Patent Publication Number: US-2022226108-A1

Title: Heart valve sealing devices and delivery devices therefor

Description:
RELATED APPLICATION 
     The present application is a continuation of Patent Cooperation Treaty application no. PCT/US2020/052758, filed on Sep. 25, 2020, which claims the benefit of U.S. Provisional Patent Application No. 62/912,828, filed on Oct. 9, 2019, titled “Heart Valve Sealing Devices and Delivery Devices Therefor,” which are incorporated herein by reference in their entireties. 
    
    
     BACKGROUND OF THE INVENTION 
     The native heart valves (i.e., the aortic, pulmonary, tricuspid, and mitral valves) serve critical functions in assuring the forward flow of an adequate supply of blood through the cardiovascular system. These heart valves can be damaged, and thus rendered less effective, by congenital malformations, inflammatory processes, infectious conditions, disease, etc. Such damage to the valves can result in serious cardiovascular compromise or death. Damaged valves can be surgically repaired or replaced during open heart surgery. However, open heart surgeries are highly invasive, and complications may occur. Transvascular techniques can be used to introduce and implant prosthetic devices in a manner that is much less invasive than open heart surgery. As one example, a transseptal technique could be used, e.g., comprising inserting a catheter into the right femoral vein, up the inferior vena cava and into the right atrium, puncturing the septum, and passing the catheter into the left atrium. 
     A healthy heart has a generally conical shape that tapers to a lower apex. The heart is four-chambered and comprises the left atrium, right atrium, left ventricle, and right ventricle. The left and right sides of the heart are separated by a wall generally referred to as the septum. The native mitral valve of the human heart connects the left atrium to the left ventricle. The mitral valve has a very different anatomy than other native heart valves. The mitral valve includes an annulus portion, which is an annular portion of the native valve tissue surrounding the mitral valve orifice, and a pair of cusps, or leaflets, extending downward from the annulus into the left ventricle. The mitral valve annulus can form a “D”-shaped, oval, or otherwise out-of-round cross-sectional shape having major and minor axes. The anterior leaflet can be larger than the posterior leaflet, forming a generally “C”-shaped boundary between the abutting sides of the leaflets when they are closed together. 
     When operating properly, the anterior leaflet and the posterior leaflet function together as a one-way valve to allow blood to flow only from the left atrium to the left ventricle. The left atrium receives oxygenated blood from the pulmonary veins. When the muscles of the left atrium contract and the left ventricle dilates (also referred to as “ventricular diastole” or “diastole”), the oxygenated blood that is collected in the left atrium flows into the left ventricle. When the muscles of the left atrium relax and the muscles of the left ventricle contract (also referred to as “ventricular systole” or “systole”), the increased blood pressure in the left ventricle urges the sides of the two leaflets together, thereby closing the one-way mitral valve so that blood cannot flow back to the left atrium and is instead expelled out of the left ventricle through the aortic valve. To prevent the two leaflets from prolapsing under pressure and folding back through the mitral annulus toward the left atrium, a plurality of fibrous cords called chordae tendineae tether the leaflets to papillary muscles in the left ventricle. 
     Mitral regurgitation occurs when the native mitral valve fails to close properly and blood flows into the left atrium from the left ventricle during the systolic phase of heart contraction. Mitral regurgitation is one of the most common forms of valvular heart disease. Mitral regurgitation can have many different causes, such as leaflet prolapse, dysfunctional papillary muscles, stretching of the mitral valve annulus resulting from dilation of the left ventricle, more than one of these, etc. Mitral regurgitation at a central portion of the leaflets can be referred to as central jet mitral regurgitation and mitral regurgitation nearer to one commissure (i.e., location where the leaflets meet) of the leaflets can be referred to as eccentric jet mitral regurgitation. Central jet regurgitation occurs when the edges of the leaflets do not meet in the middle and thus the valve does not close, and regurgitation is present. 
     A technique for treating mitral and other valvular regurgitation in patients may include securing edges of the native valve leaflets directly to one another. For example, a catheter delivered clip may be used to attempt to clip the sides of the leaflets together at the end portions of the leaflets. But significant challenges exist. For example, multiple clips may be required to eliminate or reduce regurgitation to an acceptable level, but in some circumstances, this can result in longer operation times and may result in over-restricted flow or undesirable stresses on the native anatomy. 
     Despite these prior techniques, there is a continuing need for improved devices and methods for treating valvular regurgitation. 
     SUMMARY 
     This summary is meant to provide some examples and is not intended to be limiting of the scope of the invention in any way. For example, any feature included in an example of this summary is not required by the claims, unless the claims explicitly recite the features. Also, the features, components, steps, concepts, etc. described in examples in this summary and elsewhere in this disclosure can be combined in a variety of ways. Various features and steps as described elsewhere in this disclosure may be included in the examples summarized here. 
     Example systems and valve repair devices for repairing a native valve of a patient includes a coaption portion and a plurality of paddle portions. Each paddle portion can include an extendable portion that is extendable from a resting condition to an extended condition. These paddle portions are moveable between an open position and a closed position and are configured to attach to the native valve of the patient. 
     An example valve repair device for repairing a native valve of a patient includes a plurality of paddle portions. Each paddle portion includes an extendable portion that is extendable from a resting condition to an extended condition. The paddle portions are moveable between an open position and a closed position based on movement of the cap toward and away from the collar and are configured to attach to the native valve of the patient. 
     An example valve repair device for repairing a native valve of a patient includes a plurality of paddle portions. Each paddle portion includes two extendable portions that are extendable from a resting condition to an extended condition and that surround a paddle expansion space. The paddle portions are moveable between an open position and a closed position and are configured to attach to the native valve of the patient. 
     An example system for repairing a native valve of a patient includes a catheter and a valve repair device. The valve repair device comprises a plurality of paddle portions. Each paddle portion comprises two extendable portions surrounding a paddle expansion space. Each extendable portion being transitionable between a narrow condition to a broad condition. The paddle portions are moveable between an open position and a closed position and are configured to attach to the native valve of the patient. 
     An example system for repairing a native valve of a patient includes a catheter and a valve repair device. The valve repair device includes a plurality of paddle portions. Each paddle portion includes an extendable portion that is extendable from a resting condition to an extended condition. The paddle portions are moveable between an open position and a closed position and are configured to attach to the native valve of the patient. 
     An example method for repairing a native valve of a patient includes placing a valve repair device in the heart of a patient. A plurality of paddle portions are moved between a resting condition and an extended condition. The paddle portions are moved from an open position to a closed position to attach the valve repair device to the native valve of the patient. 
     In some embodiments, a valve repair device for repairing a native valve of a patient comprises some or all of a coaption portion; a collar; a cap that can be moved away from the collar; and a plurality of paddle portions. 
     Each paddle portion of the plurality of paddle portions can include an extendable portion that is extendable from a resting condition to an extended condition. 
     The paddle portions can be configured to be moveable between an open position and a closed position by moving the cap with respect to the collar. 
     In some embodiments, a width of the extendable portion is inversely proportional to a length of the extendable portion. 
     In some embodiments, the extendable portion is formed from at least one of a tube of braided material, a shape-memory alloy, and an elastomeric material. 
     In some embodiments, the extendable portion is formed integrally with the paddle portion. 
     In some embodiments, paddle frames are connected to the cap and to the paddle portions. In some embodiments, the paddle frames reduce in width as the extended portions extend from the resting to the extended condition. The paddle frames can be hoop-shaped in some implementations. 
     A coaption element can be configured to close a gap in the native valve of the patient when the valve repair device is attached to the native valve. 
     In some embodiments, a valve repair device for repairing a native valve of a patient comprise some or all of a coaption portion; a collar attached to the coaption portion; a cap that is movable away from the collar; a plurality of paddle portions that each comprise two extendable portions surrounding a paddle expansion space. 
     Each extendable portion can be configured to be extendable from a resting condition to an extended condition. 
     In some embodiments, movement of the cap toward the collar causes the paddle portions to move to the closed position, and movement of the cap away from the collar causes the paddle portions to move to the open position. 
     In some embodiments, a width of the paddle expansion space is inversely proportional to a length of the extendable portions. 
     In some embodiments, the extendable portions are formed from at least one of tubes of braided material, a shape-memory alloy, and an elastomeric material. In some embodiments, the extendable portions are formed integrally with the paddle portion. 
     In some embodiments, the device further comprises paddle frames connected to the cap and to the paddle portions. 
     In some embodiments, the paddle frames are configured to reduce in width as the extendable portions extend from the resting to the extended condition. The paddle frames can be hoop-shaped in some implementations. 
     In some embodiments, a system (such as a valve treatment system or valve repair system, etc.) comprises a delivery catheter and a valve repair device. The valve repair device can be coupled to the delivery catheter. 
     In some embodiments, the valve repair device comprises a plurality of paddle portions, each paddle portion including an extendable portion that is extendable from a resting condition to an extended condition. The paddle portions can be configured to be moveable between an open position and a closed position by moving the cap with respect to the collar. 
     In some embodiments, a width of the extendable portion is inversely proportional to a length of the extendable portion. 
     In some embodiments, the extendable portion is formed from at least one of a tube of braided material, a shape-memory alloy, and an elastomeric material. 
     In some embodiments, the extendable portion is formed integrally with the paddle portion. 
     In some embodiments, the valve repair device further comprises paddle frames connected to the cap and to the paddle portions. 
     In some embodiments, the paddle frames reduce in width as the extended portions extend from the resting to the extended condition. 
     In some embodiments, the valve repair device further comprises a coaption element that is configured to close a gap in the native valve of the patient when the valve repair device is attached to the native valve. 
     In some embodiments, a system (e.g., a valve treatment system, valve repair system, etc.) comprises a delivery catheter and a valve repair device. The valve repair device can be coupled or coupleable to the delivery catheter. 
     In some embodiments, the valve repair device comprises a plurality of paddle portions that each comprise two extendable portions surrounding a paddle expansion space, wherein each extendable portion is transitionable between a narrow condition and a broad condition. 
     The paddle portions can be configured to be moveable between an open position and a closed position and are configured to attach to the native valve of the patient. 
     In some embodiments, the system further comprises one, some, or all of a shaft, a coaption portion, and a collar that the shaft extends through. The collar can be attached to the coaption portion. The system can also include a cap attached to the shaft such that the cap can be moved by the shaft away from the collar. 
     In some embodiments, the system is configured such that movement of the cap toward the collar causes the paddle portions to move to the closed position, and movement of the cap away from the collar causes the paddle portions to move to the open position. 
     In some embodiments, the paddle portions are hingeably connected to the cap at a plurality of outer hinge regions. 
     In some embodiments, at least one clasp is attached to at least one of the plurality of paddle portions. In some embodiments, at least one clasp is attached to each of the plurality of paddle portions. 
     In some embodiments, a width of the paddle expansion space is inversely proportional to a length of the extendable portions. 
     In some embodiments, the extendable portions are formed from at least one of tubes of braided material, a shape-memory alloy, and an elastomeric material. 
     In some embodiments, the extendable portions are formed integrally with the paddle portion. 
     In some embodiments, paddle frames are connected to the paddle portions. The paddle frames can be configured to reduce in width as the extendable portions transition from the broad condition to the narrow condition. 
     In some embodiments, the coaption element is configured to close a gap in a native valve when attached to the native valve. 
     In some embodiments, the delivery catheter is configured to facilitate delivery to a native valve and attachment of the plurality of paddles to the native valve. 
     In some embodiments, a method for repairing a native valve of a patient comprises placing a valve repair device in the heart of a patient, causing a plurality of paddle portions to extend from a resting condition to an extended condition, wherein each paddle portion includes an extendable portion; and moving the paddle portions from an open position to a closed position to attach the valve repair device to the native valve of the patient. The valve repair device can be the same as or similar to any of the valve repair devices discussed above or elsewhere herein. 
     In some embodiments, the method includes reducing paddle frames in width as the extended portions extend from the resting to the extended condition. 
     The method can further comprise closing a gap in the native valve of the patient with a coaption element when the valve repair device is attached to the native valve. 
     In some embodiments, a method for repairing a native valve of a patient comprises placing a valve repair device in the heart of a patient; causing a plurality of paddle portions to extend from a resting condition to an extended condition, wherein each paddle portion includes two extendable portions surrounding a paddle expansion space; and moving the paddle portions from an open position to a closed position to attach the valve repair device to the native valve of the patient. The valve repair device can be the same as or similar to any of the valve repair devices described above or elsewhere herein. 
     In some embodiments, the method includes reducing the paddle frames in width as the extendable portions extend from the resting to the extended condition. 
     The method can further comprise closing a gap in the native valve of the patient with a coaption element when the valve repair device is attached to the native valve. 
     In some embodiments, a system (e.g., a valve treatment system, valve repair system, etc.) comprises a plurality of paddle portions, each paddle portion comprising two extendable portions surrounding a paddle expansion space, each extendable portion being transitionable between a narrow condition to a broad condition, where the paddle portions are moveable between an open position and a closed position and are configured to attach to a native valve of a patient. 
     In some embodiments, the system includes a plurality of hinge regions at which the paddle portions are hingeably connected other portions of the system, e.g., to a coaption portion, etc. 
     In some embodiments, the system includes a shaft; a collar that the shaft extends through, the collar being attached to a coaption portion; and a cap attached to the shaft such that the cap can be moved by the shaft away from the collar. 
     In some embodiments, the system is configured such that movement of the cap toward the collar causes the paddle portions to move to the closed position, and movement of the cap away from the collar causes the paddle portions to move to the open position. 
     In some embodiments, the paddle portions are hingeably connected to the cap at a plurality of outer hinge regions. 
     In some embodiments, at least one clasp is attached to at least one of the plurality of paddle portions. In some embodiments, at least one clasp is attached to each of the plurality of paddle portions. 
     In some embodiments, a width of the paddle expansion space is inversely proportional to a length of the extendable portions. 
     In some embodiments, the extendable portions are formed from at least one of tubes of braided material, a shape-memory alloy, and an elastomeric material. 
     In some embodiments, the extendable portions are formed integrally with the paddle portion. 
     In some embodiments, paddle frames are connected to the paddle portions. In some embodiments, the paddle frames reduce in width as the extendable portions transition from the broad condition to the narrow condition. The paddle frames can be hoop-shaped. 
     The system can include a coaption element configured to close a gap in a native valve when attached to the native valve. 
     In some embodiments, the system further comprises a delivery catheter configured to facilitate delivery to a native valve and attachment of the plurality of paddles to the native valve. 
     A further understanding of the nature and advantages of the present invention are set forth in the following description and claims, particularly when considered in conjunction with the accompanying drawings in which like parts bear like reference numerals. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       To further clarify various aspects of embodiments of the present disclosure, a more particular description of the certain embodiments will be made by reference to various aspects of the appended drawings. It is appreciated that these drawings depict only typical embodiments of the present disclosure and are therefore not to be considered limiting of the scope of the disclosure. Moreover, while the figures can be drawn to scale for some embodiments, the figures are not necessarily drawn to scale for all embodiments. Embodiments and other features and advantages of the present disclosure will be described and explained with additional specificity and detail through the use of the accompanying drawings in which: 
         FIG. 1  illustrates a cutaway view of the human heart in a diastolic phase; 
         FIG. 2  illustrates a cutaway view of the human heart in a systolic phase; 
         FIG. 2A  is another cutaway view of the human heart in a systolic phase; 
         FIG. 2B  is the cutaway view of  FIG. 2A  annotated to illustrate a natural shape of mitral valve leaflets in the systolic phase; 
         FIG. 3  illustrates a cutaway view of the human heart in a diastolic phase, in which the chordae tendineae are shown attaching the leaflets of the mitral and tricuspid valves to ventricle walls; 
         FIG. 4  illustrates a healthy mitral valve with the leaflets closed as viewed from an atrial side of the mitral valve; 
         FIG. 5  illustrates a dysfunctional mitral valve with a visible gap between the leaflets as viewed from an atrial side of the mitral valve; 
         FIG. 6  illustrates a mitral valve having a wide gap between the posterior leaflet and the anterior leaflet; 
         FIG. 6A  illustrates a coaption element in the gap of the mitral valve as viewed from an atrial side of the mitral valve; 
         FIG. 6B  illustrates a valve repair device attached to mitral valve leaflets with the coaption element in the gap of the mitral valve as viewed from a ventricular side of the mitral valve; 
         FIG. 6C  is a perspective view of a valve repair device attached to mitral valve leaflets with the coaption element in the gap of the mitral valve shown from a ventricular side of the mitral valve; 
         FIG. 6D  is a schematic view illustrating a path of mitral valve leaflets along each side of a coaption element of an example mitral valve repair device; 
         FIG. 6E  is a top schematic view illustrating a path of mitral valve leaflets around a coaption element of an example native valve repair device; 
         FIG. 7  illustrates a tricuspid valve viewed from an atrial side of the tricuspid valve; 
         FIGS. 8-14  show an example embodiment of an implantable prosthetic device, in various stages of deployment; 
         FIG. 11A  shows an example embodiment of an implantable prosthetic device that is similar to the device illustrated by  FIG. 11 , but where the paddles are independently controllable; 
         FIGS. 15-20  show the implantable prosthetic device of  FIGS. 8-14  being delivered and implanted within the native valve; 
         FIG. 21  shows an example embodiment of an implantable prosthetic device or frame of an implantable prosthetic device; 
         FIG. 22  shows an example embodiment of an implantable prosthetic device or frame of an implantable prosthetic device; 
         FIGS. 23-25  show example embodiments of an implantable prosthetic device or component of an implantable medical device; 
         FIG. 23A  illustrates an exemplary embodiment of an implantable prosthetic device; 
         FIGS. 26 and 27  show an example embodiment of a barbed clasp for use in an implantable prosthetic device; 
         FIGS. 28-32  show example embodiments of an implantable prosthetic device; 
         FIG. 30A  illustrates an exemplary embodiment of an implantable prosthetic device with a cover 
       ; 
         FIGS. 32A and 32B  are perspective views of a cap and a coaption element insert of the implantable prosthetic device of  FIGS. 28-32  in sealed and spaced apart positions, respectively; 
         FIG. 33  shows a barbed clasp for use in an implantable prosthetic device; 
         FIG. 34  shows a portion of native valve tissue grasped by a barbed clasp; 
         FIGS. 35-46  show an example embodiment of an implantable prosthetic device being delivered and implanted within the native valve; 
         FIG. 47  shows a side view of an example implantable prosthetic device without barbed clasps in a closed position; 
         FIG. 47A  shows a side view of an example implantable prosthetic device without barbed clasps in a closed position; 
         FIG. 48  shows a side view of an example implantable prosthetic device with barbed clasps in a closed position; 
         FIG. 48A  shows a side view of an example implantable prosthetic device with barbed clasps in a closed position; 
         FIG. 48B  shows a side view of an example implantable prosthetic device with barbed clasps in a closed position, the device being attached to a deployment device; 
         FIG. 48C  shows a side view of the example implantable prosthetic device according to  FIG. 48B , the device being provided with a cover; 
         FIG. 48D  shows a front view of the example implantable prosthetic device according to  FIG. 48B , the device being attached to a deployment device; 
         FIG. 48E  shows a front view of the example implantable prosthetic device according to  FIG. 48D , the device being provided with a cover; 
         FIG. 48F  shows a side view of the example implantable prosthetic device according to  FIG. 48B  with barbed clasps in the closed position; 
         FIG. 48G  shows a front view of the example implantable prosthetic device according to  FIG. 48F ; 
         FIG. 48H  shows a bottom view of the example implantable prosthetic device according to  FIG. 48F ; 
         FIG. 49  shows a side view of an example implantable prosthetic device without barbed clasps in a partially-open position; 
         FIG. 50  shows a side view of an example implantable prosthetic device in a partially-open position with barbed clasps in an open position; 
         FIG. 51  shows a side view of an example implantable prosthetic device in a partially-open position with barbed clasps in a closed position; 
         FIG. 52  shows a side view of an example implantable prosthetic device without barbed clasps in a half-open position; 
         FIG. 53  shows a side view of an example implantable prosthetic device in a half-open position with barbed clasps in a closed position; 
         FIG. 53A  shows a side view of an example implantable prosthetic device in a half-open position with barbed clasps in a closed position; 
         FIG. 53B  shows a front view of the example implantable prosthetic device according to  FIG. 53A ; 
         FIG. 53C  shows a side view the example implantable prosthetic device according to  FIG. 53A , the device being provided with a cover; 
         FIG. 53D  shows a front view the example implantable prosthetic device according to  FIG. 53A , the device being provided with a cover; 
         FIG. 54  shows a side view of an example implantable prosthetic device in a half-open position with barbed clasps in an open position; 
         FIG. 54A  shows a side view of an example implantable prosthetic device in a half-open position with barbed clasps in an open position; 
         FIG. 54B  shows a front view of the example implantable prosthetic device according to  FIG. 54A ; 
         FIG. 54C  shows a side view the example implantable prosthetic device according to  FIG. 54A , the device being provided with a cover; 
         FIG. 54D  shows a front view the example implantable prosthetic device according to  FIG. 54A , the device being provided with a cover; 
         FIG. 55  shows a side view of an example implantable prosthetic device without barbed clasps in a three-quarters-open position; 
         FIG. 56  shows a side view of an example implantable prosthetic device in a three-quarters-open position with barbed clasps in a closed position; 
         FIG. 57  shows a side view of an example implantable prosthetic device in a three-quarters-open position with barbed clasps in an open position; 
         FIG. 58  shows a side view of an example implantable prosthetic device without barbed clasps near a full bailout position or near a fully-open position; 
         FIG. 59  shows a side view of an example implantable prosthetic device without barbed clasps in a full bailout position or a fully-open position; 
         FIG. 60  shows a side view of an example implantable in a full bailout position with barbed clasps in a closed position; 
         FIG. 60A  shows a side view of an example implantable in a full bailout position with barbed clasps in a closed position; 
         FIG. 60B  shows a front view of the example implantable prosthetic device according to  FIG. 60A ; 
         FIG. 60C  shows a side view the example implantable prosthetic device according to  FIG. 60A , the device being provided with a cover; 
         FIG. 60D  shows a front view the example implantable prosthetic device according to  FIG. 60A , the device being provided with a cover; 
         FIG. 61  shows a side view of an example implantable in a full bailout position with barbed clasps in an open position; 
         FIG. 61A  shows a side view of an example implantable in a full bailout position with barbed clasps in an open position; 
         FIG. 61B  shows a front view of the example implantable prosthetic device according to  FIG. 61A ; 
         FIG. 61C  shows a side view the example implantable prosthetic device according to  FIG. 61A , the device being provided with a cover; 
         FIG. 61D  shows a front view the example implantable prosthetic device according to  FIG. 61A , the device being provided with a cover; 
         FIGS. 62A-62B  illustrate the movement of the paddles of an example embodiment of an implantable prosthetic device; 
         FIGS. 63A-63C  illustrate the movement of the paddles of an example embodiment of an implantable prosthetic device; 
         FIGS. 64A-64C  illustrate the movement of the paddles of an example embodiment of an implantable prosthetic device; 
         FIG. 65  shows a perspective view of an example implantable prosthetic device in a closed position; 
         FIG. 65A  shows a perspective view of an example implantable prosthetic device in a closed position; 
         FIG. 66  shows a perspective view of the implantable prosthetic device of  FIG. 65 ; 
         FIG. 66A  shows a perspective view of the implantable prosthetic device of  FIG. 65A ; 
         FIG. 67  shows a front view of the implantable prosthetic device of  FIG. 65 ; 
         FIG. 67A  shows a front view of the implantable prosthetic device of  FIG. 65A ; 
         FIG. 68  shows a front view of the implantable prosthetic device of  FIG. 65  with additional components; 
         FIG. 68A  shows a front view of the implantable prosthetic device of  FIG. 65A  with additional components; 
         FIG. 69  shows a side view of the implantable prosthetic device of  FIG. 65 ; 
         FIG. 70  shows a top view of the implantable prosthetic device of  FIG. 65 ; 
         FIG. 70A  shows a top view of the implantable prosthetic device of  FIG. 65A ; 
         FIG. 71  shows a top view of the implantable prosthetic device of  FIG. 65  with a collar component; 
         FIG. 71A  shows a top view of the implantable prosthetic device of  FIG. 65A  with a collar component; 
         FIG. 72  shows a bottom view of the implantable prosthetic device of  FIG. 65 ; 
         FIG. 72A  shows a bottom view of the implantable prosthetic device of  FIG. 65A ; 
         FIG. 73  shows a bottom view of the implantable prosthetic device of  FIG. 65  with a cap component; 
         FIG. 73A  shows a bottom view of the implantable prosthetic device of  FIG. 65A  with a cap component; 
         FIG. 74  shows a sectioned perspective view of the implantable prosthetic device of  FIG. 65  sectioned by cross-section plane  75 ; 
         FIG. 74A  shows a sectioned perspective view of the implantable prosthetic device of  FIG. 65A  sectioned by cross-section plane  75 A; 
         FIG. 75  shows a top cross-section view of the example prosthetic device illustrated by  FIG. 74 ; 
         FIG. 75A  shows a top cross-section view of the example prosthetic device illustrated by  FIG. 74A ; 
         FIG. 76  shows a sectioned perspective view of the implantable prosthetic device of  FIG. 65  sectioned by cross-section plane  77 ; 
         FIG. 76A  shows a sectioned perspective view of the implantable prosthetic device of  FIG. 65A  sectioned by cross-section plane  77 A; 
         FIG. 77  shows a top cross-section view of the example prosthetic device illustrated by  FIG. 76 ; 
         FIG. 77A  shows a top cross-section view of the example prosthetic device illustrated by  FIG. 76A ; 
         FIG. 78  shows a sectioned perspective view of the implantable prosthetic device of  FIG. 65  sectioned by cross-section plane  77 ; 
         FIG. 78A  shows a sectioned perspective view of the implantable prosthetic device of  FIG. 65A  sectioned by cross-section plane  77 A; 
         FIG. 79  shows a top cross-section view of the example prosthetic device illustrated by  FIG. 78 ; 
         FIG. 79A  shows a top cross-section view of the example prosthetic device illustrated by  FIG. 78A ; 
         FIG. 80  shows a sectioned perspective view of the implantable prosthetic device of  FIG. 65  sectioned by cross-section plane  81 ; 
         FIG. 80A  shows a sectioned perspective view of the implantable prosthetic device of  FIG. 65A  sectioned by cross-section plane  81 A; 
         FIG. 81  shows a top cross-section view of the example prosthetic device illustrated by  FIG. 80 ; 
         FIG. 81A  shows a top cross-section view of the example prosthetic device illustrated by  FIG. 80A ; 
         FIG. 82  shows a sectioned perspective view of the implantable prosthetic device of  FIG. 65  sectioned by cross-section plane  83 ; 
         FIG. 82A  shows a sectioned perspective view of the implantable prosthetic device of  FIG. 65A  sectioned by cross-section plane  83 A; 
         FIG. 83  shows a top cross-section view of the example prosthetic device illustrated by  FIG. 82 ; 
         FIG. 83A  shows a top cross-section view of the example prosthetic device illustrated by  FIG. 82A ; 
         FIG. 84  shows an example embodiment of an implantable prosthetic device with integral barbs; 
         FIG. 85  shows an example embodiment of an implantable prosthetic device with integral barbs; 
         FIG. 86  shows an example embodiment of an implantable prosthetic device with integral barbs; 
         FIG. 86A  shows an example embodiment of an implantable prosthetic device with integral barbs; 
         FIG. 87  shows an example embodiment of an implantable prosthetic device with integral barbs; 
         FIG. 87A  shows an example embodiment of an implantable prosthetic device with integral barbs; 
         FIG. 88  shows an example embodiment of an implantable prosthetic device with integral barbs; 
         FIG. 88A  shows an example embodiment of an implantable prosthetic device with integral barbs; 
         FIG. 89  shows a perspective view of a coapting portion and paddle portions of the implantable prosthetic device illustrated by  FIG. 65 ; 
         FIG. 89A  shows a perspective view of a coapting portion and paddle portions of the implantable prosthetic device illustrated by  FIG. 65A ; 
         FIG. 90  shows a perspective view of a coapting portion and paddle portions of the implantable prosthetic device illustrated by  FIG. 65 ; 
         FIG. 90A  shows a perspective view of a coapting portion and paddle portions of the implantable prosthetic device illustrated by  FIG. 65A ; 
         FIG. 91  shows a front view of a coapting portion and paddle portions of the implantable prosthetic device illustrated by  FIG. 65 ; 
         FIG. 91A  shows a front view of a coapting portion and paddle portions of the implantable prosthetic device illustrated by  FIG. 65A ; 
         FIG. 92  shows a side view of a coapting portion and paddle portions of the implantable prosthetic device illustrated by  FIG. 65 ; 
         FIG. 92A  shows a side view of a coapting portion and paddle portions of the implantable prosthetic device illustrated by  FIG. 65A ; 
         FIG. 93  shows a top view of a coapting portion and paddle portions of the implantable prosthetic device illustrated by  FIG. 65 ; 
         FIG. 93A  shows a top view of a coapting portion and paddle portions of the implantable prosthetic device illustrated by  FIG. 65A ; 
         FIG. 94  shows a bottom view of a coapting portion and portions of the implantable prosthetic device illustrated by  FIG. 65 ; 
         FIG. 94A  shows a bottom view of a coapting portion and portions of the implantable prosthetic device illustrated by  FIG. 65A ; 
         FIG. 95  shows a sectioned perspective view of a coapting portion and paddle portions of the implantable prosthetic device illustrated by  FIG. 65  with the section taken across plane  96 ; 
         FIG. 95A  shows a sectioned perspective view of a coapting portion and paddle portions of the implantable prosthetic device illustrated by  FIG. 65A  with the section taken across plane  96 A; 
         FIG. 96  shows a cross-section view of the coapting portion and paddle portions of  FIG. 95 ; 
         FIG. 96A  shows a cross-section view of the coapting portion and paddle portions of  FIG. 95A ; 
         FIG. 97  shows a sectioned perspective view of a coapting portion and paddle portions of the implantable prosthetic device illustrated by  FIG. 65  with the section taken across plane  98 ; 
         FIG. 97A  shows a sectioned perspective view of a coapting portion and paddle portions of the implantable prosthetic device illustrated by  FIG. 65A  with the section taken across plane  98 A; 
         FIG. 98  shows a cross-section view of the coapting portion and paddle portions of  FIG. 97 ; 
         FIG. 98A  shows a cross-section view of the coapting portion and paddle portions of  FIG. 97A ; 
         FIG. 99  shows a sectioned perspective view of a coapting portion and paddle portions of the implantable prosthetic device illustrated by  FIG. 65  with the section taken across plane  100 ; 
         FIG. 99A  shows a sectioned perspective view of a coapting portion and paddle portions of the implantable prosthetic device illustrated by  FIG. 65A  with the section taken across plane  100 A′; 
         FIG. 100  shows a cross-section view of the coapting portion and paddle portions of  FIG. 99 ; 
         FIG. 100A  shows a cross-section view of the coapting portion and paddle portions of  FIG. 99A ; 
         FIG. 101  shows a sectioned perspective view of a coapting portion and paddle portions of the implantable prosthetic device illustrated by  FIG. 65  with the section taken across plane  102 ; 
         FIG. 101A  shows a sectioned perspective view of a coapting portion and paddle portions of the implantable prosthetic device illustrated by  FIG. 65A  with the section taken across plane  102 A; 
         FIG. 102  shows a cross-section view of the coapting portion and paddle portions of  FIG. 101 ; 
         FIG. 102A  shows a cross-section view of the coapting portion and paddle portions of  FIG. 101A ; 
         FIG. 103  shows an example embodiment of an implantable prosthetic device; 
         FIG. 104  shows an example embodiment of an implantable prosthetic device; 
         FIG. 105  shows an example embodiment of an implantable prosthetic device; 
         FIG. 106  shows a side view of an example embodiment of an expandable coaption element in an unexpanded condition; 
         FIG. 106A  shows a side view of an example embodiment of an expandable coaption element in an unexpanded condition; 
         FIG. 106B  shows a side view of an example embodiment of an expandable coaption element in an unexpanded condition; 
         FIG. 106C  shows a side view of an example embodiment of an expandable coaption element in an unexpanded condition; 
         FIG. 106D  shows a side view of an example embodiment of an expandable coaption element in an unexpanded condition; 
         FIG. 106E  shows a side view of an example embodiment of an expandable coaption element in an unexpanded condition; 
         FIG. 106F  shows an example embodiment of an expandable coaption element; 
         FIG. 106G  shows an example embodiment of an expandable coaption element; 
         FIG. 106H  shows an example embodiment of an expandable coaption element; 
         FIG. 106I  shows an example embodiment of an expandable coaption element; 
         FIG. 107  shows an end view of the expandable coaption element of  FIG. 106 ; 
         FIG. 108  shows the expandable coaption element of  FIG. 106  in an expanded condition; 
         FIG. 108A  shows the expandable coaption element of  FIG. 106A  in an expanded condition; 
         FIG. 108B  shows the expandable coaption element of  FIG. 106B  in an expanded condition; 
         FIG. 108C  shows the expandable coaption element of  FIG. 106C  in an expanded condition; 
         FIG. 108D  shows the expandable coaption element of  FIG. 106D  in an expanded condition; 
         FIG. 108E  shows the expandable coaption element of  FIG. 106E  in an expanded condition; 
         FIG. 109  shows an end view of the coaption element of  FIG. 108 ; 
         FIG. 110  shows a side view of an example embodiment of an implantable prosthetic device; 
         FIG. 111  shows an end view of a coaption element of the example prosthetic device of  FIG. 110 , taken along lines  111 . 
         FIGS. 112-114  show perspective views of an example embodiment of a paddle frame for the implantable prosthetic device of  FIG. 65 ; 
         FIG. 112A  shows a perspective view of an example embodiment of a paddle frame for the implantable prosthetic device of  FIG. 65A ; 
         FIG. 114A  shows a side view of the paddle frame of  FIG. 112A ; 
         FIG. 115  shows a front view of the paddle frame of  FIGS. 112-114 ; 
         FIG. 115A  shows a top view of the paddle frame of  FIG. 112A ; 
         FIG. 116  shows a top view of the paddle frame of  FIGS. 112-114 ; 
         FIG. 116A  shows a front view of the paddle frame of  FIG. 112A ; 
         FIG. 117  shows a side view of the paddle frame of  FIGS. 112-114 ; 
         FIG. 117A  shows a rear view of the paddle frame of  FIG. 112A ; 
         FIG. 118  shows a bottom view of the paddle frame of  FIGS. 112-114 ; 
         FIG. 118A  shows a bottom view of the paddle frame of  FIG. 112A ; 
         FIG. 119  shows a front view of the paddle frame of  FIGS. 112-114 ; 
         FIG. 120  shows a front view of the paddle frame of  FIGS. 112-114  in a compressed condition inside a delivery device; 
         FIG. 121  shows a side view of an example embodiment of an implantable prosthetic device in a closed condition; 
         FIG. 122  shows a front view of a paddle frame of the example prosthetic device of  FIG. 121 ; 
         FIG. 123  shows a side view of the implantable prosthetic device of  FIG. 121  in an open condition; 
         FIG. 124  shows a front view of the paddle frame of the open prosthetic device of  FIG. 123 ; 
         FIG. 125  shows a side view of an example embodiment of an implantable prosthetic device in a closed condition; 
         FIG. 126  shows a front view of a paddle frame of the example prosthetic device of  FIG. 125 ; 
         FIG. 127  shows a side view of the implantable prosthetic device of  FIG. 125  in a closed condition; 
         FIG. 128  shows a front view of the paddle frame of the open prosthetic device of  FIG. 127 ; 
         FIG. 129  shows an example embodiment of an implantable prosthetic device; 
         FIGS. 130-131  show an example embodiment of an implantable prosthetic device; 
         FIG. 132  shows an example embodiment of an implantable prosthetic device; 
         FIGS. 133-134  show an example embodiment of an implantable prosthetic device; 
         FIGS. 135-136  show an example embodiment of an implantable prosthetic device; 
         FIG. 137  shows an example embodiment of an implantable prosthetic device; 
         FIGS. 138-143  show use of an example embodiment of an implantable prosthetic device; 
         FIG. 144  shows an example embodiment of a delivery assembly including a delivery device and an example prosthetic device; 
         FIG. 145  shows a perspective view of an example embodiment of an implantable prosthetic device releasably coupled to a delivery device; 
         FIG. 146  shows the embodiment of  FIG. 145  with the implantable prosthetic device released from to the delivery device; 
         FIG. 147  shows a cross-sectional view of the coupler of  FIG. 145 ; 
         FIG. 148  shows a perspective view of the delivery assembly of  FIG. 144  with the prosthetic device shown in partial cross-section and some components of the delivery apparatus shown schematically; 
         FIG. 149  shows a plan view of a shaft of the delivery device of  FIG. 144 ; 
         FIG. 150  shows a side elevation view of a proximal end portion of the delivery device of  FIG. 144 ; 
         FIG. 151  shows a cross-sectional view of the proximal end portion of the delivery device of  FIG. 144 , taken along the line  150 - 150  shown in  FIG. 150 ; 
         FIG. 152  shows an exploded view of the proximal end portion of the delivery device of  FIG. 144 ; 
         FIGS. 153-160  show an example procedure used to repair a native valve of a heart, which is partially shown; 
         FIG. 161  shows an example embodiment of a handle for the delivery apparatus of  FIG. 144 ; 
         FIG. 162  is an exploded view of the handle of  FIG. 161 ; 
         FIG. 163  shows an example embodiment of a coupler and a proximal collar for the delivery assembly of  FIG. 144 , showing the coupler releasably coupled to the proximal collar; 
         FIG. 164  shows a perspective view of the coupler and proximal collar of  FIG. 163 , showing the coupler released from the proximal collar; 
         FIG. 165  shows example embodiments of a cap, actuation element or means of actuating, and release wire for the delivery assembly of  FIG. 144 , showing the cap releasably coupled to the actuation element or means of actuating by the release wire. 
         FIG. 166  shows a perspective view of the cap, actuation element or means of actuating, and the release wire of  FIG. 163 , showing the cap released from the actuation element or means of actuating and the release wire; 
         FIG. 167  shows example embodiments of a coupler, a proximal collar, a cap, and an actuation element or means of actuating of the delivery assembly of  FIG. 144 ; 
         FIG. 168  shows a perspective view of the coupler and proximal collar of  FIG. 167 ; 
         FIG. 169  shows an example embodiment of a clasp control member of the delivery apparatus of  FIG. 144 ; 
         FIG. 170  shows a detail view of the clasp control member of  FIG. 169 , taken from the perspective  170  shown in  FIG. 169 ; 
         FIG. 171  shows an example embodiment of a guide rail for the clasp control member of  FIG. 169 ; 
         FIG. 172  shows an example embodiment of a shaft of the delivery device of  FIG. 144 ; 
         FIG. 173  shows an example embodiment of an implantable prosthetic device and delivery device for releasing and recapturing the prosthetic device; 
         FIG. 174  shows an example embodiment of an implantable prosthetic device and delivery device for releasing and recapturing the prosthetic device; 
         FIG. 174A  shows an example embodiment of an implantable prosthetic device and delivery device for releasing and recapturing the prosthetic device; 
         FIG. 175  shows an example embodiment of an implantable prosthetic device and delivery device for releasing and recapturing the prosthetic device; 
         FIG. 175A  shows an example embodiment of an implantable prosthetic device and delivery device for releasing and recapturing the prosthetic device; 
         FIG. 176  shows an example embodiment of an implantable prosthetic device and delivery device for releasing and recapturing the prosthetic device; 
         FIGS. 177-178  show an example embodiment of a coupler for an example implantable prosthetic device; 
         FIGS. 179-181  show an example embodiment of a coupler for an example implantable prosthetic device; 
         FIGS. 182-183  show an example embodiment of a coupler for an example implantable prosthetic device; 
         FIGS. 184-185  show an example embodiment of a coupler for an example implantable prosthetic device; 
         FIG. 186  shows an example embodiment of an actuation element or means of actuating for an example prosthetic device; 
         FIG. 187  shows an actuation mechanism for an example prosthetic device; 
         FIG. 188  shows an actuation mechanism for an example prosthetic device; 
         FIG. 188A  shows an actuation mechanism for an example prosthetic device; 
         FIG. 189  shows an actuation mechanism for an example prosthetic device; 
         FIG. 190  shows an actuation mechanism for an example prosthetic device; 
         FIG. 191  is a perspective view of a blank used to make a paddle frame; 
         FIG. 192  is a perspective view of the blank of  FIG. 191  bent to make a paddle frame; 
         FIG. 193  is a perspective view of a shape-set paddle frame attached to a cap of a valve repair device; 
         FIG. 194  is a perspective view of the paddle frame of  FIG. 193  flexed and attached to inner and outer paddles at a closed position; 
         FIG. 195  is a perspective view of two of the paddle frames of  FIG. 112A  showing the paddle frames in a shape-set position; 
         FIG. 196  is a perspective view of the paddle frames of  FIG. 195  showing the paddle frames in a loaded position; 
         FIG. 197  is an enlarged side view of device of  FIG. 60C  showing the cover; 
         FIG. 198  is an enlarged side view of the device of  FIG. 60C  showing the cover; 
         FIG. 199  shows an exploded view of an example prosthetic device; 
         FIG. 200  shows an enlarged perspective view of the collar of an example prosthetic device; 
         FIG. 201  shows an enlarged perspective view of the cap of an example prosthetic device; 
         FIG. 202  shows an exploded view of the cap of  FIG. 206 ; 
         FIG. 203  shows a plan view of an inner cover for an example prosthetic device; 
         FIG. 204  shows a plan view of an outer cover for an example prosthetic device; 
         FIG. 205  shows an enlarged view of a strip of material for an example prosthetic device; 
         FIG. 206  shows an end view of the material of  FIG. 205 ; 
         FIG. 207  shows an end view of the material of  FIG. 205  arranged in a plurality of layers; 
         FIG. 208A  shows an example implantable prosthetic device in the gap of the native valve as viewed from an atrial side of the native valve during diastole, with example inflatable spacers in a deflated condition; 
         FIG. 208B  shows the device of  FIG. 208A  during systole, with example inflatable spacers in a deflated condition; 
         FIG. 209A  shows the device of  FIG. 208A  during diastole, with example inflatable spacers in an inflated condition; 
         FIG. 209B  shows the device of  FIG. 208A  during systole, with example inflatable spacers in an inflated condition; 
         FIG. 210A  shows an example expandable spacer in a compressed condition; 
         FIG. 210B  shows the expandable spacer of  FIG. 210A  in an expanded condition; 
         FIG. 211A  shows an example implantable prosthetic device, with example inflatable spacers in a deflated condition; 
         FIG. 211B  shows the device of  FIG. 211B , with example inflatable spacers in an inflated condition; 
         FIG. 212A  is a side view of an example implantable prosthetic device; 
         FIG. 212B  is a front/back view of the device of  FIG. 212A ; 
         FIG. 213A  is a top view of an example auxiliary spacer for attaching to the device of  FIG. 212A ; 
         FIG. 213B  is a side view of the spacer of  FIG. 213A ; 
         FIG. 214  is a side view of the spacer of  FIGS. 213A, 213B  being assembled to the device of  FIGS. 212A, 212B ; 
         FIG. 215A  is a side view of the spacer of  FIGS. 213A, 213B  assembled to the device of  FIGS. 212A, 212B ; 
         FIG. 215B  is a top view of the assembly of  FIG. 215A ; 
         FIG. 216A  is a side view of an example implantable prosthetic device; 
         FIG. 216B  is a front/back view of the device of  FIG. 216A ; 
         FIG. 217A  is a top view of an example auxiliary spacer for attaching to the device of  FIG. 216A ; 
         FIG. 217B  is a side view of the spacer of  FIG. 217A ; 
         FIG. 218  is an example auxiliary spacer; 
         FIG. 219A  is a top view of an example implantable prosthetic device; 
         FIG. 219B  is a side view of an example implantable prosthetic device; 
         FIG. 220A  is a top view of example auxiliary spacers; 
         FIG. 220B  is a top view of example auxiliary spacers; 
         FIG. 220C  is a top view of example auxiliary spacers; 
         FIG. 220D  is a top view of example auxiliary spacers; 
         FIG. 220E  is a top view of example auxiliary spacers; 
         FIG. 221  is a plan view of an example implantable prosthetic device cut from a flat sheet of material; 
         FIG. 222  is a perspective view of the device of  FIG. 221 ; 
         FIG. 223  shows the device of  FIGS. 221-222  in the gap of the native valve as viewed from an atrial side of the native valve; 
         FIG. 224  is a plan view of an example implantable prosthetic device cut from a flat sheet of material; 
         FIG. 225  is a perspective view of the device of  FIG. 224 ; 
         FIG. 226  shows an example embodiment of an implantable prosthetic device with a two-piece cover; 
         FIG. 227  shows an example embodiment of an implantable prosthetic device with a two-piece cover; 
         FIG. 228  shows an example embodiment of an implantable prosthetic device with a two-piece cover; 
         FIG. 229  shows an example embodiment of an implantable prosthetic device with a two-piece cover; 
         FIG. 230  shows an example embodiment of an implantable prosthetic device with a two-piece cover; 
         FIG. 231  shows an example embodiment of an implantable prosthetic device with a two-piece cover; 
         FIGS. 232-235  show an example embodiment of an implantable prosthetic device in various stages of deployment; 
         FIGS. 236-238  show the implantable prosthetic device of  FIGS. 232-235  being delivered and implanted within the native mitral valve; 
         FIGS. 239-242  show the implantable prosthetic device of  FIGS. 232-235  being delivered and implanted within the native mitral valve while avoiding an obstacle; 
         FIG. 243  shows a perspective view of a coapting portion and paddle portions of an example embodiment of an implantable prosthetic device; 
         FIG. 244  shows a side view of an example implantable prosthetic device without barbed clasps in a closed position; 
         FIG. 245  shows a side view of an example implantable prosthetic device with barbed clasps in a closed position; 
         FIGS. 246-249  show the example implantable prosthetic device of  FIGS. 243-245  attached to a deployment device and arranged in various stages of deployment; 
         FIGS. 250-253  show the example implantable prosthetic device of  FIGS. 243-245  being delivered and implanted within the native mitral valve; 
         FIGS. 254-257  show the example implantable prosthetic device of  FIGS. 243-245  being delivered and implanted within the native mitral valve while avoiding an obstacle; 
         FIG. 258  shows an example implantable prosthetic device in a closed condition; 
         FIG. 259  shows a side view of the example implantable prosthetic device of  FIG. 258 ; 
         FIG. 260  shows an example implantable prosthetic device in a partially open condition; 
         FIG. 261  shows a side view of the example implantable prosthetic device of  FIG. 260 ; 
         FIG. 262  shows an example implantable prosthetic device in a closed condition; 
         FIG. 263  shows a side view of the example implantable prosthetic device of  FIG. 262 ; 
         FIG. 264  shows an example implantable prosthetic device in a partially open condition; 
         FIG. 265  shows a side view of the example implantable prosthetic device of  FIG. 264 ; 
         FIG. 266  shows a top perspective view of an example implantable prosthetic device in a closed condition; 
         FIG. 267  shows a bottom perspective view of the example implantable prosthetic device of  FIG. 266 ; 
         FIG. 268  shows a front view of the example implantable prosthetic device of  FIG. 266 ; 
         FIG. 269  shows a side view of the example implantable prosthetic device of  FIG. 266 ; 
         FIG. 270  shows a top view of the example implantable prosthetic device of  FIG. 266 ; 
         FIG. 271  shows a bottom view of the example implantable prosthetic device of  FIG. 266 ; 
         FIG. 272  shows a top perspective view of an example implantable prosthetic device in a partially open condition; 
         FIG. 273  shows a bottom perspective view of the example implantable prosthetic device of  FIG. 272 ; 
         FIG. 274  shows a front view of the example implantable prosthetic device of  FIG. 272 ; 
         FIG. 275  shows a side view of the example implantable prosthetic device of  FIG. 272 ; 
         FIG. 276  shows a top view of the example implantable prosthetic device of  FIG. 272 ; 
         FIG. 277  shows a bottom view of the example implantable prosthetic device of  FIG. 272 ; 
         FIG. 278  shows a top perspective view of a spacer and a pair of paddles of an example implantable prosthetic device in a closed condition; 
         FIG. 279  shows a bottom perspective view of the spacer and pair of paddles of  FIG. 278 ; 
         FIG. 280  shows a front view of the spacer and pair of paddles of  FIG. 278 ; 
         FIG. 281  shows a side view of the spacer and pair of paddles of  FIG. 278 ; 
         FIG. 282  shows a top view of the spacer and pair of paddles of  FIG. 278 ; 
         FIG. 283  shows a bottom view of the spacer and pair of paddles of  FIG. 278 ; 
         FIG. 284  shows a top perspective view of a spacer and a pair of paddles of an example implantable prosthetic device in a partially open condition; 
         FIG. 285  shows a bottom perspective view of the spacer and pair of paddles of  FIG. 284 ; 
         FIG. 286  shows a front view of the spacer and pair of paddles of  FIG. 284 ; 
         FIG. 287  shows a side view of the spacer and pair of paddles of  FIG. 284 ; 
         FIG. 288  shows a top view of the spacer and pair of paddles of  FIG. 284 ; 
         FIG. 289  shows a bottom view of the spacer and pair of paddles of  FIG. 284 ; 
         FIG. 290  shows a top perspective view of an example implantable prosthetic device in a closed condition; 
         FIG. 291  shows a bottom perspective view of the example implantable prosthetic device of  FIG. 290 ; 
         FIG. 292  shows a front view of the example implantable prosthetic device of  FIG. 290 ; 
         FIG. 293  shows a side view of the example implantable prosthetic device of  FIG. 290 ; 
         FIG. 294  shows a top view of the example implantable prosthetic device of  FIG. 290 ; 
         FIG. 295  shows a bottom view of the example implantable prosthetic device of  FIG. 290 ; 
         FIG. 296  shows a top perspective view of an example implantable prosthetic device in a partially open condition; 
         FIG. 297  shows a bottom perspective view of the example implantable prosthetic device of  FIG. 296 ; 
         FIG. 298  shows a front view of the example implantable prosthetic device of  FIG. 296 ; 
         FIG. 299  shows a side view of the example implantable prosthetic device of  FIG. 296 ; 
         FIG. 300  shows a top view of the example implantable prosthetic device of  FIG. 296 ; 
         FIG. 301  shows a bottom view of the example implantable prosthetic device of  FIG. 296 ; 
         FIG. 302  shows a top perspective view of a spacer and a pair of paddles of an example implantable prosthetic device in a closed condition; 
         FIG. 303  shows a bottom perspective view of the spacer and pair of paddles of  FIG. 302 ; 
         FIG. 304  shows a front view of the spacer and pair of paddles of  FIG. 302 ; 
         FIG. 305  shows a side view of the spacer and pair of paddles of  FIG. 302 ; 
         FIG. 306  shows a top view of the spacer and pair of paddles of  FIG. 302 ; 
         FIG. 307  shows a bottom view of the spacer and pair of paddles of  FIG. 302 ; 
         FIG. 308  shows a top perspective view of a spacer and a pair of paddles of an example implantable prosthetic device in a partially open condition; 
         FIG. 309  shows a bottom perspective view of the spacer and pair of paddles of  FIG. 308 ; 
         FIG. 310  shows a front view of the spacer and pair of paddles of  FIG. 308 ; 
         FIG. 311  shows a side view of the spacer and pair of paddles of  FIG. 308 ; 
         FIG. 312  shows a top view of the spacer and pair of paddles of  FIG. 308 ; and 
         FIG. 313  shows a bottom view of the spacer of  FIG. 308 . 
     
