Patent Publication Number: US-11039917-B2

Title: Geometric prosthetic heart valves

Description:
CROSS-REFERENCE TO RELATED APPLICATION 
     This application is a continuation of U.S. patent application Ser. No. 14/133,491, filed Dec. 18, 2013, which claims the benefit of Provisional Application No. 61/802,128, filed Mar. 15, 2013, and also claims the benefit of Provisional Application No. 61/739,721, filed Dec. 19, 2012, all of which are incorporated herein by reference in their entireties for all purposes. 
    
    
     FIELD 
     The present disclosure relates generally to prosthetic heart valves and more specifically synthetic flexible leaflet-type prosthetic heart valve devices, systems, and methods. 
     BACKGROUND 
     Bioprosthetic heart valves have been developed that attempt to mimic the function and performance of a native valve. Flexible leaflets are fabricated from biological tissue such as bovine pericardium. In some bioprosthetic heart valve designs, the biological tissue is sewn onto a relatively rigid frame that supports the leaflets and provides dimensional stability when implanted. Although bioprosthetic heart valves can provide excellent hemodynamic and biomechanical performance in the short term, they are prone to calcification and cusp tears, among other failure modes, requiring reoperation and replacement. 
     Attempts have been made to use synthetic materials, such as polyurethane, among others, as a substitute for the biological tissue, to provide a more durable flexible leaflet prosthetic heart valve, herein referred to as a synthetic leaflet prosthetic heart valve (SLV). However, synthetic leaflet prosthetic heart valves have not become a valid heart valve replacement option since they suffer premature failure, due to, among other things, suboptimal design and lack of a durable synthetic material. 
     The leaflet moves under the influence of fluid pressure. In operation, the leaflets open when the upstream fluid pressure exceeds the downstream fluid pressure and close when the downstream fluid pressure exceeds the upstream fluid pressure. The leaflet free edges of the leaflets coapt under the influence of downstream fluid pressure closing the prosthetic heart valve to prevent downstream blood from flowing retrograde through the prosthetic heart valve. 
     Prosthetic heart valve durability under the repetitive loads of the leaflets opening and closing is dependent, in part, on the load distribution between the leaflet and the frame. Further, substantial load is encountered on the leaflet when in the closed position. Mechanical failure of the leaflet can arise, for example, at the mounting edge, where the flexible leaflet is supported by the relatively rigid frame. The repetitive loads of leaflet opening and closing leads to material failure by fatigue, creep or other mechanism, depending in part on the leaflet material. Mechanical failure at the mounting edge is especially prevalent with synthetic leaflets. 
     The durability of the valve leaflets is also a function of the character of bending by the leaflet during the opening-closing cycle. Small radius bends, creases and intersecting creases, can produce high stress zones in the leaflet. These high stress zones can cause the formation of holes and tears under repetitive loading. 
     Prosthetic heart valves may be delivered using surgical or transcatheter techniques. A surgical prosthetic heart valve is implanted into a patient using open-heart surgical techniques. The surgical prosthetic heart valve is usually manufactured to have a fixed diameter as opposed to a transcatheter prosthetic heart valve which is required to attain a range of diameters for access and delivery. The surgical prosthetic heart valve is usually provided with a sewing cuff about a perimeter of the prosthetic heart valve to allow for suturing to the native tissue orifice. 
     In addition to the prosthetic heart valve durability issues discussed above, the transcatheter prosthetic heart valve must also be able to withstand the handling and deployment stresses associated with being compressed and expanded 
     A preferred shape of synthetic prosthetic heart valve leaflets has been described many times, but each is different from the others. The various three-dimensional shapes range from spherical or cylindrical to truncated conical intersections with spheres and an “alpharabola”. 
     The shape most often described as preferable is modeled after the native human aortic valve. Though nature dictates the optimum shape for the native tissues to form a heart valve, we have discovered this is not true for synthetic materials; accordingly, the design specified in the current disclosure is instead intended to place the synthetic material under a minimized stress condition as compared to those based on copies of the native valve. This is partially accomplished through reduced buckling in the leaflet material. 
     SUMMARY 
     Described embodiments are directed to an apparatus, system, and methods for heart valve replacement, such as cardiac valve replacement. More specifically, described embodiments are directed toward flexible leaflet prosthetic heart valve devices. 
     In accordance with an embodiment, a prosthetic heart valve comprises a leaflet frame having a generally tubular shape with attached film. The leaflet frame defines a plurality of leaflet windows. The film defines at least one leaflet extending from each of the leaflet windows. Each leaflet attachment zone on the leaflet frame has substantially the shape of an isosceles trapezoid having two leaflet sides, a leaflet base and a leaflet free edge opposite the leaflet base. The two leaflet sides diverge from the leaflet base, wherein the leaflet base is substantially flat. 
     In accordance with other embodiments of the prosthetic heart valve, each leaflet attachment zone on the leaflet frame includes a central region and two side regions on opposite sides of the central region. The central region of the attachment zone on the leaflet frame is defined by a shape substantially that of an isosceles trapezoid defined by two central region sides, the leaflet base and the leaflet free edge. The two central region sides of the attachment zone on the leaflet frame converge from the leaflet base. Each of the side regions of the attachment zone on the leaflet frame has a shape substantially that of a triangle and each are defined by one of the central region sides, one of the leaflet sides, and the leaflet free edge. 
     In accordance with other embodiments of the prosthetic heart valve, each leaflet attachment zone on the leaflet frame includes a central region and two side regions on opposite sides of the central region. The central region of the attachment zone on the leaflet frame is defined by a shape substantially that of an isosceles triangle defined by two central region sides, the leaflet base and the leaflet free edge. The two central region sides converge from the leaflet base to the leaflet free edge. Each of the side regions of the attachment zone on the leaflet frame has a shape substantially that of a triangle and each are defined by one of the central region sides, one of the leaflet sides, and the leaflet free edge. 
     In accordance with other embodiments of the prosthetic heart valve, the leaflet frame comprises a leaflet frame first end and a leaflet frame second end opposite the leaflet frame first end, the leaflet window having a shape determined, at least in part, by wrapping a two dimensional isosceles trapezoid pattern onto the tubular shape of the leaflet frame, the isosceles trapezoid pattern having a base and two sides that diverge from the base, and wherein a side from adjacent isosceles trapezoids meet at the leaflet frame second end. 
     In accordance with other embodiments of the prosthetic heart valve, the leaflets defining a shape of a trapezoid wherein frame elements bounds two sides, one side being a leaflet free edge, and the leaflet base being is a horizontal truncation bound only by the film. 
     In accordance with an embodiment, a prosthetic heart valve comprises a plurality of leaflets, each leaflet attachment zone on the leaflet frame having a shape substantially that of an isosceles trapezoid having two leaflet sides of the attachment zone on the leaflet frame, a leaflet base, and a leaflet free edge opposite the leaflet base, wherein the two leaflet sides diverge from the leaflet base. 
     In accordance with another embodiment, a prosthetic heart valve comprises a plurality of leaflets, wherein, wherein each leaflet attachment zone on the leaflet frame includes a central region and two side regions on opposite sides of the central region, wherein the central region is defined by a shape substantially that of an isosceles triangle defined by two central region sides, the leaflet base and the leaflet free edge, wherein the two central region sides converge from the leaflet base, and wherein each of the side regions of the attachment zone on the leaflet frame have a shape substantially that of a triangle and each are defined by one of the central region sides, one of the leaflet sides, and the leaflet free edge. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The accompanying drawings are included to provide a further understanding of the present disclosure and are incorporated in and constitute a part of this specification, illustrate embodiments described herein, and together with the description serve to explain the principles discussed in this disclosure. 
         FIG. 1A  is a side view of an embodiment of a prosthetic heart valve; 
         FIG. 1B  is a side view of the embodiment of the prosthetic heart valve of  FIG. 1A  that is partially rotated about the axis X; 
         FIG. 1C  is a perspective view of the embodiment of the prosthetic heart valve of  FIG. 1A ; 
         FIG. 1D  is a representation of a prosthetic heart valve in an expanded configuration; 
         FIG. 1E  is a representation of a prosthetic heart valve in a compressed configuration; 
         FIG. 2A  is a representation of the embodiment of the prosthetic heart valve of  FIG. 1A  unrolled to a flat orientation; 
         FIG. 2B  is an exploded representation of the embodiment of the prosthetic heart valve of  FIG. 1A  unrolled to a flat orientation; 
         FIG. 3A  is an axial or top view of the embodiment of the prosthetic heart valve of  FIG. 1A  in an open configuration; 
         FIG. 3B  is an axial or top view of the embodiment of the prosthetic heart valve of  FIG. 1A  in a closed configuration; 
         FIG. 4A  is a side view of an embodiment of a transcatheter delivery system within anatomy; 
         FIG. 4B  is a side view of an embodiment of a surgical prosthetic heart valve within anatomy; 
         FIG. 5A  is a cross-sectional view of a valve during manufacture, in accordance with an embodiment; 
         FIG. 5B  is a cross-sectional view of the leaflet frame and the outer frame as nested together, in accordance with the embodiment of  FIG. 5A ; 
         FIG. 6A  is an embodiment of an outer frame unrolled to a flat orientation; 
         FIG. 6B  is an embodiment of an outer frame unrolled to a flat orientation; 
         FIG. 7A  is an embodiment of a leaflet frame unrolled to a flat orientation; 
         FIG. 7B  is an embodiment of a leaflet frame unrolled to a flat orientation; 
         FIG. 8A  is an embodiment of a leaflet frame unrolled to a flat orientation; 
         FIG. 8B  is an embodiment of a leaflet frame unrolled to a flat orientation; 
         FIG. 8C  is an embodiment of a leaflet frame unrolled to a flat orientation; 
         FIG. 8D  is an embodiment of a leaflet frame unrolled to a flat orientation; 
         FIG. 8E  is an embodiment of a leaflet frame unrolled to a flat orientation; 
         FIG. 8F  is an embodiment of a leaflet frame unrolled to a flat orientation; 
         FIG. 9A  is a side view of a leaflet frame and an outer frame on an assembly mandrel, in accordance with an embodiment; 
         FIG. 9B  is a side view of the leaflet frame and the outer frame as nested together on an assembly mandrel, in accordance with the embodiment of  FIG. 9A ; 
         FIG. 10A  is a side exploded view of a leaflet frame and an outer frame that may be coupled by a mechanical engagement member, in accordance with another embodiment; 
         FIG. 10B  is a side view of an assembled embodiment of  FIG. 10A ; 
         FIG. 11A  is a side view of an embodiment of a prosthetic heart valve; 
         FIG. 11B  is a perspective view of the embodiment of the prosthetic heart valve of  FIG. 11A ; 
         FIG. 11C  is an axial or top view of the embodiment of the prosthetic heart valve of  FIG. 11A  in an open configuration; 
         FIG. 11D  is an axial or top view of the embodiment of the prosthetic heart valve of  FIG. 1A  in a closed configuration; 
         FIG. 12  is a side view of a leaflet frame on an assembly mandrel, in accordance with an embodiment of  FIGS. 11A and 11B ; 
         FIG. 13A  is a side view of the leaflet frame on a cutting mandrel, in accordance with an embodiment; and 
         FIG. 13B  is a perspective view of the leaflet frame on the cutting mandrel of  FIG. 13A . 
