter than the primary anchor. In some embodiments, the release wire is configured to be retracted after the primary anchor engages the annulus. In some embodiments, the release wire is configured to be retracted after the primary anchor and at least one secondary anchor engages the annulus. In some embodiments, the primary anchor housing is configured to be retracted after the release wire is retracted, wherein the primary anchor driver retracts with the primary anchor housing. In some embodiments, the trajectory of the primary anchor is through the hub. In some embodiments, a cross-pin of the hub is configured to couple the primary anchor to the coaptation assistance element. In some embodiments, at least one secondary anchor is configured to have two or more trajectories. In some embodiments, the trajectory of at least one secondary anchor is determined by the orientation of a respective secondary anchor guide rail. In some embodiments, the secondary anchor guide rail comprises a curved distal end, wherein the curved distal end defines the trajectory. The coaptation assistance element delivery system can include a proximal assembly configured to lock the position of a secondary anchor guide rail relative to a secondary anchor to prevent entanglement of a secondary anchor tether. The coaptation assistance element delivery system can include a proximal assembly configured to lock the position of a secondary anchor guide rail relative to a secondary anchor driver to facilitate coupling of the secondary anchor driver to a secondary anchor. The coaptation assistance element delivery system can include a proximal assembly configured to lock the position of a secondary anchor tether, wherein the secondary anchor tether is coupled to the release wire. The coaptation assistance element delivery system can include a proximal assembly configured to lock the position of a secondary anchor tether to apply tension to the secondary anchor tether to define a trajectory for a secondary anchor. The coaptation assistance element delivery system can include an anti-rotation feature. In some embodiments, a secondary anchor comprises the anti-rotation feature. 
     In some embodiments, a coaptation assistance element for treating mal-coaptation of a heart valve is provided. In some embodiments, the heart valve has an annulus. The coaptation assistance element can include a first surface and an opposed second surface, each surface bounded by a first lateral edge, a second lateral edge, an inferior edge, and a superior edge. The coaptation assistance element can include a hub. The coaptation assistance element can include a plurality of struts spaced around the hub and extending outward from the hub, the plurality of struts comprising at least a first strut configured to be implanted within a heart superior to a valve annulus and a second strut configured to be implanted within a heart and traversing a plane of the valve annulus. 
     In some embodiments, the coaptation assistance element comprises at least one layer of ePTFE. In some embodiments, the coaptation assistance element comprises at least one layer of mesh. In some embodiments, the coaptation assistance element comprises at least one layer of UHMWPE mesh. In some embodiments, the coaptation assistance element comprises at least one layer of fabric. In some embodiments, the coaptation assistance element comprises at least one layer of polyester fabric. In some embodiments, the first surface is reinforced. In some embodiments, the second surface is reinforced. In some embodiments, a ventricular surface is reinforced. In some embodiments, a coaptation surface is reinforced. In some embodiments, an anchor zone is reinforced. In some embodiments, at least one edge comprises a raised edge. In some embodiments, the coaptation assistance element is configured to minimize contact with a posterior leaflet. In some embodiments, the coaptation assistance element is configured to engage and embed within the annulus. 
     In some embodiments, a method of delivering a coaptation assistance element is provided. The method can include delivering a coaptation assistance element to a heart of a patient. In some embodiments, the coaptation assistance element is coupled to a coaptation assistance element delivery system. In some embodiments, the coaptation assistance element delivery system comprising a primary anchor disposed within a primary anchor housing. In some embodiments, the coaptation assistance element delivery system comprising at least one release wire. The method can include expanding the coaptation assistance element within the heart. The method can include anchoring the coaptation assistance element to an annulus of the heart valve by rotating the primary anchor. 
     The method can include rotating a primary anchor driver within the primary anchor housing. In some embodiments, the at least one release wire is coupled to the primary anchor housing and extends under the coaptation assistance element when the coaptation assistance element is expanded. In some embodiments, at least one secondary anchor tether extends through the coaptation assistance element when the coaptation assistance element is expanded. In some embodiments, at least one secondary anchor tether loops around the at least one release wire when the coaptation assistance element is expanded. In some embodiments, the coaptation assistance element is delivered in a low profile configuration. In some embodiments, the at least one release wire is configured to maintain the position of the primary anchor housing relative to the coaptation assistance element. In some embodiments, the at least one release wire is configured to maintain the position of at least one secondary anchor tether relative to the coaptation assistance element. In some embodiments, the coaptation assistance element is delivered via a delivery catheter. In some embodiments, a telescoping action is configured to position the coaptation assistance element relative to a location to engage the primary anchor with the annulus. The method can include rotating the primary anchor to engage the annulus. The method can include rotating a primary anchor driver within the primary anchor housing, wherein the primary anchor driver is configured to rotate by not translate relative to the primary anchor housing. The method can include sliding a secondary anchor assembly toward the annulus, along a secondary anchor tether. The method can include maintaining engagement between a secondary anchor driver and a secondary anchor with a secondary anchor guide rail. The method can include preventing entanglement between a secondary anchor and a secondary anchor tether with a secondary anchor guide rail. The method can include coupling a secondary anchor driver to a secondary anchor. The method can include partially retracting a secondary anchor guide rail before the secondary anchor engages tissue. The method can include retracting a secondary anchor guide rail after the secondary anchor engages tissue. The method can include retracting a secondary anchor driver after retracting a secondary anchor guide rail. The method can include retracting the at least one release wire. 
     In some embodiments, a coaptation assistance element for treating mal-coaptation of a heart valve is provided, the heart valve having an annulus. The coaptation assistance element can include a first coaptation surface and an opposed second surface, each surface bounded by a first lateral edge, a second lateral edge, an inferior edge, and a superior edge. The coaptation assistance element can include a hub. The coaptation assistance element can include an anchor coupled to the hub and configured to be rotated relative to the hub to selectively deploy the anchor at a first target location. The coaptation assistance element can include a plurality of struts spaced around the hub and extending outward from the hub. In some embodiments, the plurality of struts comprises at least a first strut configured to be implanted within a heart superior to a valve annulus and a second strut configured to be implanted within a heart and traversing a plane of the valve annulus. 
     In some embodiments, the second strut has a total length that is longer than that of the first strut. In some embodiments, the hub is spaced radially inward from each of the first lateral edge, the second lateral edge, the inferior edge, and the superior edge. In some embodiments, the plurality of struts are spaced circumferentially around the hub. In some embodiments, the superior edge forms a lip cupped downward toward the inferior edge or upward from the inferior edge. In some embodiments, at least one strut of the plurality of struts has a sharpened tip configured to engage tissue. In some embodiments, the plurality of struts comprise Nitinol. In some embodiments, the anchor is helical-shaped. The coaptation assistance element can include one or more additional anchors. In some embodiments, the one or more additional anchors are active anchors. In some embodiments, the hub comprises a cross-pin configured to extend through a helix of the anchor. In some embodiments, the hub is configured to mate with a delivery catheter, wherein the delivery catheter is configured to position the hub near the first target location. In some embodiments, the delivery catheter is configured to rotate the anchor independently of the hub. The coaptation assistance element can include a radiopaque marker. The coaptation assistance element can include a plurality of radiopaque markers near the superior edge. In some embodiments, the lip is cupped downward toward the inferior edge. In some embodiments, the lip is cupped upward from the inferior edge. In some embodiments, the hub extends upward from the first coaptation surface. In some embodiments, the inferior edge curves backwards toward the hub. In some embodiments, the hub is tubular. In some embodiments, the struts and the hub are integrally formed. In some embodiments, the coaptation assistance element is configured to be collapsed relative to the hub. In some embodiments, the active anchor is configured to be selectively coupled and decoupled from tissue. 
     In some embodiments, a coaptation assistance element for treating mal-coaptation of a heart valve is provided, the heart valve having an annulus. The coaptation assistance element can include a first coaptation surface and an opposed second surface. In some embodiments, each surface bounded by a first lateral edge, a second lateral edge, an inferior edge, and a superior edge. The coaptation assistance element can include a hub. The coaptation assistance element can include an anchor coupled to the hub. In some embodiments, the anchor is configured to be rotated in a first direction to selectively deploy the active anchor to engage tissue. In some embodiments, the active anchor is configured to be rotated in a second direction, opposite the first direction, to selectively disengage tissue. The coaptation assistance element can include a plurality of struts spaced around the hub. In some embodiments, the plurality of struts comprises at least a first strut configured to be implanted within a heart superior to a valve annulus and a second strut configured to be implanted within a heart and traversing a plane of the valve annulus. 
     In some embodiments, a coaptation assistance element for treating mal-coaptation of a heart valve is provided. In some embodiments, the heart valve has an annulus, an anterior leaflet, and a posterior leaflet. The coaptation assistance element can include a first coaptation surface and an opposed second surface. In some embodiments, each surface bounded by a first lateral edge, a second lateral edge, an inferior edge, and a superior edge. The coaptation assistance element can include a hub. The coaptation assistance element can include an anchor coupled to the hub and configured to be rotated relative to the hub to selectively deploy the anchor at a first target location. In some embodiments, the anchor is configured to be selectively deployed in the annulus. The coaptation assistance element can include a plurality of struts spaced around the hub. In some embodiments, the plurality of struts comprising at least a first strut configured to be implanted within a heart superior to a valve annulus and a second strut configured to be implanted within a heart and traversing a plane of the valve annulus. 
     In some embodiments, a coaptation assistance element delivery system for treating mal-coaptation of a heart valve, the heart valve having an annulus, is provided. The coaptation assistance element delivery system can include a coaptation assistance element comprising a first surface and an opposed second surface. In some embodiments, each surface bounded by a first lateral edge, a second lateral edge, an inferior edge, and a superior edge. In some embodiments, the coaptation assistance element comprises a hub. The coaptation assistance element delivery system can include a first anchor disposed within a first anchor housing. In some embodiments, the first anchor is configured to extend through the hub to engage the annulus. The coaptation assistance element delivery system can include a release wire extending through the first anchor housing and configured to be positioned adjacent to the annulus. 
     In some embodiments, the coaptation assistance element delivery system can include a radiopaque marker. In some embodiments, the coaptation assistance element delivery system can include a second anchor tether extending through the coaptation assistance element and around the release wire. In some embodiments, the radiopaque marker is crimped to the second anchor tether. In some embodiments, the radiopaque marker is configured for visual confirmation of an anchoring depth of a second anchor. In some embodiments, the coaptation assistance element delivery system can include a second anchor. In some embodiments, the second anchor comprises a first helical portion having a first pitch and a second helical portion having a second, smaller pitch. In some embodiments, the second helical portion is configured to lock with the coaptation assistance element. In some embodiments, the second anchor includes a locking segment and an anchoring segment, the locking segment comprising having a smaller pitch than the anchoring segment. In some embodiments, the second anchor is configured to be delivered by sliding the second anchor along a second anchor tether looped around the release wire. In some embodiments, the second anchor is configured to be delivered by sliding the second anchor along a second anchor guide rail, wherein the second anchor guide rail guides the trajectory of the second anchor. In some embodiments, the second anchor is configured to be rotated to engage the annulus. In some embodiments, the second anchor is configured to have two or more trajectories. In some embodiments, the trajectory of the second anchor is determined by the orientation of a respective second anchor guide rail. In some embodiments, the coaptation assistance element delivery system can include a first anchor driver disposed within the first anchor housing, wherein the first anchor driver is configured to rotate, but not translate, relative to the first anchor housing. In some embodiments, the coaptation assistance element delivery system can include a second anchor guide rail. In some embodiments, the second anchor guide rail is configured to lock a second anchor driver to a second anchor. In some embodiments, the second anchor guide rail is configured to slide along a second anchor tether to deliver a second anchor. In some embodiments, the second anchor guide rail comprises a distal section with a bend between 30 and 90 degrees. In some embodiments, the bend determines the trajectory of a second anchor delivered along the second anchor guide rail. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIGS.  1 A- 1 F  schematically illustrate some of the tissues of the heart and mitral valve, as described in the Background section and below, and which may interact with the implants and systems described herein. 
         FIG.  2 A  illustrates a simplified cross-section of a heart, schematically showing mitral valve function during diastole. 
         FIG.  2 B  illustrates a simplified cross-section of a heart, schematically showing mitral valve function during systole. 
         FIGS.  3 A- 3 B  illustrate a simplified cross-section of a heart, schematically showing mitral valve regurgitation during systole in the setting of mal-coaptation of the mitral valve leaflets. 
         FIG.  4 A  illustrates a stylized cross section of a heart, showing mitral valve mal-coaptation in the setting of functional mitral valve regurgitation. 
         FIG.  4 B  illustrates a stylized cross section of a heart, showing mitral valve mal-coaptation in the setting of degenerative mitral valve regurgitation. 
         FIG.  5 A  illustrates a perspective view of an embodiment of a coaptation assistance element. 
         FIG.  5 B  illustrates the top view of the coaptation assistance element of  FIG.  5 A . 
         FIGS.  5 C- 5 D  illustrates an embodiment of the struts of a coaptation assistance element. 
         FIGS.  5 E- 5 G  illustrate the coaptation assistance element of  FIG.  5 A  without annular anchor site. 
         FIGS.  5 H- 5 J  illustrate the coaptation assistance element of  FIG.  5 A  with leaflet anchor sites. 
         FIG.  5 K  illustrates dimensions of the coaptation assistance element of  FIG.  5 A . 
         FIG.  6    illustrates a perspective view of an embodiment of a coaptation assistance element. 
         FIG.  7 A  illustrates a perspective view of an embodiment of a coaptation assistance element showing a first surface disposed toward a mal-coapting native leaflet. 
         FIG.  7 B  illustrates another perspective view of the coaptation assistance element of  FIG.  7 A  showing a second surface which can include a coaptation surface. 
         FIG.  7 C  illustrates a top view of the coaptation assistance element of  FIG.  7 A . 
         FIG.  7 D  illustrates the coaptation assistance element of  FIG.  7 A  implanted within a model of a mitral valve. 
         FIG.  7 E  illustrates a top view of the coaptation assistance element of  FIG.  7 A  implanted within a model of a mitral valve. 
         FIG.  8 A  schematically illustrates an embodiment of control handle of a delivery system for a transcatheter technique. 
         FIG.  8 B  schematically illustrates a top view and a side view a coaptation assistance element coupled to the delivery system of  FIG.  8 A . 
         FIG.  8 C  schematically illustrates the connection between an annular hub of the coaptation assistance element and a tip of the delivery catheter. 
         FIG.  9 A  schematically illustrates the anchor manipulation of the delivery system of  FIG.  8 A . 
         FIGS.  9 B- 9 E  schematically illustrates embodiments of the connection between an annular anchor and a driver. 
         FIG.  10    schematically illustrates a method for a transcatheter technique showing transseptal crossing. 
         FIG.  11    schematically illustrates a method for a transcatheter technique showing initial coaptation assistance element advancement. 
         FIG.  12    schematically illustrates a method for a transcatheter technique showing partial coaptation assistance element opening. 
         FIG.  13    schematically illustrates a method for a transcatheter technique showing coaptation assistance element collapsing. 
         FIG.  14    schematically illustrates a method for a transcatheter technique showing a cross-sectional view of the coaptation assistance element. 
         FIG.  15    schematically illustrates a method for a transcatheter technique showing secondary anchor placement. 
         FIG.  16    illustrates a method for implant delivery showing loading of an implant. 
         FIG.  17    illustrates a method for inserting an introducer. 
         FIG.  18    illustrates a method for connecting the introducer of  FIG.  17    to a transseptal sheath. 
         FIG.  19    illustrates a method for advancing the transseptal sheath of  FIG.  18   . 
         FIG.  20    illustrates a method for positioning the transseptal sheath of  FIG.  19   . 
         FIG.  21    illustrates a method for delivering an anchor. 
         FIGS.  22 A- 22 D  illustrate a method for deploying the implant. 
         FIG.  23    illustrates a method for utilizing one or more secondary anchor guidewires. 
         FIG.  24    illustrates a method for removing an anchor driver. 
         FIG.  25    illustrates a method for advancing secondary anchor guiderails. 
         FIG.  26    illustrates a method for delivering a secondary anchor. 
         FIG.  27    illustrates a method for inserting a secondary anchor. 
         FIG.  28    illustrates a method for delivering another secondary anchor. 
         FIG.  29    illustrates the anchored implant with guidewires. 
         FIG.  30    illustrates the anchored implant. 
         FIGS.  31 A- 31 F  illustrate a method for retrieving the implant. 
         FIG.  32    illustrates a method for inserting a secondary anchor. 
         FIG.  33    illustrates a method for delivering another secondary anchor. 
         FIG.  34    illustrates a method for inserting another secondary anchor. 
         FIG.  35    illustrates the anchored implant. 
         FIG.  36    illustrates an embodiment of lamination. 
         FIG.  37    illustrates an embodiment of lamination. 
         FIG.  38    illustrates an embodiment of 3D forming. 
         FIG.  39    illustrates an embodiment of 3D forming. 
         FIG.  40    illustrates an implant. 
         FIG.  41    illustrates an embodiment of a barb. 
         FIGS.  42 A- 42 I  illustrate an embodiment of an implant delivery system. 
         FIGS.  43 A- 43 E  illustrate an embodiment of an implant delivery system. 
         FIGS.  44 A- 44 E  illustrate an embodiment of an implant delivery system. 
         FIGS.  45 A- 45 K  illustrate an embodiment of an implant delivery system. 
         FIGS.  46 A- 46 C  illustrate an embodiment of an anchor delivery system. 
         FIGS.  47 A- 47 E  illustrate views of an embodiment of a coaptation assistance element. 
         FIG.  48    illustrates an embodiment of implant construction. 
         FIG.  49    illustrates an embodiment of an implant delivery system. 
         FIG.  50    illustrates a method of delivery. 
         FIG.  51    illustrates an embodiment of a primary anchor driver. 
         FIG.  52    illustrates an embodiment of a secondary anchor guide rail. 
         FIGS.  53 A- 53 B  illustrate an embodiment of a secondary anchor guide rail to prevent entanglement. 
         FIG.  54    illustrates an embodiment of a secondary anchor guide rail to facilitate the trajectory for a secondary anchor. 
         FIGS.  55 A- 55 C  illustrate an embodiment of a proximal assembly. 
         FIG.  56    illustrates an embodiment of an anti-rotation feature. 
         FIGS.  57 A- 57 B  illustrates an embodiment of posterior leaflet augmentation and restoration. 
         FIGS.  58 A- 58 J  illustrate an embodiment of an implant delivery system. 
         FIGS.  59 A- 59 B  illustrate an embodiment of a secondary anchor. 
         FIG.  60    illustrates an embodiment of the secondary anchor of  FIG.  59 A  and an implant. 
     
    
    
     DETAILED DESCRIPTION 
     The present invention, in some embodiments, generally provides improved medical devices, systems, and methods, often for treatment of mitral valve regurgitation and other valve diseases including tricuspid regurgitation. While the description that follows includes reference to the anterior leaflet in a valve with two leaflets such as the mitral valve, it is understood that “anterior leaflet” could refer to one or more leaflets in valve with multiple leaflets. For example, the tricuspid valve has 3 leaflets so the “anterior” could refer to one or two of the medial, lateral, and posterior leaflets. The coaptation assistance elements described herein will generally include a coaptation assist body (sometimes referred to herein as a valve body) which is generally along the blood flow path as the leaflets of the valve move back and forth between an open-valve configuration (with the anterior leaflet separated from valve body) and a closed-valve configuration (with the anterior leaflet engaging opposed surfaces of the valve body). The valve body will be disposed between the native leaflets to close the gap caused by mal-coaptation of the native leaflets by providing a surface for at least one of the native leaflets to coapt against, while effectively replacing a second native leaflet in the area of the valve which, were it functioning normally, it would occlude during systole. The gaps may be lateral (such as may be caused by a dilated left ventricle and/or mitral valve annulus) and/or axial (such as where one leaflet prolapses or is pushed by fluid pressure beyond the annulus when the valve should close). In some embodiments, the coaptation assist elements may completely assist one, two, or more valve leaflets, or in some embodiments partially assist a valve leaflet, for example, covering only one or more of the A1, A2, and/or A3 scallops of the anterior leaflet, and/or one or more of the P1, P2, and/or P3 scallops of the posterior leaflet. 
     Among other uses, the coaptation assistance elements, and methods described herein may be configured for treating functional and/or degenerative mitral valve regurgitation (MR) by creating an artificial or new coaptation zone within which at least one of the native mitral valve leaflets can seal. The structures and methods herein will largely be tailored to this application, though alternative embodiments might be configured for use in other valves of the heart and/or body, including the tricuspid valve, valves of the peripheral vasculature, the inferior vena cava, or the like. 
     Referring to  FIGS.  1 A- 1 D , the four chambers of the heart are shown, the left atrium  10 , right atrium  20 , left ventricle  30 , and right ventricle  40 . The mitral valve  60  is disposed between the left atrium  10  and left ventricle  30 . Also shown are the tricuspid valve  50  which separates the right atrium  20  and right ventricle  40 , the aortic valve  80 , and the pulmonary valve  70 . The mitral valve  60  is composed of two leaflets, the anterior leaflet  12  and posterior leaflet  14 . In a healthy heart, the two leaflets appose during systole at the coaptation zone  16 . 
     The fibrous annulus  120 , part of the cardiac skeleton, provides attachment for the two leaflets of the mitral valve, referred to as the anterior leaflet  12  and the posterior leaflet  14 . The leaflets are axially supported by attachment to the chordae tendinae  32 . The chordae, in turn, attach to one or both of the papillary muscles  34 ,  36  of the left ventricle. In a healthy heart, the chordae support structures tether the mitral valve leaflets, allowing the leaflets to open easily during diastole but to resist the high pressure developed during ventricular systole. In addition to the tethering effect of the support structure, the shape and tissue consistency of the leaflets helps promote an effective seal or coaptation. The leading edges of the anterior and posterior leaflet come together along a funnel-shaped zone of coaptation  16 , with a lateral cross-section  160  of the three-dimensional coaptation zone (CZ) being shown schematically in  FIG.  1 E . 
     The anterior and posterior mitral leaflets are dissimilarly shaped. The anterior leaflet is more firmly attached to the annulus overlying the central fibrous body (cardiac skeleton), and is somewhat stiffer than the posterior leaflet, which is attached to the more mobile posterior mitral annulus. Approximately 80 percent of the closing area is the anterior leaflet. Adjacent to the commissures  110 ,  114 , on or anterior to the annulus  120 , lie the left (lateral)  124  and right (septal)  126  fibrous trigones which are formed where the mitral annulus is fused with the base of the non-coronary cusp of the aorta ( FIG.  1 F ). The fibrous trigones  124 ,  126  form the septal and lateral extents of the central fibrous body  128 . The fibrous trigones  124 ,  126  may have an advantage, in some embodiments, as providing a firm zone for stable engagement with one or more annular or atrial anchors. The coaptation zone CL between the leaflets  12 ,  14  is not a simple line, but rather a curved funnel-shaped surface interface. The first  110  (lateral or left) and second  114  (septal or right) commissures are where the anterior leaflet  12  meets the posterior leaflet  14  at the annulus  120 . As seen most clearly in the axial views from the atrium of  FIG.  1 C,  1 D, and  1 F , an axial cross-section of the coaptation zone generally shows the curved line CL that is separated from a centroid of the annulus CA as well as from the opening through the valve during diastole CO. In addition, the leaflet edges are scalloped, more so for the posterior versus the anterior leaflet. Mal-coaptation can occur between one or more of these A-P (anterior-posterior) segment pairs A1/P1, A2/P2, and A3/P3, so that mal-coaptation characteristics may vary along the curve of the coaptation zone CL. 
     Referring now to  FIG.  2 A , a properly functioning mitral valve  60  of a heart is open during diastole to allow blood to flow along a flow path FP from the left atrium toward the left ventricle  30  and thereby fill the left ventricle. As shown in  FIG.  2 B , the functioning mitral valve  60  closes and effectively seals the left ventricle  30  from the left atrium  10  during systole, first passively then actively by increase in ventricular pressure, thereby allowing contraction of the heart tissue surrounding the left ventricle to advance blood throughout the vasculature. 
     Referring to  FIG.  3 A- 3 B and  4 A- 4 B , there are several conditions or disease states in which the leaflet edges of the mitral valve fail to oppose sufficiently and thereby allow blood to regurgitate in systole from the ventricle into the atrium. Regardless of the specific etiology of a particular patient, failure of the leaflets to seal during ventricular systole is known as mal-coaptation and gives rise to mitral regurgitation. 
     Generally, mal-coaptation can result from either excessive tethering by the support structures of one or both leaflets, or from excessive stretching or tearing of the support structures. Other, less common causes include infection of the heart valve, congenital abnormalities, and trauma. Valve malfunction can result from the chordae tendinae becoming stretched, known as mitral valve prolapse, and in some cases tearing of the chordae  215  or papillary muscle, known as a flail leaflet  220 , as shown in  FIG.  3 A . Or if the leaflet tissue itself is redundant, the valves may prolapse so that the level of coaptation occurs higher into the atrium, opening the valve higher in the atrium during ventricular systole  230 . Either one of the leaflets can undergo prolapse or become flail. This condition is sometimes known as degenerative mitral valve regurgitation. 
     In excessive tethering, as shown in  FIG.  3 B , the leaflets of a normally structured valve may not function properly because of enlargement of or shape change in the valve annulus: so-called annular dilation  240 . Such functional mitral regurgitation generally results from heart muscle failure and concomitant ventricular dilation. And the excessive volume load resulting from functional mitral regurgitation can itself exacerbate heart failure, ventricular and annular dilation, thus worsening mitral regurgitation. 
       FIG.  4 A- 4 B  illustrate the backflow BF of blood during systole in functional mitral valve regurgitation ( FIG.  4 A ) and degenerative mitral valve regurgitation ( FIG.  4 B ). The increased size of the annulus in  FIG.  4 A , coupled with increased tethering due to hypertrophy of the ventricle  320  and papillary muscle  330 , prevents the anterior leaflet  312  and posterior leaflet  314  from apposing, thereby preventing coaptation. In  FIG.  4 B , the tearing of the chordae  215  causes prolapse of the posterior leaflet  344  upward into the left atrium, which prevents apposition against the anterior leaflet  342 . In either situation, the result is backflow of blood into the atrium, which decreases the effectiveness of left ventricle compression. 
     Further description of coaptation assistance elements, tools, anchors, features, systems, and methods, which can be utilized in conjunction with the disclosure herein, can be found in the following applications, each of which is incorporated by reference in their entirety: U.S. patent application Ser. No. 13/099,532, filed May 3, 2011; U.S. patent application Ser. No. 13/531,407, filed Jun. 22, 2012; U.S. patent application Ser. No. 14/313,975, filed Jun. 24, 2014; U.S. patent application Ser. No. 14/742,199, filed Jun. 17, 2015; U.S. patent application Ser. No. 14/749,344, filed Jun. 24, 2015; and U.S. patent application Ser. No. 10/419,706, filed Apr. 18, 2003. 
     In some embodiments, the coaptation assistance elements described herein may be deployed to overlie the posterior leaflet, the chordae and papillary muscle. In some embodiments, the coaptation assistance element attaches superiorly to the posterior aspect of the annulus and inferiorly to the posterior aspect of the left ventricle via annular anchor and/or ventricular anchor. In other embodiments, more than one annular anchor and/or more than one ventricular anchor may be used to attach the coaptation assistance element. In some elements, the one or more annular anchors may be replaced by or supplemented with one or more atrial or commissural anchors, which can be annular in some embodiments. The coaptation assistance element may attach to the superior surface of the posterior annulus, the posterior atrial wall, or the annulus itself. A coaptation zone has been established between the coaptation assistance element and the native anterior leaflet. Similar coaptation assistance elements can be used in both functional and degenerative mitral valve regurgitation because the failure of leaflet coaptation occurs in both, regardless of the mechanism behind the dysfunction. In some embodiments, differently sized coaptation assistance elements can be placed such that the native anterior leaflet apposes the coaptation element at the appropriately established coaptation point, blocking flow of blood during contraction of the ventricle. 
     A variety of sizes of coaptation assistance elements may be provided, with differing dimensions configured to fit varying anatomies. For example, there may be a height, which measures from the superior annular attachment site to the inferior-most edge of the coaptation assistance element in a plane basically perpendicular to the plane defined by the annulus of the valve, a depth between the coaptation point and the superior attachment site, and a projection between the posterior wall at the level of the coaptation point and the coaptation point. There is also a medial-lateral diameter of the coaptation assistance element, typically larger in functional MR. During diastole, the coaptation assistance element may stay in substantially the same position, while movement of the native anterior leaflet opens the valve, permitting flow of blood from the left atrium to the left ventricle with minimal restriction. In some embodiments, the surface of the coaptation assistance element may balloon or stretch upwards during ventricular systole, while the anchors remain unmoved. This may be advantageous as enhancing the seal between the anterior or coaptation surface of the element and the native leaflet at the coaptation zone during systole. During diastole, the surface may return to an initial position in which it lies more anteriorly, toward the anterior leaflet. This may provide an improved blood flow path between the atrium and ventricle during diastole, improving outflow from the atrium past the coaptation assist element. 
     In some methods of use, the native posterior leaflet is left in position, and the coaptation assistance element is attached superiorly to the posterior annulus or adjacent atrial wall. Many possible alternate embodiments may have differing attachment mechanisms. In other methods of use, the posterior leaflet is not present, having been removed surgically or the result of disease. In some methods of use, the native leaflet attaches to the posterior surface of the coaptation assistance element. In some methods of use, the coaptation assistance element may attach to the anterior surface of the posterior leaflet, rather than the annulus or atrial wall. These are some examples of variations, but still others are contemplated. In some methods of use, an anchoring structure (not shown) could pass from the coaptation assistance element, through the atrial wall into the coronary sinus, wherein the anchoring structure attaches to a mating structure in the coronary sinus. In some methods of use, the anchoring structure, which could be a mechanical structure or a simple suture, can pass through the atrial wall and be anchored by a knot or mechanical element, such as a clip, on the epicardial surface of the heart. Similarly, attachment inferiorly may be to the ventricular muscle, through the apex into the epicardium or pericardium and secured from outside, or at other attachment sites using alternative attachment means. 
     The coaptation assistance element described herein may exhibit a number of desirable characteristics. Some embodiments need not rely on reshaping of the mitral annulus (such as by thermal shrinking of annular tissue, implantation of an annular ring prosthesis, and/or placement of a cinching mechanism either above or beneath the valve plane, or in the coronary sinus or related blood vessels). Advantageously, they also need not disrupt the leaflet structure or rely on locking together or fusing of the mitral leaflets. Many embodiments can avoid reliance on ventricular reshaping, and after implantation represent passive implanted devices with limited excursion which may result in very long fatigue life. Thus, the coaptation assistance element can be secured across a posterior leaflet while otherwise leaving native heart (e.g., ventricular, mitral annulus, etc.) anatomy intact. 
     Mitigation of mitral valve mal-coaptation may be effective irrespective of which leaflet segment(s) exhibit mal-coaptation. The treatments described herein will make use of coaptation assistance elements that are repositionable during the procedure, and even removable after complete deployment and/or tissue response begins or is completed, often without damaging the valve structure. Nonetheless, the coaptation assistance element described herein may be combined with one or more therapies that do rely on one or more of the attributes described above as being obviated. The coaptation assistance element can exhibit benign tissue healing and rapid endothelialization which inhibits migration, thromboembolism, infection, and/or erosion. In some cases, the coaptation assistance element will exhibit no endothelialization but its surface will remain inert, which can also inhibit migration, thromboembolism, infection and/or erosion. 
       FIGS.  5 A- 5 B  show two views of an embodiment of a coaptation assistance element  500 . The coaptation assistance element  500  can include a first surface  505  disposed toward a mal-coapting native leaflet, in the instance of a mitral valve, the posterior leaflet and a second surface  515  which may be disposed toward the anterior leaflet. The second surface  515  can include a coaptation surface  560 . The superior edge  540  of the coaptation assistance element  500  may be curved to match the general shape of the annulus or adjoining atrial wall, as described herein. The superior edge  540  can be curved downward, toward the posterior leaflet, as shown in  FIG.  5 A , or curved upward, toward the atrial wall to match the general shape of the left atrial wall, as shown in  FIG.  6    and described herein. 
     The coaptation assistance element  500  can have a geometry which permits it to traverse the valve between attachment sites in the atrium and ventricle. In some embodiments, the attachment sites are only in the atrium. In some embodiments, the attachment sites are only near the annulus and the commissures of the valve. The coaptation assistance element  500  can be unattached near the inferior edge  580 . The coaptation assistance element  500  does not require ventricular attachment. In some embodiments, the geometry of the coaptation assistance element  500  helps to maintain the position of the coaptation assistance element  500  within the valve. In some embodiments, the coaptation assistance element  500  is curved to cup the posterior leaflet. In some embodiments, the coaptation assistance element  500  is curved backwards toward the superior edge  540 . The coaptation assistance element  500  may provide the coaptation surface  560  for the anterior leaflet to coapt against.  FIGS.  5 A and  5 B  illustrate that geometry. 
     In some methods of use, the posterior leaflet can be left intact. The coaptation assistance element  500  may attach to the atrium or annulus such that it effectively seals off the posterior leaflet. In some methods of use, the posterior leaflet can be removed. The coaptation assistance element  500  may, in the instance that the leaflet is or has been removed, replace the posterior leaflet. In some embodiments, the coaptation assistance element  500  only requires annular attachment. In some embodiments, the coaptation assistance element  500  only requires attachment at a single point. The single point may be a central location of the coaptation assistance element  500 , for instance, a centrally-located hub. In some embodiments, the coaptation assistance element  500  may attach to the atrium or annulus along an edge. In some embodiments, the coaptation assistance element  500  may attach to the atrium or annulus at a location separated from the edge of the coaptation assistance element  500 , for instance, at a centrally-located hub. 
