Patent Publication Number: US-2021161660-A1

Title: Systems and methods for heart valve therapy

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a continuation of U.S. application Ser. No. 16/290,536, filed Mar. 1, 2019, which is a continuation of U.S. application Ser. No. 15/393,704 filed Dec. 29, 2016, now U.S. Pat. No. 10,265,166, issued Apr. 23, 2019, which claims the benefit of U.S. Provisional Ser. No. 62/272,865 filed Dec. 30, 2015. The disclosures of these prior applications are considered part of (and are incorporated by reference in) the disclosure of this application. 
    
    
     TECHNICAL FIELD 
     This document relates to prosthetic heart valves, such as prosthetic mitral valves that can be implanted using transcatheter techniques. Some embodiments of prosthetic mitral valves described herein include an anchor portion that couples the prosthetic mitral valve to the anatomy near the native mitral valve, and a valve portion that is mateable with the anchor portion. 
     BACKGROUND 
     The long-term clinical effect of valve regurgitation is recognized as a significant contributor to cardiovascular related morbidity and mortality. Thus, for many therapies intended to treat the mitral valve, one primary goal is to significantly reduce or eliminate regurgitation. By eliminating the regurgitation at the mitral valve, the destructive volume overload effects on the left ventricle can be attenuated. The volume overload of mitral regurgitation (MR) relates to the excessive kinetic energy required during isotonic contraction to generate overall stroke volume in an attempt to maintain forward stroke volume and cardiac output. It also relates to the pressure potential energy dissipation of the leaking valve during the most energy-consuming portion of the cardiac cycle, isovolumetric contraction. Additionally, therapies for MR reduction can have the effect of reducing the elevated pressures in the left atrium and pulmonary vasculature reducing pulmonary edema (congestion) and shortness of breath symptomatology. Such therapies for MR reduction may also have a positive effect on the filling profile of the left ventricle (LV) and the restrictive LV physiology that can result with MR. These pathophysiologic issues indicate the potential benefits of MR therapy, but also indicate the complexity of the system and the need for a therapy to focus beyond the MR level or grade. 
     In some percutaneous access procedures in which a medical device is introduced through a patient&#39;s skin and into a patient&#39;s blood vessel, such an access can be used to introduce devices into the patient without the use of large cut downs, which can be painful and in some cases can hemorrhage or become infected. A percutaneous access generally employs only a small hole through the skin, which subsequently seals relatively easily, and heals quickly in comparison to a surgical cut down. 
     SUMMARY 
     This document describes prosthetic heart valves, such as prosthetic mitral valves, that can interface and anchor in cooperation with the anatomical structures of a native mitral valve. Some embodiments of prosthetic mitral valves described herein include an anchor portion that couples the prosthetic mitral valve to the anatomy near the native mitral valve, and a valve portion that is mateable with the anchor portion. In some implementations, a prosthetic mitral valve and deployment system includes a prosthetic mitral valve system, a system of multiple catheters configured to deliver the prosthetic mitral valve system, and a deployment frame system. At least some catheters of the multiple catheters are slidably engageable with each other. At least a first catheter of the multiple catheters is releasably coupleable to the prosthetic anchor assembly. At least a second catheter of the multiple catheters is releas ably coupleable to the prosthetic valve assembly. The prosthetic mitral valve system can include a prosthetic anchor assembly comprising an anchor frame that defines an interior space, and a prosthetic valve assembly comprising a valve frame and multiple valve leaflets attached to the valve frame. The valve frame is configured to releasably couple with the prosthetic anchor assembly within the interior space of the anchor frame. 
     In one implementation, a prosthetic mitral valve system includes (i) a valve assembly comprising an expandable valve frame and an occluder attached to the expandable valve frame, and (ii) an anchor assembly comprising an expandable anchor frame that defines a longitudinal axis. The anchor assembly is configured to selectively couple with the valve assembly. The expandable anchor frame comprises a plurality of arched atrial holding features. While the expandable anchor frame is in an expanded configuration, each arched atrial holding feature of the plurality of arched atrial holding features extends transversely outward in relation to the longitudinal axis. 
     Such a prosthetic mitral valve system may optionally include one or more of the following features. The plurality of arched atrial holding features may comprise three arched atrial holding features. While the anchor assembly is coupled to a native mitral valve, each arched atrial holding feature of the plurality of arched atrial holding features may be positioned directly adjacent to, or spaced apart just superior to, an annulus of the native mitral valve. 
     In another implementation, a prosthetic mitral valve system includes (i) a valve assembly comprising an expandable valve frame and an occluder attached to the expandable valve frame, and (ii) an anchor assembly comprising an expandable anchor frame. The expandable valve frame comprises three valve frame lobes disposed on a proximal end portion of the expandable valve frame. The anchor assembly is configured to selectively couple with the valve assembly. The expandable anchor frame comprises three anchor frame lobes disposed on a proximal end portion of the expandable anchor frame. While the valve assembly and the anchor assembly are coupled, each valve frame lobe of the three valve frame lobes is aligned with a respective anchor frame lobe of the three anchor frame lobes. 
     Such a prosthetic mitral valve system may optionally include one or more of the following features. The expandable anchor frame may further comprise a plurality of arched atrial holding features. While the expandable anchor frame is in an expanded configuration, each arched atrial holding feature of the plurality of arched atrial holding features may extend transversely outward in relation to a longitudinal axis defined by the anchor assembly. The plurality of arched atrial holding features may comprise three arched atrial holding features. Each arched atrial holding feature of the three arched atrial holding features may be aligned with a corresponding valve frame lobe of the three valve frame lobes and with a corresponding anchor frame lobe of the three anchor frame lobes. 
     In another implementation, a prosthetic mitral valve system includes a valve assembly comprising an expandable valve frame and an occluder attached to the expandable valve frame, and an anchor assembly comprising an expandable anchor frame. The anchor assembly is configured to selectively couple with the valve assembly. The expandable anchor frame includes: (i) a centrally located hub; (ii) a first elongate element extending from the hub, the first elongate element including a first sub-annular foot; (iii) a second elongate element extending from the hub, the second elongate element including a second sub-annular foot; (iv) a third elongate element extending from the first elongate element, the third elongate element including a third sub-annular foot; and (v) a fourth elongate element extending from the second elongate element, the fourth elongate element including a fourth sub-annular foot. While the anchor assembly is coupled to a native mitral valve, each of the first foot, the second foot, the third foot, and the fourth foot are positioned within a sub-annular gutter of the native mitral valve. 
     Such a prosthetic mitral valve system may optionally include one or more of the following features. The expandable anchor frame may further comprise a systolic anterior motion containment member that is configured to be at least partially disposed behind an anterior leaflet of the native mitral valve while the anchor assembly is coupled to the native mitral valve. The systolic anterior motion containment member may extend from the first elongate element and the second elongate element. The hub may be located at a distal end of the expandable anchor frame. The hub may be threaded for releasable attachment with a delivery device. 
     In another implementation, a method for deploying a prosthetic mitral valve system within a native mitral valve of a patient includes: (i) navigating a delivery sheath of a prosthetic mitral valve delivery system through a vasculature of the patient such that a distal end of the delivery sheath is positioned adjacent the native mitral valve; (ii) expressing an anchor assembly of the prosthetic mitral valve system from the distal end of the delivery sheath such that the anchor assembly at least partially expands, the anchor assembly configured to selectively mate with a valve assembly of the prosthetic mitral valve system, the anchor assembly comprising an expandable anchor frame that includes three arched atrial holding features; (iii) engaging the anchor assembly with the native mitral valve such that each arched atrial holding feature of the three arched atrial holding features is positioned directly adjacent to, or spaced apart just superior to, an annulus of the native mitral valve; and (iv) mating the valve assembly with the anchor assembly. 
     In another implementation, a method for deploying a prosthetic mitral valve system within a native mitral valve of a patient includes: (i) navigating a delivery sheath of a prosthetic mitral valve delivery system through a vasculature of the patient such that a distal end of the delivery sheath is positioned adjacent the native mitral valve; (ii) expressing an anchor assembly of the prosthetic mitral valve system from the distal end of the delivery sheath such that the anchor assembly at least partially expands, the anchor assembly configured to selectively mate with a valve assembly of the prosthetic mitral valve system, the anchor assembly comprising an expandable anchor frame defining three anchor frame lobes disposed on a proximal end portion of the expandable anchor frame; (iii) engaging the anchor assembly with the native mitral valve; and (iv) mating the valve assembly with the anchor assembly. The valve assembly includes an expandable valve frame defining three valve frame lobes. As a result of the mating of the valve assembly with the anchor assembly, each of the three valve frame lobes is aligned with a respective anchor frame lobe of the three anchor frame lobes. 
     In another implementation, a method for deploying a prosthetic mitral valve system within a native mitral valve of a patient includes: (i) navigating a delivery sheath of a prosthetic mitral valve delivery system through a vasculature of the patient such that a distal end of the delivery sheath is positioned adjacent the native mitral valve; (ii) expressing an anchor assembly of the prosthetic mitral valve system from the distal end of the delivery sheath such that the anchor assembly at least partially expands. The anchor assembly is configured to selectively mate with a valve assembly of the prosthetic mitral valve system. The anchor assembly comprises an expandable anchor frame. The expandable anchor frame includes: a centrally located hub; a first elongate element extending from the hub, the first elongate element including a first foot; a second elongate element extending from the hub, the second elongate element including a second foot; a third elongate element extending from the first elongate element, the third elongate element including a third foot; and a fourth elongate element extending from the second elongate element, the fourth elongate element including a fourth foot. The method further comprises: (iii) engaging the anchor assembly with the native mitral valve such that each of the first foot, the second foot, the third foot, and the fourth foot are positioned within a sub-annular gutter of the native mitral valve; and (iv) mating the valve assembly with the anchor assembly. 
     In another implementation, a mitral valve system for deployment within a native mitral valve includes a valve means for expanding within a native mitral valve annulus and occluding regurgitation of blood flow from a left ventricle to a left atrium, and a means for anchoring the valve means within the native mitral valve annulus. 
     In another implementation a transcatheter mitral valve replacement system includes a valve assembly comprising an expandable valve frame and a set of occlude leaflets attached to the expandable valve frame, and an anchor assembly comprising an expandable anchor frame. The anchor assembly is configured to anchor with sub-annular tissue and to receivingly mate with the valve assembly. 
     In another implementation, a prosthetic mitral valve system includes: (i) a valve assembly comprising an expandable valve frame and an occluder attached to the expandable valve frame; (ii) an anchor assembly comprising an expandable anchor frame that defines a longitudinal axis, the anchor assembly configured to selectively couple with the valve assembly; and (iii) a control wire slidably engaged with the expandable anchor frame at a plurality of engagement locations at a mid-body region along the longitudinal axis of the expandable anchor frame. The control wire is manipulable to increase and decrease a diameter of the expandable anchor frame during implantation of the anchor assembly. 
     Such a prosthetic mitral valve system may optionally include one or more of the following features. The expandable anchor frame may include: (i) a centrally located hub; (ii) a first elongate element extending from the hub, the first elongate element including a first foot; (iii) a second elongate element extending from the hub, the second elongate element including a second foot; (iv) a third elongate element extending from the first elongate element, the third elongate element including a third foot; and (v) a fourth elongate element extending from the second elongate element, the fourth elongate element including a fourth foot. In some embodiments, tensioning the control wire draws each of the first foot, second foot, third foot, and fourth foot radially inwards towards the longitudinal axis, and slackening the control wire allows each of the first foot, second foot, third foot, and fourth foot to expand radially outwards away from the longitudinal axis. The control wire may be a first control wire, and the prosthetic mitral valve may further comprise a second control wire slidably engaged with the expandable anchor frame at a proximal end region of the expandable anchor frame. The proximal end region of the expandable anchor frame may comprise a plurality of arched atrial holding features. The second control wire may be manipulable such that tensioning the second control wire draws the plurality of arched atrial holding features radially inwards towards the longitudinal axis and slackening the second control wire allows the plurality of arched atrial holding features to extend transversely outward in relation to the longitudinal axis. 
     In another implementation a method for deploying a prosthetic mitral valve system within a native mitral valve of a patient includes: (i) navigating a delivery sheath of a prosthetic mitral valve delivery system through a vasculature of the patient such that a distal end of the delivery sheath is positioned in a left atrium of the patient; (ii) expressing an anchor assembly of the prosthetic mitral valve system from the distal end of the delivery sheath, the anchor assembly defining a longitudinal axis and configured to selectively mate with a valve assembly of the prosthetic mitral valve system; (iii) slackening a control wire of the prosthetic mitral valve delivery system to allow the anchor assembly to self-expand to a first diameter while the anchor assembly is within the left atrium; (iv) advancing, after the anchor assembly self-expands to the first diameter, at least a distal portion of the anchor assembly across an annulus of the native mitral valve such that the at least the distal portion of the anchor assembly is positioned within a left ventricle of the patient; and (v) slackening, after the at least the distal portion of the anchor assembly is positioned within the left ventricle, the control wire to allow the anchor assembly to self-expand to a second diameter that is larger than the first diameter. 
     Such a method for deploying a prosthetic mitral valve system within a native mitral valve of a patient may optionally include one or more of the following features. The anchor assembly may include: (a) a centrally located hub; (b) a first elongate element extending from the hub, the first elongate element including a first foot; (c) a second elongate element extending from the hub, the second elongate element including a second foot; (d) a third elongate element extending from the first elongate element, the third elongate element including a third foot; and (e) a fourth elongate element extending from the second elongate element, the fourth elongate element including a fourth foot. Each of the slackening the control wire steps may allow each of the first foot, second foot, third foot, and fourth foot to expand radially outwards away from the longitudinal axis. The method may further include seating, after the anchor assembly self-expands to the second diameter, each of the first foot, second foot, third foot, and fourth foot in a sub-annular gutter of the native mitral valve. 
     Some or all of the embodiments described herein may provide one or more of the following advantages. First, some embodiments of the prosthetic mitral valve systems provided herein can be used in a percutaneous transcatheter mitral replacement procedure (e.g., complete delivery and anchoring of the prosthetic valve components via one or more catheters advanced percutaneously into the venous system or arterial system and to the heart) that is safe, reliable, and repeatable by surgeons and/or interventional cardiologists of a variety of different skill levels. For example, in some implementations the prosthetic mitral valve system can establish a reliable and consistent anchor/substrate to which the valve/occluder structure subsequently engages. Thus, the prosthetic mitral valve system can be specifically designed to make use of the geometry/mechanics of the native mitral valve to create sufficient holding capability. In one particular aspect, the anatomical gutter found below a native mitral valve annulus can be utilized as a site for anchoring the prosthetic mitral valve system, yet the anchoring structure can be deployed in a matter that maintains native leaflet function of the mitral valve, thereby providing the ability to completely separate and stage the implantation of the components of the prosthetic mitral valve system. Accordingly, some embodiments of the prosthetic mitral valve systems described herein are configured to be implanted in a reliable, repeatable, and simplified procedure that is broadly applicable to a variety of patients and physicians, while also employing a significantly less invasive method. 
     Second, some embodiments of the prosthetic mitral valve systems provided herein include features to facilitate convenient engagement of prosthetic mitral valve components to the deployment catheter system. For example, in preparation for deployment of the prosthetic valve assembly, a clinician may need to engage one or more control wires of the deployment catheter system with the valve assembly by threading the wire through multiple control wire engagement features located on the valve assembly. To assist the clinician with that task, in some embodiments the valve assembly is provided with a removable guide tube extending through each of the control wire engagement features. To engage a control wire with the valve assembly, the clinician inserts the control wire through the tube, and then removes the tube while leaving the control wire in place relative to the valve assembly. In that fashion, the control wire can be installed through each of the control wire engagement features in a convenient manner. The same feature can be included in the prosthetic anchor assembly. 
     Third, some embodiments of the prosthetic mitral valve systems and deployment systems include multiple control wires to provide highly user-controllable diametric expansion of the prosthetic mitral valve components during deployment. For example, some embodiments of the anchor assembly and anchor assembly deployment system include a first, proximal control wire and a second, mid-body control wire. As described further below, independent control of the proximal and mid-body portions of the anchor assembly during deployment can advantageously facilitate a user-friendly and clinically effective transcatheter deployment technique. 
     Fourth, some embodiments of the prosthetic mitral valve systems are configured to perform with reduced in situ stress levels. For example, in some embodiments, the structure of the anchor and/or valve assembly framework is specifically designed to function within the dynamic environment of the heart while incurring low levels of stress and strain within the framework members. Such features can allow for greater durability and longevity of the prosthetic mitral valve systems. 
     Fifth, some embodiments of the prosthetic mitral valve systems include features to reduce the potential of interference or entanglement with the native valve&#39;s chordae tendineae. For example, in some embodiments the anchor assembly framework is specifically designed such that particular sub-annular framework members extend essentially parallel with the chordae tendineae. In result, an anchor assembly can be implanted in a native mitral valve with minimal or no impact on the natural functioning of the native valve leaflets. 
     Sixth, in particular embodiments, the prosthetic mitral valve system can include two different expandable components (e.g., an anchor assembly and a valve assembly) that are separately delivered to the implantation site, and both components can abut and engage with native heart tissue at the mitral valve. For example, the first component (e.g., the anchor assembly) can be configured to engage with the heart tissue that is at or proximate to the annulus of the native mitral valve, and the second component (e.g., the valve assembly) can be configured to provide a seal interface with native valve leaflets of the mitral valve. 