    
    
     DETAILED DESCRIPTION 
     The following description refers to the accompanying drawings, which illustrate specific embodiments of the present disclosure. Other embodiments having different structures and operation do not depart from the scope of the present disclosure. 
     Example embodiments of the present disclosure are directed to devices and methods for repairing a defective heart valve. It should be noted that various embodiments of native valve reparation devices and systems for delivery are disclosed herein, and any combination of these options can be made unless specifically excluded. In other words, individual components of the disclosed devices and systems can be combined unless mutually exclusive or otherwise physically impossible. 
     As described herein, when one or more components are described as being connected, joined, affixed, coupled, attached, or otherwise interconnected, such interconnection may be direct as between the components or may be indirect such as through the use of one or more intermediary components. Also as described herein, reference to a “member,” “component,” or “portion” shall not be limited to a single structural member, component, or element but can include an assembly of components, members, or elements. Also as described herein, the terms “substantially” and “about” are defined as at least close to (and includes) a given value or state (preferably within 10% of, more preferably within 1% of, and most preferably within 0.1% of). 
       FIGS. 1 and 2  are cutaway views of the human heart H in diastolic and systolic phases, respectively. The right ventricle RV and left ventricle LV are separated from the right atrium RA and left atrium LA, respectively, by the tricuspid valve TV and mitral valve MV; i.e., the atrioventricular valves. Additionally, the aortic valve AV separates the left ventricle LV from the ascending aorta AA, and the pulmonary valve PV separates the right ventricle from the pulmonary artery PA. Each of these valves has flexible leaflets (e.g., leaflets  20 ,  22  shown in  FIGS. 4 and 5 ) extending inward across the respective orifices that come together or “coapt” in the flow stream to form the one-way, fluid-occluding surfaces. The native valve repair systems of the present application are described primarily with respect to the mitral valve MV. Therefore, anatomical structures of the left atrium LA and left ventricle LV will be explained in greater detail. It should be understood that the devices described herein may also be used in repairing other native valves, e.g., the devices can be used in repairing the tricuspid valve TV, the aortic valve AV, and the pulmonary valve PV. 
     The left atrium LA receives oxygenated blood from the lungs. During the diastolic phase, or diastole, seen in  FIG. 1 , the blood that was previously collected in the left atrium LA (during the systolic phase) moves through the mitral valve MV and into the left ventricle LV by expansion of the left ventricle LV. In the systolic phase, or systole, seen in  FIG. 2 , the left ventricle LV contracts to force the blood through the aortic valve AV and ascending aorta AA into the body. During systole, the leaflets of the mitral valve MV close to prevent the blood from regurgitating from the left ventricle LV and back into the left atrium LA, and blood is collected in the left atrium from the pulmonary vein. In one example embodiment, the devices described by the present application are used to repair the function of a defective mitral valve MV. That is, the devices are configured to help close the leaflets of the mitral valve to prevent blood from regurgitating from the left ventricle LV and back into the left atrium LA. Unlike the prior art that describes using sutures or clips often require multiple sutures or clips and additional supports to treat large regurgitant, the devices described in the present application are designed to easily grasp and secure the native leaflets around a coaption element that acts as a filler in the regurgitant orifice. In this application, the terms coaption element, spacer, spacer element, and coaptation element and refers to a component that fills a portion of a space within a native heart valve, such as a mitral valve or a tricuspid valve. 
     Referring now to  FIGS. 1-7 , the mitral valve MV includes two leaflets, the anterior leaflet  20  and the posterior leaflet  22 . The mitral valve MV also includes an annulus  24 A, which is a variably dense fibrous ring of tissues that encircles the leaflets  20 ,  22 . Referring to  FIG. 3 , the mitral valve MV is anchored to the wall of the left ventricle LV by chordae tendineae  10 . The chordae tendineae  10  are cord-like tendons that connect the papillary muscles  12  (i.e., the muscles located at the base of the chordae tendineae and within the walls of the left ventricle) to the leaflets  20 ,  22  of the mitral valve MV. The papillary muscles  12  serve to limit the movements of the mitral valve MV and prevent the mitral valve from being reverted. The mitral valve MV opens and closes in response to pressure changes in the left atrium LA and the left ventricle LV. The papillary muscles do not open or close the mitral valve MV. Rather, the papillary muscles brace the mitral valve MV against the high pressure needed to circulate blood throughout the body. Together the papillary muscles and the chordae tendineae are known as the subvalvular apparatus, which functions to keep the mitral valve MV from prolapsing into the left atrium LA when the mitral valve closes. 
     Various disease processes can impair proper function of one or more of the native valves of the heart H. These disease processes include degenerative processes (e.g., Barlow&#39;s Disease, fibroelastic deficiency), inflammatory processes (e.g., Rheumatic Heart Disease), and infectious processes (e.g., endocarditis). In addition, damage to the left ventricle LV or the right ventricle RV from prior heart attacks (i.e., myocardial infarction secondary to coronary artery disease) or other heart diseases (e.g., cardiomyopathy) can distort a native valve&#39;s geometry, which can cause the native valve to dysfunction. However, the vast majority of patients undergoing valve surgery, such as surgery to the mitral valve MV, suffer from a degenerative disease that causes a malfunction in a leaflet (e.g., leaflets  20 ,  22 ) of a native valve (e.g., the mitral valve MV), which results in prolapse and regurgitation. 
     Generally, a native valve may malfunction in two different ways: (1) valve stenosis; and (2) valve regurgitation. Valve stenosis occurs when a native valve does not open completely and thereby causes an obstruction of blood flow. Typically, valve stenosis results from buildup of calcified material on the leaflets of a valve, which causes the leaflets to thicken and impairs the ability of the valve to fully open to permit forward blood flow. 
     The second type of valve malfunction, valve regurgitation, occurs when the leaflets of the valve do not close completely thereby causing blood to leak back into the prior chamber (e.g., causing blood to leak from the left ventricle to the left atrium). There are three main mechanisms by which a native valve becomes regurgitant—or incompetent—which include Carpentier&#39;s type I, type II, and type III malfunctions. A Carpentier type I malfunction involves the dilation of the annulus such that normally functioning leaflets are distracted from each other and fail to form a tight seal (i.e., the leaflets do not coapt properly). Included in a type I mechanism malfunction are perforations of the leaflets, as are present in endocarditis. A Carpentier&#39;s type II malfunction involves prolapse of one or more leaflets of a native valve above a plane of coaption. A Carpentier&#39;s type III malfunction involves restriction of the motion of one or more leaflets of a native valve such that the leaflets are abnormally constrained below the plane of the annulus. Leaflet restriction can be caused by rheumatic disease (Ma) or dilation of a ventricle (IIIb). 
     Referring to  FIG. 4 , when a healthy mitral valve MV is in a closed position, the anterior leaflet  20  and the posterior leaflet  22  coapt, which prevents blood from leaking from the left ventricle LV to the left atrium LA. Referring to  FIG. 5 , regurgitation occurs when the anterior leaflet  20  and/or the posterior leaflet  22  of the mitral valve MV is displaced into the left atrium LA during systole. This failure to coapt causes a gap  26  between the anterior leaflet  20  and the posterior leaflet  22 , which allows blood to flow back into the left atrium LA from the left ventricle LV during systole. As set forth above, there are several different ways that a leaflet (e.g. leaflets  20 ,  22  of mitral valve MV) may malfunction, which can thereby lead to regurgitation. 
     Referring to  FIG. 6 , in certain situations, the mitral valve MV of a patient can have a wide gap  26  between the anterior leaflet  20  and the posterior leaflet  22  when the mitral valve is in a closed position (i.e., during the systolic phase). For example, the gap  26  can have a width W between about 2.5 mm and about 17.5 mm, such as between about 5 mm and about 15 mm, such as between about 7.5 mm and about 12.5 mm, such as about 10 mm. In some situations, the gap can have a width W greater than 15 mm. In any of the above-mentioned situations, a valve repair device is desired that is capable of engaging the anterior leaflet  20  and the posterior leaflet  22  to close the gap  26  and prevent regurgitation of blood through the mitral valve MV. 
     Although stenosis or regurgitation can affect any valve, stenosis is predominantly found to affect either the aortic valve AV or the pulmonary valve PV, and regurgitation is predominantly found to affect either the mitral valve MV or the tricuspid valve TV. Both valve stenosis and valve regurgitation increase the workload of the heart H and may lead to very serious conditions if left un-treated; such as endocarditis, congestive heart failure, permanent heart damage, cardiac arrest, and ultimately death. Because the left side of the heart (i.e., the left atrium LA, the left ventricle LV, the mitral valve MV, and the aortic valve AV) is primarily responsible for circulating the flow of blood throughout the body, malfunction of the mitral valve MV or the aortic valve AV is particularly problematic and often life threatening. Accordingly, because of the substantially higher pressures on the left side of the heart, dysfunction of the mitral valve MV or the aortic valve AV is often more problematic. 
     Malfunctioning native heart valves may either be repaired or replaced. Repair typically involves the preservation and correction of the patient&#39;s native valve. Replacement typically involves replacing the patient&#39;s native valve with a biological or mechanical substitute. Typically, the aortic valve AV and pulmonary valve PV are more prone to stenosis. Because stenotic damage sustained by the leaflets is irreversible, the most conventional treatments for a stenotic aortic valve or stenotic pulmonary valve are removal and replacement of the valve with a surgically implanted heart valve, or displacement of the valve with a transcatheter heart valve. The mitral valve MV and the tricuspid valve TV are more prone to deformation of leaflets, which, as described above, prevents the mitral valve or tricuspid valve from closing properly and allows for regurgitation or back flow of blood from the ventricle into the atrium (e.g., a deformed mitral valve MV may allow for regurgitation or back flow from the left ventricle LV to the left atrium LA). The regurgitation or back flow of blood from the ventricle to the atrium results in valvular insufficiency. Deformations in the structure or shape of the mitral valve MV or the tricuspid valve TV are often repairable. In addition, regurgitation can occur due to the chordae tendineae  10  becoming dysfunctional (e.g., the chordae tendineae may stretch or rupture), which allows the anterior leaflet  20  and the posterior leaflet  22  to be reverted such that blood is regurgitated into the left atrium LA. The problems occurring due to dysfunctional chordae tendineae  10  can be repaired by repairing the chordae tendineae or the structure of the mitral valve (e.g., by securing the leaflets  20 ,  22  at the affected portion of the mitral valve). 
     The devices and procedures disclosed herein often make reference to repairing a mitral valve for illustration. However, it should be understood that the devices and concepts provided herein can be used to repair any native valve, as well as any component of a native valve. For example, referring now to  FIG. 7 , any of the devices and concepts provided herein can be used to repair the tricuspid valve TV. For example, any of the devices and concepts provided herein can be used between any two of the anterior leaflet  30 , septal leaflet  32 , and posterior leaflet  34  to prevent regurgitation of blood from the right ventricle into the right atrium. In addition, any of the devices and concepts provided herein can be used on all three of the leaflets  30 ,  32 ,  34  together to prevent regurgitation of blood from the right ventricle to the right atrium. That is, the valve repair devices provided herein can be centrally located between the three leaflets  30 ,  32 ,  34 . 
     An example implantable prosthetic device has a coaption element and at least one anchor. The coaption element is configured to be positioned within the native heart valve orifice to help fill the space and form a more effective seal, thereby reducing or preventing regurgitation described above. The coaption element can have a structure that is impervious or resistant to blood and that allows the native leaflets to close around the coaption element during ventricular systole to block blood from flowing from the left or right ventricle back into the left or right atrium, respectively. The prosthetic device can be configured to seal against two or three native valve leaflets; that is, the device may be used in the native mitral (bicuspid) and tricuspid valves. The coaption element is sometimes referred to herein as a spacer because the coaption element can fill a space between improperly functioning native mitral or tricuspid leaflets that do not close completely. 
     The coaption element (e.g., spacer, coaptation element, etc.) can have various shapes. In some embodiments, the coaption element can have an elongated cylindrical shape having a round cross-sectional shape. In some embodiments, the coaption element can have an oval cross-sectional shape, a crescent cross-sectional shape, a rectangular cross-sectional shape, or various other non-cylindrical shapes. The coaption element can have an atrial portion positioned in or adjacent to the left atrium, a ventricular or lower portion positioned in or adjacent to the left ventricle, and a side surface that extends between the native mitral leaflets. In embodiments configured for use in the tricuspid valve, the atrial or upper portion is positioned in or adjacent to the right atrium, and the ventricular or lower portion is positioned in or adjacent to the right ventricle, and the side surface that extends between the native tricuspid leaflets. 
     The anchor can be configured to secure the device to one or both of the native mitral leaflets such that the coaption element is positioned between the two native leaflets. In embodiments configured for use in the tricuspid valve, the anchor is configured to secure the device to one, two, or three of the tricuspid leaflets such that the coaption element is positioned between the three native leaflets. In some embodiments, the anchor can attach to the coaption element at a location adjacent the ventricular portion of the coaption element. In some embodiments, the anchor can attach to an actuation element, such as a shaft or actuation wire, to which the coaption element is also attached. In some embodiments, the anchor and the coaption element can be positioned independently with respect to each other by separately moving each of the anchor and the coaption element along the longitudinal axis of the shaft or actuation wire. In some embodiments, the anchor and the coaption element can be positioned simultaneously by moving the anchor and the coaption element together along the longitudinal axis of the shaft or actuation wire. The anchor can be configured to be positioned behind a native leaflet when implanted such that the leaflet is grasped by the anchor. 
     The prosthetic device can be configured to be implanted via a delivery sheath. The coaption element and the anchor can be compressible to a radially compressed state and can be self-expandable to a radially expanded state when compressive pressure is released. The device can be configured for the anchor to be expanded radially away from the still-compressed coaption element initially in order to create a gap between the coaption element and the anchor. A native leaflet can then be positioned in the gap. The coaption element can be expanded radially, closing the gap between the coaption element and the anchor and capturing the leaflet between the coaption element and the anchor. In some embodiments, the anchor and coaption element are optionally configured to self-expand. The implantation methods for various embodiments can be different and are more fully discussed below with respect to each embodiment. Additional information regarding these and other delivery methods can be found in U.S. Pat. No. 8,449,599 and U.S. Patent Application Publication Nos. 2014/0222136, and 2014/0067052, 2016/0331523 each of which is incorporated herein by reference in its entirety. These methods can be performed on a living animal or on a simulation, such as on a cadaver, cadaver heart, simulator (e.g. with the body parts, tissue, etc. being simulated), etc. 
     The disclosed prosthetic devices can be configured such that the anchor is connected to a leaflet, taking advantage of the tension from native chordae tendineae to resist high systolic pressure urging the device toward the left atrium. During diastole, the devices can rely on the compressive and retention forces exerted on the leaflet that is grasped by the anchor. 
     Referring now to  FIGS. 8-14 , a schematically illustrated implantable prosthetic device  100  (e.g., a prosthetic spacer device, etc.) is shown in various stages of deployment. The device  100  can include any other features for an implantable prosthetic device discussed in the present application, and the device  100  can be positioned to engage valve tissue  20 ,  22  as part of any suitable valve repair system (e.g., any valve repair system disclosed in the present application). 
     The device  100  is deployed from a delivery sheath or means for delivery  102  and includes a coapting portion or coaptation portion  104  and an anchor portion  106 . The coaptation portion  104  of the device  100  includes a coaption element or means for coapting  110  that is adapted to be implanted between the leaflets of a native valve (e.g., a native mitral valve, tricuspid valve, etc.) and is slidably attached to an actuation element  112  (e.g., actuation wire, actuation shaft, actuation tube, etc.). The anchor portion  106  is actuatable between open and closed conditions and can take a wide variety of forms, such as, for example, paddles, gripping elements, or the like. Actuation of the actuation element or means for actuating  112  opens and closes the anchor portion  106  of the device  100  to grasp the native valve leaflets during implantation. The actuation element  112  (e.g., wire, shaft, tube, screw, line, etc.) can take a wide variety of different forms. For example, the actuation element can be threaded such that rotation of the actuation element (e.g., wire, shaft, tube, screw, etc.) moves the anchor portion  106  relative to the coaption portion  104 . Or, the actuation element can be unthreaded, such that pushing or pulling the actuation element  112  moves the anchor portion  106  relative to the coaption portion  104 . 
     The anchor portion  106  of the device  100  includes outer paddles  120  and inner paddles  122  that are connected between a cap  114  and the coaption element or means for coapting  110  by portions  124 ,  126 ,  128 . The portions  124 ,  126 ,  128  can be jointed and/or flexible to move between all of the positions described below. The interconnection of the outer paddles  120 , the inner paddles  122 , the coaption element or means for coapting  110 , and the cap  114  by the portions  124 ,  126 , and  128  can constrain the device to the positions and movements illustrated herein. 
     In some implementations, the actuation element or means for actuating  112  (e.g., actuation wire, actuation shaft, etc.) extends through the delivery sheath and the coaption element or means for coapting  110  to the cap  114  at the distal connection of the anchor portion  106 . Extending and retracting the actuation element or means for actuating  112  increases and decreases the spacing between the coaption element or means for coapting  110  and the cap  114 , respectively. A collar or other attachment element removably attaches the coaption element or means for coapting  110  to the delivery sheath or means for delivery  102  so that the actuation element or means for actuating  112  slides through the collar or other attachment element and through the coaption element or means for coapting  110  during actuation to open and close the paddles  120 ,  122  of the anchor portion  106 . 
     Referring now to  FIG. 11 , the anchor portion  106  includes attachment portions or gripping members. The illustrated gripping members comprise barbed clasps  130  that include a base or fixed arm  132 , a moveable arm  134 , barbs or means for securing  136 , and a joint portion  138 . The fixed arms  132  are attached to the inner paddles  122 , with the joint portion  138  disposed proximate the coaption element or means for coapting  110 . The barbed clasps have flat surfaces and do not fit in a recess of the paddle. Rather, the flat portions of the barbed clasps are disposed against the surface of the inner paddle  122 . The joint portion  138  provides a spring force between the fixed and moveable arms  132 ,  134  of the barbed clasp  130 . The joint portion  138  can be any suitable joint, such as a flexible joint, a spring joint, a pivot joint, or the like. In certain embodiments, the joint portion  138  is a flexible piece of material integrally formed with the fixed and moveable arms  132 ,  134 . The fixed arms  132  are attached to the inner paddles  122  and remain stationary relative to the inner paddles  122  when the moveable arms  134  are opened to open the barbed clasps  130  and expose the barbs or means for securing  136 . In some implementations, the barbed clasps  130  are opened by applying tension to actuation lines  116  attached to the moveable arms  134 , thereby causing the moveable arms  134  to articulate, flex, or pivot on the joint portions  138 . Other actuation mechanisms are also possible. 
     During implantation, the paddles  120 ,  122  can be opened and closed, for example, to grasp the native leaflets or native mitral valve leaflets between the paddles  120 ,  122  and the coaption element or means for coapting  110 . The barbed clasps  130  can be used to grasp and/or further secure the native leaflets by engaging the leaflets with barbs or means for securing  136  and pinching the leaflets between the moveable and fixed arms  134 ,  132 . The barbs or means for securing  136  of the barbed clasps  130  increase friction with the leaflets or may partially or completely puncture the leaflets. The actuation lines  116  can be actuated separately so that each barbed clasp  130  can be opened and closed separately. Separate operation allows one leaflet to be grasped at a time, or for the repositioning of a clasp  130  on a leaflet that was insufficiently grasped, without altering a successful grasp on the other leaflet. The barbed clasps  130  can be opened and closed relative to the position of the inner paddle  122  (as long as the inner paddle is in an open position), thereby allowing leaflets to be grasped in a variety of positions as the particular situation requires. 
     The barbed clasps  130  can be opened separately by pulling on an attached actuation line  116  that extends through the delivery sheath or means for delivery  102  to the barbed clasp  130 . The actuation line  116  can take a wide variety of forms, such as, for example, a line, a suture, a wire, a rod, a catheter, or the like. The barbed clasps  130  can be spring loaded so that in the closed position the barbed clasps  130  continue to provide a pinching force on the grasped native leaflet. This pinching force remains constant regardless of the position of the inner paddles  122 . Barbs or means for securing  136  of the barbed clasps  130  can pierce the native leaflets to further secure the native leaflets. 
     Referring now to  FIG. 8 , the device  100  is shown in an elongated or fully open condition for deployment from the delivery sheath. The device  100  is loaded in the delivery sheath in the fully open position, because the fully open position takes up the least space and allows the smallest catheter to be used (or the largest device  100  to be used for a given catheter size). In the elongated condition the cap  114  is spaced apart from the coaption element or means for coapting  110  such that the paddles  120 ,  122  of the anchor portion  106  are fully extended. In some embodiments, an angle formed between the interior of the outer and inner paddles  120 ,  122  is approximately 180 degrees. The barbed clasps  130  are kept in a closed condition during deployment through the delivery sheath or means for delivery  102  so that the barbs or means for securing  136  ( FIG. 11 ) do not catch or damage the sheath or tissue in the patient&#39;s heart. 
     Referring now to  FIG. 9 , the device  100  is shown in an elongated detangling condition, similar to  FIG. 8 , but with the barbed clasps  130  in a fully open position, ranging from about 140 degrees to about 200 degrees, to about 170 degrees to about 190 degrees, or about 180 degrees between fixed and moveable portions of the barbed clasps  130 . Fully opening the paddles  120 ,  122  and the clasps  130  has been found to improve ease of detanglement or detachment from anatomy of the patient during implantation of the device  100 . 
     Referring now to  FIG. 10 , the device  100  is shown in a shortened or fully closed condition. The compact size of the device  100  in the shortened condition allows for easier maneuvering and placement within the heart. To move the device  100  from the elongated condition to the shortened condition, the actuation element or means for actuating  112  is retracted to pull the cap  114  towards the coaption element or means for coapting  110 . The joints or flexible connections  126  between the outer paddle  120  and inner paddle  122  are constrained in movement such that compression forces acting on the outer paddle  120  from the cap  114  being retracted towards the coaption element or means for coapting  110  cause the paddles  120 ,  122  or gripping elements to move radially outward. During movement from the open to closed position, the outer paddles  120  maintain an acute angle with the actuation element or means for actuating  112 . The outer paddles  120  can optionally be biased toward a closed position. The inner paddles  122  during the same motion move through a considerably larger angle as they are oriented away from the coaption element or means for coapting  110  in the open condition and collapse along the sides of the coaption element or means for coapting  110  in the closed condition. In certain embodiments, the inner paddles  122  are thinner and/or narrower than the outer paddles  120 , and the joint or flexible portions  126 ,  128  connected to the inner paddles  122  can be thinner and/or more flexible. For example, this increased flexibility can allow more movement than the joint or flexible portion  124  connecting the outer paddle  120  to the cap  114 . In some embodiments, the outer paddles  120  are narrower than the inner paddles  122 . The joint or flexible portions  126 ,  128  connected to the inner paddles  122  can be more flexible, for example, to allow more movement than the joint or flexible portion  124  connecting the outer paddle  120  to the cap  114 . In one embodiment, the inner paddles  122  can be the same or substantially the same width as the outer paddles (See for example,  FIG. 65A ). 
     Referring now to  FIGS. 11-13 , the device  100  is shown in a partially open, grasp-ready condition. To transition from the fully closed to the partially open condition, the actuation element or means for actuating  112  is extended to push the cap  114  away from the coaption element or means for coapting  110 , thereby pulling on the outer paddles  120 , which in turn pulls on the inner paddles  122 , causing the anchor portion  106  to partially unfold. The actuation lines  116  are also retracted to open the clasps  130  so that the leaflets can be grasped. In the example illustrated by  FIG. 11 , the pair of inner and outer paddles  122 ,  120  are moved in unison, rather than independently, by a single actuation element or means for actuating  112 . Also, the positions of the clasps  130  are dependent on the positions of the paddles  122 ,  120 . For example, referring to  FIG. 10  closing the paddles  122 ,  120  also closes the clasps. 
       FIG. 11A  illustrates an example embodiment where the paddles  120 ,  122  are independently controllable. The device  100 A illustrated by  FIG. 11A  is similar to the device illustrated by  FIG. 11 , except the device  100 A includes an actuation element that is configured as two independent actuation elements  112 A,  112 B, which are coupled to two independent caps  114 A,  114 B. To transition a first inner paddle and a first outer paddle from the fully closed to the partially open condition, the actuation element or means for actuating  112 A is extended to push the cap  114 A away from the coaption element or means for coapting  110 , thereby pulling on the outer paddle  120 , which in turn pulls on the inner paddle  122 , causing the first anchor portion  106  to partially unfold. To transition a second inner paddle and a second outer paddle from the fully closed to the partially open condition, the actuation element or means for actuating  112 B is extended to push the cap  114  away from the coaption element or means for coapting  110 , thereby pulling on the outer paddle  120 , which in turn pulls on the inner paddle  122 , causing the second anchor portion  106  to partially unfold. The independent paddle control illustrated by  FIG. 11A  can be implemented on any of the devices disclosed by the present application. 
     Referring now to  FIG. 12 , one of the actuation lines  116  is extended to allow one of the clasps  130  to close. Referring now to  FIG. 13 , the other actuation line  116  is extended to allow the other clasp  130  to close. Either or both of the actuation lines  116  can be repeatedly actuated to repeatedly open and close the barbed clasps  130 . 
     Referring now to  FIG. 14 , the device  100  is shown in a fully closed and deployed condition. The delivery sheath or means for delivery  102  and actuation element or means for actuating  112  is/are retracted and the paddles  120 ,  122  and clasps  130  remain in a fully closed position. Once deployed, the device  100  can be maintained in the fully closed position with a mechanical latch or can be biased to remain closed through the use of spring materials, such as steel, other metals, plastics, composites, etc. or shape-memory alloys such as Nitinol. For example, the jointed or flexible portions  124 ,  126 ,  128 ,  138 , and/or the inner and outer paddles  122 , and/or an additional biasing component (see component or frame  524  in  FIG. 28 ) can be formed of metals such as steel or shape-memory alloy, such as Nitinol—produced in a wire, sheet, tubing, or laser sintered powder—and are biased to hold the outer paddles  120  closed around the coaption element or means for coapting  110  and the barbed clasps  130  pinched around native leaflets. Similarly, the fixed and moveable arms  132 ,  134  of the barbed clasps  130  are biased to pinch the leaflets. In certain embodiments, the attachment or joint portions  124 ,  126 ,  128 ,  138 , and/or the inner and outer paddles  122 , and/or an additional biasing component (see component or frame  524  in  FIG. 28 ) can be formed of any other suitably elastic material, such as a metal or polymer material, to maintain the device in the closed condition after implantation. 
     Referring now to  FIGS. 226-231 , the implantable device  100  is shown provided with a cover  140 . The cover  140  can be a cloth material such as polyethylene cloth of a fine mesh. The cloth cover can provide a blood seal on the surface of the spacer, and/or promote rapid tissue ingrowth. The cover  140  includes first and second cover portions  142 ,  144  that each cover different portions of the device  100 . In some embodiments, a portion of one of the first and second cover portions  142 ,  144  overlaps a portion of the other of the first and second cover portion  142 ,  144 . The first and second cover portions  142 ,  144  can be arranged in various ways, and in some embodiments, can include an overlapping portion  146  that overlaps one of the first and second cover portions  142 ,  144 . 
     Referring now to  FIGS. 226-229 , various arrangements of the first and second cover portions  142 ,  144  are shown without overlapping portions  146 . Referring now to  FIG. 226 , the first cover portion  142  (represented by thin line cross-hatching), which can be made from a single piece of material, extends from the cap  114  to cover the cap  114 , outer paddles  120 , inner paddles  122 , and the fixed arms  132  of the clasps  130 . The second cover  144  (represented by thick line cross-hatching), which can be a single piece of material, covers the coaption element or means for coapting  110 . 
     Referring now to  FIG. 227 , the first cover portion  142 , which can be made from a single piece of material, extends from the cap  114  to cover the cap  114 , outer paddles  120 , inner paddles  122 , the fixed arms  132  and moveable arms  134  of the clasps  130 . As with the cover  140  of  FIG. 226 , the second cover  144  covers the coaption element or means for coapting  110 . 
     Referring now to  FIG. 228 , the first cover portion  142 , which can be made from a single piece of material, extends from the cap  114  to cover the cap  114 , outer paddles  120 , inner paddles  122 , and the fixed arms  132  of the clasps  130 . The second cover  144 , which can be made from a single piece of material, covers the coaption element or means for coapting  110  and extends from the coaption element or means for coapting  110  to cover the moveable arms  134  of the clasps  130 . 
     Referring now to  FIG. 229 , the first cover portion  142 , which can be made from a single piece of material, extends from the cap  114  to cover the cap  114  and outer paddles  120 . The second cover  144 , which can be made from a single piece of material, covers the coaption element or means for coapting  110  and extends from the coaption element or means for coapting  110  to cover the inner paddles  122 , and the fixed arms  132  and moveable arms  134  of the clasps  130 . 
     Referring now to  FIGS. 230-231 , arrangements of the first and second cover portions  142 ,  144  are shown that include an overlapping portion  146 . Referring now to  FIG. 230 , the first cover portion  142 , which can be made from a single piece of material, extends from the cap  114  to cover the cap  114 , outer paddles  120 , inner paddles  122 , and the fixed arms  132  and moveable arms  134  of the clasps  130 . The second cover  144 , which can be made from a single piece of material, covers the coaption element or means for coapting  110  and includes overlapping portions  146  that extend from the coaption element or means for coapting  110  to overlap a portion of the moveable arms  134  that are covered by the first cover  142 . 
     Referring now to  FIG. 231 , the first cover portion  142 , which can be made from a single piece of material, extends from the cap  114  to cover the cap  114 , outer paddles  120 , inner paddles  122 , and the fixed arms  132  of the clasps  130 . The second cover  144 , which can be made from a single piece of material, covers the coaption element or means for coapting  110  and moveable arms  134  of the clasps  130 . The first cover  142  also includes overlapping portions  146  that extend from the fixed arms  132  and inner paddles  122  to overlap a portion of the moveable arms  134  and coaption element or means for coapting  110  that are covered by the second cover  144 . 
     Referring now to  FIGS. 15-20 , the implantable device  100  of  FIGS. 8-14  is shown being delivered and implanted within the native mitral valve MV of the heart H. The methods and steps shown and/or discussed can be performed on a living animal or on a simulation, such as on a cadaver, cadaver heart, simulator (e.g. with the body parts, heart, tissue, etc. being simulated), etc. 
     Referring now to  FIG. 15 , the delivery sheath is inserted into the left atrium LA through the septum and the device  100  is deployed from the delivery sheath in the fully open condition. The actuation element or means for actuating  112  is then retracted to move the device  100  into the fully closed condition shown in  FIG. 16 . As can be seen in  FIG. 17 , the device  100  is moved into position within the mitral valve MV into the ventricle LV and partially opened so that the leaflets  20 ,  22  can be grasped. Referring now to  FIG. 18 , an actuation line  116  is extended to close one of the clasps  130 , capturing a leaflet  20 .  FIG. 19  shows the other actuation line  116  being then extended to close the other clasp  130 , capturing the remaining leaflet  22 . As can be seen in  FIG. 20 , the delivery sheath or means for delivery  102  and actuation element or means for actuating  112  and actuation lines  116  are then retracted and the device  100  is fully closed and deployed in the native mitral valve MV. 
     Referring now to  FIG. 21 , an example implantable prosthetic device  200  (e.g., a prosthetic spacer device, etc.) or frame thereof is shown. In certain embodiments, the device  200  includes an optional spacer member  202 , a fabric cover (not shown), and anchors  204  extending from the spacer member  202 . The ends of each anchor  204  can be coupled to respective struts of the spacer member  202  by respective sleeves  206  that can be crimped or welded around the connection portions of the anchors  204  and the struts of the spacer member  202 . In one example embodiment, a latching mechanism can bind the spacer member  202  to the anchor  204  within the sleeve  206 . For example, the sleeve can be machined to have an interior shape that matches or is slightly smaller than the exterior shape of the ends of the spacer member  202  and the anchor  204 , so that the sleeve can be friction fit on the connection portions. One or more barbs or projections  208  can be mounted on the frame of the spacer member  202 . The free ends of the barbs or projections  208  can comprise various shapes including rounded, pointed, barbed, or the like. The projections  208  can exert a retaining force against native leaflets by virtue of the anchors  204 , which are shaped to force the native leaflets inwardly into the spacer member  202 . 
     Referring now to  FIG. 22 , an example implantable prosthetic device  300  (e.g., a prosthetic spacer device, etc.) or frame thereof is shown. In certain embodiments, the prosthetic device or prosthetic spacer device  300  includes a spacer member  302 , a fabric cover (not shown), and anchors  304  extending from the spacer member  302  and can be configured similar to the prosthetic device or prosthetic spacer device  200 . One or more barbs or projections  306  can be mounted on the frame of the spacer member  302 . The ends of the projections  306  can comprise stoppers  308 . The stoppers  308  of the projections can be configured in a wide variety of different ways. For example, the stoppers  308  can be configured to limit the extent of the projections  306  that can engage and/or penetrate the native leaflets and/or the stoppers can be configured to prevent removal of the projections  306  from the tissue after the projections  306  have penetrated the tissue. 
     The anchors  304  of the prosthetic device or prosthetic spacer device  300  can be configured similar to the anchors  204  of the prosthetic device or prosthetic spacer device  200  except that the curve of each anchor  304  comprises a larger radius than the anchors  204 . As such, the anchors  304  cover a relatively larger portion of the spacer member  302  than the anchors  204 . This can, for example, distribute the clamping force of the anchors  304  against the native leaflets over a relatively larger surface of the native leaflets in order to further protect the native leaflet tissue. 
     Additional details regarding the prosthetic devices or prosthetic spacer devices can be found, for example, in U.S. Patent Application Publication No. 2016/0331523 and U.S. Provisional Application No. 62/161,688, which applications are incorporated by reference herein. The devices  200 ,  300  can include any other features for an implantable prosthetic device discussed in the present application, and the device  200 ,  300  can be positioned to engage valve tissue  20 ,  22  as part of any suitable valve repair system (e.g., any valve repair system disclosed in the present application). 
     Referring now to  FIGS. 23-27 , an example embodiment of an implantable prosthetic device  400  (e.g., a prosthetic spacer device, etc.) and components thereof are shown. The device  400  can include any other features for an implantable prosthetic device discussed in the present application, and the device  400  can be positioned to engage valve tissue  20 ,  22  as part of any suitable valve repair system (e.g., any valve repair system disclosed in the present application). 
     Referring now to  FIG. 23 , the prosthetic device or prosthetic spacer/coaption device  400  can include a coaption portion  404  and an anchor portion  406 , the anchor portion  406  including a plurality of anchors  408 . The coaption portion  404  includes a coaption or spacer member  410 . The anchor portion  406  includes a plurality of paddles  420  (e.g., two in the illustrated embodiment), and a plurality of clasps  430  (e.g., two in the illustrated embodiment). A first or proximal collar  411 , and a second collar or cap  414  are used to move the coaption portion  404  and the anchor portion  406  relative to one another. 
     As shown in  FIG. 25 , first connection portions  425  of the anchors  408  can be coupled to and extend from a first portion  417  of the coaption element or spacer member  410 , and second connection portions  421  of the anchors  408  can be coupled to the first collar  414 . The proximal collar  411  can be coupled to a second portion  419  of the coaption element/member  410 . 
     The coaption element/member  410  and the anchors  408  can be coupled together in various ways. For example, as shown in the illustrated embodiment, the coaption element/member  410  and the anchors  408  can be coupled together by integrally forming the coaption element/member  410  and the anchors  408  as a single, unitary component. This can be accomplished, for example, by forming the coaption element/member  410  and the anchors  408  from a braided or woven material, such as braided or woven nitinol wire. In some embodiments, the coaption element/member  410  and the anchors  408  can be coupled together by welding, fasteners, adhesive, joint connections, sutures, friction fittings, swaging, and/or other means for coupling. 
     Referring now to  FIG. 24 , the anchors  408  can comprise first portions or outer paddles  420  and second portions or inner paddles  422  separated by joint portions  423 . In this manner, the anchors  408  are configured similar to legs in that the inner paddles  422  are like upper portions of the legs, the outer paddles  420  are like lower portions of the legs, and the joint portions  423  are like knee portions of the legs. In some embodiments, the inner paddle portion  422 , the outer paddle portion  420 , and the joint portion  423  are formed from a continuous strip of a fabric, such as a metal fabric. In some embodiments, the strip of fabric is a composite strip of fabric. 
     The anchors  408  can be configured to move between various configurations by axially moving the cap  414  relative to the proximal collar  411  and thus the anchors  408  relative to the coaption element/member  410  along a longitudinal axis extending between the first or distal and second or proximal portions  417 ,  419  of the coaption element/member  410 . For example, the anchors  408  can be positioned in a straight configuration by moving the cap  414  away from the coaption element/member  410 . In the straight configuration, the paddle portions are aligned or straight in the direction of the longitudinal axis of the device and the joint portions  423  of the anchors  408  are adjacent the longitudinal axis of the coaption element/member  410  (e.g., similar to the configuration shown in  FIG. 59 ). From the straight configuration, the anchors  408  can be moved to a fully folded configuration (e.g.,  FIG. 23 ) by moving the toward the coaption element/member  410 . Initially as the cap  414  moves toward the coaption element/member  410 , the anchors  408  bend at the joint portions  423 ,  425 ,  421  and the joint portions  423  move radially outwardly relative to the longitudinal axis of the coaption element/member  410  and axially toward the first portion  417  of the coaption element/member  410 , as shown in  FIGS. 24-25 . As the cap  414  continues to move toward the coaption element/member  410 , the joint portions  423  move radially inwardly relative to the longitudinal axis of the coaption element/member  410  and axially toward the proximal portion  419  of the coaption element/member  410 , as shown in  FIG. 23 . 
     In some embodiments, an angle between the inner paddles  422  of the anchors  408  and the coaption element/member  410  can be approximately 180 degrees when the anchors  408  are in the straight configuration (see, e.g.,  FIG. 59 ), and the angle between the inner paddles  422  of the anchors  408  and the coaption element/member  410  can be approximately 0 degrees when the anchors  408  are in the fully folded configuration (See  FIG. 23 ). The anchors  408  can be positioned in various partially folded configurations such that the angle between the inner paddles  422  of the anchors  408  and the coaption element/member  410  can be approximately 10-170 degrees or approximately 45-135 degrees. 
     Configuring the prosthetic device or prosthetic spacer device  400  such that the anchors  408  can extend to a straight or approximately straight configuration (e.g. approximately 120-180 degrees relative to the coaption element/member  410 ) can provide several advantages. For example, this can reduce the radial crimp profile of the prosthetic device or prosthetic spacer device  400 . It can also make it easier to grasp the native leaflets by providing a larger opening in which to grasp the native leaflets. Additionally, the relatively narrow, straight configuration can prevent or reduce the likelihood that the prosthetic device/spacer device  400  will become entangled in native anatomy (e.g., chordae tendineae) when positioning and/or retrieving the prosthetic device/spacer device  400  into the delivery apparatus. 
     Referring again to  FIG. 24 , the clasps  430  can comprise attachment or fixed portions  432  and arm or moveable portions  434 . The attachment or fixed portions  432  can be coupled to the inner paddles  422  of the anchors  408  in various ways such as with sutures, adhesive, fasteners, welding, stitching, swaging, friction fit and/or other means for coupling or fastening. 
     In some embodiments, the moveable portions  434  can articulate, flex, or pivot relative to the fixed portions  432  between an open configuration (e.g.,  FIG. 24 ) and a closed configuration ( FIGS. 23 and 25 ). In some embodiments, the clasps  430  can be biased to the closed configuration. In some embodiments, in the open configuration, the fixed portions  432  and the moveable portions  434  flex or pivot away from each other such that native leaflets can be positioned between the fixed portions  432  and the moveable portions  434 . In some embodiments, in the closed configuration, the fixed portions  432  and the moveable portions  434  flex or pivot toward each other, thereby clamping the native leaflets between the fixed portions  432  and the moveable portions  434 . 
     Referring to  FIGS. 26-27 , clasps  430  are shown in top and perspective views. The fixed portions  432  (only one shown in  FIGS. 26-27 ) can comprise one or more openings  433  (e.g., three in the illustrated embodiment). At least some of the openings  433  can be used to couple the fixed portions  432  to the anchors  408 . For example, sutures and/or fasteners can extend through the openings  433  to couple the fixed portions  432  to the anchors  408  or other attachments, such as welding, adhesives, etc. can be used. 
     The moveable portions  434  can comprise one or more side beams  431 . When two side beams are included as illustrated, the side beams can be spaced apart to form slots  431 A. The slots  431 A can be configured to receive the fixed portions  432 . The moveable portions  434  can also include spring portions  434 A that are coupled to the fixed portions  432  and barb support portions  434 B disposed opposite the spring portions  434 A. 
     The barb support portions  434 B can comprise gripper or attachment elements such as barbs  436  and/or other means for frictionally engaging native leaflet tissue. The gripper elements can be configured to engage and/or penetrate the native leaflet tissue to help retain the native leaflets between the fixed portions  432  and moveable portions  434  of the clasps  430 . 
     The barb support portions  434 B can also comprise eyelets  435 , which can be used to couple the barb support portions  434 B to an actuation mechanism configured to flex or pivot the moveable portions  434  relative to the fixed portions  432 . Additional details regarding coupling the clasps  430  to the actuation mechanism are provided below. 
     In some embodiments, the clasps  430  can be formed from a shape memory material such as nitinol, stainless steel, and/or shape memory polymers. In certain embodiments, the clasps  430  can be formed by laser-cutting a piece of flat sheet material (e.g., nitinol) or a tube in the configuration shown in  FIG. 26  or a similar or different configuration and then shape-setting the clasp  430  in the configuration shown in  FIG. 27 . 
     Shape-setting the clasps  430  in this manner can provide several advantages. For example, the clasps  430  can optionally be compressed from the shape-set configuration (e.g.,  FIG. 27 ) to the flat configuration (e.g.,  FIG. 26 ), or another configuration which reduces the radial crimp profile of the clasps  430 . For example, the barbs can optionally be compressed to a flat configuration. Reducing the radial crimp profile can improve trackability and retrievability of the prosthetic device or prosthetic spacer device  400  relative to a catheter shaft of a delivery apparatus because barbs  440  are pointing radially inwardly toward the anchors  408  when the prosthetic device or prosthetic spacer device  400  is advanced through or retrieved into the catheter shaft (see, e.g.,  FIG. 33 ). This can prevent or reduce the likelihood that the clasps  430  may snag or skive the catheter shaft. 
     In addition, shape-setting the clasps  430  in the configuration shown in  FIG. 27  can increase the clamping force of the clasps  430  when the clasps  430  are in the closed configuration. This is because the moveable portions  434  are shape-set relative to the fixed portions  432  to a first position (e.g.,  FIG. 27 ) which is beyond the position the moveable portions  434  can achieve when the clasps  430  are attached to the anchors  408  (e.g.,  FIG. 25 ) because the anchors  408  prevent the moveable portions  434  from further movement toward the shape-set configuration. This results in moveable portions  434  having a preload (i.e., the clamping force is greater than zero) when the clasps  430  are attached to the anchors  408  and in the closed configuration. Thus, shape-setting the clasps  430  in the  FIG. 27  configuration can increase the clamping force of the clasps  430  compared to clasps that are shape-set in the closed configuration. 
     The magnitude of the preload of the clasps  430  can be altered by adjusting the angle in which the moveable portions  434  are shape-set relative to the fixed portions  432 . For example, increasing the relative angle between the moveable portions  434  and the fixed portions  432  increases the preload, and decreasing the relative angle between the moveable portions  434  and the fixed portions  432  decreases the preload. It can also be adjusted in other ways, such as based on the configuration of the joint, hinge, materials, etc. 
     In some embodiments, the proximal collar  411  and/or the coaption element/member  410  can comprise a hemostatic seal  413  configured to reduce or prevent blood from flowing through the proximal collar  411  and/or the coaption element/member  410 . For example, in some embodiments, the hemostatic seal  413  can comprise a plurality of flexible flaps  413 A, as shown in  FIG. 23 . In some embodiments, the flaps  413 A can be configured to pivot from a sealed configuration to an open configuration to allow a shaft of a delivery apparatus to extend through the second collar  411 . In one example embodiment, the flaps  413 A form a seal around the shaft of the delivery apparatus. When the shaft of the delivery apparatus is removed, the flaps  413 A can be configured to return to the sealed configuration from the open configuration. 
     Referring now to  FIG. 23A , an example embodiment of an implantable prosthetic device or implantable prosthetic spacer device  400 A is shown. The device  400 A can include any other features for an implantable prosthetic device discussed in the present application, and the device  400 A can be positioned to engage valve tissue  20 ,  22  as part of any suitable valve repair system (e.g., any valve repair system disclosed in the present application). 
     The prosthetic device (e.g., prosthetic spacer or coaption device)  400 A can include a coaption portion  404 A and an anchor portion  406 A, the anchor portion  406 A including a plurality of anchors  408 A. The coaption portion  404 A includes a coaption element, coaption member, or spacer  410 A. The anchor portion  406 A includes a plurality of paddles  420 A (e.g., two in the illustrated embodiment), and a plurality of clasps  430 A (e.g., two in the illustrated embodiment). A first or proximal collar  411 A, and a second collar or cap  414 A are used to move the coaption portion  404 A and the anchor portion  406 A relative to one another. 
     The coaption element/member  410 A extends from a proximal portion  419 B assembled to the collar  411 A to a distal portion  417 A that connects to the anchors  408 A. The coaption element/member  410 A and the anchors  408 A can be coupled together in various ways. For example, as shown in the illustrated embodiment, the coaption element/member  410 A and the anchors  408 A can be coupled together by integrally forming the coaption element/member  410 A and the anchors  408 A as a single, unitary component. This can be accomplished, for example, by forming the coaption element/member  410 A and the anchors  408 A from a continuous strip  401 A of a braided or woven material, such as braided or woven nitinol wire. 
     The anchors  408 A are attached to the coaption element/member  410 A by hinge portions  425 A and to the cap  414 A by hinge portions  421 A. The anchors  408 A can comprise first portions or outer paddles  420 A and second portions or inner paddles  422 A separated by joint portions  423 A. The joint portions  423 A are attached to paddle frames  424 A that are hingably attached to the cap  414 A. In this manner, the anchors  408 A are configured similar to legs in that the inner paddles  422 A are like upper portions of the legs, the outer paddles  420 A are like lower portions of the legs, and the joint portions  423 A are like knee portions of the legs. In the illustrated example, the inner paddle portion  422 A, the outer paddle portion  420 A, and the joint portion  423 A are formed from the continuous strip of fabric  401 A, such as a metal fabric. 
     The anchors  408 A can be configured to move between various configurations by axially moving the cap  414 A relative to the proximal collar  411 A and thus the anchors  408 A relative to the coaption element/member  410 A along a longitudinal axis extending between the cap  414 A and the proximal collar  411 A. For example, the anchors  408  can be positioned in a straight configuration (see  FIG. 60A ) by moving the cap  414 A away from the coaption element/member  410 A. In the straight configuration, the paddle portions  420 A,  422 A are aligned or straight in the direction of the longitudinal axis of the device and the joint portions  423 A of the anchors  408 A are adjacent the longitudinal axis of the coaption element/member  410 A (e.g., similar to the configuration shown in  FIG. 60A ). From the straight configuration, the anchors  408  can be moved to a fully folded configuration (e.g.,  FIG. 23A ) by moving the toward the coaption element/member  410 A. Initially, as the cap  414 A moves toward the coaption element/member  410 A, the anchors  408 A bend at joint portions  421 A,  423 A,  425 A, and the joint portions  423 A move radially outwardly relative to the longitudinal axis of the device  400 A and axially toward the distal portion  417 A of the coaption element/member  410 A, as shown in  FIGS. 53A and 54A . As the cap  414 A continues to move toward the coaption element/member  410 A, the joint portions  423 A move radially inwardly relative to the longitudinal axis of the device  400 A and axially toward the proximal portion  419 B of the coaption element/member  410 A, as shown in  FIG. 23A . 
     In some embodiments, an angle between the inner paddles  422 A of the anchors  408 A and the coaption element/member  410 A can be approximately 180 degrees when the anchors  408 A are in the straight configuration (see, e.g.,  FIG. 60A ), and the angle between the inner paddles  422 A of the anchors  408 A and the coaption element/member  410 A can be approximately 0 degrees when the anchors  408 A are in the fully folded configuration (see  FIG. 23A ). The anchors  408 A can be positioned in various partially folded configurations such that the angle between the inner paddles  422 A of the anchors  408 A and the coaption element/member  410 A can be approximately 10-170 degrees or approximately 45-135 degrees. 
     Configuring the prosthetic device or spacer device  400 A such that the anchors  408 A can extend to a straight or approximately straight configuration (e.g. approximately 120-180 degrees relative to the coaption element/member  410 A) can provide several advantages. For example, this can reduce the radial crimp profile of the prosthetic device or prosthetic spacer device  400 A. It can also make it easier to grasp the native leaflets by providing a larger opening in which to grasp the native leaflets. Additionally, the relatively narrow, straight configuration can prevent or reduce the likelihood that the prosthetic device or prosthetic spacer device  400 A will become entangled in native anatomy (e.g., chordae tendineae) when positioning and/or retrieving the prosthetic device/spacer device  400 A into the delivery apparatus. 
     The clasps  430 A can comprise attachment or fixed portions  432 C and arm or moveable portions  434 C. The attachment or fixed portions  432 C can be coupled to the inner paddles  422 A of the anchors  408 A in various ways such as with sutures, adhesive, fasteners, welding, stitching, swaging, friction fit, and/or other means for coupling. The clasps  430 A are similar to the clasps  430 . 
     In some embodiments, the moveable portions  434 C can articulate, flex, or pivot relative to the fixed portions  432 C between an open configuration (e.g.,  FIG. 54A ) and a closed configuration ( FIG. 53A ). In some embodiments, the clasps  430 A can be biased to the closed configuration. In the open configuration, the fixed portions  432 C and the moveable portions  434 C articulate, pivot, or flex away from each other such that native leaflets can be positioned between the fixed portions  432 C and the moveable portions  434 C. In the closed configuration, the fixed portions  432 C and the moveable portions  434 C articulate, pivot, or flex toward each other, thereby clamping the native leaflets between the fixed portions  432 C and the moveable portions  434 C. 
     The strip  401 A is attached the collar  411 A, cap  414 A, paddle frames  424 A, clasps  430 A to form both the coaption portion  404 A and the anchor portion  406 A of the device  400 A. In the illustrated embodiment, the coaption element/member  410 A, hinge portions  421 A,  423 A,  425 A, outer paddles  420 A, and inner paddles  422 A are formed from the continuous strip  401 A. The continuous strip  401 A can be a single layer of material or can include two or more layers. In certain embodiments, portions of the device  400 A have a single layer of the strip of material  401 A and other portions are formed from multiple overlapping or overlying layers of the strip of material  401 A. For example,  FIG. 23A  shows the coaption element/member  410 A and inner paddles  422 A formed from multiple overlapping layers of the strip of material  401 A. The single continuous strip of material  401 A can start and end in various locations of the device  400 A. The ends of the strip of material  401 A can be in the same location or different locations of the device  400 A. For example, in the illustrated embodiment of  FIG. 23A , the strip of material begins and ends in the location of the inner paddles  422 A. 
     Referring now to  FIG. 30A , the example implantable prosthetic device  400 A is shown covered with a cover  440 A. The cover  440 A is disposed on the coaption element/member  410 A, the collar  411 A, the cap  414 A, the paddles  420 A,  422 A, the paddle frames  424 A, and the clasps  430 A. The cover  440 A can be configured to prevent or reduce blood-flow through the prosthetic device/spacer device  400 A and/or to promote native tissue ingrowth. In some embodiments, the cover  440 A can be a cloth or fabric such as PET, velour, or other suitable fabric. In some embodiments, in lieu of or in addition to a fabric, the cover  440 A can include a coating (e.g., polymeric material, silicone, etc.) that is applied to the prosthetic device/spacer device  400 A. 
     Referring now to  FIGS. 28-30 , an example embodiment of an implantable prosthetic device  500  (e.g., a prosthetic spacer device, etc.) is shown. The implantable device  500  is one of the many different configurations that the device  100  that is schematically illustrated in  FIGS. 8-20  can take. The device  500  can include any other features for an implantable prosthetic device discussed in the present application, and the device  500  can be positioned to engage valve tissue  20 ,  22  as part of any suitable valve repair system (e.g., any valve repair system disclosed in the present application). 
     The prosthetic device or prosthetic spacer device  500  can comprise a coaption element, coaption member, or spacer  510 , a plurality of anchors  508  that include outer paddles  520 , inner paddles  522 , clasps  530 , a first or proximal collar  511 , and a second collar or cap  514 . These components of the prosthetic device or prosthetic spacer device  500  can be configured the same or substantially similar to the corresponding components of the prosthetic device or prosthetic spacer device  400 . 
     The prosthetic device or prosthetic spacer device  500  can also include a plurality of paddle extension members or paddle frames  524 . The paddle frames  524  can be configured with a round three-dimensional shape with first connection portions  526  coupled to and extending from the cap  514  and second connection portions  528  disposed opposite the first connection portions  526 . The paddle frames  524  can be configured to extend circumferentially farther around the coaption element/member  510  than the outer paddles  520 . For example, in some embodiments, each of the paddle frames  524  extend around approximately half of the circumference of the coaption element/member  510  (as shown in  FIG. 29 ), and the outer paddles  520  extend around less than half of the circumference of the coaption element/member  510  (as shown in  FIG. 28 ). The paddle frames  524  can also be configured to extend laterally (i.e., perpendicular to a longitudinal axis of the coaption element/member  510 ) beyond an outer diameter of the coaption element/member  510 . In the illustrated example, the inner paddle portions  522  and the outer paddle portions  520  can formed from a continuous strip of fabric that are connected to the paddle frames  524 . For example, the inner paddle portions and the outer paddle portions can be connected to the connection portion of the paddle frame at the flexible connection between the inner paddle portion and the outer paddle portion. 
     The paddle frames  524  can further be configured such that connection portions  528  of the paddle frames  524  are connected to or axially adjacent a joint portion  523 . The connection portions of the paddle frames  524  can be positioned between outer and inner paddles  520 ,  522 , on the outside of the paddle portion  520 , on the inside of the inner paddle portion, or on top of the joint portion  523  when the prosthetic device or prosthetic spacer device  500  is in a folded configuration (e.g.,  FIGS. 28-30 ). The connections between the paddle frames  524 , the single strip that forms the outer and inner paddles  520 ,  522 , the cap  514 , and the coaption element can constrain each of these parts to the movements and positions described herein. In particular the joint portion  523  is constrained by its connection between the outer and inner paddles  520 ,  522  and by its connection to the paddle frame. Similarly, the paddle frame  524  is constrained by its attachment to the joint portion  523  (and thus the inner and outer paddles) and to the cap. 
     Configuring the paddle frames  524  in this manner provides increased surface area compared to the outer paddles  520  alone. This can, for example, make it easier to grasp and secure the native leaflets. The increased surface area can also distribute the clamping force of the paddles  520  and paddle frames  524  against the native leaflets over a relatively larger surface of the native leaflets in order to further protect the native leaflet tissue. 
     The increased surface area of the paddle frames  524  can also allow the native leaflets to be clamped to the prosthetic device or prosthetic spacer device  500 , such that the native leaflets coapt entirely around the coaption element/member  510 . This can, for example, improve sealing of the native leaflet and thus prevent or further reduce mitral regurgitation. 
     Referring to  FIG. 30 , the prosthetic device or prosthetic spacer device  500  can also include a cover  540 . In some embodiments, the cover  540  can be disposed on the coaption element/member  510 , the paddles  520 ,  522 , and/or the paddle frames  524 . The cover  540  can be configured to prevent or reduce blood-flow through the prosthetic device or prosthetic spacer device  500  and/or to promote native tissue ingrowth. In some embodiments, the cover  540  can be a cloth or fabric such as PET, velour, or other suitable fabric. In some embodiments, in lieu of or in addition to a fabric, the cover  540  can include a coating (e.g., polymeric, silicone, etc.) that is applied to the prosthetic device  500 . 
       FIGS. 31-32  illustrate the implantable prosthetic device  500  of  FIGS. 28 and 29  with anchors  508  of an anchor portion  506  and clasps  530  in open positions. The device  500  is deployed from a delivery sheath (not shown) and includes a coaption portion  504  and the anchor portion  506 . The device  500  is loaded in the delivery sheath in the fully extended or bailout position, because the fully extended or bailout position takes up the least space and allows the smallest catheter to be used (See  FIG. 35 ). Or, the fully extended position allows the largest device  500  to be used for a given catheter size. The coaption portion  504  of the device includes a coaption element  510  for implantation between the native leaflets of a native valve (e.g., mitral valve, tricuspid valve, etc.). An insert  516 B is disposed inside the coaption element  510 . The insert  516 B and the coaption element  510  are slidably attached to an actuation element  512  (e.g., actuation wire, rod, shaft, tube, screw, suture, line, etc.). The anchors  508  of the device  500  include outer paddles  520  and inner paddles  522  that are flexibly connected to the cap  514  and the coaption element  510 . Actuation of the actuation element or means for actuation  512  opens and closes the anchors  508  of the device  500  to grasp the native valve leaflets during implantation. 
     The actuation element  512  extends through the delivery sheath (not shown), the proximal collar  511 , the coaption element  510 , the insert  516 B, and extends to the cap  514 . Extending and retracting the actuation element  512  increases and decreases the spacing between the coaption element  510  and the cap  514 , respectively. This changing of the spacing between the coaption element  510  and the cap  514  causes the anchor portion  506  of the device to move between different positions. 
     The proximal collar  511  optionally includes a collar seal  513  that forms a seal around the actuation element or means for actuation  512  during implantation of the device  500 , and that seals shut when the actuation element  512  is removed to close or substantially close the proximal end of the device  500  to blood flow through the interior of the coaption element  510  after implantation. In some embodiments, a coupler or means for coupling  2214  (see  FIG. 145 ) removably engages and attaches the proximal collar  511  and the coaption element  510  to the delivery sheath. In some embodiments, coupler or means for coupling  2214  is held closed around the proximal collar  511  by the actuation element  512 , such that removal of the actuation element  512  allows fingers (see  FIG. 145 ) of the coupler or means for coupling  2214  to open, releasing the proximal collar  511 . 
     The proximal collar  511  and the insert  516 B in the coaption element  510  slide along the actuation element  512  during actuation to open and close the paddles  520 ,  522  of the anchors  508 . Referring to  FIGS. 32A and 32B , in some embodiments the cap  514  optionally includes a sealing projection  516  that sealingly fits within a sealing opening  517  of the insert  516 B. In one example embodiment, the cap  514  includes a sealing opening and the insert  516 B includes a sealing projection. The insert  516 B can sealingly fit inside a distal opening  515  ( FIG. 31 ) of the coaption element  510 , the coaption element  510  having a hollow interior. Referring to  FIG. 32A , the sealing projection  516  of the cap  514  sealingly engages the opening  517 B in the insert  516 B to maintain the distal end of the coaption element  510  closed or substantially closed to blood flow when the device  500  is implanted and/or in the closed position. 
     In one example embodiment, instead of the sealing engagement between the cap  514  and the insert  516 B, the insert  516 B can optionally include a seal, like the collar seal  513  of the proximal collar, that forms a seal around the actuation element or means for actuation  512  during implantation of the device  500 , and that seals shut when the actuation element  512  is removed. Such a seal can close or substantially close the distal end of the coaption element  510  to blood flow after implantation. 
     The coaption element  510  and paddles  520 ,  522  are formed from a flexible material that can be a metal fabric, such as a mesh, woven, braided, or formed in any other suitable way or a laser cut or otherwise cut flexible material. The material can be cloth, shape-memory alloy wire—such as Nitinol—to provide shape-setting capability, or any other flexible material suitable for implantation in the human body. Paddle frames  524  provide additional pinching force between the inner paddles  522  and the coaption element  510  and assist in wrapping the leaflets around the sides of the coaption element  510  for a better seal between the coaption element  510  and the leaflets. In some embodiments, the covering  540  illustrated by  FIG. 30  extends around the paddle frames  524 . 
     The clasps  530  include a base or fixed arm  532 , a moveable arm  534 , barbs  536 , and a joint portion  538 . The fixed arms  532  are attached to the inner paddles  522 , with the joint portion  538  disposed proximate the coaption element  510 . The barbed clasps have flat surfaces and do not fit in a recess of the paddle. Rather, the flat portion of the barbed clasps are disposed against the surface of the inner paddle  522 . For example, the fixed arms  532  are attached to the inner paddles  522  through holes or slots  533  with sutures (not shown). The fixed arms  532  can be attached to the inner paddles  522  or another portion of the device with any suitable means, such as screws or other fasteners, crimped sleeves, mechanical latches or snaps, welding, adhesive, or the like. The fixed arms  532  remain stationary or substantially stationary relative to the inner paddles  522  when the moveable arms  534  are opened to open the barbed clasps  530  and expose the barbs  536 . The barbed clasps  530  are opened by applying tension to actuation lines (not shown) attached to holes  535  in the moveable arms  534 , thereby causing the moveable arms  534  to pivot or flex on the joint portions  538 . 
     During implantation, the anchors  508  are opened and closed to grasp the native valve leaflets between the paddles  520 ,  522  and the coaption element  510 . The barbed clasps  530  further secure the native leaflets by engaging the leaflets with barbs  536  and pinching the leaflets between the moveable and fixed arms  534 ,  532 . The barbs  536  of the barbed clasps  530  increase friction with the leaflets or may partially or completely puncture the leaflets. The actuation lines can be actuated separately so that each barbed clasp  530  can be opened and closed separately. Separate operation allows one leaflet to be grasped at a time, or for the repositioning of a clasp  530  on a leaflet that was insufficiently grasped, without altering a successful grasp on the other leaflet. The barbed clasps  530  can open and close when the inner paddle  522  is not closed, thereby allowing leaflets to be grasped in a variety of positions as the particular situation requires. 
     Referring now to  FIG. 33 , an example barbed clasp  600  for use in implantable prosthetic devices, such as the devices described above, is shown. However, a wide variety of different barbed clasps can be used. Examples of barbed clasps that can be used include but are not limited to any of the barbed clasps disclosed in the present application and any of the applications that are incorporated herein by reference and/or that the present application claims priority to. In the illustrated example, the barbed clasp  600  is formed from a top layer  602  and a bottom layer  604 . The two-layer design of the clasp  600  allow thinner sheets of material to be used, thereby improving the flexibility of the clasp  600  over a clasp formed from a single thicker sheet, while maintaining the strength of the clasp  600  needed to successfully retain a native valve leaflet. 
     The barbed clasp  600  includes a fixed arm  610 , a jointed portion  620 , and a movable arm  630  having a barbed portion  640 . The top and bottom layers  602 ,  604  have a similar shape and in certain embodiments are attached to each other at the barbed portion  640 . However, the top and bottom layers  602 ,  604  can be attached to one another at other or additional locations. The jointed portion  620  is spring-loaded so that the fixed and moveable arms  610 ,  630  are biased toward each other when the barbed clasp  600  is in a closed condition. When assembled to an implantable prosthetic device, the fixed arm  610  is attached to a portion of the prosthetic device. The clasp  600  is opened by pulling on an actuation line attached to the moveable arm  630  until the spring force of the joint portion  620  is overcome. 
     The fixed arm  610  is formed from a tongue  611  of material extending from the jointed portion  620  between two side beams  631  of the moveable arm  630 . The tongue  611  is biased between the side beams  631  by the joint portion  620  such that force must be applied to move the tongue  611  from a neutral position located beyond the side beams  631  to a preloaded position parallel or substantially parallel with the side beams  631 . The tongue  611  is held in the preloaded position by an optional T-shaped cross-bar  614  that is attached to the tongue  611  and extends outward to engage the side beams  631 . In one example embodiment, the cross-bar is omitted and the tongue  611  is attached to the inner paddle  522 , and the inner paddle  522  maintains the clasp in the preloaded position. In the two-layer clasp application, the top and bottom layers  602 ,  604  or just the top layer can be attached to the inner paddle. In some embodiments, the angle between the fixed and moveable arms  610 ,  630  when the tongue is in the neutral position is about 30 to about 100 degrees, 30 to about 90 degrees, or about 30 to about 60 degrees, or about 40 to about 50 degrees, or about 45 degrees. 
     The tongue  611  includes holes  612  for receiving sutures (not shown) that attach the fixed arm  610  to an implantable device. The fixed arm  610  can be attached to an implantable device, such as with screws or other fasteners, crimped sleeves, mechanical latches or snaps, welding, adhesive, or the like. In certain embodiments, the holes  612  are elongated slots or oval-shaped holes to accommodate sliding of the layers  602 ,  604  without damaging the sutures attaching the clasp  600  to an implantable device. 
     The joint portion  620  is formed by two beam loops  622  that extend from the tongue  611  of the fixed arm  610  to the side beams  631  of the moveable arm  630 . In certain embodiments, the beam loops  622  are narrower than the tongue  611  and side beam  631  to provide additional flexibility. The beam loops  622  each include a center portion  624  extending from the tongue  611  and an outer portion  626  extending to the side beams  631 . The beam loops  622  are bent into a somewhat spiral or helical shape by bending the center and outer portions  624 ,  626  in opposite directions, thereby forming an offset or step distance  628  between the tongue  611  and side beams  631 . The step distance  628  provides space between the arms  610 ,  630  to accommodate the native leaflet of the native valve after it is grasped. In certain embodiments, the step distance  628  is about 0.5 millimeter to about 1 millimeter, or about 0.75 millimeters. 
     When viewed in a top plan view, the beam loops have an “omega-like” shape. This shape of the beam loops  622  allows the fixed and moveable arms  610 ,  630  to move considerably relative to each other without plastically deforming the clasp material. For example, in certain embodiments, the tongue  611  can be flexed or pivoted from a neutral position that is approximately 45 degrees beyond the moveable arm  630  to a fully open position that ranges from about 140 degrees to about 200 degrees, to about 170 degrees to about 190 degrees, or about 180 degrees from the moveable arm  630  without plastically deforming the clasp material. In certain embodiments, the clasp material plastically deforms during opening without reducing or without substantially reducing the pinch force exerted between the fixed and moveable arms in the closed position. 
     Preloading the tongue  611  enables the clasp  600  to maintain a pinching or clipping force on the native leaflet when closed. The preloading of the tongue  611  provides a significant advantage over prior art clips that provide little or no pinching force when closed. Additionally, closing the clasp  600  with spring force is a significant improvement over clips that use a one-time locking closure mechanism, as the clasp  600  can be repeatedly opened and closed for repositioning on the leaflet while still maintaining sufficient pinching force when closed. In addition, the spring-loaded clasps also allow for easier removal of the device over time as compared to a device that locks in a closed position (after tissue ingrowth). In one example embodiment, both the clasps and the paddles are spring biased to their closed positions (as opposed to being locked in the closed position), which can allow for easier removal of the device after tissue ingrowth. 
     The barbed portion  640  of the moveable arm  630  includes an eyelet  642 , barbs  644 , and barb supports  646 . Positioning the barbed portion of the clasp  600  toward an end of the moveable arm  630  increases the space between the barbs  644  and the fixed arm  610  when the clasp  600  is opened, thereby improving the ability of the clasp  600  to successfully grasp a leaflet during implantation. This distance also allows the barbs  644  to more reliably disengage from the leaflet for repositioning. In certain embodiments, the barbs of the clasps can be staggered longitudinally to further distribute pinch forces and local leaflet stress. 
     The barbs  644  are laterally spaced apart at the same distance from the joint portion  620 , providing a superior distribution of pinching forces on the leaflet tissue while also making the clasp more robust to leaflet grasp than barbs arranged in a longitudinal row. In some embodiments, the barbs  644  can be staggered to further distribute pinch forces and local leaflet stress. 
     The barbs  644  are formed from the bottom layer  604  and the barb supports  646  are formed from the top layer. In certain embodiments, the barbs are formed from the top layer  602  and the barb supports are formed from the bottom layer  604 . Forming the barbs  644  only in one of the two layers  602 ,  604  allows the barbs to be thinner and therefore effectively sharper than a barb formed from the same material that is twice as thick. The barb supports  646  extend along a lower portion of the barbs  644  to stiffen the barbs  644 , further improving penetration and retention of the leaflet tissue. In certain embodiments, the ends of the barbs  644  are further sharpened using any suitable sharpening means. 
     The barbs  644  are angled away from the moveable arm  630  such that they easily penetrate tissue of the native leaflets with minimal pinching or clipping force. The barbs  644  extend from the moveable arm at an angle of about 45 degrees to about 75 degrees, or about 45 degrees to about 60 degrees, or about 48 to about 56 degrees, or about 52 degrees. The angle of the barbs  644  provides further benefits, in that force pulling the implant off the native leaflet will encourage the barbs  644  to further engage the tissue, thereby ensuring better retention. Retention of the leaflet in the clasp  600  can be further improved by the position of the T-shaped cross bar  614  near the barbs  644  when the clasp  600  is closed. In this arrangement, the tissue pierced by the barbs  644  is pinched against the moveable arm  630  at the cross bar  614  location, thereby forming the tissue into an S-shaped torturous path as it passes over the barbs  644 . Thus, forces pulling the leaflet away from the clasp  600  will encourage the tissue to further engage the barbs  644  before the leaflets can escape. For example, leaflet tension during diastole can encourage the barbs to pull toward the end portion of the leaflet. The S-shaped path can utilize the leaflet tension during diastole to more tightly engage the leaflets with the barbs. 
     Each layer  602 ,  604  of the clasp  600  is laser cut from a sheet of shape-memory alloy, such as Nitinol. The top layer  602  is aligned and attached to the bottom layer  604 . In certain embodiments, the layers  602 ,  604  are attached at the barbed portion  640  of the moveable arm  630 . For example, the layers  602 ,  604  can be attached only at the barbed portion  640 , to allow the remainder of the layers to slide relative to one another. Portions of the combined layers  602 ,  604 , such as a fixed arm  610 , barbs  644  and barb supports  646 , and beam loops  622  are bent into a desired position. The layers  602 ,  604  can be bent and shape-set together or can be bent and shape-set separately and then joined together. The clasp  600  is then subjected to a shape-setting process so that internal forces of the material will tend to return to the set shape after being subjected to deformation by external forces. After shape-setting, the tongue  611  is moved to its preloaded position so that the cross-bar  614  can be attached. In one example embodiment, the clasp  600  can optionally be completely flattened for delivery through a delivery sheath and allowed to expand once deployed within the heart. The clasp  600  is opened and closed by applying and releasing tension on an actuation line, suture, wire, rod, catheter, or the like (not shown) attached to the moveable arm  630 . In some embodiments, the actuation line or suture is inserted through an eyelet  642  near the barbed portion  640  of the moveable arm  630  and wraps around the moveable arm  630  before returning Example systems and valve repair devices for repairing a native valve of a patient includes a plurality of paddle portions. The plurality of paddle portions are moveable between an open position and a closed position by moving a cap with respect to a collar. A plurality of paddle frames are connected to the cap and to the paddle portions. A width of the plurality of paddle frames is adjustable during an implantation procedure of the valve repair device. to the delivery sheath. In certain embodiments, an intermediate suture loop is made through the eyelet and the suture is inserted through the intermediate loop. An alternate embodiment of the intermediate loop can be composed of fabric, or another material attached to the movable arm, instead of a suture loop. 
     An intermediate loop of suture material reduces friction experienced by the actuation line/suture relative to the friction between the actuation line/suture and the clasp material. When the suture is looped through the eyelet  642  or intermediate loop, both ends of the actuation line/suture extend back into and through a delivery sheath (e.g.,  FIG. 8 ). The suture can be removed by pulling one end of the suture proximally until the other end of the suture pulls through the eyelet or intermediate loop and back into the delivery sheath. 
     Referring now to  FIG. 34 , a close-up view of one of the leaflets  20 ,  22  grasped by a barbed clasp such as clasps  430 ,  530  is shown. The leaflet  20 ,  22  is grasped between the moveable and fixed arms  434 ,  534  of the clasp  430 ,  530 . As shown in  FIG. 34 , the tissue of the leaflet  20 ,  22  is not pierced by the barbs  436 ,  536 , though in some embodiments the barbs  436 ,  536  may partially or fully pierce through the leaflet  20 ,  22 . The angle and height of the barbs  436 ,  536  relative to the moveable arm  434 ,  534  helps to secure the leaflet  20 ,  22  within the clasp  430 ,  530 . In particular, a force pulling the implant off of the native leaflet will encourage the barbs  436 ,  536  to further engage the tissue, thereby ensuring better retention. Retention of the leaflet  20 ,  22  in the clasp  430 ,  530  is further improved by the position of fixed arm  432 ,  532  near the barbs  436 ,  536  when the clasp  430 ,  530  is closed. In this arrangement, the tissue is formed by the fixed arms  432 ,  532  and the moveable arms  434 ,  534  and the barbs  436 ,  536  into an S-shaped torturous path. Thus, forces pulling the leaflet away from the clasp  430 ,  530  will encourage the tissue to further engage the barbs  436 ,  536  before the leaflets can escape. For example, as mentioned above, leaflet tension during diastole can encourage the barbs to pull toward the end portion of the leaflet. The S-shaped path can utilize the leaflet tension during diastole to more tightly engage the leaflets with the barbs. 
     Referring now to  FIGS. 35-46 , the implantable device  500  is shown being delivered and implanted within the native mitral valve MV of the heart H. The methods and steps shown and/or discussed can be performed on a living animal or on a simulation, such as on a cadaver, cadaver heart, simulator (e.g., with the body parts, heart, tissue, etc. being simulated), etc. 
     As described above, the device  500  has a covering  540  (see  FIG. 30 ) over the coaption element  510 , clasps  530 , inner paddles  522  and/or the outer paddles  520 . The device  500  is deployed from a delivery sheath  502  and includes a coaption portion  504  and an anchor portion  506  including a plurality of anchors  508  (i.e., two in the illustrated embodiment). The coaption portion  504  of the device includes a coaption element  510  for implantation between the leaflets  20 ,  22  of the native mitral valve MV that is slidably attached to an actuation element or means for actuation  512 . Actuation of the actuation element or means for actuation  512  opens and closes the anchors  508  of the device  500  to grasp the mitral valve leaflets  20 ,  22  during implantation. 
     The anchors  508  of the device  500  include outer paddles  520  and inner paddles  522  that are flexibly connected to the cap  514  and the coaption element  510 . The actuation element  512  extends through a capture mechanism  503  (see  FIG. 41 ), delivery sheath  502 , and the coaption element  510  to the cap  514  connected to the anchor portion  506 . Extending and retracting the actuation element  512  increases and decreases the spacing between the coaption element  510  and the cap  514 , respectively. In the example illustrated by  FIGS. 35-46 , the pair of inner and outer paddles  522 ,  520  are moved in unison, rather than independently, by a single actuation element  512 . Also, the positions of the clasps  530  are dependent on the positions of the paddles  522 ,  520 . For example, referring to  FIG. 45  closing the paddles  522 ,  520  also closes the clasps. In one example embodiment, the device  500  can be made to have the paddles  520 ,  522  be independently controllable in the same manner as the  FIG. 11A  embodiment. 
     Fingers of the capture mechanism  503  removably attach the collar  511  to the delivery sheath  502 . The collar  511  and the coaption element  510  slide along the actuation element  512  during actuation to open and close the anchors  508  of the anchor portion  506 . In some embodiments, the capture mechanism  503  is held closed around the collar  511  by the actuation element  512 , such that removal of the actuation element  512  allows the fingers of the capture mechanism  503  to open, releasing the collar  511 , and thus the coaption element  510 . 
     In some embodiments, the coaption element  510  and paddles  520 ,  522  are formed from a flexible material that can be a metal fabric, such as a mesh, woven, braided, or formed in any other suitable way or a laser cut or otherwise cut flexible material. The flexible material can be cloth, shape-memory alloy wire—such as Nitinol—to provide shape-setting capability, or any other flexible material suitable for implantation in the human body. Other configurations are also possible. 
     The barbed clasps  530  include a base or fixed arm  532 , a moveable arm  534 , barbs  536  (see  FIG. 41 ), and a joint portion  538 . The fixed arms  532  are attached to the inner paddles  522 , with the joint portions  538  disposed proximate the coaption element  510 . Sutures (not shown) attach the fixed arms  532  to the inner paddles  522 . The fixed arms  532  can be attached to the inner paddles  522  and/or another portion of the device with any suitable means, such as screws or other fasteners, crimped sleeves, mechanical latches or snaps, welding, adhesive, or the like. The fixed arms  532  remain stationary or substantially stationary when the moveable arms  534  are opened to open the barbed clasps  530  and expose the barbs  536 . The barbed clasps  530  are opened by applying tension to clasp control members or actuation lines  537  attached to the moveable arms  534 , thereby causing the moveable arms  534  to pivot or flex on the joint portions  538 . 
     During implantation, the anchors  508  are opened and closed to grasp the native valve leaflets between the paddles  520 ,  522  and the coaption element  510 . The outer paddles  520  have a wide curved shape that fits around the curved shape of the coaption element  510  to more securely grip the leaflets  20 ,  22 . The curved shape and rounded edges of the outer paddle  520  also prohibits tearing of the leaflet tissue. The barbed clasps  530  further secure the native leaflets by engaging the leaflets with barbs  536  and pinching the leaflets between the moveable and fixed arms  534 ,  532 . The barbs  536  of the barbed clasps  530  increase friction with the leaflets or may partially or completely puncture the leaflets. The actuation lines can be actuated separately so that each barbed clasp  530  can be opened and closed separately. Separate operation allows one leaflet to be grasped at a time, or for the repositioning of a clasp  530  on a leaflet that was insufficiently grasped, without altering a successful grasp on the other leaflet. The barbed clasps  530  can be fully opened and closed when the inner paddle  522  is not closed, thereby allowing leaflets to be grasped in a variety of positions as the particular situation requires. 
     The device  500  is loaded in the delivery sheath in the fully open or fully extended position, because the fully open or fully extended position takes up the least space and allows the smallest catheter to be used (or the largest device  500  to be used for a given catheter size). Referring now to  FIG. 35 , the delivery sheath is inserted into the left atrium LA through the septum and the device  500  is deployed from the delivery sheath  502  in the fully open condition. The actuation element  512  is then retracted to move the device  500  into the fully closed condition shown in  FIGS. 36-37  and then maneuvered towards the mitral valve MV as shown in  FIG. 38 . Referring now to  FIG. 39 , when the device  500  is aligned with the mitral valve MV (or other native valve, if implanted in another valve), the actuation element  512  is extended to open the paddles  520 ,  522  into the partially opened position and the clasp control members or actuation lines  537  are retracted to open the barbed clasps  530  to prepare for leaflet grasp. Next, as shown in  FIGS. 40-41 , the partially open device  500  is inserted through the mitral valve MV until leaflets  20 ,  22  are properly positioned in between the inner paddles  522  and the coaption element  510  and inside the open barbed clasps  530 .  FIG. 42  shows the device  500  with both clasps  530  closed, though the barbs  536  of one clasp  530  missed one of the leaflets  22 . As can be seen in  FIGS. 42-44 , the out of position clasp  530  is opened and closed again to properly grasp the missed leaflet  22 . When both leaflets  20 ,  22  are grasped properly, the actuation element  512  is retracted to move the device  500  into the fully closed position shown in  FIG. 45 . With the device  500  fully implanted in the native mitral valve MV, the actuation element  512  is withdrawn to release the capture mechanism  503  from the proximal collar  511 . Once deployed, the device  500  can be maintained in the fully closed position with a mechanical means such as a latch or can be biased to remain closed through the use of spring material, such as steel, and/or shape-memory alloys such as Nitinol. For example, the paddles  520 ,  522  can be formed of steel or Nitinol shape-memory alloy—produced in a wire, sheet, tubing, or laser sintered powder—and are biased to hold the outer paddles  520  closed around the inner paddles  522 , coaption element  510 , and the barbed clasps  530  pinched around native leaflets  20 ,  22 . 
     The device  500  can have a wide variety of different shapes and sizes. Referring to  FIGS. 6 and 6A-6E , in an example embodiment, the coaption element  510  functions as a gap filler in the valve regurgitant orifice, such as the gap  26  in the native valve illustrated by  FIG. 6 . Referring to  FIG. 6A , since the coaption element  510  is deployed between two opposing valve leaflets  20 ,  22 , the leaflets will not coapt against each other in the area of the coaption element  510 , but coapt against the coaption element  510  instead. This reduces the distance the leaflets  20 ,  22  need to be approximated. A reduction in leaflet approximation distance can result in several advantages. For example, the coaption element and resulting reduced approximation can facilitate repair of severe mitral valve anatomies, such as large gaps in functional valve disease (See for example,  FIG. 6 ). Since the coaption element  510  reduces the distance the native valves have to be approximated, the stress in the native valves can be reduced or minimized. Shorter approximation distance of the valve leaflets  20 ,  22  can require less approximation forces which can result in less tension of the leaflets and less diameter reduction of the valve annulus. The smaller reduction of the valve annulus (or no reduction of the valve annulus) can result in less reduction in valve orifice area as compared to a device without a spacer. As a result, the coaption element  510  can reduce the transvalvular gradients. 
     In one example embodiment, the paddle frames  524  conform to the shape of the coaption element  510 . In one example, if the coaption element  510  is wider than the paddle frames  524 , a distance (gap) between the opposing leaflets  20 ,  22  can be created by the device  500 . Referring to  FIGS. 6A-6E , in one example embodiment the paddles are configured to conform to the shape or geometry of the coaption element  510 . As a result, the paddles can mate with both the coaption element  510  and the native valve. Referring to  FIGS. 6D and 6E , in one example embodiment the paddle frames  524  surround the coaption element  510 . Thus, when the leaflets  20 ,  22  are coapted or pressed against the coaption element  510 , the leaflets  20 ,  22  fully surround or “hug” the coaption element  510  in its entirety, thus small leaks on the medial and lateral aspects of the coaption element  510  can be prevented.  FIGS. 6B and 6C  illustrate the valve repair device  500  attached to native valve leaflets  20 ,  22  from the ventricular side of the mitral valve.  FIG. 6A  illustrates the valve repair device  500  attached to mitral valve leaflets  20 ,  22  from the atrial side of the mitral valve. Referring to  FIGS. 6A and 6B , when the paddles have a geometry that conforms to the geometry of the coaption element  510 , the leaflets  20 ,  22  can coapt around the coaption element and/or along the length of the spacer. Referring to  FIG. 6E , a schematic atrial view/surgeon&#39;s view depicts the paddle frames (which would not actually be visible from a true atrial view), conforming to the spacer geometry. The opposing leaflets  20 ,  22  (the ends of which would also not be visible in the true atrial view) being approximated by the paddles, to fully surround or “hug” the coaption element  510 . 
     Referring to  FIGS. 6B-6E , because the paddle frames  524  conform to the shape of the coaption element  510 , the valve leaflets  20 ,  22  can be coapted completely around the coaption element by the paddle frames  524 , including on the lateral and medial aspects  601 ,  603  of the coaption element  510 . This coaption of the leaflets  20 ,  22  against the lateral and medial aspects of the coaption element  510  would seem to contradict the statement above that the presence of a coaption element  510  minimizes the distance the leaflets need to be approximated. However, the distance the leaflets  20 ,  22  need to be approximated is still minimized if the coaption element  510  is placed precisely at a regurgitant gap and the regurgitant gap is less than the width (medial−lateral) of the coaption element  510 . 
     Referring to  FIGS. 6A and 6E , the coaption element  510  can take a wide variety of different shapes. In one example embodiment, when viewed from the top (and/or sectional views from the top; see  FIGS. 95-102 ), the coaption element has an oval shape or an elliptical shape. The oval or elliptical shape can allow the paddle frames  524  co conform to the shape of the coaption element and/or can reduce lateral leaks (See  FIGS. 65-83 ). 
     As mentioned above, the coaption element  510  can reduce tension of the opposing leaflets by reducing the distance the leaflets need to be approximated to the coaption element  510  at the positions  601 ,  603 . The reduction of the distance of leaflet approximation at the positions  601 ,  603  can result in the reduction of leaflet stresses and gradients. In addition, as is also explained above, the native valve leaflets  20 ,  22  can surround or “hug” the coaption element in order to prevent lateral leaks. In one example embodiment, the geometrical characteristics of the coaption element can be designed to preserve and augment these two characteristics of the device  500 . Referring to  FIG. 2A , as seen from a Left Ventricular Outflow Tract (LVOT) view, the anatomy of the leaflets  20 ,  22  is such that the inner sides of the leaflets coapt at the free end portions and the leaflets  20 ,  22  start receding or spreading apart from each other. The leaflets  20 ,  22  spread apart in the atrial direction, until each leaflet meets with the mitral annulus. 
     In one example embodiment, the valve repair device  500  and its coaption element  510  are designed to conform to the geometrical anatomy of the valve leaflets  20 ,  22 . To achieve valve sealing, the valve repair device  500  can be designed to coapt the native leaflets to the coaption element, completely around the coaption element, including at the medial  601  and lateral  603  positions of the coaption element  510 . Additionally, a reduction on forces required to bring the leaflets into contact with the coaption element  510  at the positions  601 ,  603  can minimize leaflet stress and gradients.  FIG. 2B  shows how a tapered or triangular shape of a coaption element  510  will naturally adapt to the native valve geometry and to its expanding leaflet nature (toward the annulus). 
       FIG. 6D  illustrates the geometry of the coaption element  510  and the paddle frame  524  from an LVOT perspective. As can be seen in this view, the coaption element  510  has a tapered shape being smaller in dimension in the area closer to where the inside surfaces of the leaflets  20 ,  22  are required to coapt and increase in dimension as the coaption element extends toward the atrium. The depicted native valve geometry is accommodated by a tapered coaption element geometry. Still referring to  FIG. 6D , the tapered coaption element geometry, in conjunction with the illustrated expanding paddle frame  524  shape (toward the valve annulus) can help to achieve coaptation on the lower end of the leaflets, reduce stress, and minimize transvalvular gradients. 
     Referring to  FIG. 6C , in one example embodiment remaining shapes of the coaption element  510  and the paddle frames  524  can be defined based on an Intra-Commissural view of the native valve and the device  500 . Two factors of these shapes are leaflet coaptation against the coaption element  510  and reduction of stress on the leaflets due to the coaption. Referring to  FIGS. 6C and 67 , to both coapt the valve leaflets  20 ,  22  against the coaption element  510  and reduce the stress applied to the valve leaflets  20 ,  22  by the coaption element  510  and/or the paddle frames  524 , the coaption element  510  can have a round or rounded shape and the paddle frame  524  can have a full radius that spans from one leg of the paddles to the other leg of the paddles. The round shape of the coaption element and/or the illustrated fully rounded shape of the paddle frame will distribute the stresses on the leaflets  20 ,  22  across a large, curved engagement area  607 . For example, in  FIG. 6C , the force on the leaflets  20 ,  22  by the paddle frames is spread along the entire rounded length of the paddle frame  524 , as the leaflets  20  try to open during the diastole cycle. 
     Referring to  FIG. 67 , in one example embodiment, to cooperate with the full rounded shape of the paddle frames  524 , and/or in order to maximize leaflet coaptation against the coaption element  510  and leaflet-to-leaflet coaptation at the medial portions or sides  601 ,  603  of the coaption element  510 , the shape of the coaption element in the intra-commissural view follows a round shape. Referring to  FIG. 67 , the round shape of the coaption element in this view substantially follows or is close to the shape of the paddle frames  524 . 
     In one example embodiment, the overall shape of the coaption element  510  is an elliptical or oval cross section when seen from the surgeon&#39;s view (top view—See  FIG. 70 ), a tapered shape or cross section when seen from an LVOT view (side view—See  FIG. 69 ), and a substantially round shape or rounded shape when seen from an intra-commissural view (See  FIG. 68 ). In one example embodiment, a blend of these three geometries can result in the three-dimensional shape of the illustrated coaption element  510  that achieves the benefits described above. 
     In one example embodiment, the dimensions of the coaption element are selected to minimize the number of implants that a single patient will require (preferably one), while at the same time maintaining low transvalvular gradients. In one example embodiment, the anterior-posterior distance X 47 B at the top of the spacer is about 5 mm, and the medial-lateral distance X 67 D of the spacer at its widest is about 10 mm. In one example embodiment, the overall geometry of the device  500  can be based on these two dimensions and the overall shape strategy described above. It should be readily apparent that the use of other anterior-posterior distance anterior-posterior distance X 47 B and medial-lateral distance X 67 D as starting points for the device will result in a device having different dimensions. Further, using other dimensions and the shape strategy described above will also result in a device having different dimensions. 
     Tables A, B, and C provide examples of values and ranges for dimensions of the device and components of the device for some example embodiments. However, the device can have a wide variety of different shapes and sizes and need not have all or any of the dimensional values or dimensional ranges provided in Tables A, B, and C. Table A provides examples of linear dimensions X in millimeters and ranges of linear dimensions in millimeters for the device and components of the device. Table B provides examples of radius dimensions R in millimeters and ranges of radius dimensions in millimeters for the device and components of the device. Table C provides examples of angular dimensions a in degrees and ranges of angular dimensions in degrees for the device and components of the device. The subscripts for each of the dimensions indicates the drawing in which the dimension first appears. 
     