     The coaptation assistance element  500  can include an annular hub  520  engaging an annular anchor  800 . The annular anchor  800  may be engaged at a proximal end by a driver, described herein. The annular anchor  800  can include a sharpened tip to engage tissue. In some methods of use, the tip of the annular anchor  800  is within the annular hub  520  during delivery of the coaptation assistance element  500 . In some methods of use, the tip of the annular anchor  800  is above the annular section  510  during delivery. The tip of the annular anchor  800  can remain recessed within the annular hub  520  until the annular anchor  800  is rotated to engage tissue. In some embodiments, the coaptation assistance element  500  can be assembled extra-corporeally, engaging the annular anchor  800  to the coaptation assistance element  500  via the annular hub  520  and the drivers to the annular anchor  800 . The drivers can then be withdrawn into a delivery catheter, with the coaptation assistance element  500  in a collapsed position. The drivers may be separately manipulated by the operator to place the annular anchor  800  in the appropriate position. Alternatively, the annular anchor  800  may be engaged to the coaptation assistance element  500  and/or the driver sequentially, either before or after deployment through the delivery catheter. The coaptation assistance element  500  after placement can entirely cover the posterior leaflet so that the coaptation assistance element  500  coapts with the anterior leaflet during systole and, with the native anterior leaflet, maintains the valve seal at the annular ring. 
     In some embodiments, the annular anchor  800  is an active anchor. The user can selectively engage or disengage the annular anchor  800  from tissue. Unlike barbs or other passive anchors, an active anchor can be activated such as by rotation in order to engage tissue. The annular anchor  800  allows placement of the coaptation assistance element  500  prior to engagement of the annular anchor  800 . The coaptation assistance element  500  can make contact with the tissue without any adhesion of the annular anchor  800 . In some embodiments, the annular anchor  800  and corresponding hub  520  are centrally located on the coaptation assistance element  500 . The annular anchor  800  and corresponding hub  520  are spaced apart from any edge of the coaptation assistance element  500 . The location of the annular anchor  800  and corresponding hub  520  can be at a neutral center to prevent swinging of the coaptation assistance element  500  when the coaptation assistance element  500  is held by the annular hub  520 . The corresponding hub  520  provides a convenient location to hold and move the coaptation assistance element  500 . 
     The annular hub  520  may have a built-in or coupled annular anchor  800 . In some embodiments, the annular anchor  800  can be retained by a cross-pin, described herein, within the annular hub  520 . The cross-pin may pass through the helical structure of the annular anchor  800  to prevent dislodgement of the annular anchor  800  from the annular hub  520  by a blunt force. The annular anchor  800  may comprise a helix rotatable with respect to the annular hub  520 . In some embodiments, other anchors may be used. The annular anchor  800  may be in the form of a tether or other attachment means extending from the coaptation assistance element  500  thru the ventricle septum to the right ventricle. The annular anchor  800  may be in the form of a tether or other attachment means extending thru the apex into the epicardium or pericardium. The annular anchor  800  may be secured from outside the heart in and combined endo/epi procedure. When helical anchors are used, they may comprise bio-inert materials such as Platinum/Ir, a Nitinol alloy, and/or stainless steel. 
     In some embodiments, the coaptation assistance element  500  can include a single central annular anchor  800  inside the annular hub  520 . The coaptation assistance element  500  can be delivered percutaneously as described herein by attachment of a delivery catheter to the annular hub  520 . The coaptation assistance element  500  can be configured for adjustable positioning by removing and reattachment of the annular anchor  800 . The coaptation assistance element  500  can be recapturable by removal of the annular anchor  800  and withdrawal of the coaptation assistance element  500 . The coaptation assistance element  500 , may also include secondary anchors including commissural anchors, ventricular anchor, annular anchors, barbs, tethers or any other known fixation device. 
     As may be seen in  FIGS.  5 A- 5 B , the coaptation assistance element  500  can include a plurality of struts  530 . In some embodiments, one or more of the struts  530  have one end terminating at the hub  520  and the other end extending radially outwardly toward one of the superior edge  540 , the lateral edges  570  and  575 , and the inferior edge  580  of the coaptation assistance element  500 . The struts  530  may extend outward in various directions from the hub  520 , and can be spaced apart from adjacent struts  530  at regular or irregular intervals. In some embodiments, adjacent struts  530  extend outward from the hub at an angle of between about 5 degrees and about 45 degrees, between about 10 degrees and about 30 degrees, or about 5, 10, 15, 20, 25, or 30 degrees with respect to an adjacent strut  530 . The struts  530  may be arranged generally parallel to the longitudinal axis of the coaptation assistance element  500  to assist in maintaining the shape of the coaptation assistance element  500  upon placement. The struts  530  may allow the coaptation assistance element  500  to assume a reduced configuration for deployment through a catheter. In some embodiments, the struts  530  that form a portion of the coaptation zone of the implant  500  have a maximum length that is greater than struts  530  that only form a portion of the annular zone of the implant. In some embodiments, the struts  530  that form a portion of the coaptation zone of the implant can be, for example, at least about 10%, 20%, 30%, 40%, 50%, 75%, 100%, 125%, or 150% longer than the struts  530  that form a portion of the annular zone of the implant. 
       FIG.  5 A  shows a view of the coaptation assistance element  500  with an annular anchor site  535 . The annular anchor site  535  can be a portion of the struts  530 . The annular anchor site  535  is shown extending downward from the coaptation assistance element  500  in  FIG.  5 A . In other embodiments, the annular anchor site  535  may extend in other directions from the coaptation assistance element  500  to engage tissue. In some embodiments, the annular anchor site  535  comprises one or more barbs having a sharpened tip. The annular anchor site  535  may be a passive anchor. 
     In some embodiments, the coaptation assistance element  500  can include one or more retractable barbs. For instance, the barbs can be retracted during delivery of the coaptation assistance element  500 . For instance, the barbs can be advanced after the coaptation assistance element  500  is positioned relative to the anatomical structures. In some embodiments, the barbs are actively retracted and/or advanced. For instance, the delivery catheter described herein can include a mechanism coupled to the barbs designed to retract and/or advance the barbs. In other embodiments, the barbs are passively advanced and/or retracted. In some embodiments, the coaptation assistance element  500  is delivered with the barbs in a retracted state. In some embodiments, the barbs can be covered by the valve body covering as described herein. In some embodiments, the interface between the tissue and the valve body covering pushes back the valve body covering and exposes the barbs. In some embodiments, the tissue dissolves and/or absorbs a portion of the valve body covering and exposes the barbs. In some embodiments, the motion of the purse-string suture, described herein, advances the barbs. In some embodiments, the motion of the purse-string suture causes motion of the valve body covering to expose the barbs. Other configurations are contemplated. 
     The annular anchor site  535  may define a diameter D 1  shown in  FIG.  5 B , which may in some embodiments correspond to the distance between the medial and lateral commissures of the native valve or the intracommissural distance (ICD). D 1  may range between 20-60 mm with, in some embodiments, a preferred length between 35-45 mm, as corresponding most closely to the widest range of human mitral ICD. In some embodiments, D 1  may be the distance from the right to left fibrous trigones. 
     The coaptation assistance element  500  can include a generally annular section  510 . The annular section  510  can be positioned above the native leaflets when the coaptation assistance element  500  is deployed. In some embodiments, the annular section  510  may be curved toward the annulus or curved away from the annulus. The annular section  510  can be concave. In other embodiments, the annular section  510  may be substantially flat with respect to the annulus. One or more of the struts  530  may curve laterally from the hub  520  toward the superior edge  540  to assist in maintaining the shape of the annular section  510  of the coaptation assistance element  500  upon deployment. The coaptation assistance element  500  can curve downward from the hub  520  toward the annular anchor site  535 . In some embodiments, the coaptation assistance element  500  does not rest against the posterior leaflet. In some embodiments, the annular anchor site  535  is the only point of contact between the posterior annulus of the mitral valve and the coaptation assistance element  500 . The superior edge  540  can include an annular radius of curvature. The annular curve radius can curve toward the annulus. The annular curve radius can curve toward the coaptation surface  560 . In some embodiments, the annular curve radius can be between 0 mm-5 mm, 5 mm-10 mm, 10 mm-15 mm, 15 mm-20 mm, 20 mm-25 mm, 25 mm-30 mm, etc. 
     The struts  530  may be composed of a radio-opaque material. In some embodiments, the struts  530  are composed of resiliently deformable materials such as a shape memory metal, e.g., Nitinol or a shape memory polymer. In some embodiments, the material is Elgiloy. In other embodiments, the struts  530  may be composed of other materials to include stainless steel, polypropylene, high density polyethylene (PE), Dacron, acellular collagen matrix such as SIS, or other plastics, etc. In other embodiments, the struts  530  may be a combination such as a high density PE sheath around a core of ePTFE, Dacron, and/or polypropylene. The struts  530  may have a circular cross section, an oval cross section, or be ribbon-like. In some embodiments, the struts  530  are coiled springs or zig-zag shaped. The struts  530  may have a constant stiffness. In some embodiments, one or more struts  530  can have differing stiffness along the length of the one or more struts  530 . The struts  530  may be stiffer at the annular end than at the ventricular end of the coaptation assistance element  500 . The struts  530  may be less stiff at the annular end than at the ventricular end of the coaptation assistance element  500 . The struts  530  may be stiffer at a midpoint, for instance at an inflection point or curve. The struts  530 , along with one or more other support structures, can form a frame. In some embodiments, one or more support structures may be provided which run parallel to the superior edge  540  of the coaptation assistance element  500  and assist in maintaining the shape of the superior edge  540 . The struts  530  and/or other support structures of the frame can be laser-cut from a Nitinol tube in some embodiments. 
     The coaptation assistance element body covering  550  may be comprised of a material such as ePTFE. Other materials for the coaptation assistance element body covering  550  include polyester, polyurethane foam, polycarbonate foam, biologic tissue such as porcine pericardium, processed bovine pericardium, pleura, peritoneum, silicone, Dacron, acellular collagen matrix, etc. In some embodiments, the coaptation assistance element body covering  550  can include a foam material surrounded by ePTFE. Use of sponge or foam material enhances the capability of having the coaptation assistance element  500  to fold to a small enough diameter to pass through a catheter. In some embodiments, the coaptation assistance element body covering  550  has no pores. In other embodiments, the coaptation assistance element body covering  550  may have micropores to enhance endothelialization and cellular attachment. The coaptation assistance element body covering  550  may also incorporate a radiopaque material or an echo-enhancement material for better visualization. Any support structures of the coaptation assistance element  500  including the struts  530  or support interface including the hub  520  may be coated with radio-opaque materials such as gold or platinum or impregnated with barium. The coaptation surface  560  may be coated with an echo enhancement material. The coaptation assistance element body covering  550  may be coated with a material to inhibit thrombosis, such as heparin bonding or quinoline and quinoxaline compounds, or with a material to accelerate endothelialization, or with antibiotic to inhibit infection. In some embodiments, the purse-string suture  1010  described herein can incorporate a radiopaque material or an echo-enhancement material for better visualization. 
     In some embodiments, the struts  530  may be sandwiched between layers of coaptation assistance element body covering  550 . The coaptation assistance element body covering  550  may be composed of the same material on the first surface  505  and the second surface  515 . The coaptation assistance element body covering  550  may be composed of different materials on the first surface  505 , or a portion thereof, and the second surface  515 , or a portion thereof. In some embodiments, the struts  530  may be attached to or embedded in the first surface  505  or the second surface  515  of a single layer of coaptation assistance element body covering  550 . In some embodiments, the struts  530  may be “stitched” through the coaptation assistance element body covering  550 . The annular anchor site  535  can be exposed ends of the struts  530  from the coaptation assistance element body covering  550 . 
     The coaptation assistance element  500  can include a purse-string suture  1010 . The purse-string suture  1010  can extend along a portion of the coaptation assistance element  500 . The purse-string suture  1010  can extend along the superior edge  540 , or a portion thereof. The purse-string suture  1010  can extend along the lateral edge  570 , or a portion thereof. The purse-string suture  1010  can extend along the lateral edge  575 , or a portion thereof. The purse-string suture  1010  can extend along the inferior edge  580 , or a portion thereof. The purse-string suture  1010  can extend along a perimeter, or a portion thereof, of the coaptation assistance element  500 . The purse-string suture  1010  can extend along one or more struts  530 . The purse-string suture  1010  can extend in a linear path, a non-linear path, a curve, a semi-circle or any open or closed shape. 
     In some embodiments, the purse-string suture  1010  may be sandwiched between layers of valve body covering  550 . For instance, the purse-string suture  1010  can be disposed in a lumen between layers of coaptation assistance element body covering  550 . In some embodiments, the purse-string suture  1010  may be attached to or embedded in the first surface  505  or the second surface  515  of a single layer of valve body covering  550 . In some embodiments, the purse-string suture  1010  may be “stitched” through the coaptation assistance element body covering  550 . The purse-string suture  1010  can pass from the first surface  505  to the second surface  515  and back to the first surface  505 . The purse-string suture  1010  can include one or more exposed ends from the coaptation assistance element body covering  550 . In embodiments where the purse-string suture  1010  is a loop, the purse-string suture can include one or more exposed sections of the loop from the valve body covering. 
     The coaptation assistance element  500  may be collapsed by tightening the purse-string suture  1010 . The coaptation assistance element  500  may be expanded by loosening the purse-string suture  1010 . The one or more exposed ends or loops can be manipulated by a delivery catheter or other tool to tighten or loosen the purse-string suture  1010 . The ability to collapse or expand the coaptation assistance element  500  may be beneficial for recapture of the coaptation assistance element  500  and/or repositioning of the coaptation assistance element  500 . 
     The coaptation assistance element  500  may be rotated by tightening one or more purse-string suture  1010  and/or loosening one or more purse-string suture  1010 . For instance, tightening one or more purse-string suture  1010  on the lateral edge  570  and/or loosening one or more purse-string suture  1010  on the lateral edge  575  may cause the coaptation assistance element  500  to rotate. One or more purse-string sutures  1010  may be coupled to the coaptation assistance element  500  to enable multi-directional rotation. 
     The coaptation assistance element  500  may be expanded by loosening the purse-string suture  1010 . The one or more exposed ends or loops can be manipulated by a delivery catheter or other tool to tighten or loosen the purse-string suture  1010 . The ability to collapse or expand the coaptation assistance element  500  may be beneficial for recapture of the coaptation assistance element  500  and/or repositioning of the coaptation assistance element  500 . 
     The coaptation surface  560  of the coaptation assistance element  500  may be adjusted by motion of the purse-string suture  1010 . The one or more exposed ends or loops can be manipulated by a delivery catheter or other tool to tighten or loosen the purse-string suture  1010  to change the curvature of the coaptation surface  560  in situ. The ability to adjust the curvature of the coaptation assistance element  500  may be beneficial to conform to the geometry of heart including the geometry of the anterior leaflet. 
     The annular dimension of the coaptation assistance element  500  may be adjusted by motion of the purse-string suture  1010 . The one or more exposed ends or loops can be manipulated by a delivery catheter or other tool to tighten or loosen the purse-string suture  1010  to change one or more dimensions of the coaptation assistance element  500  in situ. The ability to adjust dimensions of the coaptation assistance element  500  may be beneficial to conform to the geometry of the heart. 
     The coaptation assistance element  500  can include one or more purse-string sutures  1010 . In some embodiments, the coaptation assistance element  500  includes one purse-string suture, two purse-string sutures, three purse-string sutures, four purse-string sutures, five purse-string sutures, six purse-string suture, seven purse-string sutures, eight purse-string sutures, nine purse-string sutures, ten purse-string sutures, etc. For instance, a purse-string suture  1010  can extend along each edge of the coaptation assistance element  500 . When multiple purse-string sutures are provided, the purse-string sutures  1010  can act together to change the configuration of the coaptation assistance element  500 . When multiple purse-string sutures are provided, the purse-string sutures  1010  can act independently to change the configuration of the coaptation assistance element  500 . 
       FIG.  5 A  further illustrates a coaptation element height, corresponding to the distance between the inferior edge  580  and the annular hub  520  as measured perpendicular to the plane defined by the annulus of the valve. Coaptation element height of some embodiments may be 10-80 mm, with some embodiments ranging between 40-55 mm. The coaptation element height can be between 10-20 mm, 20-30 mm, 30-40 mm, 40-50 mm, 50-60 mm, 60-70 mm, 70-80 mm, etc. 
       FIG.  5 A  illustrates the generally triangular shape of coaptation assistance element  500 , such that the coaptation assistance element  500  has a superior edge  540 , lateral edges  570  and  575 , and inferior edge  580 . In some embodiments, the superior edge  540  has a length greater than that of inferior edge  580 , such that the transverse distance between lateral edges  570  and  575  generally decreases from superior to inferior on the coaptation assistance element  500 . For example, the length of the superior edge  540  may be in the range of 15-50 mm, or 25-35 mm, while the length of the inferior edge  580  may be in the range of 1-15 mm, or 2-6 mm. 
     The annular hub  520  may be a hub, an eyelet, or any other tether site known in the art. In some embodiments, the annular hub  520  is located at a midpoint of the distance D 1 . In some embodiments, the annular hub  520  is located at a neutral center to prevent swinging of the coaptation assistance element  500  when the coaptation assistance element  500  is held by the annular hub  520 . In other embodiments, the annular hub  520  is located at one of the commissures. While only one annular anchor  800  is shown, in other embodiments, two or more annular hubs  520  may be provided. 
     In some embodiments, the struts  530  can comprise NiTi tubing. In some embodiments, the struts  530  can be laser cut from the tubing. In some embodiments, the frame including one or more struts  530  and/or one or more support structures can be laser cut from a single piece of material. In some embodiments, the frame including one or more struts  530 , the annular hub  520 , and/or one or more support structures can be integrally formed. In some embodiments, the coaptation assistance element body covering  550  comprises ePTFE lamination. The lamination can surround one or more of the struts  530  and/or one or more support structures (e.g., one side, two sides, first side  505 , second side  515 ). The struts  530  and/or one or more support structures can be encased by two or more layers of lamination. The perimeter of the annular section  510  of the coaptation assistance element  500  can be cupped down. The perimeter of the annular section  510  of the coaptation assistance element  500  can be cupped up. The perimeter of the annular section  510  of the coaptation assistance element  500  can include secondary anchors such as the annular anchor site  535 . 
     In some embodiments, the annular anchor  800  and the annular hub  520  form a single central anchor system. In some embodiments, the coaptation assistance element  500  is affixed to the tissue by only one annular anchor  800  which passes through the hub  520 . In other embodiments, additional fixation is included. In some embodiments, the coaptation assistance element  500  is affixed to the tissue by the one anchor  800  which passes through the hub  520  and the annular anchor site  535  as described herein. The system can include features to allow rotational adjustment of the coaptation assistance element  500 . For instance, the hub  520  and/or the annular anchor  800  can be coupled to the delivery catheter to allow the transmission of axial movement and/or torque. The coaptation assistance element  500  can be immovably grasped by a delivery catheter such that rotation of a feature of the delivery catheter, such as a handle, causes rotation of the coaptation assistance element  500 . The coaptation assistance element  500  can be immovably grasped by a delivery catheter such that axial movement of a feature of the delivery catheter, such as a drive shaft, causes axial movement of the coaptation assistance element  500 . 
     In some embodiments, the hub  520  is located at a neutral position on the coaptation assistance element  500 . The neutral position can be a central location on the annular section  510 . The neutral position can be between the lateral edges  505 ,  515 . The neutral position can be between the superior edge  540  and the cooptation surface  560 . The neutral position can enhance stability of the coaptation assistance element  500  when the coaptation assistance element  500  is grasped at a single location such as the hub  520  and/or the annular anchor  800 . The neutral position can be aligned with a structure of the mitral valve. The neutral position can be aligned along the coaptation zone. 
     In some embodiments, the coaptation assistance element  500  is delivered percutaneously as described herein. In some embodiments, the coaptation assistance element  500  is adjustable via a delivery catheter. For instance, the coaptation assistance element  500  can be expanded and/or collapsed by the delivery catheter. For instance, the coaptation assistance element  500  can be rotated about a fixed position of the annular hub  520 . For instance, the coaptation assistance element  500  can be recapturable. For instance, the coaptation assistance element  500  can be engaged and reengaged by the delivery catheter. For instance, the annular anchor  800  can be disengaged from the tissue and the delivery catheter can recapture the coaptation assistance element  500 . 
       FIGS.  5 C- 5 D  illustrate embodiments of a frame  565  of the coaptation assistance element  500 . These figures illustrated the flattened patterns of the frame  565  prior to bending and/or shape setting. In some embodiments, the frame  565  is cut from a tubular stock. In other embodiments, the frame  565  is cut from flat stock such as a flat sheet of material. The frame  565  including portions thereof can be laser cut. The frame  565  can include one or more struts  530 . In the embodiment shown in  FIG.  5 D , the frame  565  includes twenty struts  530  but other configurations are contemplated (e.g., one strut, two struts, three struts, four struts, five struts, between five and ten struts, between ten and fifteen struts, between fifteen and twenty struts, between twenty and twenty-five struts, between twenty-five and thirty struts, between two and thirty struts, between five and thirty struts, etc.). In some embodiments, the frame  565  can include about, at least about, or no more than about 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, or more struts, or a range incorporating any two of the aforementioned values. In some embodiments, the length of the struts extending to the superior upwardly or downwardly cupping lip are shorter than, such as less than about 80%, 70%, 60%, 50%, 40%, 30%, 20%, or less than the longest inferior-extending strut. 
     In some embodiments, one, two, or more struts  530  are coupled to a backing  585 . In some embodiments, the backing  585  is transverse to the direction of the struts  530 . In the illustrated embodiment, the backing  585  is vertical or generally vertical and the struts  530  are horizontal or generally horizontal. In some embodiments, the backing  585  is the annular hub  520 . For instance, the two ends of the backing  585  can be joined using methods known in the art to form the annular hub  520 . The two ends are joined, for instance, if the frame  565  is cut from flat stock. In other embodiments, the frame  565  is formed from tubular stock. The backing  585  can be a portion of uncut tubular stock. The two ends of the backing  585  may not need to be joined if the frame  565  is formed from tubular stock. The uncut tubular stock can form the annular hub  520 . The patters of the frame  565  as shown in  FIG.  5 D  can be cut from tubular stock, thereby eliminating the need to join the two ends of the backing. Other modes of manufacturing are contemplated to form the frame  565 . In other embodiments, the backing  585  forms at least a portion of the annular hub  520 . In some embodiments, the backing  585  surrounds at least a portion of the annular hub  520 . In some methods of manufacturing, the backing  585  can be formed into a shape of a circle. In some methods of manufacturing, the struts  530  extend radially outward from the backing  585  once the backing  585  is shaped into a circle. The backing  585  can include one or more openings designed to accept a cross-pin, as disclosed herein. In some methods of manufacturing, the backing  585  is removed. 
     Referring to  FIG.  5 A and  5 C , a plurality of struts  530  can extend from the annular hub  520  to the inferior end  580 . In some embodiments, these struts  530  are longer than other struts  530  of the frame  565 . In some embodiments, the struts  530  might include an anchor or barb that interacts with the subvalvular structure, including the ventricular wall. In some embodiments, these struts engage the posterior leaflet or another anatomical structure. In some embodiments, the ventricular anchoring is passive. 
     Referring to  FIG.  5 A- 5 D , a plurality of struts  530  can extend from the annular hub  520  to the superior end  540 . In some embodiments, these struts  530  are shorter than other struts  530  of the frame  565 . In some embodiments, these struts  530  form an atrial anchor and/or the annular anchor site  535  described herein. In some embodiments, these struts engage the annulus or another anatomical structure. In some embodiments, the annular anchoring is passive. 
     Referring to  FIG.  5 A and  5 D , a plurality of struts  530  can extend from the annular hub  520  to the lateral edges  570  and  575 . In some embodiments, these struts  530  have a mid-length between the ventricular struts and the atrial struts. In some embodiments, these struts engage the commissures or another anatomical structure. In some embodiments, the commissural anchoring is passive. 
     The struts  530  can have a variety of lengths based on the desired shape of the coaptation assistance element  500 . As shown in  FIGS.  5 C- 5 D , two or more struts  530  have a different length. As shown in  FIGS.  5 C- 5 D , two or more struts  530  have the same length.  FIG.  5 C  shows a schematic model of the frame  565 . One or more of the top three struts can form the coaptation surface  560  and extend to the inferior edge. One or more of the bottom three struts can form the annular portion and extend to the superior edge. The struts  530  can be laser-cut from a tube. The length can be measured from the annular hub  520  to an edge of the coaptation assistance element  500 . The range of the strut length can be 1 mm to 50 mm. The range of the strut length can be 5 mm to 35 mm for the annular portion  510 . The strut length can be about 15 mm for the annular portion  510 . The range of the strut length can be 20 mm to 35 mm for the coaptation surface  560 . The strut length can be about 30 mm for the coaptation surface  560 . Other configurations of the range of strut length are contemplated e.g., 5 mm to 45 mm, 10 mm to 40 mm, 15 mm to 35 mm, about 5 mm, about 10 mm, about 15 mm, about 20 mm, about 25 mm, about 30 mm, about 35 mm, about 40 mm, about 45 mm, about 50 mm, about 55 mm, about 60 mm, 1 mm to 10 mm, 5 mm to 15 mm, 10 mm to 20 mm, 15 mm to 25 mm, 20 mm to 30 mm, 25 mm to 35 mm, 30 mm to 40 mm, etc. 
     The width can be measured perpendicular to the strut length. The range of the strut width can be 0.1 mm to 2 mm. One or more struts can have an outer diameter or width of about 0.1 mm, 0.2 mm, 0.3 mm, 0.4 mm, 0.5 mm, 0.6 mm, 0.7 mm, 0.8 mm, 0.9 mm, 1 mm, 1.1 mm, 1.2 mm, 1.3 mm, 1.4 mm, 1.5 mm, 1.6 mm, 1.7 mm, 1.8 mm, 1.9 mm, 2 mm, less than 0.5 mm, less than 1 mm, less than 1.5 mm, less than 2 mm, etc. One or more struts  530  can have a varying width along the strut length. In some embodiment, one or more struts  530  taper near an edge of the coaptation assistance element  500 . In some embodiments, one or more struts  530  taper near the annular hub  520 . The one or more struts  530  can include a reduced diameter or taper at the connection between the one or more struts  530  the annular hub  520 . The taper near the annular hub  520  can aid in collapsing the coaptation assistance element  500 . The taper near the annular hub  520  can facilitate insertion of the coaptation assistance element  500  into the delivery catheter. The taper can reduce stress and/or strain in the strut  530  during collapse. In some embodiments, the taper can aid in longer fatigue life. In some embodiments, one or more struts  530  include a varying width taper. The width of the strut  530  can vary along the length of the strut  530 . One or more struts  530  can include eyelets along the length of the strut  530 . In some embodiments, the eyelets can reduce stress of the struts  530 . In some embodiments, the eyelets can facilitate adhesion between the strut  530  and the valve body covering  550 . 
     The thickness can be measured perpendicular to the strut length and strut width. The thickness can be determined by the thickness of the material of the frame, as described herein. The range of the strut thickness can be 0.2 mm to 0.5 mm. One or more struts can have a thickness of about 0.1 mm, 0.2 mm, 0.3 mm, 0.4 mm, 0.5 mm, 0.6 mm, 0.7 mm, 0.8 mm, 0.9 mm, 1 mm, 1.1 mm, 1.2 mm, 1.3 mm, 1.4 mm, 1.5 mm, 1.6 mm, 1.7 mm, 1.8 mm, 1.9 mm, 2 mm, less than 0.5 mm, less than 1 mm, less than 1.5 mm, less than 2 mm, etc. 
     One or more the struts  530  can include barbs. In some embodiments, the barbs can be configured for placement near the ventricular end of the coaptation assistance element  500 . In some embodiments, the barbs can be bent out of the plane of the strut  530 . In some embodiments, the barb can have a bayonet configuration. In some embodiments, the barbs can have a sharped tip. In some embodiments, one or more struts  530  can be bifurcated. In some embodiments, one or more struts  530  can include one or more zigzag sections. In some embodiments, the zigzag section reduces stress and/or increases flexibility of the strut  530 . In some embodiments, the zigzag section facilitates adhesion between the strut  530  and the coaptation assistance element body covering  550 . 
     In some embodiments, one or more struts  530  can include supplemental barbs. In some embodiments, the supplemental barbs can be bent out of the plane of the strut  530 . In some embodiments, one or more portions of the strut length are bent out of the plane of the strut. For instance, a portion of the strut can be twisted or bent during manufacturing. In some embodiments, the portion that is bent out of plane is shaped to engage tissue. In some embodiments, one or more struts  530  can include increased widths to compensate for electropolishing or other post manufacturing processes. In some embodiments, the backing  585  can include one or more features to engage the delivery catheter described herein. In some embodiments, the backing  585  can include one or more notches designed to interface with a locking tab or other feature of the delivery catheter as described herein. In some embodiments, one or more struts  530  can include a greater width than other struts  530 . In some embodiments, the frame  565  includes two or more struts  530  that have a greater width than other struts  530 . The two or more struts  530  can facilitate visualization of the coaptation assistance element  500 . In some embodiments, the two or more struts  530  that have a greater width are designed to be placed near the commissures when the coaptation assistance element  500  is deployed. In some embodiments, one or more struts  530  can have smaller width compared with one or more other struts. In some embodiments, each strut  530  has the same width near the annular hub  520 .The backing  585  can be modified to interface with the delivery catheter, as described herein. The backing  585  can be designed to allow independent rotation of the anchor  800  within the hub of the coaptation assistance element  500 . 
       FIGS.  5 E,  5 F, and  5 G  show an embodiment of the coaptation assistance element  500  without barbs.  FIG.  5 E  shows a schematic perspective view of the coaptation assistance element  500 .  FIG.  5 F  shows a schematic perspective view of the first surface  505  disposed toward a mal-coapting native leaflet.  FIG.  5 G  shows a schematic cross-sectional view including the anchor  800 . 
       FIGS.  5 H,  5 I, and  5 J  show an embodiment of the coaptation assistance element  500  with leaflet anchor sites  545 . As shown in  FIG.  5 A , the annular anchor sites  535  such as barbs can extend along an edge of the coaptation assistance element  500 .  FIGS.  5 H,  5 I, and  5 J  show an embodiment of the coaptation assistance element  500  with leaflet anchor sites  545  extending from the first surface  505  disposed toward a mal-coapting native leaflet. 
       FIG.  5 H  shows a schematic perspective view of the coaptation assistance element  500  including an enlarged section showing the leaflet anchor sites  545 .  FIG.  5 I  shows a schematic perspective view of the first surface  505  disposed toward a mal-coapting native leaflet.  FIG.  5 J  shows a schematic cross-sectional view including the anchor  800 . 
     In some embodiments, the leaflet anchor sites  545  comprise one or more barbs having a sharpened tip. The leaflet anchor sites  545  may be a passive anchor. In some embodiments, the coaptation assistance element  500  can include one or more retractable barbs. For instance, the leaflet anchor sites  545  can be retracted during delivery of the coaptation assistance element  500 . For instance, the leaflet anchor sites  545  can be advanced after the coaptation assistance element  500  is positioned relative to the anatomical structures. In some embodiments, the leaflet anchor sites  545  are actively retracted and/or advanced. For instance, the delivery catheter described herein can include a mechanism coupled to the leaflet anchor sites  545  designed to retract and/or advance the barbs. In other embodiments, the leaflet anchor sites  545  are passively advanced and/or retracted. In some embodiments, the leaflet anchor sites  545  can be covered by the valve body covering as described herein. In some embodiments, the interface between the tissue and the valve body covering pushes back the valve body covering and exposes the leaflet anchor sites  545 . In some embodiments, the tissue dissolves and/or absorbs a portion of the valve body covering and exposes the leaflet anchor sites  545 . In some embodiments, the motion of the purse-string suture, described herein, advances the leaflet anchor sites  545 . In some embodiments, the motion of the purse-string suture causes motion of the valve body covering to expose the leaflet anchor sites  545 . Other configurations are contemplated. 
     One or more struts  530  may have one or more barbs along the length of the strut  530 . In the illustrated embodiment, five struts  530  each have four leaflet anchor sites  545  along the length of the struts. Other configurations are contemplated varying the number of struts  530  (e.g., one strut, two struts, three struts, four struts, five struts, six struts, seven struts, eight struts, nine struts, ten struts, etc.) and varying the number of leaflet anchor sites  545  per strut  530  (e.g., one barb, two barbs, three barbs, four barbs, five barbs, six barbs, seven barbs, eight barbs, nine barbs, ten barbs, etc.). One or more struts  530  can have the same number of leaflet anchor sites  545 . Two or more struts  530  can have a different number of leaflet anchor sites  545 . The leaflet anchor sites  545  can be disposed to engage the posterior leaflet. 
     In some embodiments, the struts  530  may be sandwiched between layers of valve body covering  550 . In some embodiments, the struts  530  may be attached to or embedded in the first surface  505  or the second surface  515  of a single layer of valve body covering  550 . In some embodiments, the struts  530  may be “stitched” through the valve body covering  550 . The first surface  505  can include one or more openings for the leaflet anchor sites  545 . In other embodiments, the leaflet anchor sites  545  can push through the valve body covering  550 . The leaflet anchor sites  545  can have a pre-set curve which can exert a force on the first surface  505 . The leaflet anchor sites  545  can be sharpened to cut through the valve body covering  550 . 
     The frame  565  can have many advantages. The frame  565  can be formed from a flattened pattern. The frame  565  can include an edge which forms the annular hub  520 . The edge can include a longitudinal strip or backing  585 . One or more struts  530  can extend from the backing  585 . In the illustrated embodiment of  FIGS.  5 C and  5 D , the one or more struts  530  are perpendicular to the longitudinal strip. The struts  530  are generally parallel. In some embodiments, the struts  530  are generally perpendicular to the backing  585  that forms the annular hub  520 . In some embodiments, the struts  530  form an angle with the backing  585 . For instance, the longitudinal axis of the struts  530  can form an acute angle with the backing  585 . The angle can aid in the collapse of the struts  530  into the delivery catheter. 
     The frame  565  can be constructed from a single, planar sheet of material. The frame  565  can be precisely cut using water jet, laser etching or similar technology. The details of the struts  530 , including barbs, can be machined into the struts  530 . The frame  565  can be bent and/or shape set to achieve the desired geometry. In some embodiments, the backing  585  is folded to form a loop. The frame  565  can be rolled into a tubular shape. The backing  585  can be welded or otherwise secured. The backing  565  when secured end to end to form a loop can be considered the annular hub  520 . 