     Seventh, in some embodiments the prosthetic mitral valve system includes features for enhanced coupling alignment and strength between the anchor assembly and the valve assembly. Such features may provide strong decoupling resistance and, in turn, enhanced migration resistance of the prosthetic mitral valve system. 
     Eighth, some embodiments of the prosthetic mitral valve systems described herein are configured with a systolic anterior motion SAM containment member feature. SAM containment members can reduce or prevent the potential for a natural mitral valve anterior leaflet to “flop” outward and/or from being drawn by a Venturi effect into the left ventricular outflow tract (LVOT). Accordingly, the SAM containment members can reduce the risk of full or partial blockages of the LVOT. In some patient scenarios, the potential for suffering future adverse health events, such as heart failure, is thereby reduced. 
     Ninth, using the devices, systems, and methods described herein, various medical conditions, such as heart valve conditions, can be treated in a minimally invasive fashion. Such minimally invasive techniques can tend to reduce recovery times, patient discomfort, and treatment costs. 
     The details of one or more embodiments of the invention are set forth in the accompanying drawings and the description below. Other features, objects, and advantages of the invention will be apparent from the description and drawings, and from the claims. 
    
    
     
       DESCRIPTION OF DRAWINGS 
         FIG. 1  shows a perspective view of a portion of a prosthetic mitral valve deployment system in a cross-sectional view of a native human heart (from a rear side of the heart), in accordance with some embodiments. 
         FIG. 2  shows a perspective view of a prosthetic mitral valve anchor assembly in the left atrium of the heart after the anchor assembly has emerged from an anchor delivery sheath of the deployment system of  FIG. 1 . 
         FIG. 3  shows a distal end portion of some components of the deployment system of  FIG. 1 , including two wires for controlling the diametric expansion of the anchor assembly of  FIG. 2 . 
         FIG. 4  shows a perspective view of the distal end portion of the deployment system as shown in  FIG. 3  in engagement with the anchor assembly of  FIG. 2 . 
         FIG. 5  shows a perspective view of the anchor assembly of  FIG. 2  after being rotated/panned in the left atrium so as to orient the anchor assembly axis generally perpendicular to the native mitral valve. 
         FIG. 6  shows a side view of a delivery catheter of prosthetic mitral valve deployment system. 
         FIG. 7  shows a perspective view in a commissural cross-sectional view of the heart (from the left side of the heart) of the anchor assembly of  FIG. 2  after being partially advanced through the native mitral valve so as to position projections of the anchor assembly below an annulus of the native mitral valve. 
         FIG. 8  shows a perspective view of the anchor assembly of  FIG. 7  after being diametrically expanded to align the projections of the anchor assembly with a sub-annular gutter of the native mitral valve. 
         FIG. 9  shows a perspective view of the anchor assembly of  FIG. 8  after being retracted so as to position the projections of the anchor assembly in the sub-annular gutter of the native mitral valve. 
         FIG. 10  shows a perspective view of the anchor assembly of  FIG. 7  after the release and retraction of the control wires of the deployment system. 
         FIG. 11  shows a perspective view of the anchor assembly of  FIG. 7  after the retraction of some of the catheters of the deployment system. 
         FIG. 12  is a top view of a native mitral valve and depicts a gutter perimeter of the sub-annular gutter of  FIG. 7  (without the anchor assembly). 
         FIG. 13  shows the native mitral valve of  FIG. 12  and a schematic representation of the sub-annular frame members of the anchor assembly of  FIG. 7 . 
         FIG. 14  shows a top view of the anchor assembly of  FIG. 7  deployed in a sheet material that represents the annular plane of a mitral valve. 
         FIG. 15  shows a perspective view (slightly from the top) of the anchor assembly of  FIG. 7  deployed in the material that represents the annular plane of a mitral valve (as in  FIG. 14 ). 
         FIG. 16  shows a perspective view (slightly from the bottom) of the anchor assembly of  FIG. 7  deployed in the material that represents the annular plane of a mitral valve (as in  FIG. 14 ). 
         FIG. 17  shows a bottom view of the anchor assembly of  FIG. 7  deployed in the material that represents the annular plane of a mitral valve (as in  FIG. 14 ). 
         FIG. 18  shows a perspective top view of an example frame of the anchor assembly of  FIG. 7 , in accordance with some embodiments. 
         FIG. 19  shows a perspective side view of the example frame of the anchor assembly of  FIG. 7 , in accordance with some embodiments. 
         FIG. 20  shows a posterior side view of the example frame of the anchor assembly of  FIG. 7 , in accordance with some embodiments. 
         FIG. 21  shows a posterior side view (slightly from the top) of the anchor assembly of  FIG. 7  including a covering material disposed on portions of the anchor frame. 
         FIG. 22  is a photographic image showing a perspective top view of the anchor assembly of  FIG. 7  implanted within a native mitral valve (with the native mitral valve leaflets in a closed state), and  FIG. 23  shows a corresponding anatomical top view of the anchor assembly of  FIG. 22 . 
         FIG. 24  is a photographic image showing a perspective top view of the anchor assembly of  FIG. 7  implanted within a native mitral valve (with the native mitral valve leaflets in an open state). 
         FIG. 25  shows a perspective view of the anchor assembly of  FIG. 7  implanted within the native mitral valve and a valve assembly delivery sheath extending into the left atrium (in a commissural cross-sectional view of the heart). 
         FIG. 26  shows a perspective view of a valve assembly in the left atrium after partial emergence from the valve assembly delivery sheath of  FIG. 25 . The valve assembly is configured in a first (partially expanded) arrangement. 
         FIG. 27  shows a perspective view of the valve assembly of  FIG. 26  with the valve deployment system being manipulated in preparation for the installation of the valve assembly into the anchor assembly. 
         FIG. 28  shows a perspective view of the valve assembly of  FIG. 26  (while still in the first, partially expanded arrangement) being positioned within the anchor assembly. 
         FIG. 29  shows a perspective view of the valve assembly of  FIG. 26 , with the valve assembly expanded within the anchor assembly, prior to deployment of the SAM containment member. 
         FIG. 30  shows a perspective view of the valve assembly of  FIG. 26 , with the valve assembly expanded within the anchor assembly after the release and retraction of the control wires of the deployment system, after deployment of the SAM containment member, and after the retraction of some of the catheters of the deployment system. 
         FIG. 31  shows an anterior side view of a valve frame of a valve assembly of  FIGS. 26-30 , in accordance with some embodiments. 
         FIG. 32  shows a bottom view of the valve frame of  FIG. 31 . 
         FIG. 33  shows a top view of the valve assembly of  FIGS. 26-30 , including a threading tube coupled to the proximal end of the valve assembly. 
         FIG. 34A  is an anterior side perspective view of the valve assembly of  FIG. 33 . 
         FIG. 34B  shows an enlarged view of a proximal portion of the valve assembly of  FIG. 34A . 
         FIG. 35  is bottom view of the valve assembly of  FIG. 33 . 
         FIG. 36A  shows an assembly of prosthetic valve leaflet components for the valve assembly of  FIG. 33 , prior to being coupled to the valve frame. 
         FIG. 36B  shows an enlarged view of a portion of the prosthetic valve leaflets of  FIG. 36A . 
         FIG. 37  shows an enlarged view of a portion of a commissural post of the valve assembly of  FIGS. 26-30  and an example leaflet attachment stitching pattern, in accordance with some embodiments. 
         FIG. 38  is an exploded posterior side view of the anchor assembly and valve assembly of  FIGS. 26-30 , in accordance with some embodiments. 
         FIG. 39  is a top view of an example prosthetic mitral valve system that includes a valve assembly engaged with an anchor assembly, in accordance with some embodiments. 
         FIG. 40  is an anterior view of the prosthetic mitral valve system of  FIG. 38 . 
         FIG. 41  is a posterior view of the prosthetic mitral valve system of  FIG. 38 . 
         FIG. 42  is a bottom view of the prosthetic mitral valve system of  FIG. 38 . 
         FIG. 43  shows a perspective view of an example prosthetic mitral valve system deployment frame system configuration in accordance with some embodiments. 
     
    
    
     Like reference symbols in the various drawings indicate like elements. 
     DETAILED DESCRIPTION OF ILLUSTRATIVE EMBODIMENTS 
     This disclosure describes embodiments of a prosthetic heart valve system, such as prosthetic mitral valve systems, and transcatheter systems and methods for implanting prosthetic heart valve systems. In some embodiments, the prosthetic mitral valve system can be deployed to interface and anchor in cooperation with the native anatomical structures of a mitral valve (and, optionally, in a manner that permits the continued natural function and movement of the chordae tendineae and the native mitral valve leaflets even after the anchor component is deployed). 
     Referring to  FIG. 1 , an example transcatheter mitral valve delivery system  100  can be navigated through a patient&#39;s vasculature to obtain access to the patient&#39;s heart  10 . The transcatheter delivery system  100  facilitates implantation of a prosthetic mitral valve in a beating heart  10  using a percutaneous, or minimally invasive technique (without open-chest surgery or open-heart surgery). For example, in some implementations the transcatheter delivery system  100  is percutaneously inserted into a femoral or iliac vein via a groin opening/incision  2  in a patient  1  ( FIG. 43 ) using a deployment frame system  6  configured to activate and/or control the movements of various components of the transcatheter delivery system  100 . In some implementations, the transcatheter delivery system  100  is used in conjunction with one or more imaging modalities such as x-ray fluoroscopy, echocardiography, magnetic resonance imaging, computed tomography (CT), and the like. 
     The heart  10  (depicted in cross-section from a posterior perspective in  FIG. 1 ) includes a right atrium  12 , a right ventricle  14 , a left atrium  16 , and a left ventricle  18 . A tricuspid valve  13  separates the right atrium  12  from the right ventricle  14 . A mitral valve  17  separates the left atrium  16  from the left ventricle  18 . An atrial septum  15  separates the right atrium  12  from the left atrium  16 . An inferior vena cava  11  is confluent with the right atrium  12 . It should be understood that this depiction of the heart  10  is somewhat stylized. The same is true for  FIGS. 2 and 5 .  FIGS. 1, 2 and 5  provide general depictions of the approach to the mitral valve  17  that is used in some implementations. But, the commissural cross-sectional views of  FIG. 7  and thereafter more accurately depict the orientation of the prosthetic mitral valves in relation to the heart  10 . 
     Still referring to  FIG. 1 , in the depicted embodiment, the delivery system  100  includes a guidewire  110 , a guide catheter  120 , and an anchor delivery sheath  130 . Additional components of the delivery system  100  will be described further below. The anchor delivery sheath  130  is slidably (and rotationally) disposed within a lumen of the guide catheter  120 . The guidewire  110  is slidably disposed with respect to a lumen of the anchor delivery sheath  130 . In this depiction, the anchor delivery sheath  130  has been partially extended relative to the guide catheter  120 , allowing an optional flared portion  132  to expand outward, as described further below. 
     In the depicted implementation, the guidewire  110  is installed into the heart  10  prior to the other components of the delivery system  100 . In some embodiments, the guidewire  110  has a diameter of about 0.035 inches (about 0.89 mm). In some embodiments, the guidewire  110  has a diameter in a range of about 0.032 inches to about 0.038 inches (about 0.8 mm to about 0.97 mm). In some embodiments, the guidewire  110  has a diameter smaller than 0.032 inches (about 0.80 mm) or larger than 0.038 inches (about 0.97 mm). In some embodiments, the guidewire  110  is made of materials such as, but not limited to, nitinol, stainless steel, high-tensile-strength stainless steel, and the like, and combinations thereof. The guidewire  110  may include various tip designs (e.g., J-tip, straight tip, etc.), tapers, coatings, covers, radiopaque (RO) markers, and other features. In some embodiments, the guidewire  110  has one or more portions with differing lateral stiffnesses, column strengths, lubricity, and/or other physical properties in comparison to other portions of the guidewire  110 . 
     In some implementations, the guidewire  110  is percutaneously inserted into a femoral vein of the patient. The guidewire  110  is routed to the inferior vena cava  11  and into the right atrium  12 . After creating an opening in the atrial septum  15  (e.g., a trans-septal puncture of the fossa ovalis or other portion of the atrial septum), the guidewire  110  is routed into the left atrium  16 , and then into the left ventricle  18 . 
     In the depicted implementation, the guide catheter  120  is installed (e.g., via the groin incision  2 , refer to  FIG. 43 ) by pushing it (and other components of delivery system  100 ) over the guidewire  110 . In some implementations, a dilator tip is used in conjunction with the guide catheter  120  as the guide catheter  120  is advanced over the guidewire  110 . Alternatively, a balloon catheter could be used as the initial dilation means. After the distal end of the guide catheter  120  reaches the left atrium  16 , the dilator tip can be withdrawn. 
     In some embodiments, in order to navigate the guidewire  110  from the left atrium  16  to the left ventricle  18 , a catheter with a curved distal tip portion (not shown) is installed over the guidewire  110  within the guide catheter  120 . Also, a balloon-tipped catheter (not shown) can be installed over the guidewire  110  within the catheter with the curved distal tip portion. The curved distal tip portion of the catheter can be used to direct the balloon-tipped catheter into the left ventricle  18  (through the mitral valve  17 ). Such a balloon-tipped catheter can be used advantageously to avoid chordal entanglement as it is advanced through the mitral valve  17 . Thereafter, the guidewire  110  can be advanced through the balloon-tipped catheter and into the left ventricle  18 . In some implementations, the guidewire  110  can be installed into the heart  10  along other anatomical pathways. The guidewire  110  thereafter serves as a rail over which other components of the delivery system  100  are passed. 
     By making various adjustments at the proximal end of the guide catheter  120  (as described further below), a clinician can attain a desirable orientation of the guide catheter  120  in relation to the heart  10 . For example, the guide catheter  120  can be rotated about its longitudinal axis so that the longitudinal axis of the distal-most tip portion of the guide catheter  120  is pointing toward the perpendicular axis of the mitral valve  17 . Such rotational movement of the guide catheter  120  can be performed by the clinician using the deployment system. In addition, in some embodiments a distal end portion of the guide catheter  120  is steerable (also referred to herein as “deflectable”). Using such steering, the distal end portion of the guide catheter  120  can be deflected to navigate the patient&#39;s anatomy and/or to be positioned in relation to the patient&#39;s anatomy as desired. For example, the guide catheter  120  can be angled within the right atrium  12  to navigate the guide catheter  120  from the inferior vena cava  11  to the atrial septum  15 . Accordingly, in some embodiments the guide catheter  120  may include at least one deflection zone  122 . As described further below, a clinician can controllably deflect the deflection zone of the guide catheter  120  as desired. 
     After the guide catheter  120  is oriented within the heart  10  as desired by the clinician, in some embodiments the clinician can releasably lock the guide catheter  120  in the desired orientation. For example, in some embodiments the clinician can releasably lock the guide catheter  120  to a deployment system that is stationary in relation to the patient. 
     Still referring to  FIG. 1 , in some embodiments the guide catheter  120  has an outer diameter of about 28 Fr (about 9.3 mm), or about 30 Fr (about 10.0 mm). In some embodiments, the guide catheter  120  has an outer diameter in the range of about 26 Fr to about 34 Fr (about 8.7 mm to about 11.3 mm). In some embodiments, the guide catheter  120  has an outer diameter in the range of about 20 Fr to about 28 Fr (about 6.7 mm to about 9.3 mm). 
     The guide catheter  120  can comprise a tubular polymeric or metallic material. For example, in some embodiments the guide catheter  120  can be made from polymeric materials such as, but not limited to, polytetrafluoroethylene (PTFE), fluorinated ethylene propylene (FEP), HYTREL®, nylon, PICOFLEX®, PEBAX®, TECOFLEX®, and the like, and combinations thereof. In alternative embodiments, the guide catheter  120  can be made from metallic materials such as, but not limited to, nitinol, stainless steel, stainless steel alloys, titanium, titanium alloys, and the like, and combinations thereof. In some embodiments, the guide catheter  120  can be made from combinations of such polymeric and metallic materials (e.g., polymer layers with metal braid, coil reinforcement, stiffening members, and the like, and combinations thereof). In some embodiments, the guide catheter  120  can comprise a slotted tube. 
     The example delivery system  100  also includes the anchor delivery sheath  130 . In some implementations, after the guide catheter  120  is positioned with its distal end in the left atrium  16 , the anchor delivery sheath  130  is installed into a lumen of the guide catheter  120  (over the guidewire  110 ) and advanced through the guide catheter  120 . As described further below, in some embodiments the anchor delivery sheath  130  is preloaded with a prosthetic valve anchor assembly and other components of the delivery system  100 . 
     In some embodiments, the anchor delivery sheath  130  can be made from the materials described above in reference to the guide catheter  120 . In some embodiments, the anchor delivery sheath  130  has an outer diameter in the range of about 20 Fr to about 28 Fr (about 6.7 mm to about 9.3 mm). In some embodiments, the anchor delivery sheath  130  has an outer diameter in the range of about 14 Fr to about 24 Fr (about 4.7 mm to about 8.0 mm). 