     
    
    
     DETAILED DESCRIPTION 
     Persons skilled in the art will readily appreciate that various aspects of the present disclosure can be realized by any number of methods and apparatus configured to perform the intended functions. Stated differently, other methods and apparatuses can be incorporated herein to perform the intended functions. It should also be noted that the accompanying drawing figures referred to herein are not necessarily drawn to scale, but may be exaggerated to illustrate various aspects of the present disclosure, and in that regard, the drawing figures should not be construed as limiting. 
     Although the embodiments herein may be described in connection with various principles and beliefs, the described embodiments should not be bound by theory. For example, embodiments are described herein in connection with prosthetic heart valves, more specifically cardiac prosthetic heart valves. However, embodiments within the scope of this disclosure can be applied toward any heart valve or mechanism of similar structure and/or function. Furthermore, embodiments within the scope of this disclosure can be applied in non-cardiac applications. 
     The term leaflet as used herein in the context of prosthetic heart valves is a component of a one-way valve wherein the leaflet is operable to move between an open and closed position under the influence of a pressure differential. In an open position, the leaflet allows blood to flow through the prosthetic heart valve. In a closed position, the leaflet substantially blocks retrograde flow through the prosthetic heart valve. In embodiments comprising multiple leaflets, each leaflet cooperates with at least one neighboring leaflet to block the retrograde flow of blood. The pressure differential in the blood is caused, for example, by the contraction of a ventricle or atrium of the heart, such pressure differential typically resulting from a fluid pressure building up on one side of the leaflets when closed. As the pressure on an inflow side of the prosthetic heart valve rises above the pressure on the outflow side of the prosthetic heart valve, the leaflets open and blood flows therethrough. As blood flows through the prosthetic heart valve into a neighboring chamber or blood vessel, the pressure on the inflow side equalizes with the pressure on the outflow side. As the pressure on the outflow side of the prosthetic heart valve rises above the blood pressure on the inflow side of the prosthetic heart valve, the leaflet returns to the closed position generally preventing retrograde flow of blood through the prosthetic heart valve. 
     The term membrane as used herein refers to a sheet of material comprising a single composition, such as, but not limited to, expanded fluoropolymer. 
     The term composite material as used herein refers to a combination of a membrane, such as, but not limited to, expanded fluoropolymer, and an elastomer, such as, but not limited to, a fluoroelastomer. The elastomer may be imbibed within a porous structure of the membrane, coated on one or both sides of the membrane, or a combination of coated on and imbibed within the membrane. 
     The term laminate as used herein refers to multiple layers of membrane, composite material, or other materials, such as elastomer, and combinations thereof. 
     The term film as used herein generically refers to one or more of the membrane, composite material, or laminate. 
     The term leaflet window is defined as that space that a leaflet frame defines from which a leaflet extends. The leaflet may extend from leaflet frame elements or adjacent to and spaced apart therefrom. 
     The term frame element as used herein refers to any portion of a leaflet frame or outer frame, such as, but not limited to, those individual portions that define a leaflet window or aperture. 
     The term attachment zone as used herein refers to the portion of the film that is attached to something so as to define the shape of the leaflet. The attachment zone may be, such as, but not limited to, that portion of the film that is coupled to the frame elements that define the leaflet window. The attachment zone may also be, such as, but not limited to, that portion of the film that is coupled to another film at a location that is not directly adjacent to a frame element. 
     The terms native heart valve orifice and tissue orifice refer to an anatomical structure into which a prosthetic heart valve may be placed. Such anatomical structure includes, but is not limited to, a location wherein a cardiac valve may or may not have been surgically removed. It is understood that other anatomical structures that may receive a prosthetic heart valve include, but are not limited to, veins, arteries, ducts and shunts. Although reference is made herein to replacing a native heart valve with a prosthetic heart valve, it is understood and appreciated that a valve orifice or implant site may also refer to a location in a synthetic or biological conduit that may receive a valve for a particular purpose, and therefore the scope of the embodiments provided herein is not limited to heart valve replacement. 
     As used herein, “couple” means to join, connect, attach, adhere, affix, or bond, whether directly or indirectly, and whether permanently or temporarily. 
     Embodiments herein include various apparatus, systems, and methods for a prosthetic heart valve suitable for surgical and transcatheter placement, such as, but not limited to, cardiac valve replacement. The prosthetic heart valve is operable as a one-way valve wherein the prosthetic heart valve defines a valve orifice into which leaflets open to permit flow and close so as to occlude the valve orifice and prevent flow in response to differential fluid pressure. 
     Embodiments provided herein are related to controlled leaflet opening. The durability of the prosthetic heart valve leaflets is largely controlled by the character of bending exhibited by the leaflet during the opening-closing cycle. Small radius bends, creases and particularly intersecting creases, can produce high stress zones in the leaflet. These high stress zones can cause the formation of holes and tears under repetitive loading. 
     Controlled bending is of particular importance in thin, high-modulus leaflets, since the bending in these materials tends to be cellophane-like. If the leaflet bending character is uncontrolled, not only do creases form, but crease intersections lead to formation of large three dimensional structures that oppose bending and slow down the leaflet motion, both in opening and closing: in order to avoid this, the sequence of opening of the parts of the leaflet must be controlled. 
     Controlled bending is achieved through a particular frame shape, in accordance with embodiments. The frame shape dictates the leaflet attachment perimeter, which further dictates leaflet movement. 
     Embodiments provided herein present advancement in prosthetic heart valve technology related to, but not limited to, mechanic and biological performance advantages. In accordance with some embodiments presented herein, a prosthetic heart valve comprises two frames, a leaflet frame and an outer frame, that are coupled together by a contiguous film in which a leaflet frame is nested into an outer frame in a telescoping manner, wherein there is no chance for the prosthetic heart valve to leak between the leaflet frame and the outer frame. 
     In accordance with some embodiments presented herein, a prosthetic heart valve comprises two frames; a leaflet frame and an outer frame. The film that comprises the leaflet may be coupled to the inner surface of the leaflet frame. In some other embodiments, the film that comprises the leaflet is contained between the leaflet frame and the outer frame and extends through a leaflet window defined by the leaflet frame. The leaflet, therefore, is significantly prevented from peeling or delaminating as it is contained between the leaflet frame and outer frame, as compared to where the leaflets are only coupled to the inner surface of the leaflet frame. 
     In accordance with some embodiments presented herein, a prosthetic heart valve comprises two frames; a leaflet frame and an outer frame. The leaflet frame and the outer frame are separated from each other by a film. In other words, there is a metal to polymer to metal interconnection, wherein there is no metal to metal contact between the leaflet frame and the outer frame. 
     In accordance with some embodiments presented herein, a prosthetic heart valve comprises two frames; a leaflet frame and an outer frame. The leaflet frame is nested within the outer frame, wherein the leaflet frame and outer frame cooperate to provide relatively high resistance to flat plate compression, among other things. In accordance with some embodiments, the outer frame provides frame elements that overlay the leaflet windows that are defined by the leaflet frame so as to provide structural support over the leaflet windows. In accordance with some embodiments, the outer frame provides frame elements that overlay the leaflet windows that are defined by the leaflet frame so as to prevent tissue from extending into the leaflet windows when implanted. In accordance with some embodiments, the outer frame provides frame elements that overlay the leaflet windows that are defined by the leaflet frame and act in concert so as to allow the frame assembly to compress and expand uniformly for trans catheter embodiments. 
     Prosthetic Heart Valve 
       FIG. 1A  is a side view of a prosthetic heart valve  100 , in accordance with an embodiment.  FIG. 1B  is also a side view of the prosthetic heart valve  100  of  FIG. 1A  rotated 60 degrees about the longitudinal axis X.  FIG. 1C  is a perspective view of the prosthetic heart valve  100  of  FIG. 1A .  FIG. 2A  is a side view of the prosthetic heart valve  100  of  FIG. 1A  wherein the prosthetic heart valve  100  has been longitudinally cut and laid open to better illustrate the elements of the generally tubular-shaped prosthetic heart valve  100 .  FIG. 2B  is an exploded view of the embodiment of  FIG. 2A .  FIGS. 3A and 3B  are axial views of the prosthetic heart valve  100  of  FIG. 1A  in an open and closed configuration, respectively. In  FIG. 3B  the leaflets  140  are shown slightly open to better show the features but it is understood that a fully closed prosthetic heart valve  100  will have the leaflet free edges  142  of the leaflets  140  coming together to coapt under the influence of downstream fluid pressure which results in closing the valve to prevent downstream blood from flowing retrograde through the valve. 