     The struts  530  are bent to the desired configuration. The struts  530  can form one or more curves. The struts  530  can have one or more inflection points. The struts  530  can have concave portions and/or convex portions. One or more struts  530  can include a radially outward flare beginning at an inflection point. In some embodiments, the superior edge  540  is curved upward away from the inferior edge  580 . In some embodiments, the superior edge  540  is curved downward toward the inferior edge  580 . In some embodiments, one or more struts  530  can be substantially flat. The struts  530  near the commissures can be substantially flat. In some embodiments, the inferior edge  580  is curved backward toward the superior edge  540 . In some embodiments, the inferior edge  580  is curved forward away from the superior edge  540 . 
     The struts  530  can be equally spaced about the circumference of the annular hub  520 . The struts  530  can be unequally spaced about the circumference of the annular hub  520 . The struts  530  extending along a portion of the circumference of the annular hub  520  are different than struts extending along another portion of the circumference of the annular hub  520 . One or more designated portions of the struts  530  can be designed to be placed near the annular region of the heart. One or more designated portions of the struts  530  can be designed to be placed near the commissure region of the heart. One or more designated portions of the struts  530  can be designed to be placed near the ventricular region of the heart. The geometry of the radially extending struts  530  can be shaped to match the geometry of the patient. In some embodiments, the geometry is patient specific. The operator can shape one or more struts  530  based on the geometry of the heart. The operator can modify the shape of one or more struts  530  based on the geometry of the patient. 
       FIG.  5 K  illustrates dimensions of the coaptation assistance element  500 . The coaptation assistance element  500  can include a dimension A. The dimension A can be a linear projected dimension or posterior projection. In some embodiments, the range of dimension A can be 1 mm to 40 mm. In some embodiments, the range of dimension A can be 4 mm to 24 mm. Other configurations of the range of dimension A are contemplated e.g., 5 mm to 35 mm, 10 mm to 30 mm, 15 mm to 25 mm, about 1 mm, about 2 mm, about 3 mm, about 4 mm, about 5 mm, about 6 mm, about 7 mm, about 8 mm, about 9 mm, about 10 mm, 1 mm to 10 mm, 5 mm to 15 mm, 10 mm to 20 mm, 15 mm to 25 mm, 20 mm to 30 mm, 25 mm to 35 mm, 30 mm to 40 mm, etc. The dimension A can be 0 mm if no posterior projection, for instance if the coaptation assistance element  500  is straight. 
     The coaptation assistance element  500  can include a dimension B. In some embodiments, the dimension B can be a radius of curvature. The radius of curvature can be concave or convex, as described herein. In some embodiments, the range of dimension B can be 1/16 inch to ½ inch. In some embodiments, the range of dimension B can be 1.5 mm to 13 mm. In some embodiments, the range of dimension B can be ¼ inch to ⅜ inch. In some embodiments, the range of dimension B can be 6 mm to 9.5 mm. In some embodiments, the range of dimension B can be 1 mm to 15 mm. Other configurations of the range of dimension B are contemplated e.g., 2 mm to 14 mm, 3 mm to 13 mm, 4 mm to 12 mm, 5 mm to 11 mm, 6 mm to 10 mm, 7 mm to 9 mm, about 1 mm, about 2 mm, about 3 mm, about 4 mm, about 5 mm, about 6 mm, about 7 mm, about 8 mm, about 9 mm, about 10 mm, 1 mm to 10 mm, 5 mm to 15 mm, 10 mm to 20 mm, etc. The dimension B can be 0 mm if no curvature, for instance if the coaptation assistance element  500  is straight. 
     The coaptation assistance element  500  can include a dimension C. In some embodiments, the dimension C can be a radius of curvature near the superior edge  540 . In some embodiments, the range of dimension C can be 1 mm to 10 mm. In some embodiments, the range of dimension C can be 1 mm to 5 mm. Other configurations of the range of dimension C are contemplated e.g., 2 mm to 9 mm, 3 mm to 8 mm, 4 mm to 7 mm, 5 mm to 6 mm, about 1 mm, about 2 mm, about 3 mm, about 4 mm, about 5 mm, about 6 mm, about 7 mm, about 8 mm, about 9 mm, about 10 mm, 1 mm to 15 mm, 5 mm to 10 mm, 3 mm to 9 mm, etc. The dimension C can be 0 mm if no curvature, for instance if the coaptation assistance element  500  is straight. 
     The coaptation assistance element  500  can include a dimension D. The dimension D can be a coaptation element height. The dimension D can correspond to the distance between the inferior edge  580  and the atrial anchor site or annular hub  520  as measured perpendicular to the plane defined by the annulus of the valve. In some embodiments, the range of dimension D can be 10 mm to 80 mm. In some embodiments, the range of dimension D can be 40 mm to 55 mm. Other configurations of the range of dimension D are contemplated e.g., 5 mm to 105 mm, 10 mm to 100 mm, 15 mm to 95 mm, 20 mm to 90 mm, 25 mm to 85 mm, 30 mm to 80 mm, 35 mm to 75 mm, 40 mm to 70 mm, 45 mm to 65 mm, 50 mm to 60 mm, about 10 mm, about 20 mm, about 30 mm, about 40 mm, about 50 mm, about 60 mm, about 70 mm, about 80 mm, about 90 mm, about 100 mm, 10 mm to 50 mm, 20 mm to 60 mm, 30 mm to 70 mm, 40 mm to 80 mm, 50 mm to 90 mm, 60 mm to 100 mm, 70 mm to 110 mm, etc. 
     The coaptation assistance element  500  can include a dimension E. The dimension E can be a linear projected dimension or anterior projection. In some embodiments, the range of dimension E can be 2 mm to 20 mm. In some embodiments, the range of dimension E can be 5 mm to 10 mm. Other configurations of the range of dimension E are contemplated e.g., 0 mm to 25 mm, 5 mm to 20 mm, 10 mm to 15 mm, about 1 mm, about 2 mm, about 3 mm, about 4 mm, about 5 mm, about 6 mm, about 7 mm, about 8 mm, about 9 mm, about 10 mm, about 11 mm, about 12 mm, about 13 mm, about 14 mm, about 15 mm, about 16 mm, about 17 mm, about 18 mm, about 19 mm, about 20 mm, 1 mm to 10 mm, 5 mm to 15 mm, 10 mm to 20 mm, 15 mm to 25 mm, 20 mm to 30 mm, 25 mm to 35 mm, 30 mm to 40 mm, etc. The dimension E can be 0 mm if no anterior projection. 
     The struts  530  of the coaptation assistance element  500  can form a posterior curve of the coaptation surface  560 . The posterior bend can have a bend length of the distal 30-100% of the strut. In some embodiments, the posterior bend can have a bend length of at least the distal 40% of the strut. The angle of the posterior bend can be in the range of 0 degrees to 90 degrees with respect to the longitudinal axis of the coaptation assistance element  500 . In some embodiments, the angle of the posterior bend can be in the range 45 degrees to 90 degrees. 
       FIG.  6    illustrates an embodiment of a coaptation assistance element  600 . The coaptation assistance element  600  can be similar to the coaptation assistance element  500 , and include any features of the coaptation assistance element  500  described herein, with certain additional features described below. 
     The coaptation assistance element  600  can include an annular hub  620  engaging an annular anchor (not shown). The annular hub  620  may have a built-in or coupled annular anchor, such as annular anchor  800  described herein. The annular anchor may include a helix rotatable with respect to the annular hub  620 . In some embodiments, the coaptation assistance element  600  can include a single annular anchor inside the annular hub  620 . The coaptation assistance element  600  can be delivered percutaneously as described herein by attachment of a delivery catheter to the annular hub  620 . 
     As may be seen in  FIG.  6   , the coaptation assistance element  600  can include struts  630 . In some embodiments, one, two, or more struts  630  have one end terminating at the annular hub  620  and the other end extending radially outwardly toward the superior edge  640 , the lateral edges  670  and  675 , and the inferior edge  680  of the coaptation assistance element  600 . The struts  630  may extend outward from the hub  620 . The struts  630  may be arranged generally parallel to the longitudinal axis of the coaptation assistance element  600  to assist in maintaining the shape of the coaptation assistance element  600  upon placement. The struts  630  may allow the coaptation assistance element  600  to assume a reduced configuration for deployment through a catheter. 
     The coaptation assistance element  600  can include an annular section  610 . The annular section  610  can be positioned above the annulus of the native leaflet when the coaptation assistance element  600  is deployed and form a lip as shown. In some embodiments, the annular section  610  may be may be curved upwardly, e.g., away from the annulus and in a direction substantially opposite from, and substantially parallel to the coaptation surface  660 , and form the superior-most portion of the coaptation assist element  600  when implanted. The annular section  610  can be convex. In other embodiments, the annular section  610  may be may be substantially flat with respect to the annulus. One or more of the struts  630  may curve laterally from the annular hub  620  toward the superior edge  640  to assist in maintaining the shape of the annular section  610  of the coaptation assistance element  600  upon deployment. The coaptation assistance element  600  can curve upward from the annular hub  620 . In some embodiments, the superior edge  640  does not rest against the posterior leaflet. The superior edge  640  can include an annular radius of curvature. The annular curve radius can curve away from the annulus. The annular curve radius can curve toward the coaptation surface  660 . In some embodiments, the annular curve radius can be between 0 mm-5 mm, 5 mm-10 mm, 10 mm-15 mm, 15 mm-20 mm, 20 mm-25 mm, 25 mm-30 mm, etc., or ranges incorporating any two of the previous values. The coaptation assistance element body covering  650  may be similar to the coaptation assistance element body covering  550  described herein. 
     In some embodiments, the perimeter of the annular section  610  is cupped upward and in a direction substantially opposite to the longitudinal axis of the coaptation surface  660 . In some embodiments, the coaptation assistance element  600  includes annular anchor site similar to annular anchor site  535 . In other embodiments, the coaptation assistance element  600  does not include annular anchor site as shown in  FIG.  6   . 
       FIGS.  7 A- 7 E  illustrate an embodiment of a coaptation assistance element  700 . The coaptation assistance element  700  can be similar to the coaptation assistance elements  500  or  600 , and can include any feature described herein, with certain elements described below. 
     The coaptation assistance element  700  can include a first surface  705  and a second surface  715 .  FIG.  7 A  illustrates a perspective view of the first surface  705  or inferior surface disposed toward a mal-coapting native leaflet, in the instance of a mitral valve, the posterior leaflet.  FIG.  7 B  illustrates a perspective view of the second surface  715  or superior surface which may be disposed toward the anterior leaflet. The second surface  715  can include a coaptation surface  760 . The superior edge  740  of the coaptation assistance element  700  may be curved to match the general shape of the annulus or adjoining atrial wall. The superior edge  740  can be curved downward, toward the posterior leaflet, as shown in  FIG.  7 B .  FIG.  7 C  illustrates a top view of the coaptation assistance element  700 . 
       FIGS.  7 A- 7 C  show a view of the coaptation assistance element  700  with an annular hub  720 . The coaptation assistance element  700  can include the annular hub  720  designed to engage the annular anchor  800 . The annular anchor  800  may be engaged at a proximal end by a driver, described herein. The annular hub  720  may have a built-in or coupled annular anchor  800 . The annular anchor  800  may comprise a helix rotatable with respect to the annular hub  720 . The coaptation assistance element  700  can be delivered percutaneously as described herein by attachment of a delivery catheter to the annular hub  720 . 
     As may be seen in  FIGS.  7 A- 7 C , the coaptation assistance element  700  can include struts  730 . In some embodiments, one or more struts  730  have one end terminating at the annular hub  720  and the other end extending radially outwardly toward the superior edge  740 , the lateral edges  770  and  775 , and the inferior edge  780  of the coaptation assistance element  700  shown in  FIG.  7 B . The annular anchor site  735  is shown extending downward from the body of the coaptation assistance element  700  in  FIG.  7 B . The annular anchor  800  can be an active anchor. The annular anchor sites  735  can be a passive anchor, such as barbs. The annular anchor sites  735  can be at the distal ends of one or more struts  730 . 
     The annular section  710  can be positioned above the native leaflets when the coaptation assistance element  700  is deployed. In some embodiments, the annular section  710  may be may be curved toward the annulus or atrial wall. One or more of the struts  730  may curve laterally from the hub  720  toward the superior edge  740  to assist in maintaining the shape of the annular section  710  of the coaptation assistance element  700  upon deployment. The coaptation assistance element  700  can curve downward from the annular hub  720  toward the annular anchor site  735 . The annular section  710  can be concave. In some embodiments, one or more support structures may be provided which run parallel to the superior edge  740  of the coaptation assistance element  700  and assist in maintaining the shape of the superior edge  740 . The struts  730  and/or other support structures of the frame can be laser-cut from a Nitinol tube in some embodiments. The valve body covering  750  may be comprised of a material as described herein. 
     In some embodiments, the coaptation assistance element  700  includes an active anchor such as annular anchor  800 . In some embodiments, the coaptation assistance element  700  includes a passive anchor such as annular anchor site  735 . The annular anchor site  735  can include barbs at the tip of one or more struts  730 . 
     The coaptation assistance element  700 , as well as any coaptation assistance element  500 ,  600  described herein, can include one or more markers  900 . The marker  900  can be positioned on any portion of the coaptation assistance element  500 ,  600 ,  700  or any element thereof, such as the struts  530 ,  630 ,  730 , the annular hub  520 ,  620 ,  720 , the purse-string suture  1010 , and/or the annular anchor sites  535 ,  735 . In some embodiments, the marker  900  is positioned on the annular anchor  800 . In other embodiments, the marker  900  is integrally formed with the coaptation assistance element  500 ,  600 ,  700  or the annular anchor  800 . A plurality of markers  900  can be arranged in specific patterns, on the coaptation assistance element, to provide a fluoroscopic visual aid for the operator to accurately orient and position the coaptation assistance element  500 ,  600 ,  700  and/or the annular anchor  800  within the heart of a patient. 
     In some embodiments, the markers  900  may be radio-opaque or they may be covered by a radio graphic marker. During the process of delivery of the coaptation assistance element  500 ,  600 ,  700  and/or the annular anchor  800 , the markers  900  may be visualized if a fluoroscope is used. The marker  900  can help position the coaptation assistance element  500 ,  600 ,  700  and/or the annular anchor  800  within the heart of a patient. In some embodiments, torque can be applied to the annular anchor  800  such that the annular anchor  800  is driven into the tissue. To provide feedback whether the annular anchor  800  is secured appropriately, fluoroscopic markers  900  may be present on the annular anchor  800 . The markers may be located at the proximal end. These markers  900  may inform the medical team about how far the annular anchor  800  may have travelled towards the annular hub  520 ,  620 ,  720  and may be informative about when the annular anchor  800  is securely in place. In some embodiments, to ensure that appropriate torque is applied, the torque level at a handle may spike as the annular anchor  800  bottoms out on the annular hub  520 ,  620 ,  720 . The systems described herein can include one or more markers  900  (e.g., one, two, three, four, five, six, seven, eight, nine, ten, more than one, more than two, more than three, more than four, etc.). The systems described herein can include two or more different markers  900 . The different markers can indicate different components of the system, different portions of the coaptation assistance element  500 ,  600 ,  700  or positioning points such as the most proximal point, most distal point, midline, etc. 
       FIGS.  7 D- 7 E  illustrate an embodiment of the coaptation assistance element  700  deployed within the heart mitral valve model. Referring back to  FIG.  1 F , the coaptation zone CL between the leaflets is not a simple line, but rather a curved funnel-shaped surface interface as shown in  FIG.  7 C . The first  110  (Anterio-lateral or left) and second  114  (Posterio-medial or right) commissures are where the anterior leaflet  12  meets the posterior leaflet at the coaptation zone, which form the coaptation line (CL). As seen most clearly in the axial views from the atrium of  FIG.  7 D , an axial cross-section of the coaptation zone generally shows the curved line CL that is separated from a centroid of the annulus as well as from the opening through the valve during diastole. In addition, the leaflet edges are scalloped, more so for the posterior versus the anterior leaflet. Mal-coaptation can occur between one or more of these A-P (anterior-posterior) segment pairs A1/P1, A2/P2, and A3/P3, so that mal-coaptation characteristics may vary along the curve of the coaptation zone CL, as shown in  FIG.  1 F . 
     In some embodiments, the coaptation assistance element  700  is placed over the posterior leaflet to create a new surface onto which the native leaflet, here the anterior leaflet, can coapt. The mitral valve is shown with the anterior leaflet  12 . The zone of coaptation occurs between the anterior leaflet  12  and the coaptation surface  760  of the coaptation assistance element  700 . 
     Referring now to  FIG.  8 A , aspects of the delivery catheter  1000  are illustrated. The delivery catheter  1000  can include a control handle. The delivery catheter  1000  can include a tip deflection control  1001 . The tip deflection control  1001  can allow a distal portion of the delivery catheter  1000  to deflect. This may be advantageous to place the coaptation assistance element  500 ,  600 ,  700  within the mitral valve. The delivery catheter  1000  can be inserted into a transseptal sheath (not shown). The transseptal sheath allows the introduction of the delivery catheter into the left atrium. The delivery catheter  1000  may further include one or more ports  1002 , such as a flush, irrigation and/or aspiration port to remove the air from the system and allow injection of fluids such as saline or contrast media to the site of implantation. The catheter  1000  can include a catheter shaft  1006 . The catheter  1000  can include an implant inserter  1007 . 
     The delivery catheter  1000  may include an implant control knob  1003 . The implant control knob  1003  can control the movements of the coaptation assistance element  500 ,  600 ,  700 . The implant control knob  1003  may enable the collapse of the coaptation assistance element  500 ,  600 ,  700 . The implant control knob  1003  may enable the expansion of the coaptation assistance element  500 ,  600 ,  700 . The arrow  1003   a  indicates the direction of movement of the implant control knob  1003  for the coaptation assistance element  500 ,  600 ,  700  to be collapsed by the delivery catheter  1000  and/or expanded by the delivery catheter  1000 . The implant control knob  1003  may enable the rotation of the coaptation assistance element  500 ,  600 ,  700 . The arrow  1003   b  indicates the direction of movement of the implant control knob  1003  for the coaptation assistance element  500 ,  600 ,  700  to be rotated. 
     The implant control knob  1003  can be internally connected to the coaptation assistance element  500 ,  600 ,  700  to allow the transmission of axial movement and/or torque. For instance, the implant control knob  1003  of the delivery catheter  1000  can be coupled to the annular hub  520 ,  620 ,  720  For instance, the implant control knob  1003  can be connected to one or more purse-string suture  1010  which may control the deployment of the coaptation assistance element  500 ,  600 ,  700 . The purse-string suture  1010  may facilitate the collapse and/or expansion of the coaptation assistance element  500 ,  600 ,  700  as described herein. The purse-string suture  1010  may facilitate the rotation of the coaptation assistance element  500 ,  600 ,  700  as described herein. In some embodiments, the delivery catheter  1000  releasably engages coaptation assistance element  500 ,  600 ,  700  such that axial movement and torque can be transmitted from the delivery catheter  1000  to the coaptation assistance element  500 ,  600 ,  700   
     In some embodiments, a tip  1300  of the delivery catheter  1000  is releasably coupled to the annular hub  520 ,  620 ,  720  For instance, the tip  1300  of the delivery catheter  1000  can lock onto the annular hub  520 ,  620 ,  720  such that movement of the delivery catheter  1000  causes movement of the coaptation assistance element  500 ,  600 ,  700 . In some embodiments, the system includes a release mechanism between the delivery catheter  1000  and the annular hub  520 ,  620 ,  720 . 
     The annular hub  520 ,  620 ,  720  may have features, which can lock with the tip  1300  of the delivery catheter  1000 . Referring back to  FIGS.  5 A- 7 E , the annular hub  520 ,  620 ,  720  can include one or more features to engage a portion of the delivery catheter  1000 . The feature can include one or more notches in the hub  520  of the Implant as shown in  FIG.  5 A . The feature can include an internal lip as shown in  FIG.  9 A . The feature can include windows accessible from the outside of the hub  520 ,  620 ,  720 , as shown in  FIG.  8 C . The feature can include any structure or mechanism capable of coupling the annular hub  520 ,  620 ,  720  and a portion of the delivery catheter  1000 . In some embodiments, the annular hub  520 ,  620 ,  720  and the delivery catheter  1000  are coupled via a screw mechanism. For instance, the annular hub  520 ,  620 ,  720  can include a female thread and the distal end of the delivery catheter  1000  can include a male thread. In some embodiments, the annular hub  520 ,  620 ,  720  and the delivery catheter  1000  are coupled via a noose and pin configuration. For instance, the annular hub  520 ,  620 ,  720  can include a pin such as an outwardly extending pin and the distal end of the delivery catheter  1000  can include a loop or noose designed to be tightened around the pin. Other configurations are contemplated. 
       FIG.  8 B  shows the coaptation assistance element  500 ,  600 ,  700  coupled to the delivery catheter  1000 . The coaptation assistance element  500 ,  600 ,  700  can be collapsed as shown or expanded as shown by the dashed lines by movement along arrow  1003   a.  The coaptation assistance element  500 ,  600 ,  700  can be rotated as shown by the dashed lines by movement along arrow  1003   b.    
     Referring to  FIG.  8 C , the delivery catheter  1000  can include the tip  1300 . The distal end of the tip  1300  can include distal locking tabs. In some embodiments, the tip  1300  includes a plurality of pre-bent or shape-set locking tabs. In some embodiments, the tip includes two locking tabs, three locking tabs, four locking tabs, five locking tabs, a plurality of locking tabs, a multitude of locking tabs, etc. This “AT-lock” (axial-torsional lock) can include nitinol locking tabs on the tip  1300 . In some embodiments, the locking tabs of the tip  1300  can be actuated by a sheath  1350 . In some embodiments, the sheath  1350  is hollow to allow movement of other components such as the driver described herein. The movement sheath  1350  can force the locking tabs inward into engagement with the annular hub  520 ,  620 ,  720 . In some embodiments, the locking tabs of the tip  1300  engage a feature such as a window or lip of the annular hub  520 ,  620 ,  720 . In some embodiments, movement of the sheath  1350  in the opposite direction can cause the release of the annular hub  520 ,  620 ,  720  from the tip. In other embodiments, the locking tabs of the tip  1300  can be actuated by a central pin inserted within tip  1300  (not shown). In some embodiments, the central pin is hollow to allow movement of other components such as the driver described herein. The movement of the central pin can force the locking tabs outward into engagement with the annular hub  520 ,  620 ,  720 . 
     In some embodiments, the distal end of the tip  1300  can be actuated to lock the delivery catheter  1000  to the annular hub  520 ,  620 ,  720 . In some embodiments, the distal end of the tip  1300  can be actuated to unlock the delivery catheter  1000  from the annular hub  520 ,  620 ,  720 . As described herein, secondary structures such as the purse-string sutures may remain coupled to the coaptation assistance element  500 ,  600 ,  700  after the annular hub  520 ,  620 ,  720  is released from the tip  1300 . In some embodiments, when the delivery catheter  1000  is unlocked, one or more secondary structures such as the purse-string sutures described herein can retain a relative position between the delivery catheter  1000  and the annular hub  520 ,  620 ,  720 . During a procedure, the tip  1300  may be repeatedly locked and unlocked. 
     Referring back to  FIG.  8 A , the delivery catheter  1000  can include the anchor control knob  1004 . In some embodiments, the anchor control knob  1004  can enable the release of the annular anchor  800  and/or the coaptation assistance element  500 ,  600 ,  700 . In some embodiments, the anchor control knob  1004  can enable the engagement of the annular anchor  800  for instance to rotate the annular anchor  800  and/or to axially move the annular anchor  800 . In some embodiments, the anchor control knob  1004  can enable the disengagement of the annular anchor  800 . In some embodiments, the anchor control knob  1004  can control a driver  1200  configured to apply torque. In some embodiments, the anchor control knob  1004  can control a driver  1200  configured to apply tension and/or release the coaptation assistance element  500 ,  600 ,  700 . In some embodiments, the anchor control knob  1004  can control a driver  1200  configured to apply tension and torque. 
     The anchor control knob  1004  of the delivery catheter  1000  may be coupled to the annular anchor  800  to allow transmission of torque to the annular anchor  800 . The anchor control knob  1004  may enable simple manipulation of the torque or position of the annular anchor  800 . The arrow  1004   a  indicates the direction of movement of the anchor control knob  1004  for the annular anchor  800  to be engaged or disengaged. For instance, moving the anchor control knob  1004  toward the annular anchor  800  may engage a driver  1200  with the annular anchor  800 . The arrow  1004   b  indicates the direction of movement of the anchor control knob  1004  for the transmission of torque to the annular anchor  800 . In some embodiments, the arrow  1004   b  indicates the direction to release the annular anchor  800 . For instance, the further application of torque may twist the driver  1200  out of engagement with the annular anchor  800 . 
     An embodiment of an annular anchor  800  is illustrated in detail in  FIG.  9 A . Other components of the delivery catheter  1000  are not shown in  FIG.  9 A , such as the component which engages the annular hub  520 ,  620 ,  720 . The annular anchor  800  may be coupled to the driver  1200  in various ways, as described herein. The annular anchor  800  may be coupled to the coaptation assistance element  500 ,  600 ,  700  in various ways. In some embodiments, the annular hub  520 ,  620 ,  720  may have a cross-pin  820 . The cross-pin  820  can provide a site about which a helical structure  815  of the annular anchor  800  may wrap around as shown. The annular anchor  800  can have a shoulder  805 . The shoulder  805  may fit around the outside of a driver  1200  of the delivery catheter  1000 . 
     In some embodiments, the driver  1200  is releasably coupled to the annular anchor  800 . The driver  1200  can be coupled and/or controlled by the anchor control knob  1004  described herein. One or more drivers  1200  can deliver torque to drive the annular anchor  800  into tissue. One or more drivers  1200  can deliver tension to hold and/or release the annular anchor  800 . In some embodiments, a single driver  1200  delivers torque and tension. In other embodiments, two or more drivers  1200  deliver torque and tension. For instance, the driver  1200  can lock onto the annular anchor  800  such that movement of the driver  1200  causes movement of the annular anchor  800 . In some embodiments, the system includes a release mechanism between the driver  1200  and the annular anchor  800 . In some embodiments, the distal end of the driver  1200  can be actuated to lock the driver  1200  to the annular anchor  800 . In some embodiments, the distal end of the driver  1200  can be actuated to unlock the driver  1200  from the annular anchor  800 . In some embodiments, when the driver  1200  is unlocked, one or more secondary structures such as the purse-string sutures can retain a relative position between the delivery catheter  1000  and the annular anchor  800 . During a procedure, the driver  1200  may be repeatedly locked and unlocked. 
       FIG.  9 B  illustrates an embodiment of a driver  1200 . The driver  1200  can include a torque shaft  1205 . The torque shaft  1205  can include a loop  1210 . The loop  1210  can engage a pin  1215  extending and looping around the tension cross-pin  1270  and through the anchor  800 . The rotation of the torque shaft  1205  can cause a torque to be applied to a torque cross-pin  1275 , thereby causing rotation of the annular anchor  800 . In some embodiments, the annular anchor  800  can include a torque cross-pin and a tension cross-pin. Another driver (not shown) can apply a torque to the tension cross-pin to apply tension to the annular anchor  800 . One or more drivers  1200  can engage the annular anchor  800  to deliver torque. One or more drivers  1200  can engage the annular anchor  800  to deliver tension. In some embodiments, delivery of the annular anchor  800  is independent of rotation of the coaptation assistance element  500 ,  600 ,  700 . 
       FIG.  9 C  illustrates an embodiment of a driver  1200 . The driver  1200  can include a torque shaft  1220 . The torque shaft  1220  can include an anchor docking cap  1225 . The anchor docking cap  1225  can engage the annular anchor  800  in a single orientation or one of a plurality of orientations. In some embodiments, the annular anchor  800  includes a protrusion  1230  and the anchor docking cap  1225  is designed to accept the protrusion  1230 . In other embodiments, the annular anchor  800  includes a recess (not shown) to accept a mating protrusion on the anchor docking cap  1225  (not shown). The rotation of the torque shaft  1220  can cause a torque to be applied to the annular anchor  800 . Another driver  1235  can apply tension to the annular anchor  800 . In some embodiments, the driver  1235  can include a release screw. In other embodiments, the loop and pin release mechanism described in  FIG.  9 B  may be used. The release screw can be rotated to release the annular anchor  800 . One or more drivers  1200  can engage the annular anchor  800  to deliver torque. One or more drivers  1200  can engage the annular anchor  800  to deliver tension. 
       FIG.  9 D  illustrates an embodiment of a driver  1200  and the annular anchor  800 . The driver  1200  can include a torque shaft  1220 . The torque shaft  1220  can include an anchor docking cap  1225 . In some embodiments, the annular anchor  800  includes a protrusion  1230  and the anchor docking cap  1225  is designed to accept the protrusion  1230 . In other embodiments, the annular anchor  800  includes a recess (not shown) to accept a mating protrusion on the anchor docking cap  1225  (not shown). Two or more wires  1240 ,  1245  can apply tension to the annular anchor  800 . In some embodiments, the wire  1240  acts as a pin, and the wire  1245  terminates in a ball. In a retained state, the wires  1240 ,  1245  are both positioned within an opening in the annular anchor  800 . The opening is too small to allow the pin and ball end of wires  1240 ,  1245  to pass side by side. In some methods of use, the wire  1240  is retracted first. The retraction of the wire  1240  yields sufficient room to allow retraction of the wire  1245 . The wires  1240 ,  1245  can be actuated to release the annular anchor  800 . One or more drivers  1200  can engage the annular anchor  800  to deliver torque. One or more drivers  1200  can engage the annular anchor  800  to deliver tension 
       FIG.  9 E  illustrates an embodiment of the driver  1200 . The driver  1200  can include a torque shaft  1255 . The shoulder  805  may have features such as windows  810  which can lock with one or more distal locking tabs  1265  of the torque shaft  1255 . The distal locking tabs  1265  may include nitinol material such as a Shape-set NiTi clip. The distal locking tabs  1265  may be pushed outward into the windows  810  by a driver  1260 . The driver  1260  acts as a release mechanism. The longitudinal movement of the driver  1260  toward the annular anchor  800  may push the distal locking tabs  1265  outward toward the windows  810 . The longitudinal movement of the driver  1260  away from the annular anchor  800  may allow the distal locking tabs  1265  to regain a neutral configuration and disengage from the windows  810 . The distal locking tabs  1265  engaged with the windows  810  of the annular anchor  800  can allow the transmission of axial movement between the torque shaft  1255  and the annular anchor  800 . The distal locking tabs  1265  engaged with the windows  810  of the annular anchor  800  can allow the transmission of torque between the torque shaft  1255  and the annular anchor  800 . In embodiments where the annular anchor  800  is built-in or captured by the annular hub  520 ,  620 ,  720 , the distal locking tabs  1265  engaged with the windows  810  can allow the transmission of axial movement between the delivery catheter and the coaptation assistance element  500 ,  600 ,  700 . 
     In some embodiments, an advantage is the annular anchor  800  can be rotated independently of the coaptation assistance element  500 ,  600 ,  700 . As described herein, the coaptation assistance element  500 ,  600 ,  700  is coupled to the delivery catheter  1000 . As described herein, the annular anchor  800  is independently coupled to the driver  1200 . The annular anchor  800  can be rotated independently of the annular hub  520 ,  620 ,  720 . The annular hub  520 ,  620 ,  720  can remain stationary as the annular anchor  800  is rotated to engage tissue. 
     In some methods, the annular anchor  800  can be preloaded onto the coaptation assistance element  500 ,  600 ,  700  and coupled to the driver  1200  during the process of mounting the coaptation assistance element  500 ,  600 ,  700  onto the delivery catheter  1000 . This can occur before the coaptation assistance element  500 ,  600 ,  700  is pulled into an implant sheath and/or another portion of the delivery catheter  1000  and is being readied for insertion into the femoral vein. As disclosed herein, torque can be applied such that the annular anchor  800  is driven into the tissue. In some embodiments, to ensure that appropriate torque is applied, the torque level at the handle may spike as the annular anchor  800  bottoms out on the annular hub  520 ,  620 ,  720 . This increased torque level may be felt at the handle providing feedback that appropriate torque has been applied. In other embodiments, radiopaque markings may aid in visually determining the level of anchor engagement within tissue. In some embodiments, the markings can be located on the annular anchor  800  and/or the coaptation assistance element  500 ,  600 ,  700 . 
       FIGS.  10 - 15    show various methods, which may be performed during a method of use of the coaptation assistance element  500 ,  600 ,  700 . The method may include collapsing the coaptation assistance element  500 ,  600 ,  700 . The method may include of coupling the coaptation assistance element  500 ,  600 ,  700  to the delivery catheter  1000 . The method may include coupling the locking tabs  1265  with the annular anchor  800  and/or the coaptation assistance element  500 ,  600 ,  700 . The method can include any step disclosed herein for manufacturing the coaptation assistance element  500 ,  600 ,  700 . 
     In some embodiments, an advantage is the coaptation assistance element  500 ,  600 ,  700  can be delivered with a hub-leading orientation. In this method of use, the annular hub  520 ,  620 ,  720  can be moved into position relative to the anatomical structures prior to another portion of the coaptation assistance element  500 ,  600 ,  700 . In some methods of use, the ventricular end of the coaptation assistance element  500 ,  600 ,  700  can be retained within the delivery catheter  1000  until the annular hub  520 ,  620 ,  720  is positioned. In some methods of use, once the annular hub  520 , 620 ,  720  and/or the annular anchor  800  are engaged with the tissue, the coaptation assistance element  500 ,  600 ,  700  can be expanded. In some methods of use, once the annular hub  520 ,  620 ,  720  and/or the annular anchor  800  are engaged with the tissue, the ventricular end of the coaptation assistance element  500 ,  600 ,  700  can be positioned. 
     In some embodiments, an advantage is the coaptation assistance element  500 ,  600 ,  700  can be delivered with a strut-leading orientation. In this method of use, one or more of the struts  530 ,  630 ,  730  of the coaptation assistance element  500 ,  600 ,  700  can be moved into position relative to the anatomical structures prior to another portion of the coaptation assistance element  500 ,  600 ,  700 . In some methods of use, the coaptation assistance element  500 ,  600 ,  700  can be expanded or partially expanded prior to the positioning of the annular hub  520 ,  620 ,  720 . In some methods of use, the annular hub  520 ,  620 ,  720  can be retained within the delivery catheter until one or more of the struts  530 ,  630 ,  730  are positioned. In some methods of use, once the struts  530 ,  630 ,  730  are positioned, the annular anchor  800  is engaged with the tissue. 