     In the depicted embodiment, the anchor delivery sheath  130  includes a flared distal end portion  132 . In some embodiments, an inverted-flare distal end portion is included. In some embodiments, no such flared distal end portion  132  is included. The flared distal end portion  132  can collapse to a lower profile when constrained within the guide catheter  120 . When the flared distal end portion  132  is expressed from the guide catheter  120 , the flared distal end portion  132  can self-expand to the flared shape. In some embodiments, the material of the flared distal end portion  132  includes pleats or folds, may be a continuous flared end or may be separated into sections resembling flower petals, and may include one or more resilient elements that bias the flared distal end portion  132  to assume the flared configuration in the absence of restraining forces (such as from containment within the guide catheter  120 ). The flared distal end portion  132  can be advantageous, for example, for recapturing (if desired) the anchor assembly within the lumen of the anchor delivery sheath  130  after the anchor assembly has been expressed from the flared distal end portion  132 . In some embodiments, a distal-most portion of the flared distal end portion  132  is everted (which can serve to help facilitate recapture of the anchor delivery sheath  130 ). In some cases, the recapture of the anchor assembly will cause a portion of the flared distal end portion  132  to become everted. 
     In some embodiments, the maximum outer diameter of the flared distal end portion  132  is in a range of about 30 Fr to about 34 Fr (about 10.0 mm to about 11.3 mm). In some embodiments, the maximum outer diameter of the flared distal end portion  132  is in a range of about 32 Fr to about 44 Fr (about 10.7 mm to about 14.7 mm). In some embodiments, the maximum outer diameter of the flared distal end portion  132  is in a range of about 24 Fr to about 30 Fr (about 8.0 mm to about 10.0 mm). In some embodiments, the maximum outer diameter of the flared distal end portion  132  is less than about 24 Fr (about 8.0 mm) or greater than about 44 Fr (about 14.7 mm). 
     Referring to  FIG. 2 , additional components of the example delivery system  100  can include an anchor delivery catheter  140 , a secondary steerable catheter  150 , and an inner catheter  160 . The anchor delivery catheter  140  is slidably disposed within a lumen of the anchor delivery sheath  130 . The secondary steerable catheter  150  is slidably disposed within a lumen of the anchor delivery catheter  140 . The inner catheter  160  is slidably disposed within a lumen of the secondary steerable catheter  150 . The guidewire  110  is slidably disposed within a lumen of the inner catheter  160 . 
     An anchor assembly  200  (shown without covering materials for enhanced visibility) is releasably attached to the inner catheter  160  and is, in effect, slidably disposed on the guidewire  110 . As described further below, the components of the delivery system  100  can be individually or jointly manipulated by a clinician operator to control the position and orientation of the anchor assembly  200  during the deployment of the anchor assembly  200 . In some embodiments, the inner catheter  160  has a filar construct to advantageously configure the inner catheter  160  to transmit torsion forces. In some implementations, a deployment frame system (such as the example deployment frame system in  FIG. 43  described below) is used to initiate and/or control the movements of various components of the transcatheter delivery system  100 . 
     In a preferred implementation of delivery system  100 , the anchor delivery catheter  140 , the secondary steerable catheter  150 , the inner catheter  160 , and the anchor assembly  200  are loaded into the anchor delivery sheath  130  prior to the advancement of the anchor delivery sheath  130  into the guide catheter  120  as shown in  FIG. 1 . That is, in a preferred implementation the anchor delivery catheter  140 , the secondary steerable catheter  150 , the inner catheter  160 , and/or the anchor assembly  200  are already installed in the anchor delivery sheath  130  as the anchor delivery sheath  130  is distally advanced into the guide catheter  120  to attain the arrangement shown in  FIG. 1 . Then the anchor delivery sheath  130  is individually pulled back (proximally) to reveal the anchor delivery catheter  140 , the secondary steerable catheter  150 , the inner catheter  160 , and/or the anchor assembly  200  as shown in  FIG. 2 . The anchor assembly  200  may also be at least partially expanded. In some such implementations, the anchor delivery catheter  140 , the secondary steerable catheter  150 , the inner catheter  160 , and/or the anchor assembly  200  are loaded into the anchor delivery sheath  130  in desired relative rotational orientations (i.e., rotational orientations about the longitudinal axis of the delivery system  100 ). In other implementations, one or more of the anchor delivery catheter  140 , the secondary steerable catheter  150 , the inner catheter  160 , and the anchor assembly  200  are distally advanced into the anchor delivery sheath  130  after the anchor delivery sheath  130  has been advanced into the guide catheter  120  to attain the arrangement shown in  FIG. 1 . 
     The inner catheter  160  is releasably coupled with a hub  210  of the anchor assembly  200 . In some such embodiments, the inner catheter  160  has a threaded distal tip portion  162  ( FIG. 3 ) that threadably engages with a complementary threaded portion of the hub  210 . In some embodiments, as described further below, the inner catheter  160  is also releasably coupled with a SAM containment member  212  (refer, for example, to  FIGS. 8 and 19 ) of the anchor assembly  200 . For example, in some embodiments the threaded distal tip portion  162  of the inner catheter  160  is threadably engaged with a complementary threaded eyelet  214  (e.g.,  FIGS. 16 and 17 ) of the SAM containment member  212 . When a clinician operator desires to uncouple the inner catheter  160  from the SAM containment member  212  and/or the hub  210 , the clinician can apply a torque to the inner catheter  160  to unscrew the threaded distal tip portion  162  from the eyelet  214  and/or the hub  210 . In some embodiments, the inner catheter  160  is a filar construct so as to configure the inner catheter  160  to transmit a torque to facilitate uncoupling the inner catheter  160  from the SAM containment member  212  and/or the hub  210 . In some embodiments, other types of mechanisms are used to releasably couple the delivery system  100  to one or more portions of the anchor assembly  200 . 
     One or more portions of the anchor assembly  200  can also be releasably coupled to one or more catheters of the delivery system  100  by one or more control wires. The one or more control wires can be used to control the anchor assembly  200  (e.g., to control the configuration of the anchor assembly  200 ). For example, the one or more control wires can be used for controlling the diametrical expansion of a self-expanding anchor assembly  200  and/or for controlling the deployment of particular features of the anchor assembly  200 . In the depicted embodiment, a proximal portion of the anchor assembly  200  is releasably coupled to the anchor delivery catheter  140  by a proximal control wire  142   a,  and a mid-body portion of the anchor assembly  200  is releasably coupled to the anchor delivery catheter  140  by a mid-body control wire  142   b.    
     Referring also to  FIGS. 3 and 4 , in the depicted embodiment the proximal control wire  142   a  emerges from and reenters into the anchor delivery catheter  140  at a proximal collar  144   a  that is integral with the anchor delivery catheter  140 , and the distal control wire  142   b  emerges from and reenters into the anchor delivery catheter  140  at a distal collar  144   b  that is integral with the anchor delivery catheter  140 . In some embodiments, the control wires  142   a  and  142   b  pass through lumens in the wall of the anchor delivery catheter  140 , and travel proximally to the deployment control system (e.g., the example deployment frame system shown in  FIG. 43 ). The two ends of each of the control wires  142   a  and  142   b  can be terminated at the deployment control system. At such a deployment control system, the tension on the control wires  142   a  and  142   b  can be manipulated by a clinician to control the configuration of the anchor assembly  200 . In this example, by tightening the control wires  142   a  and/or  142   b,  the anchor assembly  200  will be diametrically contracted, and by loosening the control wires  142   a  and/or  142   b,  the anchor assembly  200  will be permitted to diametrically self-expand (for example, so that each control wire  142   a  and  142   b  can be operated somewhat similar to an adjustable lasso to control expansion of different portions of the anchor assembly at different stages). When the clinician is satisfied with the deployment orientation of the anchor assembly  200 , the control wires  142   a  and  142   b  can be decoupled from the anchor assembly  200  by the clinician. To do so, the clinician can release one end of the control wire  142   a  and/or  142   b  and pull on the other end so that the control wire  142   a  and/or  142   b  becomes disengaged with the anchor assembly  200 . 
       FIG. 4  shows how the control wires  142   a  and  142   b  can be releasably coupled with the anchor assembly  200  in some embodiments. It should be understood that this is merely one exemplary control wire coupling arrangement and various other arrangements for coupling one or more control wires to the anchor assembly  200  are also envisioned within the scope of this disclosure. Various types of attachment elements can be used to releasably couple the control wires  142   a  and  142   b  to the anchor assembly  200 . In the depicted embodiment, suture loops  143  are used as the attachment elements. The suture loops  143  can be constructed of materials such as, but not limited to, ultra-high molecular weight polyethylene, nylon, polypropylene, polybutester, and the like. In some embodiments, two suture loops  143  are used in each location to provide redundancy. The suture loops  143  may be coupled with eyelets on the anchor assembly  200  in some cases. In some embodiments, other types of attachment elements such as, but not limited to, eyelets, grommets, rings, clips, pins, fabric portions, and/or the like, are used as attachment elements. 
     In the depicted embodiment, the proximal control wire  142   a  is releasably coupled with attachment elements associated with structural features located at the proximal end of the anchor assembly  200 . For example, the proximal control wire  142   a  is releasably coupled with attachment elements of three arched atrial holding features  240   a,    240   b,  and  240   c  (e.g., refer to  FIGS. 18-21 ) and three frame lobes  250   a,    250   b,  and  250   c  (e.g., refer to  FIGS. 18-21 ) of the anchor assembly  200 . That is, the proximal control wire  142   a  emerges from the anchor delivery catheter  140  at the proximal collar  144   a,  passes through the attachment elements of the three arched atrial holding features  240   a,    240   b,  and  240   c,  and the three frame lobes  250   a,    250   b,  and  250   c,  and reenters the anchor delivery catheter  140  at the proximal collar  144   a.  By applying tension to the proximal control wire  142   a,  the three arched atrial holding features  240   a,    240   b,  and  240   c,  and the three frame lobes  250   a,    250   b,  and  250   c  can be diametrically drawn inward towards the anchor delivery catheter  140 . In the arrangement depicted in  FIG. 2 , for example, the three arched atrial holding features  240   a,    240   b,  and  240   c,  and the three frame lobes  250   a,    250   b,  and  250   c  are drawn in very closely to the anchor delivery catheter  140 . 
     In the depicted embodiment, the mid-body control wire  142   b  is releasably coupled with attachment elements associated with structural features of the anchor assembly  200  located at the longitudinal middle region of the anchor assembly  200 . For example, the mid-body control wire  142   b  is releasably coupled with attachment elements of four inter-annular connections  270   a,    270   b,    270   c,  and  270   d  (e.g., refer to  FIGS. 18-21 ) and a mid-body portion of the supra-annular ring  250  of the anchor assembly  200 . That is, the mid-body control wire  142   b  emerges from the anchor delivery catheter  140  at the distal collar  144   b,  passes through the attachment elements of the four inter-annular connections  270   a,    270   b,    270   c,  and  270   d,  and the mid-body portion of the supra-annular ring  250 , and reenters the anchor delivery catheter  140  at the distal collar  144   b.  By applying tension to the mid-body control wire  142   b,  the four inter-annular connections  270   a,    270   b,    270   c,  and  270   d,  and the mid-body portion of the supra-annular ring  250  can be diametrically drawn inward towards the anchor delivery catheter  140 . In the arrangement depicted in  FIG. 2 , the four inter-annular connections  270   a,    270   b,    270   c,  and  270   d,  and the mid-body portion of the supra-annular ring  250  are drawn in toward the anchor delivery catheter  140  such that the diameter of the anchor assembly  200  is less than the fully expanded diameter. 
     Diametric control of the anchor assembly  200  by manipulation of the tension of the mid-body control wire  142   b  can be advantageously utilized by a clinician during the deployment of the anchor assembly  200 . For example, as described further below, the steps of advancing the anchor assembly  200  through the annulus of the native mitral valve and seating anchor feet  220   a,    220   b,    220   c,  and  220   d  (e.g., refer to  FIGS. 18-21 ) in the sub-annular gutter  19  ( FIG. 12 ) can be facilitated using the diametric control afforded by the mid-body control wire  142   b.    
     While the depicted embodiment includes two control wires  142   a  and  142   b,  in some embodiments one, three, four, five, or more than five control wires are included. A clinician can separately control the two control wires  142   a  and  142   b.  For example, in some embodiments the mid-body control wire  142   b  may be partially or fully loosened while the proximal control wire  142   a  is maintained in a state of full tension. In some implementations, a deployment frame system (such as the example deployment frame system of  FIG. 43  described below) is used to control the tension and movements of the two control wires  142   a  and  142   b.    
     Still referring to  FIG. 2 , while the components of the delivery system  100  and the anchor assembly  200  are depicted in particular relative orientations and arrangements, it should be understood that the depictions are non-limiting. For example, in some implementations of the deployment process the distal tip of the secondary deflectable catheter  150  may always be, or may sometimes be, abutted to the hub  210  of the anchor assembly  200 . Further, in some implementations of the deployment process the distal tip of the anchor delivery catheter  140  may always be, or may sometimes be, positioned within the interior of the anchor assembly  200 . In some implementations, a deployment frame system (such as the example deployment frame system of  FIG. 43  described below) is used to control such relative arrangements and movements of the anchor delivery catheter  140  and secondary deflectable catheter  150  in relation to the anchor assembly  200 , for example. 
     In some embodiments, the position of the anchor assembly  200  can be controlled by manipulating the relative positions of the inner catheter  160  and/or the anchor delivery catheter  140 . For example, in the depicted embodiment the anchor assembly  200  can be expressed out from the anchor delivery sheath  130  (as shown in  FIG. 2 ) by moving the inner catheter  160  and/or the anchor delivery catheter  140  distally in relation to the anchor delivery sheath  130 . In some implementations, the expression of the anchor assembly  200  is caused by proximally pulling back the anchor delivery sheath  130  while generally maintaining the positions of the inner catheter  160  and/or the anchor delivery catheter  140 . In some implementations, the expression of the anchor assembly  200  is caused by a combination of proximally pulling back the anchor delivery sheath  130  while distally extending the positions of the inner catheter  160  and/or the anchor delivery catheter  140 . 
     As the anchor assembly  200  emerges from the confines of the anchor delivery sheath  130 , the anchor assembly  200  may expand from a low-profile delivery configuration to an at least partially expanded configuration (for example, a partially expanded condition, as shown in  FIG. 2 , that is less that its fully expanded condition as described in more detail below). In addition to control by manipulation of the mid-body control wire  142   b,  the extent of expansion of the anchor assembly  200  can also be at least partially controlled by the relative positioning of the anchor delivery catheter  140  in relation to the inner catheter  160 . For instance, as the anchor delivery catheter  140  is moved proximally in relation to the inner catheter  160 , the anchor assembly  200  is axially elongated and radially contracted. Conversely, as the anchor delivery catheter  140  is moved distally in relation to the inner catheter  160 , the anchor assembly  200  is axially shortened and radially expanded. In some implementations, this control of the radial size of the anchor assembly  200  is used by a clinician during the process of deploying the anchor assembly  200  within the native mitral valve  17 , as described further below. As described above, the one or more control wires  142   a  and  142   b  can also be used to control diametrical expansion of the anchor assembly  200  (without changing the relative distance of the anchor delivery catheter  140  in relation to the inner catheter  160 ). 
     It should be understood that the prosthetic mitral valves provided herein are comprised of an anchor assembly  200  and a separate valve assembly (e.g., refer to FIG. 
       37 ). The anchor assembly  200  is deployed to an arrangement interfacing within the native mitral valve  17  prior to deployment of the valve assembly. Said differently, after implanting the anchor assembly  200  within the native mitral valve  17 , the valve assembly can then be deployed within the anchor assembly  200  and within the native mitral valve  17  (as described further below). Therefore, it can be said that the prosthetic mitral valves provided herein are deployed using a staged implantation method. That is, the anchor assembly  200  is deployed in one stage, and the valve assembly is deployed in a subsequent stage. In some embodiments, as described further below, the SAM containment member  212  is also deployed as part of the deployment method. In some implementations, the deployment of the valve assembly takes place right after the deployment of the anchor assembly  200  (e.g., during the same medical procedure). In some implementations, the deployment of the valve assembly takes place hours, days, weeks, or even months after the deployment of the anchor assembly  200  (e.g., during a subsequent medical procedure). 
     The staged implantation method of the prosthetic mitral valves provided herein is facilitated by the fact that when the anchor assembly  200  itself is implanted within the native mitral valve  17 , the native mitral valve  17  continues to function essentially as before the implantation of the anchor assembly  200  without a significant impact on cardiovascular physiology. That is the case because, as described further below, the anchor assembly  200  interfaces and anchors within structural aspects of the native mitral valve  17  without substantially interfering with the leaflets or chordae tendineae of the native mitral valve  17 . 
     Still referring to  FIG. 2 , in the depicted arrangement the distal end portion of the secondary steerable catheter  150  is located at least partially internally within the anchor assembly  200 . The secondary steerable catheter  150  can be manipulated by a clinician operator to reversibly bend (deflect) the distal end portion of the secondary steerable catheter  150 . As the secondary steerable catheter  150  is bent by the clinician, other components of the delivery system  100  may deflect along with the secondary steerable catheter  150 . For example, portions of one or more of the inner catheter  160  and the anchor delivery catheter  140  may bend in response to the bending of the deflectable catheter  150 . Because the anchor assembly  200  is coupled to the inner catheter  160  and the anchor delivery catheter  140 , the anchor assembly  200  can, in turn, be pivoted or “panned” by bending the secondary steerable catheter  150 . 