       
         
           
               
             
               
                 TABLE A 
               
             
            
               
                   
               
               
                 Linear Dimensions (mm) 
               
            
           
           
               
               
               
               
            
               
                   
                 Range A 
                 Range B 
                 Range C Range D Range C 
               
            
           
           
               
               
               
               
               
               
               
               
               
               
            
               
                   
                 Example 
                 (max) 
                 (min) 
                 (max) 
                 (min) 
                 (max) 
                 (min) 
                 (max) 
                 (min) 
               
               
                   
                   
               
            
           
           
               
               
               
               
               
               
               
               
               
               
            
               
                 X 47A   
                 2.8 
                 1.4 
                 4.2 
                 2.1 
                 3.5 
                 2.52 
                 3.08 
                 2.66 
                 2.94 
               
               
                 X 47B   
                 5.3 
                 2.65 
                 7.95 
                 3.975 
                 6.625 
                 4.77 
                 5.83 
                 5.035 
                 5.565 
               
               
                 X 47C   
                 2.8 
                 1.4 
                 4.2 
                 2.1 
                 3.5 
                 2.52 
                 3.08 
                 2.66 
                 2.94 
               
               
                 X 47D   
                 3.3 
                 1.65 
                 4.95 
                 2.475 
                 4.125 
                 2.97 
                 3.63 
                 3.135 
                 3.465 
               
               
                 X 47E   
                 5.4 
                 2.7 
                 8.1 
                 4.05 
                 6.75 
                 4.86 
                 5.94 
                 5.13 
                 5.67 
               
               
                 X 47F   
                 8 
                 4 
                 12 
                 6 
                 10 
                 7.2 
                 8.8 
                 7.6 
                 8.4 
               
               
                 X 47G   
                 1 
                 0.5 
                 1.5 
                 0.75 
                 1.25 
                 0.9 
                 1.1 
                 0.95 
                 1.05 
               
               
                 X 52A   
                 12 
                 6 
                 18 
                 9 
                 15 
                 10.8 
                 13.2 
                 11.4 
                 12.6 
               
               
                 X 58A   
                 11 
                 5.5 
                 16.5 
                 8.25 
                 13.75 
                 9.9 
                 12.1 
                 10.45 
                 11.55 
               
               
                 X 59A   
                 27 
                 13.5 
                 40.5 
                 20.25 
                 33.75 
                 24.3 
                 29.7 
                 25.65 
                 28.35 
               
               
                 X 59B   
                 8 
                 4 
                 12 
                 6 
                 10 
                 7.2 
                 8.8 
                 7.6 
                 8.4 
               
               
                 X 59C   
                 7 
                 3.5 
                 10.5 
                 5.25 
                 8.75 
                 6.3 
                 7.7 
                 6.65 
                 7.35 
               
               
                 X 67A   
                 2.4 
                 1.2 
                 3.6 
                 1.8 
                 3 
                 2.16 
                 2.64 
                 2.28 
                 2.52 
               
               
                 X 67B   
                 3.7 
                 1.85 
                 5.55 
                 2.775 
                 4.625 
                 3.33 
                 4.07 
                 3.515 
                 3.885 
               
               
                 X 67C   
                 10 
                 5 
                 15 
                 7.5 
                 12.5 
                 9 
                 11 
                 9.5 
                 10.5 
               
               
                 X 67D   
                 10 
                 5 
                 15 
                 7.5 
                 12.5 
                 9 
                 11 
                 9.5 
                 10.5 
               
               
                 X 67E   
                 15 
                 7.5 
                 22.5 
                 11.25 
                 18.75 
                 13.5 
                 16.5 
                 14.25 
                 15.75 
               
               
                 X 67F   
                 1 
                 0.5 
                 1.5 
                 0.75 
                 1.25 
                 0.9 
                 1.1 
                 0.95 
                 1.05 
               
               
                 X 68   
                 14.2 
                 7.1 
                 21.3 
                 10.65 
                 17.75 
                 12.78 
                 15.62 
                 13.49 
                 14.91 
               
               
                 X 70A   
                 1.7 
                 0.85 
                 2.55 
                 1.275 
                 2.125 
                 1.53 
                 1.87 
                 1.615 
                 1.785 
               
               
                 X 70B   
                 2.8 
                 1.4 
                 4.2 
                 2.1 
                 3.5 
                 2.52 
                 3.08 
                 2.66 
                 2.94 
               
               
                 X 71A   
                 6.2 
                 3.1 
                 9.3 
                 4.65 
                 7.75 
                 5.58 
                 6.82 
                 5.89 
                 6.51 
               
               
                 X 71B   
                 5.4 
                 2.7 
                 8.1 
                 4.05 
                 6.75 
                 4.86 
                 5.94 
                 5.13 
                 5.67 
               
               
                 X 71C   
                 0.9 
                 0.45 
                 1.35 
                 0.675 
                 1.125 
                 0.81 
                 0.99 
                 0.855 
                 0.945 
               
               
                 X 71D   
                 3.75 
                 1.875 
                 5.625 
                 2.8125 
                 4.6875 
                 3.375 
                 4.125 
                 3.5625 
                 3.9375 
               
               
                 X 71E   
                 4.5 
                 2.25 
                 6.75 
                 3.375 
                 5.625 
                 4.05 
                 4.95 
                 4.275 
                 4.725 
               
               
                 X 72A   
                 10.4 
                 5.2 
                 15.6 
                 7.8 
                 13 
                 9.36 
                 11.44 
                 9.88 
                 10.92 
               
               
                 X 91A   
                 8.8 
                 4.4 
                 13.2 
                 6.6 
                 11 
                 7.92 
                 9.68 
                 8.36 
                 9.24 
               
               
                 X 91B   
                 7.8 
                 3.9 
                 11.7 
                 5.85 
                 9.75 
                 7.02 
                 8.58 
                 7.41 
                 8.19 
               
               
                 X 91C   
                 8.1 
                 4.05 
                 12.15 
                 6.075 
                 10.125 
                 7.29 
                 8.91 
                 7.695 
                 8.505 
               
               
                 X 91D   
                 13.6 
                 6.8 
                 20.4 
                 10.2 
                 17 
                 12.24 
                 14.96 
                 12.92 
                 14.28 
               