       FIG.  10    illustrates an embodiment of transseptal crossing. The method may include femoral vein access. Access may be gained through a vessel such as the femoral vein in order to reach a chamber of the heart such as the right atrium  1300 . The left ventricle  1380  and its papillary muscles are also shown  1360 . The method may include transseptal puncture and crossing with standard transseptal kit  1330  to the left atrium  1320 . The method may include exchanging for custom transseptal sheath and delivery catheter  1000 , as described herein. A transseptal puncture kit may be exchanged for a transseptal sheath and dilator, and the dilator may be exchanged for an implant delivery catheter which may be as disclosed herein and in U.S. Pat. No. 8,888,843 to Khairkhahan et al., incorporated by reference in its entirety. The method may include removing a dilator. The method may include advancing the delivery catheter  1000 . However, other approaches such as transapical, transatrial, femoral artery, brachial artery, and the like are also within the scope of the invention. 
       FIG.  11    illustrates initial advancement of the coaptation assistance element  500 ,  600 ,  700 . The method may include advancing the coaptation assistance element  500 ,  600 ,  700  inside the retrieval sheath. The retrieval sheath can include a tip having a plurality of petals radiating from a central hub  1420 . The retrieval sheath may be positioned within a transseptal sheath  1400 . The mitral valve is show at the base of the left atrium  1440 . The method may include advancing the annular section  510 ,  610 ,  710  toward the annulus before advancing the coaptation surface  560 ,  660 ,  760  toward the annulus. The method may include deploying the ventricular end or inferior surface  580  after deploying the annular portion  510 . 
       FIG.  12    illustrates partial deployment of the coaptation assistance element  500 ,  600 ,  700 . The coaptation assistance element  500 ,  600 ,  700  may be advanced in proximity to the target location under imaging guidance such as ultrasound or fluoroscopy. The annular anchor  800  coupled with the coaptation assistance element  500 ,  600 ,  700  is engaged in tissue. An anchor torque shaft  1540  may be rotated internally and independent of the rotation of an implant torque shaft (not shown). Controlled release of a purse-string suture  1010  around the perimeter of the coaptation assistance element  500 ,  600 ,  700  may cause the coaptation assistance element  500 ,  600 ,  700  to expand. Prior to full expansion of the coaptation assistance element  500 ,  600 ,  700 , rotational adjustment of the coaptation assistance element  500 ,  600 ,  700  may be performed to align the interior (ventricular) section of the coaptation assistance element  500 ,  600 ,  700  with a valve opening  1580 . 
     The method may include advancing the coaptation assistance element  500 ,  600 ,  700  toward a target location. The method may include advancing the annular hub  520 ,  620 ,  720  toward a target location. The method may include advancing the annular anchor  800 , which is coupled to the annular hub  520 ,  620 ,  720 , toward a target location. The method may include echo or fluoroscopic guidance of the annular anchor  800 , the hub  520 ,  620 ,  720 , and/or the coaptation assistance element  500 ,  600 ,  700 . The method may include engaging the annular anchor  800  in tissue. The method may include rotating the anchor control knob  1004  to rotate the annular anchor  800 . The method may include the independent rotation of the annular anchor  800  from the hub  520 ,  620 ,  720 . The method may include holding the hub  520 ,  620 ,  720  stationary during rotation of the annular anchor  800 . The method may include controlled release of the purse-string suture  1010 . The release may cause the coaptation assistance element  500 ,  600 ,  700  to expand. The purse-string suture  1010  may be disposed within the coaptation assistance element  500 ,  600 ,  700  and/or along a perimeter of the coaptation assistance element  500 ,  600 ,  700 . The purse-string suture  1010  can facilitate the collapse and/or expansion of the coaptation assistance element  500 ,  600 ,  700 . The method may include rotational adjustment of the coaptation assistance element  500 ,  600 ,  700  to align an inferior edge  580 ,  680 ,  780  or ventricular section of the coaptation assistance element  500 ,  600 ,  700  with the valve opening. The method may include rotational adjustment of the coaptation assistance element  500 ,  600 ,  700  to align an inferior edge  580 ,  680 ,  780  or ventricular section around the posterior leaflet. 
       FIG.  13    illustrates recapture of the coaptation assistance element  500 ,  600 ,  700 . The coaptation assistance element  500 ,  600 ,  700  may be recaptured by tightening a purse-string suture  1010  around a portion of the perimeter  1620  of the coaptation assistance element  500 ,  600 ,  700  to collapse the coaptation assistance element  500 ,  600 ,  700 . The perimeter can include any edge, any combination of edges, or all of the edges described herein. A recapture sheath and transseptal sheath  1600  may be advanced over the collapsed coaptation assistance element  500 ,  600 ,  700 . Recapture sheath petals that radiate from a central hub may roll over the coaptation assistance element  500 ,  600 ,  700  allowing the coaptation assistance element  500 ,  600 ,  700  to be retracted into the transseptal sheath. The annular anchor  800  may be unscrewed or otherwise released, and the system may be removed. The prolapsed or partially encapsulated coaptation assistance element  500 ,  600 ,  700  by the recapture sheath petals can be another mode of delivery. The encapsulated-first delivery mode can be in contrast to the hub-first and the strut-delivery modes described herein. 
     In some methods, recapture is an optional method. The method may include tightening of the purse-string suture  1010 . This tightening may collapse the coaptation assistance element  500 ,  600 ,  700 . The method may include advancing the recapture sheath and/or the transseptal sheath over the collapsed coaptation assistance element  500 ,  600 ,  700 . The recapture sheath can fold outward to roll over the coaptation assistance element  500 ,  600 ,  700 . The method may include retracting the coaptation assistance element  500 ,  600 ,  700  into the transseptal sheath. The method may include rotating the annular anchor  800  to disengage tissue. The method may include removing the coaptation assistance element  500 ,  600 ,  700  and the annular anchor  800 . 
       FIG.  14    illustrates a cross-section view of the deployed coaptation assistance element  500 ,  600 ,  700 . The method may include releasing of the coaptation assistance element  500 ,  600 ,  700 . The method may include retraction of the delivery catheter  1000 . 
       FIG.  15    illustrates deployment of secondary anchors. In some methods, deployment of secondary anchors is an optional method. The method may include engaging annular attachment sites  535 ,  735  to the annulus. The method may include engaging ventricular anchors. The method may include engaging commissural anchors  1650 . The method may include deploying markers on strategic locations on the coaptation assistance element  500 ,  600 ,  700  and/or the annular anchor  800 . The method may include detecting markers, such as detecting radiopaque markers. The method may include facilitating the placement of anchor  800  under fluoroscopy. The method may include locating radiopaque markers along the perimeter of the coaptation assistance element  500 ,  600 ,  700  to indicate the shape of coaptation assistance element  500 ,  600 ,  700 . 
     In some embodiments, the manufacturer provides instructions for use of the system including one or more of the steps disclose herein, or any step previously described or inherent in the drawings. 
       FIGS.  16 - 30    show various methods, which may be performed during a method of use of the coaptation assistance element  500 ,  600 ,  700 . The method can include any step disclosed herein, according to some embodiments of the invention. The method can include any step disclosed herein for manufacturing and/or deploying the coaptation assistance element  500 ,  600 ,  700 . The method can include collapsing the coaptation assistance element  500 ,  600 ,  700 . 
       FIG.  16    illustrates a method for implant delivery showing loading of the coaptation assistance element  500 ,  600 ,  700 . The coaptation assistance element  500 ,  600 ,  700  can be collapsed, as described herein. The collapsed coaptation assistance element  500 ,  600 ,  700  can be loaded into a transseptal sheath introducer  1700 . The transseptal sheath introducer  1700  can include a sheath having a lumen to accommodate the collapsed coaptation assistance element  500 ,  600 ,  700 . The collapsed coaptation assistance element  500 ,  600 ,  700  can be inverted within the transseptal sheath introducer  1700 . The annular hub  520 ,  620 ,  720  can be positioned near the edge  1705  of the transseptal sheath introducer  1700 . The transseptal sheath introducer  1700  can include a multilumen catheter  1710  connected to the coaptation assistance element  500 ,  600 ,  700 . The method can include loading of the coaptation assistance element  500 ,  600 ,  700  into the transseptal sheath introducer  1700 . 
       FIG.  17    illustrates a method for inserting the transseptal sheath introducer  1700  into a transseptal sheath  1715 . The transseptal sheath introducer  1700  can include the multilumen catheter  1710 . The multilumen catheter  1710  and/or the transseptal sheath introducer  1700  can include a hub  1720 . The hub  1720  can connect with the transseptal sheath  1715 . The proximal end of the transseptal sheath  1715  is shown in  FIG.  17   . In  FIG.  17   , the transseptal sheath introducer  1700  is not connected to the transseptal sheath  1715 . In  FIG.  18   , the transseptal sheath introducer  1700  is connected to the transseptal sheath  1715 . The method can include connecting the transseptal sheath introducer  1700  to the transseptal sheath  1715 . The method can include connecting an assembly comprising the coaptation assistance element  500 ,  600 ,  700  to the transseptal sheath  1715 . 
       FIG.  19    illustrates a method for advancing the transseptal sheath introducer  1700 . The transseptal sheath introducer  1700  can be advanced to the distal end of the transseptal sheath  1715 . The coaptation assistance element  500 ,  600 ,  700  can be advanced through the transseptal sheath  1715 . The collapsed coaptation assistance element  500 ,  600 ,  700  can be inverted while advancing through the transseptal sheath  1715 . In  FIG.  19   , the coaptation assistance element  500 ,  600 ,  700  is at the distal end of the transseptal sheath  1715 . 
       FIG.  20    illustrates a method for positioning the transseptal sheath  1715 . The coaptation assistance element  500 ,  600 ,  700  can be located at the distal end of the transseptal sheath  1715  during positioning. The transseptal sheath  1715  can be positioned in the annulus. The transseptal sheath  1715  can be positioned over the posterior leaflet. The transseptal sheath  1715  can be centered over P2 described herein. The method can include locating the coaptation assistance element  500 ,  600 ,  700  to the posterior leaflet. The method can include locating the coaptation assistance element  500 ,  600 ,  700  centered over P2. The method can include locating the coaptation assistance element  500 ,  600 ,  700  in the annulus. The transseptal sheath  1715  can be rotated as shown by the arrows. The transseptal sheath  1715  can position the coaptation assistance element  500 ,  600 ,  700  by rotating. The transseptal sheath  1715  can correct atrial/ventricle orientation. The transseptal sheath  1715  can include one or more markings/indicia  1725 . The markings  1725  can enable a user to guide the rotation of the transseptal sheath  1715 . The markings  1725  can enable a user to provide correct orientation of an annulus portion of the coaptation assistance element  500 ,  600 ,  700 . The markings  1725  can enable a user to provide correct orientation of a ventricle portion of the coaptation assistance element  500 ,  600 ,  700 . In some embodiments, the marking  1725  can include a radiopaque marker.  FIG.  20    shows the coaptation assistance element  500 ,  600 ,  700  and the transseptal sheath  1715  centered over P2 in the annulus of a mitral valve.  FIG.  20    shows rotation of the coaptation assistance element  500 ,  600 ,  700  and the transseptal sheath  1715 . 
       FIG.  21    illustrates a method for delivering the anchor  800 . The anchor  800  can include any of the features of the anchors described herein. The anchor  800  can be considered a P2 anchor based on the location of the anchor  800  after deployment. The anchor  800  can extend through the annular hub  520 ,  620 ,  720  as described herein. The method can include delivering in the anchor  800  while the coaptation assistance element  500 ,  600 ,  700  is within the transseptal sheath  1715 . In some embodiments, the anchor  800  is coupled to the annular hub  520 ,  620 ,  720  of the coaptation assistance element  500 ,  600 ,  700  before loading into the transseptal sheath  1715 . In some embodiments, the anchor  800  is coupled to the annular hub  520 ,  620 ,  720  of the coaptation assistance element  500 ,  600 ,  700  while within the transseptal sheath  1715 . In some embodiments, the anchor  800  is coupled to the annular hub  520 ,  620 ,  720  of the coaptation assistance element  500 ,  600 ,  700  after the transseptal sheath  1715  is positioned within the annulus. The method can include delivering the anchor  800  while the coaptation assistance element  500 ,  600 ,  700  is within the transseptal sheath  1715 . The coaptation assistance element  500 ,  600 ,  700  can be centered over P2 in the annulus during delivery of the anchor  800 . The anchor  800  can be inserted by rotating the anchor  800  into the tissue of the annulus, as described herein. 
       FIGS.  22 A- 22 D  illustrate a method for deploying the coaptation assistance element  500 ,  600 ,  700 . The coaptation assistance element  500 ,  600 ,  700  can be deployed by retracting the transseptal sheath  1715 . The transseptal sheath  1715  can be retracted by moving the transseptal sheath  1715  proximally from the anchor  800 . The coaptation assistance element  500 ,  600 ,  700  can be inverted within the transseptal sheath  1715 . In some embodiments, the annular portion near the annular hub  520 ,  620 ,  70  of the coaptation assistance element  500 ,  600 ,  700  can be deployed first as shown in  FIG.  22 A . In some embodiments, the ventricular portion of the coaptation assistance element  500 ,  600 ,  700  can be deployed next as shown in  FIG.  22 B . The coaptation assistance element  500 ,  600 ,  700  can be inverted such that the ventricular portion extends proximally from the annular portion. In some embodiments, the coaptation assistance element  500 ,  600 ,  700  can expand outward from P2 as the coaptation assistance element  500 ,  600 ,  700  is deployed as shown in  FIG.  22 C . The coaptation assistance element  500 ,  600 ,  700  can be inverted such that the ventricular portion extends proximally from the annular portion. The coaptation assistance element  500 ,  600 ,  700  can be inverted such that the ventricular portion extends toward the transseptal sheath  1715 . 
     In some embodiments, the coaptation assistance element  500 ,  600 ,  700  can be folded back as shown in  FIG.  22 D . The coaptation assistance element  500 ,  600 ,  700  can be reversed from the initially deployed configuration such that the ventricular portion extends distally from the annular portion. The coaptation assistance element  500 ,  600 ,  700  can be positioned such that the ventricular portion extends away from the transseptal sheath  1715 . The method can include deploying the coaptation assistance element  500 ,  600 ,  700  by retracting the transseptal sheath  1715 .  FIGS.  22 A- 22 D  show deployment of the coaptation assistance element  500 ,  600 ,  700 . 
       FIGS.  23 - 30    illustrate deploying one or more secondary anchors  850 . The secondary anchor  850  can include any of the features of the anchor  800 . The secondary anchor  850  can comprise a helix or helical structure. The secondary anchor  850  can be designed to engage the tissue of heart, such as the tissue of the annulus. The secondary anchor  850  can comprise bio-inert materials such as Platinum/Ir, a Nitinol alloy, and/or stainless steel. 
       FIG.  23    illustrates a method for utilizing one or more secondary anchor guidewires. The coaptation assistance element  500 ,  600 ,  700  can include one or more secondary anchor guidewires. In the illustrated embodiment, the coaptation assistance element  500 ,  600 ,  700  can include the first guidewire  1730  and the second guidewire  1735 . In some embodiments, the coaptation assistance element  500 ,  600 ,  700  can include any number of secondary anchor guidewires (e.g., about or at least about one, two, three, four, five, etc.). In some embodiments, the number of secondary anchor guidewires corresponds to (equals) the number of secondary anchors (e.g., one guidewire for one secondary anchor, two guidewires for two secondary anchors, etc.).  FIG.  23    illustrates an embodiment of a docking tube  1740 . The docking tube  1740  can include any of the features described herein, including those shown in  FIGS.  42 A- 45 K . 
       FIG.  23    illustrates a tether mode. The tether mode can correspond to one or more methods to evaluate the coaptation assistance element  500 ,  600 ,  700 . The tether mode can correspond to one or more methods to evaluate the function of the coaptation assistance element  500 ,  600 ,  700  without one or more delivery systems. In some embodiments, the tether mode can correspond to one or more methods to evaluate the function of the coaptation assistance element  500 ,  600 ,  700  without the transseptal sheath  1715 . The tether mode can evaluate function without the bulk of the delivery system attached.  FIG.  23    shows the deployed coaptation assistance element  500 ,  600 ,  700 .  FIG.  23    shows the coaptation assistance element  500 ,  600 ,  700  going to tether mode by retracting an implant shaft.  FIG.  23    shows the coaptation assistance element  500 ,  600 ,  700  going to tether mode by retracting the transseptal sheath  1715 . 
       FIG.  24    illustrates a method involving the docking tube  1740 . The docking tube  1740  can include internal threads. The docking tube  1740  can include an internally threaded DS hub for coupling to an externally threaded portion  525 ,  625 ,  725  of the annular hub  520 ,  620 ,  720 . The docking tube  1740  can include an internally threaded hub for coupling to the coaptation assistance element  500 ,  600 ,  700 . In some methods of use, the docking tube  1740  is removed for tether mode.  FIG.  24    shows the coaptation assistance element  500 ,  600 ,  700  going to tether mode by retracting the docking tube  1740 . 
       FIG.  24    illustrates a method involving an anchor driver  1745 . The anchor driver  1745  can be disposed within the docking tube  1740 . The anchor driver  1745  can include any of the features described herein, including those shown in  FIGS.  42 A- 45 K . The anchor driver  1745  can rotate the anchor  800  during the method shown in  FIG.  21   . The anchor driver  1745  can rotate the anchor  800  through the annular hub  520 ,  620 ,  720 . In some methods of use, the anchor driver  1745  is removed for tether mode.  FIG.  24    shows the coaptation assistance element  500 ,  600 ,  700  going to tether mode by retracting the anchor driver  1745 . 
     The anchor driver  1745  can include a tether rail  1750 . The tether rail  1750  can include any of the features described herein, including those shown in  FIGS.  42 A- 45 K . The tether rail  1750  can be secured to the anchor  800 . The tether rail  1750  can allow for a minimal force evaluation of the effective of the coaptation assistance element  500 ,  600 ,  700  prior to releasing the coaptation assistance element  500 ,  600 ,  700 . As one example, the user can verify that the coaptation assistance element  500 ,  600 ,  700  is functional. As one example, the user can verify that the native leaflet is coapting against the coaptation assistance element  500 ,  600 ,  700 . As one example, the user can verify that the force exerted on the coaptation assistance element  500 ,  600 ,  700  is within an acceptable range. As one example, the user can verify that the coaptation assistance element  500 ,  600 ,  700  is not deforming under the force of the native leaflet. As one example, the user can verify that the coaptation assistance element  500 ,  600 ,  700  is deployed. As one example, the user can verify that the coaptation assistance element  500 ,  600 ,  700  spans the mitral valve. The docking tube  1740  can be retracted as shown. As shown in  FIG.  24   , the tether rail  1750  can remain coupled to the anchor  800  during tether mode. 
       FIG.  25    illustrates a method for advancing secondary anchor guiderails. In the illustrated embodiment, the method can include the first guiderail  1755  and the second guidewire  1760 . In some embodiments, the coaptation assistance element  500 ,  600 ,  700  can include any number of secondary anchor guiderails (e.g., one, two, three, four, five, etc.). In some embodiments, the number of secondary anchor guiderails corresponds to the number of secondary guidewires (e.g., one guiderail for one secondary guidewire, two guiderails for two secondary guidewires, etc.). The first guiderail  1755  can be advance along the first guidewire  1730 . The second guiderail  1760  can be advanced along the second guidewire  1735 . The method can involve advancing both secondary anchor guiderails  1755 ,  1760 . The secondary anchor guiderails  1755 ,  1760  are over the guidewires  1730 ,  1735  in  FIG.  25   . 
     The distal end  1765  of each secondary anchor guiderail  1755 ,  1760  can be threaded. In some embodiments, the distal end  1765  of each secondary anchor guiderail  1755 ,  1760  engages tissue in the annulus. The distal end  1765  can be threaded to temporarily secure the secondary anchor to the guiderail  1755 ,  1760  during delivery. In some embodiments, the distal end  1765  of each secondary anchor guiderail  1755 ,  1760  can reduce the likelihood that the secondary anchor inadvertently comes off the secondary anchor guiderail  1755 ,  1760 . The secondary anchor guiderails  1755 ,  1760  can reduce the likelihood that the secondary anchors get tangled with the guide wires  1730 ,  1735 . In some embodiments, the diameter of the secondary anchor guiderails  1755 ,  1760  is greater than or equal to the secondary anchor pitch. 
     In some methods of use, the docking tube  1740  can be coupled to the coaptation assistance element  500 ,  600 ,  700 . The attachment can allow for recess of the anchor  800  during delivery of the coaptation assistance element  500 ,  600 ,  700 . In some embodiments, the secondary anchor guiderails  1755 ,  1760  are advanced over guidewires  1730 ,  1735  prior to deploying the anchor  800 . In some embodiments, the secondary anchor guiderails  1755 ,  1760  are advanced over guidewires  1730 ,  1735  after deploying the anchor  800 .  FIG.  25    shows the coaptation assistance element  500 ,  600 ,  700  secured to the annulus with the anchor  800  with secondary anchor guiderails advanced to the surface of the coaptation assistance element  500 ,  600 ,  700 . 
       FIG.  26    illustrates a method for delivering a secondary anchor  1770 . The secondary anchor  1770  is advanced over the first guiderail  1755 . The secondary anchor  1770  can be advanced toward the coaptation assistance element  500 ,  600 ,  700 . The secondary anchor  1770  can be installed with a driver  1775 . The driver  1775  can translate the secondary anchor  1770  along the first guiderail  1755 . 
       FIG.  27    illustrates a method for inserting the secondary anchor  1770 . The driver  1775  can rotate the secondary anchor  1770  along the first guiderail  1755 . The secondary anchor  1770  can be threaded through the coaptation assistance element  500 ,  600 ,  700 . The secondary anchor  1770  can be rotated to engage tissue underneath the coaptation assistance element  500 ,  600 ,  700 .  FIG.  26    shows the coaptation assistance element  500 ,  600 ,  700  secured to the annulus with the anchor  800  when the secondary anchor  1770  is delivered.  FIG.  26    shows the coaptation assistance element  500 ,  600 ,  700  secured to the annulus with the anchor  800  when the secondary anchor  1770  is inserted into tissue. The driver  1775  is still attached as shown in  FIG.  27    The secondary anchor  1770  can be a medial anchor. The secondary anchor  1770  can be positioned on a medial side of the anchor  800 . 
       FIG.  28    illustrates a method for delivering a secondary anchor  1780 . The secondary anchor  1780  is advanced over the second guiderail  1760 . The secondary anchor  1780  can be advanced toward the coaptation assistance element  500 ,  600 ,  700 . In some methods of use, the secondary anchor  1780  can be installed with a driver  1775 . In some methods of use, the driver  1775  can be retracted along the first guide rail  1755  prior to being advanced along the second guiderail  1760 . In other methods of use, the secondary anchor  1780  is installed with a different driver than the secondary anchor  1770 . The driver  1775  can translate the secondary anchor  1780  along the first guiderail  1760 . In some methods of use, the secondary anchor  1770  can be previously inserted into the tissue. 
     The driver  1775  can rotate the secondary anchor  1780  along the second guiderail  1760 . The secondary anchor  1780  can be threaded through the coaptation assistance element  500 ,  600 ,  700 . The secondary anchor  1780  can be rotated to engage tissue underneath the coaptation assistance element  500 ,  600 ,  700 .  FIG.  28    shows the coaptation assistance element  500 ,  600 ,  700  secured to the annulus with the anchor  800  and the secondary anchor  1770  when the secondary anchor  1780  is delivered.  FIG.  26    shows the coaptation assistance element  500 ,  600 ,  700  secured to the annulus with the anchor  800  and the secondary anchor  1770  when the secondary anchor  1780  is inserted into tissue. The secondary anchor  1780  can be a lateral anchor. The secondary anchor  1780  can be positioned on a lateral side of the anchor  800 . 
       FIG.  29    illustrates the coaptation assistance element  500 ,  600 ,  700  with secondary anchor guidewires  1730 ,  1735 . The tether rail  1750  can remain coupled to the anchor  800 . The secondary anchor guidewires  1730 ,  1735  remain connected. The delivery system can be re-attached. In some methods of use, one or more guiderails  1755 ,  1760  can be re-attached. In some methods of use, the driver  1775  is re-attached. One or more secondary anchors  1770 ,  1780  can be removed. One or more secondary anchors  1770 ,  1780  can be repositioned. In some methods of use, the docking tube  1740  can be re-attached. In some methods of use, the anchor driver  1745  can be re-attached. The anchor  800  can be removed. The anchor  800  can be repositioned. The anchor  800  and the secondary anchors  1770 ,  1780  can be removed. The coaptation assistance element  500 ,  600 ,  700  can be retrieved.  FIG.  29    shows the deployed and anchored coaptation assistance element  500 ,  600 ,  700  with the secondary anchor guidewires  1730 ,  1735  and the tether rail  1750  remaining, allowing for retrieval. 
       FIG.  30    illustrates the anchored coaptation assistance element  500 ,  600 ,  700 . The secondary anchor guidewires  1730 ,  1735  are removed. The tether rail  1750  is removed. In some embodiments, the tether rail  1750  is rotated and retracted. The coaptation assistance element  500 ,  600 ,  700  is shown completely deployed and anchored. In some methods of use, retrieval is no longer possible. In some methods of use, retrieval through the method described in  FIGS.  31 A- 31 F  is no longer possible. 
       FIGS.  31 A- 31 F  illustrate methods for retrieving the coaptation assistance element  500 ,  600 ,  700 . The coaptation assistance element  500 ,  600 ,  700  can be retrieved through the transseptal sheath  1715 . In some methods of use, without secondary anchors  1770 ,  1780 , the coaptation assistance element  500 ,  600 ,  700  can be retrieved after the anchor  800  is removed. In some methods of use, the coaptation assistance element  500 ,  600 ,  700  can be retrieved after the anchor  800  and all the secondary anchors  1770 ,  1780  are removed. The coaptation assistance element  500 ,  600 ,  700  is being retrieved through the transseptal sheath  1715  in  FIGS.  31 A- 31 F . In some methods of use, the retrieval is optional. In some methods of use, the retrieval occurs after the method shown in  FIG.  29    and before the method shown in  FIG.  30   . 
       FIGS.  32 - 35    illustrate a method for installing one or more secondary anchors. One or more methods can be used in conjunction with methods described herein. One or more methods can be as an alternative to methods described herein. As one example, one or more methods shown in  FIGS.  32 - 35    can replace one or more methods shown in  FIGS.  23 - 30   . The secondary anchors described herein can be delivered using guidewires and/or guiderails with a variety of designs. In some embodiments, each secondary anchor can have a dedicated lumen (e.g., two secondary anchors use two lumens; four secondary anchors use four lumens, etc.). In some embodiments, each secondary anchor can have a dedicated guidewire (e.g., two secondary anchors use two guidewires, four secondary anchor use four guidewires, etc.). In some embodiments, two secondary anchors share a lumen (e.g., two secondary anchors in one lumen, four secondary anchors in two lumens; two guidewires in one lumen, four guidewires in two lumens, etc.) In some embodiments, each of the two guidewires in the shared lumen is covered by a guiderail. The guiderail can reduce secondary anchor entanglement. The guiderail can reduce secondary anchor entanglement with the two or more guidewires in the lumen. 
       FIG.  32    illustrates a method for inserting a secondary anchor. In some methods of use, the secondary anchor  1770  is inserted as described herein. The guidewire  1735  can extend from the secondary anchor  1770 . The guidewire  1735  can extend into a lumen or a shared lumen. In some methods of use, the secondary anchor  1770  is inserted as described herein. One or more secondary anchors  1170 ,  1780  can be inserted. 
     In some embodiments, one guidewire  1735  can be used for two secondary anchors. In some methods of sue, to facilitate removal of the guidewire  1735  after delivery of the first secondary anchor  1770 , the guidewire  1735  can be snared and removed. In some embodiments, the guidewire  1735  forms a loop. In some embodiments, a portion of the loop of the guidewire  1735  is contained within the coaptation assistance element  500 ,  600 ,  700 . In some embodiments, the loop threads through the coaptation assistance element  500 ,  600 ,  700 . In some embodiments, a snare  1785  can be positioned along the guidewire  1735 . In some embodiments, the snare  1785  forms a loop. In some embodiments, a portion of the loop of the guidewire  1735  is contained within loop of the snare  1785 . The method can include using the snare  1785 . The snare  1785  can be for unthreading the guidewire  1735 . The snare  1785  can be retracted. The snare  1785  can be pulled proximally through a lumen. 
       FIG.  33    illustrates a method for delivering a secondary anchor  1790 . The snare  1785  has been retracted within the lumen. The snare  1785  has pulled the guidewire  1735  proximally. In some embodiments, the driver  1775  or another driver can advance the secondary anchor  1790  along the guidewire  1735 . In some embodiments the secondary anchor  1790  is to be delivered with the guidewire  1735  removed using the snare  1785  from the anchor  1770 . 
       FIG.  34    illustrates a method for inserting the secondary anchor  1790 . The secondary anchor  1790  can be rotated. The secondary anchor  1790  can be threaded through the coaptation assistance element  500 ,  600 ,  700 . The secondary anchor  1790  can be rotated to engage tissue underneath the coaptation assistance element  500 ,  600 ,  700 .  FIG.  34    shows the coaptation assistance element  500 ,  600 ,  700  secured to the annulus with the anchor  800  and the secondary anchor  1770  when the secondary anchor  1790  is delivered. The secondary anchor  1790  can be a medial anchor. The secondary anchor  1790  can be positioned on a medial side of the anchor  800 . The secondary anchor  1790  can be positioned between the anchor  800  and the secondary anchor  1770 . 
       FIG.  35    illustrates the anchored coaptation assistance element  500 ,  600 ,  700 . The methods can be repeated to install one or more additional secondary anchors. For instance, one or more additional secondary anchors can be positioned between the secondary anchor  1780  and the anchor  800  as shown in  FIG.  30   . For instance, one or more additional secondary anchors can be positioned between the secondary anchor  1770  and the anchor  800  as shown in  FIG.  30   . For instance, one or more additional secondary anchors can be positioned anywhere on the annular portion of the coaptation assistance element  500 ,  600 ,  700 . 
       FIGS.  36  and  37    illustrates embodiments of 2D lamination.  FIGS.  38  and  39    illustrate embodiments of 3D forming. In some embodiments, the coaptation assistance element  500 ,  600 ,  700  comprises a multi-layer laminate on the entire, or only a portion of the coaptation assistance element. In some embodiments, the multi-layer laminate can comprise two or more layers of laminate (e.g., two, three, four, five, etc.). Two or more layers of the multi-layer laminate can comprise the same material. Two or more layers of the multi-layer laminate can comprise different materials. Two or more layers of the multi-layer laminate can comprise the same dimensions (e.g., length, width, thickness, diameter, etc.). Two or more layers of the multi-layer laminate can comprise one or more different dimensions. The laminate can be variable, depending on the zone of the coaptation assistance element  500 ,  600 ,  700 . In some embodiments, the cooptation zone can have additional protective layers. In some embodiments, the coaptation surface  560 ,  660 ,  760  includes one or more additional layers than another portion of the coaptation assistance element  500 ,  600 ,  700 .  FIG.  38    shows the additional layer  1795  only in the coaptation zone (e.g., inferior zone) of the coaptation assistance element  500 ,  600 ,  700 . As such the inferior coaptation zone can be thicker than that of the superior zone of the coaptation assistance element residing proximate the heart valve annulus, such at least about 10%, 25%, 50%, 75%, 100%, 150%, 200%, 250%, 300%, or more thicker than that of the superior zone, or ranges incorporating any two of the aforementioned values. 
     The multi-layer laminate can be fabricated in 2D lamination methods. In some methods of use, two or more layers are bonded together. The layers can be bonded by heat. The layers can be bonded by adhesive. The layers can be bonded together through any mechanical or chemical change. The coaptation assistance element  500 ,  600 ,  700  can have a generally 2D shape. The coaptation assistance element  500 ,  600 ,  700  can be flat or generally flat. In some embodiments, one or more layers comprise high density polyethylene (PE), polypropylene Dacron, acellular collagen matrix such as SIS, or other plastics. 
     The multi-layer laminate can be fabricated in 3D shape forming methods. The coaptation assistance element  500 ,  600 ,  700  can be shaped. As described herein, the coaptation assistance element  500 ,  600 ,  700  can comprise struts  530 ,  630 ,  730 . In some embodiments, the struts  530 ,  630 ,  730  are composed of resiliently deformable materials such as a shape memory metal, e.g., Nitinol or a shape memory polymer. In some embodiments, the material is Elgiloy. In some embodiments, the struts  530  may be composed of other materials to include stainless steel, polypropylene, high density polyethylene (PE), Dacron, acellular collagen matrix such as SIS, or other plastics, etc. The 3D forming can involve molding the shape of the struts  530 ,  630 ,  730 . The 3D forming can include adjusting the shape memory metal into the appropriate shape. The shape can be set with appropriate molds which bend the struts  530 ,  630 ,  730  into the desired shape. Shape setting or shape training may include constraining the coaptation assistance element  500 ,  600 ,  700  on a fixture or within a mold. In some methods of use, an appropriate heat treatment is applied to the coaptation assistance element  500 ,  600 ,  700  while on the fixture or within the mold. In some embodiments, the temperature, time and/or other parameters are adjusted to heat set the coaptation assistance element  500 ,  600 ,  700 . In some embodiments, the temperature for heat setting is greater than 300° C., greater than 400° C., greater than 500° C., greater than 600° C., etc. In some embodiments, the time for heat setting is 1 minute, 2 minutes, 3 minutes, 4 minutes, 5 minutes, 6 minutes, 7 minutes, 8 minutes, 9 minutes, 10 minutes, more than 2 minutes, more than 5 minutes, more than 10 minutes, etc. In some embodiments, the method can include rapid cooling. In some embodiments, the method can include rapid cooling via water or air. 