       FIG. 11A  is a side view of a prosthetic heart valve  200 , in accordance with an embodiment.  FIG. 11B  is a perspective view of the prosthetic heart valve  200  of  FIG. 1A . The prosthetic heart valve  200  comprises a leaflet frame  130   f  and film  160  that defines leaflets  140 .  FIG. 8D  is a side view of the leaflet frame  130   f  of the prosthetic heart valve  200  of  FIG. 11A  wherein the leaflet frame  130   f  has been longitudinally cut and laid open to better illustrate the elements of the generally tubular-shaped prosthetic heart valve  200 . In  FIG. 11B , the leaflets  140  are shown slightly open to better show the features but it is understood that a fully closed prosthetic heart valve  200  will have the leaflet free edges  142  of the leaflets  140  coming together to coapt under the influence of downstream fluid pressure which results in closing the valve to prevent downstream blood from flowing retrograde through the valve. The term “frame element” as used herein refers to any portion of the leaflet frame  130 , such as, but not limited to, those individual portions that define a leaflet window  137 . The leaflet frame first end  131   a  further comprises commissure posts  136  extending from an apex of the leaflet frame elements defining substantially a triangle. 
       FIG. 8D  is a side view of the leaflet frame  130   f  of the prosthetic heart valve  200  of  FIGS. 11A and 11B  wherein the leaflet frame  130   f  has been longitudinally cut and laid open to better illustrate the elements of the generally tubular-shaped prosthetic heart valve  200 . The leaflet frame  130   f  comprises a plurality of spaced apart frame elements  130  defining substantially isosceles triangles interconnected by a base element  138   f  defining leaflet windows  137   f  having the shape of an isosceles trapezoid. Each leaflet window side  133  is defined by a side of one triangle and a side of an adjacent triangle, and wherein each leaflet window base  134  is defined by the base element  138 . The term “frame element” as used herein refers to any portion of the leaflet frame  130 , such as, but not limited to, those individual portions that define a leaflet window  137 . 
     Referring again to  FIGS. 11A and 8D , the leaflet frame first end  131   a  further comprises commissure posts  136  extending from an apex of the leaflet frame elements defining substantially an isosceles triangle. The commissure post  136  may affect the leaflet free edge  142  so as to create a larger or wider coaptation region  146  between adjacent leaflet free edges  142 . 
     Outer Frame 
     The outer frame  120  is a generally tubular member defining a generally open pattern of apertures  122 , in accordance with an embodiment, as shown in  FIG. 1C . The outer frame  120  is comprised of a generally cylindrical arrangement of three triangular-shaped leaflet windows  137 , the centers of which are each spaced apart by 120°, as shown in  FIG. 2B . 
     In accordance with transcatheter embodiments, the outer frame  120  is operable to allow it to be compressed and expanded between different diameters. The outer frame  120  comprises an outer frame outer surface  126   a  and an outer frame inner surface  126   b  opposite the outer frame outer surface  126   a , as shown in  FIG. 5A . The outer frame  120  may comprise a structure known in the art as a stent. A stent is a tubular member that may have a small diameter suitable for percutaneous transcatheter delivery into the anatomy, and may be expanded to a larger diameter when deployed into the anatomy. Stents having various designs and material properties are well known in the art. 
     By way of example, and as illustrated in the embodiments of  FIGS. 1A-1C and 2A-2B , the prosthetic heart valve  100  includes the outer frame  120  that defines a stent having apertures  122  having generally a diamond shape when in a large diameter configuration, as shown generally in  FIG. 1D . Upon compression to a smaller diameter, the apertures  122  deform to generally define an elongated diamond shape, as shown generally in  FIG. 1E . Upon re-expansion to a larger diameter, the apertures  122  re-expand to again define a generally diamond shape. 
     As shown in  FIGS. 5A and 5B , both views showing the elements in cross-section, the leaflet frame  130  has a generally tubular shape defining a plurality of leaflet windows (not shown). The outer frame  120  has a generally tubular shape. The leaflet frame  130  is coaxially disposed at least partially within the outer frame  120 . The leaflet frame  130  and outer frame  120  are coupled at least in part by a contiguous portion of the film  160 . At least a portion of the contiguous portion of the film  160  is contained between and couples the leaflet frame  130  to the outer frame  120  to inhibit relative movement therebetween. The film defines a leaflet  140  extending from each of the leaflet windows. The leaflet base  143  is defined at a fold line  145  in the film  160 . In accordance with an embodiment, at least a portion of the contiguous portion of the film  160  that is contained between and coupling the leaflet frame  130  and outer frame  120  prevents contact between the leaflet frame  130  and outer frame  120 . 
       FIGS. 6A and 6B  are side views of alternative embodiments of the outer frame  120   a ,  120   b  wherein the outer frame has been longitudinally cut and laid open to better illustrate the elements of the outer frame 
     An open framework of the stent can define any number of features, repeatable or otherwise, such as geometric shapes and/or linear or meandering series of sinusoids. Geometric shapes can comprise any shape that facilitates substantially uniform circumferential compression and expansion. The outer frame  120  may comprise a cut tube, or any other element suitable for the particular purpose. The outer frame  120  may be etched, cut, laser cut, or stamped into a tube or a sheet of material, with the sheet then formed into a substantially cylindrical structure. Alternatively, an elongated material, such as a wire, bendable strip, or a series thereof, can be bent or braided and formed into a substantially cylindrical structure wherein the walls of the cylinder comprise an open framework that is compressible to a smaller diameter in a generally uniform and circumferential manner and expandable to a larger diameter. 
     It is known that stents of various designs may be elastically deformable so as to be self-expanding under spring loads. It is also known that stents of various designs may be plastically deformable so as to be mechanically expanded such as with a balloon. It is also known that stents of various designs may be plastically deformable as well as elastically deformable. The embodiments of the outer frame  120  presented herein are not to be limited to a specific stent design or mode of expansion. 
     The outer frame  120  can comprise any metallic or polymeric biocompatible material. For example, the outer frame  120  can comprise a material, such as, but not limited to nitinol, cobalt-nickel alloy, stainless steel, or polypropylene, acetyl homopolymer, acetyl copolymer, ePTFE, other alloys or polymers, or any other biocompatible material having adequate physical and mechanical properties to function as described herein. 
     In accordance with embodiments, the frame  30  can be configured to provide positive engagement with an implant site to firmly anchor the prosthetic heart valve  100  to the site, as shown in  FIG. 4A  representing a transcatheter deployment of the prosthetic heart valve  100 . In accordance with an embodiment, the outer frame  120  can comprise a sufficiently rigid frame having small elastic recoil so as to maintain sufficient apposition against a tissue orifice  150  to maintain position. In accordance with another embodiment, the outer frame  120  can be configured to expand to a diameter that is larger than a tissue orifice  150  so that when prosthetic heart valve  100  expands into the tissue orifice  150 , it can be firmly seated therein. In accordance with another embodiment, the outer frame  120  can comprise one or more anchors (not shown) configured to engage the implant site, such as a tissue orifice  150 , to secure the prosthetic heart valve  100  to the implant site. 
     It is appreciated that other elements or means for coupling the prosthetic heart valve  100  to an implant site are anticipated. By way of example, but not limited thereto, other means, such as mechanical and adhesive means may be used to couple the prosthetic heart valve  100  to a synthetic or biological conduit. 
     As will be discussed later, the surgical prosthetic heart valve  100  embodiment may or may not have the zigzag configuration since the surgical prosthetic heart valve  100  may be of a fixed diameter and need not be operable to compress and re-expand. 
     The leaflet frame comprises a plurality of spaced apart leaflet windows  137   f  each leaflet attachment zone defines substantially an isosceles triangle interconnected by a base element  138   f , wherein each leaflet window side is defined by a side of one triangle and a side of an adjacent triangle, and wherein each leaflet window base is defined by the base element  138   f.    
       FIG. 7A  is a representation of another embodiment of a leaflet frame  130   a  unrolled to a flat orientation. The leaflet frame  130   a  comprises frame elements  139  suitable for affecting compression and expansion as would be needed for intravascular placement. The leaflet window  137   a  is defined by two leaflet window sides  133   a  that meet at a leaflet window base  134   a . A leaflet  140  is shown in dashed line to represent where the leaflet  140  is located within the leaflet window  137   a . The leaflet sides  141  are coupled to the leaflet window sides  133   a  and the leaflet base  143  is coupled to the leaflet window base  134   a.    
       FIG. 7B  is a representation of another embodiment of a leaflet frame  130   b  unrolled to a flat orientation. The leaflet window  137   b  is defined by two leaflet window sides  133   b  that meet at a leaflet window base  134   b  that is elongated and horizontal with the valve axis. A leaflet  140  is shown in dashed line to represent where the leaflet  140  is located within the leaflet window  137   a . The leaflet sides  141  are coupled to the leaflet window sides  133   a  and the leaflet base  143   b  is coupled to the leaflet window base  134   a . The leaflet window base  134   b  is flat such that the leaflet bends from a flat base during opening and closing. 
       FIG. 8A  is a representation of another embodiment of a leaflet frame  130   c  unrolled to a flat orientation. The leaflet frame  130   c  comprises frame elements  139  suitable for affecting compression and expansion as would be needed for intravascular placement. The leaflet window  137   c  is defined by two leaflet window sides  133   c  that meet at a leaflet window base  134   c . A leaflet  140  is shown in dashed line to represent where the leaflet  140  is located within the leaflet window  137   c . The leaflet sides  141  are coupled to the leaflet window sides  133   c  and the leaflet base  143   c  is coupled to the leaflet window base  134   c.    
       FIG. 8B  is a representation of another embodiment of a leaflet frame  130   d  unrolled to a flat orientation. The leaflet frame  130   d  comprises frame elements  139  suitable for affecting compression and expansion as would be needed for intravascular placement. The leaflet window  137   d  is defined by two leaflet window sides  133   d  that meet at a leaflet window base  134   d . A leaflet  140  is shown in dashed line to represent where the leaflet  140  is located within the leaflet window  137   d . The leaflet sides  141  are coupled to the leaflet window sides  133   d  and the leaflet base  143   d  is coupled to the leaflet window base  134   d . The leaflet window sides  133   d  define a parabolic shape. 
       FIG. 8C  is a representation of another embodiment of a leaflet frame  130   e  unrolled to a flat orientation. The leaflet frame  130   e  comprises frame elements  139  suitable for affecting compression and expansion as would be needed for intravascular placement. The leaflet window  137   e  is defined by two leaflet window sides  133   e  that meet at a leaflet window base  134   e . A leaflet  140  is shown in dashed line to represent where the leaflet  140  is located within the leaflet window  137   e . The leaflet sides  141  are coupled to the leaflet window sides  133   e  and the leaflet base  143   e  is coupled to the leaflet window base  134   a.    