               
                 X 92A   
                 0.05 
                 0.025 
                 0.075 
                 0.0375 
                 0.0625 
                 0.045 
                 0.055 
                 0.0475 
                 0.0525 
               
               
                 X 92B   
                 1.5 
                 0.75 
                 2.25 
                 1.125 
                 1.875 
                 1.35 
                 1.65 
                 1.425 
                 1.575 
               
               
                 X 92C   
                 10.8 
                 5.4 
                 16.2 
                 8.1 
                 13.5 
                 9.72 
                 11.88 
                 10.26 
                 11.34 
               
               
                 X 95A   
                 13.8 
                 6.9 
                 20.7 
                 10.35 
                 17.25 
                 12.42 
                 15.18 
                 13.11 
                 14.49 
               
               
                 X 96A   
                 8.2 
                 4.1 
                 12.3 
                 6.15 
                 10.25 
                 7.38 
                 9.02 
                 7.79 
                 8.61 
               
               
                 X 96B   
                 5.1 
                 2.55 
                 7.65 
                 3.825 
                 6.375 
                 4.59 
                 5.61 
                 4.845 
                 5.355 
               
               
                 X 96C   
                 0.5 
                 0.25 
                 0.75 
                 0.375 
                 0.625 
                 0.45 
                 0.55 
                 0.475 
                 0.525 
               
               
                 X 97   
                 10.8 
                 5.4 
                 16.2 
                 8.1 
                 13.5 
                 9.72 
                 11.88 
                 10.26 
                 11.34 
               
               
                 X 98A   
                 9.8 
                 4.9 
                 14.7 
                 7.35 
                 12.25 
                 8.82 
                 10.78 
                 9.31 
                 10.29 
               
               
                 X 98B   
                 5 
                 2.5 
                 7.5 
                 3.75 
                 6.25 
                 4.5 
                 5.5 
                 4.75 
                 5.25 
               
               
                 X 99   
                 8 
                 4 
                 12 
                 6 
                 10 
                 7.2 
                 8.8 
                 7.6 
                 8.4 
               
               
                 X 100A   
                 9.7 
                 4.85 
                 14.55 
                 7.275 
                 12.125 
                 8.73 
                 10.67 
                 9.215 
                 10.185 
               
               
                 X 100B   
                 4 
                 2 
                 6 
                 3 
                 5 
                 3.6 
                 4.4 
                 3.8 
                 4.2 
               
               
                 X 101   
                 5.2 
                 2.6 
                 7.8 
                 3.9 
                 6.5 
                 4.68 
                 5.72 
                 4.94 
                 5.46 
               
               
                 X 102A   
                 8 
                 4 
                 12 
                 6 
                 10 
                 7.2 
                 8.8 
                 7.6 
                 8.4 
               
               
                 X 102B   
                 2.9 
                 1.45 
                 4.35 
                 2.175 
                 3.625 
                 2.61 
                 3.19 
                 2.755 
                 3.045 
               
               
                 X 117A   
                 4.2 
                 2.1 
                 6.3 
                 3.15 
                 5.25 
                 3.78 
                 4.62 
                 3.99 
                 4.41 
               
               
                 X 117B   
                 14.5 
                 7.25 
                 21.75 
                 10.875 
                 18.125 
                 13.05 
                 15.95 
                 13.775 
                 15.225 
               
               
                 X 117C   
                 13 
                 6.5 
                 19.5 
                 9.75 
                 16.25 
                 11.7 
                 14.3 
                 12.35 
                 13.65 
               
               
                   
               
            
           
         
       
     
     
       
         
           
               
             
               
                 TABLE B 
               
             
            
               
                   
               
               
                 Radius Dimensions (mm) 
               
            
           
           
               
               
               
               
            
               
                   
                 Range A 
                 Range B 
                 Range C Range D Range C 
               
            
           
           
               
               
               
               
               
               
               
               
               
               
            
               
                   
                 Example 
                 (max) 
                 (min) 
                 (max) 
                 (min) 
                 (max) 
                 (min) 
                 (max) 
                 (min) 
               
               
                   
                   
               
            
           
           
               
               
               
               
               
               
               
               
               
               
            
               
                 R 47A   
                 1.3 
                 0.65 
                 1.95 
                 0.975 
                 1.625 
                 1.17 
                 1.43 
                 1.235 
                 1.365 
               
               
                 R 47B   
                 1 
                 0.5 
                 1.5 
                 0.75 
                 1.25 
                 0.9 
                 1.1 
                 0.95 
                 1.05 
               
               
                 R 47C   
                 0.6 
                 0.3 
                 0.9 
                 0.45 
                 0.75 
                 0.54 
                 0.66 
                 0.57 
                 0.63 
               
               
                 R 47D   
                 5 
                 2.5 
                 7.5 
                 3.75 
                 6.25 
                 4.5 
                 5.5 
                 4.75 
                 5.25 
               
               
                 R 47E   
                 0.75 
                 0.375 
                 1.125 
                 0.5625 
                 0.9375 
                 0.675 
                 0.825 
                 0.7125 
                 0.7875 
               
               
                 R 67A   
                 0.75 
                 0.375 
                 1.125 
                 0.5625 
                 0.9375 
                 0.675 
                 0.825 
                 0.7125 
                 0.7875 
               
               
                 R 67B   
                 0.9 
                 0.45 
                 1.35 
                 0.675 
                 1.125 
                 0.81 
                 0.99 
                 0.855 
                 0.945 
               
               
                 R 70A   
                 1.4 
                 0.7 
                 2.1 
                 1.05 
                 1.75 
                 1.26 
                 1.54 
                 1.33 
                 1.47 
               
               
                 R 70B   
                 0.4 
                 0.2 
                 0.6 
                 0.3 
                 0.5 
                 0.36 
                 0.44 
                 0.38 
                 0.42 
               
               
                 R 70C   
                 0.6 
                 0.3 
                 0.9 
                 0.45 
                 0.75 
                 0.54 
                 0.66 
                 0.57 
                 0.63 
               
               
                 R 70D   
                 7 
                 3.5 
                 10.5 
                 5.25 
                 8.75 
                 6.3 
                 7.7 
                 6.65 
                 7.35 
               
               
                 R 71A   
                 1.6 
                 0.8 
                 2.4 
                 1.2 
                 2 
                 1.44 
                 1.76 
                 1.52 
                 1.68 
               
               
                 R 72A   
                 1.85 
                 0.925 
                 2.775 
                 1.3875 
                 2.3125 
                 1.665 
                 2.035 
                 1.7575 
                 1.9425 
               
               
                 R 73A   
                 1.9 
                 0.95 
                 2.85 
                 1.425 
                 2.375 
                 1.71 
                 2.09 
                 1.805 
                 1.995 
               
               
                 R 91A   
                 9.2 
                 4.6 
                 13.8 
                 6.9 
                 11.5 
                 8.28 
                 10.12 
                 8.74 
                 9.66 
               
               
                 R 91B   
                 0.3 
                 0.15 
                 0.45 
                 0.225 
                 0.375 
                 0.27 
                 0.33 
                 0.285 
                 0.315 
               
               
                 R 91C   
                 0.3 
                 0.15 
                 0.45 
                 0.225 
                 0.375 
                 0.27 
                 0.33 
                 0.285 
                 0.315 
               
               
                 R 92A   
                 0.75 
                 0.375 
                 1.125 
                 0.5625 
                 0.9375 
                 0.675 
                 0.825 
                 0.7125 
                 0.7875 
               
               
                 R 94A   
                 1.65 
                 0.825 
                 2.475 
                 1.2375 
                 2.0625 
                 1.485 
                 1.815 
                 1.5675 
                 1.7325 
               
               
                 R 96A   
                 1.7 
                 0.85 
                 2.55 
                 1.275 
                 2.125 
                 1.53 
                 1.87 
                 1.615 
                 1.785 
               
               
                 R 96B   
                 4.7 
                 2.35 
                 7.05 
                 3.525 
                 5.875 
                 4.23 
                 5.17 
                 4.465 
                 4.935 
               
               
                 R 98A   
                 1.3 
                 0.65 
                 1.95 
                 0.975 
                 1.625 
                 1.17 
                 1.43 
                 1.235 
                 1.365 
               
               
                 R 98B   
                 7.6 
                 3.8 
                 11.4 
                 5.7 
                 9.5 
                 6.84 
                 8.36 
                 7.22 
                 7.98 
               
               
                 R 100A   
                 0.9 
                 0.45 
                 1.35 
                 0.675 
                 1.125 
                 0.81 
                 0.99 
                 0.855 
                 0.945 
               
               
                 R 100B   
                 9.6 
                 4.8 
                 14.4 
                 7.2 
                 12 
                 8.64 
                 10.56 
                 9.12 
                 10.08 
               
               
                 R 102A   
                 0.45 
                 0.225 
                 0.675 
                 0.3375 
                 0.5625 
                 0.405 
                 0.495 
                 0.4275 
                 0.4725 
               
               
                 R 102B   
                 8.5 
                 4.25 
                 12.75 
                 6.375 
                 10.625 
                 7.65 
                 9.35 
                 8.075 
                 8.925 
               
               
                 R 115A   
                 9.3 
                 4.65 
                 13.95 
                 6.975 
                 11.625 
                 8.37 
                 10.23 
                 8.835 
                 9.765 
               
               
                 R 115B   
                 7.8 
                 3.9 
                 11.7 
                 5.85 
                 9.75 
                 7.02 
                 8.58 
                 7.41 
                 8.19 
               
               
                 R 115C   
                 7.8 
                 3.9 
                 11.7 
                 5.85 
                 9.75 
                 7.02 
                 8.58 
                 7.41 
                 8.19 
               
               
                 R 115D   
                 6.7 
                 3.35 
                 10.05 
                 5.025 
                 8.375 
                 6.03 
                 7.37 
                 6.365 
                 7.035 
               
               
                 R 115E   
                 1.5 
                 0.75 
                 2.25 
                 1.125 
                 1.875 
                 1.35 
                 1.65 
                 1.425 
                 1.575 
               
               
                   
               
            
           
         
       
     
     
       
         
           
               
             
               
                 TABLE C 
               
             
            
               
                   
               
               
                 Angular Dimensions (degrees) 
               
            
           
           
               
               
               
               
            
               
                   
                 Range A 
                 Range B 
                 Range C Range D Range C 
               
            
           
           
               
               
               
               
               
               
               
               
               
               
            
               
                   
                 Example 
                 (max) 
                 (min) 
                 (max) 
                 (min) 
                 (max) 
                 (min) 
                 (max) 
                 (min) 
               
               
                   
                   
               
            
           
           
               
               
               
               
               
               
               
               
               
               
            
               
                 α 47   
                 12 
                 6 
                 18 
                 9 
                 15 
                 10.8 
                 13.2 
                 11.4 
                 12.6 
               
               
                 α 91A   
                 9 
                 4.5 
                 13.5 
                 6.75 
                 11.25 
                 8.1 
                 9.9 
                 8.55 
                 9.45 
               
               
                 α 91B   
                 14 
                 7 
                 21 
                 10.5 
                 17.5 
                 12.6 
                 15.4 
                 13.3 
                 14.7 
               
               
                 α 91C   
                 20 
                 10 
                 30 
                 15 
                 25 
                 18 
                 22 
                 19 
                 21 
               
               
                 α 117A   
                 39 
                 19.5 
                 58.5 
                 29.25 
                 48.75 
                 35.1 
                 42.9 
                 37.05 
                 40.95 
               
               
                 α 117B   
                 3 
                 1.5 
                 4.5 
                 2.25 
                 3.75 
                 2.7 
                 3.3 
                 2.85 
                 3.15 
               
               
                   
               
            
           
         
       
     
     Referring now to  FIGS. 47-61 , an implantable device  500  is shown in various positions and configurations. The implantable device  500  can include any other features for an implantable prosthetic device discussed in the present application, and the device  500  can be positioned to engage valve tissue  20 ,  22  as part of any suitable valve repair system (e.g., any valve repair system disclosed in the present application). 
     The implantable device  500  has a proximal or attachment portion  505 , a coaption element  510  (e.g., spacer, etc.), inner anchor portions or inner paddles  522 , outer anchor portions or outer paddles  520 , anchor extension members or paddle frames  524 , and a distal portion  507 . The inner paddles  522  are attached (e.g., jointably attached, etc.) between the coaption element  510  and the outer paddles  520 . The outer paddles  520  are attached (e.g., jointably attached, etc.) between the inner paddles  522  and the distal portion  507 . The paddle frames  524  are attached to the cap  514  at the distal portion  507  and extend to the joint portion  523  between the inner and outer paddles  522 ,  520 . In some embodiments, the paddle frames  524  are formed of a material that is more rigid and stiff than the material forming the paddles  522 ,  520  so that the paddle frames  524  provide support for the paddles  522 ,  520 . In one example embodiment, the inner paddles  522  are stiff, relatively stiff, rigid, have rigid portions and/or are stiffened by a stiffening member or the fixed portion of the clasps  530 . The stiffening of the inner paddle allows the device to move to the various different positions shown and described herein. The inner paddle  522 , the outer paddle  520 , the coaption can all be interconnected as described herein, such that the device  500  is constrained to the movements and positions shown and described herein. 
     Referring now to  FIGS. 47-48 , the device  500  is shown in a closed position. When closed, the inner paddles  522  are disposed between the outer paddles  520  and the coaption element  510 . In some embodiments, the device  500  includes clasps or gripping members  530  ( FIG. 48 ) that can be opened and closed to grasp the native leaflets  20 ,  22  of the mitral valve MV. The clasps  530  are attached to and move with the inner paddles  522  and are disposed between the inner paddles  522  and the coaption element  510 . 
     Referring now to  FIGS. 49-51 , the device  500  is shown in a partially open position. The device  500  is moved into the partially open position by an actuation element or means for actuation  512  that passes through the attachment portion  505  and coaption element  510  and can removably engage the distal portion  507 . The actuation element  512  is extended through the attachment portion  505  such that a distance D between the attachment portion  505  and distal portion  507  increases as the actuation element  512  is extended. In the example illustrated by  FIGS. 49-51 , the pair of inner and outer paddles  522 ,  520  are moved in unison, rather than independently, by a single actuation element  512 . Also, the positions of the clasps  530  are dependent on the positions of the paddles  522 ,  520 . For example, referring to  FIG. 48  closing the paddles  522 ,  520  also closes the clasps. In one example embodiment, the device  500  can be made to have the paddles  520 ,  522  be independently controllable in the same manner as the  FIG. 11A  embodiment. 
     Extending the actuation element  512  pulls down on the bottom portions of the outer paddles  520  and paddle frames  524 . The outer paddles  520  and paddle frames  524  pull down on the inner paddles  522 , where the inner paddles  522  are connected to the outer paddles  520  and the paddle frames  524 . Because the attachment portion  505  and coaption element  510  are held in place, the inner paddles  522  are caused to flex or pivot in an opening direction. The inner paddles  522 , the outer paddles  520 , and the paddle frames all flex to the position shown in  FIG. 49 . Opening the paddles  522 ,  520  and frames  524  forms a gap  520 D between the coaption element  510  and the inner paddle  522  that can receive and grasp the native leaflets  20 . 
     As is described above, some embodiments of the device  500  include clasps or gripping members  530 . When the device  500  is partially opened the clasps  530  are exposed. In some embodiments, the closed clasps  530  ( FIG. 50 ) can be opened ( FIG. 51 ), thereby creating a second opening or gap  530 A for receiving and capturing the native leaflets  20 ,  22 . The extent of the gap  530 A in the clasps  530  is limited to the extent that the inner paddle  522  has spread away from the coaption element  510 . 
     Referring now to  FIGS. 52-54 , the device  500  is shown in a laterally extended or open position. The device  500  is moved into the laterally extended or open position by continuing to extend the actuation element  512  described above, thereby increasing the distance D between the attachment portion  505  and distal portion  507 . Continuing to extend the actuation element  512  pulls down on the outer paddles  520  and paddle frames  524 , thereby causing the inner paddles  522  to spread apart further from the coaption element  510 . In the laterally extended or open position, the inner paddles  522  extend horizontally more than in other positions of the device  500  and form an approximately 90-degree angle with the coaption element  510 . Similarly, the paddle frames  524  are at their maximum spread position when the device  500  is in the laterally extended or open position. The increased gap  520 D formed in the laterally extended or open position allows clasps  530  to open further ( FIG. 54 ) before engaging the coaption element  510 , thereby increasing the size of the gap  530 A. 
     Referring now to  FIGS. 55-57 , the device  500  is shown in a three-quarters extended position. The device  500  is moved into the three-quarters extended position by continuing to extend the actuation element  512  described above, thereby increasing the distance D between the attachment portion  505  and distal portion  507 . Continuing to extend the actuation element  512  pulls down on the outer paddles  520  and paddle frames  524 , thereby causing the inner paddles  522  to spread apart further from the coaption element  510 . In the three-quarters extended position, the inner paddles  522  are open beyond 90 degrees to an approximately 135-degree angle with the coaption element  510 . The paddle frames  524  are less spread than in the laterally extended or open position and begin to move inward toward the actuation element  512  as the actuation element  512  extends further. The outer paddles  520  also flex back toward the actuation element  512 . As with the laterally extended or open position, the increased gap  520 D formed in the laterally extended or open position allows clasps  530  to open even further ( FIG. 57 ), thereby increasing the size of the gap  530 A. 
     Referring now to  FIG. 58 , the device  500  is shown in an almost fully extended position. The device  500  is moved into the almost fully extended position by continuing to extend the actuation element  512  described above, thereby increasing the distance D between the attachment portion  505  and distal portion  507 . Continuing to extend the actuation element  512  pulls down on the outer paddles  520  and paddle frames  524 , thereby causing the inner paddles  522  to spread apart further from the coaption element  510 . In the almost fully extended position the inner paddles  522  begin to approach an approximately 180-degree angle with the coaption element  510 . Although the inner paddles move to this position, the outer paddles  520  and the paddle frames  522  never move or flex to or past a ninety-degree angle with respect to the coaption element  510 . In the almost fully extended position the inner and outer paddles  522 ,  520  can have a somewhat curved shape. 
     Referring now to  FIGS. 59-61 , the device  500  is shown in a fully extended position. The device  500  is moved into the fully extended position by continuing to extend the actuation element  512  described above, thereby increasing the distance D between the attachment portion  505  and distal portion  507  to a maximum distance allowable by the device  500 . Continuing to extend the actuation element  512  pulls down on the outer paddles  520  and paddle frames  524 , thereby causing the inner paddles  522  to spread apart further from the coaption element  510 . The outer paddles  520  and paddle frames  524  move to a position where they are close to the actuation element. In the fully extended position, the inner paddles  522  are open to an approximately 180-degree angle with the coaption element  510 . The inner and outer paddles  522 ,  520  are stretched straight in the fully extended position to form an approximately 180-degree angle between the paddles  522 ,  520 . The fully extended position of the device  500  provides the maximum size of the gap  520 D between the paddles, and, in some embodiments, allows clasps  530  to also open fully to approximately 180 degrees ( FIG. 61 ) between portions of the clasp  530 . The position of the device  500  is the narrowest configuration. Thus, the fully extended position of the device  500  may be a desirable position for bailout of the device  500  from an attempted implantation or may be a desired position for placement of the device in a delivery catheter, or the like. 
     Referring now to  FIGS. 47A, 48A-48H, 53A-53C, 54A-54D, 60A-60D, and 61A-61D , an implantable device  500 A is shown in various positions and configurations. The implantable device  500 A can include any other features for an implantable prosthetic device discussed in the present application, and the device  500 A can be positioned to engage valve tissue  20 ,  22  as part of any suitable valve repair system (e.g., any valve repair system disclosed in the present application). 
     The implantable device  500 A has a proximal or attachment portion  505 A, a coaption element  510 A, inner anchor portions or inner paddles  522 A, outer anchor portions or outer paddles  520 A, anchor extension members or paddle frames  524 A, and a distal portion  507 A. The inner paddles  522 A are attached (e.g., jointably attached, etc.) between the coaption element  510 A, e.g., by joint portions  525 A and the outer paddles  520 A by joint portions  523 A. The outer paddles  520 A are attached (e.g., jointably attached, etc.) between the inner paddles  522 A, e.g., by joint portions  523 A and the distal portion  507 A by joint portions  521 A. The paddle frames  524 A are attached to the cap  514 A ( FIG. 48A ) at the distal portion  507 A and extend to the joint portion  523 A between the inner and outer paddles  522 A,  520 A. In some embodiments, the paddle frames  524 A are formed of a material that is more rigid and stiff than the material forming the paddles  522 A,  520 A so that the paddle frames  524 A provide support for the paddles  522 A,  520 A. The paddle frames  524 A include a connection portion, such as an opening or slot  524 B ( FIG. 70A ) for receiving the joint portions  523 A ( FIG. 65A ). In some embodiments, the inner paddles  522 A are stiff, relatively stiff, rigid, have rigid portions and/or are stiffened by a stiffening member or the fixed portion of the clasps  530 C. The stiffening of the inner paddle allows the device to move to the various different positions shown and described herein. The inner paddle  522 A, the outer paddle  520 A, and the coaption element can all be interconnected as described herein, such that the device  500 A is constrained to the movements and positions shown and described herein. 
     The coaption element  510 A, inner paddles  522 A, outer paddles  520 A can be attached together by integrally forming the coaption element  510 A and the paddles  520 A,  522 A as a single, unitary component. This can be accomplished, for example, by forming the coaption element  510 A and the paddles  520 A,  522 A from a continuous strip  501 A of a braided or woven material, such as braided or woven nitinol wire. 
     The continuous strip  501 A is attached a collar  511 D, a cap  514 A, paddle frames  524 A, clasps  530 C. In the illustrated embodiment, the coaption element  510 A, hinge portions  521 A,  523 A,  525 A, outer paddles  520 A, and inner paddles  522 A are formed from the continuous strip  501 A. The continuous strip  501 A can be a single layer of material or can include two or more layers. In certain embodiments, portions of the device  500 A have a single layer of the strip of material  501 A and other portions are formed from multiple overlapping or overlying layers of the strip of material  501 A. For example,  FIG. 47A  shows the coaption element  510 A and inner paddles  522 A formed from multiple overlapping or overlying layers of the strip of material  501 A. Consequently, the coaption element  510 A and inner paddle  522 A have an increased stiffness relative to the outer paddles  520 A that are formed from a single layer of material  501 A. The single continuous strip of material  501 A can start and end in various locations of the device  500 A. The ends of the strip of material  501 A can be in the same location or different locations of the device  500 A. For example, in the illustrated embodiment of  FIG. 47A , the strip of material begins and ends in the location of the inner paddles  522 . 
     The clasps  530 C can comprise attachment or fixed portions  532 C, arm or moveable portions  534 C, barbs  536 C, and joint portions  538 C. The attachment or fixed portions  532 C can be coupled to the inner paddles  522 A in various ways such as with sutures, adhesive, fasteners, welding, stitching, swaging, friction fit and/or other means for coupling with the joint portions  538 C disposed proximate the coaption element  510 A. The clasps  530 C can be similar to clasps  430 , 
     The moveable portions  534 C can pivot or flex relative to the fixed portions  532 C between an open configuration (e.g.,  FIG. 54A ) and a closed configuration ( FIG. 48A ). In some embodiments, the clasps  530 C can be biased to the closed configuration. In the open configuration, the fixed portions  532 C and the moveable portions  534 C pivot or flex away from each other such that native leaflets can be positioned between the fixed portions  532 C and the moveable portions  534 C. In the closed configuration, the fixed portions  532 C and the moveable portions  534 C pivot or flex toward each other, thereby clamping the native leaflets between the fixed portions  532 C and the moveable portions  534 C. The fixed arms  532 C remain stationary or substantially stationary when the moveable arms  534 C are opened to open the barbed clasps  530 C and expose the barbs  536 C. The barbed clasps  530 C are opened by applying tension to actuation lines  516 A attached to the moveable arms  534 C, thereby causing the moveable arms  534 C to pivot or flex on the joint portions  538 C. 
     Referring now to  FIGS. 47A, and 48A-48H , the device  500 A is shown in a closed position. A side view of the device  500 A is shown in  FIGS. 48B, 48C, and 48F , from a front view in Figures  FIGS. 48D, 48E, and 48G , and from a bottom view in  FIG. 48H . The device  500 A is narrower when viewed from the front than the side. From the side, the device  500 A has a generally inverted trapezoidal shape that is rounded and tapers toward the distal portion  507 A of the device  500 A. From the front, the device  500 A has a generally rounded rectangle shape that tapers somewhat toward the distal portion  507 A. As can be seen from the bottom view of the device  500 A shown in  FIG. 48H , the device  500 A has a generally rounded rectangle shape when viewed from below (and when viewed from above as can be seen in, for example,  FIG. 70A ). 
     In the closed configuration of the device  500 A, the inner paddles  522 A are disposed between the outer paddles  520 A and the coaption element  510 A. In some embodiments, the device  500 A includes clasps or gripping members  530 C ( FIG. 48A ) that can be opened and closed to grasp the native leaflets  20 ,  22  of the mitral valve MV. The clasps  530 C are attached to and move with the inner paddles  522 A and are disposed between the inner paddles  522 A and the coaption element  510 A. 
     Referring now to  FIGS. 48B-48D , the device  500 A is shown attached to a delivery device  502 A. The delivery device  502 A has actuatable members or fingers  503 A that releasably engage the attachment portion  505 A. An actuation element  512 A extends from the delivery device  502 A to the cap  514 A through the attachment portion  505 A and coaption element  510 A of the prosthetic device  500 A. Extending and retracting the actuation element  512 A causes the device  500 A to open and close, as is described below. Actuation lines/sutures  516 A extend from the delivery device  502 A to attach to the clasps  530 C. Tension can be applied to the sutures  516 A to open the clasps  530 C and released to allow the clasps  530 C to close. The device  500 A is shown separated from the delivery device  502 A in a deployed condition in  FIGS. 48F-48G . 
     Referring now to  FIGS. 48C and 48E , the device  500 A is shown with a cover  540 A. The cover  540 A can be formed from a single piece of material, or from multiple segments abutting or joined to each other. In the illustrated embodiment, the cover  540 A has an outer or lower cover  541 A and an inner or upper cover  543 A. The outer cover  541 A covers the cap  514 A, outer paddles  520 A, inner paddles  522 A, and clasps  530 C. The inner cover  543 A covers the coaption element  510 A and the proximal ends of the inner paddles  522 A and clasps  530 C where the coaption element  510 A meets the inner paddles  522 A and clasps  530 C. The cover  540 A can be a cloth material such as polyethylene cloth of a fine mesh. The cloth cover can provide a blood seal on the surface of the spacer, and/or promote rapid tissue ingrowth. 
     Referring now to  FIGS. 53A-53D and 54A-54D , the device  500 A is shown in a laterally extended or open position. The device  500 A is moved into the open position by the actuation element or means for actuation  512 A that passes through the attachment portion  505 A and coaption element  510 A and can removably engage the distal portion  507 A. The actuation element  512 A is extended through the attachment portion  505 A such that a distance D 2  between the attachment portion  505 A and distal portion  507 A increases as the actuation element  512 A is extended. In the example illustrated by  FIGS. 53A-53D and 54A-54D , the pair of inner and outer paddles  520 A,  522 A are moved in unison, rather than independently, by a single actuation element  512 A. Also, the positions of the clasps  530 C are dependent on the positions of the paddles  520 A,  522 A. For example, referring to  FIG. 48A  closing the paddles  520 A,  522 A also closes the clasps  530 C. In one example embodiment, the device  500 A can be made to have the paddles  520 A,  522 A be independently controllable in the same manner as the  FIG. 11A  embodiment. 
     Extending the actuation element  512 A pulls down on the bottom portions of the outer paddles  520 A and paddle frames  524 A to transition the device  500 A from a closed to partially open position. The outer paddles  520 A and paddle frames  524 A pull down on the inner paddles  522 A where the inner paddles  522 A are connected to the outer paddles  520 A and the paddle frames  524 A. Because the attachment portion  505 A and coaption element  510 A are held in place, the inner paddles  522 A are caused to pivot or flex in an opening direction. The inner paddles  522 A, the outer paddles  520 A, and the paddle frames all flex to the position shown in  FIG. 53A . Opening the paddles  522 A,  520 A and frames  524  forms a gap  520 D between the coaption element  510 A and the inner paddle  522 A that can receive and grasp the native leaflets  20 . 
     Continuing to extend the actuation element  512 A pulls down on the outer paddles  520 A and paddle frames  524 A, thereby causing the inner paddles  522 A to spread apart further from the coaption element  510 A. In the laterally extended or open position, the inner paddles  522 A extend horizontally more than in other positions of the device  500 A and form an approximately 90-degree angle with the coaption element  510 A. Similarly, the paddle frames  524 A are at their maximum spread position when the device  500 A is in the laterally extended or open position. The increased gap  520 D formed in the laterally extended or open position allows clasps  530 C to open further ( FIG. 54A ) before engaging the coaption element  510 A, thereby increasing the size of the gap  530 D as compared to the partially open position. 
     As is described above, some embodiments of the device  500 A include clasps or gripping members  530 C. When the device  500 A is opened the clasps  530 C are exposed. In some embodiments, the closed clasps  530 C ( FIGS. 53A-53D ) can be opened ( FIGS. 54A-54D ), thereby creating a second opening or gap  530 D for receiving and capturing the native leaflets  20 ,  22 . The extent of the gap  530 D in the clasps  530 C is limited to the extent that the inner paddle  522 A has spread away from the coaption element  510 A. 
     Referring now to  FIGS. 60A-60D and 61A-61D , the device  500 A is shown in a fully extended position. The device  500 A is moved into the fully extended position by continuing to extend the actuation element  512 A described above, thereby increasing the distance D 2  between the attachment portion  505 A and distal portion  507 A to a maximum distance allowable by the device  500 A. Continuing to extend the actuation element  512 A pulls down on the outer paddles  520 A and paddle frames  524 A, thereby causing the inner paddles  522 A to extend further away from the coaption element  510 A. The outer paddles  520 A and paddle frames  524 A move to a position where they are close to the actuation element. In the fully extended position, the inner paddles  522 A are open to an approximately 180-degree angle with the coaption element  510 A. The inner and outer paddles  522 A,  520 A are stretched straight or substantially straight in the fully extended position to form an approximately 180-degree angle between the paddles  522 A,  520 A. The fully extended position of the device  500 A provides the maximum size of the gap  520 D between the paddles, and, in some embodiments, allows clasps  530 C to also open fully to approximately 180 degrees ( FIG. 61A ) between portions of the clasp  530 C. The position of the device  500 A is the narrowest configuration. Thus, the fully extended position of the device  500 A may be a desirable position for bailout of the device  500 A from an attempted implantation or may be a desired position for placement of the device in a delivery catheter, or the like. 
     Referring now to  FIGS. 197-198 , enlarged views of portions of  FIG. 60C  are shown. Referring now to  FIG. 197 , the inner cover  543 A can be seen covering the coaption element  510 A from the proximal portion  519 B to the distal portion  517 A. In some embodiments, the inner cover  543 A is formed from a flat sheet (see  FIG. 201 ) of a cloth material such as polyethylene cloth of a fine mesh and is folded around the coaption element  510 A and held in place by stitches  545 A. Referring now to  FIG. 198 , the outer cover  541 A can be seen covering the clasps  530 C and inner paddles  522 A. Collar portions  548 A of inner cover  543 A cover the portion of the clasps  530 C and inner paddles  522 A closest to the coaption element  510 A. Transition portions  547 A of the inner cover  543 A extend from the coaption element  510 A to the collar portions  548 A to provide a smooth transition between the coaption element  510 A and the clasps  530 C and inner paddles  522 A so that native tissue is not caught on the device  500 A during implantation. 
     Referring now to  FIG. 199 , an exploded view of the device  500 A is shown. The coaption element  510 A, outer paddles  520 A, and inner paddles  522 A are formed from a single strip of material  501 A, as described above. The collar  511 D, cap  514 A, paddle frames  524 A, and clasps  530 C are assembled to the strip of material  501 A to form the device  500 A. The cap  514 A includes a retention body  560 A with a locking aperture  561 A for receiving a retaining nut  562 A having a threaded bore  564 A that engages a threaded portion  568 A of a retaining bolt  566 A. The threaded portion  568 A of the retaining bolt  566 A is inserted through the opening  527 B to engage the retention body and nut  560 A,  562 A to attach the cap  514 A to the strip of material  501 A. 
     In some embodiments, a stiffening member  539 C is attached to the inner paddle  522 A to stiffen the inner paddle  522 A to maintain the inner paddle in a straight or substantially straight configuration as the inner paddle is moved between the various positions. A cutout  539 D in the stiffening member  539 C is shaped to receive the fixed arm  532 C of the clasp  530 C so that the stiffening member  539 C can fit around the fixed arm  532 C when both the stiffening member  539 C and clasp  530 C are attached to the inner paddle  522 A. Like the fixed arm  532 C, the stiffening member  539 C can be coupled to the inner paddles  522 A in various ways such as with sutures, adhesive, fasteners, welding, stitching, swaging, friction fit and/or other means for coupling. 
     Referring now to  FIG. 200 , an enlarged view of the collar  511 A attached to the proximal portion  519 B of the coaption element  510 A is shown. The collar  511 A includes protrusions  511 E for releasably engaging the fingers  503 A of the delivery device  502 A. An aperture  515 A in the collar  511 A receives the actuation element  512 A. The proximal portion  519 B of the coaption element  510 A flares outward to form two loops  519 D that are inserted through the arcuate openings  513 A of the collar  511 D to attach the collar  511 D to the proximal portion  519 B of the coaption element  510 A. The loops  519 D are formed by folding the strip of material  501 A to form first and second layers  581 A,  582 A. In some embodiments, the arcuate openings  513 A include an opening (not shown) similar to the 
     Referring now to  FIGS. 201-202 , enlarged and exploded views of the cap  514 A are shown, respectively.  FIG. 201  shows an enlarged view of the cap  514 A attached to the distal portion  527 A of the strip of material  501 A is shown. The retention body  560 A, retaining nut  562 A, and retaining bolt  566 A cooperate to attach the paddle frames  524 A to the distal portion  527 A of the strip of material  501 A. In particular, the retaining bolt  566 A is inserted through the opening  527 B of the distal portion  527 A ( FIG. 202 ) to prohibit movement of the cap  514 A along the strip of material  501 A. A channel  560 B in the retention body  560 A and a flange  567 A of the bolt  566 A form a passageway  514 B through the cap  514 A for the distal portion  527 A. 
     Referring now to  FIG. 202 , the components of the cap  514 A are shown in an exploded view to better illustrate the features of the components of the cap  514 A and paddle frames  524 A and to show how those features interlock during assembly of the cap  514 A to the distal portion  527 A. Forming the cap  514 A from multiple components that can be assembled around the strip of material  501 A allows the cap  514 A to be attached after the strip of material  501 A has been folded to form the coaption element  510 A and paddles  520 A,  522 A and been woven through the collar  511 D and paddle frames  524 A. 
     The retention body  560 A includes a locking aperture  561 A for receiving the retaining nut  562 A. The locking aperture  561 A has a generally rectangular shape and includes two opposing locking channels  561 B that receive the attachment portions  524 C of the paddle frames  524 A. A transverse locking channel  561 C formed in the bottom of the retention body  560 A has the same width as the locking channels  561 B. The paddle frames  524 A include notches  524 D in the attachment portions  524 C that form hook portions  524 E that engage the transverse locking channel  561 A to secure the paddle frames  524 A to the cap  514 A. 
     The retaining nut  562 A includes a rectangular locking body  563 A extending distally from a flange  563 B. The locking body  563 A is configured to slidably engage the locking aperture  561 A of the retention body  560 A while leaving the locking channels  561 B unobstructed. Thus, the locking body  563 A can be inserted into the locking aperture  561 A to lock the attachment portions  524 C of the paddle frames  524 A within the locking channels  561 B. Notches  563 C in the flange  563 B accommodate the attachment portions  524 C of the paddle frames  524 A. The threaded bore  564 A is formed through the retaining nut  562 A to receive the retaining bolt  566 A. 
     The retaining bolt  566 A includes a threaded portion  568 A extending from the flange  567 A. The threaded portion  568 A is inserted through the opening  527 B in the distal portion  527 A to threadedly engage the threaded bore  564 A of the retaining nut  562 A. The flange  567 A has a rounded shape that provides a rounded end to the distal portion  507 A of the device  500 A. The flange  567 A includes openings  567 B for receiving a tool (not shown) that engages the bolt  566 A so that the bolt  566 A can be turned during assembly to couple the components of the cap  514 A together. 
     To assemble the paddle frames  524 A and cap  514 A to the distal portion  527 A, the paddle frames  524 A are squeezed to narrow the width of the attachment portion  524 C so that the attachment portions  524 C can be inserted into the locking channels  561 B of the locking aperture  561 A. When the paddle frames  524 A are allowed to expand, the attachment portions  524 C expand outward so that the notches  524 D engage the retention body  560 A and the hook portions  524 E engage the transverse locking channel  561 C. The retaining nut  562 A is then inserted into the locking aperture  561 A with the locking portion  563 A arranged between the two attachment portions  524 C of each paddle frame  524 A, thereby locking the paddle frames  524 A in engagement with the retention body  560 A. The assembled paddle frames  524 A, retention body  560 A, and retaining nut  562 A are placed on the distal portion  527 A so that the threaded bore  564 A aligns with the opening  527 B and the threaded portion  568 A of the bolt  566 A is inserted through the opening  527 B to threadedly engage the threaded bore  564 A. The bolt  566 A is then tightened until the flange  567 A engages the retention body  560 A and the cap  514 A is securely assembled to the distal portion  527 A. 
     Referring now to  FIGS. 203 and 204 , portions of the cover  540 A are shown cut from flat sheets of material. The cover  540 A includes the outer cover  541 A and the inner cover  543 A. Each of the covers  541 A,  543 A include different shaped segments or portions to attach to different portions of the device  500 A. In particular, the covers  541 A,  543 A are shaped to smooth transitions between portions of the device  500 A to reduce catch points and provide a smoother exterior to the device  500 . 
     The various segments of the covers  541 A,  543 A extend from a middle portion that is shaped to attach to an end of the device  500 A. In some embodiments, the portion of the cover  541 A,  543 A that attaches to an end of the device  500 A is located at an end of the covers  541 A,  543 A or can be located anywhere between the middle and ends of the covers  541 A,  543 A. Various portions of the covers  541 A,  543 A can be shaped to wrap around portions of the device  500 A. The cover  540 A can be made of any suitable material, such as a polyethylene cloth of a fine mesh. In certain embodiments, the cover is formed out of a single piece of material. In some embodiments, the cover can be formed of any number of pieces of material that are attached to the device and/or joined together by any suitable means, such as by stitching, adhesives, welding, or the like. 
     Referring to  FIGS. 60C and 204 , the outer cover  541 A extends outward from a middle portion  580  to end portions  588 . The middle portion  580  is shaped to be attached to the cap  514 A of the device  500 A. Outer paddle portions  582  extend from the middle portion  580  to inner paddle and inside clasp portions  584 . The inner paddle and inside clasp portions  584  extend from the outer paddle portions  582  to outside moveable clasp portions  586 . The outside moveable clasp portions  586  extend from the clasp and/or inner paddle portions  584  to the end portions  588 . 
     The outer paddle portions  582  include wing portions  583  that extend laterally to a width that is wider than the other portions of the outer cover  541 A so that the outer paddle portions  582  can attach to the outer paddles  520 A and paddle frames  524 A of the device  500 A. The clasp and/or inner paddle portions  584  attach to the inner paddles  522 A, stationary arms  532 C, and the inside surface (the side with the barbs) of the moveable arms  534 C. The outside clasp portions  586  attach to the outside surface (the side without the barbs) of the moveable arms  534 C of the clasps  530 C. The ends  588  of the outer cover  541 A terminate near the joint portion  538 C of the clasp  530 C on the outside of the clasps  530 C. The inner paddle and inside clasp portions  584  include openings  585  that allow the barbs  536 C of the clasps  530 C to protrude through the outer cover  541 A to engage tissue of the native heart valve. 
     Referring to  FIGS. 60C and 203 , the inner cover  543 A extends outward from a middle portion  590  to end portions  598 . The middle portion  590  is configured to be attached to the collar  511 D of the device  500 A. Openings  591  in the middle portion  590  expose the protrusions  511 E from the collar  511 D when the middle portion  590  is attached to the collar  511 D so that the protrusions  511 E can be engaged by the delivery device  502 A. Coaption portions  592  extend from the middle portion  590  to flexible hinge portions  594 . Holes  593  along the edges of the coaption portions  592  allow each of the coaption portions  592  to be joined together after being folded around the coaption element  510 A, such as, for example, by stitches  545 A. The flexible hinge portions  594  extend from the coaption portions  592  to transition portions  596 . The transition portions  596  extend from the flexible hinge portions  594  to the end portions  598 . Holes  597  along the edges of the transition portions  596  allow each of the transition portions  596  to be wrapped around the inner paddle  522 A and ends of the clasp  530 C and secured to itself by stitches or other suitable securing means. The flexible hinge portions  594  bridge the gaps between the coaption element  510 A and the clasps  530 C when the device  500 A is opened, as can be seen in  FIG. 198 . 
     Referring now to  FIGS. 62A-64C , an implantable device  700  is shown. The implantable device  700  has paddles  702  that open and close to grasp leaflets  20 ,  22  against barbed clasps or gripping devices  704 . The paddles  702  move to create an opening  706  between the paddles  702  and gripping devices  704  in which the leaflets  20 ,  22  can be grasped. The device  700  can be configured to close a wide gap  26  ( FIG. 6 ) in the native heart valve MV, TV. In addition, the implantable device  700  can include any other features for a device discussed in the present application, and the device  700  can be positioned to engage valve leaflets  20 ,  22  as part of any suitable valve repair system (e.g., any valve repair system disclosed in the present application). The device  700  can include any other features for an implantable prosthetic device discussed in the present application, and the device  700  can be positioned to engage valve tissue  20 ,  22  as part of any suitable valve repair system (e.g., any valve repair system disclosed in the present application). 
     Referring to  FIG. 62A , the paddles  702  of the device  700  are moved, rotated, or pivoted outward in the direction X to create an opening  706  between the paddles  702  and the gripping members  704  having a width W. The width W can be, for example, between about 5 mm and about 15 mm, such as between 7.5 mm and about 12.5 mm, such as about 10 mm. In alternative embodiments, the width W can be less than 5 mm or greater than 15 mm. 
     Referring to  FIG. 62B , the paddles  702  of the device  700  are moved outward in the direction Z such that the opening  706  has a width H. The width H can be, for example, between about 10 mm and about 25 mm, such as between about 10 mm and about 20 mm, such as between about 12.5 mm and about 17.5 mm, such as about 15 mm. In some embodiments, the width H can be less than 10 mm or more than 25 mm. In certain embodiments, the ratio between the width H and the width W can be about 5 to 1 or less, such as about 4 to 1 or less such as about 3 to 1 or less, such as about 2 to 1 or less, such as about 1.5 to 1 or less, such as about 1.25 to 1 or less, such as about 1 to 1. The device  700  can be configured such that the paddles  702  are moved, rotated, or pivoted outward in the direction X and then moved outward in the direction Z to create the opening  706  having a width H between the paddles  702  and the gripping members  704 . Optionally, the device  700  can be configured such that the paddles are moved outward in the direction Z and then moved or pivoted outward in the direction X to create width H between the paddles  702  and gripping members  704 . In addition, the device  700  can be configured such that the paddles  702  are moved or pivoted outward in the direction X and moved outward in the direction Z simultaneously to create the width H between the paddles  702  and the gripping members  704 . 
       FIGS. 63A-63C  illustrate an implantable device  700  in which the paddles  702  are moved, rotated, or pivoted outward in the direction X, and, subsequently, moved outward in the direction Z to create a wider opening  706 .  FIG. 63A  illustrates the implantable device  700  in a closed position, such that the paddles  702  are engaging the gripping members  704 . Referring to  FIG. 63B , the paddles  702  are moved or pivoted outward in the direction X to create an opening  706  having a width W for receiving valve tissue. Referring to  FIG. 63C , after the paddles  702  are moved or pivoted outward in the direction X, the paddles  702  are moved outward in the direction Z such that the opening  706  has a width H. After valve tissue is received in the openings  706  between the paddles  702  and the gripping members  704 , the valve repair device is moved back to the closed position (as shown in  FIG. 63A ) to secure the valve repair device  700  to the valve tissue. The implantable device  700  can include any other features for an implantable device discussed in the present application, and the implantable device  700  can be positioned to engage valve tissue  20 ,  22  as part of any suitable valve repair system (e.g., any valve repair system disclosed in the present application). 
       FIGS. 64A-64C  illustrate an implantable device  700  in which the paddles  702  are moved outward in the direction Z, and, subsequently, moved, extended, or pivoted outward in the direction X to create a wider opening  706 .  FIG. 64A  illustrates the implantable device  700  in a closed position, such that the paddles  702  are engaging the gripping members  704 . Referring to  FIG. 64B , the paddles  702  are moved outward in the direction Z to create an opening  706  having a width W for receiving valve tissue. Referring to FIG.  64 C, after the paddles  702  are moved outward in the direction Z, the paddles  702  are moved or pivoted outward in the direction X such that the opening  706  has a width H. After valve tissue is received in the openings  706  between the paddles  702  and the gripping members  704 , the implantable device  700  is moved back to the closed position (as shown in  FIG. 64A ) to secure the implantable device  700  to the valve tissue. The implantable device  700  can include any other features for an implantable device discussed in the present application, and the implantable device  700  can be positioned to engage valve tissue  20 ,  22  as part of any suitable valve repair system (e.g., any valve repair system disclosed in the present application). 
     While  FIGS. 63A-63C  illustrate a device  700  in which the paddles  702  are moved or pivoted and then spread apart, and  FIGS. 64A-64C  illustrate a device  700  in which the paddles  702  are spread apart and then moved or pivoted, in alternative embodiments, a device  700  can include paddles  702  that can be spread apart and moved or pivoted simultaneously. In addition, in certain embodiments, the paddles  702  can be spread apart and moved or pivoted independently of each other. That is, in the embodiments for the valve repair device  700  shown in  FIGS. 63A-63C and 64A-64C , as well as the embodiment in which the spreading apart and moving or pivoting of each paddle  702  is completed simultaneously, the paddles  702  can be controlled independently of each other. 
     Referring now to  FIGS. 65-83 , the example implantable device  500  is shown in the closed condition. Referring now to  FIGS. 65-66 , the device  500  extends from a proximal portion  505  to a distal portion  507  and includes a coaption portion  510 , inner paddles  522 , outer paddles  520 , and paddle frames  524 . In some embodiments, the outer paddles  520  extend to and/or around the paddle frames  524  and can have more than one layer to surround the paddle frames  524 . The proximal portion  505  can include a collar  511  for attaching a delivery device (not shown). The distal portion  507  can include a cap  514  that is attached (e.g., jointably attached, etc.) to the outer paddles  520  and is engaged by an actuation element (not shown) to open and close the device  500  to facilitate implantation in the native valve as described in the present application. 
     Referring now to  FIGS. 67-68 , a front view of the device  500  is shown. The device  500  has a shape that is symmetrical or substantially symmetrical around a vertical front-to-back plane  550  and is generally narrower at the distal portion  507  than the proximal portion  505 . The shape of the coaption element  510  and paddle frames  524  is rounded or generally rounded to prevent the device  500  from catching or snagging on structures of the heart, such as the chordae tendineae, during implantation. For this reason, the proximal collar  511  ( FIG. 68 ) and cap  514  ( FIG. 68 ) also have round edges. When viewed from the front or back, the paddle frames  524  can be seen to have a rounded or generally rounded shape, extending upwards and outwards from the distal portion  507  to approximately coincide with the shape of the coaption element  510  when viewed from the front or back. Thus, the coaption element  510  and paddle frames  524  generally define the shape of the device  500  when viewed from the front or back. In addition, the rounded shape of the paddle frames  524  and the corresponding rounded shape of the coaption element can distribute leaflet stress across a wider surface. In some example embodiments, the paddle frames  524  and/or the coaption element  510  can have other shapes. 
     Referring now to  FIG. 69 , a side view of the device  500  is shown. As with the front and back views ( FIGS. 67-68 ), the device  500  has a shape that is symmetrical or substantially symmetrical around a vertical side-to-side plane  552  when viewed from the side. The distal portion  507  is also generally narrower than the proximal portion  505  when the device  500  is viewed from the side. The coaption element  510  optionally also has a tapering or generally tapering shape that narrows toward the distal portion  507  of the device  500 . However, in some example embodiments, the coaption element does not taper as it extends from the proximal portion of the device to the distal portion of the device. 
     The rounded features of the device  500  are further demonstrated by the round shape of the paddles  520 ,  522  where the inner and outer paddles  520 ,  522  are joined together and the round shape of the paddle frames  524 . However, the paddles  520 ,  522  and paddle frames  524  can take a wide variety of different forms. For example, the paddles  520 ,  522  and the paddle frames  524  can be rounded along the top edges but be flat or substantially flat on the sides of the paddles  520 ,  522  and/or the paddle frames. By making the paddles  520 ,  522  flat or substantially flat on the sides, two devices can be implanted side-by-side on the native valve leaflet, with the two devices sitting flush or substantially flush against each other. 
     The closed paddles  520 ,  522  form gaps  542  between the inner paddles  522  and the coaption element  510  that are configured to receive native tissue. As can be seen in FIG.  69 , the narrowing of the coaption element  510  gives the gaps  542  a somewhat teardrop shape that increases in width as the gaps  542  approach the distal portion  507  of the device. The widening of the gaps  542  toward the distal portion  507  allows the paddles  520 ,  522  to contact tissue grasped in the gaps  542  nearer to the proximal portion  505 . 
     The paddle frames  524  extend vertically from the distal portion  507  toward the proximal portion  505  until approximately a middle third of the device  500  before bending or flaring outward so that the connection portion of the frames  524  passes through gaps  544  formed by the inner paddles  522  folded inside of the outer paddles  520 . However, in some embodiments the connection of the frames are positioned inside the inner paddles  522  or outside the outer paddles  520 . The outer paddles  520  have a rounded shape that is similar to that of the coaption element  510  when viewed from the front or back ( FIGS. 67-68 ). Thus, the device  500  has a rounded shape or substantially round shape. The round shape of the device  500  is particularly visible when the device  500  is viewed from the top ( FIGS. 70-71 ) or bottom ( FIGS. 72-73 ). 
     Referring now to  FIGS. 70-71 , top views of the device  500  are shown. The device  500  has a shape that is symmetrical or substantially symmetrical around a front-to-back plane  550  and is also symmetrical or substantially symmetrical around a side-to-side plane  552  when viewed from the top. An opening  519 A in the coaption element  510  is visible at the proximal portion  505  of the device  500 . As can be seen in  FIG. 70 , the coaption element  510  can be hollow inside. The proximal collar  511  shown in  FIG. 71  can be secured to the coaption element  510  to close off the coaption element  510 . 
     In one example embodiment, the coaption element is not planar and has all curved surfaces. For example, the coaption elements  510  illustrated herein can be formed of a series of blended surfaces have a variety of different radii of curvature. The coaption element  510  has an oval or generally oval-shape when viewed from the top. However, in some example embodiments, the coaption element  510  can have other shapes when viewed from the top. For example, the coaption element can have a rectangular, square, diamond, elliptical, or any other shape. The paddle frames  524  each have an arcuate shape with a smaller radius than the coaption element  510  so that the gaps  542  formed between the inner paddles  522  and paddle frames  524  and the coaption element  510  taper as they approach left  551  and right  553  sides of the device  500 . Thus, native tissue, such as the leaflets  20 ,  22  tend to be pinched between the paddle frames  524  and the coaption element  510  towards the left and right sides  551 ,  553  of the device  500 . 
     Referring now to  FIGS. 72-73 , bottom views of the device  500  are shown. As with the top views ( FIGS. 70-71 ), the device  500  has a shape that is symmetrical or substantially symmetrical around the front-to-back plane  550  and is also symmetrical or substantially symmetrical around the side-to-side plane  552  when viewed from the bottom. The cap  514  is shown in  FIG. 73  and can jointably attach to the outer paddles  520  and the paddle frames  524 . 
     The paddle frames  524  extend outward from the distal portion  507  of the device  500  to the left and right sides  551 ,  553  at a narrow or slight angle from the side-to-side plane  552 . The paddle frames  524  extend further away from the side-to-side plane  552  as the paddle frames  524  extend toward the proximal portion of the device  500  ( FIG. 69 ) to ultimately form the arcuate shape seen in  FIGS. 70-71 . 
     Referring now to  FIGS. 74-83 , perspective and cross-sectional views of the device  500  are shown. Referring now to  FIG. 74 , the device  500  is shown sliced by cross-section plane  75  near the proximal portion of the coaption element  510 . Referring now to  FIG. 75 , a cross-sectional view of the device  500  is shown as viewed from cross-section plane  75  in  FIG. 74 . At the location of the plane  75 , the coaption element  510  has a round or generally round shape with lobes arranged along the front-to-back plane  550 . The gaps  542  between the paddle frames  524  and coaption element  510  form a crescent-like shape with a central width  543 . As noted above, the gaps  542  narrow as the gaps  542  approach the left and right sides  551 ,  553 . 
     Referring now to  FIG. 76 , the device  500  is shown sliced by cross-section plane  77  positioned about three-quarters of the way between the distal portion  507  and the proximal portion  505  of the coaption element  510 . Referring now to  FIG. 77 , a cross-sectional view of the device  500  is shown as viewed from cross-section plane  77  in  FIG. 76 . At the location of the plane  75 , the coaption element  510  has an oval or generally oval shape oriented along the side-to-side plane  552 . The gaps  542  between the paddle frames  524  and coaption element  510  form a crescent or crescent-like shape with a central width  543  that is less than the central width  543  seen in  FIG. 75 . At the location of the plane  77 , the width  543  of the gaps  542  is narrower towards the center of the device, widens somewhat as the gaps  542  approach the left and right sides  551 ,  553  before narrowing again. Thus, the native tissue is pinched in the center of the gaps  542  about three-quarters of the way up the coaption element  510 . 
     Referring now to  FIG. 78 , the device  500  is shown sliced by cross-section plane  79  positioned about half of the way between the distal portion  507  and the proximal portion  505  of the coaption element  510 . Referring now to  FIG. 79 , a cross-sectional view of the device  500  is shown as viewed from cross-section plane  79  in  FIG. 78 . At the location of the plane  79 , the coaption element  510  has an oval or generally oval shape oriented along the side-to-side plane  552 . The paddle frames  524  can be seen near the left and right sides  551 ,  553  very close to or in contact with the coaption element  510 . The gaps  542  are crescent or generally crescent shaped and are wider than the gaps  542  viewed along the plane  77  ( FIG. 77 .) 
     Referring now to  FIG. 80 , the device  500  is shown sliced by cross-section plane  81  positioned about one-quarter of the way between the distal portion  507  and the proximal portion  505  of the coaption element  510 . Referring now to  FIG. 81 , a cross-sectional view of the device  500  is shown as viewed from cross-section plane  81  in  FIG. 80 . At the location of the plane  81 , the coaption element  510  has an oval or generally oval shape oriented along the side-to-side plane  552  that is narrower than the oval shape seen in  FIG. 77 . The paddle frames  524  can be seen near the left and right sides  551 ,  553  very close to or in contact with the coaption element  510 . The gaps  542  are crescent or generally crescent shaped and are wider than the gaps  542  viewed along the plane  79  ( FIG. 79 .) 
     Referring now to  FIG. 82 , the device  500  is shown sliced by cross-section plane  83  positioned near the distal portion  507  of the coaption element  510 . Referring now to  FIG. 83 , a cross-sectional view of the device  500  is shown as viewed from cross-section plane  83  in  FIG. 82 . At the location of the plane  83 , the coaption element  510  has an oval or generally oval shape oriented along the side-to-side plane  552  that is narrower than the oval shape seen in  FIG. 79  as the coaption element  510  tapers toward the distal portion  507  of the device  500 . The paddle frames  524  can be seen near the left and right sides  551 ,  553  very close to or in contact with the coaption element  510 . While the inner paddles  522  are not visible in  FIG. 81 , the gaps  542  are crescent or generally crescent shaped and are wider than the gaps  542  viewed along the plane  81  ( FIG. 81 .) 
     Referring now to  FIGS. 65A, 66A, 67A, 68A, 70A, 71A, 72A, 73A, 74A, 75A, 76A, 77A, 78A, 79A, 80A, 81A, 82A, and 83A , the example implantable device  500 A is shown in the closed condition. Referring now to  FIGS. 65A and 66A , the device  500 A extends from a proximal portion  505 A to a distal portion  507 A and includes a coaption portion  510 A, inner paddles  522 A, outer paddles  520 A, and paddle frames  524 A. The proximal portion  505 A can include a collar  511 D for attaching a delivery device (not shown). The distal portion  507 A can include a cap  514 A that is attached (e.g., jointably attached, etc.) to the outer paddles  520 A and is engaged by an actuation element (not shown) to open and close the device  500 A to facilitate implantation in the native valve as described in the present application. 
     Referring now to  FIGS. 67A and 68A , front views of the device  500 A are shown. The device  500 A has a shape that is symmetrical or substantially symmetrical around a vertical front-to-back plane  550 A and is generally narrower at the distal portion  507 A than along the paddle frames  524 A. The shape of the coaption element  510 A and paddle frames  524 A is a generally rounded rectangular shape to prevent the device  500 A from catching or snagging on structures of the heart, such as the chordae tendineae, during implantation. For this reason, the proximal collar  511 D ( FIG. 68A ) and cap  514 A ( FIG. 68A ) can also have round edges. When viewed from the front or back, the paddle frames  524 A can be seen to have a generally rounded rectangular shape, extending upwards and outwards from the distal portion  507 A to a shape that has sides that are wider than and approximately parallel to the coaption element  510 A when viewed from the front or back. Thus, the paddle frames  524 A generally define the shape of the device  500 A when viewed from the front or back. In addition, the rounded rectangular shape of the paddle frames  524 A can distribute leaflet stress across a wider surface. In some example embodiments, the paddle frames  524 A and/or the coaption element  510 A can have other shapes. 
     As with the front and back views ( FIGS. 67A and 68A ), the device  500 A has a shape that is symmetrical or substantially symmetrical around a vertical side-to-side plane  552 A ( FIG. 70A ) when viewed from the side (e.g.,  FIG. 47A ). The distal portion  507 A is also generally narrower than the proximal portion  505 A when the device  500 A is viewed from the side. In the embodiment illustrated in  FIG. 48B , the coaption element  510 A does not taper as it extends from the proximal portion  505 A of the device  500 A to the distal portion  507 A of the device  500 A. However, in some example embodiments, the coaption element does taper as it extends from the proximal portion of the device to the distal portion of the device (e.g.,  FIG. 47 ). 
     The generally rounded features of the device  500 A are further demonstrated by the rounded shape of the paddles  520 A,  522 A where the inner and outer paddles  520 A,  522 A are joined together. However, the paddles  520 A,  522 A and paddle frames  524 A can take a wide variety of different forms. For example, the paddles  520 A,  522 A and the paddle frames  524 A can be rounded along the top edges and be flat or substantially flat on the sides (e.g., the sides of the paddle frames  524 A arranged at the front and back sides of the device  500 A). By making the paddles  520 A,  522 A flat or substantially flat on the sides, two devices can be implanted side-by-side on the native valve leaflet, with the two devices sitting flush or substantially flush against each other. 
     The closed paddles  520 A,  522 A form gaps  542 A between the inner paddles  522 A and the coaption element  510 A that are configured to receive native tissue. As can be seen in  FIGS. 48B and 48F , the proximal end of the coaption element  510 A has an approximately dog-bone shape so that the gaps  542 A are narrower toward the proximal portion  505 A than as the gaps  542 A approach the distal portion  507 A of the device. The narrowing of the gaps  542 A toward the proximal portion  505 A allows the paddles  520 A,  522 A to contact tissue grasped in the gaps  542 A nearer to the proximal portion  505 A. 
     The paddle frames  524 A extend vertically from the distal portion  507 A toward the proximal portion  505 A until approximately a middle third of the device  500 A before bending or flaring outward so that a connection portion or slot  524 B of the frames  524 A passes through gaps  544 A formed by the inner paddles  522 A folded inside of the outer paddles  520 A. However, in some embodiments the connections of the frames are positioned inside the inner paddles  522 A or outside the outer paddles  520 A. The outer paddles  520 A have a rounded rectangular shape that is similar to that of the coaption element  510 A when viewed from the front or back ( FIGS. 67A and 68A ). Thus, the device  500 A has a rounded rectangular shape. The rounded rectangular shape of the device  500 A is particularly visible when the device  500 A is viewed from the top ( FIGS. 70A and 71A ) or bottom ( FIGS. 72A and 73A ). 
     Referring now to  FIGS. 70A and 71A , top views of the device  500 A are shown. The device  500 A has a shape that is symmetrical or substantially symmetrical around a front-to-back plane  550 A and is also symmetrical or substantially symmetrical around a side-to-side plane  552 A when viewed from the top. A proximal opening  519 C in the coaption element  510 A is visible at the proximal portion  505 A of the device  500 A. The actuation element  512 A is received through the opening  519 C so that the coaption element  510 A wraps around the actuation element  512 A. In some embodiments, the opening  519 C is formed by inserting the actuation element  512 A between the folded and overlapping layers of the strip of material  501 A (described in detail below). In some embodiments, the opening  519 C is formed by shape-setting the folded layers of the strip of material  501 A forming the coaption element  510 A around a blank or jig to give the coaption element  510 A a rounded or generally rounded shape. The proximal collar  511 D shown in  FIG. 71A  can be secured to the coaption element  510 A to close off the coaption element  510 A. The proximal collar  511 D includes attachment portions  513 A that engage with openings  546 A formed by the folded layers of the strip of material  501 A that form the coaption element  510 A. In some embodiments, the attachment portions  513 A are holes in the collar  511 D so that the strip of material  501 A must be inserted through the collar  511 D before folding the strip of material  501 A during assembly of the device  500 A. In some embodiments, the attachment portions  513 A are open slots (e.g., the attachment portions or slot  524 B of the paddle frames  524 A) that receive the strip of material  501 A before or after folding the strip of material  501 A. 
     As is noted above, the coaption element  510 A has a generally rectangular shape when viewed from the top. In some example embodiments, the coaption element  510 A can have other shapes when viewed from the top. For example, the coaption element can have a round, square, diamond, elliptical, or any other shape. The paddle frames  524 A each have a rounded rectangular shape when viewed from the top so that the paddle frames  224 A surround the rectangular coaption element  510 A. Thus, native tissue, such as the leaflets  20 ,  22  tend to be pinched or compressed evenly in the gaps  542 A formed between the inner paddles  522 A and paddle frames  524 A and the coaption element  510 A. 
     Referring now to  FIGS. 72A and 73A , bottom views of the device  500 A are shown. As with the top views ( FIGS. 70A and 71A ), the device  500 A has a shape that is symmetrical or substantially symmetrical around the front-to-back plane  550 A and is also symmetrical or substantially symmetrical around the side-to-side plane  552 A when viewed from the bottom. A distal portion  527 A of the strip of material  501 A includes an aperture  527 B for receiving the cap  514 A shown in  FIG. 73A . 
     The paddle frames  524 A extend outward from the distal portion  507 A of the device  500 A to the left and right sides  551 A,  553 A at a narrow or slight angle from the side-to-side plane  552 A. The paddle frames  524 A extend further away from the side-to-side plane  552 A while maintaining a generally constant distance relative to the front-to-back plane  550 A as the paddle frames  524 A extend toward the proximal portion  505 A of the device  500 A ( FIG. 65A ) to ultimately form the rounded rectangle shape seen in  FIGS. 70A and 71A . 
     In one example embodiment, the dimensions of the device  500 A are selected to minimize the number of implants that a single patient will require (preferably one), while at the same time maintaining low transvalvular gradients. In one example embodiment, the anterior-posterior distance Y 47 I of the device  500 A at the widest is less than 10 mm, and the medial-lateral distance Y 67 C of the spacer at its widest is less than 6 mm. In one example embodiment, the overall geometry of the device  500 A can be based on these two dimensions and the overall shape strategy described above. It should be readily apparent that the use of other anterior-posterior distance Y 47 I and medial-lateral distance Y 67 C as starting points for the device  500 A will result in a device having different dimensions. Further, using other dimensions and the shape strategy described above will also result in a device having different dimensions. 
     Tables D and E provide examples of values and ranges for dimensions of the device  500 A and components of the device  500 A for some example embodiments. However, the device  500 A can have a wide variety of different shapes and sizes and need not have all or any of the dimensional values or dimensional ranges provided in Tables D and E. Table D provides examples of linear dimensions Y in millimeters and ranges of linear dimensions in millimeters for the device  500 A and components of the device  500 A. Table B provides examples of radius dimensions S in millimeters and ranges of radius dimensions in millimeters for the device  500 A and components of the device  500 A. The subscripts for each of the dimensions indicates the drawing in which the dimension first appears. 
     