     Referring to  FIG. 5 , as described above, in some embodiments the secondary steerable catheter  150  can be articulated (also referred to as “steered,” “deflected,” “bent,” “curved,” and the like) to orient the anchor assembly  200  in relation to the mitral valve  17  as desired. That is, in some embodiments the secondary steerable catheter  150  has one or more deflection zones at a distal end portion of the secondary steerable catheter  150 . For example, in the depicted embodiment the secondary steerable catheter  150  has two deflection zones  152  and  154  (refer to  FIG. 7 ) at the distal end portion of the secondary steerable catheter  150 . In some embodiments, the two deflection zones  152  and  154  allow for deflection of the distal end portion of the secondary steerable catheter  150  within two separate and distinct planes. For example, in the depicted embodiment deflection zone  152  allows for deflection of the distal end portion of the secondary steerable catheter  150  generally within the plane of  FIGS. 1, 2, and 5 , while deflection zone  154  allows for deflection of the distal end portion of the secondary steerable catheter  150  generally orthogonal to the plane of  FIGS. 1, 2, and 5 . In some implementations, a deployment frame system (such as the example deployment frame system of  FIG. 43  described below) is used to initiate and control such deflection of the secondary steerable catheter  150 , including deflection of the distal end portion of the secondary steerable catheter  150  within two separate and distinct planes, individually. 
     In some implementations, it is desirable to orient (e.g., laterally pivot, pan, etc.) the anchor assembly  200  within the atrium  16  so that the longitudinal axis of the anchor assembly  200  is generally perpendicular to the native mitral valve  17 , and coaxial with the native mitral valve  17  (e.g., to center the anchor assembly  200  with the line or coaptation of the mitral valve  17 ). The orienting of the partially or fully expanded anchor assembly  200  within the atrium  16  may be advantageous versus having to orient the anchor assembly  200  while it is still constrained within a delivery sheath, as the latter assembly is a relatively large and stiff catheter assembly. 
     In some implementations, the anchor assembly  200  within the atrium  16  can be additionally, or alternatively, oriented in relation to the native mitral valve  17  by rotating the guide catheter  120  about its longitudinal axis. Such a rotation of the guide catheter  120  about its longitudinal axis can result in a directional adjustment of the longitudinal axis of the distal tip portion of the guide catheter  120 . That is, rotation of the guide catheter  120  about its longitudinal axis can result in pointing the distal tip portion of the guide catheter  120  (and the components of the delivery system  100 ) in a desired direction within the atrium  16 . In some implementations, a deployment frame system is used to initiate and control such rotation of the guide catheter  120  about its longitudinal axis. 
     In some implementations, the relative rotational alignment of the anchor assembly  200  in relation to the mitral valve  17  can be adjusted as desired in preparation for engaging the anchor assembly  200  with the native mitral valve  17 . For example, in some implementations the anchor assembly  200  can be rotated about its longitudinal axis by rotating the inner catheter  160  and the anchor delivery catheter  140  generally in unison, while keeping the secondary steerable catheter  150  essentially stationary. In some implementations, a deployment frame system (such as the example deployment frame systems described below) is used to initiate and control such rotation of the anchor assembly  200  about its longitudinal axis. 
     In preparation for engaging the anchor assembly  200  with the native mitral valve  17 , the clinician operator may manipulate the radial size of the anchor frame  200  so that the anchor frame  200  can be passed through the native mitral valve  17  without damaging the native mitral valve  17 . For example, the clinician can diametrically expand or retract one or more portions of the anchor assembly  200  by manipulation of the mid-body control wire  142   b.  Alternatively, or additionally, the clinician can move the anchor delivery catheter  140  proximally in relation to the inner catheter  160  to radially contract the anchor assembly  200 . With the anchor assembly  200  configured in a desired diametrical size, and appropriately aligned with the mitral valve  17 , the anchor frame  200  can be safely passed through the native mitral valve  17  without damaging the native mitral valve  17  and/or entangling chordae tendineae of the mitral valve  17 . Moreover, by controlling the diametrical size of the anchor assembly  200  to just slightly less than the size of the annulus of the mitral valve  17 , an advantageous natural centering of the anchor assembly  200  can occur as the sub-annular portions of the anchor assembly  200  are advanced through the mitral valve  17 . 
     Referring to  FIG. 7 , a commissural cross-sectional view of the heart  10  provides another perspective of the anchor assembly  200  in relation to the native mitral valve  17 . This commissural cross-sectional view of the heart  10  is a cross-sectional view taken through the mitral valve  17  along a plane through the left atrium  16  and left ventricle  18  that is parallel to the line that intersects the two commissures of the mitral valve. In the following  FIGS. 8-11 and 25-30 , the commissural cross-sectional view of the heart  10  will be used to describe the delivery system  100  and methods for deploying the prosthetic mitral valves provided herein. The view in  FIGS. 7-11 and 25-30  is slightly tilted so that better visualization of the anchor assembly  200  is provided. 
     While the secondary steerable catheter  150  is retained in its bent (deflected) configuration as described in reference to  FIG. 5 , the inner catheter  160  and the anchor delivery catheter  140  can be simultaneously advanced. Because the inner catheter  160  is releasably coupled to the hub  210  of the anchor assembly  200 , and because the anchor delivery catheter  140  is releasably coupled to the proximal end and the mid-body region of the anchor assembly  200  via the control wires  142   a  and  142   b,  generally simultaneous advancement of the inner catheter  160  and the anchor delivery catheter  140  results in advancement of the anchor assembly  200 . 
     In preparation for the advancement of the distal portions of the anchor assembly  200  through the annulus of the mitral valve  17 , the mid-body control wire  142   b  can be manipulated to adjust a mid-body diameter D 1  of the anchor assembly  200  to a desired size. For example, in some implementations it is desirable to adjust the mid-body diameter D 1  to size that is slightly smaller than the size of the annulus of the mitral valve  17 . In such a case, while advancing the distal portions of the anchor assembly  200  through the annulus of the mitral valve  17 , a self-centering of the anchor assembly  200  in relation to the mitral valve  17  may naturally occur. 
     As depicted, the anchor assembly  200  is advanced such that the distal end portions of anchor assembly  200  are positioned within the left ventricle  18  while the proximal end portions of the anchor assembly  200  remain positioned within the left atrium  16 . Hence, some portions of the anchor assembly  200  are on each side of the native mitral valve  17 . Said differently, the deployed anchor assembly  200  includes supra-annular portions and sub-annular portions. 
     In the depicted embodiment, the anchor assembly  200  includes four anchor feet: a lateral anterior foot  220   a,  a lateral posterior foot  220   b,  a medial posterior foot  220   c,  and a medial anterior foot  220   d  (refer also to  FIGS. 18-21 ). In some embodiments, fewer or more anchor feet may be included (e.g., two, three, five, six, or more than six). In some embodiments, the anchor feet  220   a,    220   b,    220   c,  and  220   d  are portions of the anchor assembly  200  that are configured for contact with a sub-annular gutter  19  (also refer to  FIG. 12 ) of the native mitral valve  17 , without penetrating tissue of the native mitral valve  17 . Accordingly, the anchor feet  220   a,    220   b,    220   c,  and  220   d  have atraumatic surfaces that are generally comparable to feet. However, in some embodiments one or more of the anchor feet  220   a,    220   b,    220   c,  and  220   d  are configured to penetrate tissue and may have anchor features such as barbs, coils, hooks, and the like. 
     In the arrangement of  FIG. 7 , the anchor feet  220   a,    220   b,    220   c,  and  220   d  are positioned below the sub-annular gutter  19 . In this arrangement then, the mid-body diameter D 1  of the anchor assembly  200  can thereafter be increased to align the anchor feet  220   a,    220   b,    220   c,  and  220   d  with the sub-annular gutter  19 . For example, in some embodiments the mid-body control wire  142   b  positioned on or around the mid-body portion of the anchor assembly  200  can be manipulated (e.g., slackened) to allow radial self-expansion of the anchor assembly  200 , to align the anchor feet  220   a,    220   b,    220   c,  and  220   d  with the sub-annular gutter  19 . Alternatively, or additionally, in some embodiments the clinician can move the anchor delivery catheter  140  distally in relation to the inner catheter  160  to radially expand the anchor assembly  200  to align the anchor feet  220   a,    220   b,    220   c,  and  220   d  with the sub-annular gutter  19 . Such alignment can be performed in preparation for seating the anchor feet  220   a,    220   b,    220   c,  and  220   d  within the sub-annular gutter  19 . 
     Referring to  FIG. 8 , the anchor feet  220   a,    220   b,    220   c,  and  220   d  are positioned below the sub-annular gutter  19 . In this position, the anchor feet  220   a,    220   b,    220   c,  and  220   d  are positioned under the systolic and diastolic excursions of the leaflets of the native mitral valve  17 . 
     With the anchor feet  220   a,    220   b,    220   c,  and  220   d  positioned below the sub-annular gutter  19 , the anchor feet  220   a,    220   b,    220   c,  and  220   d  can be aligned with the sub-annular gutter  19  in preparation for seating the anchor feet  220   a,    220   b,    220   c,  and  220   d  within the sub-annular gutter  19 . For example, to align the anchor feet  220   a,    220   b,    220   c,  and  220   d  with the sub-annular gutter  19 , in some implementations tension from the mid-body control wire  142   b  can be relieved by the clinician to allow the mid-body diameter to expand from D 1  ( FIGS. 7 ) to D 2 . When the anchor assembly  200  has a mid-body diameter D 2 , the anchor feet  220   a,    220   b,    220   c,  and  220   d  are posed in diametrical positions for seating within the sub-annular gutter  19 . 
     Referring to  FIG. 9 , the inner catheter  160  and the anchor delivery catheter  140  can be simultaneously retracted while maintaining the secondary steerable catheter  150  and the guide catheter  120  in fixed positions. As a result, the anchor feet  220   a,    220   b,    220   c,  and  220   d  become seated in the sub-annular gutter  19 . As described further below, simultaneous movement of two or more components of the delivery system  100  (e.g., the inner catheter  160  in conjunction with the anchor delivery catheter  140 , while maintaining the secondary steerable catheter  150  and the guide catheter  120  in fixed positions) can be initiated and controlled using a deployment frame system (such as the example deployment frame system of  FIG. 43  described below). 
     With the anchor feet  220   a,    220   b,    220   c,  and  220   d  seated in the sub-annular gutter  19 , the anchor feet  220   a,    220   b,    220   c,  and  220   d  are positioned under the systolic and diastolic excursions of the leaflets of the native mitral valve  17 , and the other structures of the anchor assembly  200  do not inhibit the movements of the leaflets. Therefore, with the anchor assembly  200  coupled to the structures of the mitral valve  17  as described, the mitral valve  17  can continue to function as it did before the placement of the anchor assembly  200 . In addition, the manner in which the anchor assembly  200  interfaces with the native mitral valve  17  does not result in deformation of the native mitral valve  17 . With the SAM containment member  212  in its pre-deployed configuration, the SAM containment member  212  does not affect the natural function of the native mitral valve  17 . Therefore, the native mitral valve  17  can continue to function as it did before the placement of the anchor assembly  200 . 
     Referring to  FIG. 10 , with the anchor assembly  200  engaged within the native mitral valve  17 , components of the delivery system  100  can be uncoupled from the anchor assembly  200 . For example, the one or more control wires  142   a  and  142   b  ( FIGS. 2-5 and 7-9 ) can be uncoupled from the anchor assembly  200  (e.g., from the mid-body and proximal end portions of the anchor assembly  200  in some embodiments). As described further below, in some embodiments the frame members of the anchor assembly  200  can be made of an elastic or a super-elastic material with shape memory such that portions of the anchor assembly  200  self-expand/deploy to intended orientations in the absence of constraining forces, such as constraining forces from the control wires  142   a  and/or  142   b.    
     In the depicted embodiment, when the mid-body control wire  142   b  is uncoupled from the anchor assembly  200 , the mid-body regions of the anchor assembly  200  are no longer diametrically constrained by the mid-body control wire  142   b.  Hence, mid-body regions of the anchor assembly  200  are allowed to diametrically expand when the mid-body control wire  142   b  is uncoupled from the anchor assembly  200 . 
     When the proximal control wire  142   a  is loosened and/or detached from one or more proximal end portions of the anchor assembly  200 , the one or more portions that were coupled to the proximal control wire  142   a  become free to expand and deploy to intended orientations in relation to the mitral valve  17 . For example, in the depicted embodiment, the proximal control wire  142   a  was coupled to three arched atrial holding features  240   a,    240   b,  and  240   c.  When the proximal control wire  142   a  is uncoupled (e.g., slid out from or “un-lassoed”) from the three arched atrial holding features  240   a,    240   b,  and  240   c,  the three arched atrial holding features  240   a,    240   b,  and  240   c  are free to deploy to their intended orientations in relation to the mitral valve  17 . The three arched atrial holding features  240   a,    240   b,  and  240   c  deploy generally radially outward (transversely) in relation to the longitudinal axis (the axis extending between the proximal and distal ends of the anchor assembly  200 ) of the anchor assembly  200 . Hence, in the depicted embodiment the three arched atrial holding features  240   a,    240   b,  and  240   c  self-deploy to respective positions directly adjacent to, or spaced apart just above, the annulus of the mitral valve  17 . In those positions, the three arched atrial holding features  240   a,    240   b,  and  240   c  resist migration of the anchor assembly  200  towards the left ventricle  18 . 
     In addition, in the depicted embodiment when the proximal control wire  142   a  is loosened and subsequently detached from the three frame lobes  250   a,    250   b,  and  250   c,  the three frame lobes  250   a,    250   b,  and  250   c  become free to expand and deploy to intended orientations. In the depicted embodiment the three frame lobes  250   a,    250   b,  and  250   c  diametrically expand into positions that are designed to interface with a valve assembly that will be deployed into a mating arrangement with the anchor assembly  200  as described further below. 
     In the depicted arrangement, the anchor assembly  200  is deployed in engagement with the native mitral valve  17 . Nevertheless, the native mitral valve  17  is free to function normally. Moreover, in the depicted arrangement, while the inner catheter  160  is still coupled with the anchor assembly  200  at the hub  210 , the anchor delivery catheter  140  (and other components of the transcatheter delivery system  100 ) are no longer attached to the anchor assembly  200 . Hence, some components of the transcatheter delivery system  100  that were used to deploy the anchor assembly  200  can now be retracted and removed from the patient. 
     Referring also to  FIG. 11 , with the anchor assembly  200  deployed within the mitral valve  17  (as described above), the anchor delivery catheter  140  can be withdrawn, the secondary steerable catheter  150  can be withdrawn, and the anchor delivery sheath  130  can also be withdrawn. In fact, if so desired, the anchor delivery catheter  140 , the secondary steerable catheter  150 , and the anchor delivery sheath  130  can be completely withdrawn from the guide catheter  120 . In contrast, in some implementations the inner catheter  160  is advantageously left attached to the hub  210  of the anchor assembly  200  (and left attached to the SAM containment member  212  in some implementations). As will be described further below, in some implementations the inner catheter  160  can be used as a “rail” on which a valve assembly is later deployed into the interior of the anchor assembly  200 . However, in some implementations the anchor assembly  200  is completely detached from the delivery system  100 , and the delivery system  100  is removed from the patient. After a period of minutes, hours, days, weeks, or months, subsequent to the deployment of the anchor assembly  200 , a valve assembly can be installed into the anchor assembly  200  to complete the installation of the prosthetic mitral valve. 
     In some implementations, withdrawal of the anchor delivery catheter  140 , the secondary steerable catheter  150 , and the anchor delivery sheath  130  can be performed as follows. First, the anchor delivery catheter  140  can be withdrawn into the anchor delivery sheath  130 . Then, the secondary steerable catheter  150  can be withdrawn into the anchor delivery sheath  130  while generally simultaneously undeflecting (relaxing) the bend(s) in the secondary steerable catheter  150 . Thereafter, in some embodiments the anchor delivery catheter  140 , the secondary steerable catheter  150 , and the anchor delivery sheath  130  can be simultaneously withdrawn further, including up to completely from the guide catheter  120 . As described further below, such individual and/or simultaneous movements of components of the delivery system  100  can be initiated and controlled using a deployment frame system (such as the example deployment frame system of  FIG. 43  described below) in some implementations. 
     In the depicted implementation, the SAM containment member  212  is still restrained in its pre-deployed configuration. As described further below, in some embodiments the depicted embodiment of the SAM containment member  212  is deployed after the installation of a valve assembly into the anchor assembly  200 . Alternatively, as described further below, in some embodiments of the SAM containment member  212 , the SAM containment member  212  is deployed prior to the installation of a valve assembly into the anchor assembly  200 . 
     Referring to  FIG. 12 , the anatomy of the native mitral valve  17  includes some consistent and predictable structural features across patients that can be utilized for engaging the anchor assembly  200  therewith. For example, the native mitral valve  17  includes the aforementioned sub-annular gutter  19 . In addition, the native mitral valve  17  includes a D-shaped annulus  28 , an anterolateral commissure  30   a,  a posteromedial commissure  30   b,  a left fibrous trigone  134   a,  and a right fibrous trigone  134   b.  Further, the native mitral valve  17  includes an anterior leaflet  20  and a three-part posterior leaflet  22 . The posterior leaflet  22  includes a lateral scallop  24   a,  a middle scallop  24   b,  and a medial scallop  24   c.  The free edges of the posterior leaflet  22  and the anterior leaflet  20  meet along a coaptation line  32 . 