       FIG. 8D  is a side view of an alternative embodiment of the leaflet frame  130   f  wherein the leaflet frame  130   f  has been longitudinally cut and laid open to better illustrate the elements of the leaflet frame  130   f , of a valve substantially shown as the prosthetic heart valve  100  of  FIGS. 11A and 11B . A leaflet  140   f  is shown in dashed line to represent where the leaflet  140   f  is located within the leaflet window  137   f , the leaflet window  137   f  being defined by the leaflet window sides  133   f  and the leaflet window base  134   f . The two leaflet sides  141   f  diverge from the leaflet base  143   f , wherein the leaflet base  143   f  is substantially flat, with the leaflet free edge  142   f  opposite the leaflet base  143   f , as shown in dashed lines in  FIG. 8D . The leaflet frame  130   f  further defines commissure posts  136  from which the leaflet free edge  142   f  extends. 
       FIG. 8E  is a side view of an alternative embodiment of the leaflet frame  130   g  wherein the leaflet frame  130   g  has been longitudinally cut and laid open to better illustrate the elements of the leaflet frame  130   g . A leaflet  140   g  is shown in dashed line to represent where the leaflet  140   g  is located within the leaflet window  137   g , the leaflet window  137   g  being defined by the leaflet window sides  133   g  and the leaflet window base  134   g . Two leaflet sides  141   g  diverge from the leaflet base  143   g , wherein the leaflet base  143   g  is substantially flat, with the leaflet free edge  142   g  opposite the leaflet base  143   g , as shown in dashed lines in  FIG. 8E . The leaflet frame  130   g  comprises a plurality of leaflet frame elements defining a plurality of isosceles triangles interconnected by a leaflet window base  134   g  defining leaflet windows  137   g  that define isosceles trapezoids. Each leaflet window side  133   g  is defined by a side of one triangle and a side of an adjacent triangle. 
       FIG. 8F  is a side view of an alternative embodiment of the leaflet frame  130   h  wherein the leaflet frame  130   h  has been longitudinally cut and laid open to better illustrate the elements of the leaflet frame  130   h . The leaflet frame  130   h  comprises a base element  138   h  and a plurality of spaced apart spade elements  170  interconnected by the base element  138   h . Each leaflet window  137   h  is defined by a spade side  175  of one spade element  170  and a spade side  175  of an adjacent spade element  170 , and wherein each leaflet window base  134   h  is defined by the base element  138   h . The spade side  175  does not extend to the base element  138   h . By virtue of the geometry, the leaflet  140   h , during opening and closing, will bend about the spade side  175  and towards the base element  138   h  defining a partially frameless leaflet window  137   h  where the leaflet  140  is not bending directly adjacent a frame element  139 , defining an attachment zone  163 . The leaflet base  143   h  may be defined a distance away from the base element  138   h  such that the leaflet base  143   h  is not bending directly adjacent the base element  138   h . A leaflet base  143   h  that is not directly adjacent the base element  138   h  is referred herein as a virtual leaflet window base, virtual in the sense that it is not defined directly by a frame element. In accordance with an embodiment of the prosthetic heart valve, each leaflet  140   h  takes the form of substantially the shape of an isosceles trapezoid having two leaflet sides  141   h , a leaflet base  143   h  and a leaflet free edge  142   h  opposite the leaflet base  143   h , wherein the two leaflet sides  141   h  diverge from the leaflet base  143   h , wherein the leaflet base  143   h  is substantially flat, as shown in dashed lines in  FIG. 8F . 
     In another embodiment substantially as shown in  FIG. 8F , a first layer of film  160   a  is coupled to a leaflet frame inner surface  132   b  of the leaflet frame  130   h  and a second layer of film  160   b  is coupled to a leaflet frame outer surface  132   a  of the leaflet frame  130   h  opposite from the leaflet frame inner surface  132   b . The first layer of film  160  and the second layer of film  160   b  are coupled together to define an attachment zone  163 . 
     As previously discussed, the leaflet window base may be used to define the leaflet base in accordance with embodiments. Also as previously discussed, the leaflet base may be defined as a virtual leaflet base  143  by a fold line  145  in the film  160  in the fold region spaced apart from the leaflet window base  134 , as shown in  FIGS. 1A and 1B , and shown by the dashed lines in  FIG. 2B . It is appreciated that there are many embodiments of the outer frame having configurations suitable for the particular purpose. 
       FIG. 10A  is a side exploded view of another prosthetic heart valve comprising a leaflet frame  1130  having a generally tubular shape and an outer frame  1120  having a generally tubular shape that are coupled by a mechanical engagement member  1110 , in accordance with another embodiment.  FIG. 10B  is an assembled view of the embodiment of  FIG. 10A . 
     As previously discussed, the leaflet window base may be used to define the leaflet base in accordance with embodiments. Also as previously discussed, the leaflet base may be defined as a virtual leaflet base  143   a  by a fold line  145  in the film  160  in the fold region  144  spaced apart from the leaflet window base, as shown in  FIGS. 1B and 2B . It is appreciated that there are many embodiments of the leaflet frame having configurations suitable for the particular purpose. 
     In transcatheter prosthetic heart valve  100  embodiments, the leaflet frame  130  is elastically, plastically, or both, compressible to obtain a relatively small diameter to accommodate percutaneous transcatheter mounting and delivery. 
     In accordance with an embodiment, the leaflet frame  130  and the outer frame  120  comprise a shape memory material operable to flex under load and retain its original shape when the load is removed, thus allowing the leaflet frame  130  and the outer frame  120  to self-expand from a compressed shape to a predetermined shape. In accordance with an embodiment the leaflet frame  130  is plastically deformable to be expanded by a balloon. In another embodiment, the outer frame  120  is elastically deformable so as to be self-expanding. 
     Film 
     The film  160  is generally any sheet-like material that is biologically compatible and configured to couple to leaflets to the leaflet frame, in accordance with embodiments. It is understood that the term “film” is used generically for one or more biocompatible materials suitable for a particular purpose. The leaflets  140  are also comprised of the film  160 . 
     In accordance with an embodiment, the biocompatible material is a film  160  that is not of a biological source and that is sufficiently flexible and strong for the particular purpose, such as a biocompatible polymer. In an embodiment, the film  160  comprises a biocompatible polymer that is combined with an elastomer, referred to as a composite. 
     Details of various types of film  160  are discussed below. In an embodiment, the film  160  may be formed from a generally tubular material to at least partially cover the outer frame  120  and the leaflet frame  130 . The film  160  can comprise one or more of a membrane, composite material, or laminate. Details of various types of film  160  are discussed below. 
     Leaflet 
     Each leaflet window  137  is provided with a biocompatible material, such as a film  160 , which is coupled to a portion of the leaflet window sides  133  with the film  160  defining a leaflet  140 . Each leaflet  140  defines a leaflet free edge  142  and a leaflet base  143 , in accordance with an embodiment. As will be described below, it is anticipated that a plurality of embodiments of leaflet base configurations may be provided. In accordance with an embodiment, the film  160  is coupled to a portion of the leaflet window sides  133  and to the leaflet window base  134  where the leaflet  140  is defined by the portion of the leaflet window sides  133  and to the leaflet window base  134 . In accordance with another embodiment, the film  160  is coupled to a portion of the leaflet window sides 
     The shape of the leaflets  140  are defined in part by the shape of the leaflet window  137  and the leaflet free edge  142 . As will be discussed below in accordance with an embodiment, the shape of the leaflets  140  also depends in part on a process that induces a fold at the fold line  145  to define a virtual leaflet base  143   a  as will be described further below, so as to impart a predetermined shape to the leaflet  140 . Since high bending stresses are located at the leaflet base, defining a virtual leaflet base  143   a  that is not bound by the leaflet window base  134  may reduce the chance of tearing of the leaflet  140  at the leaflet base  143 —leaflet window base  134  interface. It may also reduce blood pooling and stagnation at the leaflet base as compared with a rounded leaflet base. 
     When the leaflets  140  are in a fully open position, the prosthetic heart valve  100  presents a substantially circular valve orifice  102  as shown in  FIG. 3A . Fluid flow is permitted through the valve orifice  102  when the leaflets  140  are in an open position. 
     As the leaflets  140  cycle between the open and closed positions, the leaflets  140  generally flex about the leaflet base  143  and the portion of the leaflet window sides  133  to which the leaflet are coupled. When the prosthetic heart valve  100  is closed, generally about half of each leaflet free edge  142  abuts an adjacent half of a leaflet free edge  142  of an adjacent leaflet  140 , as shown in  FIG. 3B . The three leaflets  140  of the embodiment of  FIG. 3B  meet at a triple point  148 . The valve orifice  102  is occluded when the leaflets  140  are in the closed position stopping fluid flow. 
     Referring to  FIG. 3B , in accordance with an embodiment, each leaflet  140  includes a central region  182  and two side regions  184  on opposite sides of the central region  182 . The central region  182  is defined by a shape substantially that of an isosceles triangle defined by two central region sides  183 , the leaflet base  143  and the leaflet free edge  142 . The two central region sides  183  converge from the leaflet base  143  to the leaflet free edge  142 . Each of the side regions  184  have a shape substantially that of a triangle and each are defined by one of the central region sides  183 , one of the leaflet sides  141 , and the leaflet free edge  142 . 
     In accordance with an embodiment, each of the two side regions  184  and the central region  182  are substantially planar when the prosthetic heart valve  100  is in the closed position. 
     The leaflet  140  can be configured to actuate at a pressure differential in the blood caused, for example, by the contraction of a ventricle or atrium of the heart, such pressure differential typically resulting from a fluid pressure building up on one side of the prosthetic heart valve  100  when closed. As the pressure on an inflow side of the prosthetic heart valve  100  rises above the pressure on the outflow side of the prosthetic heart valve  100 , the leaflet  140  opens and blood flows therethrough. As blood flows through the prosthetic heart valve  100  into a neighboring chamber or blood vessel, the pressure equalizes. As the pressure on the outflow side of the prosthetic heart valve  100  rises above the blood pressure on the inflow side of the prosthetic heart valve  100 , the leaflet  140  returns to the closed position generally preventing the retrograde flow of blood through the inflow side of the prosthetic heart valve  100 . 