       
         
           
               
             
               
                 TABLE D 
               
             
            
               
                   
               
               
                 Linear Dimensions (mm) 
               
            
           
           
               
               
               
               
               
            
               
                   
                 Range A 
                 Range B 
                 Range C 
                 Range D 
               
            
           
           
               
               
               
               
               
               
               
               
               
               
            
               
                   
                 Example 
                 (max) 
                 (min) 
                 (max) 
                 (min) 
                 (max) 
                 (min) 
                 (max) 
                 (min) 
               
               
                   
                   
               
            
           
           
               
               
               
               
               
               
               
               
               
               
            
               
                 Y 47A   
                 2.58 
                 2.25 
                 3.87 
                 1.94 
                 5.23 
                 2.32 
                 2.84 
                 2.45 
                 2.71 
               
               
                 Y 47B   
                 1.43 
                 0.72 
                 2.15 
                 1.07 
                 1.79 
                 1.29 
                 1.57 
                 1.36 
                 1.50 
               
               
                 Y 47C   
                 3.75 
                 1.88 
                 5.63 
                 2.81 
                 4.68 
                 3.38 
                 4.13 
                 3.56 
                 3.94 
               
               
                 Y 47D   
                 0.35 
                 0.18 
                 0.53 
                 0.26 
                 0.44 
                 0.32 
                 0.39 
                 0.33 
                 0.37 
               
               
                 Y 47E   
                 0.71 
                 0.36 
                 1.07 
                 0.53 
                 0.89 
                 0.64 
                 0.78 
                 0.67 
                 0.75 
               
               
                 Y 47F   
                 1.07 
                 0.94 
                 1.61 
                 0.80 
                 1.34 
                 0.96 
                 1.18 
                 1.02 
                 1.12 
               
               
                 Y 47G   
                 7.68 
                 3.84 
                 11.52 
                 5.76 
                 9.60 
                 6.91 
                 8.45 
                 7.30 
                 8.06 
               
               
                 Y 47H   
                 5.41 
                 2.71 
                 8.12 
                 4.06 
                 6.76 
                 4.87 
                 5.95 
                 5.14 
                 9.62 
               
               
                 Y 47I   
                 9.16 
                 4.58 
                 13.74 
                 6.87 
                 11.45 
                 8.24 
                 10.08 
                 8.70 
                 9.62 
               
               
                 Y 47J   
                 0.72 
                 0.36 
                 1.08 
                 0.54 
                 0.90 
                 0.65 
                 0.79 
                 0.68 
                 0.76 
               
               
                 Y 67A   
                 1.61 
                 0.81 
                 2.42 
                 1.21 
                 2.01 
                 1.45 
                 1.77 
                 1.53 
                 1.69 
               
               
                 Y 67B   
                 3.25 
                 1.63 
                 4.88 
                 2.44 
                 4.06 
                 2.93 
                 3.58 
                 3.09 
                 3.41 
               
               
                 Y 67C   
                 5.90 
                 2.95 
                 8.85 
                 4.43 
                 7.38 
                 5.31 
                 6.49 
                 5.61 
                 6.20 
               
               
                 Y 67D   
                 15.21 
                 7.60 
                 22.81 
                 11.41 
                 19.01 
                 13.69 
                 16.73 
                 14.45 
                 15.97 
               
               
                 Y 67E   
                 3.25 
                 1.63 
                 4.88 
                 2.44 
                 4.06 
                 2.93 
                 3.58 
                 3.09 
                 3.41 
               
               
                 Y 68A   
                 14.04 
                 7.02 
                 21.06 
                 10.53 
                 17.55 
                 12.64 
                 15.44 
                 13.34 
                 14.74 
               
               
                 Y 71A   
                 4.50 
                 2.25 
                 6.75 
                 3.38 
                 5.63 
                 4.05 
                 4.95 
                 4.28 
                 4.73 
               
               
                 Y 72A   
                 2.50 
                 1.25 
                 3.75 
                 1.88 
                 3.13 
                 2.25 
                 2.75 
                 2.38 
                 2.63 
               
               
                 Y 114A   
                 4.34 
                 2.17 
                 6.50 
                 3.25 
                 5.42 
                 3.90 
                 4.77 
                 4.12 
                 4.55 
               
               
                 Y 114B   
                 13.28 
                 6.64 
                 19.92 
                 9.96 
                 16.60 
                 11.95 
                 14.61 
                 12.62 
                 13.94 
               
               
                 Y 116A   
                 14.79 
                 7.39 
                 22.18 
                 11.09 
                 18.48 
                 13.31 
                 16.27 
                 14.05 
                 15.53 
               
               
                   
               
            
           
         
       
     
     
       
         
           
               
             
               
                 TABLE E 
               
             
            
               
                   
               
               
                 Radius Dimensions (mm) 
               
            
           
           
               
               
               
               
               
            
               
                   
                 Range A 
                 Range B 
                 Range C 
                 Range D 
               
            
           
           
               
               
               
               
               
               
               
               
               
               
            
               
                   
                 Example 
                 (max) 
                 (min) 
                 (max) 
                 (min) 
                 (max) 
                 (min) 
                 (max) 
                 (min) 
               
               
                   
                   
               
            
           
           
               
               
               
               
               
               
               
               
               
               
            
               
                 S 47A   
                 0.74 
                 0.37 
                 1.11 
                 0.56 
                 0.93 
                 0.67 
                 0.81 
                 0.70 
                 0.78 
               
               
                 S 47B   
                 0.68 
                 0.34 
                 1.02 
                 0.51 
                 0.85 
                 0.61 
                 0.75 
                 0.65 
                 0.71 
               
               
                 S 47C   
                 1.10 
                 0.55 
                 1.65 
                 0.83 
                 1.38 
                 0.99 
                 1.21 
                 0.05 
                 1.16 
               
               
                 S 47D   
                 5.62 
                 2.81 
                 8.43 
                 4.22 
                 7.03 
                 5.06 
                 6.18 
                 5.34 
                 5.90 
               
               
                 S 47E   
                 0.96 
                 0.48 
                 1.44 
                 0.72 
                 1.20 
                 0.86 
                 1.06 
                 0.91 
                 1.01 
               
               
                 S 71A   
                 0.63 
                 0.31 
                 0.94 
                 0.47 
                 0.78 
                 0.56 
                 0.69 
                 0.59 
                 0.66 
               
               
                 S 71B   
                 2.07 
                 1.04 
                 3.11 
                 1.55 
                 2.59 
                 1.86 
                 2.28 
                 1.97 
                 2.17 
               
               
                 S 73A   
                 1.88 
                 0.94 
                 2.81 
                 1.41 
                 2.34 
                 1.69 
                 2.06 
                 1.78 
                 1.97 
               
               
                 S 114A   
                 5.62 
                 2.81 
                 8.43 
                 4.22 
                 7.03 
                 5.06 
                 6.18 
                 5.34 
                 5.90 
               
               
                 S 114B   
                 6.00 
                 3.00 
                 9.00 
                 4.50 
                 7.50 
                 5.40 
                 6.60 
                 5.70 
                 6.30 
               
               
                 S 114C   
                 3.15 
                 1.58 
                 4.73 
                 2.36 
                 3.94 
                 2.84 
                 3.47 
                 2.99 
                 3.31 
               
               
                 S 117A   
                 1.15 
                 0.58 
                 1.73 
                 0.86 
                 1.44 
                 1.04 
                 1.27 
                 1.09 
                 1.21 
               
               
                 S 117B   
                 2.69 
                 1.35 
                 4.04 
                 2.02 
                 3.36 
                 2.42 
                 2.96 
                 2.56 
                 2.82 
               
               
                   
               
            
           
         
       
     