     The D-shaped annulus  28  defines the structure from which the anterior leaflet  20  and posterior leaflet  22  extend and articulate. The left and right fibrous trigones  134   a  and  134   b  are located near the left and right ends of the anterior leaflet  20  and generally adjacent the lateral and medial scallops  24   a  and  24   c  of the posterior leaflet  22 . The sub-annular gutter  19  runs along the annulus  28  between the left and right fibrous trigones  134   a  and  134   b  along the posterior leaflet  22 . 
     The regions at or near the high collagen annular trigones  134   a  and  134   b  can generally be relied upon to provide strong, stable anchoring locations. The muscle tissue in the regions at or near the trigones  134   a  and  134   b  also provides a good tissue ingrowth substrate for added stability and migration resistance of the anchor assembly  200 . Therefore, the regions at or near the trigones  134   a  and  134   b  define a left anterior anchor zone  34   a  and a right anterior anchor zone  34   d  respectively. The left anterior anchor zone  34   a  and the right anterior anchor zone  34   d  provide advantageous target locations for placement of the lateral anterior foot  220   a  and the medial anterior foot  220   d  respectively. 
     Referring also to  FIG. 13 , a schematic representation of the anchor assembly  200  is shown in combination with the native mitral valve  17  of  FIG. 12 . The depicted portions of the anchor assembly  200  include the hub  210 , the lateral anterior anchor foot  220   a,  the lateral posterior anchor foot  220   b,  the medial posterior anchor foot  220   c,  the medial anterior anchor foot  220   d,  the lateral anterior sub-annular support arm  230   a,  the lateral posterior sub-annular support arm  230   b,  the medial posterior sub-annular support arm  230   c,  and the medial anterior sub-annular support arm  230   d.  Each of those portions of the anchor assembly  200  reside below the mitral valve  17  when deployed, hence those portions of the anchor assembly  200  are drawn with dashed lines. 
     In the depicted embodiment, the lateral anterior sub-annular support arm  230   a  extends from the hub  210 . The lateral anterior anchor foot  220   a  is disposed on an outer end of the lateral anterior sub-annular support arm  230   a.  Similarly, the medial anterior sub-annular support arm  230   d  extends from the hub  210 , and the medial anterior anchor foot  220   d  is disposed on an outer end of the medial anterior sub-annular support arm  230   d.  The lateral posterior sub-annular support arm  230   b  extends from a middle portion of the lateral anterior sub-annular support arm  230   a.  The lateral posterior anchor foot  220   b  is disposed on an outer end of the lateral posterior sub-annular support arm  230   b.  The medial posterior sub-annular support arm  230   c  extends from a middle portion of the medial anterior sub-annular support arm  230   d.  The medial posterior anchor foot  220   c  is disposed on an outer end of the medial posterior sub-annular support arm  230   c.    
     The depicted arrangement of the sub-annular support arms  230   a,    230   b,    230   c,  and  230   d  is advantageous because the arrangement is designed to reduce or minimize the potential for interference (by the anchor assembly  200 ) with the natural functioning of the chordae tendineae of the mitral valve  17 . For example, the lateral posterior sub-annular support arm  230   b  and the medial posterior sub-annular support arm  230   c  are aligned generally parallel with the chordae tendineae in the areas where the posterior sub-annular support arms  230   b  and  230   c  are disposed. 
     Moreover, other sub-annular portions of the anchor assembly are also positioned in advantageous locations for interfacing with the native mitral valve  17 . For example, the hub  210  is advantageously positioned generally directly below the coaptation line  32 . In addition, the lateral anterior anchor foot  220   a  can be positioned in the left anterior anchor zone  34   a  and the medial anterior anchor foot  220   d  can be positioned in the right anterior anchor zone  34   d.  Further, the lateral posterior anchor foot  220   b  and the medial posterior anchor foot  220   c  can be positioned in posterior areas of the sub-annular gutter  19 , namely a lateral posterior anchor zone  34   b  and a medial posterior anchor zone  34   c,  respectively, in order to provide balanced and atraumatic coupling of the anchor assembly  200  to the native mitral valve  17 . In some implementations, the locations of the lateral posterior anchor zone  34   b  and the medial posterior anchor zone  34   c  may vary from the depicted locations while still remaining within the sub-annular gutter  19 . It should be understood that the depicted anchor assembly  200  is merely one non-limiting example of the anchor assemblies provided within the scope of this disclosure. 
     With reference to  FIGS. 14 and 15 , the example anchor assembly  200  is shown in a sheet material that represents the annular plane of a native mitral valve, to more clearly show which structures are supra-annular vs. sub-annular. A covering-material  270  is included on the framework of the anchor assembly  200 . The supra-annular structures of the example anchor assembly  200  are shown. 
     In the depicted embodiment, the supra-annular structures of the anchor assembly  200  include: the lateral anterior atrial holding feature  240   a,  the posterior atrial holding feature  240   b,  and the medial anterior atrial holding feature  240   c;  the lateral anterior anchor arch  250   a,  the posterior anchor arch  250   b,  and the medial anterior anchor arch  250   c.  The lateral anterior anchor arch  250   a,  the posterior anchor arch  250   b,  and the medial anterior anchor arch  250   c  are joined with each other to form an undulating supra-annular ring  250  that acts as a supra-annular structural element for the anchor assembly  200 . As will be described further below, the supra-annular ring  250  also defines an opening to a space within the interior of the anchor assembly  200  that is configured to receive and engage with a valve assembly. The atrial holding features  240   a,    240   b,  and  240   c  are configured to contact the shelf-like supra-annular tissue surface above the mitral valve annulus, and to thereby stabilize the anchor assembly  200  in supra-annular areas and to provide migration resistance in the direction towards the left ventricle. 
     In some embodiments, the anchor assembly  200  includes a covering material  270  disposed on one or more portions of the anchor assembly  200 . The covering material  270  can provide various benefits. For example, in some implementations the covering material  270  can facilitate tissue ingrowth and/or endothelialization, thereby enhancing the migration resistance of the anchor assembly  200  and preventing thrombus formation on blood contact elements. In another example, as described further below, the covering material  270  can be used to facilitate coupling between the anchor assembly  200  and a valve assembly that is received therein. The cover material  270  also prevents or minimizes abrasion and/or fretting between the anchor assembly  200  and valve assembly  300 . The cover material  270  also prevents valve outer tissue abrasion related wear, and supports to the cuff material to enhance durability. The covering material  270  may also provide redundant sealing in addition to the cuff material of the valve assembly. 
     In the depicted embodiment, the covering material  270  is disposed essentially on the entire anchor assembly  200 , including the SAM containment member  212  (except for the eyelet  214 , although in some embodiments the eyelet  214  may be essentially covered by the covering material  270 ). In some embodiments, the covering material  270  is disposed on one or more portions of the anchor assembly  200 , while one or more other portions of the anchor assembly  200  do not have the covering material  270  disposed thereon. While the depicted embodiment includes the covering material  270 , the covering material  270  is not required in all embodiments. In some embodiments, two or more portions of covering material  270 , which can be separated and/or distinct from each other, can be disposed on the anchor assembly  200 . That is, in some embodiments a particular type of covering material  270  is disposed on some areas of the anchor assembly  200  and a different type of covering material  270  is disposed on other areas of the anchor assembly  200 . 
     In some embodiments, the covering material  270 , or portions thereof, comprises a fluoropolymer, such as an expanded polytetrafluoroethylene (ePTFE) polymer. In some embodiments, the covering material  270 , or portions thereof, comprises a polyester, a silicone, a urethane, ELAST-EON™ (a silicone and urethane polymer), another biocompatible polymer, DACRON®, polyethylene terephthalate (PET), copolymers, or combinations and subcombinations thereof. In some embodiments, the covering material  270  is manufactured using techniques such as, but not limited to, extrusion, expansion, heat-treating, sintering, knitting, braiding, weaving, chemically treating, and the like. In some embodiments, the covering material  270 , or portions thereof, comprises a biological tissue. For example, in some embodiments the covering material  270  can include natural tissues such as, but not limited to, bovine, porcine, ovine, or equine pericardium. In some such embodiments, the tissues are chemically treated using glutaraldehyde, formaldehyde, or triglycidylamine (TGA) solutions, or other suitable tissue crosslinking agents. 
     In the depicted embodiment, the covering material  270  is disposed on the interior and the exterior of the anchor assembly  200 . In some embodiments, the covering material  270  is disposed on the just the exterior of the anchor assembly  200 . In some embodiments, the covering material  270  is disposed on the just the interior of the anchor assembly  200 . In some embodiments, some portions of the anchor assembly  200  are covered by the covering material  270  in a different manner than other portions of the anchor assembly  200 . 
     In some embodiments, the covering material  270  is attached to at least some portions of the anchor assembly  200  using an adhesive. In some embodiments, epoxy is used as an adhesive to attach the covering material  270  to the anchor assembly  200 , or portions thereof. In some embodiments, wrapping, stitching, lashing, banding, and/or clips, and the like can be used to attach the covering material  270  to the anchor assembly  200 . In some embodiments, a combination of techniques are used to attach the covering material  270  to the anchor assembly  200 . 
     In some embodiments, the covering material  270 , or portions thereof, has a microporous structure that provides a tissue ingrowth scaffold for durable sealing and/or supplemental anchoring strength of the anchor assembly  200 . In some embodiments, the covering material  270  is made of a membranous material that inhibits or reduces the passage of blood through the covering material  270 . In some embodiments, the covering material  270 , or portions thereof, has a material composition and/or configuration that inhibits or prevents tissue ingrowth and/or endothelialization to the covering material  270 . 
     In some embodiments, the covering material  270  can be modified by one or more chemical or physical processes that enhance certain physical properties of the covering material  270 . For example, a hydrophilic coating may be applied to the covering material  270  to improve the wettability and echo translucency of the covering material  270 . In some embodiments, the covering material  270  may be modified with chemical moieties that promote or inhibit one or more of endothelial cell attachment, endothelial cell migration, endothelial cell proliferation, and resistance to thrombosis. In some embodiments, the covering material  270  may be modified with covalently attached heparin or impregnated with one or more drug substances that are released in situ. 
     In some embodiments, covering material  270  is pre-perforated to modulate fluid flow through the covering material  270  and/or to affect the propensity for tissue ingrowth to the covering material  270 . In some embodiments, the covering material  270  is treated to make the covering material  270  stiffer or to add surface texture. In some embodiments, selected portions of the covering material  270  are so treated, while other portions of the covering material  270  are not so treated. Other covering material  270  material treatment techniques can also be employed to provide beneficial mechanical properties and tissue response interactions. In some embodiments, portions of the covering material  270  have one or more radiopaque markers attached thereto to enhance in vivo radiographic visualization. 
     In some embodiments, the anchor assembly  200  can include features that are designed for coupling with a valve assembly that is received by the anchor assembly  200 . For example, the lateral anterior anchor arch  250   a,  the posterior anchor arch  250   b,  and the medial anterior anchor arch  250   c  can be shaped and arranged for coupling with a valve assembly (as described further below). In addition, in some embodiments the anchor arches  250   a,    250   b,  and  250   c  can include one or more covering-material cut-outs  252   a,    252   b,  and  252   c  respectively. In some embodiments, the valve assembly (as described further below in reference to  FIG. 38 ) can include features that become physically disposed within the covering-material cut-outs  252   a,    252   b,  and  252   c  when the valve assembly is coupled with the anchor assembly  200 . Such an arrangement can serve to provide a robust coupling arrangement between the valve assembly and the anchor assembly  200 . 
     With reference to  FIGS. 16 and 17 , the example anchor assembly  200  is shown in a sheet material that represents the annular plane of a native mitral valve. The sub-annular portions of the example anchor assembly  200  are shown. 
     In the depicted embodiment, the sub-annular portions of the anchor assembly  200  include the hub  210 , the SAM containment member  212 , the lateral anterior anchor foot  220   a,  the lateral posterior anchor foot  220   b,  the medial posterior anchor foot  220   c,  the medial anterior anchor foot  220   d,  the lateral anterior sub-annular support arm  230   a,  the lateral posterior sub-annular support arm  230   b,  the medial posterior sub-annular support arm  230   c,  and the medial anterior sub-annular support arm  230   d.  Each of those portions of the anchor assembly  200  reside below the native mitral valve annulus when deployed the anchor assembly  200  is deployed in a native mitral valve. 
     In the depicted embodiment, the lateral anterior sub-annular support arm  230   a  extends from the hub  210 . The lateral anterior anchor foot  220   a  is disposed on an outer end of the lateral anterior sub-annular support arm  230   a.  Similarly, the medial anterior sub-annular support arm  230   d  extends from the hub  210 , and the medial anterior anchor foot  220   d  is disposed on an outer end of the medial anterior sub-annular support arm  230   d.  The lateral posterior sub-annular support arm  230   b  extends from a middle portion of the lateral anterior sub-annular support arm  230   a.  The lateral posterior anchor foot  220   b  is disposed on an outer end of the lateral posterior sub-annular support arm  230   b.  The medial posterior sub-annular support arm  230   c  extends from a middle portion of the medial anterior sub-annular support arm  230   d.  The medial posterior anchor foot  220   c  is disposed on an outer end of the medial posterior sub-annular support arm  230   c.  A first end of the SAM containment member  212  extends from the lateral anterior sub-annular support arm  230   a,  and a second end of the SAM containment member  212  extends from the medial anterior sub-annular support arm  230   d.    
     Referring to  FIGS. 18-21 , the frame of an example anchor assembly  200  is shown in its fully expanded configuration. The anchor assembly  200  is shown without a covering-material so that the elongate member framework of the example anchor assembly  200  is clearly visible in  FIGS. 18-20 , and with covering-material in  FIG. 21 . 
     In some embodiments, the elongate members of the anchor assembly  200  are formed from a single piece of precursor material (e.g., sheet or tube) that is cut, expanded, and connected to the hub  210 . For example, some embodiments are fabricated from a tube that is laser-cut (or machined, chemically etched, water-jet cut, etc.) and then expanded and shape-set into its final expanded size and shape. In some embodiments, the anchor assembly  200  is created compositely from multiple elongate members (e.g., wires or cut members) that are joined together with the hub  210  and each other to form the anchor assembly  200 . 
     The elongate members of the anchor assembly  200  can be comprised of various materials and combinations of materials. In some embodiments, nitinol (NiTi) is used as the material of the elongate members of the anchor assembly  200 , but other materials such as stainless steel, L605 steel, polymers, MP35N steel, stainless steels, titanium, cobalt/chromium alloy, polymeric materials, Pyhnox, Elgiloy, or any other appropriate biocompatible material, and combinations thereof can be used. The super-elastic properties of NiTi make it a particularly good candidate material for the elongate members of the anchor assembly  200  because, for example, NiTi can be heat-set into a desired shape. That is, NiTi can be heat-set so that the anchor assembly  200  tends to self-expand into a desired shape when the anchor assembly  200  is unconstrained, such as when the anchor assembly  200  is deployed out from the anchor delivery sheath  130 . A anchor assembly  200  made of NiTi, for example, may have a spring nature that allows the anchor assembly  200  to be elastically collapsed or “crushed” to a low-profile delivery configuration and then to reconfigure to the expanded configuration as shown in  FIGS. 18-20 . The anchor assembly  200  may be generally conformable, fatigue resistant, and elastic such that the anchor assembly  200  can conform to the topography of the surrounding tissue when the anchor assembly  200  is deployed in a native mitral valve of a patient. 
     In some embodiments, the diameter or width/thickness of one or more of the elongate members forming the anchor assembly  200  may be within a range of about 0.008″ to about 0.015″ (about 0.20 mm to about 0.40 mm), or about 0.009″ to about 0.030″ (about 0.23 mm to about 0.76 mm), or about 0.01″ to about 0.06″ (about 0.25 mm to about 1.52 mm), or about 0.02″ to about 0.10″ (about 0.51 mm to about 2.54 mm), or about 0.06″ to about 0.20″ (about 1.52 mm to about 5.08 mm). In some embodiments, the elongate members forming the anchor assembly  200  may have smaller or larger diameters or widths/thicknesses. In some embodiments, each of the elongate members forming the anchor assembly  200  has essentially the same diameter or width/thickness. In some embodiments, one or more of the elongate members forming the anchor assembly  200  has a different diameter or width/thickness than one or more of the other elongate members of the anchor assembly  200 . In some embodiments, one or more portions of one or more of the elongate members forming the anchor assembly  200  may be tapered, widened, narrowed, curved, radiused, wavy, spiraled, angled, and/or otherwise non-linear and/or not consistent along the entire length of the elongate members of the anchor assembly  200 . Such features and techniques can also be incorporated with the valve assemblies of the prosthetic mitral valves provided herein. 
     In some embodiments, the elongate members forming the anchor assembly  200  may vary in diameter, thickness and/or width so as to facilitate variations in the forces that are exerted by the anchor assembly  200  in specific regions thereof, to increase or decrease the flexibility of the anchor assembly  200  in certain regions, to enhance migration resistance, and/or to control the process of compression (crushability) in preparation for deployment and the process of expansion during deployment of the anchor assembly  200 . 