     It is understood that the leaflet frame  130  may comprise any number of leaflet windows  137 , and thus leaflets  140 , suitable for a particular purpose, in accordance with embodiments. Leaflet frames  130  comprising one, two, three or more leaflet windows  137  and corresponding leaflets  140  are anticipated. 
     In accordance with an embodiment of a transcatheter prosthetic heart valve  100 , with reference to  FIGS. 1D-1E , the prosthetic heart valve  100  may be compressed into a collapsed configuration having a smaller diameter and expanded into an expanded configuration so that the prosthetic heart valve  100  can be delivered via catheter in the collapsed configuration and expanded upon deployment within the tissue orifice  150  as shown in  FIG. 4A . The outer frame  120  can be operable to recover circumferential uniformity when transitioning from the collapsed configuration to the expanded configuration. 
     The prosthetic heart valve  100  may be mounted onto a delivery catheter, suitable for a particular purpose. The diameter of the prosthetic heart valve  100  in the collapsed configuration is determined in part by the thickness of the leaflet frame and the leaflet thickness. 
     Leaflet Film 
     The biocompatible material that makes up the leaflet  140  can comprise any biological tissue or synthetic, biocompatible materials sufficiently compliant and flexible, such as a biocompatible polymer. In an embodiment, the leaflet  140  comprises a biocompatible polymer that is combined with an elastomer, referred to as a composite. A material according to one embodiment includes a composite material comprising an expanded fluoropolymer membrane, which comprises a plurality of spaces within a matrix of fibrils, and an elastomeric material. It should be appreciated that multiple types of fluoropolymer membranes and multiple types of elastomeric materials can be combined to form a laminate while remaining within the scope of the present disclosure. It should also be appreciated that the elastomeric material can include multiple elastomers, multiple types of non-elastomeric components, such as inorganic fillers, therapeutic agents, radiopaque markers, and the like while remaining within the scope of the present disclosure. 
     In accordance with an embodiment, the composite material includes an expanded fluoropolymer material made from porous ePTFE membrane, for instance as generally described in U.S. Pat. No. 7,306,729 to Bacino. 
     The expandable fluoropolymer, used to form the expanded fluoropolymer material described, may comprise PTFE homopolymer. In alternative embodiments, blends of PTFE, expandable modified PTFE and/or expanded copolymers of PTFE may be used. Non-limiting examples of suitable fluoropolymer materials are described in, for example, U.S. Pat. No. 5,708,044, to Branca, U.S. Pat. No. 6,541,589, to Baillie, U.S. Pat. No. 7,531,611, to Sabol et al., U.S. patent application Ser. No. 11/906,877, to Ford, and U.S. patent application Ser. No. 12/410,050, to Xu et al. 
     The expanded fluoropolymer membrane can comprise any suitable microstructure for achieving the desired leaflet performance. In accordance with an embodiment, the expanded fluoropolymer comprises a microstructure of nodes interconnected by fibrils, such as described in U.S. Pat. No. 3,953,566 to Gore. The fibrils radially extend from the nodes in a plurality of directions, and the membrane has a generally homogeneous structure. Membranes having this microstructure may typically exhibit a ratio of matrix tensile strength in two orthogonal directions of less than 2, and possibly less than 1.5. 
     In another embodiment, the expanded fluoropolymer membrane has a microstructure of substantially only fibrils, as is generally taught by U.S. Pat. No. 7,306,729, to Bacino. The expanded fluoropolymer membrane having substantially only fibrils, can possess a high surface area, such as greater than 20 m 2 /g, or greater than 25 m 2 /g, and in some embodiments can provide a highly balanced strength material having a product of matrix tensile strengths in two orthogonal directions of at least 1.5×10 5  MPa 2 , and/or a ratio of matrix tensile strengths in two orthogonal directions of less than 4, and possibly less than 1.5. 
     The expanded fluoropolymer membrane can be tailored to have any suitable thickness and mass to achieve the desired leaflet performance. By way of example, but not limited thereto, the leaflet  140  comprises an expanded fluoropolymer membrane having a thickness of about 0.1 μm. The expanded fluoropolymer membrane can possess a mass per area of about 1.15 g/m 2 . Membranes according to an embodiment of the invention can have matrix tensile strengths of about 411 MPa in the longitudinal direction and 315 MPa in the transverse direction. 
     Additional materials may be incorporated into the pores or within the material of the membranes or in between layers of membranes to enhance desired properties of the leaflet. Composite materials described herein can be tailored to have any suitable thickness and mass to achieve the desired leaflet performance. Composite materials according to embodiments can include fluoropolymer membranes and have a thickness of about 1.9 μm and a mass per area of about 4.1 g/m 2 . 
     The expanded fluoropolymer membrane combined with elastomer to form a composite material provides the elements of the present disclosure with the performance attributes required for use in high-cycle flexural implant applications, such as prosthetic heart valve leaflets, in various ways. For example, the addition of the elastomer can improve the fatigue performance of the leaflet by eliminating or reducing the stiffening observed with ePTFE-only materials. In addition, it may reduce the likelihood that the material will undergo permanent set deformation, such as wrinkling or creasing, that could result in compromised performance. In one embodiment, the elastomer occupies substantially all of the pore volume or space within the porous structure of the expanded fluoropolymer membrane. In another embodiment the elastomer is present in substantially all of the pores of the at least one fluoropolymer layer. Having elastomer filling the pore volume or present in substantially all of the pores reduces the space in which foreign materials can be undesirably incorporated into the composite. An example of such foreign material is calcium that may be drawn into the membrane from contact with the blood. If calcium becomes incorporated into the composite material, as used in a prosthetic heart valve leaflet, for example, mechanical damage can occur during cycling open and closed, thus leading to the formation of holes in the leaflet and degradation in hemodynamics. 
     In an embodiment, the elastomer that is combined with the ePTFE is a thermoplastic copolymer of tetrafluoroethylene (TFE) and perfluoromethyl vinyl ether (PMVE), such as described in U.S. Pat. No. 7,462,675 to Chang et al. As discussed above, the elastomer is combined with the expanded fluoropolymer membrane such that the elastomer occupies substantially all of the void space or pores within the expanded fluoropolymer membrane to form a composite material. This filling of the pores of the expanded fluoropolymer membrane with elastomer can be performed by a variety of methods. In one embodiment, a method of filling the pores of the expanded fluoropolymer membrane includes the steps of dissolving the elastomer in a solvent suitable to create a solution with a viscosity and surface tension that is appropriate to partially or fully flow into the pores of the expanded fluoropolymer membrane and allow the solvent to evaporate, leaving the filler behind. 
     In one embodiment, the composite material comprises three layers: two outer layers of ePTFE and an inner layer of a fluoroelastomer disposed therebetween. Additional fluoroelastomers can be suitable and are described in U.S. Publication No. 2004/0024448 to Chang. 
     In another embodiment, a method of filling the pores of the expanded fluoropolymer membrane includes the steps of delivering the filler via a dispersion to partially or fully fill the pores of the expanded fluoropolymer membrane. 
     In another embodiment, a method of filling the pores of the expanded fluoropolymer membrane includes the steps of bringing the porous expanded fluoropolymer membrane into contact with a sheet of the elastomer under conditions of heat and/or pressure that allow elastomer to flow into the pores of the expanded fluoropolymer membrane. 
     In another embodiment, a method of filling the pores of the expanded fluoropolymer membrane includes the steps of polymerizing the elastomer within the pores of the expanded fluoropolymer membrane by first filling the pores with a prepolymer of the elastomer and then at least partially curing the elastomer. 
     After reaching a minimum percent by weight of elastomer, the leaflets constructed from fluoropolymer materials or ePTFE generally performed better with increasing percentages of elastomer resulting in significantly increased cycle lives. In one embodiment, the elastomer combined with the ePTFE is a thermoplastic copolymer of tetrafluoroethylene and perfluoromethyl vinyl ether, such as described in U.S. Pat. No. 7,462,675 to Chang et al., and other references that would be known to those of skill in the art. Other biocompatible polymers which can be suitable for use in leaflet  140  include but are not limited to the groups of urethanes, silicones(organopolysiloxanes), copolymers of silicon-urethane, styrene/isobutylene copolymers, polyisobutylene, polyethylene-co-poly(vinyl acetate), polyester copolymers, nylon copolymers, fluorinated hydrocarbon polymers and copolymers or mixtures of each of the foregoing. 
     Other Considerations 
     In accordance with an embodiment, the prosthetic heart valve can be configured to prevent interference with a heart conduction system by not covering a bundle branch in the left ventricle when implanted, such as might be encountered with an aortic valve replacement procedure. For example, the prosthetic heart valve can comprise a length of less than about 25 mm or less than about 18 mm. The prosthetic heart valve can also comprise an aspect ratio of less than one, wherein the ratio describes the relationship between the length of the prosthetic heart valve to the expanded, functional diameter. However, the prosthetic heart valve can be constructed at any length and, more generally, any desirable dimension. 
     In a transcatheter embodiment, in a collapsed state, the prosthetic heart valve can have a collapsed profile that is less than about 35% of the expanded profile. For example, the prosthetic heart valve  100  comprising a 26 mm expanded diameter can have a collapsed diameter of less than about 8 mm, or less than about 6 mm. The percent difference in diameter is dependent on dimensions and materials of the prosthetic heart valve and its various applications, and therefore, the actual percent difference is not limited by this disclosure. 