     Referring now to  FIGS. 74A, 75A, 76A, 77A, 78A, 79A, 80A, 81A, 82A, and 83A , perspective and cross-sectional views of the device  500 A are shown. Referring now to  FIG. 74A , the device  500 A is shown sliced by cross-section plane  75 A near the proximal portion of the coaption element  510 A. Referring now to  FIG. 75A , a cross-sectional view of the device  500 A is shown as viewed from cross-section plane  75 A in  FIG. 74A . At the location of the plane  75 A, the coaption element  510 A has a generally rounded rectangular shape. The gaps  542 A between the inner paddles  522 A and coaption element  510 A have a width  542 B. As noted above, the gaps  542 A have a consistent or generally consistent width. 
     Referring now to  FIG. 76A , the device  500 A is shown sliced by cross-section plane  77 A positioned about three-quarters of the way between the distal portion  507 A and the proximal portion  505 A of the coaption element  510 A. Referring now to  FIG. 77A , a cross-sectional view of the device  500 A is shown as viewed from cross-section plane  77 A in  FIG. 76A . As can be seen in  FIGS. 76A and 77A , the strip of material  501 A forming the device  500 A is overlapped to form four layers in the area of the coaption element  510 A. A single layer of the strip of material  501 A forms each of the inner paddle  522 A and the outer paddle  520 A. At the location of the plane  75 A, the coaption element  510 A has a generally rectangular shape oriented along the side-to-side plane  552 A. The gaps  542 A between the inner paddle  522 A and the coaption element  510 A are visible. The gaps  542 A between the inner paddles  522 A and coaption element  510 A have a width  542 B that is greater than the width  542 B seen in  FIG. 75A . The gaps  544 A between the outer and inner paddles  520 A,  522 A have a consistent or generally consistent width  544 B for receiving the attachment portion or slot  524 B of the paddle frames  524 A. 
     Referring now to  FIG. 78A , the device  500 A is shown sliced by cross-section plane  79 A positioned about half of the way between the distal portion  507 A and the proximal portion  505 A of the device  500 A. Referring now to  FIG. 79A , a cross-sectional view of the device  500 A is shown as viewed from cross-section plane  79 A in  FIG. 78A . As can be seen in  FIGS. 78A and 79A , the strip of material  501 A forming the device  500 A is overlapped to form four layers in the area of the coaption element  510 A, two layers in the area of the inner paddle  522 A, and one layer in the area of the outer paddle  520 A. At the location of the plane  79 A, the coaption element  510 A has a generally rectangular shape oriented along the side-to-side plane  552 A. The gaps  542 A between the inner paddles  522 A and the coaption element  510 A have a width  542 B that is the same or about the same as the width  542 B seen in  FIG. 77A . 
     Referring now to  FIG. 80A , the device  500 A is shown sliced by cross-section plane  81 A positioned about one-quarter of the way between the distal portion  507 A and the proximal portion  505 A of the device  500 A. Referring now to  FIG. 81A , a cross-sectional view of the device  500 A is shown as viewed from cross-section plane  81 A in  FIG. 80A . As can be seen in  FIGS. 80A and 81A , the strip of material  501 A forming the device  500 A is overlapped to form four layers in the area of the coaption element  510 A, two layers in the area of the inner paddle  522 A, and the outer paddle  520 A is formed by a single layer. At the location of the plane  81 A, the coaption element  510 A has a generally rectangular shape oriented along the side-to-side plane  552 A. The gaps  542 A between the inner paddle  522 A and coaption element  510 A have a width  542 B that is about the same as the central width  542 B seen in  FIG. 79A . 
     Referring now to  FIG. 82A , the device  500 A is shown sliced by cross-section plane  83 A positioned about one-quarter of the way between the distal portion  507 A and the proximal portion  505 A of the device  500 A. Referring now to  FIG. 83A , a cross-sectional view of the device  500 A is shown as viewed from cross-section plane  83 A in  FIG. 82A . As can be seen in  FIGS. 82A and 83A , the strip of material  501 A forming the device  500 A is overlapped to form four layers in the area of the coaption element  510 A, two layers in the area of the inner paddle  522 A, and a single layer forms the outer paddle  520 A. At the location of the plane  83 A, the coaption element  510 A has a generally rectangular shape oriented along the side-to-side plane  552 A. The gaps  542 A between the inner paddles  522 A and coaption element  510 A form an arcuate shape with a width  542 B that is about the same as the central width  542 B seen in  FIG. 81A . 
     Referring now to  FIGS. 84-88, 86A, 87A, and 88A , example implantable devices  100 ,  500 ,  500 A are shown without clasps or articulable gripping members. Rather, the example devices  100 ,  500 ,  500 A shown in  FIGS. 84-88, 86A, 87A, and 88A , have barbs or gripping members  800 / 800 A and/or  802 / 802 A integrated into portions of the coaption element or paddles of the anchor portion of the devices to facilitate grasping of the tissue of the native heart valve. 
     Referring now to  FIG. 84 , an example implantable device  100  is shown that does not include articulable clasps or gripping elements. As described above, the device  100  is deployed from a delivery sheath or means for delivery  102  and includes a coaption portion  104  and an anchor portion  106 . The coaption portion  104  of the device  100  includes a coaption element or means for coapting  110  that is adapted to be implanted between the leaflets  20 ,  22  of a native valve (e.g., mitral valve MV, etc.) and is slidably attached to an actuation element or shaft  112  that extends through the coaption element or means for coapting  110  to a distal cap  114 . 
     The anchor portion  106  of the device  100  includes outer paddles  120  and inner paddles  122  that are connected between the distal cap  114  and the coaption element or means for coapting  110 . The anchor portion  106  is actuatable between open and closed conditions and can take a wide variety of forms, such as, for example, paddles, gripping elements, or the like. Actuation of the actuation element or means for actuating  112  opens and closes the anchor portion  106  of the device  100  to grasp the native valve leaflets  20 ,  22  during implantation. 
     Rather than articulable clasps or gripping elements, the device  100  shown in  FIG. 84  includes barbed portions  800  arranged on the coaption element or means for coapting  110 , with each side of the coaption element or means for coapting  110  having at least one barbed portion  800 . When the anchor portion  106  of the device  100  is closed, tissue grasped between the inner paddles  122  and the coaption element or means for coapting  110  is pressed against the barbed portions  800 . The barbed portions  800  can be sharp so that they engage—and in some embodiments, pierce—the native tissue and prohibit the tissue from retracting from the device  100 . In some embodiments, the barbed portions  800  are angled downward to increase engagement with the native tissue. 
     Referring now to  FIG. 85 , the example implantable device  100  is shown without separate articulable clasps. As described above, the device  100  is deployed from a delivery sheath or means for delivery  102  and includes a coaption portion  104  and an anchor portion  106 . The coaption portion  104  of the device  100  includes a coaption element or means for coapting  110  that is adapted to be implanted between the leaflets  20 ,  22  of the native valve or mitral valve MV and is slidably attached to an actuation element  112  (e.g., actuation wire, shaft, rod, suture, line, etc.) that extends through the coaption element or means for coapting  110  to a distal cap  114 . 
     The anchor portion  106  of the device  100  includes outer paddles  120  and inner paddles  122  that are connected between the distal cap  114  and the coaption element or means for coapting  110 . The anchor portion  106  is actuatable between open and closed conditions and can take a wide variety of forms, such as, for example, paddles, gripping elements, or the like. Actuation of the actuation element or means for actuating  112  opens and closes the anchor portion  106  of the device  100  to grasp the native valve leaflets  20 ,  22  during implantation. 
     Rather than separate articulable clasps or gripping elements, the device  100  shown in  FIG. 85  includes barbed portions  800  arranged on the inner paddles  122 , with each inner paddle  122  having at least one barbed portion  800 . When the anchor portion  106  of the device  100  is closed, tissue grasped between the inner paddles  122  and the coaption element or means for coapting  110  is pressed against the barbed portions  800 . The barbed portions  800  are sharp so that they engage—and in some embodiments, pierce—the native tissue and prohibit the tissue from retracting from the device  100 . In some embodiments, the barbed portions  800  are angled downward to increase engagement with the native tissue. 
     Referring now to  FIG. 86 , the example implantable device  500  is shown that does not include articulable clasps or gripping elements. As described above, the device  500  includes a coaption portion  504  and an anchor portion  506 . The coaption portion  504  of the device  500  includes a coaption element  510  that is adapted to be implanted between the leaflets  20 ,  22  of the native valve or native mitral valve MV and is slidably attached to an actuation element or means for actuation  512  that extends through the coaption element  510  to a distal cap  514 . 
     The anchor portion  506  of the device  500  includes outer paddles  520  and inner paddles  522  that are connected between the distal cap  514  and the coaption element  510 . The anchor portion  506  is actuatable between open and closed conditions and can take a wide variety of forms, such as, for example, paddles, gripping elements, or the like. Actuation of the actuation element  512  opens and closes the anchor portion  506  of the device  500  to grasp the native valve leaflets  20 ,  22  during implantation. 
     Rather than articulable clasps or gripping elements, the device  500  includes barbed portions  800  arranged on the inner paddles  522 , with each inner paddle  522  optionally having more than one barbed portion  800 . When the anchor portion  506  of the device  500  is closed, tissue grasped between the inner paddles  522  and the coaption element  510  is pressed against the barbed portions  800 . The barbed portions  800  are sharp so that they engage—and in some embodiments, pierce—the native tissue and prohibit the tissue from retracting from the device  500 . In some embodiments, the barbed portions  800  are angled downward to increase engagement with the native tissue. 
     Referring now to  FIG. 86A , the example implantable device  500 A is shown that does not include articulable clasps or gripping elements. As described above, the device  500 A a coaption element  510 A that is adapted to be implanted between the leaflets  20 ,  22  of the native valve or native mitral valve MV and is slidably attached to an actuation element or means for actuation (not shown) that extends through the coaption element  510 A to a distal cap  514 A. The device  500 A also includes outer paddles  520 A and inner paddles  522 A that are connected between the distal cap  514 A and the coaption element  510 A. The device  500 A is actuatable between open and closed conditions and can take a wide variety of forms, such as, for example, paddles, gripping elements, or the like. Actuation of the actuation element opens and closes the paddles  520 A,  522 A of the device  500 A to grasp the native valve leaflets  20 ,  22  during implantation. 
     Rather than articulable clasps or gripping elements, the device  500 A includes barbed portions  800 A arranged on the inner paddles  522 A, with each inner paddle  522 A optionally having more than one barbed portion  800 A. When the device  500 A is closed, tissue grasped between the inner paddles  522 A and the coaption element  510 A is pressed against the barbed portions  800 A. The barbed portions  800 A are sharp so that they engage—and in some embodiments, pierce—the native tissue and prohibit the tissue from retracting from the device  500 A. In some embodiments, the barbed portions  800 A are angled downward to increase engagement with the native tissue. 
     Referring now to  FIG. 87 , the example implantable device  500  is shown that does not include separate articulable clasps or gripping elements. As described above, the device  500  includes a coaption portion  504  and an anchor portion  506 . The coaption portion  504  of the device  500  includes a coaption element  510  that is adapted to be implanted between the leaflets  20 ,  22  of the native valve or native mitral valve MV and is slidably attached to an actuation element or means for actuation  512  that extends through the coaption element  510  to a distal cap  514 . 
     The anchor portion  506  of the device  500  includes outer paddles  520  and inner paddles  522  that are connected between the distal cap  514  and the coaption element  510 . The anchor portion  506  is actuatable between open and closed conditions and can take a wide variety of forms, such as, for example, paddles, gripping elements, or the like. Actuation of the actuation element  512  opens and closes the anchor portion  506  of the device  500  to grasp the native valve leaflets  20 ,  22  during implantation. 
     Rather than separate articulable clasps or gripping elements, the device  500  includes barbed portions  800  arranged on the coaption element  510 , with each side of the coaption element  510  having more than one barbed portion  800 . When the anchor portion  506  of the device  500  is closed, tissue grasped between the inner paddles  522  and the coaption element  510  is pressed against the barbed portions  800 . The barbed portions  800  are sharp so that they engage—and in some embodiments, pierce—the native tissue and prohibit the tissue from retracting from the device  500 . In some embodiments, the barbed portions  800  are angled downward to increase engagement with the native tissue. 
     Referring now to  FIG. 87A , the example implantable device  500 A is shown that does not include articulable clasps or gripping elements. As described above, the device  500 A can have a coaption element  510 A that is adapted to be implanted between the leaflets  20 ,  22  of the native valve or native mitral valve MV and is slidably attached to an actuation element or means for actuation (not shown) that extends through the coaption element  510 A to a distal cap  514 A. The device  500 A also includes outer paddles  520 A and inner paddles  522 A that are connected between the distal cap  514 A and the coaption element  510 A. The device  500 A is actuatable between open and closed conditions and can take a wide variety of forms, such as, for example, paddles, gripping elements, or the like. Actuation of the actuation element opens and closes the paddles  520 A,  522 A of the device  500 A to grasp the native valve leaflets  20 ,  22  during implantation. 
     Rather than separate articulable clasps or gripping elements, the device  500 A includes barbed portions  800 A arranged on the coaption element  510 A, with each side of the coaption element  510 A having more than one barbed portion  800 A. When the device  500 A is closed, tissue grasped between the inner paddles  522 A and the coaption element  510 A is pressed against the barbed portions  800 A. The barbed portions  800 A are sharp so that they engage—and in some embodiments, pierce—the native tissue and prohibit the tissue from retracting from the device  500 A. In some embodiments, the barbed portions  800 A are angled downward to increase engagement with the native tissue. 
     Referring now to  FIG. 88 , the example implantable device  500  is shown that does not include separate articulable clasps or gripping elements. As described above, the device  500  includes a coaption portion  504  and an anchor portion  506 . The coaption portion  504  of the device  500  includes a coaption element  510  that is adapted to be implanted between the leaflets  20 ,  22  of the native valve or native mitral valve MV and is slidably attached to an actuation element or means for actuation  512  that extends through the coaption element  510  to a distal cap  514 . 
     The anchor portion  506  of the device  500  includes outer paddles  520  and inner paddles  522  that are connected between the distal cap  514  and the coaption element  510 . The anchor portion  506  is actuatable between open and closed conditions and can take a wide variety of forms, such as, for example, paddles, gripping elements, or the like. Actuation of the actuation element  512  opens and closes the anchor portion  506  of the device  500  to grasp the native valve leaflets  20 ,  22  during implantation. 
     Rather than articulable clasps or gripping elements, the device  500  includes barbed portions  800  arranged on the coaption element  510 , with each side of the coaption element  510  including at least one barbed portion  800 . Similar to device shown in  FIG. 85 , the device  500  also includes barbed portions  802  arranged on the inner paddles  522 , with each inner paddle  522  having at least one barbed portion  802 . 
     When the anchor portion  506  of the device  500  is closed, tissue grasped between the inner paddles  522  and the coaption element  510  is pressed against the barbed portions  800 ,  802 . The barbed portions  800 ,  802  are sharp so that they engage—and in some embodiments, pierce—the native tissue and prohibit the tissue from retracting from the device  500 . In some embodiments, the barbed portions  800 ,  802  are angled downward to increase engagement with the native tissue. The combination of barbed portions  800  on the coaption element  510  and barbed portions  802  on the inner paddles  522  forms the grasped tissue into an S-shaped tortuous path as it passes over the barbed portions  800 ,  802 . Thus, forces pulling the tissue away from the device  500  will encourage the tissue to further engage the barbed portions  800 ,  802  before the tissue can escape. 
     Referring now to  FIG. 88A , the example implantable device  500 A is shown that does not include articulable clasps or gripping elements. As described above, the device  500 A can have a coaption element  510 A that is adapted to be implanted between the leaflets  20 ,  22  of the native valve or native mitral valve MV and is slidably attached to an actuation element or means for actuation (not shown) that extends through the coaption element  510 A to a distal cap  514 A. The device  500 A also includes outer paddles  520 A and inner paddles  522 A that are connected between the distal cap  514 A and the coaption element  510 A. The device  500 A is actuatable between open and closed conditions and can take a wide variety of forms, such as, for example, paddles, gripping elements, or the like. Actuation of the actuation element opens and closes the paddles  520 A,  522 A of the device  500 A to grasp the native valve leaflets  20 ,  22  during implantation. 
     Rather than articulable clasps or gripping elements, the device  500 A includes barbed portions  800 A arranged on the coaption element  510 A, with each side of the coaption element  510 A including at least one barbed portion  800 A. The device  500 A also includes barbed portions  802 A arranged on the inner paddles  522 A, with each inner paddle  522 A having at least one barbed portion  802 A. 
     When the device  500 A is closed, tissue grasped between the inner paddles  522 A and the coaption element  510 A is pressed against the barbed portions  800 A,  802 A. The barbed portions  800 A,  802 A are sharp so that they engage—and in some embodiments, pierce—the native tissue and prohibit the tissue from retracting from the device  500 A. In some embodiments, the barbed portions  800 A,  802 A are angled downward to increase engagement with the native tissue. The combination of barbed portions  800 A on the coaption element  510 A and barbed portions  802 A on the inner paddles  522 A forms the grasped tissue into an S-shaped tortuous path as it passes over the barbed portions  800 A,  802 A. Thus, forces pulling the tissue away from the device  500 A will encourage the tissue to further engage the barbed portions  800 A,  802 A before the tissue can escape. 
     Referring now to  FIGS. 89-102 , the coaption element  510  and paddles  520 ,  522  of the example device  500  are shown. The coaption element  510  and the paddles can be made from a wide variety of different materials. The coaption element  510  and paddles  520 ,  522  can be formed from one or more of a variety of materials, for example, a metal fabric, such as a mesh, woven, braided, electrospun, deposited or formed in any other suitable way, laser cut, or otherwise cut material or flexible material. The material can be cloth, shape-memory alloy wire—such as Nitinol—to provide shape-setting capability, or any other flexible material suitable for implantation in the human body. 
     In one example embodiment, the coaption element is made from a braided mesh of metal wires, such as a braided mesh of nitinol wires. In one example embodiment, the coaption element  510  is made of a braided mesh of between 25 and 100 wires, such as between 40 and 85 wires, such as between 45 and 60 wires, such as about 48 Nitinol wires or 48 Nitinol wires. 
     The coaption element can be covered in a cloth, such as a polyethylene cloth. The coaption element  510 , can be surrounded in its entirety with a cloth cover, such as a polyethylene cloth of a fine mesh. The cloth cover can provide a blood seal on the surface of the spacer, and/or promote rapid tissue ingrowth. 
     The use of a shape memory material, such as braided Nitinol wire mesh, for the construction of the coaption element  510  results in a coaption element that can self-expandable, flexible in all directions, and/or results in low strains when the coaption element is crimped and/or bent. The material can be a single piece, two halves joined together, or a plurality of sections or pieces that are fastened or joined together in any suitable manner, such as, by welding, with adhesives, or the like. 
     Referring now to  FIGS. 89-90 , the device  500  extends from a proximal portion  505  to a distal portion  507  and includes a coaption element  510 , inner paddles  522 , and outer paddles  520 . The coaption element  510  includes a proximal opening  519 A and a distal opening  515  ( FIGS. 92 and 94 ). The proximal opening  519 A of the coaption element  510  is formed in a proximal portion  519  of the coaption element  510 . The coaption element  510  is jointably connected to the inner paddles  522  by joint portions  525 . The inner paddles  522  are jointably connected to the outer paddles  520  by joint portions  523 . The outer paddles  520  are attached (e.g., jointably attached, etc.) to distal portions  527  by joint portions  521 . Coaption gaps  542  are formed between the inner paddles  522  and the coaption element  510 . Paddle gaps  544  are formed between the inner and outer paddles  520 ,  522  when the paddles  520 ,  522  are folded, for example, as shown in  FIG. 90 . 
     Referring now to  FIG. 91 , a front view of the device  500  is shown (a back view of which would be identical). The coaption element  510  includes the proximal portion  519 , a middle portion  518 , and a distal portion  517 . The proximal portion  519  includes the proximal opening  519 A. The distal portion  517  includes the distal opening  515  and is connected to the joint portions  525 . The shape of the coaption element  510  is rounded or generally rounded to prevent the device  500  from catching or snagging on structures of the heart, such as the chordae tendineae, during implantation. 
     Referring now to  FIG. 92 , a side view of the device  500  is shown. Similar to the device  500  viewed from the front, the distal portion  507  of the device  500  is generally narrower than the proximal portion  505  of the device  500  when the device  500  is viewed from the side. The coaption element  510  flares outwards in the proximal portion  519  from the proximal opening  519 A to the middle portion  518 . The coaption element  510  then tapers or narrows in the middle portion  518  from the proximal portion  519  to the distal portion  517 . The distal portion  517  remains narrow and then splits into the two joint portions  525 . The generally rounded features of the device  500  are further demonstrated by the round shape of the joint portions  523  that jointably connect the inner and outer paddles  520 ,  522  and the outwardly bowed shape of the outer paddles  520 . 
     The coaption gaps  542  formed between the inner paddles  522  and the coaption element  510  are configured to receive native tissue. The narrowing of the coaption element  510  gives the gaps  542  a somewhat teardrop shape that increases in width as the gaps  542  approach the distal portion  507  of the device  500 . The widening of the gaps  542  toward the distal portion  507  allows the inner paddles  522  to contact tissue grasped in the gaps  542  nearer to the proximal portion  505  where pinching forces are greater as a result of the mechanical advantage provided by the length of the paddles  520 ,  522  and other securing or anchoring elements, such as those described in the present application. 
     Referring now to  FIG. 93 , a top view of the device  500  is shown. The proximal opening  519 A in the coaption element  510  is visible at the proximal portion  505  of the device  500  and the coaption element  510  can be seen to be hollow inside. The coaption element  510  has an oval or generally oval-shape when viewed from the top. While the paddles  520 ,  522  appear as protruding rectangular shapes, the paddles  520 ,  522  can extend laterally and have an arcuate or crescent-like shape. 
     Referring now to  FIG. 94 , a bottom view of the device  500  is shown. The distal opening  515  in the coaption element  510  is visible at the distal portion  507  of the device  500  and the coaption element  510  can be seen to be hollow inside. The coaption element  510  has an oval or generally oval-shape when viewed from the top. While the paddles  520 ,  522  appear as protruding rectangular shapes, the paddles  520 ,  522  can extend laterally and have an arcuate or crescent-like shape. The distal portion  517  of the coaption element  510  can be seen splitting in two to join with the joint portions  525 . 
     Referring now to  FIGS. 89A, 90A, 91A, 92A, 93A, 94A, 95A, 96A, 97A, 98A, 99A, 100A, 101A, and 102A , the portions of the device  500 A formed by the strip of material  501 A (e.g., a single, continuous strip of material, a composite strip of material, etc.), that is, the coaption element  510 A and paddles  520 A,  522 A, are shown. The coaption element  510 A and the paddles can be made from a wide variety of different materials. The coaption element  510 A, and paddles  520 A,  522 A can be formed from a material that can be a metal fabric, such as a mesh, woven, braided, electrospun, deposited or formed in any other suitable way, laser cut, or otherwise cut material or flexible material. The material can be cloth, shape-memory alloy wire—such as Nitinol—to provide shape-setting capability, or any other flexible material suitable for implantation in the human body. 
     In one example embodiment, the coaption element  510 A, inner paddle  522 A, and outer paddle  520 A are made from a single, continuous strip of material  501 A. The strip of material  501 A can be formed from a material that can be a metal fabric, such as a mesh, woven, braided, electrospun, deposited or formed in any other suitable way, laser cut, or otherwise cut material or flexible material. The material can be cloth, shape-memory alloy wire—such as Nitinol—to provide shape-setting capability, or any other flexible material suitable for implantation in the human body. In one example embodiment, the strip of material  501 A is made of a braided mesh of between 25 and 100 strands, such as between 40 and 85 strands, such as between 45 and 60 strands, such as about 48 Nitinol wires or 48 Nitinol wires. 
     Referring now to  FIGS. 205-207 , an example woven or braided material  4000  that can be used for the strip of material  501 A is shown. Referring now to  FIG. 205 , an enlarged plan view of the material  4000  is shown. The material  4000  extends from a first edge  4002  to a second edge  4004 . The edges  4002 ,  4004  surround a central portion or field  4006 . The material  4000  is formed by braiding or weaving together central strands  4020 , such as Nitinol wires. Edge strands  4010  extend longitudinally through the material  4000  along the edges  4002 ,  4004 . The central strands  4020  are woven or braided such that the central strands  4020  wrap around the edge strands  4010 . Wrapping the central strands  4020  around the edge strands  4010  causes the material  4000  near the edges  4002 ,  4004  to be thicker than the material in the central portion  4006 , forming a lobed or dog-bone-like shape when the material  4000  is viewed from the end, as is shown in  FIG. 206 . Thus, the edges  4002 ,  4004  of the material  4000  are less flexible than the central portion  4006 . The edge strands  4010  and central strands  4020  can be similar in diameter and can have a diameter ranging from about 0.06 millimeters to about 0.18 millimeters. In some embodiments, the edge strands  4010  can have a larger diameter than the central strands  4020  to impart more stiffness or rigidity to the edges  4002 ,  4004  than the central portion  4006 . For example, the edge strands  4010  can have a diameter ranging from 0.07 millimeters to about 0.27 millimeters, or about 0.17 millimeters, and the central strands  4020  can have a diameter ranging from about 0.04 millimeters to about 0.15 millimeters, or about 0.009 millimeters. In some embodiments, the edges  4002 ,  4004  are made less flexible than the central portion  4006  by using different materials for the edge strands  4010  and central strands  4020 , such as, for example, a metal material—e.g., Nitinol—for the edge strands  4010  and a cloth or plastic material—e.g., polyethylene—for the central strands  4020 . Alternatively, the edge strands  4010  and central strands  4020  can be made from the same material that is subjected to different chemical and or thermal processes that alter the flexibility of the materials so that the central strands  4020  are more flexible than the edge strands  4010 . 
     Referring now to  FIG. 207 , folded portions of material  4000  are layered on top of each other to form a section that has four layers  4000 A,  4000 B,  4000 C,  4000 D. The lobed shape of the individual layers, with thicker edges  4002 ,  4004  than the central portion  4006 , creates three gaps  4001 A,  4001 B,  4001 C between the layers  4000 A,  4000 B,  4000 C,  4000 D of material  4000  in the location of the central portion  4006 . Outer gaps  4001 A,  4001 C are formed between outer layers  4000 A,  4000 D and the adjacent middle layers  4000 B,  4000 C. 
     As is discussed in the present disclosure, the coaption element  510 A of the device  500 A can be formed from four layers of material, such as the material  4000 . When layers of the material  4000  are used to form the coaption element  510 A, the actuation element  512 A of the device  500 A can be inserted through the middle gap  4001 B formed in the center of the four layers of material  4000 . The actuation element  512 A can have a larger diameter than the width of the gap  4001 B, so that inserting the actuation element  512 A causes the middle gap  4001 B to stretch open and adjacent outer gaps  4001 A,  4001 C to reduce in size. In some embodiments, inserting the actuation element  512 A causes the center body portions  4006  on either side to bulge outward to a thickness that is greater than the thickness of the four stacked edge portions  4002 ,  4004 . 
     The coaption element  510 A and paddles  520 A,  522 A can be covered in a cloth, such as a polyethylene cloth. The coaption element  510 A and paddles  520 A,  522 A can be surrounded in their entirety with a cloth cover (e.g., cover  540 A), such as a polyethylene cloth of a fine mesh. The cloth cover can provide a blood seal on the surface of the spacer, and/or promote rapid tissue ingrowth. 
     The use of a shape memory material, such as braided Nitinol wire mesh, for the construction of the coaption element  510 A and paddles  520 A,  522 A results in a coaption element and paddles that can be self-expandable, flexible in all directions, and/or results in low strains when crimped and/or bent. The material can be a single piece, two halves joined together, or a plurality of sections or pieces that are fastened or joined together in any suitable manner, such as, by welding, with adhesives, or the like. 
     Referring now to  FIGS. 89A and 90A , the device  500 A extends from a proximal portion  505 A to a distal portion  507 A and includes a coaption element  510 A, inner paddles  522 A, and outer paddles  520 A. The single, continuous strip of material  501 A extends between two ends  501 B and is folded to form the coaption element  510 A, inner paddles  522 A, and outer paddles  520 A. Some portions of the device  500 A are formed from multiple layers of the strip of material  501 A. For example, the strip of material  501 A is overlapped to form four layers in the area of the coaption element  510 A and two layers in the area of the inner paddle  522 A. 
     The coaption element  510 A and paddles  520 A,  522 A are jointably connected together by joint portions of the strip of material  501 A. The coaption element  510 A is jointably connected to the inner paddles  522 A by joint portions  525 A. The inner paddles  522 A are jointably connected to the outer paddles  520 A by joint portions  523 A. The outer paddles  520 A are attached (e.g., jointably attached, etc.) to the distal portion  527 A by joint portions  521 A. The aperture  527 B in the distal portion  527 A engages the cap  514 A. 
     Various gaps are formed between portions of the device  500 A when the strip of material  501 A is folded into the desired shape. Coaption gaps  542 A are formed between the inner paddles  522 A and the coaption element  510 A. Paddle gaps  544 A are formed between the inner and outer paddles  520 A,  522 A when the paddles  520 A,  522 A are folded, for example, as shown in  FIG. 90A . Collar gaps  546 A are formed when the strip of material  501 A is folded to form the proximal portions  519 B of the coaption element  510 A. 
     Referring now to  FIG. 91A , a front view of the device  500 A is shown (a back view of which would be identical). The coaption element  510 A includes the proximal portion  519 B extending above the joint portions  523 A of the paddles  520 A,  522 A. The distal portion  517 A of the coaption element  510 A is concealed by the paddles  520 A,  522 A when viewed from the front or back, giving the device  500 A a long and narrow rounded rectangular shape. The shape of the coaption element  510 A helps prevent the device  500 A from catching or snagging on structures of the heart, such as the chordae tendineae, during implantation. 
     Referring now to  FIG. 92A , a side view of the device  500 A is shown. The distal end  507 A of the device  500 A is generally narrower than the proximal end  505 A of the device  500 A when the device  500 A is viewed from the side, forming a generally blunt and rounded shape. The coaption element  510 A includes the proximal portion  519 B, a middle portion  518 A, and the distal portion  517 A. The proximal portion  519 B flares outward from the middle portion  518 A to engage the collar  511 D ( FIG. 48A ). The middle portion  518 A of the coaption element  510 A is straight or generally straight when viewed from the side. The distal portion  517 A is attached (e.g., jointably attached, etc.) to the inner paddles  522 A by the joint portions  525 A. The generally rounded features of the device  500 A are further demonstrated by the round shape of the joint portions  523 A that jointably connect the paddles  520 A,  522 A. The joint portions  521 A connecting the outer paddles  520 A to the distal portion  527 A are also rounded and ease the transition in shape from the strip of material  501 A to the cap  514 A ( FIG. 48A ) that is assembled to the flat or generally flat distal portion  527 A. 
     The coaption gaps  542 A formed between the inner paddles  522 A and the coaption element  510 A are configured to receive native tissue. The general straightness of the middle portion  518 A of the coaption element  510 A and the inner paddles  522 A gives the gaps  542 A a consistent or generally consistent width with a narrow upper end where the proximal portion  519 B flares outward to engage the collar  511 D ( FIG. 48A ). Thus, the inner paddles  522 A contact the tissue grasped in the gaps  542 A nearer to the proximal portion  505 A where pinching forces are greater as a result of the mechanical advantage provided by the length of the paddles  520 A,  522 A and other securing or anchoring elements, such as those described in the present application. 
     As discussed above, the coaption element  510 A and paddles  520 A,  522 A of the device  500 A are formed by folding the strip of material  501 A. The strip of material  501 A is then unfolded and assembled with other components, such as the collar  511 D, cap  514 A, and paddle frames  524 A. The strip of material  501 A is shape-set after being formed into a desired shape so that the strip of material  501 A returns to the desired shape after assembly with other components. In some embodiments, a jig is used during folding and shape-setting of the strip of material  501 A to ensure that the strip of material  501 A is folded in the proper location with the desired radius. 
     Referring again to  FIG. 92A , portions of a jig  570 A to aid in folding and shape-setting the device  500 A are shown. The strip of material  501 A is shown folded around the jig  570 A so that the strip of material  501 A forms a desired shape. To fold the strip of material  501 A into the shape of the device  500 A using the jig  570 A, the strip of material  501 A is arranged with one of the ends  501 B at the location of the inner paddle  522 A. The strip  501 A is extended from the end  501 B in a distal direction  507 B to form a first layer  581 A of the inner paddle  522 A, around a first jig portion  572 A to form a first layer  581 A of the hinge portion  525 A, and then in a proximal direction  505 B to form the first layer  581 A of the coaption element  510 A. The first layer  581 A of material forms the sides of the inner paddle  522 A and coaption element  510 A that surround the coaption gap  542 A. The strip  501 A is then wrapped around a second jig portion  574 A to form one of the proximal portions  519 B and openings  546 A of the coaption element  510 A. The strip  501 A is then extended in a distal direction  507 B along the first layer  581 A to form a second layer  582 A of the coaption element  510 A. The strip  501 A is then wrapped back round the first jig portion  572 A, forming the second layer  582 A of the hinge portion  525 A and back in the proximal direction  505 B to form the second layer  582 A of the inner paddle  522 A. The strip  501 A is then wrapped around a third jig portion  576 A to form the joint portion  523 A. The strip  501 A then extends in the distal direction  507 B along the inner paddle  522 A to form the outer paddle  520 A before being folded around a fourth jig portion  578 A to form the joint portion  521 . The strip  501 A is then extended laterally to form the distal portion  527 . The routing of the strip  501 A through the jig  570 A is then performed in reverse order on the opposite side of the jig  570 A to form the second half of the device  500 A. That is, the strip  501 A is then wrapped around the fourth, third, first, second, and first jig portions (a second time)  578 A,  576 A,  572 A,  574 A,  572 A to form the second half of the device  500 A. Once the strip  501 A has been wrapped around the jig portions as described above, a shape-setting operation is performed. While the portions of the illustrated jig have a rounded or generally round shape, the portions can have any shape to aid in the folding and shaping of the strip of material  501 A. The jig  570 A can have more or fewer portions for engaging the strip of material  501 A. 
     Referring now to  FIG. 93A , a top view of the device  500 A is shown. The first and second layers  581 A,  582 A of each half of the device  500 A form the four layers of the coaption element  510 A. The proximal opening  519 C of the coaption element  510 A is formed between the two second layers  582 A. In some embodiments, the opening  519 C is formed by inserting the actuation element  512 A (not shown) between the folded and overlapping layers of the strip of material  501 A after shape-setting of the strip of material  501 A. In some embodiments, the opening  519 C is formed by shape-setting the folded layers  581 A,  582 A of the strip of material  501 A around an additional jig portion (not shown) to give the coaption element  510 A a rounded or generally rounded shape when viewed from the top. 
     Referring now to  FIG. 94A , a bottom view of the device  500 A is shown. The distal portion  527 A of the strip of material  501 A is shown, as is the aperture  527 B for receiving the cap  514 A. The coaption element  510 A and outer paddles  520 A have a generally rounded rectangle shape when viewed from below. 
     Referring now to  FIGS. 95-102 , perspective and cross-sectional views of the device  500  are shown. Referring now to  FIG. 95 , the device  500  is shown sliced by cross-section plane  96  near the proximal portion of the coaption element  510 . Referring now to  FIG. 96 , a cross-sectional view of the device  500  is shown as viewed from cross-section plane  96  in  FIG. 95 . At the location of the plane  96 , the coaption element  510  has an oval or generally oval shape with thicker portions along the sides of the coaption element  510 . The distal opening  515  is visible from the proximal portion and the coaption element  510  has a hollow interior. 
     Referring now to  FIG. 97 , the device  500  is shown sliced by cross-section plane  98  positioned about half of the way between the distal portion  507  and the proximal portion  505  of the coaption element  510 . Referring now to  FIG. 98 , a cross-sectional view of the device  500  is shown as viewed from cross-section plane  98  in  FIG. 97 . At the location of the plane  98 , the coaption element  510  has an oval or generally oval shape that is larger than the oval shape of  FIG. 96 . 
     Referring now to  FIG. 99 , the device  500  is shown sliced by cross-section plane  100 ′ positioned about one-quarter of the way between the distal portion  507  and the proximal portion  505  of the coaption element  510 . Referring now to  FIG. 99 , a cross-sectional view of the device  500  is shown as viewed from cross-section plane  100 ′ in  FIG. 99 . At the location of the plane  100 ′, the coaption element  510  has an oval or generally oval shape that is narrower than the oval shape seen in  FIG. 98 . 
     Referring now to  FIG. 101 , the device  500  is shown sliced by cross-section plane  102 ′ positioned near the distal portion  507  of the coaption element  510 . Referring now to  FIG. 102 , a cross-sectional view of the device  500  is shown as viewed from cross-section plane  102 ′ in  FIG. 101 . At the location of the plane  102 ′, the coaption element  510  has an oval or generally oval shape that is smaller than the oval shape seen in  FIG. 100  and that is split as the coaption element  510  joins the joint portions  525 . 
     Referring now to  FIGS. 95A, 96A, 97A, 98A, 99A, 100A, 101A, and 102A , perspective and cross-sectional views of the portions of the device  500 A formed by the single, continuous strip of material  501 A are shown. Referring now to  FIG. 95A , the device  500 A is shown sliced by cross-section plane  96 A near the proximal portion of the coaption element  510 A. Referring now to  FIG. 96A , a cross-sectional view of the device  500 A is shown as viewed from cross-section plane  96 A in  FIG. 95A . At the location of the plane  96 A, the coaption element  510  has a rectangular or generally rectangular shape. In some embodiments, when the actuation element (not shown) is inserted between the layers  582 A of the coaption element  510 A, the coaption element  510 A remains straight when viewed from the side but bows outward to form a rounded or generally round shape when viewed from cross-section plane  96 A. 
     Referring now to  FIG. 97A , the device  500 A is shown sliced by cross-section plane  98 A near the proximal portion of the coaption element  510 A. Referring now to  FIG. 98A , a cross-sectional view of the device  500 A is shown as viewed from cross-section plane  98 A in  FIG. 97A . At the location of the plane  98 A, the coaption element  510  has a rectangular or generally rectangular shape. In some embodiments, when the actuation element (not shown) is inserted between the layers  582 A of the coaption element  510 A, the coaption element  510 A remains straight when viewed from the side but bows outward to form a rounded or generally round shape when viewed from cross-section plane  98 A. 
     Referring now to  FIG. 99A , the device  500 A is shown sliced by cross-section plane  100 A′ near the proximal portion of the coaption element  510 A. Referring now to  FIG. 100A , a cross-sectional view of the device  500 A is shown as viewed from cross-section plane  100 A′ in  FIG. 99A . At the location of the plane  100 A′, the coaption element  510  has a rectangular or generally rectangular shape. In some embodiments, when the actuation element (not shown) is inserted between the layers  582 A of the coaption element  510 A, the coaption element  510 A remains straight when viewed from the side but bows outward to form a rounded or generally round shape when viewed from cross-section plane  100 A′. 
     Referring now to  FIG. 101A , the device  500 A is shown sliced by cross-section plane  102 A near the proximal portion of the coaption element  510 A. Referring now to  FIG. 102A , a cross-sectional view of the device  500 A is shown as viewed from cross-section plane  102 A in  FIG. 101A . At the location of the plane  102 A, the coaption element  510  has a rectangular or generally rectangular shape. In some embodiments, when the actuation element (not shown) is inserted between the layers  582 A of the coaption element  510 A, the coaption element  510 A remains straight when viewed from the side but bows outward to form a rounded or generally round shape when viewed from cross-section plane  102 A. 
     Referring now to  FIGS. 103-105 , the example implantable prosthetic device  100  is shown having covered and uncovered portions. The device  100  is shown implanted in the native mitral valve MV and secured to the native leaflets  20 ,  22 . As described above, the device  100  includes a coaption element or means for coapting  110 , paddles  120 , clasps  130 , and a cap  114 . The paddles  120  and clasps  130  are in a closed position to secure the device  100  to the grasped native leaflets  20 ,  22  of the mitral valve MV. A proximal portion  105  of the device  100  is exposed to the left atrium LA and a distal portion  107  of the device  100  is exposed to the left ventricle LV. 
     Referring now to  FIG. 103 , the device  100  is shown with a covering  900  that covers the entirety of the coaption element or means for coapting  110  and the cap  114 . In some embodiments, the covering  900  can be a cloth or fabric or polymer such as PET, velour, electrospun, deposited, or other suitable material. In some embodiments, in lieu of or in addition to a fabric, the cover can include a coating (e.g., polymeric) that is applied to the prosthetic device/spacer device and/or mechanical sealing mechanisms, such as silicone and interlocking joints can be used. The covering  900  can be formed from a metal fabric, such as a mesh, woven, braided, or formed in any other suitable way or a laser cut or otherwise cut flexible material. The covering  900  can be cloth, shape-memory alloy wire—such as Nitinol—to provide shape-setting capability, or any other flexible material suitable for implantation in the human body. The covering  900  prohibits blood flow through coaption element or means for coapting  110  at the proximal portion  105 , and also provides a seal between the device  100  and the leaflets  20 ,  22 . Thus, the covering  900  aids in the prohibition of blood flow through the native valve at the location of the device  100 . The covering  900  also prohibits recirculating blood flow from entering the device  100  from the distal portion  107 . 
     Referring now to  FIG. 104 , the device  100  is shown with a covering  1000  that partially covers the coaption element or means for coapting  110  from the proximal portion  105  of the device  100  to the portion of the coaption element or means for coapting  110  that engages the native leaflets  20 ,  22 . In some embodiments, the cover can be a cloth or fabric such as PET, velour, or other suitable fabric. In some embodiments, in lieu of or in addition to a fabric, the cover can include a coating (e.g., polymeric) that is applied to the prosthetic device or prosthetic spacer device. The covering  1000  can be formed from a metal fabric, such as a mesh, woven, braided, or formed in any other suitable way or a laser cut or otherwise cut flexible material. The covering  1000  can be cloth, shape-memory alloy wire—such as Nitinol—to provide shape-setting capability, or any other flexible material suitable for implantation in the human body. Thus, the covering  1000  prohibits blood flow through the coaption element or means for coapting  110  at the proximal portion  105 . 
     Referring now to  FIG. 105 , the device  100  is shown with a covering  1100  that partially covers the coaption element or means for coapting  110  extending from the portion of the coaption element or means for coapting  110  that engages the native leaflets  20 ,  22  toward the distal portion  107 . The covering  1100  also covers the cap  114 . In some embodiments, the cover can be a cloth or fabric such as PET, velour, or other suitable fabric. In some embodiments, in lieu of or in addition to a fabric, the cover can include a coating (e.g., polymeric) that is applied to the prosthetic device or prosthetic spacer device. The covering  1100  can be formed from a mesh, woven, braided, or formed in any other suitable way. The covering  1100  can be cloth, polymer, silicone, electrospun material, deposited material, and/or shape-memory alloy wire—such as Nitinol—to provide shape-setting capability, or any other flexible material suitable for implantation in the human body. Thus, blood flow can enter the coaption element or means for coapting  110  but is prohibited from passing through the device by the covering  1100  arranged toward the distal portion  107 . The covering  1100  also prohibits recirculating blood flow from entering the device  100  from the distal portion  107 . 
     Referring now to  FIGS. 106-109 , an example coaption element  1200  for an implantable prosthetic device is shown. The coaption element  1200  can be used with any of the implantable prosthetic devices described in the present application. Referring to  FIG. 106 , the coaption element  1200  has a cylindrical or generally cylindrical shape extending between two caps  1201 . However, the coaption element  1200  can have any shape, such as any of the shapes disclosed herein. In one example embodiment, the direction of expansion of the coaption element  1200  can be controlled. For example, the width/size of the coaption element in the Anterior to Posterior direction (when implanted), Medial to Lateral direction (when implanted), or both can be expanded (or contracted) in a controlled manner. The coaption element  1200  can be made from a mesh of material. Referring now to  FIG. 107 , the mesh wall of the generally cylindrical coaption element  1200  extends outward from the caps  1201  by a distance  1204 . Referring now to  FIG. 108 , axial forces  1208  are applied to the caps  1201  of the coaption element  1200  causing the coaption element  1200  to compress in an axial direction. Compressing the coaption element  1200  axially causes the coaption element  1200  to expand or bulge in an outward direction  1210 , such that the distance  1204  increases. 
     The coaption element  1200  can be compressed in a wide variety of different ways. For example, a threaded connection can be used to draw the two ends of the coaption element together or push the two ends of the coaption element apart. For example, a collar can be provided on each end of the coaption element. One of the collars can threadedly engage a threaded shaft, while the other collar is rotatably connected to the shaft. Rotating the shaft in one direction draws the collars together. Rotating the shaft in the opposite direction moves the collars apart. 
     Incorporating the coaption element  1200  into an implantable prosthetic device of the present application allows the coaption element to be expanded to press outward against tissue grasped between the coaption element and the paddles and/or gripping members. 
     Referring now to  FIGS. 106A, 108A, 106B, and 108B , example coaption elements  1200 , similar to the embodiment illustrated by  FIGS. 106-109 , for an implantable prosthetic device is shown. The coaption element  1200  can be used with any of the implantable prosthetic devices described in the present application. Referring to  FIG. 106A , the coaption element  1200  has a cylindrical or generally cylindrical shape extending between two caps  1201 . However, the coaption element  1200  can have any shape, such as any of the shapes disclosed herein. In the example illustrated by  FIGS. 106A and 108A , the coaption element  1200  comprises a tube  1203  with slots  1205 . For example, the tube  1203  can be made from a shape memory alloy, such as nitinol, and the slots can be cut, such as laser cut, into the tube. The slots can be cut into the material that forms the tube, before the material is formed into a tube. 
     In one example embodiment, the direction of expansion of the coaption element  1200  can be controlled. For example, the configuration of the slots  1205  and/or a shape-set of the tube can be selected to control the shape of the expanded coaption element  1200 . For example, the configuration of the slots  1205  and/or a shape-set can determine the way the width/size of the coaption element in the Anterior to Posterior direction, and/or Medial to Lateral direction expanded (and/or contract). Referring to  FIG. 106A , the tube wall of the generally cylindrical coaption element  1200  can extend outward from caps  1201  by a distance  1204 . Referring now to  FIG. 108A , axial forces  1208  and/or rotational forces  1209  can be applied to the caps  1201  of the coaption element  1200  causing the coaption element  1200  to expand from the configuration illustrated by  FIG. 106A  to the configuration illustrated by  FIG. 108A . In the illustrated example, compressing the coaption element  1200  axially and twisting the coaption element the coaption element  1200  to expand or bulge in an outward direction  1210 , such that the distance  1204  increases. 
     Referring to  FIGS. 106B and 108B , the coaption element  1200  can be compressed in a wide variety of different ways. For example, a threaded connection  1221  can be used to draw the two ends of the coaption element together and twist the coaption element in a first direction or push the two ends of the coaption element apart and twist the coaption element in a second direction. For example, a collar can be provided on each end of the coaption element. One of the collars can threadedly engage a threaded shaft, while the other collar is fixedly connected to the shaft. Rotating the shaft in one direction draws the collars together and rotates the collars relative to one another in a first direction. Rotating the shaft in the opposite direction moves the collars apart and rotates the collars relative to one another in a second direction. The pitch of the threaded connection can be selected to set a ratio between the distance the coaption element  1200  is compressed and the angle that the coaption element is twisted. 
     Incorporating the coaption elements  1200  illustrated by  FIGS. 106A, 108A, 106B , and  108 B into an implantable prosthetic device of the present application allows the coaption element to be expanded to press outward against tissue grasped between the coaption element and the paddles and/or gripping members. 
       FIGS. 106C and 108C  illustrate an example embodiment of a controllably expandable coaption element  1200  for an implantable prosthetic device. The coaption element  1200  can be used on its own, with a covering, or inside any of the coaption elements described herein (to expand the coaption element). The coaption element  1200  can be used with any of the implantable prosthetic devices described in the present application. Referring to  FIG. 106C , the coaption element  1200  has pairs of pivotally connected arms  1231 . The pairs of pivotally connected arms  1231  each extending between and pivotally connected to two caps  1201 . In the illustrated example, there are two pairs of pivotally connected arms  1231 . However, there can be one, three, four, or any number of pairs of pivotally connected arms. 
     In one example embodiment, the direction of expansion of the coaption element  1200  can be controlled. For example, two pairs (as illustrated) of pivotally connected arms can be included to change the width/size of the coaption element in only one of the Anterior to Posterior direction, and/or Medial to Lateral direction. Four pairs of pivotally connected arms  1231  can be included to change the width/size of the coaption element in both the Anterior to Posterior direction and Medial to Lateral direction. When four pairs of pivotally connected arms  1231  are included, the arms can have different lengths and/or pivot point locations to make the coaption element  1200  expand (or contract) differently in different dictions. For example, the lengths of the arms can be selected to expand more in the Medial to Lateral direction than the Anterior to Posterior direction. 
     Referring now to  FIG. 108C , axial forces  1208  can be applied to the caps  1201  of the coaption element  1200  causing the coaption element  1200  to expand from the configuration illustrated by  FIG. 106C  to the configuration illustrated by  FIG. 108C . In the illustrated example, compressing the pivotally connected arms  1231  axially causes the pivotal connections  1233  or knees to spread apart in an outward direction  1210 , such that the distance  1204  increases. 
     Referring to  FIGS. 106C and 108C , the coaption element  1200  can be compressed in a wide variety of different ways. For example, a threaded connection  1221  can be used to draw the two ends of the coaption element together or push the two ends of the coaption element apart. For example, a collar can be provided on each end of the coaption element. One of the collars can threadedly engage a threaded shaft, while the other collar is rotatably connected to the shaft. Rotating the shaft in one direction draws the collars together. Rotating the shaft in the opposite direction moves the collars apart. 
     Incorporating the coaption element  1200  illustrated by  FIGS. 106C, and 108C  into an implantable prosthetic device of the present application allows the coaption element to be expanded to press outward against tissue grasped between the coaption element and the paddles and/or gripping members. 
       FIGS. 106D and 108D  illustrate an example embodiment of an expandable coaption element  1200  for an implantable prosthetic device. The coaption element  1200  can be used on its own, with a covering (See  FIGS. 106E and 108E ), or inside any of the coaption elements described herein (to expand the coaption element). The coaption element  1200  can be used with any of the implantable prosthetic devices described in the present application. Referring to  FIG. 106E , the coaption element  1200  has, a central support member  1243 , one or more pivotally connected arms  1241 , and connection lines  1245 . Each arm  1241  extends from a pivotal connection to the central support member  1243 . Each connection line  1245  is connected to the central support member  1243  and a pivotally connected arm  1241 . The length of the connection line  1245  sets the degree to which the connection arms pivot away from the central support member  1243 . In the illustrated example, there are two pivotally connected arms  1241 . However, there can be one, three, four, or any number of pivotally connected arms. 
     In one example embodiment, the direction of expansion of the coaption element  1200  can be controlled. For example, two pivotally connected arms can be included to change the width/size of the coaption element in only one of the Anterior to Posterior direction, and/or Medial to Lateral direction. Four pivotally connected arms  1241  can be included to change the width/size of the coaption element in both the Anterior to Posterior direction and Medial to Lateral direction. When four pivotally connected arms  1241  are included, the arms and/or the connection lines  1245  can have different lengths and/or pivot point locations to make the coaption element  1200  expand (or contract) differently in different dictions. For example, the lengths of the arms and/or the connection lines can be selected to expand more in the Medial to Lateral direction than the Anterior to Posterior direction. 
     The arms  1241  can be moved from the contracted position ( FIG. 106D ) to the expanded position ( FIG. 108D ). For example, the arms  1241  can be biased toward the expanded position by a spring or other biasing means. In the illustrated example, restraints  1247 , such as sutures hold the arms  1241  in the contracted position. The restraints  1247  can be removed or broken to cause the coaption element  1200  to expand from the configuration illustrated by  FIG. 106D  to the configuration illustrated by  FIG. 108D . 
       FIGS. 106E and 108E  illustrate an example embodiment that is similar to the embodiment illustrated by  FIGS. 106D and 108D , except that the coaption element includes a covering material  1253 . The covering material  1253  can extend from the central support member  1243  to each arm  1241 . The covering material  1253  can be used with the connection lines  1245  or the covering material can eliminate the need for the connection lines  1245 . 
     Referring now to  FIG. 106F , an example coaption element  1200 , similar to the embodiment illustrated by  FIGS. 106-109 , for an implantable prosthetic device is shown. The coaption element  1200  can be used with any of the implantable prosthetic devices described in the present application. Referring to  FIG. 106F , the coaption element  1200  is defined by a coil  1263  extending between two caps  1201 . The coaption element  1200  can have any shape, such as any of the shapes disclosed herein. The coil  1263  can be made from a shape memory alloy, such as nitinol. 
     In one example embodiment, the direction of expansion of the coaption element  1200  can be controlled. For example, the shape-set of the coil  1263  can be selected to control the shape of the expanded coaption element  1200 . For example, the configuration of the shape-set can determine the way the width/size of the coaption element in the Anterior to Posterior direction, and/or Medial to Lateral direction expand (and/or contract). Referring to Axial forces  1208  and/or rotational forces  1209  can be applied to caps  1201  of the coaption element  1200  causing the coaption element  1200  to expand or retract from the configuration illustrated by  FIG. 106F . In the illustrated example, extending the coil  1263  axially and twisting the coil  1263  contracts the coil in an inward direction  1211  and compressing the coil  1263  axially and twisting the coil in the opposite direction expands or bulge the coil in an outward direction. 
     Referring to  FIG. 106F , the coaption element  1200  can be compressed in a wide variety of different ways. For example, a threaded connection  1221  can be used to draw the two ends of the coaption element together and twist the coaption element in a first direction or push the two ends of the coaption element apart and twist the coaption element in a second direction. For example, a collar can be fixedly connected to each end of the coil  1263 . One of the collars can threadedly engage a threaded shaft, while the other collar is fixedly connected to the shaft. Rotating the shaft in one direction draws the collars together and rotates the collars relative to one another in a first direction. Rotating the shaft in the opposite direction moves the collars apart and rotates the collars relative to one another in a second direction. The pitch of the threaded connection can be selected to set a ratio between the distance the coaption element  1200  is compressed and the angle that the coaption element is twisted. 
     Incorporating the coaption elements  1200  illustrated by  FIG. 106F  into an implantable prosthetic device of the present application allows the coaption element to be expanded to press outward against tissue grasped between the coaption element and the paddles and/or gripping members. 
       FIGS. 106G-106I  illustrate example embodiments of expandable coaption elements  1200 . In the examples illustrated by  FIGS. 106G-106I , the coaption elements are inflated by a fluid medium to expand the coaption element. The fluid medium can take a wide variety of different forms. Examples of fluids that can be used to inflate the coaption element  1200  include, but are not limited to, air, gel, water, blood, foaming materials, etc. The coaption element  1200  can be used with any of the implantable prosthetic devices described in the present application. 
     Referring to  FIG. 106G , the coaption element  1200  can have an outer layer  1271  (For example, any of the coaption elements  110 ,  510  disclosed herein) and an inner layer  1273  or balloon. The coaption element  1200  can have any shape, such as any of the shapes disclosed herein. In the example illustrated by  FIGS. 106G and 1086 , the inner layer  1273  is disposed in the outer layer  1271  and can have the same or generally the same shape as the inner surface of the outer layer. The inner layer can be made from an expandable material, such as a rubber or other material traditionally used for making balloons and angioplasty devices. The outer layer  1271  can be made from a shape memory alloy, such as nitinol. 
     Referring to  FIGS. 106H and 106I , in one example embodiment, the direction of expansion of the coaption element  1200  can be controlled. In the example illustrated by  FIG. 106H , the inner layer  1273  comprises two balloons that are optionally connected together. However, any number of balloons can be used. For example, the inner layer can comprise 3, 4, or any number of balloons. The balloons can be individually inflated to control the shape of expansion of the coaption element  1200 . When the balloons are connected together, the connection can also affect the shape of expansion. In the example illustrated by  106 H, the balloons are connected together along a plane or area  1275 . Expansion of the inner layer  1273  in the direction  1277  will be less than the expansion in the direction  1279  due to the connection along the plane  1275 . As such, in this example, the expansion due to inflation can be limited to or substantially limited to expansion in the Medial to Lateral direction. 
     The use of multiple balloons and the configuration of any connections between the balloons can determine the way the width/size of the coaption element in the Anterior to Posterior direction, and/or Medial to Lateral direction expand (and/or contract). 