       FIG.  40    illustrates a coaptation assistance element  400 . The coaptation assistance element  400  can include any of the features of the coaptation assistance elements described herein. The coaptation assistance element  400  can include an annular hub  420  to facilitate attachment to a delivery system, similar to the annular hubs described herein. The annular hub  425  can include an externally threaded portion  425 . The coaptation assistance element  400  can include struts  430 . The struts  430  can be atrial arms that may be bend in the superior and/or inferior direction. 
     The coaptation assistance element  400  can include an annular anchor site  435 . The annular anchor site  435  can be a portion of the struts  430 . In some embodiments, the annular anchor site  435  comprises one or more barbs having a sharpened tip. The annular anchor site  435  can be a passive anchor. The barbs can be exposed fully and shaped as shown in  FIG.  40   . In some embodiments, the barbs extend from the multi-layer laminate. The barbs can be the free ends of the struts  430 . In some embodiments, the barbs can lay on the surface of the coaptation assistance element  400 . In some embodiments, the barbs can engage tissue with push-back of laminate. For instance, the multi-layer laminate can be pushed back as shown in  FIG.  41   .  FIG.  41    illustrates an embodiment of a barb. In some methods of use, engagement of the barb with tissue may cause the multi-layer laminate to push back. 
     The coaptation assistance element  400  can include a knotless sutured edge  455 . The edge may reduce trauma to the native tissue. The coaptation assistance element  400  can include one or more rounded edges that reduce trauma. In some embodiment, the lateral edges of the coaptation assistance element  400  are rounded. In some embodiment, the superior edge of the coaptation assistance element  400  is rounded. In some embodiment, the inferior edge of the coaptation assistance element  400  is rounded. 
     The coaptation assistance element  400  can include a coaptation surface  460 . The coaptation surface  460  can include additional protective layers. In some embodiments, the coaptation surface  460  can include one or more additional layers of the multi-layer laminate. In some embodiments, the coaptation surface  460  can include one or more different layers of the multi-layer laminate. The one or more layers of the coaptation surface  460  can be designed to facilitate longevity of the coaptation assistance element  400 . The one or more layers of the coaptation surface  460  can be designed to facilitate coaptation with the native leaflet. 
       FIGS.  42 A- 45 K  illustrate embodiments of implant delivery systems. The implant delivery systems can include any coaptation assistance element described herein. The implant delivery systems can be designed to position the coaptation assistance element within the heart. The implant delivery systems can include any anchor described herein. The implant delivery systems can be designed to engage the anchor with tissue. The implant delivery systems can be designed to rotate the anchor. 
       FIGS.  42 A- 42     i  illustrate an embodiment of implant delivery system  1800 . The implant delivery system  1800  can include a docking tube  1805 . The docking tube  1805  is connected to an implant torque shaft  1810 . In some embodiments, the implant torque shaft  1810  can be rigidly coupled to the docking tube  1805 . In some embodiments, the implant torque shaft  1810  is welded or soldered to the docking tube  1805 . The implant torque shaft  1810  can transmit torque to the docking tube  1805 , as described herein. The docking tube  1805  can be coupled to the coaptation assistance element  400 ,  500 ,  600 ,  700 . In the illustrated embodiment, only a portion of the struts  430 ,  530 ,  630 ,  730  are shown. 
     Referring now to  FIGS.  42 A- 42 B , the docking tube  1805  can include one or more slots  1815 . In the illustrated embodiment, the docking tube  1805  can include one slot  1815 , but other configurations are contemplated (e.g., two slots, three slots, four slots, two diametrically opposed slots, four radially spaced slots, etc.). The slot  1815  can extend through the docking tube  1815 . In some embodiments, the docking tube  1805  can include one or more grooves, which do not extend through the docking tube. The slots  1815  can extend along the length of the docking tube  1805 , or a portion thereof. The slots  1815  can extend between a distal end and a proximal end of the docking tube  1805 . 
     The docking tube  1805  can include a pin  1820  disposed within the slot  1815 . In some embodiments, the docking tube  1805  can include a spring  1825  disposed within the slot  1815 . The pin  1820  can be coupled to a pullwire  1830 . The pullwire  1830  can cause the pin  1820  to move within the slot  1815 , as described herein. The annular hub  420 ,  520 ,  620 ,  720  can include a groove  1835 . The groove  1835  in the annular hub  420 ,  520 ,  620 ,  720  can align with the slot  1815  in the docking tube  1805 . The pin  1820  can be disposed within the groove  1835 . 
     The annular hub  420 ,  520 ,  620 ,  720  can include an externally threaded portion  425 ,  525 ,  625 ,  725 . The docking tube  1805  can include an internally threaded portion  1840 . In some methods of use, the docking tube  1805  is rotated to engage the docking tube  1805  to the annular hub  420 ,  520 ,  620 ,  720 . The internally threaded portion  1840  engages the externally threaded portion  425 ,  525 ,  625 ,  725 . The groove  1835  can be cut on the outer diameter of the threads on the externally threaded portion  425 ,  525 ,  625 ,  725 . The slot  1815  can be cut on the inner diameter of the internally threaded portion  1840  of the docking tube  1805 . The slot  1815  can align with the groove  1835 . In some embodiments, the slot  1815  can align with the groove  1835  when the docking tube  1805  is bottomed out against the coaptation assistance element  400 ,  500 ,  600 ,  700 . 
       FIGS.  42 A- 42 B  illustrate a neutral position of the pin  1820 . The spring  1825  biases the pin  1820  downward and into engagement with the groove  1835 . The pin  1835  spans between the docking tube  1805  and the annular hub  420 ,  520 ,  620 ,  720 . The natural state is with the pin  1820  forward. In this state, the pin  1820  is locking the threaded connection between the internally threaded portion  1840  of the docking tube  1805  and the externally threaded portion  425 ,  525 ,  625 ,  725  of the annular hub  420 ,  520 ,  620 ,  720 . The pin  1820  allows the user to torque the coaptation assistance element  400 ,  500 ,  600 ,  700  in both directions via the docking tube  1805  and the implant torque shaft  1810 . The pin  1820  allows the user to rotate the coaptation assistance element  400 ,  500 ,  600 ,  700  clockwise or counterclockwise by rotating the docking tube  1805 . In some methods of use, the pin  1820  can facilitate movement of the coaptation assistance element  400 ,  500 ,  600 ,  700  via the docking tube  1805 . When the slot  1815  and the groove  1835  are aligned, the spring-loaded pin  1820  can slip into the groove  1835  and essentially jam the threads.  FIG.  42 A  shows the pin  1820  forward such that the docking tube  1805  and the coaptation assistance element  400 ,  500 ,  600 ,  700  are locked together.  FIG.  42 B  shows a cross-sectional view of the locking pin  1820  in its natural forward position. 
       FIG.  42 C- 42 D  show the release of the pin  1820 . The pin  1820  can be pulled back via the pullwire  1830 . The pin  1820  can compress the spring  1825 . The pin  1820  can be removed from the groove  1835 . The pin  1820  slides along the slot  1815 . In this position, the docking tube  1805  can be unscrewed from the coaptation assistance element  400 ,  500 ,  600 ,  700 . The internally threaded portion  1840  can be disengaged from the externally threaded portion  425 ,  525 ,  625 ,  725  by rotation of the docking tube  1805 .  FIG.  42 C  shows a cross-sectional view of the retracted pin  1820 . With the pin  1820  retracted, the docking tube  1805  can be unscrewed from the annular hub  420 ,  520 ,  620 ,  720 .  FIG.  42 A- 42 D  illustrate that the docking hub  1805  can be coupled to the coaptation assistance element  400 ,  500 ,  600 ,  700  in order to position the coaptation assistance element  400 ,  500 ,  600 ,  700 .  FIG.  42 A- 42 D  illustrate that the docking hub  1805  can be coupled to the coaptation assistance element  400 ,  500 ,  600 ,  700  in order to rotate the coaptation assistance element  400 ,  500 ,  600 ,  700 . 
       FIG.  42 E- 42     i  illustrate the use of the anchor  800  with the implant delivery system  1800 . The anchor  800  is located within the docking hub  1805  as shown in  FIG.  42 E . The anchor  800  is in a retracted state within the docking hub  1805 . The anchor  800  is internal to the locking mechanism or pin  1820 . The docking hub  1805  is shown in line form, or penciled in. The docking hub  1805  and the implant torque shaft  1810  shown in  FIG.  42 E  are removed in  FIG.  42 F  for clarity. 
     The anchor  800  can be screwed in at the anatomical P2 position on the posterior leaflet, as described herein. The anchor  800  can be considered the P2 anchor. The anchor  800  can be driven by a driver  1845 .  FIG.  42 G  shows a close-up view of the driver  1845 . The driver  1845  has driven the anchor  800  fully into the issue and down onto the annular hub  420 ,  520 ,  620 ,  720  of the coaptation assistance element  400 ,  500 ,  600 ,  700 . The driver  1845  is connected to an internal torque shaft  1850 . The driver  1845  and the anchor  800  are fully housed within the docking hub  1805  as described herein. The internal torque shaft  1850  can extend through the implant torque shaft  1810 , see  FIG.  42 E . 
       FIG.  42 H  shows an internal, cross-sectional view of the anchor  800 . To ensure a secure connection to the driver  1845 , the anchor  800  can be tensioned against the driver  1845  by a tether rail  1855 . The tether rail  1855  can include a guidewire with a small screw or externally threaded portion  1860  at the distal tip. The externally threaded portion  1860  of the tether rail  1855  is configured to engage an internally threaded portion  1865  of the anchor  800 . The internal view of the tether rail  1855  as well as the connection between the anchor  800  and the annular hub  420 , 520 ,  620 ,  720  is shown in  FIG.  42 H   
       FIG.  42 H  also shows a square recess  1870  of the head of the anchor  800 . The driver  1845  can include a square portion (not shown) configured to engage the square recess  1870  in the head of the anchor  800 . Other designs for mating the anchor  800  and the driver  1845  are contemplated (e.g., any non-round shape, polygonal, hex, Philips, elliptical, etc.). 
     The anchor  800  can include a shoulder  1875 . Once the anchor  800  is completely driven into the tissue, the shoulder  1875  of the anchor  800  pushes the annular hub  420 ,  520 ,  620 ,  720  down to secure the coaptation assistance element  400 ,  500 ,  600 ,  700 .  FIG.  42   i    shows the view of the anchored coaptation assistance element  400 ,  500 ,  600 ,  700 . 
       FIGS.  43 A- 43 E  illustrate an embodiment of an implant delivery system  1900 . The implant delivery system  1900  can include a docking tube  1905 . The docking tube  1905  can be cylindrical. The docking tube  1905  is connected to an implant torque shaft  1910 . In some embodiments, the implant torque shaft  1910  can be rigidly coupled to the docking tube  1905 . In some embodiments, the implant torque shaft  1910  is welded or soldered to the docking tube  1905 . The implant torque shaft  1910  can transmit torque to the docking tube  1905 , as described herein. The docking tube  1905  can be coupled to the coaptation assistance element  400 ,  500 ,  600 ,  700 . In the illustrated embodiment, only a portion of the struts  430 ,  530 ,  630 ,  730  are shown. 
     The docking tube  1905  can include two or more hypotubes  1915  embedded in the wall. The hypotubes  1915  can include a lumen. The hypotubes  1915  can be diametrically opposed. The hypotubes  1915  can be spaced 180° apart. The hypotubes  1915  can extend within a slot. The hypotubes  1915  can extend along a portion of the length of the docking tube  1905 . In some embodiments, the docking tube  1905  comprises two or more lumens. In some embodiments, the lumens are monolithically or integrally formed with the docking tube  1905 . In the illustrated embodiment, the docking tube  1905  can include two hypotubes  1915 , but other configurations are contemplated (e.g., four hypotubes, etc.). 
     The docking tube  1905  can include tether  1920  disposed within the hypotubes  1915 . In some embodiments, the tether  1920  can be looped through opposing gaps in the coaptation assistance element  400 ,  500 ,  600 ,  700 . In some embodiments, the tether  1920  can be threaded between struts  430 ,  530 ,  630 ,  730  in the coaptation assistance element  400 ,  500 ,  600 ,  700 . The tether  1920  can extend through one hypotube  1915 , through the coaptation assistance element  400 ,  500 ,  600 ,  700 , underneath the annular hub  420 ,  520 ,  620 ,  720 , through the coaptation assistance element  400 ,  500 ,  600 ,  700 , and through the other hypotube  1915 . The tether  1920  can loop through the coaptation assistance element  400 ,  500 ,  600 ,  700 . The tether  1920  can loop through the coaptation assistance element  400 ,  500 ,  600 ,  700  and back up to the proximal or handle end of the system. 
       FIGS.  43 A- 43 B  illustrate an initial position of the tether  1920 . In this state, the tether  1920  holds the docking tube  1905  and coaptation assistance element  400 ,  500 ,  600 ,  700  together. The tether  1920  allows the user to torque the coaptation assistance element  400 ,  500 ,  600 ,  700  in both directions via the docking tube  1905  and the implant torque shaft  1910 . The tether  1920  allows the user to rotate the coaptation assistance element  400 ,  500 ,  600 ,  700  clockwise or counterclockwise by rotating the docking tube  1905 . In some methods of use, the tether  1920  can facilitate movement of the coaptation assistance element  400 ,  500 ,  600 ,  700  via the docking tube  1905 . The tether  1920  can be released. With the tether  1920  released, the docking tube  1905  can be uncoupled from the annular hub  420 ,  520 ,  620 ,  720 .  FIG.  43 A- 43 B  illustrates that the docking hub  1905  can be coupled to the coaptation assistance element  400 ,  500 ,  600 ,  700  in order to position the coaptation assistance element  400 ,  500 ,  600 ,  700 .  FIG.  43 A- 43 B  illustrate that the docking hub  1805  can be coupled to the coaptation assistance element  400 ,  500 ,  600 ,  700  in order to rotate the coaptation assistance element  400 ,  500 ,  600 ,  700 . 
       FIG.  43 C- 43 E  illustrate the use of the anchor  800  with the implant delivery system  1900 . The anchor  800  is located within the docking hub  1905  as shown in  FIG.  43 C . The anchor  800  is in a retracted state within the docking hub  1905 . The anchor  800  is internal to the locking mechanism or tether  1920 . The docking hub  1905  is shown in line form in  FIG.  43 B . 
     The anchor  800  can be screwed in at the anatomical P2 position on the posterior leaflet, as described herein. The anchor  800  can be considered the P2 anchor. The anchor  800  can be driven by a driver  1945 .  FIG.  43 D  shows a close-up view of the driver  1945 . The driver has driven the anchor  800  fully into the tissue and down onto the annular hub  420 ,  520 ,  620 ,  720  of the coaptation assistance element  400 ,  500 ,  600 ,  700 . The driver  1945  is connected to an internal torque shaft  1950 . In some embodiments, the internal torque shaft  1950  is welded or soldered to the driver  1945 . The driver  1945  and the anchor  800  are fully housed within the docking hub  1905 . The internal torque shaft  1950  can extend through the implant torque shaft  1910 .  FIG.  43 C  illustrates advancement of the anchor  800  prior to full seating of the anchor  800 .  FIG.  43 D  shows the anchor  800  screwed down into tissue. 
       FIG.  43 C  also shows an internal, cross-sectional view of the anchor  800 . To ensure a secure connection to the driver  1945 , the anchor  800  can be tensioned against the driver  1945  by a tether rail  1955 . The tether rail  1955  can include a guidewire with a small screw or externally threaded portion  1960  at the distal tip. The externally threaded portion  1960  of the tether rail  1955  is configured to engage an internally threaded portion  1965  of the anchor  800 . The internal view of the tether rail  1955  as well as the connection between the anchor  800  and the annular hub  420 ,  520 ,  620 ,  720  is shown in  FIG.  42 C . The tether rail  1955  can allow for minimal force evaluation of the effectiveness of the coaptation assistance element  400 ,  500 ,  600 ,  700  prior to release of the coaptation assistance element  400 ,  500 ,  600 ,  700 . The tether rail  1955  can allow for minimal force evaluation of the effectiveness of the coaptation assistance element  400 ,  500 ,  600 ,  700  prior to release of tether  1920 .  FIG.  43 C  illustrates a cross-sectional view showing the path of the tether  1920 . 
       FIG.  43 E  shows the view of the implanted anchor  800 .  FIG.  42 E  also shows a square recess  1970  of the head of the anchor  800 . The driver  1945  can include a square portion (not shown) configured to engage the square recess  1970  in the head of the anchor  800 . Other designs for mating the anchor  800  and the driver  1945  are contemplated (e.g., any non-round shape, polygonal, hex, Philips, elliptical, etc.). The anchor  800  can comprise an anchor hub. The hub can include the internally threaded portion  1965  of the anchor  800  to allow for a connection to the tether rail  1955 . The anchor  800  can include an anchor helix. The anchor helix can include a ground tip for optimal tissue penetration. 
     The coaptation assistance element  400 ,  500 ,  600 ,  700  can include some cutouts to minimize the sliding friction of the tether  1920 . The anchor  800  can be screwed into the tissue and bottomed out on the hub  420 ,  520 ,  620 ,  720 . The user can retract the docking tube  1905  leaving behind the two ends of the tether  1920 . The tether can be connected via a connecting inner torque shaft. If the user is satisfied with the performance of the coaptation assistance element  400 ,  500 ,  600 ,  700 , the user can remove the tether  1920 . If the user is unsatisfied with the performance of the coaptation assistance element  400 ,  500 ,  600 ,  700 , the user can re-dock the implant delivery system  1900  with the tether  1920 . If the user is unsatisfied with the performance of the coaptation assistance element  400 ,  500 ,  600 ,  700 , the user can thread the tether  1920  through the hypotubes  1915 . If the user is unsatisfied with the performance of the coaptation assistance element  400 ,  500 ,  600 ,  700 , the user can remove the anchor  800  and/or remove the coaptation assistance element  400 ,  500 ,  600 ,  700  entirely. 
       FIGS.  44 A- 44 E  illustrate an embodiment of an implant delivery system  2000 . The implant delivery system  2000  can include a docking tube  2005 . The docking tube  2005  can be a desired shape, such as cylindrical for example. The docking tube  2005  is connected to an implant torque shaft  2010 . In some embodiments, the implant torque shaft  2010  can be rigidly coupled to the docking tube  2005 . In some embodiments, the implant torque shaft  2010  is welded or soldered to the docking tube  2005 . The implant torque shaft  2010  can transmit torque to the docking tube  2005 , as described herein. The docking tube  2005  can include a docking endcap  2015 . 
     The docking tube  2005  can include one, two, or more retention arms  2020  cut out at the distal end. The one, two, or more retention arms  2020  can allow for the transfer of torque as well as push/push to the coaptation assistance element  400 ,  500 ,  600 ,  700  via the implant torque shaft  2010 . The docking tube  2005  can include three retention arms  2020 . The retention arms  2020  can be equally spaced around the docking tube  2005 . The retention arms  2020  can be spaced about, at least about, or no more than about 120° apart or another desired angle. The retention arms  2020  can extend along a portion of the length of the docking tube  2005 . In some embodiments, the retention arms  2020  are monolithically or integrally formed with the docking tube  2005 . In the illustrated embodiment, the docking tube  2005  can include three retention arms  2020 , but other configurations are contemplated (e.g., one retention arm, two retention arms, four retention arms, five retention arms, etc.). The retention arms  2020  can be formed from a U-shaped cut in the docking tube  2005 . 
       FIGS.  44 B- 44 C  illustrate an initial position of the retention arms  2020 . In this state, the retention arms  2020  hold the docking tube  2005  and coaptation assistance element  400 ,  500 ,  600 ,  700  together. The retention arms  2020  allow the user to torque the coaptation assistance element  400 ,  500 ,  600 ,  700  in both directions via the docking tube  2005  and the implant torque shaft  2010 . The retention arms  2020  allow the user to rotate the coaptation assistance element  400 ,  500 ,  600 ,  700  clockwise or counterclockwise by rotating the docking tube  2005 . In some methods of use, the retention arms  2020  can facilitate movement of the coaptation assistance element  400 ,  500 ,  600 ,  700  via the docking tube  2005 . 
     Referring to  FIG.  44 E , the retention arms  2020  engage windows  2025  in the head of the anchor  800 . In some embodiments, the windows  2025  are laser cut windows. In some embodiments, the windows  2025  extend through the annular hub  420 ,  520 ,  620 ,  720 . In some embodiments, the windows  2025  are slots or grooves. The number of windows  2025  can correspond to the number of retention arms  2020 . In some embodiments, each retention arms  2020  engages a window  2025 . The windows  2025  can be shaped to accept a portion of a retention arm  2020  such as a tab  2030 . In some embodiments, each retention arm  2020  can include an inwardly facing tab  2030 . The tab  2030  can have an increased thickness relative to the retention arm  2020 . The tab  2030  can be shaped to engage the window  2025 . The tab  2030  can be a distal inner section of the retention arm  2020 . 
       FIG.  44 B- 44 D  illustrate the use of the anchor  800  with the implant delivery system  2000 . The anchor  800  is located within the docking hub  2005  as shown in  FIG.  44 B . The anchor  800  is in a retracted state within the docking hub  2005 . The anchor  800  is internal to the locking mechanism or tabs  2030  of the retention arms  2020 . The docking hub  2005  is shown in line form in  FIG.  44 B .  FIG.  44 C  shows advance of the anchor  800 .  FIG.  44 C  illustrate anchor  800  advancement prior to full seating of the anchor  800  and prior to flexing of the retention arms  2020 . 
     The anchor  800  can be screwed in, for example, at the anatomical P2 position on the posterior leaflet, as described herein. The anchor  800  can be considered the P2 anchor. The anchor  800  can be driven by a driver  2045 .  FIG.  44 D  shows a close-up view of the driver  2045 . The driver  2045  has driven the anchor  800  fully into the issue and down onto the annular hub  420 ,  520 ,  620 ,  720  of the coaptation assistance element  400 ,  500 ,  600 ,  700 . The driver  2045  is connected to an internal torque shaft  2050 . In some embodiments, the internal torque shaft  2050  is welded or soldered to the driver  2045 . The driver  2045  and the anchor  800  are fully housed within the docking hub  2005  as shown in  FIG.  44 B . The internal torque shaft  2050  can extend through the implant torque shaft  2010 . 
       FIG.  44 D  shows an internal, cross-sectional view of the anchor  800 . To ensure a secure connection to the driver  2045 , the anchor  800  can be tensioned against the driver  2045  by a tether rail  2055 . The tether rail  2055  can include a guidewire with a small screw or externally threaded portion  2060  at the distal tip. The externally threaded portion  2060  of the tether rail  2055  is configured to engage an internally threaded portion  2065  of the anchor  800 . The internal view of the tether rail  2055  as well as the connection between the anchor  800  and the annular hub  420 ,  520 ,  620 ,  720  is shown in  FIG.  44 D . The tether rail  2055  can allow for minimal force evaluation of the effectiveness of the coaptation assistance element  400 ,  500 ,  600 ,  700  prior to release of the coaptation assistance element  400 ,  500 ,  600 ,  700 . The tether rail  2055  can allow for minimal force evaluation of the effectiveness of the coaptation assistance element  400 ,  500 ,  600 ,  700  prior to release of retention arms  2020 . 
       FIG.  44 D  illustrates a cross-sectional view showing the release of the retention arms  2020 . When the anchor  800  is screwed into tissue, the annular hub  420 ,  520 ,  620 ,  720  makes contact with the tabs  2030  of the retention arms  2020 . The retention arms  2020  can bend outward from the windows  2025  of the anchor  800  due to the distal movement of the annular hub  420 ,  520 ,  620 ,  720 . The tabs  2030  can include angled faces  2035  which allow for easy removal of the docking tube  2005  from the annular hub  420 ,  520 ,  620 ,  720  when the retention arms  2020  are bent outward.  FIG.  44 D  illustrate anchor  800  advancement wherein the retention arms  2020  bend outward as the anchor  800  is fully driven in. 
     With the retention arms  2020  bent outward, the docking tube  2005  can be uncoupled from the annular hub  420 ,  520 ,  620 ,  720 .  FIG.  44 D  illustrates that the docking hub  2005  can be uncoupled to the coaptation assistance element  400 ,  500 ,  600 ,  700 .  FIGS.  44 A- 44 C  illustrates that the docking hub  2005  can be coupled to the coaptation assistance element  400 ,  500 ,  600 ,  700  in order to position the coaptation assistance element  400 ,  500 ,  600 ,  700 .  FIGS.  44 A- 44 C  illustrate that the docking hub  2005  can be coupled to the coaptation assistance element  400 ,  500 ,  600 ,  700  in order to rotate the coaptation assistance element  400 ,  500 ,  600 ,  700 . 
       FIG.  44 E  shows the view of the implanted anchor  800 .  FIG.  44 E  also shows a square recess  2070  of the head of the anchor  800 . The driver  2045  can include a square portion (not shown) configured to engage the square recess  2070  in the head of the anchor  800 . Other designs for mating the anchor  800  and the driver  2045  are contemplated (e.g., any non-round shape, polygonal, hex, Philips, elliptical, etc.). The anchor  800  can comprise an anchor hub. The hub can include the internally threaded portion  2065  of the anchor  800  to allow for a connection to the tether rail  2055 . The anchor  800  can include an anchor helix. The anchor  800  can include the windows  2025 . The windows  2025  allow the retention arms  2020  to snap in and hold onto the annular hub  420 ,  520 ,  620 ,  720 . The windows  2025  allow the retention arms  2020  hold onto the annular hub  420 ,  520 ,  620 ,  720  in compression, tension and torsion. 
       FIGS.  45 A- 45 K  illustrate an embodiment of an implant delivery system  2100 . The implant delivery system  2100  can include a docking tube  2105 . The docking tube  2105  can be cylindrical. The docking tube  2105  is connected to an implant torque shaft  2110 . In some embodiments, the implant torque shaft  2110  can be rigidly coupled to the docking tube  2105 . In some embodiments, the implant torque shaft  2110  is welded or soldered to the docking tube  2105 . The implant torque shaft  2110  can transmit torque to the docking tube  2105 , as described herein. The docking tube  2105  can include a docking endcap  2115 . 
     The docking tube  2105  can include one or more slots  2120  cut out at the distal end. The slot  2120  can be a bayonet slot. The slot  2120  can have a bayonet configuration. The one or more slots  2120  can allow for the transfer of torque as well as push/push to the coaptation assistance element  400 ,  500 ,  600 ,  700  via the implant torque shaft  2110 . The docking tube  2105  can include three slots  2120 . The slots  2120  can be equally spaced around the docking tube  2105 . The slots  2120  can be spaced 120° apart. The slots  2120  can extend along a portion of the length of the docking tube  2105 . In some embodiments, the slots  2120  are monolithically or integrally formed with the docking tube  2105 . In the illustrated embodiment, the docking tube  2105  can include three slots  2120 , but other configurations are contemplated (e.g., one slot, two slots, four slots, five slots, etc.). The slots  2120  can be formed from a J-shaped cut in the docking tube  2105 . 
     The docking tube  2105  can include a flared ring  2125  shown in  FIG.  45 B . The flared ring  2125  can ensure that the slots  2120  do not weaken the distal end of the docking tube  2105 . The flared ring  2125  can ensure the ease of re-docking. The flared ring  2125  can be welded or soldered to the distal end of the docking tube  2105 . 
     Referring to  FIG.  45 F , the slots  2120  engage retention pins  2030  in the head of the anchor  800 . In some embodiments, the retention pins  2030  protrude a sufficient amount to ensure proper interface with the slots  2120  at the tip of the docking tube  2105 . In some embodiments, the retention pins  2030  extend radially outward from the annular hub  420 ,  520 ,  620 ,  720 . In some embodiments, the retention pins  2030  are cylindrical. The number of retention pins  2030  can correspond to the number of slots  2120 . In some embodiments, each slot  2120  engages a retention pin  2025 . The slots  2120  can be shaped to accept and guide the retention pins  2030 . 
       FIGS.  45 B- 45 C  illustrate an initial position of the slots  2120  relative to retention pins  2030 . In this state, the slots  2120  and retention pins  2030  hold the docking tube  2005  and coaptation assistance element  400 ,  500 ,  600 ,  700  together. The slots  2120  and retention pins  2030  allows the user to torque the coaptation assistance element  400 ,  500 ,  600 ,  700  in both directions via the docking tube  2005  and the implant torque shaft  2010 . The slots  2120  and retention pins  2030  allow the user to rotate the coaptation assistance element  400 ,  500 ,  600 ,  700  clockwise or counterclockwise by rotating the docking tube  2005 . In some methods of use, the slots  2120  and retention pins  2030  can facilitate movement of the coaptation assistance element  400 ,  500 ,  600 ,  700  via the docking tube  2105 . 
       FIG.  45 B- 45 E  illustrate the use of the anchor  800  with the implant delivery system  2100 . The anchor  800  is located within the docking hub  2105  as shown in  FIG.  45 B . The anchor  800  is in a retracted state within the docking hub  2105 . The anchor  800  is internal to the locking mechanism or the slots  2120 . The docking hub  2105  is shown in line form in  FIG.  45 B .  FIG.  45 C  shows advancement of the anchor  800 . 
     The anchor  800  can be screwed in at the anatomical P2 position on the posterior leaflet, as described herein. The anchor  800  can be considered the P2 anchor. The anchor  800  can be driven by a driver  2145 .  FIG.  45 D  shows a close-up view of the driver  2145 . The driver  2145  has driven the anchor  800  fully into the tissue and down onto the annular hub  420 ,  520 ,  620 ,  720  of the coaptation assistance element  400 ,  500 ,  600 ,  700 . The driver  2145  is connected to an internal torque shaft  2150 . In some embodiments, the internal torque shaft  2150  is welded or soldered to the driver  2145 . The driver  2145  and the anchor  800  are fully housed within the docking hub  2105  as shown in  FIG.  45 B . The internal torque shaft  2150  can extend through the implant torque shaft  2110 . 
       FIG.  45 E  shows an internal, cross-sectional view of the anchor  800 . To ensure a secure connection to the driver  2145 , the anchor  800  can be tensioned against the driver  2145  by a tether rail  2155 . The tether rail  2155  can include a guidewire with a small screw or externally threaded portion  2160  at the distal tip. The externally threaded portion  2160  of the tether rail  2155  is configured to engage an internally threaded portion  2165  of the anchor  800 . The internal view of the tether rail  2055  as well as the connection between the anchor  800  and the annular hub  420 ,  520 ,  620 ,  720  is shown in  FIG.  45 E . The tether rail  2155  can allow for minimal force evaluation of the effectiveness of the coaptation assistance element  400 ,  500 ,  600 ,  700  prior to release of the coaptation assistance element  400 ,  500 ,  600 ,  700 . The tether rail  2155  can allow for minimal force evaluation of the effectiveness of the coaptation assistance element  400 ,  500 ,  600 ,  700  prior to release of retention pins  2030 . 
     When the anchor  800  is screwed into tissue, the retention pins  2030  of the annular hub  420 ,  520 ,  620 ,  720  moves proximally within the slots  2120 . The docking tube  2005  can be rotated, thereby moving the retention pins  2030  of the annular hub  420 ,  520 ,  620 ,  720  laterally within the slots  2120 . The docking tube  2005  can be moved proximally, thereby moving the retention pins  2030  of the annular hub  420 ,  520 ,  620 ,  720  distally within the slots  2120 . Further movement of the docking tube  2005  proximally can release the docking tube  2105  from the annular hub  420 ,  520 ,  620 ,  720 .  FIGS.  45 A- 45 C  illustrates that the docking hub  2005  can be coupled to the coaptation assistance element  400 ,  500 ,  600 ,  700  in order to position the coaptation assistance element  400 ,  500 ,  600 ,  700 .  FIGS.  45 A- 45 C  illustrate that the docking hub  2105  can be coupled to the coaptation assistance element  400 ,  500 ,  600 ,  700  in order to rotate the coaptation assistance element  400 ,  500 ,  600 ,  700 . 
       FIG.  45 E- 45 F  show the view of the implanted anchor  800 .  FIG.  45 E  also shows a square recess  2170  of the head of the anchor  800 . The driver  2145  can include a square portion (not shown) configured to engage the square recess  2170  in the head of the anchor  800 . Other designs for mating the anchor  800  and the driver  2145  are contemplated (e.g., any non-round shape, polygonal, hex, Philips, elliptical, etc.). The anchor  800  can comprise an anchor hub. The hub can include the internally threaded portion  2165  of the anchor  800  to allow for a connection to the tether rail  2155 . The anchor  800  can include an anchor helix. In some embodiments, the annular hub  420 ,  520 ,  620 ,  720  can include three laser cut holes to accept the three retention pins  2130 . The retention pins  2130  can be welded to the holes. In some embodiments, the retention pins  2130  are nitinol.  FIGS.  45 G- 45 K  show additional views. 
       FIGS.  45 A- 45 C  illustrate deploying one or more secondary anchors  850 ,  1770 ,  1780 . The secondary anchor  850 ,  1770 ,  1780  can include any of the features of the anchor  800 . The secondary anchor  850 ,  1770 ,  1780  can comprise a helix or helical structure  852 . The secondary anchor  850 ,  1770 ,  1780  can be designed to engage the tissue of heart, such as the tissue of the annulus. The secondary anchor  850 ,  1770 ,  1780  can include a tip  854  designed to engage tissue. The tip  854  can be sharpened. The tip  854  can be ground for optimal penetration. The secondary anchor  850 ,  1770 ,  1780  can include a hub  856 . The hub  856  can be an annular hub having any of the features of annular hub  420 ,  520 ,  620 ,  720  described herein. The hub  856  can include one or more mating features  858 . The mating feature  858  can be a cutout. The mating feature  858  can create two semi-circular portions at different heights. The mating feature  858  can include a first circular portion and a second circular portion. The first and second circular portions can be separated by a perpendicular cut. The mating feature  858  can include any configuration which allows torque to be transmitted to the secondary anchor  850 ,  1770 ,  1780 . 