     The prosthetic heart valve can further comprise a bio-active agent. Bio-active agents can be coated onto a portion or the entirety of the film  160  for controlled release of the agents once the prosthetic heart valve is implanted. The bio-active agents can include, but are not limited to, vasodilator, anti-coagulants, anti-platelet, anti-thrombogenic agents such as, but not limited to, heparin. Other bio-active agents can also include, but are not limited to agents such as, for example, anti-proliferative/antimitotic agents including natural products such as vinca alkaloids (i.e. vinblastine, vincristine, and vinorelbine), paclitaxel, epidipodophyllotoxins (i.e. etoposide, teniposide), antibiotics (dactinomycin (actinomycin D) daunorubicin, doxorubicin and idarubicin), anthracyclines, mitoxantrone, bleomycins, plicamycin (mithramycin) and mitomycin, enzymes (L-asparaginase which systemically metabolizes L-asparagine and deprives cells which do not have the capacity to synthesize their own asparagine); antiplatelet agents such as G(GP) IIb/IIIa inhibitors and vitronectin receptor antagonists; anti-proliferative/antimitotic alkylating agents such as nitrogen mustards (mechlorethamine, cyclophosphamide and analogs, melphalan, chlorambucil), ethylenimines and methylmelamines (hexamethylmelamine and thiotepa), alkyl sulfonates-busulfan, nitrosoureas (carmustine (BCNU) and analogs, streptozocin), trazenes-dacarbazinine (DTIC); anti-proliferative/antimitotic antimetabolites such as folic acid analogs (methotrexate), pyrimidine analogs (fluorouracil, floxuridine, and cytarabine), purine analogs and related inhibitors (mercaptopurine, thioguanine, pentostatin and 2-chlorodeoxyadenosine {cladribine}); platinum coordination complexes (cisplatin, carboplatin), procarbazine, hydroxyurea, mitotane, aminoglutethimide; hormones (i.e. estrogen); anti-coagulants (heparin, synthetic heparin salts and other inhibitors of thrombin); fibrinolytic agents (such as tissue plasminogen activator, streptokinase and urokinase), aspirin, dipyridamole, ticlopidine, clopidogrel, abciximab; antimigratory; antisecretory (breveldin); anti-inflammatory: such as adrenocortical steroids (cortisol, cortisone, fludrocortisone, prednisone, prednisolone, 6α-methylprednisolone, triamcinolone, betamethasone, and dexamethasone), non-steroidal agents (salicylic acid derivatives i.e. aspirin; para-aminophenol derivatives i.e. acetominophen; indole and indene acetic acids (indomethacin, sulindac, and etodalac), heteroaryl acetic acids (tolmetin, diclofenac, and ketorolac), arylpropionic acids (ibuprofen and derivatives), anthranilic acids (mefenamic acid, and meclofenamic acid), enolic acids (piroxicam, tenoxicam, phenylbutazone, and oxyphenthatrazone), nabumetone, gold compounds (auranofin, aurothioglucose, gold sodium thiomalate); immunosuppressives: (cyclosporine, tacrolimus (FK-506), sirolimus (rapamycin), azathioprine, mycophenolate mofetil); angiogenic agents: vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF); angiotensin receptor blockers; nitric oxide donors; anti-sense oligionucleotides and combinations thereof; cell cycle inhibitors, mTOR inhibitors, and growth factor receptor signal transduction kinase inhibitors; retenoids; cyclin/CDK inhibitors; HMG co-enzyme reductase inhibitors (statins); and protease inhibitors. 
     Transcatheter Delivery System 
     In an embodiment, with reference to  FIG. 4A , a valve delivery system  500  comprises a prosthetic heart valve  100  having a collapsed configuration and an expanded configuration as previously described and an elongated flexible catheter  480 , such as a balloon catheter, configured to deploy the prosthetic heart valve  100  via catheter. The catheter  480  can comprise a balloon to expand the prosthetic heart valve  100  and/or if required, to touch up the prosthetic heart valve  100  to ensure proper seating. The prosthetic heart valve  100  can be mounted to the distal section of the catheter  480  for delivery through the vasculature. In order to hold the prosthetic heart valve in a collapsed configuration on the catheter  480 , the valve delivery system may further comprise a removable sheath (not shown) to closely fit over the transcatheter prosthetic heart valve  100 . 
     A method of delivery can comprise the steps of radially compressing a prosthetic heart valve into its collapsed configuration onto the distal end of an elongate flexible catheter having proximal and distal ends; delivering the prosthetic heart valve to a tissue orifice, such as a native aortic valve orifice, via a transfemoral or transapical route, and expanding the prosthetic heart valve into the tissue orifice. The prosthetic heart valve can be expanded by inflating a balloon. 
     A method of delivery can comprise the steps of radially compressing a prosthetic heart valve into its collapsed configuration, onto the distal section of an elongated flexible catheter having proximal and distal ends. A restraint, which can be connected to a tether that passes through the orifice of the prosthetic heart valve and the lumen of the catheter, is fitted around the commissure posts of the prosthetic heart valve. The prosthetic heart valve is then delivered to a native valve orifice, such as a native aortic valve orifice, via a route of delivery and expanded into the native orifice. The route of delivery can comprise a transfemoral or transapical route. The prosthetic heart valve can be expanded by inflating a balloon. 
     Surgical Embodiments 
     It is appreciated that the embodiments of the prosthetic heart valve  100  may be surgically implanted rather than using transcatheter techniques. Embodiments of a surgically implanted prosthetic heart valve  100  may be substantially the same as those described above, with the addition of a sewing cuff  190  adjacent to the outer frame outer surface  126   a , shown in  FIG. 4B , in accordance with an embodiment. The sewing cuff  190 , which is well known in the art, is operable to provide structure that receives suture for coupling the prosthetic heart valve  100  to an implant site, such as the tissue orifice  150 . The sewing cuff  190  may comprise any suitable material, such as, but not limited to, double velour polyester. The sewing cuff  190  may be located circumferentially around the outer frame  120 . 
     Method of Making 
     Embodiments described herein also pertain to a method of making the prosthetic heart valve  100  embodiments as described herein. In order to make the various embodiments, a cylindrical mandrel  710  can be used. With reference to  FIG. 9A , the mandrel  710  comprises a structural form operable to receive the outer frame  120  thereon. 
     With reference to  FIGS. 9A and 9B , an embodiment of a method of making a prosthetic heart valve  100  comprises the steps of wrapping a first layer of film  160 , e.g., a composite as described herein, into a tubular form about the mandrel  710 ; placing the outer frame  120  over the first layer of film  160 , as shown in  FIG. 9A ; forming a second layer of film  160  over the outer frame  120 ; thermally setting the assembly; cutting the film  160  across the leaflet window top within the leaflet window  137 , mask with make material  170  a portion of the film  160  in the leaflet window that defines the leaflet  140  to prevent further bonding of leaflet  140  during subsequent processing steps; wrapping a second layer of film  160  into a tubular form over the  120 , and over the first layer of film  160 ; thermal setting the assembly; remove the assembly from the mandrel. 
     Embodiments described herein also pertain to a method of making the prosthetic heart valve  200  embodiments as described herein. In order to make the various embodiments, a cylindrical mandrel  710  can be used. With reference to  FIG. 12 , the mandrel  710  comprises a structural form operable to receive the leaflet frame  130  thereon. An embodiment of a method of making a prosthetic heart valve  200  comprises the steps of wrapping a first layer of film  160 , e.g., a composite as described herein, into a tubular form about the mandrel  710 ; placing the leaflet frame  130  over the first layer of film  160 , as shown in  FIG. 12 ; forming a second layer of film  160  over the leaflet frame  130 ; thermally setting the assembly; receiving the assembly over a cutting mandrel  712  as shown in  FIGS. 13A and 13B ; cutting the film  160  across the leaflet window top within the leaflet window  137 , resulting in the prosthetic heart valve  200  of  FIGS. 11A and 11B .  FIG. 11A  is a side view of an embodiment of a prosthetic heart valve and  FIG. 11B  is a perspective view of the embodiment of the prosthetic heart valve of  FIG. 11A . In  FIGS. 11A and 11B  the leaflets  140  are shown slightly open as when held by the cutting mandrel  712 . It is understood that a fully closed prosthetic heart valve  200  will have the leaflet free edges  142  of the leaflets  140  coming together to coapt under the influence of downstream fluid pressure which results in closing the valve to prevent downstream blood from flowing retrograde through the valve. 
     EXAMPLES 
     Example 1 
     A prosthetic heart valve was produced having polymeric leaflets formed from a composite material having an expanded fluoropolymer membrane and an elastomeric material and joined between two collapsible metallic frames. 
     The leaflet frame and outer frame were laser machined from a length of SS316LVM tube hard tempered with an outside diameter of 23.0 mm and a wall thickness of 0.65 mm in the shape shown illustratively and generally indicated in  FIG. 9A . The leaflet frame  130  and outer frame  120  were electro-polished resulting in 0.0127 mm material removal from each surface and leaving the edges rounded. 
     Fluorinated ethylene propylene (FEP) powder (Daikin America, Orangeburg N.Y.) was then applied to the leaflet frame  130  and outer frame  120 . More specifically, the FEP powder was stirred to form an airborne “cloud” in an enclosed blending apparatus, such as a standard kitchen type blender, while the leaflet frame and outer frame were suspended in the cloud. The leaflet frame and outer frame were exposed to the FEP powder cloud until a uniform layer of powder was adhered to the entire surface of the leaflet frame and outer frame. The leaflet frame and outer frame were then subjected to a thermal treatment by placing it in a forced air oven set to 320° C. for approximately three minutes. This caused the powder to melt and adhere as a thin coating over the entire leaflet frame and outer frame. The leaflet frame and outer frame were removed from the oven and left to cool to room temperature. 
     Initial Assembly and Thermal Process Cycle 
     A 21 mm diameter vented metal cylindrical mandrel having a diameter corresponding to the inner diameter of the leaflet frame  130  and outer frame  120  was helically wrapped with sintered ePTFE fiber. A thin film of type 1 (ASTM D3368) FEP was constructed using melt extrusion and stretching. The type 1 (ASTM D3368) FEP film was about 40 μm thick and was about 7.7 cm wide. The mandrel was helically wrapped with one layer of this type 1 FEP film over the sintered ePTFE fiber only in the region of outer frame. 
     The mandrel was radially wrapped with five layers of an ePTFE membrane with an FEP coating towards the mandrel. The ePTFE membrane was manufactured according to the general teachings described in U.S. Pat. No. 7,306,729. The ePTFE membrane had a mass per area of 2.3 g/m 2 , a bubble point of 101.5 MPa, a thickness of about 356 nm, a matrix tensile strength of 319 MPa in the longitudinal direction and 407 MPa in the transverse direction. 