     In the example illustrated by  FIG. 106I , the inner layer  1273  comprises one or more supports  1281  or struts. One support  1281  is illustrated, but any number can be used. For example, the inner layer can comprise 2, 3, 4, or any number of supports. The supports  1281  can divide the inner layer into multiple independently inflatable chambers or the supports may not seal off independent chambers and inflation fluid applied to any chamber will fill all of the chambers. When there are independently inflatable chambers, the chambers can be individually inflated to control the shape of expansion of the coaption element  1200 . The supports also affect the shape of expansion. In the example illustrated by  106 I, the support  1281  will reduce or eliminate expansion of the inner layer  1273  in the direction  1277 . As such, in this example, the expansion due to inflation can be limited to or substantially limited to expansion in the Medial to Lateral direction. 
     The use of multiple independently inflatable chambers and/or the configuration of the support members  1281  can determine the way the width/size of the coaption element in the Anterior to Posterior direction, and/or Medial to Lateral direction expand (and/or contract). 
     Incorporating the coaption elements  1200  illustrated by  FIGS. 106G-106I  into an implantable prosthetic device of the present application allows the coaption element to be expanded to press outward against tissue grasped between the coaption element and the paddles and/or gripping members. 
     Referring now to  FIGS. 110-111 , an example implantable prosthetic device  1300  is shown. The device  1300  is similar to the device  100 , described above, and includes a coaption element  1310 , paddles  1320 , and clasps or gripping members  1330 . Referring now to  FIG. 111 , a top view of the coaption element  1310  is shown. As can be seen in  FIG. 111 , the coaption element  1310  has an oval or generally oval-shaped cross-section. The coaption element  1310  does not include a central opening and can be formed from a solid piece of material, such as foam. Forming the coaption element  1310  from a solid piece of foam material prohibits blood from flowing through the center of the coaption element  1310 , thereby substantially eliminating a location where blood can be captured. The device  1300  can include any other features for an implantable prosthetic device discussed in the present application, and the device  1300  can be positioned to engage valve tissue  20 ,  22  as part of any suitable valve repair system (e.g., any valve repair system disclosed in the present application). The prosthetic device  1300  can be opened and closed in a wide variety of different ways. For example, a sleeve can be slidably disposed over the coaption element to engage and open the paddles. Or, the paddles can be opened by pulling a line or suture that opens the clasps and the movement of the clasps can open the paddles. However, any mechanism for opening and closing the device  1300  can be used. 
     Referring now to  FIGS. 112-128 , an example paddle frame  1400  for an implantable prosthetic device is shown. The paddle frame  1400  can be used with any of the implantable prosthetic devices described in the present application. The paddle frame  1400  is formed from a piece of material  1402 , such as nitinol, or any other suitable material. The paddle frame  1400  extends from a cap attachment portion  1410  to a paddle connection portion  1420  and has a proximal portion  1422 , a middle portion  1424 , and a distal portion  1426 . In some embodiments, the paddle frame  1400  includes attachment portions  1440  for securing a cover (see  FIG. 30 ), the inner paddle  520 , and/or the outer paddle  522  to the paddle frame  1400 . In some embodiments, the paddle frame  1400  is thinner in the location of the fifth curve  1438  to facilitate bending of both sides of the paddle frame  1400  toward the center plane  1404  during, for example, crimping of the device. 
     The paddle frame  1400  extends between a first attachment portion  1412  in a rounded, three-dimensional shape through the proximal, middle, and distal portions  1422 ,  1424 ,  1426  and returns to a second attachment portion  1414 . To form a rounded three-dimensional shape, the paddle frame  1400  is bent or curved in multiple locations as the paddle frame  1400  extends between the first and second attachment portions  1412 ,  1414 . The attachment portions  1412 ,  1414  include notches  1416 ,  1418  respectively for attachment to the cap. The paddle frame  1400  flexes at the area  1419 . The area  1419  can include a wider portion  1417  to distribute the stress that results from flexing the paddle frame  1400  over a greater area. Also, notches  1416 ,  1418  can include radiused notches  1415  at each end of the notches. The radiused notches  1415  serve as strain reliefs for the bending area  1419  and the area where the paddle frame  1400  connects to the cap. 
     The paddle frame  1400  curves away from a median or central plane  1404  ( FIG. 115 ) at a first curve  1430  to widen the shape of the paddle frame  1400 . As can be seen in  FIG. 117 , the paddle frame  1400  also curves away from a frontal plane  1406  in the location of the first curve  1430 . The paddle frame  1400  curves away from the outward direction of the first curve  1430  at a second curve  1432  to form sides of the frame  1400 . The paddle frame continues to slope away from the frontal plane  1406  in the location of the second curve  1432 . In some embodiments, the second curve  1432  has a larger radius than the first curve  1430 . The paddle frame  1400  curves away from the frontal plane  1406  at a third curve  1434  as the paddle frame  1400  continues to curve in the arc of the second curve  1432  when viewed from the frontal plane  1406 . This curvature at the third curve  1434  results in a gradual departure of the frame  1400 , and thus the native valve leaflet from the centerline or frontal plane  1406 . This departure from the centerline results in spreading of the leaflet tissue toward the valve annulus, which can result in less stress on the leaflet tissue. The paddle frame  1400  curves toward the lateral plane  1404  at a fourth curve  1436  as the frame  1400  continues to curve away from the frontal plane  1406 . The rounded three-dimensional shape of the paddle frame  1400  is closed with a fifth curve  1438  that joins both sides of the paddle frame  1400 . As can be seen in  FIGS. 116 and 118 , the paddle frame  1400  has an arcuate or generally arcuate shape as the frame  1400  extends away from the attachment portion  1420  and to the closed or distal portion  1426 . The middle portion  1424  of the frame is closer to the frontal plane  1406  than the closed portion  1426 , giving the sides of the middle portion  1424  a rounded, wing-like shape that engages the curved surface of coaption element (not shown) during grasping of native tissue between a paddle (not shown) and coaption element of an implantable device of the present invention. 
     Referring to  FIG. 191 , in an example embodiment, a flat blank  1403  of paddle frame  1400  can be cut, for example laser cut, from a flat sheet of material. Referring to  FIG. 192 , the cut blank  1403  can then be bent to form the three-dimensional shaped paddle frame  1400 . 
     Referring to  FIGS. 193 and 194 , in one example embodiment, the paddle frames  1400  can be shape-set to provide increased clamping force against or toward the coaption element  510  when the paddles  520 ,  522  are in the closed configuration. This is because the paddle frames are shape-set relative to the closed position (e.g.  FIG. 194 ) to a first position (e.g.,  FIG. 193 ) which is beyond the position where the inner paddle  520  would engage the coaption element, such as beyond the central plane  552  of the device  500 , such as beyond the opposite side of the coaption element, such as beyond the outer paddle on the opposite side of the coaption element. Referring to  FIG. 194 , the paddle frame  1400  is flexed and attached to the inner and outer paddles  522 ,  520 , for example by stitching. This results in the paddle frames having a preload (i.e., the clamping force against or toward the coaption element is greater than zero) when the paddle frames  1400  are in the closed configuration. Thus, shape-setting the paddle frames  1400  in the  FIG. 193  configuration can increase the clamping force of the paddle frames  1400  compared to paddle frames that are shape-set in the closed configuration ( FIG. 194 ). 
     The magnitude of the preload of the paddle frames  1400  can be altered by adjusting the degree to which the paddle frames  1400  are shape-set relative to the coaption element  510 . The farther the paddle frames  1400  are shape-set past the closed position, the greater the preload. 
     The curves of the paddle frame  1400  can be independent from one another, that is, one curve is complete before another curve starts, or can be combined, that is, the paddle frame  1400  curves in multiple directions simultaneously. 
     Referring now to  FIGS. 112A, 114A, 115A, 116A, 117A, and 118A , example paddle frames  1400 A for an implantable prosthetic device are shown. The paddle frames  1400 A can be used with any of the implantable prosthetic devices described in the present application. Each paddle frame  1400 A is formed from a piece of material  1402 A, such as nitinol, or any other suitable material. Each paddle frame  1400 A extends from a cap attachment portion  1410 A to a paddle connection portion  1420 A and has a proximal portion  1422 A, a middle portion  1424 A, and a distal portion  1426 A. 
     Each paddle frame  1400 A extends between a first attachment portion  1412 A in a rounded, three-dimensional shape through the proximal, middle, and distal portions  1422 ,  1424 ,  1426  and returns to a second attachment portion  1414 . To form a rounded three-dimensional shape, each paddle frame  1400 A is bent or curved in multiple locations as the paddle frame  1400 A extends between the first and second attachment portions  1412 A,  1414 A. The attachment portions  1412 A,  1414 A include notches  1416 A,  1418 A respectively for attachment to the cap. The paddle frames  1400 A flex at the area  1419 A. The area  1419 A can include a wider portion  1417 A to distribute the stress that results from flexing the paddle frame  1400 A over a greater area. Also, notches  1416 A,  1418 A can include radiused notches  1415 A at each end of the notches  1416 A,  1418 A. The radiused notches  1415 A serve as strain reliefs for the bending area  1419 A and the area where the paddle frame  1400 A connects to the cap. 
     Each paddle frame  1400 A curves away from a median or central plane  1404 A ( FIG. 116A ) at a first curve  1430 A to widen the shape of the paddle frame  1400 A. As can be seen in  FIG. 114A , the paddle frame  1400 A also curves away from a frontal plane  1406 A in the location of the first curve  1430 A. The paddle frame  1400 A curves away from the outward direction of the first curve  1430 A at a second curve  1432 A to form sides  1433 A of the frame  1400 A that are parallel or substantially parallel to the central plane  1404 A when viewed from the frontal plane  1406 A. The paddle frame continues to slope away from the frontal plane  1406 A in the location of the second curve  1432 A. In some embodiments, the second curve  1432 A has a larger radius than the first curve  1430 A. The paddle frame  1400 A curves back toward from the frontal plane  1406 A at a third curve  1434 A in the middle portion  1424 A while the sides  1433 A of the paddle frame  1400 A remain parallel or substantially parallel to the central plane  1404 A. The paddle frame  1400 A curves away from the central plane  1404 A a second time at a fourth curve  1436 A and continues to curve away from the central plane  1404 A through the remainder of the middle and distal portions  1424 A,  1426 A. The rounded three-dimensional shape of the paddle frame  1400 A is closed by an end portion  1442 A connected to the sides  1433 A by fifth curves  1438 A that form rounded corners of the distal end  1426 A of the paddle frame  1400 A. 
     The end portion  1442 A can be wider than the remainder of the paddle frame  1400 A to accommodate features that allow the paddle frames  1400 A to be attached to the paddles (not shown) and cover (not shown). For example, the end portion  1442 A can include a slot  1444 A for receiving a portion of a strip of material, such as the strip of material  401 A,  501 A described above. An opening or slot  1446 A in the end portion  1442 A allows a strip of material to be inserted into the slot  1444 A. The end portion  1442 A can also include attachment holes  1440 A for securing a cover (see  FIG. 30A ) to the paddle frame  1400 A. 
     As can be seen in  FIGS. 116A and 117A , the paddle frame  1400 A has a generally rounded rectangle shape as the frame extends away from the attachment portion  1410 A to the closed end of the paddle connection portion  1420 A. The middle portion  1424 A of the frame is closer to the frontal plane  1406 A than the distal portion  1426 A, giving the sides of the middle portion  1424 A a rounded, wing-like shape that engages the front and back surfaces of the coaption element (not shown) during grasping of native tissue between a paddle (not shown) and coaption element of an implantable device described herein. 
     Referring to  FIGS. 195 and 196 , the paddle frames  1400 A are shown assembled to the cap  514 A of an example implantable device, such as the device  500 A described above. In one example embodiment, the paddle frames  1400 A can be shape-set to provide increased clamping force against or toward a coaption element  510 A when the paddles  520 A,  522 A are in the closed configuration. This is because the paddle frames  1400 A are shape-set relative to the closed position (e.g.,  FIG. 196 ) to a first position (e.g.,  FIG. 195 ) which is beyond the position where the inner paddle  522 A would engage the coaption element  510 A, such as beyond the central plane  552 A of the device  500 A (e.g.,  FIG. 70A ), such as beyond the opposite side of the coaption element, such as beyond the outer paddle on the opposite side of the coaption element. In the first position the sides  1433 A of the paddle frames  1400 A are intertwined in that the sides  1433 A of one paddle frame  1400 A are moved slightly laterally to allow movement past the sides  1433 A of the other paddle frame  1400 A until the end portions  1442 A of each frame  1400 A contact each other and the sides  1433 A and prevent further movement. 
     The magnitude of the preload of the paddle frames  1400 A can be altered by adjusting the degree to which the paddle frames  1400 A are shape-set relative to the coaption element  510 A. The farther the paddle frames  1400 A are shape-set past the closed position, the greater the preload force when the paddle frames  1400 A are moved into the open position. 
     The curves of the paddle frame  1400 A can be independent from one another, that is, one curve is complete before another curve starts, or can be combined, that is, the paddle frame  1400 A curves in multiple directions simultaneously. 
     Like the paddle frame  1400  shown in  FIGS. 191 and 192 , in an example embodiment, the paddle frame  1400 A can be formed from a flat blank that is cut from a flat sheet of material, for example, by laser cutting. The cut blank can then be bent to form the three-dimensional shape of the paddle frame  1400 A. 
     Referring now to  FIGS. 119-120 , the paddle frame  1400  is shown in an expanded condition ( FIG. 119 ) and a compressed condition ( FIG. 120 ). The paddle frame  1400  is in a compressed condition when the paddles are disposed in a delivery device  1450 . Referring to  FIG. 119 , the paddle frame  1400  is moved from the expanded condition to the compressed condition by compressing the paddle in the direction X and extending a length of the paddle in the direction Y. When the paddles  1400  are in the compressed condition, the paddles have a width H. The width H can be, for example between about 4 mm and about 7 mm, such as, between about 5 mm and about 6 mm. In alternative embodiments, the width H can be less than 4 mm or more than 7 mm. In certain embodiments, the width H of the compressed paddles  1400  is equal or substantially equal to a width D of the delivery opening  1452  of the delivery device  1450 . The ratio between the width W of the paddles in the expanded condition and the width H of the paddles in the compressed condition can be, for example, about 4 to 1 or less, such as about 3 to 1 or less, such as about 2 to 1 or less, such as about 1.5 to 1, such as about 1.25 to 1, such as about 1 to 1. In alternative embodiments, the ratio between the width W and the width H can be more than 4 to 1.  FIG. 120  illustrates the connection portions  1410  compressed from the positions illustrated by  FIG. 119 . However, in some example embodiments, the connection portions  1410  will not be compressed. For example, the connection portions  1410  will not be compressed when the connection portions  1410  are connected to a cap  514 . The paddle frame  1400 A shown in  FIGS. 112A and 114A-118A  can be similarly compressed. 
     Referring now to  FIGS. 121-124 , the example implantable device  500  is shown in open and closed conditions with paddle frames that are compressed or stretched as the anchor portion  506  of the device is opened and closed. The paddle frames  1524  are like the paddle frame  1400  described above. Referring now to  FIG. 121 , the anchor portion  506  is shown in a closed condition. Referring now to  FIG. 122 , the paddle frames  1524  have a first width W 1  and a first length L 1 . Referring now to  FIG. 123 , the anchor portion  506  is shown in an open condition and the paddle frames  1524  are in an extended condition ( FIG. 124 ). Opening the anchor portion  506  of the device  500  causes the paddle frames  1524  to move, extend, or pivot outward from the coaption portion  510  and transition to the extended condition. In the extended condition, the paddle frames  1524  have a second or extended length L 2  and a second or extended width W 2 . In the extended condition, the paddle frame  1524  lengthens and narrows such that the second length L 2  is greater than the first length L 1  and the second width W 2  is narrower than the first width W 1 . One advantage of this embodiment is that the paddle frames become narrower and can have less chordal engagement during grasping of the leaflets. However, the paddle frames become wide when the implant is closed to enhance support of the leaflet. Another advantage of this embodiment is that the paddle frames also become narrower and longer in the bailout position. The narrower paddle size in the extended, elongated, or bailout position can allow for less chordal entanglement and increased ease of bailout. 
     Referring now to  FIGS. 125-128 , the example implantable device  500  is shown in open and closed conditions with paddle frames that are compressed or stretched as the anchor portion  506  of the device is opened and closed. The paddle frames  1624  are similar to the paddle frame  1400  described above. Referring now to  FIG. 125 , the anchor portion  506  is shown in a closed condition. Referring now to  FIG. 126 , the paddle frames  1624  have a first width W 1  and a first length L 1 . Referring now to  FIG. 127 , the anchor portion  506  is shown in an open condition and the paddle frames  1624  are in a compressed condition ( FIG. 128 ). Opening the anchor portion  506  of the device  500  causes the paddle frames  1624  to move, extend, or pivot outward from the coaption portion  510  and transition to the compressed condition. In the compressed condition, the paddle frames  1624  have a second or compressed length L 2  and a second or compressed width W 2 . In the compressed condition, the paddle frame  1624  shortens and widens such that the second length L 2  is less than the first length L 1  and the second width W 2  is wider than the first width W 1 . 
     Referring now to  FIGS. 129-136 , example implantable prosthetic devices are shown that can be locked or fastened closed. Referring now to  FIG. 129 , the example implantable prosthetic device  500  is shown that can be locked or retained in a closed condition with magnets. As described above, the device  500  includes a coaption element  510  and paddles  520 . The paddles  520  open and close to grasp leaflets  20 ,  22  of the native heart valve, as described in more detail above. The coaption element  510  includes one or more magnets  1700  and the paddles  520  include one or more magnets  1702 . The magnets  1700 ,  1702  have opposite poles facing each other such that the magnets  1702  in the paddles  520  are attracted to the magnets  1700  in the coaption element  510  and the magnetic attractive forces between the magnets  1700 ,  1702  retain the paddles  520  in a closed condition. In certain embodiments, the magnets  1700 ,  1702  are programmed or polymagnets with patterns of polarity such that the implantable device  500  can be locked and unlocked by moving—such as rotating—the magnet  1700  within the coaption element. For example, the magnet  1700  can be configured such that the magnet  1700  attracts the magnets  1702  in the paddles  520  in a first orientation and repels the magnets  1702  in the paddles  520  when the magnet  1700  is rotated 90 degrees into a second orientation. 
     Referring now to  FIGS. 130-131 , the example implantable prosthetic device  500  is shown that can be locked or retained in a closed condition with an elastic band  1800 . The elastic band  1800  can be made from any flexible material and have any configuration. For example, the elastic band can comprise coiled nitinol, can have a stent like structure, etc. 
     As described above, the device  500  includes a coaption element  510 , paddles  520 , and barbed clasps  530 . The paddles  520  and barbed clasps  530  open and close to grasp leaflets  20 ,  22  of the native heart valve, as described in more detail above. The paddles  520  move between an open condition ( FIG. 130 ) to a closed condition ( FIG. 131 ) by actuation of an actuation element or means for actuation  512 , as described above. The elastic band  1800  can be arranged to lock or retain the device  500  in a closed condition. When the device  500  is in the open condition ( FIG. 130 ) the band  1800  is arranged around the paddles  520  in a relaxed or disengaged condition. For example, the band  1800  can be arranged around a narrower portion of the open device  500 , such as a tapered portion of the paddles  520  near a distal portion  507  of the device. When the device  500  is in the closed condition ( FIG. 131 ) the band  1800  is arranged around the paddles  520  in an engaged condition. In certain embodiments, when the band  1800  is in the engaged condition it is arranged around the widest portion of the device  500  or can be arranged around the center of the device  500 . 
     The band  1800  is moved from the disengaged condition in a closing or engaging direction  1802  to the engaged condition with sutures (not shown) or other suitable means of moving the band  1800 . Movement of the band  1800  can cause the paddles  520  to move in a closing direction  1804 , thereby closing and securing the device  500  in a single movement of the band  1800 . Alternatively, device  500  can be closed and the band  1800  moved into the engaged location to secure the device  500  in the closed condition. 
     Referring now to  FIG. 132 , the example implantable prosthetic device  500  is shown that can be locked or retained in a closed condition with a biasing member  1900 . As described above, the device  500  includes a coaption element  510 , paddles  520 , and barbed clasps  530 . The paddles  520  are moved between open and closed positions with an actuation element  512  extending through the coaption element  510  to a cap  514 . The paddles  520  and barbed clasps  530  are opened and closed to grasp leaflets  20 ,  22  of the native heart valve, as described in more detail above. In the closed condition, the paddles  520  and the clasps  530  engage the tissue of valve leaflets  20 ,  22  and each other to secure the device  500  to the valve tissue. 
     The biasing member  1900  (e.g., a spring) is configured to bias the cap  514  toward the coaption element  510 , thereby biasing the device  500  toward the closed condition. After the device  500  is delivered to and attached to the valve tissue with a delivery device (not shown), the delivery device is removed from the patient&#39;s body and the biasing member  1900  maintains the device  500  in a closed condition to prevent detachment of the device  500  from the valve tissue. 
     Referring now to  FIGS. 133-134 , an example implantable prosthetic device  2000  is shown that can be locked or retained in a closed condition with latches. The device  2000  can include any other features for an implantable prosthetic device discussed in the present application, and the device  2000  can be positioned to engage valve tissue  20 ,  22  as part of any suitable valve repair system (e.g., any valve repair system disclosed in the present application). 
     The device  2000  is similar to other implantable devices described above and includes paddles  2002  and gripping members or clasps  2004 . The paddles  2002  are opened and closed to grasp the native leaflets  20 ,  22  in a gap  2006  between the paddles  2002  and gripping members  2004 . The device  2000  also includes a latch member  2008  attached to the paddles  2002 , in which the latch member  2008  is configured to attach the paddles  2002  to the gripping members  2004  when the device  2000  is in the closed position. In some embodiments, the latch member  2008  serves as a secondary latching mechanism and is configured to keep the device  2000  in the closed position when other mechanisms fail. 
     Referring to  FIG. 133 , the device  2000  is in an open position with valve tissue  20 ,  22  disposed in the gap or opening  2006  between the paddles  2002  and the gripping members  2004 . Referring to  FIG. 134 , the device  2000  is moved to the closed position such that the valve tissue  20 ,  22  is secured between the paddles  2002  and the gripping members  2004 . The device  2000  can be moved to the closed position by any suitable manner, such as, for example, any manner described in the present application. When the device  2000  is moved to the closed position, the latch member  2008  punctures the valve tissue  20 ,  22  and is inserted into or through the gripping member  2004  to secure the paddle  2002  to the gripping member  2004 . The latch member  2008  can take any suitable form that can secure the paddles  2002  to the gripping members  2004 , such as, for example, metals, plastics, etc. 
     Referring now to  FIGS. 135-136 , the example implantable prosthetic device  2000  is shown that can be locked or retained in a closed condition with latches. In  FIGS. 135-136 , the device  2000  includes a coaption element  2010 . Referring to  FIG. 135 , the device  2000  is in an open position with valve tissue  20 ,  22  disposed in the gap or opening  2006  between the paddles  2002  and the gripping members  2004 . Referring to  FIG. 136 , the device  2000  is moved to the closed position such that the valve tissue  20 ,  22  is secured between the paddles  2002  and the gripping members  2004 . The device  2000  can be moved to the closed position by any suitable manner, such as, for example, any manner described in the present application. When the device  2000  is moved to the closed position, the latch member  2008  punctures the valve tissue  20 ,  22  and is inserted into or through the gripping member  2004  to secure the paddle  2002  to the gripping member  2004 . In the illustrated embodiment, the latch member  2008  protrudes beyond the gripping members  2004  and into the coaption element  2010 . In some embodiments, the latch member  2008  can be secured in the coaption element  2010  by latching onto a portion of the coaption element  2010  or by penetrating the coaption element  2010  material. The latch member  2008  can take any suitable form that can secure the paddles  2002  to the gripping members  2004 , such as, for example, metals, plastics, etc. 
     Referring now to  FIGS. 137-145 , various embodiments of implantable prosthetic devices and methods of using the same are shown that facilitate release of native tissue grasped by the implantable prosthetic devices. The devices can include any other features for an implantable prosthetic device discussed in the present application, and the devices can be positioned to engage valve tissue  20 ,  22  as part of any suitable valve repair system (e.g., any valve repair system disclosed in the present application). 
     Referring now to  FIG. 137 , a device  2100  with stretchable clasps or gripping members is shown. The device  2100  is delivered from a delivery sheath  2102  and has a coaption element  2110 , paddles  2120 , and clasps or gripping members  2130 . The gripping members  2130  include barbs  2132  and stretchable portions  2134 . The stretchable portions  2134  allow the clasps  2130  to be stretched in a stretching direction  2136 . Actuation lines or actuation sutures  2104  extend from the delivery sheath  2102  to the clasps  2130 . Retracting the lines/sutures  2104  in a retraction direction  2106  opens and stretches the clasps  2130  to a fully extended position. In certain embodiments, the clasps  2130  primarily stretch once the clasps  2130  are in the fully open position. Movement of the barbs  2132  in the stretching direction  2136  allows for clean disengagement from the native tissue. In some embodiments, the stretchable portion  2134  is configured to be moved such that the barbs  2132  exit the valve tissue in a direction opposite or substantially opposite the direction in which the barbs entered the native tissue. Alternatively, the clasps  2130  can be otherwise extendable to allow for disengagement from the native tissue without tearing the native tissue. For example, joint portions  2131  can be configured to allow the barbs  2132  of the clasps  2130  to be pulled in the direction  2136 . 
     Referring now to  FIGS. 138-143 , two example embodiments of methods of releasing valve tissue from the prosthetic device  500  are shown. As described above, the device  500  includes a coaption element  510 , inner paddles  522 , outer paddles  520 , and barbed clasps  530 . The device  500  is deployed from a delivery sheath  502 . An actuation element  512  extends through the coaption element  510  to a cap  514 . Actuation of the actuation element  512  opens and closes the paddles  520 ,  522  to open and close the device. The barbed clasps  530  include barbs  536 , moveable arms  534 , and stationary arms  532 . The stationary arms  532  are attached to the inner paddles  522  so that the clasps  530  move with the movement of the inner paddles  522 . Clasp control members or actuation lines/sutures  537  extend from the delivery sheath  502  to the moveable arms  534  of the clasps  530 . 
       FIGS. 138-141  illustrate an example method of releasing grasped valve tissue. In the example illustrated by  FIGS. 138-141 , the device is shown in an open or substantially open position to more clearly illustrate the movements of the parts of the device  500  that are involved with tissue release. However, in practice the tissue release method is more likely to be practiced with the device  500  in the more closed positions illustrated by  FIGS. 142 and 143 . That is, it is not likely that the paddles and clasps will be substantially opened before moving the clasps to release the valve tissue as illustrated by  FIGS. 138-141 . It is more likely that the paddles and clasps will only be opened slightly before releasing the valve tissue as illustrated by  FIGS. 142 and 143 . The same parts that move in the example illustrated by  FIGS. 138-141  move in the example illustrated by  FIGS. 142-143 . 
     Referring now to  FIG. 138 , the device  500  is shown in an open or substantially open position with the clasps  530  in a closed position. Retraction of the clasp control members or actuation lines/sutures  537  articulates, flexes, or pivots the moveable arms  534  of the clasps  530  to a partially open position ( FIG. 139 ) and then to a fully open position ( FIG. 140 ). Referring now to  FIG. 141 , once the clasps  530  are in the fully open position ( FIG. 140 ), further retraction of the actuation lines/sutures  537  in the retraction direction  560  pulls upward on the moveable arms  534 , barbs  536 , and inner paddles  522  in a tissue release direction. The portion  523  of the inner paddles  522  closest to the coaption element flex upward in direction  562  to allow this movement in the retraction direction  560 . There can optionally be a small gap G 140  between the claps  530  and the coaption element  510 . The inner paddles can flex at the small gap (if there is a small gap) or at the connection  523  between the coaption element  510  and the inner paddles if there is not a gap. This flexing movement  562  of the inner paddles  522  can optionally also cause the outer paddles to move or pivot downward. Movement of the barbs  536  in the tissue release direction  560  allows for clean disengagement from the native tissue. The barbs can be at an angle θ (see  FIG. 138 ) to the moveable arms  534  that facilitates release from the tissue. For example, the angle θ can be between 10 and 60 degrees, such as 20 and 50 degrees, such as 25 and 45 degrees, such as about 30 degrees, or 30 degrees. 
     Referring now to  FIGS. 142-143 , the device  500  is shown in a slightly opened position or a closed position. As mentioned above, the same parts of the device  500  move in the example illustrated by  FIGS. 142 and 143  as in the example illustrated by  FIGS. 138-141 . In the partially open position or closed position, further retraction of the actuation lines/sutures  537  in the retraction direction  560  pulls upward on the moveable arms  534 , barbs  536 , and inner paddles  522 . The portion of the inner paddles  522  closest to the coaption element flexes or is lifted-up in the direction  562  to allow the movement  560 . As mentioned above, there can optionally be a small gap G 140  between the clasps  530  and the coaption element  510 . The inner paddles can flex  562  at the small gap (if there is a small gap) or at the connection between the coaption element  510  and the inner paddles if there is not a gap. The movement of the barbs  536  in the direction  560  releases the valve tissue from the barbs. The lifting on the inner paddles  522  can optionally also force the outer paddles  520  to move outward in an opening direction  564 . The optional outward movement  564  of the outer paddles  520  relieves the pinching force applied to grasped tissue by the paddles and the coaption element. Relieving the pinching force on the tissue can also assist in the release of the tissue from the barbs. In one example embodiment, the device  500  is moved from the position illustrated by  FIG. 143  to the position illustrated by  FIG. 140 or 141  to fully disengage the device from the native valve. 
       FIGS. 144-152  show an example delivery assembly  2200  and its components. Referring to  FIG. 144 , the delivery assembly  2200  can comprise the implantable device or prosthetic spacer device  500  (or any other implantable device described in the present application) and a delivery apparatus  2202 . The delivery apparatus  2202  can comprise a plurality of catheters and catheter stabilizers. For example, in the illustrated embodiment, the delivery apparatus  2202  includes a first catheter  2204 , a second catheter  2206 , a third catheter  2208 , and catheter stabilizers  2210 . The second catheter  2206  extends coaxially through the first catheter  2204 , and the third catheter  2208  extends coaxially through the first and second catheters  2204 ,  2206 . The prosthetic device or prosthetic spacer device  500  can be releasably coupled to a distal end portion of the third catheter  2208  of the delivery apparatus  2202 , as further described below. 
     In the illustrated embodiment, the delivery assembly  2200  is configured, for example, for implanting the prosthetic device or prosthetic spacer device  500  in a native valve via a transvascular approach (e.g., the native mitral valve MV via a transseptal delivery approach, etc.). In some embodiments, the delivery assembly  2200  can be configured for implanting the prosthetic device or prosthetic spacer device  500  in aortic, tricuspid, or pulmonary valve regions of a human heart. Also, the delivery assembly  2200  can be configured for various delivery methods, including transseptal, transaortic, transventricular, etc. 
     Referring to  FIG. 146 , the first collar or cap  514  of the prosthetic device or prosthetic spacer device  500  can include a bore  516 C. In some embodiments, the bore  516 C can comprise internal threads configured to releasably engage corresponding external threads on a distal end  512 B of the actuation element or means of actuating  512  of the delivery apparatus  2202 , as shown in  FIG. 145 . 
     Referring again to  FIG. 146 , the second or proximal collar  511  of the prosthetic device or prosthetic spacer device  500  can include a central opening  511 C that is axially aligned with the bore  516 C of the cap  514 . The central opening  511 C of the proximal collar  511  can be configured to slidably receive the actuation element, actuation shaft, or means of actuating  512  of the delivery apparatus  2202 , as shown in  FIG. 145 . In some embodiments, the proximal collar  511  and/or the coaption element  510  can have a sealing member (not shown, but see, e.g., the sealing member  413  shown in  FIG. 23 ) configured to seal the central opening  511 C when the actuation element or means of actuating  512  is withdrawn from the central opening  511 C. 
     As shown in  FIG. 146 , the proximal collar  511  can also include a plurality of engagement portions or projections  511 E and a plurality of guide openings  511 B. The projections  511 E can extending radially outwardly and can be circumferentially offset (e.g., by about 90 degrees) relative to the guide openings  511 B. The guide openings  511 B can be disposed radially outwardly from the central opening  511 C. The projections  511 E and the guide openings  511 B of the proximal collar  511  can be configured to releasably engage a coupler or means for coupling  2214  of the delivery apparatus  2202 , as shown in  FIG. 145 . 
     Referring again to  FIG. 144  and as mentioned above, the delivery apparatus  2202  can include the first and second catheters  2204 ,  2206 . The first and second catheters  2204 ,  2206  can be used, for example, to access an implantation location (e.g., a native mitral valve or tricuspid valve region of a heart) and/or to position the third catheter  2208  at the implantation location. 
     The first and second catheters  2204 ,  2206  can comprise first and second sheaths  2216 ,  2218 , respectively. The catheters  2204 ,  2206  can be configured such that the sheaths  2216 ,  2218  are steerable. Additional details regarding the first catheter  2204  can be found, for example, in U.S. Published Patent Application No. 2016/0155987, which is incorporated by reference herein in its entirety. Additional details regarding the second catheter  2206  can be found, for example, in U.S. Provisional Patent Application No. 62/418,528, which is incorporated by reference herein in its entirety. 
     Referring still to  FIG. 144 , delivery apparatus  2202  can also include the third catheter  2208 , as mentioned above. The third catheter  2208  can be used, for example, to deliver, manipulate, position, and/or deploy the prosthetic device or prosthetic spacer device  500  at the implantation location. 
     Referring to  FIG. 148 , the third catheter  2208  can comprise the actuation element or inner shaft  512 , the coupler or means for coupling  2214 , an outer shaft  2220 , a handle  2222  (shown schematically), and clasp control members or actuation lines  537 . A proximal end portion  2220 A of the outer shaft  2220  can be coupled to and extend distally from the handle  2222 , and a distal end portion  2220 B of the outer shaft  2220  can be coupled to the coupler or means for coupling  2214 . A proximal end portion  512 C of the actuation element or means of actuating  512  can coupled to an actuation knob  2226 . The actuation element or means of actuating  512  can extend distally from the knob  2226  (shown schematically), through the handle  2222 , through the outer shaft  2220 , and through the coupler or means for coupling  2214 . The actuation element or means of actuating  512  can be moveable (e.g., axially and/or rotationally) relative to the outer shaft  2220  and the handle  2222 . The clasp control members or actuation lines  537  can extend through and be axially movable relative to the handle  2222  and the outer shaft  2220 . The clasp control members/actuation lines  537  can also be axially movable relative to the actuation element or means of actuating  512 . 
     As shown in  FIGS. 145-146 , the actuation element or means of actuating  512  (e.g., actuation shaft, etc.) of the third catheter  2208  can be releasably coupled to the cap  514  of the prosthetic device or prosthetic spacer device  500 . For example, in some embodiments, the distal end portion  512 B of the actuation element or means of actuating  512  can comprise external thread configured to releasably engage the interior threads of the bore  516 C of the prosthetic device or prosthetic spacer device  500 . As such, rotating the actuation element or means of actuating  512  in a first direction (e.g., clockwise) relative to the cap  514  of the prosthetic device or prosthetic spacer device  500  releasably secures the actuation element or means of actuating  512  to the cap  514 . Rotating the actuation element or means of actuating  512  in a second direction (e.g., counterclockwise) relative to the cap  514  of the prosthetic device or prosthetic spacer device  500  releases the actuation element or means of actuating  512  from the cap  514 . 
     Referring now to  FIGS. 145-147 , the coupler or means for coupling  2214  of the third catheter  2208  can be releasably coupled to the proximal collar  511  of the prosthetic device or prosthetic spacer device  500 . For example, in some embodiments, the coupler or means for coupling  2214  can comprise a plurality of flexible arms  2228  and a plurality of stabilizer members  2230 . The flexible arms  2228  can comprise apertures  2232 , ports  2233  ( FIG. 146 ), and eyelets  2234  ( FIG. 147 ). The flexible arms  2228  can be configured to move or pivot between a first or release configuration ( FIG. 146 ) and a second or coupled configuration ( FIGS. 145 and 147 ). In the first configuration, the flexible arms  2228  extend radially outwardly relative to the stabilizer members  2230 . In the second configuration, the flexible arms  2230  extend axially parallel to the stabilizer members  2230  and the eyelets  2234  radially overlap, as shown in  FIG. 147 . The flexible arms  2228  can be configured (e.g., shape-set) to be biased to the first configuration. 
     The prosthetic device or prosthetic spacer device  500  can be releasably coupled to the coupler or means for coupling  2214  by inserting the stabilizer members  2230  of the coupler or means for coupling  2214  into the guide openings  511 B of the prosthetic device or prosthetic spacer device  500 . The flexible arms  2228  of the coupler or means for coupling  2214  can then be moved or pivoted radially inwardly from the first configuration to the second configuration such that the projections  511 E of the prosthetic device or prosthetic spacer device  500  extend radially into the apertures  2232  of the flexible arms  2228 . The flexible arms  2228  can be retained in the second configuration by inserting the distal end portion  512 B of the actuation element or means of actuating  512  (e.g., actuation shaft, etc.) through openings  2236  of the eyelets  2234 , which prevents the flexible arms  2228  from moving or pivoting radially outwardly from the second configuration to the first configuration, thereby releasably coupling the prosthetic device or prosthetic spacer device  500  to the coupler or means for coupling  2214 . 
     The prosthetic device or prosthetic spacer device  500  can be released from the coupler or means for coupling  2214  by proximally retracting the actuation element or means of actuating  512  relative to the coupler or means for coupling  2214  such that the distal end portion  512 B of the actuation element or means of actuating  512  withdraws from the openings  2236  of the eyelets  2234 . This allows the flexible arms  2228  to move or pivot radially outwardly from the second configuration to the first configuration, which withdraws the projections  511 E of the prosthetic device/spacer device  500  from the apertures  2232  of the flexible arms  2228 . The stabilizer members  2230  can remain inserted into the guide openings  511 B of the prosthetic device/spacer device  500  during and after the flexible arms  2228  are released. This can, for example, prevent the prosthetic device/spacer device  500  from moving (e.g., shifting and/or rocking) while the flexible arms  2228  are released. The stabilizer members  2230  can then be withdrawn from the guide openings  511 B of the prosthetic device/spacer device  500  by proximally retracting the coupler or means for coupling  2214  relative to the prosthetic device/spacer device  500 , thereby releasing the prosthetic device/spacer device  500  from the coupler or means for coupling  2214 . 
     Referring to  FIG. 148 , the outer shaft  2220  of the third catheter  2208  can be an elongate shaft extending axially between the proximal end portion  2220 A, which is coupled the handle  2222 , and the distal end portion  2220 B, which is coupled to the coupler or means for coupling  2214 . The outer shaft  2220  can also include an intermediate portion  2220 C disposed between the proximal and distal end portions  2220 A,  2220 B. 
     Referring to  FIG. 149 , the outer shaft  2220  can comprise a plurality of axially extending lumens, including an actuation element lumen or means of actuating lumen  2238  and a plurality of control member lumens  2240  (e.g., four in the illustrated embodiment). In some embodiments, the outer shaft  2220  can comprise more (e.g., six) or less (e.g., two) than four control member lumens  2240 . 
     The actuation element lumen or means of actuating lumen  2238  can be configured to receive the actuation element or means of actuating  512 , and the control member lumens  2240  can be configured to receive one or more clasp control members or actuation lines  537 . The lumens  2238 ,  2240  can also be configured such that the actuation element or means of actuating  512  and clasp control members/lines  537  can be movable axially and/or rotationally) relative to the respective lumens  2238 ,  2240 . In particular embodiments, the lumens  2238 ,  2240  can comprise a liner or coating configured to reduce friction within the lumens  2238 ,  2240 . For example, the lumens  2238 ,  2240  can comprise a liner comprising PTFE. 
     Referring still to  FIGS. 148-149 , the outer shaft  2220  can be formed from various materials, including metals and polymers. For example, in one particular embodiment, the proximal end portion  2220 A can comprise stainless steel and the distal and intermediate portions  2220 B,  2220 C can comprise PEBAX (e.g., PEBAX®). The outer shaft  2220  can also comprise an outer covering or coating, such as a polymer that is reflowed over the portions  2220 A,  2220 B, and  2220 C. 
     The outer shaft  2220  can include one or more coil portions  2242  disposed radially outwardly from the lumens  2238 ,  2240 . For example, in one particular embodiment, the outer shaft  2220  can comprise a first coil  2242   a , a second coil  2242   b , and a third coil  2242   c . The first coil  2242   a  can be the radially outermost coil, the third coil  2242   c  can be the radially innermost coil, and the second coil  2242   b  can be radially disposed between the first coil  2242   a  and the third coil  2242   c.    
     The coil portions  2242  can comprise various materials and/or configurations. For example, the coil portions  2242  can be formed from stainless steel. In one particular embodiment, the first and third coils  2242   a ,  2242   c  comprise stainless steel coils wound in a left-hand configuration, and the second coil  2242   b  comprises a stainless-steel coil wound in a right-hand configuration. 
     The coil portions  2242  can also comprise various pitches. The pitch of one or more of the coils  2242  can be the same or different than the pitch of one or more other coils  2242 . In one particular embodiment, the first and second coils  2242   a ,  2242   b  can have a first pitch (e.g., 0.74 in.), and the third coil can comprise a second pitch (e.g., 0.14 in.). 
     The outer shaft  2220  can also comprise a tie layer  2244  disposed radially inwardly from the third coil  2242   c . The tie layer  2244  can be formed of various materials including polymers, such as PEBAX (e.g., PEBAX®). 
     As shown in  FIGS. 150-152 , the handle  2222  of the third catheter  2208  can include a housing  2246 , an actuation lock mechanism  2248 , a clasp control mechanism  2250 , and a flushing mechanism  2252 . Referring to  FIG. 150 , a distal end portion of the housing  2246  can be coupled to the proximal end portion  2220 A of the outer shaft  2220 . The actuation lock mechanism  2248 , the clasp control mechanism  2250 , and a flushing mechanism  2252  can be coupled to a proximal end of the housing  2246 . The actuation lock mechanism  2248  can be configured to selectively lock the position of the actuation element or means of actuating  512  relative to the housing  2246  and the outer shaft  2220 . The clasp control mechanism  2250  can also be coupled to proximal end portions of the clasp control members or actuation lines  537  and can be configured to secure the clasp control members  537  relative to the handle  2222  and to move the clasp control members  537  relative to the outer shaft  2220  and the actuation element or means of actuating  512 . The flushing mechanism  2252  can be configured for flushing (e.g., with a saline solution) the outer shaft  2220  prior to inserting the outer shaft  2220  into a patient&#39;s vasculature. 
     As shown in  FIGS. 151-152 , the housing  2246  of the handle  2222  can comprise a main body  2254  and a nose portion  2256  coupled to a distal end portion of the main body  2254 . The main body  2254  and the nose portion  2256  can be coupled together in various manners, including fasteners  2258  and/or pins  2260  (e.g., as shown in the illustrated embodiment), adhesive, and/or other coupling means. The housing  2246  can be formed from various materials, including polymers (e.g., polycarbonate). 
     The main body  2254  of the housing  2246  can comprise a plurality of lumens, including an actuation element lumen or means of actuating lumen  2262  (e.g., an actuation shaft lumen, actuation tube, etc.), control member lumens  2264  ( FIG. 152 ), and a flushing lumen  2266  that connects with the actuation element lumen or means of actuating lumen  2262  ( FIG. 151 ). As shown in  FIG. 152 , the main body  2254  can also include a plurality of tubes (e.g., hypotubes), including an actuation tube  2268  and control member tubes  2270  that are disposed at least partially in the actuation element lumen or means of actuating lumen  2262  and the control member lumens  2264 , respectively. The tubes  2268 ,  2270  can be axially movable (e.g., slidable) relative the lumens  2262 ,  2264 , respectively. 
     The proximal end of the actuation tube or lumen  2268  can extend proximally from the main body  2254  and can be coupled to the knob  2226  and to the proximal end portion  512 C of the actuation element or means of actuating  512 . The proximal ends of the control member tubes  2270  can extend proximally from the main body  2254  and can be coupled to the clasp control mechanism  2250  and the clasp control members  537 . 
     The distal ends of the tubes  2268 ,  2270  can comprise flanges  2272 ,  2274  configured to engage a stopper to limit the axial movement of the tubes  2268 ,  2270  relative to the main body  2254 . For example, the flanges  2272 ,  2274  can be configured to contact respective surfaces of the main body  2254  (e.g., a lip) to prevent to tubes  2268 ,  2270  from withdrawing completely from the proximal ends of the lumens  2262 ,  2264 , respectively. 
     The actuation tube or lumen  2268  can be configured to receive and be coupled to the proximal end portion of the actuation element or means of actuating  512 . The control member tubes  2270  can be configured to receive portions of the clasp control mechanism  2250 , as further described below. The tubes  2268 ,  2270  can be formed from various materials, including polymers and metals (e.g., stainless steel). 
     In some embodiments, the main body  2254  can include a plurality of seal members  2276  (e.g., O-rings) configured to prevent or reduce blood leakage through the lumens and around the shafts and/or tubes. The seal members can be secured relative to the main body  2254 , for example, by fasteners  2278  (e.g., hollow-lock or socket-jam set screws). 
     As shown in  FIG. 152 , the nose portion  2256  of the housing  2246  can comprise a plurality of lumens, including an actuation element lumen or means of actuating lumen  2280  (e.g., an actuation shaft lumen, etc.), and control member lumens  2282 . The actuation element lumen or means of actuating lumen  2280  of the nose portion  2256  can be extend coaxially with the actuation element lumen or means of actuating lumen  2262  of the main body  2254 . Proximal ends of the control member lumens  2282  of the nose portion  2256  can be aligned with the control member lumens  2264  of the main body  2254  at the proximal end of the nose portion  2256  (i.e., the lumens  2282 ,  2264  are in the same plane). The control member lumens  2282  can extend from the proximal ends at an angle (i.e., relative to the control member lumens  2264  of the main body  2254 ), and distal ends of the control member lumens  2282  can connect with the actuation element lumen or means of actuating lumen  2280  of the nose portion  2256  at a location toward the distal end of the nose portion  2256 . In other words, the proximal ends of the lumens  2282  are in a first plane (i.e., the plane of the control member lumens  2264  of the main body  2254 ), and the distal ends of the lumens  2282  are in a second plane (i.e., the plane of the actuation shaft lumen or means of actuating lumen  2262  of the main body  2254 ). 
     As shown in  FIG. 151 , the actuation element lumen or means of actuating lumen  2280  of the nose portion  2256  can be configured to receive the proximal end portion of the outer shaft  2220 . The proximal end portion of the outer shaft  2220  can be coupled to the nose portion  2256  in many ways such as with adhesive, fasteners, frictional fit, and/or other coupling means. 
     Referring still to  FIG. 151 , the actuation lock mechanism  2248  of the handle  2222  can be coupled to the proximal end portion of the main body  2254  of the housing  2246  and to the actuation tube  2268 . The actuation lock mechanism  2248  can be configured to selectively control relative movement between the actuation tube  2268  and the housing  2246 . This, in turn, selectively controls relative movement between the actuation element or means of actuating  512  (which is coupled to the actuation tube  2268 ) and the outer shaft  2220  (which is coupled to the nose portion  2256  of the housing  2246 ). 
     In some embodiments, the actuation lock mechanism  2248  can comprise a lock configuration, which prevents relative movement between the actuation tube  2268  and the housing  2246 , and a release configuration, which allows relative movement between the actuation tube  2268  and the housing  2246 . In some embodiments, the actuation lock mechanism  2248  can be configured to include one or more intermediate configurations (i.e., in addition to the lock and release configuration) which allow relative movement between the actuation tube  2268  and the housing  2246 , but the force required to cause the relative movement is greater than when the actuation lock mechanism is in the release configuration. 
     As shown in  FIG. 151  of the illustrated embodiment, the actuation lock mechanism  2248  can comprise a lock (e.g., a Tuohy-Borst adapter)  2284  and a coupler (e.g., a female luer coupler)  2286 . The coupler  2286  can be attached to the distal end of the lock  2284  and coupled to the proximal end of the main body  2254  of the housing  2246 . The actuation tube  2268  can coaxially extend through the lock  2284  and the coupler  2286 . As such, rotating a knob  2288  of the lock  2284  in a first direction (e.g., clockwise) can increase the frictional engagement of the lock  2284  on the actuation tube  2268 , thus making relative movement between the actuation tube  2268  and the housing  2246  more difficult or preventing it altogether. Rotating a knob  2288  of the lock  2284  in a second direction (e.g., counterclockwise) can decrease the frictional engagement of the lock  2284  on the actuation tube  2268 , thus making relative movement between the actuation tube  2268  and the housing  2246  easier. 
     In some embodiments, actuation lock mechanism  2248  can comprise other configurations configured for preventing relative movement between the actuation tube  2268  and the housing  2246 . For example, the locking mechanism  2248  can include lock configured like a stopcock valve in which a plunger portion of valve selectively engages the actuation tube  2268 . 
     The clasp control mechanism  2250  can comprise an actuator member  2290  and one or more locking members  2292  (e.g., two in the illustrated embodiment). A distal end portion of the actuator member  2290  can be coupled to the control member tubes  2270 , which extend from the proximal end of the main body  2254  of the housing  2246 , as best shown in  FIG. 151 . The locking members  2292  can be coupled to a proximal end portion of the actuator member  2290 . 
     As shown in the illustrated embodiment, the actuator member  2290  can, optionally, comprise a first side portion  2294  and a second side portion  2296  selectively coupled to the first side portion  2294  by a connecting pin  2298 . The actuator member  2290  can be configured such that the first and second side portions  2294 ,  2296  move together when the connecting pin  2298  is inserted through the first and second side portions  2294 ,  2296 . When the connecting pin  2298  is withdrawn, the first and second side portions  2294 ,  2296  can be moved relative to each other. This can allow the clasp control members or lines  537  (which are releasably coupled to the first and second side portions  2294 ,  2296  by the locking elements  2292 ) to be individually actuated. 
     The connection between the first and second side portions  2294 ,  2296  can be configured such that the first and second side portions  2294 ,  2296  can move axially (i.e., proximally and distally) but not rotationally relative to each other when the connecting pin  2298  is withdrawn. This can be accomplished, for example, by configuring the first side portion  2294  with keyed slot or groove and configuring second side portion  2296  with a keyed projection or tongue that corresponds to the keyed slot or groove of the first side portion  2294 . This can, for example, prevent or reduce the likelihood that the clasp control members/lines  537  from twisting relative to the outer shaft  2220 . 
     The first and second side portions  2294 ,  2296  can include axially extending lumens  2201 . Distal ends of the lumens  2201  can be configured to receive the proximal end portions of the control member tubes  2270 . Proximal ends of the lumens  2201  can be configured to receive portions of the locking members  2292 . 
     The locking members  2292  can be configured to selectively control relative movement between a clasp control member  537  and the respective first or second side portion  2294 ,  2296  of the actuator member  2290 . The locking members  2292  can comprise a lock configuration, which prevents relative movement between a clasp control member  537  and the respective first or second side portion  2294 ,  2296 , and a release configuration, which allows relative movement between a clasp control member  537  and the respective first or second side portion  2294 ,  2296 . In some embodiments, the locking members  2292  can also comprise one or more intermediate configurations (i.e., in addition to the lock and release configuration) which allows relative movement between a clasp control member  537  and the respective first or second side portion  2294 ,  2296 , but the force required to cause the relative movement is greater than when the locking members  2292  are in the release configuration. 
     As shown in the illustrated embodiment, the locking members  2292  can be configured similar to stopcock valves. Thus, rotating knobs  2203  in a first direction (e.g., clockwise) can increase the frictional engagement between the locking members  2292  on the clasp control members/lines  537  and make relative movement between a clasp control member  537  and the respective first or second side portion  2294 ,  2296  more difficult or prevent it altogether. Rotating knobs  2203  in a second direction (e.g., counterclockwise) can decrease the frictional engagement between the locking members  2292  on the clasp control members  537  and make relative movement between a clasp control member  537  and the respective first or second side portion  2294 ,  2296  easier. In some embodiments, actuation locking members  2292  can comprise other configurations configured for preventing relative movement between the locking members  2292  on the clasp control members  537 . 
     The flushing mechanism  2252  can comprise a flushing tube  2205  and a valve  2207  (e.g., a stopcock valve). A distal end of the flushing tube  2205  can be coupled to and in fluidic communication with the flushing lumen  2266  and thus with the actuation shaft lumen or means of actuating lumen  2262  of the main body  2254 . A proximal end of the flushing tube  2205  can be coupled to the valve  2207 . In this manner, the flushing mechanism  2252  can be configured for flushing (e.g., with a saline solution) the outer shaft  2220  prior to inserting the outer shaft  2220  into a patient&#39;s vasculature. 
     The clasp control members  537  or actuation lines can be configured to manipulate the configuration of the clasps  530 , as further described below. As shown in  FIG. 148 , each of the clasp control members or lines  537  can be configured as a suture (e.g., wire, thread, etc.) loop. Proximal end portions of the control members  537  can extend proximally from the proximal end portion of the clasp control mechanism  2250  and can be releasably coupled to the locking mechanisms  2292  of the clasp control mechanism  2250 . 
     From the locking mechanisms  2292 , the clasp control members or actuation lines  537  can form loops extending distally through the lumens  2201  of the clasp control mechanism  2250 , through the control member tubes  2270 , the control member lumens  2264 ,  2282  of the handle  2222 , and through the control member lumens  2240  of the outer shaft  2220 . The clasp control members  537  can extend radially outwardly from the lumens  2240 , for example, through the ports  2233  ( FIG. 146 ) of the coupler or means for coupling  2214 . The clasp control members  537  can then extend through openings  535  of the clasps  530 . The clasp control members  537  can then extend proximally back to the coupler or means for coupling  2214 , radially inwardly through the ports  2233  of the coupler or means for coupling  2214 , and then proximally through the outer shaft  2220  and the handle  2222 , and to the locking mechanisms  2292  of the clasp control mechanism  2250 . 
     In  FIG. 148 , the clasp control members or lines  537  are shown slacken and the clasps  530  are partially open in order to illustrate the clasp control members  537  extending through the openings  535  of the clasps  530 . However, ordinarily when the clasp control members  537  are slacken, the clasps  530  would be in the closed configuration. 
     As shown in the illustrated embodiment, each of the clasp control members or actuation lines  537  can extend through multiple lumens  2240  of the outer shaft  2220 . For example, each of the clasp control members  537  can be looped through two of the lumens  2240 . In some embodiments, each of the clasp control members  537  can be disposed in a single lumen  2240 . In some embodiments, multiple clasp control members  537  can be disposed in a single lumen  2240 . 
     With the clasp control members or actuation lines  537  coupled to the clasps  530 , the clasp control mechanism  2250  can be used to actuate the clasps  530  between open and closed configurations. The clasps  530  can be opened by moving the actuator member  2290  proximally relative to the knob  2226  and the housing  2246 . This increases tension of the clasp control members  537  and causes the clasp  530  to move from the closed configuration to the open configuration. The clasps  530  can be closed by moving the actuator member  2290  distally relative to the knob  2226  and the housing  2246 . This decreases tension on the clasp control members  537  and allows the clasp  530  to move from the open configuration to the closed configuration. The clasps  530  can be individually actuated by removing the pin  2298  and moving the first or second side portions  2294 ,  2296  relative to each other, the knob  2226 , and the housing  2246 . 
     When the handle  2222  is assembled as best shown in  FIGS. 150-151 , the actuation element or means of actuating  512  can extend distally from the knob  2226 , through the actuation tube  2268 , through the actuation lumens  2262 ,  2280  of the housing  2246 , through the actuation lumen  2238  of the outer shaft  2220 , and through the coupler or means for coupling  2214 . 
     Referring now to  FIGS. 153-160 , the delivery assembly  2200  is used, for example, to implant the prosthetic device or prosthetic spacer device  500  in native mitral valve MV of a heart H using a transseptal delivery approach.  FIGS. 153-160  are similar to  FIGS. 15-20 , described above, that show the implantable prosthetic device  100  being implanted in the heart H and  FIGS. 35-46 , described above, that show the implantable prosthetic device  500  being implanted in the heart H. The methods and steps shown and/or discussed can be performed on a living animal or on a simulation, such as on a cadaver, cadaver heart, simulator (e.g., with the body parts, heart, tissue, etc. being simulated), etc. 
     Although not shown, a guide wire can be inserted into the patient&#39;s vasculature (e.g., a femoral vein) through an introducer sheath. The guide wire can be advanced through the femoral vein, through the inferior vena cava, into the right atrium, through the interatrial septum IAS (e.g., via the fossa ovalis), and into the left atrium LA. The first sheath  2216  of the first catheter  2204  can be advanced over the guide wire such that a distal end portion of the first sheath  2216  is disposed in the left atrium LA, as shown in  FIG. 153 . 
     With the prosthetic device or prosthetic spacer device  500  coupled to the third catheter  2208  (e.g., as shown in  FIG. 145 ) and configured in a radially compressed, delivery configuration, the prosthetic device or prosthetic spacer device  500  can be loaded into the first sheath  2216  at a distal end of the second sheath  2218  of the second catheter  2206 . The first sheath  2216  retains the prosthetic device or prosthetic spacer device  500  in the delivery configuration. In some embodiments, the radially compressed, delivery configuration can be an axially elongated configuration (e.g., like the configuration shown in  FIG. 153 ). In some embodiments, the radially compressed, delivery configuration can be an axially foreshorten configuration (e.g., similar to the configuration shown in  FIG. 155 ). The second catheter  2206  along with the prosthetic device or prosthetic spacer device  500  and the third catheter  2208  can then be advanced together through the first catheter  2204  such that a distal end portion of the sheath  2218  exposed from the distal end portion of the first sheath  2216  and is disposed in the left atrium LA, as shown in  FIG. 153 . 