     In some embodiments, one or more of the elongate members of the elongate members forming the anchor assembly  200  may have a circular cross-section. In some embodiments, one or more of the elongate members forming the anchor assembly  200  may have a rectangular cross-sectional shape, or another cross-sectional shape that is not rectangular. Examples of cross-sectional shapes that the elongate members forming the anchor assembly  200  may have include circular, C-shaped, square, ovular, rectangular, elliptical, triangular, D-shaped, trapezoidal, including irregular cross-sectional shapes formed by a braided or stranded construct, and the like. In some embodiments, one or more of the elongate members forming the anchor assembly  200  may be essentially flat (i.e., such that the width to thickness ratio is about 2:1, about 3:1, about 4:1, about 5:1, or greater than about 5:1). In some examples, one or more of the elongate members forming the anchor assembly  200  may be formed using a center-less grind technique, such that the diameter of the elongate members varies along the length of the elongate members. 
     The anchor assembly  200  may include features that are directed to enhancing one or more desirable functional performance characteristics of the prosthetic mitral valve devices. For example, some features of the anchor assembly  200  may be directed to enhancing the conformability of the prosthetic mitral valve devices. Such features may facilitate improved performance of the prosthetic mitral valve devices by allowing the devices to conform to irregular tissue topographies and/or dynamically variable tissue topographies, for example. Such conformability characteristics can be advantageous for providing effective and durable performance of the prosthetic mitral valve devices. In some embodiments of the anchor assembly  200 , some portions of the anchor assembly  200  are designed to be more conformable than other portions of the same anchor assembly  200 . That is, the conformability of a single anchor assembly  200  can be designed to be different at various areas of the anchor assembly  200 . 
     In some embodiments, the anchor assembly  200  includes features for enhanced in vivo radiographic visibility. In some embodiments, portions of the anchor assembly  200 , such as one or more of the anchor feet  220   a,    220   b,    220   c,  and  220   d,  and/or SAM containment member  212 , may have one or more radiopaque markers attached thereto. In some embodiments, some or all portions of the anchor assembly  200  are coated (e.g., sputter coated) with a radiopaque coating. 
     The anchor assembly  200  can also include one or more eyelets  226  in frame portions adjacent the arches. The eyelets  226  can be used for various purposes such as, but not limited to, holding radiopaque marker material, attachment points for suture loops or other elements which are additional control points for delivery and retrieval of the assembly, locations to secure a positional delivery frame, and the like. 
     In some embodiments, such as the depicted embodiment, the supra-annular structures and sub-annular structures of the anchor assembly  200  are interconnected by a lateral anterior inter-annular connection  270   a,  a lateral posterior inter-annular connection  270   b,  a medial posterior inter-annular connection  270   c,  and a medial anterior inter-annular connection  270   d.  For example, the lateral anterior inter-annular connection  270   a  connects the lateral anterior anchor foot  220   a  with the lateral anterior anchor arch  250   a.  Similarly, the medial anterior inter-annular connection  270   d  connects the medial anterior anchor foot  220   d  with the medial anterior anchor arch  250   c.  In addition, the lateral posterior inter-annular connection  270   b  connects the lateral posterior anchor foot  220   b  with the lateral anterior anchor arch  250   a  and the posterior anchor arch  250   b,  and the medial posterior inter-annular connection  270   c  connects the medial posterior anchor foot  220   c  with the posterior anchor arch  250   b  and the medial anterior anchor arch  250   c.    
     In the depicted embodiment, the SAM containment member  212  extends anteriorly from the sub-annular support arms of the anchor assembly  200 . For example, the SAM containment member  212 , as depicted, comprises an elongate member with a first end that extends from the lateral anterior sub-annular support arm  230   a  and a second end that extends from the medial anterior sub-annular support arm  230   d.  In some embodiments, portions of the SAM containment member  212  may extend from other areas on the anchor assembly  200 . While one particular embodiment of the SAM containment member  212  is depicted, it should be understood that multiple SAM containment member embodiments are envisioned and within the scope of this disclosure. 
     In the depicted embodiment, the SAM containment member  212  is integrally formed as part of the anchor assembly  200 . In specific embodiments, the SAM containment member  212 , or portions thereof, may be formed separately from the anchor assembly  200  and thereafter attached to the anchor assembly  200 . 
     The SAM containment member  212 , as shown, is in a deployed configuration. In some embodiments, the SAM containment member  212  is biased to self-reconfigure to the deployed configuration when the SAM containment member  212  is unconstrained. When the anchor assembly  200  is implanted in a native mitral valve and the SAM containment member  212  is in the deployed configuration, the SAM containment member  212  is disposed behind the anterior leaflet of a native mitral valve to physically block the anterior leaflet from obstructing the LVOT. As used herein, “behind” an anterior leaflet refers to the aortic side of the native mitral valve leaflet when the leaflet is open. In some implementations, while the SAM containment member  212  is deployed, the elongate members of the SAM containment member  212  may engage with the anterior leaflet and/or chordae to reduce the likelihood of SAM. The engagement can be anywhere along the lengths of the elongate members of the SAM containment member  212 . For example, in some implementations portions of the elongate members of the SAM containment member  212  can actually engage the lateral edge of the anterior leaflet and/or chordae to spread or widen the anterior leaflet at the lateral edges thereby restricting its movement and also reducing likelihood of SAM. 
     In some embodiments, a shape-setting process is used to instill a bias so that the SAM containment member  212  tends seek its deployed configuration. Alternatively or additionally, as described further below, in some embodiments the SAM containment member  212  may be deflected into the deployed configuration by the application of one or more forces during the deployment of the SAM containment member  212 . 
     In some embodiments, the SAM containment member  212  includes an attachment element  214  (a threaded eyelet  214  in this embodiment). The eyelet  214  provides an attachment feature that can be used to control the configuration and deployment of the SAM containment member  212 . In some embodiments, other types of attachment elements  214  (as alternatives to the eyelet  214 ) can be included on the SAM containment member  212 . For example, in some embodiments one or more protrusions, ball ends, recesses, clips, breakable elements, deflectable elements, bends, and the like, and combinations thereof, can be included on the SAM containment member  212  as an attachment element  214 . 
     Still referring to  FIGS. 18-21 , as described above the anchor feet  220   a,    220   b,    220   c,  and  220   d  are sized and shaped to engage the sub-annular gutter  19  of the mitral valve  17  ( FIG. 12 ). In some embodiments, the anterior feet  220   a  and  220   d  are spaced apart from each other by a distance in a range of about 30 mm to about 45 mm, or about 20 mm to about 35 mm, or about 40 mm to about 55 mm. In some embodiments, the posterior feet  220   b  and  220   c  are spaced apart from each other by a distance in a range of about 20 mm to about 30 mm, or about 10 mm to about 25 mm, or about 25 mm to about 40 mm. 
     In some embodiments, the anchor feet  220   a,    220   b,    220   c,  and  220   d  have a height ranging from about 8 mm to about 12 mm, or more than about 12 mm. In some embodiments, the anchor feet  220   a,    220   b,    220   c,  and  220   d  have a gutter engaging surface area (when fabric covered) ranging from about 6 mm 2  to about 24 mm 2 . In some embodiments, the anchor feet  220   a,    220   b,    220   c,  and  220   d  each have essentially the same gutter engaging surface area. In particular embodiments, one or more of the anchor feet  220   a,    220   b,    220   c,  and  220   d  has a different gutter engaging surface area than one or more of the other anchor feet  220   a,    220   b,    220   c,  and  220   d.  The anchor feet  220   a,    220   b,    220   c,  and  220   d  can have widths ranging within about 1.5 mm to about 4.0 mm or more, and lengths ranging within about 3 mm to about 6 mm or more. The anchor feet  220   a,    220   b,    220   c,  and  220   d  are sized and shaped so that the anchor assembly  200  does not significantly impair the natural function of mitral valve chordae tendineae, the native mitral valve leaflets, and papillary muscles even after the anchor assembly is anchored at the mitral valve site. 
     As described previously, the anchor assembly  200  is designed to avoid interference with the functioning of the native mitral valve  17  ( FIG. 12 ). Therefore, the anchor assembly  200  can be implanted within the native mitral valve  17  some time prior to the deployment therein of a replacement valve assembly, without degradation of valve  17  function during the period of time between the anchor implantation and the valve implantation (whether that time is on the order of minutes, or even several days or months). To avoid such interference between the anchor assembly  200  and the native mitral valve  17 , the inter-annular connections  270   a,    270   b,    270   c,  and  270   d  pass through the coaptation line  32  approximately. More particularly, the lateral anterior inter-annular connection  270   a  passes through the coaptation line  32  adjacent to the anterolateral commissure  30   a.  In like manner, the medial anterior inter-annular connection  270   d  passes through the coaptation line  32  adjacent to the posteromedial commissure  30   b.  In some implementations, the lateral posterior inter-annular connection  270   b  and medial posterior inter-annular connection  270   c  pass through the native mitral valve  17  in locations that are posteriorly biased from the natural coaptation line  32 . In such a case, the posterior leaflet  22  will tend to compliantly wrap around the lateral posterior inter-annular connection  270   b  and medial posterior inter-annular connection  270   c  to facilitate sealing of the mitral valve  17  with the anchor assembly  200  coupled thereto. 
     Referring to  FIGS. 22-24 , the anchor assembly  200  is shown implanted within a native mitral valve  17 . The inner catheter  160  is still coupled to the anchor assembly  200  in these figures.  FIG. 22  is a photographic image that corresponds to  FIG. 23  which shows the mitral valve  17  in a closed state.  FIG. 24  is a photographic image showing the anchor assembly  200  coupled with the native mitral valve  17  while the mitral valve  17  is in an open state. These illustrations are from the perspective of the left atrium looking inferior (downwardly) towards the mitral valve  17 . For instance, in  FIG. 24  some chordae tendineae  40  are visible through the open leaflets of the mitral valve  17 . 
     These figures illustrate the supra-annular structures and sub-annular structures of the anchor assembly  200  in their relationships with the native mitral valve  17 . For example, the closed state of the native mitral valve  17  in  FIGS. 22 and 23  allows visibility of the supra-annular structures such as the lateral anterior atrial holding feature  240   a,  the posterior atrial holding feature  240   b,  and the medial anterior atrial holding feature  240   c.  In addition, the lateral anterior anchor arch  250   a,  the posterior anchor arch  250   b,  and the medial anterior anchor arch  250   c  are visible. However, the sub-annular structures are not visible in  FIG. 13A  because such structures are obstructed from view by the anterior leaflet  20  and the three-part posterior leaflet  24   a,    24   b,  and  24   c.    
     In contrast, in  FIG. 24  certain sub-annular structures of the anchor assembly  200  are visible because the native mitral valve  17  is open. For example, the medial anterior sub-annular support arm  230   d  and hub  210  are in view through the open mitral valve  17 . Other sub-annular portions of the anchor assembly  200 , such as the anchor feet  220   a,    220   b,    220   c,  and  220   d,  remain out of view because of visual obstructions of the native mitral valve  17 . In addition, no SAM containment member (which is a sub-annular structure) is visible in this view as it is in its pre-deployed configuration. 
     Referring to  FIG. 25 , after implantation of the anchor assembly  200  within the native mitral valve  17  (as performed, for example, in accordance with  FIGS. 1-5 and 7-11  described above), a valve delivery sheath  170  of the delivery system  100  can be used to deploy a valve assembly within the anchor assembly  200 . As described above in reference to  FIG. 11 , with the inner catheter  160  coupled with the hub  210  of the anchor assembly  200 , the inner catheter  160  can be used to guide the valve assembly into the interior of the anchor assembly  200 . 
     In the depicted embodiment, the SAM containment member  212  is constrained in its pre-deployed configuration. However, in some other SAM containment member embodiments, the SAM containment member may be deployed prior to installation of a valve assembly within the anchor assembly  200 . Generally speaking, depending on the SAM containment member embodiment&#39;s design, if the SAM containment member may potentially interfere with the function of the anterior leaflet, it may be preferable to wait until the valve is implanted to deploy the SAM containment member. But, if the SAM containment member does not or is unlikely to interfere with the leaflet function, the SAM containment member may be deployed prior to valve implant (which may be beneficial for situations where the anchor is implanted in a separate procedure from the valve implantation). 
     In some implementations, with the guide catheter  120  positioned with its distal end in the left atrium  16 , the valve delivery sheath  170  is installed into a lumen of the guide catheter  120  (over the inner catheter  160 ) and advanced through the guide catheter  120 . As described further below, in some embodiments the valve delivery sheath  170  is loaded at that time with a prosthetic valve assembly and other components of the delivery system  100 . The guide catheter  120  may be the same catheter that was used to deliver the anchor assembly  200 , or it may be a different catheter (but still referred to here as the guide catheter  120  for simplicity sake). Depending on the time interval between implantation of the anchor assembly  200  and the valve assembly  300 , it may also be desirable to leave the same guide catheter  120  in situ during the time between the deliveries of each assembly. 
     In some embodiments, the valve delivery sheath  170  can be made from the materials described above in reference to the guide catheter  120 . In some embodiments, the valve delivery sheath  170  has an outer diameter in the range of about 20 Fr to about 28 Fr (about 6.7 mm to about 9.3 mm). In some embodiments, the valve delivery sheath  170  has an outer diameter in the range of about 14 Fr to about 24 Fr (about 4.7 mm to about 8.0 mm). 
     In the depicted embodiment, the valve delivery sheath  170  includes a flared distal end portion  172 . In some embodiments, no such flared distal end portion  172  is included. The flared distal end portion  172  can collapse to a lower profile when constrained within the guide catheter  120 . When the flared distal end portion  172  is expressed from the guide catheter  120 , the flared distal end portion  172  can self-expand to the flared shape. In some embodiments, the material of the flared distal end portion  172  includes pleats or folds, may be a continuous flared end or may be separated into sections such as flower pedals, and may include one or more resilient elements that bias the flared distal end portion  172  to assume the flared configuration in the absence of restraining forces (such as from containment within the guide catheter  120 ). The flared distal end portion  172  can be advantageous, for example, for recapturing the valve assembly (if desired) within the lumen of the valve delivery sheath  170  after the valve assembly has been expressed from the flared distal end portion  172 . 
     In some embodiments, the maximum outer diameter of the flared distal end portion  172  is in a range of about 30 Fr to about 34 Fr (about 10.0 mm to about 11.3 mm). In some embodiments, the maximum outer diameter of the flared distal end portion  172  is in a range of about 32 Fr to about 44 Fr (about 10.7 mm to about 14.7 mm). In some embodiments, the maximum outer diameter of the flared distal end portion  172  is in a range of about 24 Fr to about 30 Fr (about 8.0 mm to about 10.0 mm). In some embodiments, the maximum outer diameter of the flared distal end portion  172  is less than about 24 Fr (about 8.0 mm) or greater than about 44 Fr (about 14.7 mm). 
     Referring also to  FIG. 26 , in some implementations the valve delivery sheath  170  can be withdrawn into the guide catheter  120  while a valve delivery catheter  180  is held substantially stationary to thereby express a valve assembly  300  from a lumen of the valve delivery sheath  170 . The valve delivery sheath  170  and the valve delivery catheter  180  are additional components in some embodiments of the example delivery system  100 . It should be understood that movements of the components (e.g., the valve delivery sheath  170  and the valve delivery catheter  180 ) of the delivery system  100 , whether the movements be those of individual components or two or more components in combination with each other, can in some embodiments be initiated and controlled using a deployment frame system (such as the example deployment frame system of  FIG. 43  described below). 
     Referring also to  FIG. 6 , in some embodiments the valve delivery catheter  180  can be advantageously configured with multiple zones that have differing mechanical properties such as flexibility, durometer, column strength, crush strength, elasticity, torqueability, trackability, and the like. For example, in the depicted embodiment the valve delivery catheter  180  includes a first zone  180   a,  a second zone  180   b,  a third zone  180   c,  a fourth zone  180   d,  and a fifth zone  180   e.  In one example, the first zone  180   a  has a durometer of about 72D, the second zone  180   b  has a durometer of about 35D, the third zone  180   c  has a durometer of about 25D, the fourth zone  180   d  has a durometer of about 55D, and the fifth zone  180   e  has a durometer of about 35D. The different zones may be constructed differently in relation to each other (e.g., using different polymers, coatings, coil reinforcements, braided reinforcements, hypotubes, etc.). Such variations in the mechanical properties (e.g., flexibility, etc.) of the valve delivery catheter  180  can be advantageous for the navigation of the valve delivery catheter  180  through the curvatures of a patient&#39;s vasculature. For example, in the depicted embodiment, the first zone  180   a  being 72D (for example) provides column strength for the section of the valve delivery catheter  180  that is expected to be in the inferior vena cava and/or right atrium. The zones  180   b,    180   c,    180   d  and  180   e  having example durometers of 35D, 25D, 55D and 35D respectively provide the flexibility for the valve delivery catheter  180  to navigate the curvature from right atrium to mitral annulus plane through fossa ovalis and left atrium. The zone  180   d  of 55D (for example) also provides the stiffness profile to align the axis of the valve delivery catheter  180  along the normal to the native mitral annulus plane. It should be understood that this is merely one example and other arrangements are also envisioned within the scope of this disclosure. Moreover, one or more other catheter devices of delivery system  100  can be configured with such multiple zones that have differing mechanical properties (as exemplified here in regard to valve delivery catheter  180 ). 