     The mandrel was helically wrapped with one layer of type 1 FEP film. 
     The diameter of the leaflet frame and outer frame were expanded slightly and received on the wrapped mandrel with approximately a 10 mm space between them, rotational alignment was not necessary. 
     The leaflet frame, outer frame and the space therebetween were helically wrapped with 1 layer of type 1 FEP film. 
     The leaflet frame, outer frame and the space therebetween that will become the bridge portion  162  and the fold region  144 , as shown in  FIG. 2B , were circumferentially wrapped with 5 layers of the same ePTFE membrane with an FEP coating as described above with the coating toward the mandrel. 
     The wrapped leaflet frame, outer frame and the space therebetween were wrapped with several layers of an ePTFE membrane imbibed with a polyimide material referred to as a release liner. 
     A substantially nonporous ePTFE membrane was configured into a cylinder and placed over the assembly, referred to as sacrificial tube. Sintered ePTFE fiber was used to seal both ends of the sacrificial tube against the mandrel. 
     The assembly, including the mandrel, was heated in an oven capable of applying pneumatic pressure external to the sacrificial tube described above and while maintaining a vacuum internal to the mandrel for 40 min such that the mandrel temperature reached approximately 360° C. The assembly was removed from the oven and allowed to cool to room temperature while still pressurized and under vacuum. 
     The sacrificial tube and release liner was removed. The sintered ePTFE fiber was removed to release the frame assembly from the mandrel. 
     The polymeric material was trimmed and removed from the leaflet windows of the leaflet frame. The ends of each leaflet frame and outer frame were circumferentially trimmed by a scalpel. 
     Intermediate Assembly and Thermal Process Cycle 
     An unsintered 15 mm diameter ePTFE tube was disposed on a 21.5 mm vented metal mandrel. Two layers of a substantially nonporous ePTFE membrane with a FEP coating was circumferentially wrapped on the mandrel with the coating side towards the mandrel. The wrapped mandrel was placed in a convection oven set to 320° C. and heated for 20 min. The ePTFE and substantially nonporous ePTFE membrane combined to serve as a release liner and was perforated to communicate pressure between the vent holes in the mandrel. 
     The leaflet frame was disposed onto the vented metal mandrel and vent holes were made in the apertures of the leaflet frame over the mandrel vent holes. 
     A leaflet material was then prepared. A membrane of ePTFE was manufactured according to the general teachings described in U.S. Pat. No. 7,306,729. The ePTFE membrane had a mass per area of 0.452 g/m 2 , a thickness of about 508 nm, a matrix tensile strength of 705 MPa in the longitudinal direction and 385 MPa in the transverse direction. This membrane was imbibed with a fluoroelastomer. The copolymer consists essentially of between about 65 and 70 weight percent perfluoromethyl vinyl ether and complementary about 35 and 30 weight percent tetrafluoroethylene. 
     The fluoroelastomer was dissolved in Novec HFE7500 (3M, St Paul, Minn.) in a 2.5% concentration. The solution was coated using a Mayer bar onto the ePTFE membrane (while being supported by a polypropylene release film) and dried in a convection oven set to 145° C. for 30 seconds. After two coating steps, the final ePTFE/fluoroelastomer or composite had a mass per area of 1.75 g/m 2 , 29.3% fluoropolymer by weight, a dome burst strength of about 8.6 KPa, and thickness of 0.81 μm. 
     The following test methods were used to characterize the ePTFE layers and the multi-layered composite. The thickness was measured with a Mutitoyo Snap Gage Absolute, 12.7 mm (0.50″) diameter foot, Model ID-C112E, Serial #10299, made in Japan. The density was determined by a weight/volume calculation using an Analytical Balance Mettler PM400 New Jersey, USA. The force to break and tensile strengths were measured using an Instron Model #5500R Norwood, Mass., load cell 50 kg, gage length=25.4 cm, crosshead speed=25 mm/minute (strain rate=100% per minute) with flat faced jaws. Unless otherwise noted, these test methods were used to generate the data in subsequent examples. 
     Ten layers of the composite leaflet material were wrapped around the leaflet frame with an elastomer rich side of the composite facing towards the mandrel. In exemplary embodiments, the composite material is oriented to have a predetermined matrix tensile strength along a direction generally perpendicular with the longitudinal axis of the combined tool assembly. More specifically, the predetermined matrix tensile strength is about 705 MPa. 
     The mandrel was radially wrapped with one layer of a substantially nonporous ePTFE membrane with an FEP coating towards the mandrel with a spacing 8 mm from the base of the leaflet frame. The ePTFE membrane was manufactured according to the general teachings described in U.S. Pat. No. 7,306,729. The ePTFE membrane had a mass per area of about 11 g/m 2 , a thickness of about 5.5 μm, a matrix tensile strength of 310 MPa in the longitudinal direction and 103 MPa in the transverse direction. 
     A Kapton® (EI DuPont de Nemours, Inc., Wilmington, Del.) polyimide film acting as a mask was wrapped over the substantially nonporous ePTFE membrane with an FEP coating layer. 
     The outer frame was placed on the mandrel with 10 mm spacing between the leaflet frame and the outer frame. The leaflet frame and the outer frame were aligned such that the longitudinal outer frame posts were collinear with the leaflet frame commissure posts. 
     The leaflet frame and outer frame were wrapped with 24 layers of the composite leaflet material described earlier with an elastomer rich side of the composite facing towards the mandrel. In exemplary embodiments, the composite material is oriented to have a predetermined matrix tensile strength along a direction generally perpendicular with the longitudinal axis of the combined tool assembly. More specifically, the predetermined matrix tensile strength is about 705 MPa. 
     The final leaflet was comprised of 29.3% fluoropolymer by weight with a thickness of approximately 27 μm. Each leaflet had 34 layers of the composite and a ratio of thickness/number of layers of 0.8 μm. 
     The mandrel was again radially wrapped with one layer of a substantially nonporous ePTFE membrane with an FEP coating towards the mandrel with a spacing 8 mm from the base of the leaflet frame. 
     The assembly was wrapped with several layers of the sacrificial release liner. A sacrificial tube was placed over the assembly and sintered ePTFE fiber was used to seal both ends of the sacrificial tube against the mandrel. 
     The assembly was processed in an oven capable of applying pneumatic pressure external to the sacrificial material configured into a tube described above and while maintaining a vacuum internal to the tube for 25 min such that the mandrel temperature reached approximately 330° C. The assembly was removed from the oven and allowed to cool to room temperature while still pressurized and under vacuum. 
     The sacrificial tube and liner were removed from the frame assembly and the frame assembly was removed from the mandrel. The Kapton® mask was removed. 
     A scalpel was used to circumferentially trim the leaflet free edge of each leaflet and the distal end of leaflet frame. 
     Final Assembly and Thermal Process Cycle 
     The outer frame was radially expanded to a 24 mm diameter using a tapered mandrel. 
     A release liner as described above was placed on a 21.5 mm vented mandrel. 
     Three Kapton® masks were cut to the shape of leaflet window with a 30 mm tapered extension. 
     The leaflet frame and outer frame with leaflet material were placed onto the mandrel and the tapered extensions of the Kapton® masks were inserted under the top ring of the leaflet frame from the trimmed end and were advanced axially until the masks aligned with the leaflet window. 
     The leaflet frame was wrapped with 2 layers of the type 1 FEP film. 
     A hot iron was used to remove the FEP film from the leaflet window region by melting it away from the perimeter and to tack the FEP film in all regions of leaflet frame outside the masks. 
     Vent holes were made within all the leaflet frame apertures and in the polymer tube region connecting the inner frame and outer frame. 
     While holding the leaflet frame in place, the outer frame was coaxially disposed over the leaflet frame by telescopically inverting the contiguous tube. 
     The frame assembly was circumferentially wrapped with one substantially nonporous ePTFE membrane with an FEP coating towards the mandrel. 
     The assembly was wrapped with several layers of the sacrificial release liner. A sacrificial tube was placed over the assembly and sintered ePTFE fiber was used to seal both ends of the sacrificial tube against the mandrel. 
     The assembly was processed in an oven capable of applying pneumatic pressure external to the sacrificial material configured into a tube described above and while maintaining a vacuum internal to the tube for 25 min such that the mandrel temperature reached approximately 330° C. The assembly was removed from the oven and allowed to cool to room temperature while still pressurized and under vacuum. 
     The frame assembly was removed from the mandrel. 
     A scalpel was used to circumferentially trim each end of leaflet frame. 
     The Kapton was rotationally peeled away from inside the outer frame and away from leaflets. 
     Using scissors, both ends of the leaflet frame were trimmed to follow frame contour. 
     The resulting prosthetic heart valve  100  includes leaflets  140  formed from a composite material with more than one fluoropolymer layer having a plurality of pores and an elastomer present in substantially all of the pores of the more than one fluoropolymer layer. Each leaflet  140  is movable between a closed position, shown in  FIG. 3B , in which blood is substantially prevented from flowing through the valve assembly, and an open position, shown in  FIG. 3A , in which blood is allowed to flow through the valve assembly. Thus, the leaflets  140  of the prosthetic heart valve  100  cycle between the closed and open positions generally to regulate blood flow direction in a human patient. 
     The performance of the prosthetic heart valve leaflets was characterized on a real-time pulse duplicator that measured typical anatomical pressures and flows across the prosthetic heart valve. The flow performance was characterized by the following process: 
     The valve assembly was potted into a silicone annular ring (support structure) to allow the valve assembly to be subsequently evaluated in a real-time pulse duplicator. The potting process was performed according to the recommendations of the pulse duplicator manufacturer (ViVitro Laboratories Inc., Victoria BC, Canada). 
     The potted valve assembly was then placed into a real-time left heart flow pulse duplicator system. The flow pulse duplicator system included the following components supplied by VSI Vivitro Systems Inc., Victoria BC, Canada: a Super Pump, Servo Power Amplifier Part Number SPA 3891; a Super Pump Head, Part Number SPH 5891B, 38.320 cm 2  cylinder area; a valve station/fixture; a Wave Form Generator, TriPack Part Number TP 2001; a Sensor Interface, Part Number VB 2004; a Sensor Amplifier Component, Part Number AM 9991; and a Square Wave Electro Magnetic Flow Meter, Carolina Medical Electronics Inc., East Bend, N.C., USA. 