       FIGS.  46 A- 46 C  illustrate a delivery catheter  860  designed for deploying one or more secondary anchors  850 ,  1770 ,  1780 . The distal end of the delivery catheter  860  is shown in the figures. The delivery catheter  860  can include a proximal end outside the body of the patient. The proximal end can include one or more controls to manipulate the delivery catheter  860 . The delivery catheter  860  can include a torque shaft  862 . In some embodiments, the torque shaft  862  can rotate the secondary anchors  850 ,  1770 ,  1780  in either direction. The torque shaft  862  can include a lumen  864 . The torque shaft  862  can include a helix or helical structure  866 . The helix or helical structure  866  of the torque shaft  862  can have the same or similar features as the helix or helical structure  852  of the one or more secondary anchors  850 ,  1770 ,  1780 . The helix or helical structure  866  of the torque shaft  862  can have the same pitch as the helix or helical structure  852  of the one or more secondary anchors  850 ,  1770 ,  1780 . The helix or helical structure  866  of the torque shaft  862  can have the same diameter as the helix or helical structure  852  of the one or more secondary anchors  850 ,  1770 ,  1780 . The helix or helical structure  866  of the torque shaft  862  can have the same wire diameter as the helix or helical structure  852  of the one or more secondary anchors  850 ,  1770 ,  1780 . 
     The delivery catheter  860  can include a locking hub  868 . The locking hub  868  can be an annular hub. The locking hub  868  can include one or more mating features  870 . The mating feature  870  can be designed to lock with the mating feature  858  of the hub  856 . The mating feature  870  can create two semi-circular portions at different heights. The mating feature  870  can include a first circular portion and a second circular portion. The first and second circular portions can be separated by a perpendicular cut. The mating feature  870  can include any configuration which allows torque to be transmitted to the hub  856  of the one or more secondary anchors  850 ,  1770 ,  1780 . The locking hub  868  can be coupled to a locking shaft  872 . 
       FIG.  46 A  shows a configuration in which the delivery catheter  860  is not engaged with the secondary anchor  850 ,  1770 ,  1780 .  FIG.  46 B  shows a configuration in which the delivery catheter  860  is engaged with the secondary anchor  850 ,  1770 ,  1780 . In some embodiments, the helix or helical structure  866  can engage the helix or helical structure  852  of the secondary anchor  850 ,  1770 ,  1780 . In some embodiments, both helices can have the same pitch and diameter. Because both helices have same pitch and diameter, the combined profile will be the same as the profile of the secondary anchor  850 ,  1770 ,  1780 . The helix or helical structure  866  can interlock with the helix or helical structure  852  of the secondary anchor  850 ,  1770 ,  1780 . The helix or helical structure  866  can fit within the voids of the helix or helical structure  852  of the secondary anchor  850 ,  1770 ,  1780 . The diameter of the combined structure can be the same as the diameter of the helix or helical structure  852  of the secondary anchor  850 ,  1770 ,  1780 . In some embodiments, the torque shaft  862  can be rotated to engage the helix or helical structure  866  with the helix or helical structure  852  of the secondary anchor  850 ,  1770 ,  1780 . In some embodiments, the secondary anchor  850 ,  1770 ,  1780  can be rotated to engage the helix or helical structure  852  of the secondary anchor  850 ,  1770 ,  1780  with the helix or helical structure  866 .  FIG.  46 B  shows the engaged helices. 
     In some embodiments, the locking hub  868  is engaged with the hub  856  of the secondary anchor  850 ,  1770 ,  1780 . In some embodiments, the locking hub  868  can be translated within the lumen  864  of the torque shaft  862  toward the secondary anchor  850 ,  1770 ,  1780 . The mating feature  870  of the locking hub  868  can interlock with the mating feature  858  of the hub  565  of the secondary anchor  850 ,  1770 ,  1780 . The locking hub  868  can engage the secondary anchor  850 ,  1770 ,  1780 . The hub  856  of the secondary anchor  850 ,  1770 ,  1780  and the locking hub  868  are engaged to connect the secondary anchor  850 ,  1770 ,  1780  to the delivery catheter  860 . In some embodiments, the locking shaft  872  can advance or withdraw the locking hub  868 . 
       FIG.  46 C  shows the locking hub  868  engaged with the hub  856  of the secondary anchor  850 ,  1770 ,  1780 . The locking hub  868  engaged with the hub  856  allow rotation of the secondary anchor  850 ,  1770 ,  1780 . In some embodiments, the locking hub  868  engaged with the hub  856  can reduce the likelihood of disengagement of the delivery catheter  860  from the secondary anchor  850 ,  1770 ,  1780  during delivery. In some embodiments, the locking hub  868  engaged with the hub  856  allow counter-clockwise rotation of the secondary anchor  850 ,  1770 ,  1780  without disengaging from the delivery catheter  860 . The secondary anchor  850 ,  1770 ,  1780  can be rotated counter-clockwise to be driven into tissue. 
     Once the secondary anchor  850 ,  1770 ,  1780  is driven into tissue, the delivery catheter  860  can be disengaged from the secondary anchor  850 ,  1770 ,  1780 . In some embodiments, the locking hub  868  can be disengaged with the hub  856  of the secondary anchor  850 ,  1770 ,  1780 . The locking hub  868  can be translated within the lumen  864  of the torque shaft  862  away from the secondary anchor  850 ,  1770 ,  1780 . The locking shaft  872  can withdraw the locking hub  868 . In some embodiments, the torque shaft  862  can be rotated to disengage the helices. In some embodiments, the torque shaft  862  can be rotated to disengage the helix or helical structure  866  with the helix or helical structure  852  of the secondary anchor  850 ,  1770 ,  1780 . 
     In some embodiments, the coaptation assistance element  400 ,  500 ,  600 ,  700  can include an annular section configured to be implanted within a heart superior to a valve annulus. In some embodiments, the coaptation assistance element  400 ,  500 ,  600 ,  700  can include a plurality of struts comprising at least a first strut residing within the annular section and a second strut having a total length that is longer than that of the first strut. In some embodiments, the coaptation assistance element  400 ,  500 ,  600 ,  700  can include a superior edge which is cupped and carried by annular section. In some embodiments, the coaptation assistance element  400 ,  500 ,  600 ,  700  can improve the entire length coaptation without disrupting the anatomy. In some embodiments, the coaptation assistance element  400 ,  500 ,  600 ,  700  can include a plurality of radial struts. In some embodiments, the coaptation assistance element  400 ,  500 ,  600 ,  700  can include a plurality of radial struts comprising first struts residing within the annular section and second struts having a total length that is longer than that of the first struts. In some embodiments, the coaptation assistance element  400 ,  500 ,  600 ,  700  includes a superior edge which is cupped. In some embodiments, the coaptation assistance element  400 ,  500 ,  600 ,  700  can include a hub positioned near the annulus. In some embodiments, the coaptation assistance element  400 ,  500 ,  600 ,  700  can include struts which are radially expanding. In some embodiments, the coaptation assistance element  400 ,  500 ,  600 ,  700  can include improving coaptation of struts over the entire length without disrupting the anatomy. In some embodiments, the coaptation assistance element  400 ,  500 ,  600 ,  700  can be expanded via the struts. 
     In some methods, the method can include positioning the hub near the annulus. In some methods, the struts are radially expanding. In some methods, the method can include improving coaptation of struts over the entire length without disrupting anatomy. In some methods, the method can include expansion of the coaptation element carried via the struts extending radially outward. In some methods, the method can include expansion of the coaptation element carried via the struts extending radially outward to form an annulus section. In some methods, the method can include expansion of the coaptation element carried via the struts forming an annulus section. 
     In some embodiments, the annular hub  420 ,  520 ,  620 ,  720  is spaced inward from the lateral edges of the coaptation assistance element  400 ,  500 ,  600 ,  700 . In some embodiments, the annular hub  420 ,  520 ,  620 ,  720  is spaced inward from the superior edge of the coaptation assistance element  400 ,  500 ,  600 ,  700 . In some embodiments, the annular hub  420 ,  520 ,  620 ,  720  is spaced inward from the inferior edge of the coaptation assistance element  400 ,  500 ,  600 ,  700 . In some embodiments, the annular hub  420 ,  520 ,  620 ,  720  is not expandable. In some embodiments, the annular hub  420 ,  520 ,  620 ,  720  has a fixed circumference. In some embodiments, the annular hub  420 ,  520 ,  620 ,  720  retains the shape during expansion of the coaptation assistance element  400 ,  500 ,  600 ,  700 . In some embodiments, the annular hub  420 ,  520 ,  620 ,  720  is formed from a tube. The struts  430 ,  530 ,  630 ,  730  can be laser cut from the tube. The cuts can extend from one end of the tubing toward the second end. The uncut portion of the tubing can be annular hub  420 ,  520 ,  620 ,  720 . In some embodiments, the coaptation assistance element  400 ,  500 ,  600 ,  700  can be formed from a sheet of material. The sheet can be laser cut to include the struts  430 ,  530 ,  630 ,  730 . The sheet can be rolled to form a tube. The tube can be welded or otherwise held together. The uncut portion of the sheet can form the annular hub  420 ,  520 ,  620 ,  720 . 
     In some embodiments, the anchor  800  is an active anchor. The anchor  800  can be coupled to the annular hub  420 ,  520 ,  620 ,  720 . The anchor  800  can be coupled to the annular hub  420 ,  520 ,  620 ,  720  by interlocking the helix of the anchor  800  with a structure of the annular hub  420 ,  520 ,  620 ,  720 . The anchor  800  can be configured to be rotated relative to the annular hub  420 ,  520 ,  620 ,  720 . The anchor  800  can be configured to be rotated relative to the annular hub  420 ,  520 ,  620 ,  720  when coupled to the annular hub  420 ,  520 ,  620 ,  720 . The anchor  800  is configured to be rotated to be selectively deployed. The anchor  800  is configured to be rotated to engage tissue. The anchor  800  is configured to be rotated to engage the annulus. The anchor  800  is configured to be rotated through the annulus. The anchor  800  is configured to be rotated in a first direction relative the annular hub  420 ,  520 ,  620 ,  720 . The anchor  800  is configured to be rotated in a first direction to selectively deploy the anchor  800 . The anchor  800  is configured to be rotated to deploy the anchor  800  at a first target location. The anchor  800  is configured to be rotated to engage tissue in the annulus. The anchor  800  can be selectively deployed in the annulus. The annular hub  420 ,  520 ,  620 ,  720  can remain stationary as the anchor  800  is rotated to engage tissue. The non-expandable, annular hub  420 ,  520 ,  620 ,  720  can remain stationary as the anchor  800  is rotated to engage tissue. 
     In some embodiments, the anchor  800  is configured to be rotated in a second direction relative the annular hub  420 ,  520 ,  620 ,  720 . The anchor  800  is configured to be rotated in a second direction to selectively disengage the anchor  800 . The anchor  800  is configured to be rotated to disengage the anchor  800  from the first target location. The anchor  800  is configured to be rotated to disengage tissue in the annulus. The annular hub  420 ,  520 ,  620 ,  720  can remain stationary as the anchor  800  is rotated to disengage tissue. The non-expandable, annular hub  420 ,  520 ,  620 ,  720  can remain stationary as the anchor  800  is rotated to disengage tissue. The second direction can be opposite the first direction. In some embodiments, the first direction can be clockwise and the second direction can be counter-clockwise. In some embodiments, the first direction can be counter-clockwise and the second direction can be clockwise. 
     In some embodiments, the plurality of struts  430 ,  530 ,  630 ,  730  are spaced circumferentially around the annular hub  420 ,  520 ,  620 ,  720 . In some embodiments, the plurality of struts  430 ,  530 ,  630 ,  730  are evenly spaced around the annular hub  420 ,  520 ,  620 ,  720 . In some embodiments, the plurality of struts  430 ,  530 ,  630 ,  730  are unevenly spaced around the annular hub  420 ,  520 ,  620 ,  720 . In some embodiments, the struts  430 ,  530 ,  630 ,  730  comprising the annular section are evenly spaced around the annular hub  420 ,  520 ,  620 ,  720 . In some embodiments, the struts  430 ,  530 ,  630 ,  730  comprising the annular section are unevenly spaced around the annular hub  420 ,  520 ,  620 ,  720 . In some embodiments, the struts  430 ,  530 ,  630 ,  730  forming the superior edge are evenly spaced around the annular hub  420 ,  520 ,  620 ,  720 . In some embodiments, the struts  430 ,  530 ,  630 ,  730  forming the superior edge are unevenly spaced around the annular hub  420 ,  520 ,  620 ,  720 . In some embodiments, the struts  430 ,  530 ,  630 ,  730  comprising the ventricular section are evenly spaced around the annular hub  420 ,  520 ,  620 ,  720 . In some embodiments, the struts  430 ,  530 ,  630 ,  730  comprising the ventricular section are unevenly spaced around the annular hub  420 ,  520 ,  620 ,  720 . In some embodiments, the struts  430 ,  530 ,  630 ,  730  forming the inferior edge are evenly spaced around the annular hub  420 ,  520 ,  620 ,  720 . In some embodiments, the struts  430 ,  530 ,  630 ,  730  forming the inferior edge are unevenly spaced around the annular hub  420 ,  520 ,  620 ,  720 . In some embodiments, two or more struts  430 ,  530 ,  630 ,  730  are evenly spaced around the annular hub  420 ,  520 ,  620 ,  720 . In some embodiments, two or more  430 ,  530 ,  630 ,  730  are unevenly spaced around the annular hub  420 ,  520 ,  620 ,  720 . 
     In some embodiments, the plurality of struts  430 ,  530 ,  630 ,  730  extend outward from the annular hub  420 ,  520 ,  620 ,  720 . In some embodiments, the plurality of struts  430 ,  530 ,  630 ,  730  have a portion near the annular hub  420 ,  520 ,  620 ,  720  which is radial. In some embodiments, the plurality of struts  430 ,  530 ,  630 ,  730  are placed along a radius. In some embodiments, the plurality of struts  430 ,  530 ,  630 ,  730  diverge from a center. In some embodiments, the plurality of struts  430 ,  530 ,  630 ,  730  diverge from the annular hub  420 ,  520 ,  620 ,  720 . In some embodiments, the plurality of struts  430 ,  530 ,  630 ,  730  develop uniformly around a central axis. In some embodiments, the plurality of struts  430 ,  530 ,  630 ,  730  develop uniformly around the annular hub  420 ,  520 ,  620 ,  720 . In some embodiments, the plurality of struts  430 ,  530 ,  630 ,  730  develop uniformly around the anchor  800 . In some embodiments, the plurality of struts  430 ,  530 ,  630 ,  730  can form spokes. In some embodiments, the plurality of struts  430 ,  530 ,  630 ,  730  extend from the center outward. In some embodiments, the plurality of struts  430 ,  530 ,  630 ,  730  extend from the edge of the coaptation assistance element  400 ,  500 ,  600 ,  700  inward. In some embodiments, the plurality of struts  430 ,  530 ,  630 ,  730  are branched. In some embodiments, the plurality of struts  430 ,  530 ,  630 ,  730  are outspread. In some embodiments, the plurality of struts  430 ,  530 ,  630 ,  730  are radiating. In some embodiments, the plurality of struts  430 ,  530 ,  630 ,  730  spread outward. In some embodiments, the plurality of struts  430 ,  530 ,  630 ,  730  can include an inflection point. In some embodiments, a strut  430 ,  530 ,  630 ,  730  can include an inflection point. In some embodiments, the plurality of struts  430 ,  530 ,  630 ,  730  can include a curved shape. In some embodiments, a strut  430 ,  530 ,  630 ,  730  can include a curved shape. In some embodiments, a strut  430 ,  530 ,  630 ,  730  can include a U-shaped curve. In some embodiments, a strut  430 ,  530 ,  630 ,  730  can include a C-shaped curve. In some embodiments, a strut  430 ,  530 ,  630 ,  730  can include an S-shaped curve. In some embodiments, a strut  430 ,  530 ,  630 ,  730  can include an L-shaped curve. 
     In some embodiments, the plurality of struts  430 ,  530 ,  630 ,  730  increase the volume of the coaptation assistance element  400 ,  500 ,  600 ,  700  when deployed. In some embodiments, the plurality of struts  430 ,  530 ,  630 ,  730  increase the thickness of the coaptation assistance element  400 ,  500 ,  600 ,  700  when deployed. In some embodiments, the plurality of struts  430 ,  530 ,  630 ,  730  increase the length of the coaptation assistance element  400 ,  500 ,  600 ,  700  when deployed. In some embodiments, the plurality of struts  430 ,  530 ,  630 ,  730  increase the height of the coaptation assistance element  400 ,  500 ,  600 ,  700  when deployed. In some embodiments, the plurality of struts  430 ,  530 ,  630 ,  730  increase the width of the coaptation assistance element  400 ,  500 ,  600 ,  700  when deployed. 
     In some embodiments, the plurality of struts  430 ,  530 ,  630 ,  730  can include a first strut. The first strut can be configured to be implanted within a heart superior to a valve annulus. The first strut can be an annular strut. In some embodiments, the plurality of struts  430 ,  530 ,  630 ,  730  can include a second strut. The second strut can be configured to be implanted within a heart inferior to a valve annulus. The second strut can be a ventricular strut. The second strut can traverse the mitral valve. The second strut can traverse a plane of the valve annulus. In some embodiments, the first strut and the second strut have different lengths. In some embodiments, the second strut is longer than the first strut. 
     In some embodiments, the superior edge of the coaptation assistance element  400 ,  500 ,  600 ,  700  forms a curve. In some embodiments, the superior edge forms a lip. In some embodiments, the superior edge is cupped downward toward the inferior edge. In some embodiments, the superior edge is cupped upward from the inferior edge. In some embodiments, the annular hub  420 ,  520 ,  620 ,  720  extends upward from the inferior edge. In some embodiments, the annular hub  420 ,  520 ,  620 ,  720  extends upward from the superior edge. In some embodiments, the annular hub  420 ,  520 ,  620 ,  720  extends upward from the annular portion of the coaptation assistance element  400 ,  500 ,  600 ,  700 . In some embodiments, the annular hub  420 ,  520 ,  620 ,  720  extends upward from the coaptation surface of the coaptation assistance element  400 ,  500 ,  600 ,  700 . In some embodiments, the annular hub  420 ,  520 ,  620 ,  720  is tubular. In some embodiments, the annular hub  420 ,  520 ,  620 ,  720  forms a circle. In some embodiments, the annular hub  420 ,  520 ,  620 ,  720  has the form of a ring. In some embodiments, the hub  420 ,  520 ,  620 ,  720  is non-annular. In some embodiments, the hub  420 ,  520 ,  620 ,  720  forms a polygon (e.g., triangular, square, rectangular, hexagonal, octagonal, etc.). In some embodiments, the hub  420 ,  520 ,  620 ,  720  forms a non-round shape. In some embodiments, the hub  420 ,  520 ,  620 ,  720  forms an elliptical shape. 
       FIGS.  47 A- 47 E  illustrates embodiments of implant features.  FIGS.  47 A- 47 E  illustrate some nonlimiting potentially clinically relevant aspects of the implant. While the coaptation assistance element  400  is illustrated, any of the coaptation assistance elements described herein can include the features described herein. In addition, the coaptation assistance element  400  can include any of the features of the coaptation assistance elements described herein with respect to other embodiments, for example. 
     As described herein, the coaptation assistance element  400  can include the annular hub  420  which can be relatively centrally located. The coaptation assistance element  400  can have a generally elongate shape, but other shapes are contemplated, for example, polygonal, circular, elliptical, rounded, rectangular, triangular, etc. The coaptation assistance element  400  can have a superior edge  440 , lateral edges  470  and  475 , and inferior edge  480 . In some embodiments, the superior edge  440  has a length greater than that of inferior edge  480 , such that the transverse distance between lateral edges  470  and  475  generally decreases from superior to inferior on the coaptation assistance element  400 . The superior edge  440  of the coaptation assistance element  400  can be curved to match the general shape of the annulus or adjoining atrial wall. 
     The coaptation assistance element  400  can include a first surface  405  configured to be disposed toward a mal-coapting native leaflet, in use, and a second surface  415  configured to be disposed toward the anterior leaflet. The second surface  415  can include a coaptation surface  460 . The coaptation assistance element  400  can include one or more struts  430 . The plurality of struts  430  can provide structural support for the coaptation assistance element  400 . The plurality of struts  430  can provide the deployed shape for the coaptation assistance element  400 . As described herein, the plurality of struts can comprise a shape memory material, such as a shape memory metal or plastic. 
     In some embodiments, a first strut  430  of the plurality of struts extends from the annular hub  420  to or toward the superior edge  440 . In some embodiments, a second strut  430  of the plurality of struts extends from the annular hub  420  to or toward the inferior edge  480 . In some embodiments, a third strut  430  of the plurality of struts extends from the annular hub  420  to or toward the lateral edge  470 . In some embodiments, a fourth strut  430  of the plurality of struts extends from the annular hub  420  to or toward the lateral edge  475 . Any two or more of the first strut, the second strut, the third strut, or the fourth strut can include the same features, including material, length, width, thickness, configuration, pre-formed bend, curvature, etc. Any two or more of the first strut, the second strut, the third strut, or the fourth strut can include different features, including material, length, width, thickness, configuration, pre-formed bend, curvature, etc. In some embodiments, at least one of the struts, e.g., in the superior zone of the implant can extend radially outwardly of, and protrude from the covering  450  of the implant  400  to act as spaced-apart barbs and can assist with anchoring and/or tissue ingrowth in the valve annulus. In some embodiments, the barbs extend only in the annular zone (e.g., superior zone) of the implant but are not present in the inferior (leaflet) copation zone which is atraumatic in some embodiments. In some embodiments, the entire peripheral edge of the implant can be atraumatic. 
     In some embodiments, the struts  430  can be covered with one, two, or more layers of coaptation assistance element body covering  450 . The coaptation assistance element body covering  450  can include a layer or a plurality of layers (e.g., one layer, two layers, three layers, four layers, five layers, or more, or ranges incorporating any two of the foregoing values). In some embodiments, the first surface  405  can include one or more layers. In some embodiments, the second surface  415  can include one or more layers. Any two or more layers of the plurality of layers can include the same or different features, including material, length, width, thickness, etc. In some embodiments, one or more layers extend along the entire, or only a portion of the first surface  405 . In some embodiments, one or more layers extend along the entire, or only a portion of the second surface  415 . The layers can be formed from any process described herein. 
     The coaptation assistance element body covering  450  may be comprised of a material such as a polymer, e.g., ePTFE. Other materials for the coaptation assistance element body covering  450  include polyester, polyurethane foam, polycarbonate foam, biologic tissue such as porcine pericardium, processed bovine pericardium, pleura, peritoneum, silicone, Dacron, acellular collagen matrix, combinations thereof, etc. In some embodiments, the coaptation assistance element body covering  450  can include a foam material surrounded by ePTFE. 
     In some embodiments, the struts  430  can be formed with or embedded one or more layers of coaptation assistance element body covering  450 . In some embodiments, the struts  430  can be encased or at least partially encased by the coaptation assistance element body covering  450 . In some embodiments, a portion of the strut  430  can extend from the coaptation assistance element body covering  450  to engage tissue as described elsewhere herein.  FIGS.  47 A- 47 E  illustrate features which may facilitate interaction between the coaptation assistance element  400 , or a portion thereof, and the native anatomy. 
       FIG.  47 A  illustrates the coaptation surface  460 , which can define a relatively inferior zone of the implant. The anterior ventricular coaption surface can be reinforced. As described herein, the coaptation surface  460  can contact a leaflet of the patient. The coaptation assistance element  400 , after placement, can entirely cover the posterior leaflet so that the anterior leaflet coapts with the coaptation surface  460  during systole. The coaptation assistance element  400  and anterior leaflet can maintain the valve seal at the annular ring. 
     In some embodiments, the second surface  415 , or a portion thereof, is reinforced. In some embodiments, the coaptation surface  460  is reinforced. The second surface  415  including but not limited to the coaptation surface  460  can be reinforced with one or more additional layers. The one or more additional layers can extend over the second surface  415  or a portion thereof. The one or more additional layers can extend over the coaptation surface  460  or a portion thereof. The one or more additional layers can extend over a portion of the second surface  415  including the coaptation surface  460 . The one or more additional layers can extend over a portion of the second surface  415  larger than the coaptation surface  460 . 
     The coaptation surface  460  can be reinforced with any material described herein. The coaptation surface  460  can be reinforced with ePTFE. The coaptation surface  460  can be reinforced any material of the coaptation assistance element body covering  450 , such as ePTFE, Dacron, and/or polypropylene. 
       FIG.  47 B  illustrates the first surface  405 . The posterior ventricular coaption surface can be reinforced. As described herein, the first surface  405  can contact a leaflet of the patient. The coaptation assistance element  400 , after placement, can entirely cover the posterior leaflet with the first surface  405 . The first surface  405  can be opposite the second surface  415  which includes the coaptation surface  460 . 
     In some embodiments, the first surface  405 , or a portion thereof, is reinforced. The first surface  405  can be reinforced with one or more additional layers. The one or more additional layers can extend over the first surface  405  or a portion thereof. The one or more additional layers can be diametrically opposed to the one or more additional layers that extend over the second surface  415 . The one or more additional layers can extend over a portion of the first surface  405  opposite the coaptation surface  460 . The one or more additional layers can extend over a portion of the first surface  405  larger than the contact area with the posterior leaflet. 
     The first surface  405  can be reinforced with any material described herein. The first surface  405 , or a portion thereof, can be reinforced with ePTFE. The first surface  405  can be reinforced with any material of the coaptation assistance element body covering  450 , such as ePTFE, Dacron, and/or polypropylene, which can advantageously create an atraumatic surface to reduce the risk of native leaflet damage from repeated coaptation against the coaptation surface of the coaptation assist body. 
       FIGS.  47 C- 47 D  illustrate an edge of the coaptation assistance element  400 . As described herein, the coaptation assistance element  400  can include a reinforced edge with increased thickness, e.g., the knotless sutured edge  455 . The superior edge  440 , the lateral edges  470  and  475 , and/or the inferior edge  480  of the coaptation assistance element  400  can include a raised edge or bumper. In some embodiments, only one, two, or more edges of the superior edge  440 , the lateral edges  470  and  475 , or the inferior edge  480  can include a raised edge or bumper. In some embodiments, the raised edge or bumper can comprise Gore-Tex. In some embodiments, the raised edge or bumper is circumferential or at least partially circumferential around the peripheral edge of the inferior zone, or the entire coaptation assist body. 
     The raised edge or bumper can be formed from a suture. The suture can be wrapped around the edge to form a raised edge or bumper. The raised edge or bumper may have features, such as increased thickness and/or softness for example reduce trauma to the native tissue. The raised edge or bumper can reduce contact between the coaptation assistance element  400  and the anatomy of the patient. The raised edge or bumper can reduce contact between the coaptation assistance element  400  and posterior leaflet, in the case of the mitral valve. In some embodiments, only the first surface  405  includes the raised edge. In some embodiments, both the first surface  405  and the second surface  415  include the raised edge. The raised edge or bumper can be at or near the edge of the first surface  405  or the second surface  415 . The raised edge or bumper can be spaced inward from the first surface  405  or the second surface  415 .  FIG.  47 C  illustrates the posterior surface.  FIG.  47 D  illustrates the anterior surface. 
     The raised edge or bumper can include one or more rounded edges that reduce contact between the coaptation assistance element  400  and the underlying anatomy of the patient. In some embodiments, contact is reduced between the coaptation assistance element  400  and the posterior leaflet. In some embodiments, contact is not reduced between the coaptation assistance element  400  and the annulus. In some embodiments, the coaptation assistance element  400  is configured to minimize contact with the posterior leaflet but maximize contact with the annulus. Other configurations are contemplated. 
       FIG.  47 E  illustrates an anchor zone. The coaptation assistance element  400  can include a generally annular superior section  410 . The anchor zone can be located within the annular section  410 , and can comprise two sections spaced apart from and extending laterally from the hub  420 . The annular section  410  can be positioned relative to the annulus when the coaptation assistance element  400  is deployed. In some embodiments, the annular section  410  may be curved toward the annulus or curved away from the annulus. In other embodiments, the annular section  410  may be substantially flat with respect to the annulus. The annular section  410  can be configured to accept one or more secondary anchors. The secondary anchors can be advanced over a guide rail which can be coupled to the coaptation assistance element  400  as described herein. The secondary anchors can be rotated to penetrate the annular section  410 . The secondary anchor can engage the tissue disposed under the coaptation assistance element  400 . 
     The annular section  410  such as an anchor zone can be reinforced to have an increased thickness with respect to the rest of the superior zone, and more than, equal to, or less than the thickness of the inferior coaptation zone of the implant. The annular section  410  can be reinforced in the area configured to accept one, two, three, four, or more secondary anchors. As described herein, the first surface  405  of the coaptation assistance element  400  can lie against the annulus after placement with the heart of the patient. The second surface  415  can face upward from the annulus. In some embodiments, the annular section  410  or a portion thereof is reinforced. The annular section  410  can be reinforced with one or more additional layers. The one or more additional layers can extend over the annular section  410  or a portion thereof. The one or more additional layers can be diametrically opposed relative to the annular hub  420 . The one or more additional layers can extend over a portion of the first surface  405 . The one or more additional layers can extend over a portion of the second surface  415 . The anchor zone can be near the annular hub  420 . The anchor zone can include one or more separate zones. 
     The annular section  410  can be reinforced with any material described herein. The annular section  410 , or a portion thereof, can be reinforced with ePTFE. The annular section  410 , or a portion thereof, can be reinforced with velour. The annular section  410  can be reinforced any material of the coaptation assistance element body covering  450 , such as ePTFE, Dacron, and/or polypropylene. The one or more additionally layers can extend outward from the annular hub  420 . The one or more additionally layers be any shape sufficient to cover an area larger than the area engaged by the one or more secondary anchors. 
     In some embodiments, the annular portion  410  can include a sharper edge than another edge of the coaptation assistance element  400 . In some embodiments, the superior edge  440  is thinner and/or sharper than another edge of the coaptation assistance element  400  (e.g., the lateral edge  470 , the lateral edge  474 , or the inferior edge  480 ). In some embodiments, the annular portion  410  and/or the superior edge  440  can be irritating to or engaging with the tissue. In some embodiments, the annular portion  410  is configured to be implanted near the annulus. In some embodiments, the annular portion  410  is configured to promote an immune response. In some embodiments, the annular portion  410  is configured to promote tissue ingrowth. 
       FIG.  48    illustrates an exploded view of an embodiment of a covering surrounding part of the implant, and includes the laminate. While the coaptation assistance element  400  is illustrated, any of the coaptation assistance elements described herein can include any number of the features described herein, can exclude/omit any of the features as described herein, or be placed in a different order relative to each other. In addition, the coaptation assistance element  400  can include or exclude/omit any of the features of the coaptation assistance elements described herein. The exploded view illustrates the thick reinforcement layer for the anterior and posterior ventricular portions. The exploded view illustrates the single velour anchor zone. The raised edge or bumper is not shown. The raised edge or bumper can be added in the final stage of assembly. The laminate  1100  described herein can form the coaptation assistance element body covering  450 . The laminate  1100  can include one or more layers as described herein. The laminate  1100  can include one or more layers in any order. 
     The coaptation assistance element  400  can include a posterior layer  1102 . The posterior layer can form the first surface  405 . In some embodiments, the posterior layer  1102  is thin relative to other layers. In some embodiments, the posterior layer  1102  is ePTFE. In some embodiments, the posterior layer  1102  has a thickness (e.g., about 0.001″, about 0.0015″, about 0.002″, about 0.0025″, about 0.003″, or any range including two of the foregoing values). The posterior layer  1102  can include an opening for the anchor  800  to extend there through. The posterior layer  1102  can be any shape including rectangular, polygonal, triangular, circular, and elliptical. In some embodiments, the posterior layer  1102  is not the final shape of the coaptation assistance element  400 . 
     The coaptation assistance element  400  can include a first supporting structure layer  1104 . The first supporting structure  1104  can be a mesh. In some embodiments, the first supporting structure layer  1104  comprises UHMPE. The first supporting structure  1104  can be disposed over the posterior layer  1102 . The first supporting structure layer  1104  can be disposed on the posterior side of the struts  430 . The first supporting structure layer  1104  can include an opening for the anchor  800  to extend there through. 
     The coaptation assistance element  400  can include a first fabric layer  1106 . The first fabric layer  1106  can be relatively thin, and in some cases has a thickness (e.g., about 0.001″, about 0.0015″, about 0.002″, about 0.0025″, about 0.003″, about 0.004″, about 0.005″, about 0.01″ or any range including two of the foregoing values). In some embodiments, the first fabric layer  1106  comprises a polyester fabric. The first fabric layer  1106  can be disposed over the first supporting structure layer  1104 . The first fabric layer  1106  can be disposed on the posterior side of the struts  430 . The first fabric layer  1106  can include an opening for the anchor  800  to extend there through. In some embodiments, the first fabric layer  1106  extends only along a portion of the coaptation assistance element  400 . In some embodiments, the first fabric layer  1106  includes a cut out portion. 
     The coaptation assistance element  400  can include a first ventricular layer  1108 . The ventricular surface layer  1108  can be the reinforcement layer for the first surface  405 . In some embodiments, the first ventricular layer  1108  is thick relative to other layers. In some embodiments, the first ventricular layer  1108  is ePTFE. In some embodiments, the first ventricular layer  1108  has a thickness (e.g., about 0.01″, 0.02″ 0.03″, about 0.035″, about 0.040″, about 0.045″, about 0.05″, about 0.07″, about 0.10″ or any range including two of the foregoing values). The first ventricular layer  1108  can be any shape including rectangular, polygonal, triangular, circular, elliptical, etc. The first ventricular layer  1108  can be disposed on the posterior side of the struts  430 . 
     The coaptation assistance element  400  can include an anchor layer  1110 . The anchor layer  1110  can be the reinforcement layer for the one or more secondary anchor. In some embodiments, the anchor layer  1110  is thick relative to other layers. In some embodiments, the anchor layer  1110  is ePTFE. In some embodiments, the anchor layer  1110  is velour. In some embodiments, the anchor layer  1110  has a thickness (e.g., about 0.01″, 0.02″, 0.03″, about 0.035″, about 0.040″, about 0.045″, about 0.05″, about 0.07″, about 0.10″or any range including two of the foregoing values). The anchor layer  1110  can be any shape including rectangular, polygonal, triangular, circular, elliptical, etc. In some embodiments, the coaptation assistance element  400  includes a single anchor zone which forms the anchor layer  1110 . In some embodiments, the coaptation assistance element  400  includes two or more separate anchor zones which form the anchor layer  1110 . The anchor layer  1110  can be disposed on the posterior side of the struts  430  as shown. In the illustrate embodiment, the ventricular surface layer  1108  and the anchor layer  1110  can be sandwiched between the same two adjoining layers. In some embodiments, the ventricular surface layer  1108  and the anchor layer  1110  are separated by one or more layers. 