     Still referring to  FIG. 26 , the valve assembly  300  can be releasably coupled to the valve delivery catheter  180  and retained in a low-profile configuration. In some embodiments, both the distal and proximal ends of the valve assembly  300  are releasably coupled to the valve delivery catheter  180 . In some embodiments, just one of the distal end or the proximal end of the valve assembly  300  is releasably coupled to the valve delivery catheter  180 . In particular embodiments, one or more control wires may be included to releasably couple one or more portions of the valve assembly  300  to the valve delivery catheter  180 . In some such embodiments, the one or more control wires may act as lassos to radially constrain the bias of the valve assembly  300  from radially self-expanding. Hence, a release of tension on the one or more control wires may allow at least a portion of the valve assembly  300  to radially self-expand. Referring to  FIGS. 27 and 28 , the delivery system  100  can be manipulated by a clinician operator to perform a lateral pivot (panning, rotation, etc.) of the valve assembly  300  within the left atrium  16 . The rotation of the valve assembly  300  changes the alignment of the valve assembly  300  from being generally axial with the distal end portion of the guide catheter  120  to being generally axial with the anchor assembly  200  (in preparation for installation of the valve assembly  300  into the interior of the anchor assembly  200 ). 
     In some implementations, the aforementioned rotation of the valve assembly  300  can be performed as follows. As shown in  FIG. 26 , because of the influence from the guide catheter  120  on the valve delivery catheter  180 , the axis of the valve assembly  300  is initially in general alignment with the axis of the distal end portion of the guide catheter  120 . From this arrangement, a generally simultaneous counter-movement of/between the inner catheter  160  and the valve delivery catheter  180  can be performed by the clinician to rotate the valve assembly  300 . That is, as the inner catheter  160  is pulled proximally, the valve delivery catheter  180  is pushed distally. As a result of that counter movement, the valve assembly  300  rotates/pans in a relatively tight radius within the left atrium  16 , as required by the confines of the left atrium  16 . Thereafter, the valve delivery catheter  180  can be advanced further so that the valve assembly  300  is coaxially positioned within the interior of the anchor assembly  200  as shown in  FIG. 28 . As with other movements of the components of the delivery system  100  described herein (and other movements of the components of the delivery system  100  that are like those described herein), the generally simultaneous counter-movements of/between the inner catheter  160  and the valve delivery catheter  180  can be initiated and controlled using a deployment frame system (such as the example deployment frame system of  FIG. 43  described below) in some implementations. 
     Referring now also to  FIGS. 29 and 30 , in some embodiments the valve assembly  300  and the anchor assembly  200  become aligned with each other coaxially, linearly (along their axes), and rotationally prior to or during the expansion of the valve assembly  300 , resulting in engagement between the valve assembly  300  and the anchor assembly  200 . 
     Coaxial alignment between the valve assembly  300  and the anchor assembly  200 , as described above, is achieved by virtue of the valve delivery catheter  180  being slidably disposed over the inner catheter  160 . Linear alignment between the valve assembly  300  and the anchor assembly  200  can be achieved by the interaction of a distal end feature  182  ( FIG. 28 ) of the valve delivery catheter  180  and the hub  210  of the anchor assembly  200 . For example, in some embodiments an abutting of the distal end feature  182  and the hub  210  can result in proper linear alignment between the valve assembly  300  and the anchor assembly  200 . Such abutting of the distal end feature  182  and the hub  210  can be attained by translating the valve delivery catheter  180  distally until the distal end feature  182  abuts the hub  210 . 
     Relative rotational alignment between the valve assembly  300  and the anchor assembly  200  (about their longitudinal axes) can be achieved in various manners. For example, in some embodiments the valve delivery catheter  180  is mechanically keyed to the inner catheter  160  to slidably fix a desired rotational alignment between the valve assembly  300  and the anchor assembly  200 . In some embodiments, other types of mechanical features (e.g., pins/holes, protrusions/receptacles, etc.) can be included to facilitate a desired rotational/spin alignment between the valve assembly  300  and the anchor assembly  200 . Alternatively, or additionally, one or more radiopaque markers can be included on the valve assembly  300  and/or on the anchor assembly  200  in locations and/or patterns that are indicative of the relative rotational orientation (about their axes) of the valve assembly  300  and the anchor assembly  200 . Accordingly, fluoroscopy can be used to attain a desired relative orientation of the radiopaque markers and, consequently, of the valve assembly  300  and the anchor assembly  200 . For example, in some embodiments one or more radiopaque markers  183  are disposed on the distal end feature  182 . The one or more radiopaque markers  183  can be in locations and/or arranged in patterns to indicate the rotational orientation of the distal end feature  182  and, in turn, the rotational orientation of the valve assembly  300  that is releasably coupled in relation to the distal end feature  182 . In some embodiments, the one or more radiopaque markers  183  can be arranged as one or more beads, one or more half-rings, and the like, and combinations thereof. One or more radiopaque markers can be included on the SAM containment member  212  in some embodiments. 
     In some embodiments (e.g., when the valve delivery catheter  180  is configured to be “torqueable”), the valve delivery catheter  180  can be rotated about its longitudinal axis until the radiopaque markers are in proper position relative to the anchor assembly  200 , prior to final expansion of valve assembly  300 . Such rotation of the valve delivery catheter  180  can, in some implementations, be initiated and controlled using a deployment frame. Fluoroscopy can be used to attain a desired relative orientation of the radiopaque markers, and of the valve assembly  300  and the anchor assembly  200  (including on the SAM containment member) correspondingly. 
     In the depicted implementation, the SAM containment member  212  is still in its pre-deployed configuration. Therefore, the depicted embodiment of the SAM containment member  212  is deployed after the valve assembly  300  is engaged within the anchor assembly  200 . However, for some alternative embodiments of the SAM containment member (as described further below) the SAM containment member is deployed prior to the engagement of the valve assembly  300  within the anchor assembly  200 . 
     After proper alignment between the valve assembly  300  and the anchor assembly  200  is achieved, the valve assembly  300  can be expanded within the interior of the anchor assembly  200  such that the valve assembly  300  and anchor assembly  200  become releasably coupled to each other. In some embodiments, force(s) are applied to the valve assembly  300  to cause it to expand. In some embodiments, the valve assembly  300  is biased to self-expand. 
     The expansion of a self-expanding valve assembly  300  can be initiated by releasing tension on the one or more control wires of the valve delivery catheter  180 . For example, in some embodiments the valve delivery catheter  180  includes a proximal control wire  184   a  that restrains the proximal end portion of the valve assembly  300 , and a distal control wire  184   b  that restrains the distal end portion of the valve assembly  300 . As tension on the proximal control wire  184   a  is released, the proximal end portion of the valve assembly  300  is allowed to radially expand. Similarly, as tension on the distal control wire  184   b  is released, the distal end portion of the valve assembly  300  is allowed to radially expand. The expansions of the portions of the valve assembly  300  may be allowed to take place sequentially, concurrently, or partially concurrently. As described further below, such individual and/or simultaneous movements of components of the delivery system  100  (such as the one or more control wires of the valve delivery catheter  180 ) can be initiated and controlled using a deployment frame system in some implementations. 
     After the valve assembly  300  has been expanded into a coupled relationship with the anchor assembly  200 , the clinician can verify that the anchor assembly  200  and the valve assembly  300  are in the desired positions. Additionally, the clinician may verify other aspects such as, but not limited to, the hemodynamic performance and sealing of the anchor assembly  200  and the valve assembly  300 . 
     In some embodiments, the SAM containment member  212  is deployed after the valve assembly  300  has been expanded into a coupled relationship with the anchor assembly  200 . To deploy the SAM containment member  212 , in some embodiments the inner catheter  160  is rotated about its longitudinal axis so that the distal end of the inner catheter  160  is uncoupled from the hub  210  of the anchor assembly  200 . For example, in some embodiments the distal end of the inner catheter  160  is uncoupled from the hub  210  by unthreading the distal end of the inner catheter  160  from the hub  210  by rotating the inner catheter  160  about its longitudinal axis. Then, in some embodiments the guidewire  110  is retracted to allow full deployment of the SAM containment member  212 . The SAM containment member  212  may self-expand to its fully deployed configuration in some embodiments. The configuration of the fully deployed SAM containment member  212  is depicted in  FIGS. 16-21 and 42 , for example. 
     In its fully deployed configuration, the SAM containment member  212  is at least partially disposed behind the natural mitral valve anterior leaflet  20  ( FIG. 12 ). The deployed SAM containment member  212  can reduce or prevent the potential for the natural mitral valve anterior leaflet  20  to “flop” outward and/or from being drawn by a Venturi effect into the left ventricular outflow tract (LVOT). Accordingly, the SAM containment member  212  can reduce the risk of full or partial blockages of the LVOT. In some patient scenarios, the potential for suffering future adverse health events, such as heart failure, is thereby reduced. 
     With the valve assembly  300  and the anchor assembly  200  fully deployed and functioning as desired, the remaining components of the delivery system  100  can be withdrawn. To do so, the valve delivery catheter  180  and the inner catheter  160  can be retracted into the guide catheter  120 . Then the valve delivery catheter  180 , the inner catheter  160 , and the guide catheter  120  can be jointly or individually withdrawn from the patient. 
     Referring to  FIGS. 31 and 32 , an example valve assembly  300  is shown without any covering or valve/occluder leaflets. Hence, a valve assembly frame  301  of the valve assembly  300  is shown.  FIG. 30  shows an anterior side view of the valve assembly frame  301 , and  FIG. 31  shows a bottom view of the valve assembly frame  301 . The valve assembly  300  can be constructed using any of the various materials and manufacturing techniques described above in reference to the anchor frame  200  (e.g., refer to  FIG. 9 ). It should be understood that the depicted valve assembly  300  is merely one non-limiting example of the valve assemblies provided within the scope of this disclosure. 
     The valve assembly  300  includes a proximal end portion  302  and a distal end portion  304 . The valve assembly includes a flared external skirt portion  303  and defines an interior orifice portion  305 . When the valve assembly  300  is implanted in a native mitral valve, the proximal end portion  302  is located supra-annular (in the left atrium) and the distal end portion  304  is located sub-annular (in the left ventricle). The proximal end portion  302  defines the generally circular entrance orifice of the valve assembly  300 , as described further below. 
     In the depicted embodiment, the valve assembly  300  generally flares outward along a distal direction. Said differently, the distal end portion  304  is flared outward in comparison to the proximal end portion  302 . Accordingly, the proximal end portion  302  defines a smaller outer profile in comparison to the distal end portion  304 . However, some regions of the distal end portion  304  bow inwardly. In particular, for example, a posteromedial commissural corner  330   a  and anterolateral commissural corner  330   b  of the valve assembly  300  may bow inwardly. Such inward bowing of the commissural corners  330   a  and  330   b  can serve to mitigate LVOT obstructions and enhance sealing in some cases. It should be understood that the outward flare of the distal end portion  304  in comparison to the proximal end portion  302  is merely one example configuration for a profile of the valve assembly  300 . In some embodiments, for example, a shoulder (a portion of the valve assembly  300  having the largest outer periphery) is located proximal of the middle of the valve assembly  300 . 
     The valve assembly  300  also includes an anterior side  306  between the posteromedial commissural corner  330   a  and anterolateral commissural corner  330   b.  When the valve assembly  300  is implanted in a native mitral valve, the anterior side  306  faces the anterior leaflet of the native mitral valve. The anterior side  306  of the distal end portion  304  defines a generally flat surface, whereas the other sides of the distal end portion  304  are rounded. Hence, the periphery of the distal end portion  304  is generally D-shaped. The D-shaped periphery of the distal end portion  304  provides the valve assembly  300  with an advantageous outer profile for interfacing and sealing with the native mitral valve. As described further below, sealing is attained by coaptation between the D-shaped periphery of the distal end portion  304  and the leaflets of the native mitral valve, and, in some embodiments, between the D-shaped periphery in the region of the skirt  303  with the native valve annulus. 
     In the depicted embodiment, the proximal end portion  302  of the valve assembly  300  includes three atrial leaflet arches  310   a,    310   b,  and  310   c  that together define an undulating ring at the proximal end portion  302 . Each of the leaflet arches  310   a,    310   b,  and  310   c  includes an apex having a one or more attachment holes  312   a,    312   b,  and  312   c  respectively. In some embodiments, the attachment holes  312   a,    312   b,  and  312   c  are used for coupling the proximal end of the valve assembly  300  to a delivery catheter (e.g., valve delivery catheter  180  of  FIGS. 26-30  using proximal control wire  184   a ). In some embodiments, one or more of the attachment holes  312   a,    312   b,  and  312   c  are used for containing radiopaque material. 
     The valve assembly  300  also includes three commissural posts  320   a,    320   b,  and  320   c  that each extend distally from the intersections of the three leaflet arches  310   a,    310   b,  and  310   c.  In some embodiments, the commissural posts  320   a,    320   b,  and  320   c  are disposed at about 120° apart from each other. The commissural posts  320   a,    320   b,  and  320   c  each have a series of holes that can be used for attachment of leaflets, such as by suturing. The three leaflet arches  310   a,    310   b,  and  310   c  and the three commissural posts  320   a,    320   b,  and  320   c  are areas on the valve assembly  300  to which three prosthetic valve leaflets become attached to comprise a tri-leaflet occluder (e.g., refer to  FIG. 35 ). 
     As seen in  FIG. 32 , the three leaflet arches  310   a,    310   b,  and  310   c  and the commissural posts  320   a,    320   b,  and  320   c  define a generally cylindrical frame for the tri-leaflet occluder construct. As such, the valve assembly  300  provides a proven and advantageous frame configuration for the tri-leaflet occluder. The tri-leaflet occluder provides open flow during diastole and occlusion of flow during systole. 
     Referring to  FIGS. 33, 34A, 34B and 35 , in some embodiments the valve assembly  300  is configured to make the process of coupling one or more control wires (e.g., control wires  142   a  and  142   b  as described above in reference to  FIGS. 3 and 4 ) to the valve assembly  300  more convenient. For example, in the depicted embodiment the valve assembly  300  is releasably coupled with a proximal end threading tube  185   a  and a distal end threading tube  185   b.  The threading tubes  185   a  and  185   b  can be used by a clinician as tools for threading the control wires  142   a  and  142   b  into engagement with the valve assembly  300 . After using the threading tubes  185   a  and  185   b  to thread the control wires  142   a  and  142   b  into engagement with the valve assembly  300 , the clinician can uncouple the threading tubes  185   a  and  185   b  from the valve assembly  300  and discard the threading tube  185   a  and  185   b.    
     It should be understood that, in some embodiments, the valve assembly  300  is stored and transported to clinicians in sterile packaging containing a storage solution that keeps the valve assembly  300  moist. The storage solution is beneficial for preserving tissue of the valve assembly  300  during shipment and storage. The valve assembly  300  is not coupled to a delivery system during shipment and storage of the valve assembly  300 . Therefore, an individual at the end-use site (e.g., a clinician in preparation for a procedure) will perform the task of coupling the valve assembly  300  to the delivery system (e.g., delivery system  100  as described above). In some embodiments, the task of coupling the valve assembly  300  to the delivery system includes coupling control wires (e.g., proximal control wire  184   a  and distal control wire  184   b ) to the valve assembly  300 . Because the task of coupling control wires to the valve assembly  300  can be time-consuming, in some embodiments the valve assembly  300  is provided with one or more threading tubes, such as the proximal end threading tube  185   a  and the distal end threading tube  185   b  in the depicted embodiment. 
     The threading tubes  185   a  and  185   b  can be made of various materials such as, but not limited to, polyether ether ketone (PEEK), polyaryl ether ketone (PAEK), PTFE, FEP, HYTREL®, nylon, PICOFLEX®, PEBAX®, TECOFLEX®, nitinol, and the like, and combinations thereof. 
     In some embodiments, the proximal end threading tube  185   a  is releasably engaged with the valve assembly  300 . For example, in the depicted embodiment the proximal end threading tube  185   a  passes through one or more attachment features (suture loops in this example) at the attachment holes  312   a,    312   b,  and  312   c  that are located at the apices of the leaflet arches  310   a,    310   b,  and  310   c  respectively. In the depicted example of  FIG. 34B , a suture loop  344   a  is attached at the apex of leaflet arch  310   a  using the attachment holes  312   a.  The same or a similar type of arrangement can be used at the attachment holes  312   b  and  312   c  located at the apices of leaflet arches  310   b  and  310   c  respectively. While in the depicted embodiment a single suture loop  344   a  is used, in some embodiments two or more suture loops are included at a single site. Such an arrangement can be used for redundancy, for example. The suture loops can be constructed of materials such as, but not limited to, ultra-high molecular weight polyethylene, nylon, polypropylene, polybutester, and the like. In some embodiments, other types of attachment elements (other than suture loops) such as, but not limited to, eyelets, grommets, rings, clips, pins, fabric portions, and/or the like, are used as to couple a threading tube (and control wire) to the valve assembly  300 . 