     In general, the flow pulse duplicator system uses a fixed displacement, piston pump to produce a desired fluid flow through the prosthetic heart valve under test. 
     The heart flow pulse duplicator system was adjusted to produce the desired flow (5 L/min), mean pressure (15 mmHg), and simulated pulse rate (70 bpm). The prosthetic heart valve under test was then cycled for about 5 to 20 minutes. 
     Pressure and flow data were measured and collected during the test period, including right ventricular pressures, pulmonary pressures, flow rates, and pump piston position. 
     Parameters used to characterize a prosthetic heart valve are effective orifice area and regurgitant fraction. The effective orifice area (EOA), which can be calculated as follows: EOA(cm 2 )=Q rms /(51.6*(ΔP) 1/2 ) where Q rms  is the root mean square systolic/diastolic flow rate (cm 3 /s) and ΔP is the mean systolic/diastolic pressure drop (mmHg). 
     Another measure of the hydrodynamic performance of a prosthetic heart valve is the regurgitant fraction, which is the amount of fluid or blood regurgitated through the prosthetic heart valve divided by the stroke volume. 
     The hydrodynamic performance measured values were; EOA=2.06 cm 2 , and regurgitant fraction=8.2%. 
     Example 2 
     Another prosthetic heart valve was made as described in Example 1 with the following exceptions. 
     Initial Assembly and Thermal Process Cycle 
     The diameter of the leaflet frame and outer frame were expanded slightly and received on the wrapped mandrel with 16 mm space between them, rotational alignment of the leaflet frame and outer frame was made. 
     Final Assembly and Thermal Process Cycle 
     A scalpel was used to cut above the mechanical linking tab. The tab was deformed to link the leaflet frame to the outer frame. 
     The resulting prosthetic heart valve  100  includes leaflets  140  formed from a composite material with more than one fluoropolymer layer having a plurality of pores and an elastomer present in substantially all of the pores of the more than one fluoropolymer layer. Each leaflet  140  is movable between a closed position, shown in  FIG. 3B , in which blood is substantially prevented from flowing through the valve assembly, and an open position, shown in  FIG. 3A , in which blood is allowed to flow through the valve assembly. Thus, the leaflets  140  of the prosthetic heart valve  100  cycle between the closed and open positions generally to regulate blood flow direction in a human patient. 
     The hydrodynamic performance was measured. The performance values were; EOA=2.3 cm 2  and regurgitant fraction=11.8%. 
     Numerous characteristics and advantages have been set forth in the preceding description, including various alternatives together with details of the structure and function of the devices and/or methods. The disclosure is intended as illustrative only and as such is not intended to be exhaustive. It will be evident to those skilled in the art that various modifications can be made, especially in matters of structure, materials, elements, components, shape, size and arrangement of parts including combinations within the principles of the disclosure, to the full extent indicated by the broad, general meaning of the terms in which the appended claims are expressed. To the extent that these various modifications do not depart from the spirit and scope of the appended claims, they are intended to be encompassed therein. 
     Example 3 (Single Leaflet Frame Prosthetic Heart Valve) 
     In exemplary embodiments, a prosthetic heart valve having polymeric leaflets formed from a composite material having an expanded fluoropolymer membrane and an elastomeric material and joined to a semi-rigid, non-collapsible metallic frame, and further a having strain relief was constructed according to the following process: 
     A leaflet frame was laser machined from a length of MP35N cobalt chromium tube hard tempered with an outside diameter of 26.0 mm and a wall thickness of 0.6 mm in the shape. The leaflet frame was electro-polished resulting in 0.0127 mm material removal from each surface and leaving the edges rounded. The leaflet frame was exposed to a surface roughening step to improve adherence of leaflets to the leaflet frame. The leaflet frame was cleaned by submersion in an ultrasonic bath of acetone for approximately five minutes. The entire metal leaflet frame surface was then subjected to a plasma treatment using equipment (e.g. PVA TePLa America, Inc Plasma Pen, Corona, Calif.) and methods commonly known to those having ordinary skill in the art. This treatment also served to improve the wetting of the fluorinated ethylene propylene (FEP) adhesive. 
     FEP powder (Daikin America, Orangeburg N.Y.) was then applied to the leaflet frame. More specifically, the FEP powder was stirred to form an airborne “cloud” in an enclosed blending apparatus, such as a standard kitchen type blender, while the leaflet frame is suspended in the cloud. The leaflet frame was exposed to the FEP powder cloud until a layer of powder was adhered to the entire surface of the leaflet frame. The leaflet frame was then subjected to a thermal treatment by placing it in a forced air oven set to 320° C. for approximately three minutes. This caused the powder to melt and adhere as a thin coating over the entire leaflet frame. The leaflet frame was removed from the oven and left to cool to approximately room temperature. 
     The strain relief was attached to the leaflet frame in the following manner. A thin (122 μm) walled sintered 15 mm diameter ePTFE tube was disposed on a 24.5 mm vented metal mandrel by stretching radially over a tapered mandrel. Two layers of a substantially nonporous ePTFE membrane with a continuous FEP coating was circumferentially wrapped on the mandrel with the FEP side towards the mandrel. The wrapped mandrel was placed in a convection oven set to 320° C. and heated for 20 min. The ePTFE and substantially nonporous ePTFE membrane combined to serve as an inner release liner and was perforated using a scalpel blade to communicate pressure between the vent holes in the mandrel. This entire release liner is removed in a later step. 
     A 5 cm length of the thick (990μ) walled partially sintered 22 mm inner diameter ePTFE tube (density=0.3 g/cm 3 ) was disposed onto the 24.5 mm vented metal mandrel with release liner. The ePTFE tube inner diameter was enlarged by stretching it on a tapered mandrel to accommodate the larger mandrel diameter. 
     A thin (4 μm) film of type 1 FEP (ASTM D3368) was constructed using melt extrusion and stretching. One layer of the FEP was wrapped over the 5 cm length of the ePTFE tube. 
     The FEP powder coated leaflet frame was disposed onto the vented metal mandrel generally in the middle of the 5 cm span of ePTFE tube and FEP film. 
     One layer of the FEP was wrapped over the leaflet frame and 5 cm length of the ePTFE tube. 
     A second 5 cm length of the 990 μm thick/22 mm inner diameter ePTFE tube was disposed onto the assembly layered onto 24.5 mm vented metal mandrel by stretching its radius over a tapered mandrel to accommodate the larger construct diameter. 
     A substantially nonporous ePTFE membrane was configured into a cylinder at a diameter larger than the construct and placed over the assembly, referred to as sacrificial tube. Sintered ePTFE fiber (e.g. Gore Rastex® Sewing Thread, Part #S024T2, Newark Del.) was used to seal both ends of the sacrificial tube against the mandrel. 
     The assembly, including the mandrel, was heated in a convection oven (temperature set point of 390° C.) capable of applying pneumatic pressure of 100 psi external to the sacrificial tube described above while maintaining a vacuum internal to the mandrel. The assembly was cooked for 40 min such that the mandrel temperature reached approximately 360° C. (as measured by a thermocouple direct contact with the inner diameter of the mandrel). The assembly was removed from the oven and allowed to cool to approximately room temperature while still under 100 psi pressure and vacuum. 
     The sacrificial tube was then removed. Approximately 30 psi of pressure was applied to the internal diameter of the mandrel to assist in removal of the assembly. The inner release liner was peeled away from the internal diameter of the assembly by inverting the liner and axially pulling it apart. 
     The polymeric material was trimmed with a scalpel and removed from the leaflet windows and bottom of the leaflet frame leaving approximately 0.5 to 1.0 mm of material overhang. 
     A leaflet material was then prepared. A membrane of ePTFE was manufactured according to the general teachings described in U.S. Pat. No. 7,306,729. The ePTFE membrane had a mass per area of 0.452 g/m 2 , a thickness of about 508 nm, a matrix tensile strength of 705 MPa in the longitudinal direction and 385 MPa in the transverse direction. This membrane was imbibed with a fluoroelastomer. The copolymer consists essentially of between about 65 and 70 weight percent perfluoromethyl vinyl ether and complementary about 35 and 30 weight percent tetrafluoroethylene. 
     The fluoroelastomer was dissolved in Novec HFE7500 (3M, St Paul, Minn.) in a 2.5% concentration. The solution was coated using a mayer bar onto the ePTFE membrane (while being supported by a polypropylene release film) and dried in a convection oven set to 145° C. for 30 seconds. After 2 coating steps, the final ePTFE/fluoroelastomer or composite had a mass per area of 1.75 g/m 2 , 29.3% fluoropolymer by weight, a dome burst strength of about 8.6 KPa, and thickness of 0.81 μm. 
     The final leaflet was comprised of 28.22% fluoropolymer by weight with a thickness of 50.3 μm. Each leaflet had 26 layers of the composite and a ratio of thickness/number of layers of 1.93 μm. 
     The resulting prosthetic heart valve  200  includes leaflets  140  formed from a composite material with more than one fluoropolymer layer having a plurality of pores and an elastomer present in substantially all of the pores of the more than one fluoropolymer layer. Each leaflet  140  is movable between a closed position, shown illustratively in  FIG. 11D , in which blood is substantially prevented from flowing through the valve assembly, and an open position, shown illustratively in  FIG. 11C , in which blood is allowed to flow through the prosthetic heart valve  200 . Thus, the leaflets  140  of the prosthetic heart valve  200  cycle between the closed and open positions generally to regulate blood flow direction in a human patient. 
     The hydrodynamic performance was measured prior to accelerated wear testing. The performance values were; EOA=2.4 cm 2  and regurgitant fraction=11.94%. 
     It will be apparent to those skilled in the art that various modifications and variations can be made in the present embodiments without departing from the spirit or scope of the embodiments. Thus, it is intended that the present embodiments cover the modifications and variations of this invention provided they come within the scope of the appended claims and their equivalents.