     The coaptation assistance element  400  can include a second supporting structure layer  1112 . The second supporting structure layer  1112  can be a mesh. In some embodiments, the second supporting structure layer  1112  comprises UHMPE. The second supporting structure layer  1112  can be disposed over the ventricular surface layer  1108 . The second supporting structure layer  1112  can be disposed on the posterior side of the struts  430 . In some embodiments, the second supporting structure layer  1112  extends only along a portion of the coaptation assistance element  400 . In some embodiments, the second supporting structure layer  1112  extends only along the ventricular portion of the coaptation assistance element  400 . 
     The coaptation assistance element  400  can include a frame  465 . In some embodiments, the frame  465  is cut from a tubular stock. The frame  465  can include one or more struts  430 . The frame  465  can be constructed from a single, unitary piece of material. The frame  465  including the struts  430  thereof can be formed using any method described herein including a water jet, laser etching or similar technology. The details of the struts  430 , including barbs, can be machined into the struts  430 . The frame  465  can be bent and/or shape set to achieve the desired geometry. The frame  465  including the struts  430  thereof can comprise a resiliently deformable material such as a shape memory metal, e.g., Nitinol or a shape memory polymer. In some embodiments, the material is Elgiloy. In some embodiments, the frame  465  can comprise of other materials including stainless steel, polypropylene, high density polyethylene (PE), Dacron, acellular collagen matrix such as SIS, or other plastics, etc. In some embodiments, the struts  430  can include shape memory material and a strut covering. The strut covering can be any material described herein and can cover the entire strut  430  or a portion thereof. In some embodiments, the struts  430  can comprise Nitinol and a LDPE tubing or covering over each strut  430 . In some embodiments, the frame  465  can be considered a layer. 
     The coaptation assistance element  400  can include a second ventricular layer  1114 . The second ventricular layer  1114  can be the reinforcement layer for the second surface  415 . In some embodiments, the second ventricular layer  1114  is thick relative to other layers. In some embodiments, the second ventricular layer  1114  is ePTFE. In some embodiments, the second ventricular layer  1114  has a thickness (e.g., about 0.03″, about 0.035″, about 0.040″, about 0.045″, about 0.05″, or any range including two of the foregoing values or other thickness values as described with respect to other layers herein). second ventricular layer  1114  can be any shape including rectangular, polygonal, triangular, circular, elliptical, etc. The second ventricular layer  1114  can be disposed on the anterior side of the struts  430 . In some embodiments, the second ventricular layer  1114  extends only along a portion of the coaptation assistance element  400 . In some embodiments, the second ventricular layer  1114  extends only along the ventricular portion of the coaptation assistance element  400 . In some embodiments, the first ventricular layer  1108  and second ventricular layer  1114  are the same shape. 
     The coaptation assistance element  400  can include a third supporting structure layer  1116 . The a third supporting structure layer  1116  can be a mesh. In some embodiments, the a third supporting structure layer  1116  can comprise UHMPE. The third supporting structure layer  1116  can be disposed over the second ventricular layer  1114 . The third supporting structure layer  1116  can be disposed on the anterior side of the struts  430 . In some embodiments, the third supporting structure layer  1116  extends only along a portion of the coaptation assistance element  400 . In some embodiments, the third supporting structure layer  1116  extends only along the ventricular portion of the coaptation assistance element  400 . 
     The coaptation assistance element  400  can include a second fabric layer  1118 . The second fabric layer  1118  can be thin relative to other layers. In some embodiments, the second fabric layer  1118  has a thickness (e.g., about 0.001″, about 0.0015″, about 0.002″, about 0.0025″, about 0.003″, or any range including two of the foregoing values). In some embodiments, the second fabric layer  1118  comprises a polyester fabric. The second fabric layer  1118  can be disposed over the third supporting structure layer  1116 . The second fabric layer  1118  can be disposed on the anterior side of the struts  430 . The second fabric layer  1118  can include an opening for the anchor  800  to extend there through. 
     The coaptation assistance element  400  can include a fourth supporting structure layer  1120 . The fourth supporting structure layer  1120  can be a mesh. In some embodiments, the fourth supporting structure layer  1120  can comprise UHMPE. The fourth supporting structure layer  1120  can be disposed over the second fabric layer  1118 . The fourth supporting structure layer  1120  can be disposed on the anterior side of the struts  430 . The fourth supporting structure layer  1120  can include an opening for the anchor  800  to extend there through. In some embodiments, the first supporting structure layer  1104  and the fourth supporting structure layer  1120  are the same shape. 
     The coaptation assistance element  400  can include an anterior layer  1122 . The anterior layer  1122  can form the second surface  415 . In some embodiments, the anterior layer  1122  is thin relative to other layers. In some embodiments, the anterior layer  1122  is ePTFE. In some embodiments, the anterior layer  1122  has a thickness (e.g., about 0.001″, about 0.0015″, about 0.002″, about 0.0025″, about 0.003″, or any range including two of the foregoing values, or other thickness values as described with respect to other layers herein). The anterior layer  1122  can include an opening for the anchor  800  to extend there through. The anterior layer  1122  can be any shape including rectangular, polygonal, triangular, circular, and elliptical. In some embodiments, the anterior layer  1122  is not the final shape of the coaptation assistance element  400 . In some embodiments, the posterior layer  1102  and the anterior layer  1122  are the same shape. 
       FIG.  49    illustrate an embodiment of implant delivery system  2200 . The implant delivery system  2200  can include any of the features of implant delivery systems described herein. The implant delivery system  2200  can include a primary anchor housing  2202 . In some embodiments, the primary anchor housing  2202  is a docking tube. The primary anchor housing  2202  can be cylindrical. The primary anchor housing  2202  can include a central lumen. The primary anchor housing  2202  can be disposed around the annular hub  420 ,  520 ,  620 ,  720  of the coaptation assistance element  400 ,  500 ,  600 ,  700 . 
     The implant delivery system  2200  can include a primary anchor driver  2204 . The primary anchor housing  2202  can be dimensioned to fit the primary anchor driver  2204 . In some embodiments, the primary anchor driver  2204  is a torque shaft. In some embodiments, the primary anchor driver  2204  is configured to rotate relative to the primary anchor housing  2202 . In some embodiments, the primary anchor driver  2204  is not configured to translate relative to the primary anchor housing  2202 . The primary anchor driver  2204  can be considered a primary anchor fork driver, as described herein. The primary anchor driver  2204  can designed to engage and rotate the anchor  800 . The anchor  800  can be considered a primary anchor  800  to distinguish from one or more secondary anchors. 
     The implant delivery system  2200  can include one or more release wires  2206 ,  2208 . In the illustrated embodiment, the implant delivery system  2200  can include two release wires  2206 ,  2208 , but other configurations are contemplated (e.g., one release wire, two release wires, three release wires, four release wires, five release wires, six release wires, etc.). The release wires  2206 ,  2208  can extend proximally from the primary anchor housing  2202 . In some embodiments, the release wires  2206 ,  2208  can extend beyond the implant surface. The release wires  2206 ,  2208  can extend through at least a portion of the primary anchor housing  2202 . The release wires  2206 ,  2208  can extend through one or more channels or tubes within the primary anchor housing  2202 . The release wires  2206 ,  2208  can be diametrically opposed within the primary anchor housing  2202 . 
     The release wires  2206 ,  2208  can extend outside of the primary anchor housing  2202 . The primary anchor housing  2202  can include slots  2210 ,  2212  that allow the release wires  2206 ,  2208  to extend there through. The release wires  2206 ,  2208  can extend from inside the primary anchor housing  2202  to outside of the primary anchor housing  2202  through the slots  2210 ,  2212  (e.g., the release wire  2206  can extend through slot  2210 , the release wire  2208  can extend through slot  2212 ). 
     The release wires  2206 ,  2208  can extend back inside the primary anchor housing  2202 . The primary anchor housing  2202  can include slots  2214 ,  2216  that allow the release wires  2206 ,  2208  to extend there through. The release wires  2206 ,  2208  can extend from outside the primary anchor housing  2202  to inside of the primary anchor housing  2202  through the slots  2214 ,  2216  (e.g., the release wire  2206  can extend through slot  2214 , the release wire  2208  can extend through slot  2216 ). The release wires  2206 ,  2208  can weave in and out of the primary anchor housing  2202 . The release wires  2206 ,  2208  can couple to the primary anchor housing  2202 . The release wires  2206 ,  2208  can extend through the anchor  800 . The release wires  2206 ,  2208  can cross. 
     The release wires  2206 ,  2208  can extend along the coaptation assistance element  400 ,  500 ,  600 ,  700 . The release wires  2206 ,  2208  can extend along the annular surface  410 ,  510 ,  610 ,  710 . The release wires  2206 ,  2208  can extend underneath the coaptation assistance element  400 ,  500 ,  600 ,  700 . The release wires  2206 ,  2208  can extend in opposite directions. The release wires  2206 ,  2208  can be diametrically opposed. The release wires  2206 ,  2208  can be coaxial. The release wires  2206 ,  2208  can be generally along a line. The release wires  2206 ,  2208  can be adjacent to the annulus. The release wires  2206 ,  2208  can contact the annulus. The release wires  2206 ,  2208  can facilitate coupling between the implant delivery system  2200  and the coaptation assistance element  400 ,  500 ,  600 ,  700 . The release wires  2206 ,  2208  can rigidly hold the primary anchor housing  2202  against the annular hub  420 ,  520 ,  620 ,  720  of the coaptation assistance element  400 ,  500 ,  600 ,  700 . The release wires  2206 ,  2208  can extend from the anterior side to the posterior side of the coaptation assistance element  400 ,  500 ,  600 ,  700 . In some embodiments, the ends of the release wires  2206 ,  2208  wrap around the coaptation assistance element  400 ,  500 ,  600 ,  700 . In some embodiments, the ends of the release wires  2206 ,  2208  are curved or form a c-shaped configuration. 
     The implant delivery system  2200  can include one or more secondary anchors  2220 ,  2222 ,  2224 ,  2226  (e.g., one secondary anchor, two secondary anchors, three secondary anchors, four secondary anchors (as shown), five secondary anchors, six secondary anchors, seven secondary anchors, eight secondary anchors, etc.). In some embodiments, two or more secondary anchors  2220 ,  2222 ,  2224 ,  2226  are the same. In some embodiments, two or more secondary anchors  2220 ,  2222 ,  2224 ,  2226  are different (e.g., different pitch, different diameter, different material, different shoulder, different window, etc.). In some embodiments, the secondary anchor  2220 ,  2222 ,  2224 ,  2226  can be helical anchors. The secondary anchor  2220 ,  2222 ,  2224 ,  2226  can have a smaller diameter than the primary anchor  800 . The secondary anchor  2220 ,  2222 ,  2224 ,  2226  can have a smaller pitch than the primary anchor  800 . The secondary anchor  2220 ,  2222 ,  2224 ,  2226  can be configured to rotate to engage tissue in the annulus. 
     The implant delivery system  2200  can include one or more secondary anchor drivers  2230 ,  2232 ,  2234 ,  2236  (e.g., one secondary anchor driver, two secondary anchor drivers, three secondary anchor drivers, four secondary anchor drivers (as shown), five secondary anchor drivers, six secondary anchor drivers, seven secondary anchor drivers, eight secondary anchor drivers, etc.). In some embodiments, two or more secondary anchor drivers  2230 ,  2232 ,  2234 ,  2236  are the same. In some embodiments, two or more secondary anchor drivers  2230 ,  2232 ,  2234 ,  2236  are different (e.g., different configuration, mirror image, different anchor coupled therewith, etc.). In some embodiments, the secondary anchor driver  2230 ,  2232 ,  2234 ,  2236  is a torque shaft. In some embodiments, the secondary anchor driver  2230 ,  2232 ,  2234 ,  2236  is configured to rotate the respective secondary anchor  2220 ,  2222 ,  2224 ,  2226 . In some embodiments, the secondary anchor driver  2230 ,  2232 ,  2234 ,  2236  is configured to translate the respective secondary anchor  2220 ,  2222 ,  2224 ,  2226 . 
     In some embodiments, the secondary anchor driver  2230 ,  2232 ,  2234 ,  2236  can be coupled to the respective secondary anchor  2220 ,  2222 ,  2224 ,  2226  according to any embodiment described herein. In some embodiments, each secondary anchor drivers  2230 ,  2232 ,  2234 ,  2236  couples to a respective secondary anchor  2220 ,  2222 ,  2224 ,  2226 . In some embodiments, each secondary anchor drivers  2230 ,  2232 ,  2234 ,  2236  couples to two or more secondary anchors  2220 ,  2222 ,  2224 ,  2226 . In some embodiments, a single secondary anchor driver, for example  2230 , couples to all of the secondary anchors  2220 ,  2222 ,  2224 ,  2226 . 
     The implant delivery system  2200  can include one or more secondary anchor guide rails  2240 ,  2242 ,  2244 ,  2246  (e.g., one secondary anchor guide rail, two secondary anchor guide rails, three secondary anchor guide rails, four secondary anchor guide rails (as shown), five secondary anchor guide rails, six secondary anchor guide rails, seven secondary anchor guide rails, eight secondary anchor guide rails, etc.). The number of secondary anchor guide rails  2240 ,  2242 ,  2244 ,  2246  can correspond to the number of secondary anchors  2220 ,  2222 ,  2224 ,  2226 . The secondary anchor  2220 ,  2222 ,  2224 ,  2226  can include a passageway there through. The passageway can extend through the middle of the helical wire of the secondary anchor  2220 ,  2222 ,  2224 ,  2226 . The secondary anchor guide rail  2240 ,  2242 ,  2244 ,  2246  can be configured to extend through the respective passageway. 
     The implant delivery system  2200  can include one or more secondary anchor tethers  2250 ,  2252 ,  2254 ,  2256  (e.g., one secondary anchor tether, two secondary anchor tethers, three secondary anchor tethers, four secondary anchor tethers (as shown), five secondary anchor tethers, six secondary anchor tethers, seven secondary anchor tethers, eight secondary anchor tethers, etc.). The number of secondary anchor tethers  2250 ,  2252 ,  2254 ,  2256  can correspond to the number of secondary anchors  2220 ,  2222 ,  2224 ,  2226 . The secondary anchor tethers  2250 ,  2252 ,  2254 ,  2256  can form a loop. Each secondary anchor tether  2250 ,  2252 ,  2254 ,  2256  can include a first strand, a second strand, and an arc there between. Each secondary anchor tether  2250 ,  2252 ,  2254 ,  2256  can loop around a respective release wire  2206 ,  2208  as described herein. The secondary anchor tethers  2250 ,  2252 ,  2254 ,  2256  can extend through the coaptation assistance element  400 ,  500 ,  600 ,  700 . The coaptation assistance element  400 ,  500 ,  600 ,  700  can include one or more passageways to facilitate passage of the secondary anchor tether  2250 ,  2252 ,  2254 ,  2256  there through. 
     The secondary anchor guide rails  2240 ,  2242 ,  2244 ,  2246  can include a passageway there through. The passageway can extend through the middle of the secondary anchor guide rails  2240 ,  2242 ,  2244 ,  2246 . The secondary anchor tethers  2250 ,  2252 ,  2254 ,  2256  can be configured to extend through the passageway of the secondary anchor guide rails  2240 ,  2242 ,  2244 ,  2246 . In some embodiments, each secondary anchor tethers  2250 ,  2252 ,  2254 ,  2256  extends through a respective secondary anchor guide rails  2240 ,  2242 ,  2244 ,  2246 . The secondary anchor drivers  2230 ,  2232 ,  2234 ,  2236  can include a passageway there through. The passageway can extend through the middle of the secondary anchor drivers  2230 ,  2232 ,  2234 ,  2236 . The secondary anchor tethers  2250 ,  2252 ,  2254 ,  2256  can be configured to extend through the passageway of the secondary anchor drivers  2230 ,  2232 ,  2234 ,  2236 . 
     The release wires  2206 ,  2208  can maintain the connection to the coaptation assistance element  400 ,  500 ,  600 ,  700 . The release wires  2206 ,  2208  can maintain the connection between the coaptation assistance element  400 ,  500 ,  600 ,  700  and the primary anchor  800 . The release wires  2206 ,  2208  can maintain the connection between the coaptation assistance element  400 ,  500 ,  600 ,  700  and the primary anchor driver  2204 . The release wires  2206 ,  2208  can maintain the connection between the coaptation assistance element  400 ,  500 ,  600 ,  700  and the secondary anchor tethers  2250 ,  2252 ,  2254 ,  2256 . 
       FIG.  50    illustrates the telescoping action to access the primary anchor location according to some embodiments of the invention. The primary anchor  800  can be positioned near the leaflets. The primary anchor  800  can be positioned near the annulus. In some methods, access is achieved with the transseptal sheath  1400 . The transseptal sheath  1400  can include a lumen for the passage of one or more additional catheters. The coaptation assistance element  400 ,  500 ,  600 ,  700  described herein can be delivered via a delivery catheter  1402 . The coaptation assistance element  400 ,  500 ,  600 ,  700  can be within the delivery catheter  1402 . The delivery catheter  1402  can telescope relative to the transseptal sheath  1400 . The delivery catheter  1402  can telescope relative to the transseptal sheath  1400  to extend outward relative to the transseptal sheath  1400  for delivery of the coaptation assistance element  400 ,  500 ,  600 ,  700 . The coaptation assistance element  400 ,  500 ,  600 ,  700  can telescope relative to the delivery catheter  1402  to extend outward relative to the delivery catheter  1402  for delivery of the coaptation assistance element  400 ,  500 ,  600 ,  700 . 
       FIG.  51    illustrates the rotation of the primary anchor driver  2204  according to some embodiments of the invention.  FIG.  51    illustrates a progression of engaging the primary anchor  800 . On the left, the initial position of the primary anchor driver  2204  and the primary anchor  800  are illustrated. The primary anchor  800  can be proximal the tissue in a proximal position. In the middle, the primary anchor driver  2204  is rotated to rotate the primary anchor  800 . The primary anchor  800  rotates and translates relative to the primary anchor driver  2204 . The primary anchor  800  engages the tissue. On the right, the primary anchor  800  is further rotated to engage tissue. The primary anchor  800  can be reversible. The primary anchor  800  can be rotated in one direction to engage tissue, and rotated in a second, opposite direction to disengage tissue. 
     The primary anchor driver  2204  can engage and rotate the primary anchor  800 . The primary anchor driver  2204  can be disposed within the primary anchor housing  2202 . The primary anchor  800  can be disposed within the primary anchor housing  2202 . The release wires  2206 ,  2208  can extend through at least a portion of the primary anchor housing  2202 . As the primary anchor  800  is rotates, the helixes of the primary anchor pass around the release wires  2206 ,  2208 . The release wires  2206 ,  2208  maintain their position as the primary anchor  800  rotates. The primary anchor  800  can be advanced to engage tissue when the coaptation assistance element  400 ,  500 ,  600 ,  700  is adjacent to the annulus. The primary anchor driver  2204  can include a hub  2260  and one or more extensions  2262 ,  2264 . The primary anchor driver  2204  can include two extensions  2262 ,  2264 , but other configurations are contemplated. The extensions  2262 ,  2264  can be perpendicular to the hub  2560  or extend at other angles. The primary anchor driver  2204  can be a fork driver. The primary anchor  800  can include a cross-bar  802 . The cross-bar  802  can form the proximal part of the primary anchor  800 . The cross-bar  802  can be formed from a helix of the helical anchor. The two extensions  2262 ,  2264  can be configured to slide within the passageway of the primary anchor  800  on either side of the cross-bar  802 . The cross-bar  802  can be disposed between the extensions  2262 ,  2264 . Other configurations of coupling the primary anchor driver  2204  to the primary anchor  800  are contemplated including any of the mating configurations described herein. 
     In some embodiments, the primary anchor driver  2204  rotates but does not move in the axial direction. In some embodiments, the primary anchor driver  2204  rotates but does not translate relative to the primary anchor housing  2202 . The fork of the primary anchor driver  2204  rotates to drive the primary anchor  800 . In some embodiments, the primary anchor driver  2204  does not advance axially. In some embodiments, the primary anchor driver  2204  is retained within the primary anchor housing  2202 . In some embodiments, an advantage is to limit translation of the primary anchor driver  2204 . The limit related to axial movement of the primary anchor driver  2204  can reduce or prevent inadvertent interaction of the primary anchor driver  2204  with the tissue. The limit related to axial movement of the primary anchor driver  2204  can reduce or prevent inadvertent interaction of the primary anchor driver  2204  with the release wires  2206 ,  2208 . 
       FIG.  52    illustrates the connection between the secondary anchor driver  2230  and the respective secondary anchor  2220  according to some embodiments. While the secondary anchor driver  2230  and the secondary anchor  2220  are illustrated, each secondary anchor drivers  2230 ,  2232 ,  2234 ,  2236  can couple to a respective secondary anchor  2220 ,  2222 ,  2224 ,  2226 . 
     The secondary anchor  2220  can include a helical body  2270 . The secondary anchor  2220  can include a shoulder  2272 . The shoulder  2272  can be configured to engage the secondary anchor driver  2230 . The shoulder  2272  can have features such as one or more windows  2274 . The windows  2274  can be diametrically opposed, equally spaced, or otherwise spaced apart. While two windows  2274  are shown, other configurations of windows are contemplated (e.g., one window, two windows (shown), three windows, four windows, five windows, six windows, etc.). 
     The secondary anchor driver  2230  can include an elongated shaft  2276 . The elongated shaft can include a lumen for passage of the secondary anchor guide rail  2240  there through. The secondary anchor driver  2230  can include one or more locking tabs  2278 . The locking tabs  2278  can be diametrically opposed, equally spaced, or otherwise spaced apart. While two locking tabs  2278  are shown, other configurations of locking tabs are contemplated (e.g., one locking tab, two locking tabs (shown), three locking tabs, four locking tabs, five locking tabs, six locking tabs, etc.). The number and configuration of the locking tabs can correspond to the number of windows. The locking tabs  2278  can include a shape memory or springy material. The locking tabs  2278  can be designed to flex outward into engagement with the windows  2274 . 
     The secondary anchor guide rail  2240  can activate the lock mechanism between the secondary anchor driver  2230  and the respective secondary anchor  2220 . The lock mechanism can be an axial-torsional lock. Once coupled, the axial movement of the secondary anchor driver  2230  can cause axial movement of the secondary anchor  2220 . Once coupled, the torsional movement of the secondary anchor driver  2230  can cause torsional movement of the secondary anchor  2220 . The secondary anchor guide rail  2240  can lock the secondary anchor driver  2230  to the secondary anchor  2220 . This lock can be temporary. This lock can be reversible. The secondary anchor guide rail  2240  can push outward the locking tabs  2278 . The locking tabs  2278  can be pushed outward into the windows  2274  by the secondary anchor guide rail  2240 . 
     The secondary anchor guide rail  2240  can maintain the locking tabs  2278  in the open position to keep the locking tabs  2278  engaged with the windows  2274  in the secondary anchor  2230 . In some embodiments, the longitudinal movement of the secondary anchor guide rail  2240  toward the secondary anchor  2220  can push the locking tabs  2278  outward toward the windows  2274 . In some embodiments, the longitudinal movement of the secondary anchor guide rail  2240  away from the secondary anchor  2220  can allow the locking tabs  2278  to regain a neutral configuration and disengage from the windows  2274 . The locking tabs  2278  engaged with the windows  2274  of the secondary anchor  2220  can allow the transmission of axial movement between the secondary anchor driver  2230  and the secondary anchor  2220 . The locking tabs  2278  engaged with the windows  2274  of the secondary anchor  2220  can allow the transmission of torque between the secondary anchor driver  2230  and the secondary anchor  2220 . In some embodiments, an advantage is the secondary anchor  2220  can be rotated independently of the rotation of the primary anchor  800 . In some embodiments, an advantage is the secondary anchor  2220  can be rotated independently of the rotation of one or more other secondary anchors  2232 ,  2234 ,  2236 . 
       FIGS.  53 A- 53 B  illustrates the relationship between the secondary anchor guide rail  2240 , secondary anchor tether  2250 , and the respective secondary anchor  2220  according to some embodiments. While the secondary anchor guide rail  2240 , secondary anchor tether  2250 , and the secondary anchor  2220  are illustrated, each secondary anchor guide rail  2240 ,  2242 ,  2244 ,  2246  can engage a respective secondary anchor  2220 ,  2222 ,  2224 ,  2226 . The secondary anchor guide rail  2240  can limit or prevent anchor and tether engagement.  FIGS.  53 A- 53 B  illustrate the secondary anchor tether  2250  and an adjacent secondary anchor tether  2252 . Each secondary anchor tether can include two strands and an arc there between, see secondary anchor tether  2252 . 
     The secondary anchor  2220  can be a helical anchor. The helical anchor can include a pitch and a diameter. The helical anchor can include an open distal end. The pitch of the secondary anchor  2220  can be larger than a strand of the secondary anchor tether (e.g., secondary anchor tether  2252 ). The open end of the secondary anchor  2220  can be larger than a strand of the secondary anchor tether (e.g., secondary anchor tether  2252 ). The dimension of the open end can be defined by the pitch. This configuration may allow the secondary anchor  2220  and the secondary anchor tether  2252  to become tangled as shown in  FIG.  53 A . In this figure, the secondary anchor tether  2252  and the secondary anchor  2220  can become entangled because the secondary anchor guide rail  2240  is proximal, exposing the open end of the secondary anchor  2220 . 
       FIG.  53 B  illustrates the secondary anchor guide rail  2240  extending through the open end of the pitch the secondary anchor  2220 , according to some embodiments of the invention. The pitch of the secondary anchor  2220  can be smaller than a strand of the secondary anchor tether (e.g., secondary anchor tether  2252 ). The open end of the secondary anchor  2220  can be smaller than a strand of the secondary anchor tether (e.g., secondary anchor tether  2252 ). The space between the secondary anchor guide rail  2240  and the secondary anchor  2220  can be advantageously too small to allow the entanglement of the secondary anchor tether  2252 . This configuration may prevent the secondary anchor  2220  and the secondary anchor tether  2252  from becoming tangled. In  FIG.  53 B , the open end of the secondary anchor is protected from entanglement. 
       FIG.  54    illustrates the secondary anchor guide rail  2240 , according to some embodiments of the invention. While the secondary anchor guide rail  2240  is illustrated, one or more secondary anchor guide rails  2240 ,  2242 ,  2244 ,  2246  can be deployed. The secondary anchor guide rail  2240 ,  2242 ,  2244 ,  2246  can include a pre-shaped material. The secondary anchor guide rail  2240 ,  2242 ,  2244 ,  2246  can include a shape memory material such as a shape memory metal or plastic. The secondary anchor guide rail  2240 ,  2242 ,  2244 ,  2246  can include any shape including one or more linear segments and one or more non-linear segments such as one or more curved segments. The pre-shape of the secondary anchor guide rail  2240 ,  2242 ,  2244 ,  2246  can facilitate the trajectory for the respective secondary anchor  2220 ,  2222 ,  2224 ,  2226 . The pre-shaped distal end of the secondary anchor guide rail  2240 ,  2242 ,  2244 ,  2246  can influence the anchoring trajectory for the secondary anchor  2220 . In  FIG.  54   , the secondary anchor guide rail  2240  is pre-shaped to include a distal curve. The secondary anchor guide rail  2240  is shown in two different orientations. The orientation of the secondary anchor guide rail  2240  can allow the ability to define different secondary anchor trajectories. In some embodiments, two or more trajectories can be defined by secondary anchor guide rail  2240 . 
       FIGS.  55 A- 55 C  illustrates the proximal assembly for secondary anchors, according to some embodiments of the invention. The proximal assembly can include one or more guide rail locks. The secondary anchor guide rails  2240 ,  2242 ,  2244 ,  2246  can be locked to limit or prevent axial movement. Locking of the secondary anchor guide rails  2240 ,  2242 ,  2244 ,  2246  can ensure that the secondary anchor guide rails  2240 ,  2242 ,  2244 ,  2246  will be distal to the secondary anchor  2220 ,  2222 ,  2224 ,  2226 , see  FIG.  53 B . The secondary anchor guide rails  2240 ,  2242 ,  2244 ,  2246  can be locked in a position wherein at least a portion is distal to the open end of the secondary anchor  2220 ,  2222 ,  2224 ,  2226 . The secondary anchor guide rails  2240 ,  2242 ,  2244 ,  2246  can be locked to ensure that the secondary anchor  2220 ,  2222 ,  2224 ,  2226  does not become entangled with the secondary anchor tethers  2250 ,  2252 ,  2254 ,  2256 . The secondary anchor guide rails  2240 ,  2242 ,  2244 ,  2246  can be locked to ensure that the secondary anchor  2220 ,  2222 ,  2224 ,  2226  remains coupled to a respective secondary anchor drivers  2230 ,  2232 ,  2234 ,  2236 . The secondary anchor guide rails  2240 ,  2242 ,  2244 ,  2246  can be locked to ensure that the secondary anchor  2220 ,  2222 ,  2224 ,  2226  does not become prematurely released. 
     The proximal assembly can include one or more tether locks. The secondary anchor tethers  2250 ,  2252 ,  2254 ,  2256  can be locked to ensure appropriate tension is maintained. In some embodiments, applying appropriate tension to the secondary anchor tethers  2250 ,  2252 ,  2254 ,  2256  defines the desired trajectory for the secondary anchor  2220 ,  2222 ,  2224 ,  2226 . Locking the secondary anchor tethers  2250 ,  2252 ,  2254 ,  2256  after tension is applied can ensure that the tension is reliably maintained during the delivery of the secondary anchor  2220 ,  2222 ,  2224 ,  2226 . 
       FIG.  55 A  illustrates the proximal assembly coupled to the secondary anchor driver  2230 . While secondary anchor driver  2230  is illustrated, each secondary anchor driver  2230 ,  2232 ,  2234 ,  2236  can be coupled to a proximal assembly. In some embodiments, two or more secondary anchor drivers  2230 ,  2232 ,  2234 ,  2236  can be coupled to the same proximal assembly in order to lock two or more respective secondary anchor guide rails or two or more respective secondary anchor tethers. The proximal assembly can include the secondary anchor guide rail lock  2280 . The proximal assembly can include the secondary anchor tether lock  2282 .  FIG.  55 B  illustrates the secondary anchor guide rail lock  2280  in a locked position wherein the secondary anchor guide rails  2240  is prevented or limited from moving proximally. The secondary anchor guide rail lock  2280  can include a threaded bolt configured to engage a threaded nut. The secondary anchor guide rail lock  2280  can limit proximal motion by functioning as a stop when locked. The secondary anchor guide rail lock  2280  can allow proximal motion when unlocked. In some embodiments, the secondary anchor guide rails  2240  can be removed in the unlocked position. The secondary anchor guide rails  2240  can be removed to release the secondary anchor driver  2230  from the secondary anchor  2220 . 
       FIG.  55 C  illustrates the secondary anchor tether lock  2282  in an unlocked position wherein the secondary anchor tether  2250  can move proximally. The secondary anchor tether lock  2282  can include a threaded bolt configured to engage a threaded nut. The secondary anchor tether lock  2282  can limit any proximal motion by functioning as a stop when locked. In some embodiments, the secondary anchor tether  2250  can be removed in the unlocked position. The secondary anchor tether  2250  can be removed after the secondary anchor  2220  is delivered. The secondary anchor tether  2250  can be pulled from outside of the body of the patient. The secondary anchor tether  2250  can allow the user to perform a suture count. 
       FIG.  56    illustrates an anti-rotation feature on the secondary anchor  2220 ,  2222 ,  2224 ,  2226 . The secondary anchor  2220  can include the shoulder  2272 . The shoulder  2272  can be configured to engage the secondary anchor driver  2230  as described herein. The shoulder  2272  can have features such as one or more anti-rotation features  2284 . The anti-rotation feature  2284  can include one or more barbs configured to engage tissue. While one anti-rotation feature  2284  is shown, other configurations of anti-rotation features are contemplated (e.g., one anti-rotation feature (shown), two anti-rotation features, three anti-rotation features, four anti-rotation features, five anti-rotation features, six anti-rotation features, etc.). Two or more anti-rotation features  2284  can be diametrically opposed, equally spaced, or otherwise spaced apart. In some embodiments, the anti-rotation feature  2284  prevents further rotation of the secondary anchor  2220 ,  2222 ,  2224 ,  2226 . In some embodiments, the secondary anchor  2220 ,  2222 ,  2224 ,  2226  is configured for left-handed rotation. In some embodiments, the secondary anchor  2220 ,  2222 ,  2224 ,  2226  is configured for right-handed rotation. In some embodiments, the anti-rotation feature  2284  is configured for reduce or limit left-handed rotation. In some embodiments, the anti-rotation feature  2284  is configured for reduce or limit right-handed rotation. 
       FIG.  57    illustrates posterior leaflet augmentation and restoration in diastole.  FIG.  57    illustrates posterior leaflet augmentation and restoration in systole. 
     Referring back to  FIG.  49   , the coaptation assistance element  400 ,  500 ,  600 ,  700  can be delivered to the valve annulus. The primary anchor  800  can be disposed within the primary anchor housing  2202 . The primary anchor driver  2204  can be disposed within the primary anchor housing  2202 . The one or more release wires  2206 ,  2208  can engage the primary anchor housing  2202 . The release wires  2206 ,  2208  can engage the primary anchor  800 . The release wires  2206 ,  2208  can be disposed on the annular side of the coaptation assistance element  400 ,  500 ,  600 ,  700 . The secondary anchor tethers  2250 ,  2252 ,  2254 ,  2256  can extend through the coaptation assistance element  400 ,  500 ,  600 ,  700 . The secondary anchor tethers  2250 ,  2252 ,  2254 ,  2256  can form a loop around the release wires  2206 ,  2208 . The secondary anchor tethers  2250 ,  2252 ,  2254 ,  2256  can extend proximally. The secondary anchor tethers  2250 ,  2252  can extend around release wire  2208 . The secondary anchor tethers  2250 ,  2252  can be spaced apart along the release wire  2208 . The secondary anchor tethers  2254 ,  2256  can extend around release wire  2206 . The secondary anchor tethers  2254 ,  2256  can be spaced apart along the release wire  2206 . 