     In some embodiments, the distal end threading tube  185   b  is releasably engaged with the valve assembly  300 . For example, in the depicted embodiment the distal end threading tube  185   b  passes through one or more attachment features (suture loops in this example) that are located on or near the distal end of the framework of the valve assembly  300 . In some embodiments, the distal end threading tube  185   b  can be used to couple the distal control wire  142   b  to the distal portion of the valve assembly  300 . 
     In some implementations, a clinician can perform the following technique for using the threading tubes  185   a  and  185   b  to thread the control wires  142   a  and  142   b  into engagement with the valve assembly  300 . For example, a clinician can insert a free end of the proximal control wire  142   a  into a lumen of the proximal end threading tube  185   a  at a first end of the proximal end threading tube  185   a.  The clinician can push the proximal control wire  142   a  in relation to the proximal end threading tube  185   a,  through the lumen of the proximal end threading tube  185   a,  until the free end emerges from a second end (opposite of the first end) of the proximal end threading tube  185   a.  Then, while holding the proximal control wire  142   a  essentially stationary in relation to the valve assembly  300 , the clinician can slide the proximal end threading tube  185   a  out of engagement with the valve assembly  300 , and off of the proximal control wire  142   a.  The proximal end threading tube  185   a  can then be discarded. The technique for using the distal end threading tube  185   b  to couple the distal control wire  142   b  to the distal portion of the valve assembly  300  can be the same technique as described in regard to the proximal end threading tube  185   a.  Thereafter, each of the free ends of the control wires  142   a  and  142   b,  having been passed through the suture loops, can be fed back into the distal portion of the valve delivery catheter  180  ( FIGS. 26-30 ) and to a proximal securement and control system (not shown). The control wires  142   a  and  142   b  can then be tensioned which will reduce the diameter of the valve assembly  300 , and allow for insertion into the distal end of the valve delivery sheath  170 . 
     Still referring to  FIGS. 33, 34A, 34B and 35 , the valve assembly  300  can include an occluder portion, such as a tri-leaflet occluder or another type of occluder. For example, in the depicted embodiment the valve assembly  300  includes three leaflets  350   a,    350   b,  and  350   c  that perform the occluding function of the prosthetic mitral valve  400 . The cusps of the three leaflets  350   a,    350   b,  and  350   c  are fixed to the three atrial leaflet arches  310   a,    310   b,  and  310   c,  and to the three commissural posts  320   a,    320   b,  and  320   c  (refer to  FIGS. 20 and 21 ). The free edges of the three leaflets  350   a,    350   b,  and  350   c  can seal by coaptation with each other during systole and open during diastole. 
     The three leaflets  350   a,    350   b,  and  350   c  can be comprised of natural or synthetic materials. For example, the three leaflets  350   a,    350   b,  and  350   c  can be comprised of any of the materials described above in reference to the covering  340 , including the natural tissues such as, but not limited to, bovine, porcine, ovine, or equine pericardium. In some such embodiments, the tissues are chemically cross-linked using glutaraldehyde, formaldehyde, or triglycidyl amine solution, or other suitable crosslinking agents. In some embodiments, the leaflets  350   a,    350   b,  and  350   c  have a thickness in a range of about 0.005″ to about 0.020″ (about 0.13 mm to about 0.51 mm), or about 0.008″ to about 0.012″ (about 0.20 mm to about 0.31 mm). In some embodiments, the leaflets  350   a,    350   b,  and  350   c  have a thickness that is less than about 0.005″ (about 0.13 mm) or greater than about 0.020″ (about 0.51 mm). 
     Referring also to  FIGS. 36A and 36B , in some embodiments, prior to attaching the three leaflets  350   a,    350   b,  and  350   c  to the framework of the valve assembly  300 , the lateral edges of the three leaflets  350   a,    350   b,  and  350   c  (or portions thereof) are folded and/or overlapped into engagement with each other. Such a technique can be used in preparation for securely attaching the three leaflets  350   a,    350   b,  and  350   c  to the three commissural posts  320   a,    320   b,  and  320   c.    
     The depicted example folded configuration of the three leaflets  350   a,    350   b,  and  350   c  effectively reduces the leaflet stresses in the commissural region when the valve is subjective to physiological pressures. Therefore, such engagement between the three leaflets  350   a,    350   b,  and  350   c  can serve to improve the durability of the three leaflets  350   a,    350   b,  and  350   c.    
     In the depicted embodiment, each of the junctures of the lateral edges of the three leaflets  350   a,    350   b,  and  350   c  includes a folded portion and an overlapping portion. For example, the juncture of leaflets  350   b  and  350   c  includes a folded portion  352   c  and an overlapping portion  352   bc . The folded portion  352   c  is a lateral extension of the leaflet  350   c  that is folded onto the leaflet  350   b.  Alternatively, in some embodiments, a lateral extension of leaflet  350   b  can be folded onto leaflet  350   c.  The overlapping portion  352   bc  is made up of a lateral extension of each of the leaflets  350   b  and  350   c.  Hence, the overlapping portion  352   bc  includes two layers (a layer of leaflet  350   b  and a layer of leaflet  350   c ). Further, the overlapping portion  352   bc  of the leaflet assembly is wrapped around the commissural post  320   c  of the valve frame assembly  300 . The same type of arrangement can be implemented at the commissural posts  320   a  and  320   b.  Such an arrangement can enhance the durability of the valve frame assembly  300  by reducing the likelihood of suture elongation/wear because of direct load transfer from the leaflets  350   a,    350   b,  and  350   c  to the valve frame  301  ( FIGS. 31 and 32 ) when subjected to physiological loading. 
     Referring also to  FIG. 37 , in some embodiments the commissural posts  320   a ,  320   b,  and  320   c  each have one or more openings that can be used for attachment of the three leaflets  350   a,    350   b,  and  350   c,  such as by suturing. For example, commissural post  320   c,  as shown, defines a first opening  322   c,  a second opening  324   c,  and a third opening  326   c.  Each of the other commissural posts  320   a  and  320   b  can also define such openings. 
     The openings  322   c,    324   c,  and  326   c  provide structural features that can be advantageously used for suturing the lateral edges of the leaflets  350   b  and  350   c  to the commissural post  320   c.  In some embodiments, the overlapping portion  352   bc  of leaflets  350   b  and  350   c  can be passed through the third opening  326   c,  and the overlapping portion  352   c  can be abutted against the portion of commissural post  320   c  that defines the first opening  322   c  and the second opening  324   c.  With the leaflets  350   b  and  350   c  in such an arrangement relative to the commissural post  320   c,  the lateral edges of the leaflets  350   b  and  350   c  can be sutured to the commissural post  320   c.  Such an arrangement can enhance the durability of the leaflets  350   b  and  350   c  by reducing the likelihood of suture elongation/wear because of direct load transfer from the leaflets  350   b  and  350   c  to the valve frame  301  ( FIGS. 31 and 32 ) when subjected to physiological loading. Similar arrangements can be created at commissural posts  320   a  and  320   b.    
     In some embodiments, a particular suture stitching pattern can be used to attach the lateral edges of the three leaflets  350   a,    350   b,  and  350   c  to the commissural posts  320   a,    320   b,  and  320   c.  Such a stitching pattern can advantageously result in a secure and durable attachment of the leaflets  350   a,    350   b,  and  350   c  to the commissural posts  320   a,    320   b,  and  320   c.  For example,  FIG. 37  depicts an example suture stitching pattern  328  that can be used to attach the lateral edges of the leaflets  350   b  and  350   c  to the commissural post  320   c.  The depicted view of commissural post  320   c  is from the outside of the valve assembly  300 . 
     In some embodiments, the example stitching pattern  328  is used to attach the lateral edges of the leaflets  350   b  and  350   c  to the commissural post  320   c.  The solid lines of the stitching pattern  328  represent sutures that are visible in this view. The dashed lines of the stitching pattern  328  represent sutures that are not visible in this view. The stitching pattern  328  can include suture knots at various locations. For example, two suture knots can be tied in or near the first opening  322   c.  One or more knots can also be tied at a distal end  329  of the commissural post  320   c.    
     Referring to  FIG. 38 , an exploded depiction of an example prosthetic mitral valve  400  includes an anchor assembly  200  and a valve assembly  300 . This figure provides a posterior side view of the anchor assembly  200  and the valve assembly  300 . 
     The valve assembly  300  includes a covering  340 . The covering  340  can be made of any of the materials and constructed using any of the techniques described above in reference to covering  270 . Additionally, in some embodiments the covering  340  can comprise natural tissues such as, but not limited to, bovine, porcine, ovine, or equine pericardium. In some such embodiments, the tissues are chemically cross-linked using glutaraldehyde, formaldehyde, or triglycidyl amine solution, or other suitable crosslinking agents. 
     When the valve assembly  300  and the anchor assembly  200  are coupled together, the valve assembly  300  is geometrically interlocked within the interior defined by the anchor assembly  200  (e.g., in some embodiments by virtue of the tapered shape of the proximal end  302  valve assembly  300  within the supra-annular ring  250  and interior space defined by the anchor assembly  200 ). In particular, in some embodiments the valve assembly  300  is contained within the interior space between the supra-annular ring  250  and the sub-annular support arms  230   a,    230   b,    230   c,  and  230   d.  As described above, the interlocked arrangement between the valve assembly  300  and the anchor assembly  200  is accomplished by positioning a valve assembly  300  in a low-profile configuration within the interior of the anchor assembly  200  and then allowing expansion of the valve assembly  300  within the interior of the anchor assembly  200  (e.g., refer to  FIGS. 28-30 ). 
     In some embodiments, such as the depicted embodiment, a fabric portion  314   a  is attached (e.g., sewn) to the outer surface of coving  340  near the apex of the leaflet arch  310   a.  The other leaflet arches  310   b  and  310   c  can also have such a fabric portion. The fabric portion  314   a  aligns up with the covering-material cut out  252   b  of the anchor assembly  200  when the valve assembly  300  is coupled with the anchor assembly  200 . By positioning the fabric portion  314   a  within the covering-material cut out  252   b,  the valve assembly  300  becomes coupled with the anchor assembly  200  with an additional resiliency. This additional securement resiliency may be advantageous, for example, to resist migration of the valve assembly  300  into the ventricle during diastole. 
     While in the depicted embodiment a triangular shape is used for the fabric portion  314   a  and the covering-material cut out  252   b,  in some embodiments other shapes such as, but not limited to, polygons, circles, ovals, and the like can be used. In some embodiments, the fabric portion  314   a  (and the other fabric portions on leaflet arches  310   b  and  310   c ) is made of a material such as, but not limited to, felt, polyester, a silicone, a urethane, ELAST-EON™ (a silicone and urethane polymer), another biocompatible polymer, DACRON®, polyethylene terephthalate (PET), copolymers, or combinations and subcombinations thereof. 
     In some embodiments, one or more supplementary covering portions are attached (e.g., sewn) to the outer surface of the covering  340  of the valve assembly  300 . In some cases, such supplementary covering portions can provide an enhanced sealing capability between the skirt  303  and surrounding native tissues when the prosthetic mitral valve  400  is deployed in a native mitral valve. Moreover, such supplementary covering portions can facilitate tissue healing and/or ingrowth, which can in turn provide enhanced sealing. For example, in the depicted embodiment, the valve assembly  300  includes a first supplementary covering portion  316   a  and a second supplementary covering portion  316   b.  In some embodiments, the first supplementary covering portion  316   a  and the second supplementary covering portion  316   b  are made of a material such as, but not limited to, DACRON®, felt, polyester, a silicone, a urethane, ELAST-EON™ (a silicone and urethane polymer), another biocompatible polymer, polyethylene terephthalate (PET), copolymers, or combinations and subcombinations thereof. 
     Referring to  FIGS. 39-42 , the prosthetic mitral valve  400  (comprised of the valve assembly  300  coupled within the anchor assembly  200 ) is shown in top (atrial), anterior, posterior, and bottom (ventricle) views, respectively. In some embodiments, the occluding function of the prosthetic mitral valve  400  can be performed using configurations other than the depicted tri-leaflet occluder. For example, bi-leaflet, quad-leaflet, or mechanical valve constructs can be used in some embodiments. 
     As shown in  FIG. 40 , a supplemental covering portion  316   c  can positioned on an anterior surface of the valve assembly  300 . The supplemental covering portion  316   c  can provide an enhanced sealing capability between the skirt  303  and surrounding native tissues (e.g., an anterior leaflet) when the prosthetic mitral valve  400  is deployed in a native mitral valve. The supplemental covering portion  316   c  can be made of a material such as, but not limited to, DACRON®, felt, polyester, a silicone, a urethane, ELAST-EON™ (a silicone and urethane polymer), another biocompatible polymer, polyethylene terephthalate (PET), copolymers, or combinations and subcombinations thereof. 
     Referring to  FIG. 43 , in some implementations the prosthetic mitral valve  400  of  FIGS. 39-42  is deployed in a patient  1  using the transcatheter delivery system  100  as described above. In some implementations, the prosthetic mitral valve  400  is percutaneously deployed via a femoral or iliac vein through a groin opening/incision  2  in the patient  1 . In particular implementations, a deployment frame system  6  is used to initiate and/or control the movements of various components of the transcatheter delivery system  100 . 
     While the deployment frame system  6  is described in the context of the deployment of the prosthetic mitral valve  400  using the transcatheter delivery system  100 , it should be understood that the practical applications of the inventive concepts associated with the deployment frame system  6  is not limited to such a context. That is, the inventive concepts associated with the deployment frame system  6  can be applied to contexts such as, but not limited to, other types of delivery systems for prosthetic heart valves of any type, deployment systems for other types of medical devices/implants, and so on. 
     In the depicted embodiment, the deployment frame system  6  is attached or releasably attached to an operating table  4  on which the patient  1  is laying. In some embodiments, the deployment frame system  6  is separated or substantially separated from the operating table  4 . 
     As described above in reference to  FIGS. 1-11 and 25-30 , the deployment of the prosthetic mitral valve  400  is, in summary, a two-step process. The first step is the deployment of the anchor assembly  200 , and the second step is the deployment of the valve assembly  300 . Some components of the deployment frame system  6  may be used for both steps, while other components of the deployment frame system  6  may be used for one or the other of the two steps. 
     In general, the configuration of the deployment frame system  6  is different for the two deployment steps (i.e., the first step being the deployment of the anchor assembly  200 , and the second step being the deployment of the valve assembly  300 ). That is, the configuration of the deployment frame system  6  for delivering the anchor assembly  200  is different than the configuration of the deployment frame system  6  for delivering the valve assembly  300 . 
     The transcatheter delivery system  100  can be releasably coupled with deployment frame system  6 , as described further below. The deployment frame system  6  can be used by one or more clinicians to initiate and control movements of the components of the delivery system  100 . Some such movements of the components of the delivery system  100  are described above in reference to  FIGS. 1-11 and 25-30 . 
     As described above, the example transcatheter delivery system  100  includes the guidewire  110 , the guide catheter  120 , the anchor delivery sheath  130 , the anchor delivery catheter  140 , the secondary steerable catheter  150 , and the inner catheter  160 . In general, in the depicted embodiment those components of delivery system  100  are disposed in a telescopic fashion in relation to each other. That is, the guidewire  110  is slidably disposed within the inner catheter  160 ; the inner catheter  160  is slidably disposed within the secondary steerable catheter  150 ; the secondary steerable catheter  150  is slidably disposed within the anchor delivery catheter  140 ; the anchor delivery catheter  140  is slidably disposed within the anchor delivery sheath  130 ; and the anchor delivery sheath  130  is slidably disposed within the guide catheter  120 . 
     A proximal end portion of those components (e.g., the guide catheter  120 , the anchor delivery sheath  130 , the anchor delivery catheter  140 , the secondary steerable catheter  150 , and the inner catheter  160 ) can be terminated at a respective location along the deployment frame system  6 . As described further below, by manipulating the respective components&#39; proximal end portions (individually or in unison) using the deployment frame system  6 , clinicians can initiate and control movements of the delivery system  100 . In some embodiments, the example deployment frame system  6  includes a main frame and a secondary frame. 
     As described above in reference to  FIGS. 1-11 and 25-30 , various movements of the components of the delivery system  100  may be desired during the process of deploying (or retrieving) a medical device, such as the anchor assembly  200  and valve assembly  300  of prosthetic mitral valve  400  (refer to  FIG. 38 ). For example, the types of desired movements of the components of the delivery system  100  may include, but are not limited to: (i) a distal longitudinal translation, (ii) a proximal longitudinal translation, (iii) rotations about the longitudinal axis in either direction, (iv) a deflection of one or more portions of a component (e.g., steering or bending), and (v) a tensioning or untensioning of a control wire. 
     In some implementations, it may be desirable to initiate some of such movements (e.g., example movements (i)-(v) above) in synchronization (e.g., generally simultaneously) with one or more other such movements. One example, of desirable simultaneous movement of two or more components of the delivery system  100  was described above in reference to  FIG. 7 . In that example, the inner catheter  160  and the anchor delivery catheter  140  were translated distally in conjunction with each other, while maintaining the positions of the other components of the delivery system  100  (e.g., the secondary steerable catheter  150 ) generally stationary. The secondary frame of the deployment frame system  6  can be advantageously utilized to facilitate such synchronization of movements of two or more components of the delivery system  100 . 
     A number of embodiments of the invention have been described. Nevertheless, it will be understood that various modifications may be made without departing from the scope of the invention. Accordingly, other embodiments are within the scope of the following claims.