     The coaptation assistance element  400 ,  500 ,  600 ,  700  can be delivered in a low profile configuration. The coaptation assistance element  400 ,  500 ,  600 ,  700  can rolled, compressed, folded, or otherwise reduced in size for delivery. In some embodiments, the release wires  2206 ,  2208  help to maintain the position of the primary anchor driver  2204  relative to the coaptation assistance element  400 ,  500 ,  600 ,  700 . In some embodiments, the release wires  2206 ,  2208  help to maintain the position of the primary anchor  800  relative to the coaptation assistance element  400 ,  500 ,  600 ,  700 . In some embodiments, the release wires  2206 ,  2208  help to maintain the position of the secondary anchor tethers  2250 ,  2252 ,  2254 ,  2256  relative to the coaptation assistance element  400 ,  500 ,  600 ,  700 . In some embodiments, the ends of the release wires  2206 ,  2208  wrap around the coaptation assistance element  400 ,  500 ,  600 ,  700  to maintain the position of the release wires  2206 ,  2208  relative to the coaptation assistance element  400 ,  500 ,  600 ,  700 . 
     The coaptation assistance element  400 ,  500 ,  600 ,  700  can be delivered via the delivery catheter  1402  as shown in  FIG.  50   . The telescoping action can position the coaptation assistance element  400 ,  500 ,  600 ,  700  relative to a location to engage the primary anchor  800  with tissue. The coaptation assistance element  400 ,  500 ,  600 ,  700  can be expanded, or partially expanded within the heart valve. 
     The primary anchor  800  can be rotated to engage tissue as shown in  FIG.  51   . The primary anchor driver  2204  can rotate to rotate the primary anchor  800 . The primary anchor driver  2204  can rotate, but in some embodiments, does not translate. The primary anchor driver  2204  can engage the cross-bar  802  of the primary anchor  800 . The primary anchor driver  2204  can include forked configuration to engage either side of the cross-bar  802 . The primary anchor  800  can be removed by rotating the primary anchor driver  2204  in the opposite direction. The coaptation assistance element  400 ,  500 ,  600 ,  700  can be functionally tested prior to engaging one or more secondary anchors  2220 ,  2222 ,  2224 ,  2226 . In some embodiments, only the primary anchor  800  is utilized. In some embodiments, only one or more secondary anchors  2220 ,  2222 ,  2224 ,  2226  are utilized. In some embodiments, one or more secondary anchors  2220 ,  2222 ,  2224 ,  2226  engage tissue after the primary anchor  800  engages tissue. 
     Referring back to  FIG.  49   , in some methods, the secondary anchor assembly is moved toward the annulus. The secondary anchor drivers  2230 ,  2232 ,  2234 ,  2236  can engage a respective secondary anchor  2220 ,  2222 ,  2224 ,  2226 . Referring to  FIG.  52   , the secondary anchor guide rails  2240 ,  2242 ,  2244 ,  2246  can maintain the engagement between the secondary anchor drivers  2230 ,  2232 ,  2234 ,  2236  and the respective secondary anchors  2220 ,  2222 ,  2224 ,  2226 . The secondary anchor guide rails  2240 ,  2242 ,  2244 ,  2246  can keep the locking tabs  2278  engaged with the windows  2274 . Referring to  FIG.  53   , the secondary anchor guide rails  2240 ,  2242 ,  2244 ,  2246  can extend beyond the open end of the secondary anchor  2220 ,  2222 ,  2224 ,  2226 . The secondary anchor guide rail  2240 ,  2242 ,  2244 ,  2246  can prevent entanglement between the secondary anchor  2220 ,  2222 ,  2224 ,  2226  and an adjacent tether. Referring to  FIG.  55 B , the guide rail lock  2280  can reduce or prevent proximal movement of the secondary anchor guide rails  2240 ,  2242 ,  2244 ,  2246 . 
       FIG.  48    illustrates the delivery of the secondary anchor  2224 . The secondary anchor driver  2234  can be coupled with the secondary anchor  2224 . The secondary anchor guide rail  2244  can extend beyond the open end of the secondary anchor  2224 . The secondary anchor guide rail  2244  can facilitate the coupling between the secondary anchor driver  2234  and the secondary anchor  2224 . The secondary anchor guide rail  2244  can reduce or prevent tangling between the secondary anchor  2224  and the adjacent secondary anchor tethers  2256 . The secondary anchor guide rail  2244  can slide along the secondary anchor tethers  2254  toward the annulus. The secondary anchor guide rail  2244  can be partially retracted when the secondary anchor  2224  is near the coaptation assistance element  400 ,  500 ,  600 ,  700 . The secondary anchor guide rail  2244  can facilitate the coupling between the secondary anchor driver  2234  and the secondary anchor  2224  when partially retracted. The secondary anchor guide rail  2244  can be partially retracted along the helical length of the secondary anchor  2224 , however, the secondary anchor guide rail  2244  can still be positioned to interact with the locking tabs  2278  (see position in  FIG.  52   ). 
     The secondary anchor driver  2234  can rotate to engage the secondary anchor  2224  with tissue. The secondary anchor  2224  can penetrate the coaptation assistance element  400 ,  500 ,  600 ,  700 . The secondary anchor  2224  can include one or more anti-rotation feature  2284 . The secondary anchor  2224  can be rotated until the anti-rotation feature  2284  is adjacent or engages tissue. The secondary anchor  2224  can be rotated until the anti-rotation feature  2284  is adjacent or engages the coaptation assistance element  400 ,  500 ,  600 ,  700 . 
     After deploying the secondary anchor  2224 , the secondary anchor guide rail  2244  can be removed which can allow the secondary anchor driver  2234  to decouple from the secondary anchor  2224 . The secondary anchor driver  2234  can be removed. The anchor tether  2254  can be removed by pulling on an extracorporeal end of a strand of the tether  2254 . The secondary anchors  2220 ,  2222 ,  2224 ,  2226  can be similarly deployed using the respective secondary anchor drivers  2230 ,  2232 ,  2234 ,  2236 , secondary anchor guide rails  2240 ,  2242 ,  2244 ,  2246 , and secondary anchor tethers  2250 ,  2252 ,  2254 ,  2256 . The secondary anchors  2220 ,  2222 ,  2224 ,  2226  can be independently rotated to engage tissue. The secondary anchors  2220 ,  2222 ,  2224 ,  2226  can be simultaneously rotated to engage tissue. The secondary anchors  2220 ,  2222 ,  2224 ,  2226  can be sequentially rotated to engage tissue. 
     After deployment of the primary anchor  800  and/or one or more secondary anchors  2220 ,  2222 ,  2224 ,  2226 , the release wires  2206 ,  2208  can be removed. The release wires  2206 ,  2208  can be removed by pulling on the extracorporeal end of the release wire  2206 ,  2208 . The primary anchor housing  2202  can be removed with the primary anchor driver  2204  disposed therein. 
       FIGS.  58 A- 58 J  illustrate an embodiment of an implant delivery system  2300 . The implant delivery system  2300  can include any of the features of implant delivery systems described herein. The implant delivery system  2300  can include features of implant delivery system  2200  and similar references numbers are used herein. 
     Referring to  FIG.  58 A , the telescoping action to access the primary anchor location according to some embodiments is illustrated. In some methods, access is achieved with the transseptal sheath  1400 . The transseptal puncture  1404  through the atrial septum, e.g., fossa ovalis, is shown for reference. The transseptal sheath  1400  can include a lumen for the passage of one or more additional catheters. The coaptation assistance element  400 ,  500 ,  600 ,  700  described herein can be delivered via a delivery catheter (not shown in  FIG.  58 A ). The delivery catheter can telescope relative to the transseptal sheath  1400  to extend outward relative to the transseptal sheath  1400  for delivery of the coaptation assistance element  400 ,  500 ,  600 ,  700 . The coaptation assistance element  400 ,  500 ,  600 ,  700  can include a frame, e.g.,  465 ,  565 . 
     The implant delivery system  2300  can include a primary anchor housing  2302 . The primary anchor housing  2302  can be disposed around the annular hub  420 ,  520 ,  620 ,  720  of the coaptation assistance element  400 ,  500 ,  600 ,  700  illustrated in  FIG.  58 B . The implant delivery system  2300  can include a primary anchor driver  2304  illustrated in  FIG.  58 B . The primary anchor housing  2302  can be dimensioned to fit the primary anchor driver  2304 . In some embodiments, the primary anchor driver  2304  is a torque shaft. The primary anchor driver  2304  can designed to engage and rotate the anchor  800  shown in  FIG.  58 J . The anchor  800  can be considered a primary anchor  800  to distinguish from one or more secondary anchors. 
     The implant delivery system  2300  can include one or more release wires  2306 ,  2308 . In the illustrated embodiment, the implant delivery system  2300  can include two release wires  2306 ,  2308 , but other configurations are contemplated (e.g., at least about, about, or no more than about, e.g., one release wire, two release wires, three release wires, four release wires, five release wires, six release wires, etc.). The release wires  2306 ,  2308  can extend proximally from the primary anchor housing  2302  as shown in  FIG.  58 B . The release wires  2306 ,  2308  can extend through at least a portion of the primary anchor housing  2302 . The release wires  2306 ,  2308  can be diametrically opposed within the primary anchor housing  2302 . The primary anchor housing  2302  can include slots  2310 ,  2312  that allow the release wires  2306 ,  2308  to extend there through. 
     The release wires  2306 ,  2308  can extend back inside the primary anchor housing  2302 . The primary anchor housing  2302  can include slots  2314 ,  2316  that allow the release wires  2306 ,  2308  to extend there through. The release wires  2306 ,  2308  can weave in and out of the primary anchor housing  2302 . The release wires  2306 ,  2308  can extend through the anchor  800 . The release wires  2306 ,  2308  can cross. 
     The release wires  2306 ,  2308  can extend along the coaptation assistance element  400 ,  500 ,  600 ,  700 . The release wires  2306 ,  2308  can extend underneath the coaptation assistance element  400 ,  500 ,  600 ,  700 . The release wires  2306 ,  2308  can extend in opposite directions. The release wires  2306 ,  2308  can be adjacent to the annulus. The release wires  2306 ,  2308  can rigidly hold the primary anchor housing  2302  against the annular hub  420 ,  520 ,  620 ,  720  of the coaptation assistance element  400 ,  500 ,  600 ,  700 . The release wires  2306 ,  2308  can extend beyond the coaptation assistance element  400 ,  500 ,  600 ,  700  as shown in  FIG.  58 A . 
     The implant delivery system  2300  can include one or more secondary anchors  2320 ,  2322 ,  2324 ,  2326  shown in  FIG.  58 G  (e.g., one secondary anchor, two secondary anchors, three secondary anchors, four secondary anchors (as shown), five secondary anchors, six secondary anchors, seven secondary anchors, eight secondary anchors, etc.). In some embodiments, the secondary anchors  2320 ,  2322 ,  2324 ,  2326  can be helical anchors. Each secondary anchors  2320 ,  2322 ,  2324 ,  2326  can have a smaller diameter than the primary anchor  800 . The secondary anchors  2320 ,  2322 ,  2324 ,  2326  can be configured to rotate to engage tissue in the annulus. 
     The implant delivery system  2300  can include one or more secondary anchor drivers  2330 ,  2332 ,  2334 ,  2336 , see  FIG.  58 D  which illustrates the secondary anchor driver  2330 , (e.g., one secondary anchor driver, two secondary anchor drivers, three secondary anchor drivers, four secondary anchor drivers, five secondary anchor drivers, six secondary anchor drivers, seven secondary anchor drivers, eight secondary anchor drivers, etc.). In some embodiments, the secondary anchor driver  2330 ,  2332 ,  2334 ,  2336  is a torque shaft. In some embodiments, the secondary anchor driver  2330 ,  2332 ,  2334 ,  2336  is configured to rotate the respective secondary anchor  2320 ,  2322 ,  2324 ,  2326 . In some embodiments, the secondary anchor driver  2330 ,  2332 ,  2334 ,  2336  is configured to translate the respective secondary anchor  2320 ,  2322 ,  2324 ,  2326 . 
     In some embodiments, the secondary anchor driver  2330 ,  2332 ,  2334 ,  2336  can be coupled to the respective secondary anchor  2320 ,  2322 ,  2324 ,  2326  according to any embodiment described herein. 
     The implant delivery system  2300  can include one or more secondary anchor guide rails  2340 ,  2342 ,  2344 ,  2346 , see  FIG.  58 C  which illustrates the secondary anchor guide rail  2340 , (e.g., one secondary anchor guide rail, two secondary anchor guide rails, three secondary anchor guide rails, four secondary anchor guide rails, five secondary anchor guide rails, six secondary anchor guide rails, seven secondary anchor guide rails, eight secondary anchor guide rails, etc.). The number of secondary anchor guide rails  2340 ,  2342 ,  2344 ,  2346  can correspond to the number of secondary anchors  2320 ,  2322 ,  2324 ,  2326 . Each secondary anchor  2320 ,  2322 ,  2324 ,  2326  can include a passageway there through. The passageway can extend through the middle of the helical wire of the secondary anchor  2320 ,  2322 ,  2324 ,  2326 . The secondary anchor guide rail  2340 ,  2342 ,  2344 ,  2346  can be configured to extend through the respective passageway. 
     The implant delivery system  2300  can include one or more secondary anchor tethers  2350 ,  2352 ,  2354 ,  2356  as shown in  FIG.  58 A  (e.g., one secondary anchor tether, two secondary anchor tethers, three secondary anchor tethers, four secondary anchor tethers (as shown), five secondary anchor tethers, six secondary anchor tethers, seven secondary anchor tethers, eight secondary anchor tethers, etc.). The number of secondary anchor tethers  2350 ,  2352 ,  2354 ,  2356  can correspond to the number of secondary anchors  2320 ,  2322 ,  2324 ,  2326 . The secondary anchor tethers  2350 ,  2352 ,  2354 ,  2356  can form a loop. Each secondary anchor tether  2350 ,  2352 ,  2354 ,  2356  can include a first strand, a second strand, and an arc therebetween. Each secondary anchor tether  2350 ,  2352 ,  2354 ,  2356  can loop around a respective release wire  2306 ,  2308  as described herein. The secondary anchor tethers  2350 ,  2352 ,  2354 ,  2356  can extend through the coaptation assistance element  400 ,  500 ,  600 ,  700 . The coaptation assistance element  400 ,  500 ,  600 ,  700  can include one or more passageways to facilitate passage of the secondary anchor tether  2350 ,  2352 ,  2354 ,  2356  there through. The release wires  2306 ,  2308  can maintain the connection between the coaptation assistance element  400 ,  500 ,  600 ,  700  and the secondary anchor tethers  2350 ,  2352 ,  2354 ,  2356 . 
     The implant delivery system  2300  can include one or more radiopaque markers  2360 ,  2362 ,  2364 ,  2366  as shown in  FIGS.  58 A and  58 B  (e.g., radiopaque marker, two radiopaque markers, three radiopaque markers, four radiopaque markers (as shown), five radiopaque markers, six radiopaque markers, seven radiopaque markers, eight radiopaque markers, etc.). The number of radiopaque markers  2360 ,  2362 ,  2364 ,  2366  can correspond to the number of secondary anchor tethers  2350 ,  2352 ,  2354 ,  2356 . As described herein, the secondary anchor tethers  2350 ,  2352 ,  2354 ,  2356  can form a loop around a respective release wire  2306 ,  2308  as described herein. The radiopaque marker  2360 ,  2362 ,  2364 ,  2366  can encase the first strand and the second strand of the loop. The radiopaque marker  2360 ,  2362 ,  2364 ,  2366  can encase the free end of the secondary anchor tethers  2350 ,  2352 ,  2354 ,  2356 . Each radiopaque marker  2360 ,  2362 ,  2364 ,  2366  can be coupled to a corresponding secondary anchor tether  2350 ,  2352 ,  2354 ,  2356 . In some embodiments, the radiopaque marker  2360 ,  2362 ,  2364 ,  2366  can be crimped to the respective secondary anchor tether  2350 ,  2352 ,  2354 ,  2356 . The radiopaque marker  2360 ,  2362 ,  2364 ,  2366  can extend on one side of the coaptation assistance element  400 ,  500 ,  600 ,  700 . The radiopaque marker  2360 ,  2362 ,  2364 ,  2366  can be on the opposite side of the coaptation assistance element  400 ,  500 ,  600 ,  700  as the release wires  2306 ,  2308 . In the illustrated embodiment, the implant delivery system  2300  can include four radiopaque markers  2360 ,  2362 ,  2364 ,  2366  coupled to the four secondary anchor tethers  2350 ,  2352 ,  2354 ,  2356 , but fewer radiopaque markers may be employed. In some embodiments, each secondary anchor tethers  2350 ,  2352 ,  2354 ,  2356  can include a radiopaque marker  2360 ,  2362 ,  2364 ,  2366 . 
     Each radiopaque marker  2360 ,  2362 ,  2364 ,  2366  can have a length, e.g., between 0 and 5 mm, between 1 and 6 mm, between 2 and 7 mm, between 3 and 8 mm, between 4 and 9 mm, between 5 and 10 mm, between 6 and 11 mm, between 7 and 12 mm, between 8 and 13 mm, between 9 and 14 mm, between 10 and 15 mm, between 0 and 10 mm, between 5 and 15 mm, between 10 and 20 mm, approximately 5 mm, approximately 10 mm, etc. Each radiopaque marker  2360 ,  2362 ,  2364 ,  2366  can have a diameter or cross-section less than the dimeter of a lumen of the secondary anchor guide rails  2340 ,  2342 ,  2344 ,  2346 . In some embodiments, each secondary anchor guide rails  2340 ,  2342 ,  2344 ,  2346  is configured to slide over the corresponding radiopaque marker  2360 ,  2362 ,  2364 ,  2366  to deliver the secondary anchor. In some embodiments, each secondary anchor driver  2330 ,  2332 ,  2334 ,  2336  is configured to slide over the corresponding radiopaque marker  2360 ,  2362 ,  2364 ,  2366  to deliver the secondary anchor. In some embodiments, each secondary anchor  2320 ,  2322 ,  2324 ,  2326  is configured to slide over the corresponding radiopaque marker  2360 ,  2362 ,  2364 ,  2366  to be driven into tissue. 
     The radiopaque marker  2360 ,  2362 ,  2364 ,  2366  can serve many functions. In some embodiments, one advantageous purpose of the radiopaque marker  2360 ,  2362 ,  2364 ,  2366  can be to prevent the secondary anchor tethers  2350 ,  2352 ,  2354 ,  2356  from moving with respect to the surface of the coaptation assistance element  400 ,  500 ,  600 ,  700 . In some embodiments, preventing this movement thus eliminates the entanglement of the secondary anchor tethers  2350 ,  2352 ,  2354 ,  2356  with the coaptation assistance element  400 ,  500 ,  600 ,  700 , including the frame or struts as described herein. The radiopaque marker  2360 ,  2362 ,  2364 ,  2366  can provide a rigid connection between the secondary anchor tethers  2350 ,  2352 ,  2354 ,  2356  and the coaptation assistance element  400 ,  500 ,  600 ,  700 . In some embodiments, the radiopaque marker  2360 ,  2362 ,  2364 ,  2366  are fixed to the secondary anchor tethers  2350 ,  2352 ,  2354 ,  2356 . In some embodiments, the radiopaque marker  2360 ,  2362 ,  2364 ,  2366  are fixed to the coaptation assistance element  400 ,  500 ,  600 ,  700 . 
     In some embodiments, an advantageous purpose of the radiopaque marker  2360 ,  2362 ,  2364 ,  2366  can be to create a rigid segment to support the secondary anchors  2320 ,  2322 ,  2324 ,  2326  as they are being engaged into the surface of the coaptation assistance element  400 ,  500 ,  600 ,  700 . This allows controlled engagement of the secondary anchors  2320 ,  2322 ,  2324 ,  2326  with the coaptation assistance element  400 ,  500 ,  600 ,  700 . It also prevents entanglement of the secondary anchors  2320 ,  2322 ,  2324 ,  2326  with the secondary anchor tethers  2350 ,  2352 ,  2354 ,  2356 . The radiopaque marker  2360 ,  2362 ,  2364 ,  2366  can reinforce the secondary anchor tethers  2350 ,  2352 ,  2354 ,  2356 , providing support and rigidity to the secondary anchor tethers  2350 ,  2352 ,  2354 ,  2356 . The radiopaque marker  2360 ,  2362 ,  2364 ,  2366  can support the secondary anchor guide rails  2340 ,  2342 ,  2344 ,  2346  during orienting the trajectory of the secondary anchor  2320 ,  2322 ,  2324 ,  2326 . 
     In some embodiments, the purpose of the radiopaque markers  2360 ,  2362 ,  2364 ,  2366  can be to provide a visual aid, under fluoroscopy, to verify the engagement of the secondary anchors  2320 ,  2322 ,  2324 ,  2326  with the coaptation assistance element  400 ,  500 ,  600 ,  700 . The purpose of the radiopaque markers  2360 ,  2362 ,  2364 ,  2366  can be to evaluate the depth of the secondary anchors  2320 ,  2322 ,  2324 ,  2326  engagement based on the distance between the hub of the secondary anchors  2320 ,  2322 ,  2324 ,  2326  and the radiopaque marker s 2360 ,  2362 ,  2364 ,  2366 . The radiopaque markers  2360 ,  2362 ,  2364 ,  2366  can provide a visual indication of the placement of the secondary anchor tethers  2350 ,  2352 ,  2354 ,  2356 . The radiopaque markers  2360 ,  2362 ,  2364 ,  2366  can provide a visual indication of the placement of the secondary anchor guide rails  2340 ,  2342 ,  2344 ,  2346 . The radiopaque markers  2360 ,  2362 ,  2364 ,  2366  can provide a visual indication of the placement of the secondary anchors  2320 ,  2322 ,  2324 ,  2326 . The radiopaque markers  2360 ,  2362 ,  2364 ,  2366  can determine the depth of insertion of the secondary anchors  2320 ,  2322 ,  2324 ,  2326 . 
     Referring to  FIG.  58 C , the secondary anchor guide rail  2340  is illustrated. While the secondary anchor guide rail  2340  is illustrated, each secondary anchor guide rail  2340 ,  2342 ,  2344 ,  2346  can include similar features. The flexible distal section of the secondary anchor guide rail  2340  can include a bend. The bend can be any angle from 30-90 degrees, preferably 45 degrees. This passive bend allows steering of the secondary anchor guide rail  2340 . By rotating the proximal section of the secondary anchor guide rail  2340  in either direction, the distal bent section can be steered in different directions. This will allow the user to orient the secondary anchor  2320  corresponding to the secondary anchor guide rail  2340  in an optimal projection, before engaging the secondary anchor  2320  into the coaptation assistance element  400 ,  500 ,  600 ,  700  and the tissue. 
     Each secondary anchor guide rail  2340 ,  2342 ,  2344 ,  2346  can increase the steerability of the corresponding secondary anchor  2320 ,  2322 ,  2324 ,  2326 . The secondary anchors  2320 ,  2322 ,  2324 ,  2326  can be oriented before engaging the secondary anchors  2320 ,  2322 ,  2324 ,  2326  in the tissue. Each secondary anchor guide rail  2340 ,  2342 ,  2344 ,  2346  can provide two or more trajectories for the corresponding secondary anchor  2320 ,  2322 ,  2324 ,  2326 . Each secondary anchor guide rail  2340 ,  2342 ,  2344 ,  2346  can be rotated which rotates the distal end with the bend. Each secondary anchor guide rail  2340 ,  2342 ,  2344 ,  2346  can be rotated until the distal end defines the preferred trajectory for the corresponding secondary anchors  2320 ,  2322 ,  2324 ,  2326 . 
     Referring to  FIG.  58 D , the secondary anchor guide rail  2340  is illustrated. The secondary anchor guide rail  2340  (only one shown here) is advance to contact the surface of the coaptation assistance element  400 ,  500 ,  600 ,  700 . The secondary anchor guide rail  2340  can be advanced along the secondary anchor tethers  2350 . The secondary anchor guide rail  2340  can be locked, from the proximal end, to the secondary anchor tethers  2350  once the secondary anchor guide rail  2340  reaches the coaptation assistance element  400 ,  500 ,  600 ,  700 . The secondary anchor  2320  can be coupled to the secondary anchor drivers  2330  as described herein. 
     Referring to  FIG.  58 E , the secondary anchor  2320  is advanced over the secondary anchor guide rail  2340  toward the surface of the coaptation assistance element  400 ,  500 ,  600 ,  700 . The secondary anchor  2320 , using the secondary anchor drivers  2330 , is advance to the distal tip of the secondary anchor guide rail  2340 . 
     Referring to  FIG.  58 F , the flexible distal section of the secondary anchor guide rail  2340  includes a bend from 30-90 degrees, preferably 45 degrees. This passive bend allows steering of the secondary anchor guide rail  2340 . By rotating the proximal section of the secondary anchor guide rail  2340  in either direction, the distal bent section can be steered in different directions. This will allow the user to orient the secondary anchor  2320  in an optimal projection, before engaging the secondary anchor  2320  into the implant and the tissue 
     Referring to  FIG.  58 G , the secondary anchors  2320 ,  2322 ,  2324 ,  2326  are engaged in with the coaptation assistance element  400 ,  500 ,  600 ,  700 . The secondary anchors  2320 ,  2322 ,  2324 ,  2326  are engaged with the tissue, such as the annulus. The secondary anchors  2320 ,  2322 ,  2324 ,  2326  can be rotated and/or translated to engage the tissue. The secondary anchors  2320 ,  2322 ,  2324 ,  2326  can be inserted in the optimal orientation due to the flexible distal section of the secondary anchor guide rails  2340 ,  2342 ,  2344 ,  2346 . In some embodiments, the optimal orientation of each of the secondary anchors  2320 ,  2322 ,  2324 ,  2326  can be between 40 and 50 degrees with respect to the plane of mitral annulus toward the posterior annulus. Other angles are contemplated, e.g., 0 degrees with respect to the plane of mitral annulus, 10 degrees with respect to the plane of mitral annulus, 20 degrees with respect to the plane of mitral annulus, 30 degrees with respect to the plane of mitral annulus, 40 degrees with respect to the plane of mitral annulus, 50 degrees with respect to the plane of mitral annulus, 60 degrees with respect to the plane of mitral annulus, 70 degrees with respect to the plane of mitral annulus, 80 degrees with respect to the plane of mitral annulus, 90 degrees with respect to the plane of mitral annulus, approximately 45 degrees, between 15 and 45 degrees, between 30 and 60 degrees, between 45 and 60 degrees, etc. 
     At this stage, all or any of the anchoring steps can be reversed. For instance, the secondary anchors  2320 ,  2322 ,  2324 ,  2326  can be disengaged with the tissue. For instance, the coaptation assistance element  400 ,  500 ,  600 ,  700  can be withdrawn into the delivery catheter. For instance, the coaptation assistance element  400 ,  500 ,  600 ,  700  can be retrieved through the transseptal sheath  1400 . 
     Referring to  FIGS.  58 H and  58 I , after the secondary anchors  2320 ,  2322 ,  2324 ,  2326  are engaged with the coaptation assistance element  400 ,  500 ,  600  and the tissue, the release wires  2306 ,  2308  can be released. In some embodiments, the release wires  2306 ,  2308  are pulled back to release the secondary anchor tethers  2350 ,  2352 ,  2354 ,  2356 . The secondary anchor tethers  2350 ,  2352 ,  2354 ,  2356  can be retracted through the transseptal sheath  1400 . The secondary anchor guide rails  2340 ,  2342 ,  2344 ,  2346  can be retracted through the transseptal sheath  1400 . The secondary anchor drivers  2330 ,  2332 ,  2334 ,  2336  can decouple from the secondary anchors  2320 ,  2322 ,  2324 ,  2326 . The implant hub can be release, as described herein. The secondary anchor drivers  2330 ,  2332 ,  2334 ,  2336  can be retracted through the transseptal sheath  1400 . The secondary anchor drivers  2330 ,  2332 ,  2334 ,  2336  can be pulled back and decoupled from the corresponding secondary anchor. As shown, three anchor drivers  2332 ,  2324 ,  2326  have been decoupled from their corresponding anchors. The secondary anchor tethers  2350 , the secondary anchor guide rail  2340 , and the secondary anchor driver  2330  can be withdrawn together. The secondary anchor tether  2350 , the secondary anchor guide rail  2340 , and the secondary anchor driver  2330  can be withdrawn sequentially, separately, and/or independently. 
     Referring to  FIG.  58 J , after the secondary anchor drivers  2330 ,  2332 ,  2334 ,  2336  are de-coupled and withdrawn into the transseptal sheath  1440 , the primary anchor housing  2302  can be retracted. The primary anchor driver  2304  can be disposed and retained within the primary anchor housing  2302 . The primary anchor housing  2302  can be pulled back to detach from the coaptation assistance element  400 ,  500 ,  600 . The primary anchor housing  2302  can be withdrawn into the transseptal sheath  1440 . 
       FIGS.  59 A- 59 B  illustrate the respective secondary anchor  2320  according to some embodiments. While the secondary anchor  2320  is illustrated, each secondary anchor  2320 ,  2322 ,  2324 ,  2326  can include similar features. 
     The secondary anchor  2320  can include a shoulder  2372 . The shoulder  2372  can be configured to engage the secondary anchor driver  2330 . The shoulder  2372  can have features such as one or more windows  2374 . The windows  2374  can be diametrically opposed, equally spaced, or otherwise spaced apart. While two windows  2374  are shown, other configurations of windows are contemplated (e.g., one window, two windows (shown), three windows, four windows, five windows, six windows, etc.). 
     The secondary anchor  2320  can include a helical body  2386 . The secondary anchor  2320  can be formed or wound. The secondary anchor  2320  can be made from an isodiametric wire. The wire can have a diameter of between 0.006 inch and 0.025 inch, preferably, 0.017 inch. The anchoring segment  2388  of the secondary anchor  2320  can be formed with a larger pitch of between 0.5 and 1.5 mm, preferably 1 mm. The secondary anchor  2320  can include a secondary anchor locking segment  2390 . The secondary anchor locking segment  2390  can be a portion of the secondary anchor  2320  between the shoulder  2372  and the anchoring segment  2388 . The secondary anchor locking segment  2390  of the secondary anchor  2320  can be formed at a pitch equal to the diameter of the wire. This will create no gap between the loops on the secondary anchor locking segment  2390 . Once the anchoring segment  2388  of the secondary anchor  2320  is fully engaged in the coaptation assistance element  400 ,  500 ,  600 ,  700  additional torque could be applied to the secondary anchor  2320  to engage the secondary anchor locking segment  2390  with the coaptation assistance element  400 ,  500 ,  600 ,  700 . The compression from the closed loops of the secondary anchor locking segment  2390  can prevent the secondary anchor  2320  from un-screwing from the secondary anchor locking segment  2390  during the cyclical motion of the tissue (e.g. heart beat). The smaller pitch of the locking segment  2390  can create a locking feature on the secondary anchor  2320 . The locking segment  2390  is intended to prevent un-screwing of the implant as the heart beats. 
     In  FIG.  60   , the secondary anchor locking segment  2390  has been engaged in the lamination of the coaptation assistance element  400 ,  500 ,  600 ,  700  to lock the secondary anchor  2320  to the top and bottom surfaces of the coaptation assistance element  400 ,  500 ,  600 ,  700 . In  FIG.  60   , the anchoring segment  2388  has been engaged into the tissue. In some embodiments, the coaptation assistance element  400 ,  500 ,  600 ,  700  extends between the close pitch of adjacent helical spirals. The close pitch can be configured to securely couple to the coaptation assistance element  400 ,  500 ,  600 ,  700 . Other configurations of locking segments are contemplated. 
     In some embodiments, the secondary anchor  2320  can be formed using a tapered wire. The smaller diameter of the tapered wire could be used to form the anchoring segment  2388  while the larger diameter of the wire could be used to form the secondary anchor locking segment  2390 . The secondary anchor locking segment  2390  can apply additional forces to the coaptation assistance element  400 ,  500 ,  600 ,  700  thus preventing the secondary anchor  2320  from un-screwing with cyclical motion when the secondary anchor  2320  engaged in a tissue. 
     It is contemplated that various combinations or subcombinations of the specific features and aspects of the embodiments disclosed above may be made and still fall within one or more of the inventions. Further, the disclosure herein of any particular feature, aspect, method, property, characteristic, quality, attribute, element, or the like in connection with an embodiment can be used in all other embodiments set forth herein. Accordingly, it should be understood that various features and aspects of the disclosed embodiments can be combined with or substituted for one another in order to form varying modes of the disclosed inventions. Thus, it is intended that the scope of the present inventions herein disclosed should not be limited by the particular disclosed embodiments described above. Moreover, while the invention is susceptible to various modifications, and alternative forms, specific examples thereof have been shown in the drawings and are herein described in detail. It should be understood, however, that the invention is not to be limited to the particular forms or methods disclosed, but to the contrary, the invention is to cover all modifications, equivalents, and alternatives falling within the spirit and scope of the various embodiments described and the appended claims. Any methods disclosed herein need not be performed in the order recited. The methods disclosed herein include certain actions taken by a practitioner; however, they can also include any third-party instruction of those actions, either expressly or by implication. For example, actions such as “inserting a coaptation assist body proximate the mitral valve” includes “instructing the inserting of a coaptation assist body proximate the mitral valve.” The ranges disclosed herein also encompass any and all overlap, sub-ranges, and combinations thereof. Language such as “up to,” “at least,” “greater than,” “less than,” “between,” and the like includes the number recited. Numbers preceded by a term such as “approximately”, “about”, and “substantially” as used herein include the recited numbers, and also represent an amount close to the stated amount that still performs a desired function or achieves a desired result. For example, the terms “approximately”, “about”, and “substantially” may refer to an amount that is within less than 10% of, within less than 5% of, within less than 1% of, within less than 0.1% of, and within less than 0.01% of the stated amount.