     As shown in  FIG. 153 , the prosthetic device or prosthetic spacer device  500  can be exposed from the first sheath  2216  by distally advancing the outer shaft  2220  and the actuation element or means of actuating  512  of the third catheter  2208  relative to the first sheath  2216  and/or retracting the first sheath  2216  relative to the outer shaft  2220  and the actuation element or means of actuating  512 , thus forcing the paddles  520 ,  522  of the anchors  508  out of the first sheath  2216 . Once exposed from the first sheath  2216 , the paddles  520 ,  522  can be folded by retracting the actuation element or means of actuating  512  of the third catheter  2208  relative to the outer shaft  2220  of the third catheter  2208  and/or by advancing the outer shaft  2220  relative to the actuation element or means of actuating  512 , causing the paddles  520 ,  522  to bend from the configuration shown in  FIG. 153 , to the configuration shown in  FIG. 154 , and then to the configuration shown in  FIG. 155 . This can be accomplished, for example, by placing the actuation lock mechanism  2248  in the release configuration (e.g., by rotating the knob  2288  counterclockwise relative to the handle  2222 ) and then moving the knob  2226  proximally relative to the housing  2246 . Another option is to set the locking knob  2288  to maintain enough friction that you can actively slide the actuation element or means for actuation  512  but the actuation element or means for actuation will not move on its own. At any point in the procedure, the physician can lock the relative position of the actuation element or means of actuating  512  and the outer shaft  2220 , and thus the position of the paddles  520 ,  522 , by actuating the actuation locking mechanism  2248 . 
     The prosthetic device or prosthetic spacer device  500  can then be positioned coaxial relative to the native mitral valve MV by manipulating (e.g., steering and/or bending) the second sheath  2218  of the second catheter  2206 , as shown in  FIG. 155 . The prosthetic device or prosthetic spacer device  500  can also be rotated (e.g., by rotating the housing  2246 ) relative to the native mitral valve MV such that the paddles  520 ,  522  align with native leaflets  20 ,  22  of the mitral valve MV. 
     The paddles  520 ,  522  of the prosthetic device or prosthetic spacer device  500  can then be partially opened (i.e., moved radially outwardly relative to the coaption element  510 ) to the configuration shown in  FIG. 156  by moving the knob  2226  distally relative to the housing  2246 . The prosthetic device or prosthetic spacer device  500  can then be advanced through the annulus of the native mitral valve MV and at least partially into the left ventricle LV. The prosthetic device or prosthetic spacer device  500  is then partially retracted such that the paddles  520 ,  522  are positioned behind the ventricular portions of the leaflets  20 ,  22  (e.g., at the A 2 /P 2  positions) and the coaption element  510  is disposed on the atrial side of the leaflets  20 ,  22 . 
     In this configuration, the native leaflets  20 ,  22  can be secured relative to the paddles  520 ,  522  by capturing the native leaflets with the clasps  530 . The native leaflets  20 ,  22  can be grasped simultaneously or separately by actuating the actuator member  2290 . For example,  FIG. 157  shows separate leaflet grasping. This can be accomplished by removing the pin  2298  from the actuator member  2290  and moving the first or second side portions  2294 ,  2296  relative to each other, the knob  2226 , and the housing  2246 . Moving the first or second side portions  2294 ,  2296  distally relative to the knob  2226  and the housing  2246  closes the clasps  530  on the native leaflets  20 ,  22  (e.g., as shown by the left clasp  530  as illustrated in  FIG. 157 ). Moving the first or second side portions  2294 ,  2296  proximally relative to the knob  2226  and the housing  2246  opens the clasps  530  (e.g., as shown by the right clasp  530  as illustrated in  FIG. 157 ). Once a clasp  530  is closed, a physician can re-open the clasp  530  to adjust the positioning of the clasp  530 . 
     With both of the native leaflets  20 ,  22  secured within the clasps  530 , the physician can move the knob  2226  proximally relative to the housing  2246 . This pulls the paddles  520 ,  522  and thus the native leaflets  20 ,  22  radially inwardly against the coaption element  510 , as shown in  FIG. 158 . The physician can then observe the positioning and/or reduction in regurgitation. If repositioning or removal is desired the physician can re-open the paddles  520 ,  522  and/or the clasps  530 . 
     Once the desired positioning and/or reduction in regurgitation is achieved, the physician can release the prosthetic device or prosthetic spacer device  500  from the delivery apparatus  2202 . The clasps  530  can be released from the delivery apparatus  2202  by releasing the clasp control members or actuation lines  537  from the locking members  2292  and unthreading the clasp control members or actuation lines  537  from the openings  535  of the clasps  530 . The cap  514  of the prosthetic device or prosthetic spacer device  500  can be released from the delivery apparatus  2202  by rotating the knob  2226  in the second direction relative to the housing  2246  such that the actuation element or means of actuating  512  withdraws from the bore  516 C. The actuation element or means of actuating  512  can then be retracted proximally through the prosthetic device or prosthetic spacer device  500  by pulling the knob  2226  proximally relative to the main body  2254 . The proximal collar  511  of the prosthetic device or prosthetic spacer device  500  can be released from the delivery apparatus  2202  by retracting the actuation element or means of actuating  512  proximally relative to the coupler or means for coupling  2214  such that the distal end portion of the actuation element or means of actuating  512  withdraws from the eyelets  2234  of the coupler or means for coupling  2214 . This allows the flexible arms  2228  of the coupler or means for coupling  2214  to move radially outwardly away from the projections  511 E of the proximal collar  511 . The stabilizer members  2230  of the coupler or means for coupling  2214  can then be withdrawn from the guide openings  511 B of the proximal collar  511  by pulling the housing  2246  proximally, thereby releasing the prosthetic device or prosthetic spacer device  500  from the delivery apparatus  2202  as shown in  FIG. 159 . 
     The shafts  512 ,  2220  of the third catheter  2208  can then be retracted proximally into the second sheath  2218  of the second catheter  2206 , and the second sheath  2218  of the second catheter  2206  can be retracted proximally into the first sheath  2216  of the first catheter  2204 . The catheters  2204 ,  2206 ,  2208  can then be retracted proximally and removed from the patient&#39;s vasculature. 
     With the prosthetic device or prosthetic spacer device  500  implanted at the A 2 /P 2  position, the native mitral valve MV comprises a double orifice during ventricular diastole, as shown in  FIG. 160 . During ventricular systole, the side surfaces of the native leaflets  20 ,  22  can coapt all the way around the prosthetic device or prosthetic spacer device  500  to prevent or reduce mitral regurgitation. 
     Referring now to  FIGS. 161-162 , an example embodiment of a handle  2300  for the delivery apparatus  2200  is shown. Referring to  FIG. 161 , the handle  2300  can comprise a housing  2302 , an actuation control mechanism  2304 , the clasp control mechanism  2250 , and a flushing mechanism (not shown, but see, e.g., the flushing mechanism  2252  in  FIG. 150 ). The housing  2302  can include a main body  2306  and the nose portion  2256 . The nose portion  2256  of the housing  2302  can be coupled to a proximal end portion of the outer shaft  2220 . The actuation control mechanism  2304 , the clasp control mechanism  2250 , and a flushing mechanism  2252  can be coupled to a proximal end of the main body  2306  of the housing  2302 . 
     The handle  2300  can be configured similar to the handle  2222 , except that the handle  2300  is configured such that rotational movement of the first knob  2318  of the actuation control mechanism  2304  relative to the housing  2302  causes axial movement of the actuation tube  2268  and the actuation element or means of actuating  512 ; whereas, the handle  2222  is configured such that axial movement of the knob  2226  relative to the housing  2246  causes axial movement of the actuation tube  2268  and the actuation element or means of actuating  512 . 
     As mentioned above, the housing  2302  can include a main body  2306  and the nose portion  2256 . Referring to  FIG. 162 , the main body  2306  of the housing  2302  can comprise an actuation lumen  2308 , control member lumens  2310 , and a flange portion  2312 . The flange portion  2312  can extend axially from a proximal end portion of the main body  2306  and annularly around the actuation lumen  2308 . 
     The flange portion  2312  of the main body  2306  can comprise one or more circumferential grooves  2314 , a bore (not shown), and a guide pin  2316 . The grooves  2314  can be configured to interact with the actuation control mechanism  2304 , as further described below. The bore can extend radially inwardly from an outside diameter to an inside diameter of the flange portion  2312  and can be configured to receive the guide pin  2316 . The guide pin  2316  can be partially disposed in the bore and can extend radially inwardly from the bore such that the guide pin  2316  protrudes into the actuation lumen  2308 . 
     Referring still to  FIG. 162 , the actuation control mechanism  2304  can comprise a first knob  2318 , attachment pins  2320 , a drive screw  2322 , a collet  2324 , and a second knob  2326 . The first knob  2318  can have a distal end portion  2328  and a proximal end portion  2330 . The first knob  2318  can be configured such that the inside diameter of the distal end portion  2328  is relatively larger than the inside diameter of the proximal end portion  2330 . The distal end portion  2328  can comprise openings  2332  that extend radially inwardly from an outside diameter to the inside diameter of the distal end portion  2328 . 
     Referring again to  FIG. 161 , the inside diameter of the distal end portion  2328  can be configured such that the distal end portion  2328  of the first knob  2318  can extend over the flange portion  2312  of the main body  2306 . The openings  2332  ( FIG. 162 ) can be configured to axially align with the grooves  2314  when the first knob  2318  is disposed over the flange  2312 . The attachment pins  2320  can be configured so as to extend through the openings  2332  of the first knob  2318  and into grooves  2314  of the flange  2312 . In this manner, the attachment pins  2320  allow relative rotational movement and prevent relative axial movement between the first knob  2318  and the flange  2312 . 
     The inside diameter of the proximal end portion  2330  of the first knob  2318  can have internal threads (not shown) configured to engage corresponding external threads  2334  of the drive screw  2322 . As shown in  FIG. 162 , the drive screw  2322  can have a slot  2336  that extends axially across the external threads  2334 . The slot  2336  can be configured to receive the guide pin  2316  of the flange portion  2312 . As such, when the handle  2300  is assembled ( FIG. 161 ) and the first knob  2318  is rotated relative to the flange  2312 , the guide pin  2316  prevents the drive screw  2322  from rotating together with the first knob  2318  and causes the drive screw  2322  to move axially relative to the first knob  2318  and the flange  2312 . In this manner, rotating the first knob  2318  in a first direction (e.g., clockwise) moves the drive screw distally relative to the housing  2302 , and rotating the first knob  2318  in a second direction (e.g., counterclockwise) moves the drive screw proximally relative to the housing  2302 . 
     The drive screw  2322  can also have a lumen  2338 , as shown in  FIG. 162 . The lumen  2338  can be configured such that the actuation tube  2268  can extend through the drive screw  2322 . The lumen  2338  can be configured such that a distal end portion  2340  of the collet  2324  can also be inserted into a proximal end portion of the lumen  2338 . 
     The second knob  2326  can comprise a first, distal portion  2342  and a second, proximal portion  2344 . The first portion  2342  can include internal threads (not shown) corresponding to the external threads  2334  of the drive screw  2322 . The second portion  2344  can comprise a conical inside surface configured to engage a proximal end portion  2346  of the collet  2324 . 
     When assembled ( FIG. 161 ), the actuation tube  2268  can extend through the lumen  2338  of the drive screw  2322 , through the collet  2324 , and through the second knob  2326 . The second knob  2326  can be disposed over the collet  2324  and the internal threads of the first portion  2342  of the second knob can threadedly engage the external threads  2334  of the drive screw  2322 . Accordingly, rotating the second knob  2326  in a first direction (e.g., clockwise) relative to the drive screw  2322  causes the second portion  2344  of the second knob  2326  to move toward the proximal end portion  2346  of the collet  2324  and thus urges the collet  2324  radially inwardly against the actuation tube  2268 . As a result, the actuation tube  2268  and the drive screw  2322  move axially together when the first knob  2318  is rotated relative to the housing  2302 . Rotating the second knob  2326  in a second direction (e.g., counterclockwise) relative to the drive screw  2322  causes the second portion  2344  of the second knob  2326  to move away from the proximal end portion  2346  of the collet  2324  and thus allows the collet  2324  to move radially outwardly relative to the actuation tube  2268 . As a result, the actuation tube  2268  and the drive screw  2322  can move relative to each other. 
     With the prosthetic device or prosthetic spacer device  500  coupled to the actuation element or means of actuating  512  and the outer shaft  2220  of the delivery apparatus  2202 , the physician can use the actuation control mechanism  2304  of the handle  2300  to manipulate the paddles  520 ,  522  of the prosthetic device or prosthetic spacer device  500  relative to the spacer member  202  of the prosthetic device or prosthetic spacer device  500 . The actuation control mechanism  2304  can be activated by rotating the second knob  2326  in the first direction relative to the drive screw  2322  to secure the actuation tube  2268  and thus the actuation element or means of actuating  512  to the drive screw  2322 . The physician can then rotate the first knob  2318  relative to the housing  2302 , which causes the drive screw  2322  and thus the actuation tube  2268  and the actuation element or means of actuating  512  to move axially relative to the housing  2302  and thus the outer shaft  2220 . This, in turn, causes the paddles  520 ,  522  (which are coupled to the actuation element or means of actuating  512  via the cap  514 ) to move relative to the coaption element  510  (which is coupled to the outer shaft  2220  via coupler or means for coupling  2214  and the proximal collar  511 ). 
     The prosthetic device or prosthetic spacer device  500  can be released from the delivery apparatus  2202  by rotating the second knob  2326  in the second direction relative to the drive screw  2322 . This allows the actuation tube  2268  and thus the actuation element or means of actuating  512  to move relative to the drive screw  2322 . The shafts  512 ,  2220  of the delivery apparatus  2202  can then be removed from the respective collars of the prosthetic device or prosthetic spacer device  500 , as described above. 
     Configuring a delivery apparatus with the actuation control mechanism  2304  can provide several advantages. For example, the rotational forces required to actuate the first knob  2318  of the handle  2300  can be less than the axial forces required to actuate the knob  2226  of the handle  2300 . 
     The actuation control mechanism  2304  can also provide relatively more precise control of the paddles  520 ,  522  because the axial movement of the actuation element or means of actuating  512  is controlled by rotation of the first knob  2318  and the thread pitch of the drive screw  2322  rather than be axial movement of the knob  2226 . In other words, the actuation control mechanism  2304  can be configured, for example, such that one rotation of the first knob  2318  moves the actuation element or means of actuating  512  a small axial distance (e.g., 1 mm): whereas, it can be relatively more difficult to axially move the knob  2226  and thus the shaft  512  in small increments (e.g., 1 mm). 
     Additionally, the actuation control mechanism  2304  can prevent or reduce inadvertent movement and release of the actuation element or means of actuating  512 . For example, because the actuation control mechanism  2304  requires rotational movement of the first knob  2318  to move the actuation element or means of actuating  512 , it can prevent or reduce the likelihood that the actuation element or means of actuating  512  will move if the knob  2226  is inadvertently contacted. Also, the physician has to rotate the second knob  2326  to release the actuation tube  2268  from the drive screw  2322  before the physician can rotate the knob  2226  to release the actuation element or means of actuating  512  from the cap  514  of the prosthetic device or prosthetic spacer device  500  and proximally retract the actuation element or means of actuating  512 . This two-step release process could reduce the likelihood of a physician inadvertently releasing the prosthetic device/spacer device  500  from the delivery apparatus  2202 . 
       FIGS. 163-164  show example embodiments of a coupler  2400  and a proximal collar  2402 . Although not shown, the coupler  2400  can be coupled to the distal end portion of the outer shaft  2220  ( FIG. 149 ) in a manner similar to the coupler or means for coupling  2214 . As shown, the proximal collar  2402  can be coupled to a proximal end portion of the coaption element  510  in a manner similar to the proximal collar  511  ( FIG. 146 ). As such, the coupler  2400  and the proximal collar  2402  can be used, for example, in lieu of the coupler or means for coupling  2214  and the proximal collar  511  of the delivery assembly  2200 , respectively, to releasably couple the prosthetic device or prosthetic spacer device  500  to the outer shaft  2220  ( FIG. 149 ). 
     Referring to  FIG. 164 , the coupler  2400  can comprise an axially-extending lumen  2404  and a plurality of radially-extending openings  2406 . The lumen  2404  can be configured to receive the actuation element or means of actuating  512  ( FIG. 163 ). The openings  2406  can be configured to receive the proximal collar  2402 , as further described below. 
     The proximal collar  2402  can comprise a plurality of proximally-extending tabs or fingers  2408 . Free end portions  2410  of the fingers  2408  can have radially-extending projections  2412  formed thereon. The fingers  2408  can be configured to move or pivot between a first or resting state ( FIG. 164 ) and a second or deflected state ( FIG. 163 ). In the first state, the free end portions  2410  of the fingers  2408  press radially inwardly against each other. In the second state, the free end portions  2410  of the fingers  2408  are radially spaced from each other. 
     Referring to  FIG. 163 , the coupler  2400  and the proximal collar  2402  be releasably coupled together by positioning the fingers  2408  of the proximal collar  2402  within the coupler  2400 . The actuation element or means of actuating  512  can then be advanced through the lumen  2404  of the coupler  2400  and through the fingers  2408  of the proximal collar  2402 , thus causing the free ends  2410  of the fingers  2408  to move or pivot radially-outwardly from the first state to the second state. The projections  2412  of the fingers  2408  and the openings  2406  of the coupler  2400  can be rotationally aligned such that the projections  2412  extend into the openings  2406 , thereby releasably coupling the coupler  2400  to the proximal collar  2402 . The coupler  2400  can be released from the proximal collar  2402  by retracting the actuation element or means of actuating  512  from the finger  2408  of the proximal collar  2402 . This allows the free end portions  2410  of the fingers  2408  to move or pivot from the second state back to the first state and causes the projections  2412  of the fingers  2408  to withdraw from the openings  2406  of the coupler  2400 , thus releasing the coupler  2400  from the proximal collar  2402 . 
     In some embodiments, the fingers  2408  of the proximal collar  2402  can be configured to create a hemostatic seal when the fingers  2408  are in the first state. This can, for example, prevent or reduce blood from flowing through the proximal collar  2402  when the prosthetic device or prosthetic spacer device  500  is implanted in a patient. 
       FIGS. 165-166  show example embodiments of a cap  2500 , an actuation element or means of actuating  2502  (e.g., actuation shaft, etc.), and a release member (e.g., wire)  2504 , which can be used, for example, with the delivery assembly  2200 . Although not shown, the cap  2500  can be coupled to the distal portion of the prosthetic device or prosthetic spacer device  500 . A proximal portion (not shown) of the actuation element or means of actuating  2502  can be coupled to the actuation tube  2268  and the knob  2226 . From the proximal end portion, the actuation element or means of actuating  2502  can extend distally through the handle  2222  ( FIG. 150 ), through the outer shaft  2220  ( FIG. 150 ), and into the prosthetic device or prosthetic spacer device  500  ( FIG. 145 ). A distal end portion of the actuation element or means of actuating  2502  can be releasably coupled to the cap  2500  of the prosthetic device or prosthetic spacer device  500 . As such, the cap  2500  and the actuation element or means of actuating  2502  can be used, for example, in lieu of the cap  514  and the actuation element or means of actuating  512  of the delivery assembly  2200 , respectively. 
     Referring to  FIG. 166 , the cap  2500  can comprise a central bore  2506  and a tongue or tab  2508  formed (e.g., laser cut) in a side surface  2510  of the cap  2500 . The tongue  2508  can have an opening  2512  formed (e.g., laser cut) therein. The central bore  2506  can be configured to receive a distal end portion of the actuation element or means of actuating  2502 . The tongue  2508  can be movable or pivotable relative to the side surface of the cap  2500  from a first or resting configuration ( FIG. 166 ) to a second or deflected configuration ( FIG. 165 ). In the first configuration, the tongue  2508  can be flush with the side surface  2510 . In the second configuration, the tongue  2508  can extend radially inwardly relative to the side surface  2510  to protrude into the central bore  2506 . 
     The tongue  2508  can be used, for example, to releasably couple the cap  2500  to the actuation element or means of actuating  2502 , as shown in  FIGS. 165 and 166 . For example, the actuation element or means of actuating  2502  can be inserted into the central bore  2506  of the cap  2500 . The tongue  2508  can then be pushed radially inwardly from the first configuration to the second configuration such that the tongue  2508  presses against the actuation element or means of actuating  2502 . The release member  2504  can then be advanced distally such that a distal end portion  2514  of the release member  2504  extends through the opening  2512  of the tongue  2508 . Thus, the release member  2504  retains the tongue  2508  in the second configuration against the actuation element or means of actuating  2502 , thereby releasably coupling the cap  2500  to the actuation element or means of actuating  2502 . 
     The cap  2500  can be released from the actuation element or means of actuating  2502  by retracting the release member  2504  proximally such that the distal end portion  2514  of the release member  2504  withdraws from the opening  2512  of the tongue  2508 . This allows the tongue to move radially outwardly from the second state back to the first state, thereby releasing the cap  2500  from the actuation element or means of actuating  2502 . 
     This configuration can provide several advantages. For example, in some embodiments, the cap  2500  and the actuation element or means of actuating  2502  can be formed without threads. Removing the threads can make manufacturing the cap  2500  and the actuation element or means of actuating  2502  easier and/or less expensive. Removing the threads from the actuation element or means of actuating  2502  can also reduce the likelihood the actuation element or means of actuating  2502  could catch or snag on another component of the delivery assembly  2200 . 
       FIGS. 167-168  show example embodiments of a coupler  2600 , a proximal collar  2602 , a cap  2604 , and an actuation element or means of actuating  2606  (e.g., actuation shaft, etc.), which can be used, for example, with the delivery assembly  2200 . Referring to  FIG. 167 , the coupler  2600  can be coupled to the distal end portion of the outer shaft  2220 . The proximal collar  2602  can be coupled to the proximal portion of the prosthetic device or prosthetic spacer device  500  (shown schematically in partial cross-section), and the cap  2604  can be coupled to the distal portion of the prosthetic device or prosthetic spacer device  500 . A proximal portion (not shown) of the actuation element or means of actuating  2606  can be coupled to the actuation tube  2268  and the knob  2226 . From the proximal end portion, the actuation element or means of actuating  2606  can extend distally through the handle  2222  ( FIG. 150 ), through the outer shaft  2220  ( FIG. 150 ), and into the prosthetic device or prosthetic spacer device  500  ( FIG. 145 ). A distal end portion of the actuation element or means of actuating  2606  can be releasably coupled to the cap  2604  of the prosthetic device/spacer device  500 . As such, the coupler  2600 , the proximal collar  2602 , the cap  2604 , and the actuation element or means of actuating  2606  can be used, for example, in lieu of the coupler or means for coupling  2214 , the proximal collar  511 , the cap  514 , and the actuation element or means of actuating  512  of the delivery assembly  2200 , respectively. 
     Referring to  FIG. 168 , the coupler  2600  can comprise a connection portion  2608 , a plurality of pins  2610  (e.g., three in the illustrated embodiment), and one or more securing members  2612  (e.g., three in the illustrated embodiment). The pins  2610  and the securing members can be coupled to and extend distally from the coupler  2600 . 
     The connection portion  2608  can have an axially-extending lumen  2614  configured to slidably receive the actuation element or means of actuating  2606 . In some embodiments, the connection portion  2608  can also have a recessed outwardly facing surface  2615  configured to be inserted into the distal end portion of the outer shaft  2220 , as shown in  FIG. 167 . 
     As best shown in  FIG. 168 , the pins  2610  can be spaced circumferentially relative to each other and relative to the securing members  2612 . The securing members  2612  can be spaced circumferentially relative to each other. In some embodiments, the pins  2610  and the securing members  2612  can be configured in an alternating type pattern (e.g., pin-securing member-pin and so on) on the connection portion  2608 . 
     Referring to  FIG. 167 , the pins  2610  can be configured to extend into openings  2616  of the proximal collar  2602 . In certain embodiments, the securing members  2612  can be suture loops. The securing members  2612  can be configured to extend through the openings  2616  of the proximal collar  2602  and around the actuation element or means of actuating  2606 . For clarity, only one securing member  2612  is shown extending around the actuation element or means of actuating  2606  in  FIG. 167 . 
     Referring again to  FIG. 168 , in addition to the openings  2616 , the proximal collar  2602  can comprise a central lumen  2618  disposed radially inward from the openings  2616 . The central lumen  2618  can extend axially and can be configured to slidably receive the actuation element or means of actuating  2606 , as shown in  FIG. 167 . 
     The cap  2604  can be configured in a sleeve-like manner such that the actuation element or means of actuating  2606  can slidably extend through the cap  2604 , as shown in  FIG. 167 . 
     The actuation element or means of actuating  2606  can comprise a radially-expandable portion  2620  disposed at or near the distal end portion  2622  of the actuation element or means of actuating  2606 . The radially-expandable portion  2620  can be configured to be selectively expandable from a compressed configuration to an expanded configuration. The radially-expandable portion  2620  can be configured such that an outside diameter of the radially-expandable portion  2620  is less than the inside diameter of the cap  2604 , the central lumen  2618  of the proximal collar  2602 , and the lumen  2614  of the coupler  2600  when the radially-expandable portion  2620  is in the compressed configuration. When the radially expandable portion  2620  is in the expanded configuration, the outside diameter of the radially-expandable portion  2620  is greater than the inside diameter of the cap  2604 . Thus, in the expanded configuration, the radially-expandable portion  2620  can prevent the distal end portion  2622  from moving proximally relative to the cap  2604 . 
     As shown in  FIG. 167 , the prosthetic device or prosthetic spacer device  500  can be releasably coupled to the outer shaft  2220  and the actuation element or means of actuating  2606  by inserting the pins  2610  and the securing members  2612  through respective openings  2616  in the proximal collar  2602 . With the radially-expandable portion  2620  in the compressed configuration, the actuation element or means of actuating  2606  can be advanced distally through the lumen  2614  of the coupler  2600 , through the lumen  2618  and the securing members  2612  of the proximal collar  2602 , and through the cap  2604  such that the radially-expandable portion  2620  is disposed distal relative to the cap  2604 . The radially-expandable portion  2620  of the actuation element or means of actuating  2606  can then be expanded from the compressed configuration to the expanded configuration, thus releasably coupling the prosthetic device or prosthetic spacer device  500  to the outer shaft  2220  and the actuation element or means of actuating  2606 . 
     The prosthetic device  500  can be released from the outer shaft  2220  and the actuation element or means of actuating  2606  by compressing the radially-expandable portion  2620  of the actuation element or means of actuating  2606  and proximally retracting the actuation element or means of actuating  2606  through the cap  2604 , through the securing members  2612  and the lumen  2618  of the proximal collar  2602 . The outer shaft  2220  can then be retracted proximally relative to the prosthetic device or prosthetic spacer device  500  such that the pins  2610  and the securing members  2612  withdraw from the openings  2616  in the proximal collar  2602 , thus releasing the prosthetic device or prosthetic spacer device  500  from the outer shaft  2220  and the actuation element or means of actuating  2606 . 
       FIGS. 169-170  show an example embodiment of clasp control members  2700 , which can be used, for example, in lieu of the clasp control members  537  of the delivery assembly  2200 . Referring to  FIG. 170 , the clasp control members  2700  can comprise sleeves  2702 , connecting members  2704 , and release members  2706 . The connecting members  2704  and the release members  2706  can extend axially through and can be movable relative to the sleeves  2702 . 
     Proximal end portions (not shown) of the sleeves  2702  can be coupled to the control member tubes  2270 , and distal end portions of the sleeves  2708  can be releasable coupled to the clasps  530  of the prosthetic device/spacer device  500  by the connecting members  2704  and the release members  2706 , as further described below. 
     The connecting members  2704  can, for example, be suture loops that extend distally from the clasp control mechanism  2250  of the delivery apparatus  2202 , through the control member tubes  2270 , through the sleeves  2702 , and through the openings  535  of the clasps  530 . The connecting members  2704  can be releasably coupled to the clasps  530  the prosthetic device/spacer device  500  by the release members  2706 . 
     The release members  2706  can, for example, be wires that extend distally from the clasp control mechanism  2250  of the delivery apparatus  2202 , through the control member tubes  2270 , through the sleeves  2702 , and through the loops of the connecting members  2704 . In this manner, the release members  2706  releasably couple the connecting members  2704  and thus the sleeves  2702  to the clasps  530  by preventing the connection members  2704  from withdrawing through the openings  535  of the clasps  530 . The connection members  2704  can be released from the clasps  530  by withdrawing the release members  2706  from the loops of the connecting members  2704  and withdrawing the connecting members  2704  from the openings  535  of the clasps  530 . 
     With the sleeves  2702  releasably coupled to the clasps  530  of the prosthetic device or prosthetic spacer device  500  by the connecting members  2704  and the release members  2706 , the clasps  530  can be actuated (either together or separately) by moving the sleeves  2702  axially relative to the outer shaft  2220  and the actuation element or means of actuating  512 . This can be accomplished, for example, by moving the actuator member  2290 , which are coupled to the sleeves  2702  via the control tubes  2268 , relative to the housing  2246  and actuation tube  2268 . Moving the actuation member  2290  proximally relative to the housing  2246  and actuation tube  2268  can open the clasps  530  and moving the actuation member  2290  distally relative to the housing  2246  and actuation tube  2268  can close the clasps  530 . 
     Because the sleeves  2702  are relatively rigid (e.g., compared to the clasp control members  537 ), the sleeves  2702  can be used to push the clasps  530  closed (either in lieu of or in addition to the bias of the clasps  530  to the closed position). This pushability can help to ensure the native leaflets are grasped within the clasps  530  and thus secured to the paddles  520 ,  522 . 
       FIG. 171  shows an example embodiment of a guide rail or means for guiding  2800 . The guide rail or means for guiding  2800  can, for example, be coupled to the clasps  530  of the prosthetic device or prosthetic spacer device  500 . In some embodiments, the clasp control member  2700  can be releasably coupled to the guide rail or means for guiding  2800  in a snare-like manner similar to that described above with respect to  FIG. 170 . 
     Coupling a clasp control member  2700  to the guide rail or means for guiding  2800  rather than directly to the clasps  530  allows the clasp control member  2700  to slide longitudinally along the guide rail or means for guiding  2800  as the clasp  530  moves between the open and the closed configurations. This can, for example, allow the clasp control member  2700  to maintain a relatively constant angle relative to the paddles  520 ,  522  as the clasps  530  are actuated. For example, the clasp control member  2700  can slide outwardly toward a first side portion  2802  of the guide rail or means for guiding  2800  when the clasp  206  is pulled open, and the clasp control member  2700  can slide inwardly toward a second side portion  2804  of the guide rail or means for guiding  2800  when the clasp  530  is pushed closed. This can therefore reduce the force required to actuate the clasp control member  2700 . For example, the sleeves  2702  can remain more substantially straight as the movable portion of the clasp  530  swings through its full arc of motion. This is due to the sliding movement on the guide rail or means for guiding  2800 . By sliding and remaining substantially straight, the amount of bending of the sleeves is limited. 
       FIG. 172  shows an example embodiment of a shaft  2900 . The shaft  2900  can be used, for example, with the delivery apparatus in lieu of the outer shaft  2220  (See  FIG. 167 ). The shaft  2900  can comprise a plurality of axially extending lumens, including an actuation element lumen or means of actuating lumen  2902  (e.g., an actuation shaft lumen, actuation tube, etc.), and a plurality of control member lumens  2904  (e.g., four in the illustrated embodiment) disposed radially outwardly from the actuation element lumen or means of actuating lumen  2902 . The control member lumens  2904  can be spaced relative to each other and can be evenly distributed circumferentially around the actuation element lumen or means of actuating lumen  2902 . For example, each of the control member lumens  2904  can be located approximately 90 degrees from an adjacent control member lumen  2904 . 
     The actuation element lumen or means of actuating lumen  2902  can be configured to receive the actuation element or means of actuating  512 , and the control member lumens  2904  can be configured to receive the clasp control members or actuation lines  537 . The lumens  2902 ,  2904  can also be configured such that the actuation element or means of actuating  512  and clasp control members/lines  537  can be movable (e.g., axially and/or rotationally) relative to the lumens  2902 ,  2904 , respectively. In particular embodiments, the lumens  2902 ,  2904  can comprise a liner or coating (e.g., PTFE, polymer, hydrogel, etc.) configured to reduce friction between the lumens  2902 ,  2904  and the actuation element or means of actuating  512  and clasp control members/lines  537 , respectively. 
     The shaft  2900  can be formed from various materials, including metals and polymers. For example, in one particular embodiment, the shaft  2900  can comprise a first portion  2906 , a second portion  2908 , and a third portion  2910 . The first portion  2906  be the radially outermost portion, the third portion  2910  can be the radially innermost portion, and the second portion  2908  can be disposed radially between the first and third portions  2906 ,  2910 . In certain embodiments, the first and third portions  2906 ,  2910  can be formed from polymeric material (e.g., PEBAX or other material having a Type D Shore durometer value of 55D), and the second portion  2908  can be formed from a metallic material (e.g., braided stainless steel). 
     Configuring the shaft  2900  in this manner can, for example, further improve control of the distal end portion of the shaft  2900 . For example, this configuration can prevent or reduce “whipping” (e.g., sudden or abrupt movement) at the distal end portion of the shaft  2900  when the shaft  2900  is rotated at the proximal end portion (e.g., by rotating the housing  2246  of the handle  2222 ). As such, a physician can more precisely control the distal end portion of the shaft  2900  and thus more precisely control the prosthetic device or prosthetic spacer device (e.g., the spacer device  500 ) during the implantation procedure such as when the physician rotates the prosthetic device or prosthetic spacer device to align the anchors of the prosthetic device or prosthetic spacer device with the native leaflets. 
     It should be noted that in certain embodiments the housing  2246  of the handle  2222  can comprise four control member lumens  2264 ,  2282  (i.e., four of each) that are coupled to the control member lumens  2904 . As such, each portion of the clasp control members or lines  537  can extend distally in a separate lumen from the clasp control mechanism  2250  of the handle  2222  to the prosthetic device or prosthetic spacer device  500 . 
     Referring to  FIG. 173 , the actuation element  512  can be hollow so that a tethering line or suture  3000  can be extended through the actuation element  512  to the device  500 . The actuation element  512  extends through the device  500  and is attached to the cap  514 . Retracting the tethering line  3000  in the retraction direction X relative to a coupler of the delivery assembly  2200  reduces the length of the tethering line  3000 , thereby moving the coupler of the delivery assembly  2200  toward the device  500  in a recapture direction Y. 
     Referring again to  FIG. 173 , the device  500  is shown in a closed position as if after delivery and implantation in a native valve. Once the device  500  is implanted, the coupler of the delivery assembly  2200  is opened and moved away from the device in a retraction direction X so that the performance of the device  500  can be monitored to see if any adjustments may be desirable. If further adjustments to the device  500  are desired, the tethering line  3000  is retracted in the retraction direction X so that the coupler of the delivery assembly  2200  moves in the recapture direction Y toward the device  500 . 
     Referring now to  FIG. 174 , the coupler of the delivery assembly  2200  has been moved into a suitable position to recapture the device  500 . Once in position, the actuation lines  3002  for each moveable arm  2228  are retracted in an actuation direction A to cause the moveable arms  2228  to move in a closing direction B close around the proximal collar  511  of the device  500 . In some embodiments, the tethering line  3000  is adjusted simultaneously with the actuation lines  3002  to aid in recapturing the device  500  which may be moving around as the native valve opens and closes. 
     Referring now to  FIG. 175 , the moveable arms  2228  are closed around the proximal collar  511 . The actuation element  512  is then moved in a distal direction C, through the securing portions or eyelets  2234  of the moveable arms  2228  and into the device  500  along the tethering line  3000 . To recapture and secure the device  500 , a threaded end  512 B of the actuation element  512  is threaded into a threaded receptacle  516 C of the cap  514  as shown in  FIG. 176 . 
       FIGS. 174A and 175A  illustrate an example of a mechanism that can be used to recouple the coupler of the delivery assembly  2200  to the collar  511  of the device  500 . In the example of  FIGS. 174A and 175A , the actuation element  512  can be hollow so that a tethering line or suture  3000  can be extended through the actuation element  512  to the device  500 . As in the embodiment illustrated by  FIGS. 174 and 175 , retracting the tethering line  3000  in the retraction direction X moves the coupler of the delivery assembly  2200  toward the device  500  in a recapture direction Y. 
     Referring now to  FIGS. 174A and 175A , the coupler of the delivery assembly  2200  has been moved into a suitable position to recapture the device  500 . Once in position, a closing sleeve  3003  that fits around the moveable arms  2228  is advanced over the coupler of the delivery assembly  2200  in a closing direction C to press the moveable arms  2228  inward in a closing direction D around the proximal collar  511  of the device  500 . In some embodiments, the tethering line  3000  is adjusted simultaneously with the closing sleeve  3003  to aid in recapturing the device  500  which may be moving around as the native valve opens and closes. 
     Referring now to  FIG. 175A , the moveable arms  2228  are closed around the proximal collar  511 . The actuation element  512  is then moved in a distal direction E and into the device  500  along the tethering line  3000 . To recapture and secure the device  500 , a threaded end  512 B of the actuation element  512  is threaded into a threaded receptacle  516 C of the cap  514  as shown in  FIG. 176 . 
     Referring now to  FIGS. 177-178 , an example implantable prosthetic device  3100  is shown. The device  3100  includes an implantable prosthetic device  3110  and a coupler  3120 . An actuation element or means of actuating or wire  3130  can extend through the coupler  3120  to the device  3110  to open and close the device  3110 . The device  3110  is similar to example implantable prosthetic devices described in the present application and includes a proximal collar  3112  having an opening  3114  and radially disposed apertures  3116 . The coupler  3120  has moveable arms or fingers  3122  that can be moved between open and closed positions. The moveable arms  3122  include protrusions  3124  configured to engage the apertures  3116  of the proximal collar  3112  of the device  3110 . The moveable arms  3122  are biased inward so that moving the actuation element or means of actuating  3130  in a distal direction Y through the coupler  3120  and between the moveable arms  3122  spreads the moveable arms  3122  outwards so that the protrusions  3124  engage the apertures  3116 . In the illustrated embodiment, the protrusions  3124  and apertures  3116  are tapered to ease engagement of the protrusions  3124  with the apertures  3116 . Moving the actuation element or means of actuating  3130  in a retraction direction X allows the moveable arms  3122  to move inward so that the protrusions  3124  disengage the apertures  3116 . In this way the device  3110  can be released and recaptured by the coupler  3120 . 
     Referring now to  FIGS. 179-181 , an example implantable prosthetic device  3200  is shown. The device  3200  includes an implantable prosthetic device  3210  and a coupler  3220 . An actuation element or means of actuating or wire  3230  can extend through the coupler  3220  to the device  3210  to open and close the device  3210 . The device  3210  is similar to example implantable prosthetic devices described in the present application and includes a proximal collar  3212  having an opening  3214  and radially disposed apertures  3216 . 
     The coupler  3220  has moveable arms or fingers  3222  that can be moved between open and closed positions. The moveable arms  3222  include protrusions  3224  configured to engage the apertures  3216  of the proximal collar  3212  of the device  3210 . The moveable arms  3222  are biased inward so that moving the actuation element or means of actuating  3230  in a distal direction Y through the coupler  3220  and between the moveable arms  3222  spreads the moveable arms  3222  outwards so that the protrusions  3224  engage the apertures  3216 . Moving the actuation element or means of actuating  3230  in a retraction direction X allows the moveable arms  3222  to move inward so that the protrusions  3224  disengage the apertures  3216 . In this way the device  3210  can be released and recaptured by the coupler  3220 . 
     The actuation element  3230  (e.g., actuation wire, shaft, tube, etc.) can be hollow so that a tethering line or suture  3232  can be extended through the actuation element  3230  to the device  3210 . The actuation element  3230  extends through the opening  3214  of the device  3210  and is attached to securing portions  3218 . Retracting the tethering line  3232  in the retraction direction X ( FIG. 180 ) reduces the length of the tethering line  3232 , thereby moving the coupler  3220  toward the device  3210  such that the moveable arms  3222  are inserted into the opening  3214  of the device  3210  as shown in  FIG. 180 . 
     Referring now to  FIG. 181 , once the coupler  3220  has been moved into position to recapture the device  3210  the actuation element  3230  is moved in the distal direction Y to recouple the coupler  3220  to the device  3210 . The actuation element  3230  engages the moveable arms  3222 , thereby causing the protrusions  3224  to move in an outward direction A to engage the apertures  3216  of the device  3210 . In the illustrated embodiment, the protrusions  3224  and apertures  3216  are tapered to ease engagement of the protrusions  3224  with the apertures  3216 . In some embodiments, the tethering line  3232  is adjusted simultaneously as the actuation element or means of actuating  3230  is extended to take up slack in the actuation line and maintain engagement between the coupler  3220  and device  3210 . 
     Referring now to  FIGS. 182-183 , an example implantable prosthetic device  3300  is shown. The device  3300  includes an implantable prosthetic device  3310  and a coupler  3320 . An actuation element or means of actuating or wire  3330  can extend through the coupler  3320  to the device  3310  to open and close the device  3310 . The device  3310  is similar to example implantable prosthetic devices described in the present application and includes a proximal collar  3312  having an opening  3314  and radially disposed apertures  3316 . 
     The coupler  3320  has moveable arms or fingers  3322  that can be moved between open and closed positions. The moveable arms  3322  include distal protrusions  3324  configured to engage the apertures  3316  of the proximal collar  3312  of the device  3310 . The moveable arms  3322  also include internal protrusions  3326  having apertures  3328  configured to receive the actuation element or means of actuating  3330 . In the closed position, the internal apertures  3328  are offset from the actuation element or means of actuating  3330 . The actuation element or means of actuating  3330  has a tapered end  3332  to engage the offset apertures  3328 . As successive apertures  3328  are engaged by the tapered end  3332  of the actuation element or means of actuating  3330 , the moveable arms  3322  are moved outward to engage the opening  3314 . 
     The moveable arms  3322  are biased inward so that moving the actuation element or means of actuating  3330  in a distal direction Y through the coupler  3320  and between the moveable arms  3322  spreads the moveable arms  3322  outwards so that the protrusions  3324  engage the apertures  3316 . Moving the actuation element or means of actuating  3330  in a retraction direction X allows the moveable arms  3322  to move inward so that the protrusions  3324  disengage the apertures  3316 . In this way the device  3310  can be released and recaptured by the coupler  3320 . In some embodiments, the prosthetic device  3300  is similar to the device  3200  and includes a tethering line (not shown) that allows the device  3300  to be recaptured. 
     Referring now to  FIGS. 184-185 , an example implantable prosthetic device  3400  is shown. The device  3400  includes an implantable prosthetic device  3410  and a coupler  3420 . An actuation element or means of actuating or wire  3430  can extend through the coupler  3420  to the device  3410  to open and close the device  3410 . The device  3410  is similar to example implantable prosthetic devices described in the present application and includes a proximal collar  3412  having radially disposed apertures  3414 . 
     The coupler  3420  has moveable arms or fingers  3422  that can be moved between open and closed positions. The moveable arms  3422  include distal protrusions  3424  configured to engage the apertures  3414  of the proximal collar  3412  of the device  3410 . The moveable arms  3422  also include internal protrusions  3426  having apertures  3428  configured to receive the actuation element or means of actuating  3430 . In the closed position, the internal apertures  3428  are offset from the actuation element or means of actuating  3430 . The actuation element or means of actuating  3430  has a tapered end  3432  to engage the offset apertures  3428 . As successive apertures  3428  are engaged by the tapered end  3432  of the actuation element or means of actuating  3430 , the moveable arms  3422  are moved inward to engage the circumferential opening  3414 . 
     The moveable arms  3422  are biased outward so that moving the actuation element or means of actuating  3430  in a distal direction Y through the coupler  3420  and between the moveable arms  3422  retracts the moveable arms  3422  inwards so that the protrusions  3424  engage the apertures  3414 . Moving the actuation element or means of actuating  3430  in a retraction direction X allows the moveable arms  3422  to spread outward so that the protrusions  3424  disengage the apertures  3414 . In this way the device  3410  can be released and recaptured by the coupler  3420 . In some embodiments, the prosthetic device  3400  is similar to the device  3200  and includes a tethering line (not shown) that allows the device  3400  to be recaptured. 
     Referring to  FIG. 186 , an actuation element or means of actuating  3500  for placing and actuating an implantable prosthetic device is shown. The actuation element or means of actuating  3500  includes a hollow positioning shaft  3510  and a hollow device shaft  3520  that fit over a retaining shaft  3530  that holds the hollow positioning and device shafts  3510 ,  3520  together at a connection  3502 . The hollow positioning shaft  3510  extends from a delivery device  3504  and when coupled to the device shaft  3520  allows an implantable device  3506  to be placed in a suitable location for implantation. The location of the connection  3502  between the hollow positioning shaft  3510  and the device shaft  3520  can be at a wide variety of different positions in an implantable device. For example, the connection  3502  can be at a proximal portion of a device or can be at a distal portion of a device. 
     The hollow positioning shaft  3510  can include a protruding portion  3512  and a recessed receiving portion  3514 . The device shaft  3520  can also include a protruding portion  3522  and a recessed receiving portion  3524 . When the hollow positioning and device shafts  3510 ,  3520  are coupled, the protruding portion  3512  of the hollow positioning shaft  3510  is received by the receiving portion  3524  of the device shaft  3520 , and the protruding portion  3522  of the device shaft  3520  is received by the receiving portion  3514  of the hollow positioning shaft  3510 . 
     The hollow positioning and device shafts  3510 ,  3520  can be connected in a wide variety of different ways. For example, the hollow positioning shaft  3510  can include a bore or channel  3516  that is aligned with a bore or channel  3526  of the hollow device shaft  3520  when the protruding portions  3512 ,  3522  are disposed in the receiving portions  3514 ,  3524 , respectively. When the openings  3516 ,  3526  are aligned and the retaining shaft  3530  is placed into the openings  3516 ,  3526  in the direction X, the hollow positioning and device shafts  3510 ,  3520  are retained together. When the retaining shaft  3530  is removed from the openings  3516 ,  3526  in the direction Z, protruding portions  3512 ,  3522  can be removed from the receiving portions  3514 ,  3524 , such that the device  3506  is detached from the hollow positioning shaft  3510 . 
     Still referring to  FIG. 186 , in some embodiments, when the hollow positioning and device shafts  3510 ,  3520  are secured to each other, an aperture  3540  is created at interface  3542  between the hollow positioning and device shafts  3510 ,  3520 . The aperture  3540  is configured to secure a control line  3544  between the hollow positioning and device shafts  3510 ,  3520  to allow for separate control of clasps or gripping members (not shown). That is, the aperture  3540  is configured such that the line  3544  does not move relative to the aperture  3540  when the hollow positioning and device shafts  3510 ,  3520  are joined together. Upon detachment of the hollow positioning and device shafts  3510 ,  3520 , the line  3544  is released from the aperture  3540  and can be removed from the implantable device  3506 . The line  3544  can then be retracted into the catheter to release the clasps gripping members. 
     Referring now to  FIG. 187 , an actuation or control mechanism  3600  is shown. The control mechanism  3600  can be used to open and close first and second clasps or gripping members  3610 ,  3620  to grasp native leaflets for implantation of an implantable prosthetic device. The control mechanism  3600  includes a first gripper control member  3612  and a second gripper control member  3622 . The first gripper control member  3612  is configured to move the first gripping member  3610  bi-directionally in the direction X, and the second gripper control member  3622  is configured to move the first gripping member  3620  bi-directionally in the direction Z. Movement of the first gripping member  3610  in the direction X adjusts the width W of a first opening  3616  between the first gripping member  3610  and a first paddle  3614 , and movement of the second gripping member  3620  in the direction Z will adjust the width H of a second opening  3626  between the second gripping member  3620  and a second paddle  3624 . 
     In the illustrated embodiment, the gripper control members  3610 ,  3620  include actuation lines configured as push/pull links  3611 ,  3621 , such as, for example, a catheter, a flexible rod, a stiff wire, etc. and a coupler  3613 ,  3623 . Each push/pull link  3611 ,  3621  extends from a delivery device  3602  and is removably attached to the corresponding gripping member  3612 ,  3622  by the couplers  3613 ,  3623 . The link  3611  is configured to be pushed and pulled in the direction Y. Movement of the link  3611  in the direction Y causes the gripping member  3610  to move in the direction X. Similarly, the link  3621  is configured to be pushed and pulled in the direction M, and movement of the link  3621  in the direction M causes the gripping member  3620  to move in the direction H. 
     Referring now to  FIGS. 188 and 188A , an actuation or control mechanism  3700  for use in implantable prosthetic devices, such as the devices described in the present application, is shown. The actuation mechanism  3700  allows for pushing and pulling of portions of an implantable device, such as the clasps or gripping members described above. The mechanism  3700  includes first and second control members  3710 ,  3720  that extend from a delivery device  3702 . The delivery device  3702  can be any suitable device, such as a sheath or catheter. The first and second control members  3710 ,  3720  include first and second sutures  3712 ,  3722  and first and second flexible wires  3714 ,  3724 . The first and second flexible wires  3714 ,  3724  extend from the delivery device  3702  and each include a loop  3716 ,  3726  for receiving the first and second sutures  3712 ,  3722  and for engaging a clasp or gripping member. Each of the first and second sutures  3712 ,  3722  extends from the delivery device  3702 , through a one of the first and second loops  3716 ,  3726 , respectively, and back into the delivery device  3702 . In the example illustrated by  FIG. 188 , each suture  3712 ,  3722  extends through one of the loops  3716 ,  3726  once. In the example illustrated by  FIG. 188 , each suture  3712 ,  3722  extends through one of the loops  3716 ,  3726  twice. In some embodiments, the first and second control members  3712 ,  3722  extend through separate delivery devices  3702 . The sutures  3712 ,  3722  are removably attached to moveable arms of example barbed clasps described above. The first and second loops  3716 ,  3726  of the respective wires  3714 ,  3724  are able to move along the corresponding sutures  3712 ,  3722  such that the loops  3716 ,  3726  can engage the corresponding barbed clasps to engage the moveable arms. That is, the sutures  3712 ,  3722  are used to pull the moveable arms in an opening direction and the wires  3714 ,  3724  are used to push the moveable arms in a closing direction. The wires  3714 ,  3724  can be made of, for example, steel alloy, nickel-titanium alloy, or any other metal or plastic material. In certain embodiments, the wires  3714 ,  3724  can have a diameter between about 0.10 mm and about 0.35 mm, between about 0.15 mm and about 0.30 mm, and between about 0.20 mm and about 0.25 mm. While the wires  3714 ,  3724  are shown as coming out of separate lumens than the sutures  3712 ,  3722 , in one embodiment, the wires  3714 ,  3724  can share a lumen with a suture. 
     In the examples of  FIGS. 188 and 188A , the wires  3714 ,  3724  can be replaced with a rigid or semi-rigid tube or pushable coil. The tube or pushable coil can share a lumen with a suture loop, the suture loop can be disposed inside the tube or pushable coil. The tube or pushable coil can be advanced over one side or both sides of each suture loop to push. The tube, pushable coil, or wire can be retracted as necessary into the catheter when not needed. 
     Referring now to  FIG. 189 , an example embodiment of an actuation or control mechanism  3800  includes a first catheter  3811 , a second catheter  3821 , and single line  3830 , such as a wire or suture. The first catheter  3811  and line  3830  are configured to move a first gripping member  3810  in the direction X, and the second catheter  3821  and line  3830  configured to move a second gripping member  3820  in the direction Z. Movement of the gripping member  3810  in the direction X will adjust the width W of a first opening  3816  between the first gripping member  3810  and a first paddle  3814 , and movement of the second gripping member  3820  in the direction Z will adjust the width H of a second opening  3826  between the second gripping member  3820  and a second paddle  3824 . The line  3830  extends from a delivery device  3802  through the catheters  3811 ,  3821  and is threaded through openings in both gripping member  3810 ,  3820 . Each catheter  3811 ,  3821  is configured to engage and move the corresponding gripping member  3810 ,  3820 . In particular, the first catheter  3811  is configured to be pushed in the direction Y while the line  3830  is payed out of the second catheter  3821  or tension in the line  3830  is reduced. The first catheter  3811  is configured to be pulled in the direction Y while the line  3830  is pulled into the first catheter  3811  or tension in the line is increased. Movement of the first catheter  3811  in the direction Y causes the first catheter  3811  to move the first gripping member  3810  in the direction X. Similarly, the second catheter  3821  is configured to be pushed in the direction M while the line  3830  is payed out of the first catheter  3811  or tension in the line  3830  is reduced. The second catheter  3821  is configured to be pulled in the direction M while the line  3830  is pulled into the second catheter  3821  or tension in the line  3830  is increased. Movement of the second catheter  3821  in the direction M causes the second catheter  3821  to move the second gripping member  3820  in the direction H. In an alternative embodiment, the control mechanism  3800  described above with reference to  FIG. 189  can include a first flexible wire with a loop (e.g., the flexible wire  3714  with the loop  3716  shown in  FIG. 188 ) and a second flexible wire with a loop (e.g., the flexible wire  3724  with the loop  3726  shown in  FIG. 188 ), and the single line  3830  extends through the loop  3716 ,  3726  of each of the wires  3830 . 
     Referring to  FIG. 190 , an example embodiment of an actuation or control mechanism  3900  includes a single line  3930 , such as a suture or wire, that is removably attached to first and second clasps or gripping members  3910 ,  3920  and removably fixed between a shaft or positioning shaft  3904  and a shaft or device shaft  3906  of an implantable device. While described as two shafts  3904 ,  3906 , these could be configured as a single shaft passing through a loop of line  3930 , e.g., and can be retractable from the loop to release the line. The shafts  3904 ,  3906  are similar to the hollow positioning and device shafts  3510 ,  3520 , described in more detail above. The single line  3930  is connected at a connection  3908  between the shafts  3904 ,  3906 , such that the single line  3930  can separately control the gripping members  3910 ,  3920 . That is, movement of a first portion  3932  of the line  3930  in a direction Y will adjust a width W between the first gripping member  3910  and a first paddle  3914  but will not adjust a width H between the second gripping member  3920  and a second paddle  3924 . Similarly, movement of a second portion  3934  of the line  3930  in a direction M will adjust a width H between the second gripping member  3920  and a second paddle  3924  but will not adjust the width W between the first gripping member  3910  and the first paddle  3914 . After the valve repair device is in a closed position and secured to the native valve tissue, the positioning shaft  3904  is detached from the device shaft  3906 . Decoupling the shafts  3904 ,  3906  releases the line  3930  from the connection  3908 . The line  3930  can then be retracted into the catheter  3902  to release the gripping members  3910 ,  3920  by pulling one end of the line  3930  into the catheter  3902 . Pulling one end of the line  3930  into the catheter  3902  pulls the other end of the line  3930  through the gripping members  3910 ,  3920  and then into the catheter  3902 . Any of the lines described herein can be retracted in this manner. While described here as a single line, a similar configuration could also be used where line  3930  is two separate lines each connecting in a similar way to a respective clasp or gripping member  3910 ,  3920 , and with each of the separate lines attaching to the shafts  3904 ,  3906  or to a combined single shaft (e.g., that passes through loops at the ends of the two lines and can be retracted to release the two lines). 
     Referring now to  FIGS. 208A, 208B, 209A, and 209B , an example implantable prosthetic device  4100 , such as the devices described in the present application, is shown anchored to native leaflets  20 ,  22 . The device  4100  includes a coaption or spacer element  4102  and anchors  4104 . The anchors  4104  attach the device  4100  to the leaflets  20 ,  22 . As can be seen in  FIG. 208B , first and second gaps  26 A,  26 B remain between the closed leaflets  20 ,  22  after the device  4100  is deployed. The coaption element  4102  includes first and second auxiliary, inflatable coaption or spacer elements  4106 ,  4108  that are shown in a deflated condition in  FIGS. 208A and 208B . 
     Referring now to  FIGS. 209A, 209B , the device  4100  is shown with the auxiliary coaption elements  4106 ,  4108  in an inflated condition. The first and second auxiliary coaption elements  4106 ,  4108  can be inflated to fill the first and second gaps  26 A,  26 B. Filling the gaps  26 A,  26 B allows the leaflets  20 ,  22  to more fully seal around the device  4100 . The auxiliary coaption elements  4106 ,  4108  are independently inflatable so that the first auxiliary coaption element  4106  can be inflated to a different size than the second auxiliary coaption element  4108  to fill different size gaps  26 A,  26 B. 
     Referring now to  FIGS. 210A and 210B , an example expandable coaption or spacer element  4200  for use with a prosthetic implantable device of the present disclosure is shown. Referring now to  FIG. 210A , the expandable coaption element  4200  is shown in a compressed condition. The expandable coaption element  4200  is formed from a coiled wire  4202  that is retained in the compressed condition by a retaining element  4204 . Once the coaption element  4200  is in a desired location, an actuation line or actuation suture  4206  is used to pull the retaining element  4204  in an actuation direction  4208 . Removing the retaining element  4204  allows the coaption element  4200  to expand in an expansion direction  4210  to a larger, expanded size. The coaption element  4200  can be used as the auxiliary coaption element  4016 ,  4018  in the embodiment of  FIGS. 208A, 208B, 208C , and  208 D. 
     Referring now to  FIGS. 211A and 211B , an example implantable prosthetic device  4300 , such as the devices described in the present application, is shown. The device  4300  extends from a proximal end  4301  to a distal end  4303 . Like the device  4100  described above, the device  4300  includes a coaption or spacer element  4302  that has first and second auxiliary, inflatable coaption or spacer elements  4306 ,  4308  that are shown in a deflated condition in  FIG. 211A . Each auxiliary coaption element  4306 ,  4308  extends from a proximal end  4306 A,  4308 A to a distal end  4306 B,  4308 B. Referring now to  FIG. 211B , the device  4300  is shown with the auxiliary coaption elements  4306 ,  4308  in an inflated condition. When inflated, the proximal ends  4306 A,  4308 A and distal end  4306 B,  4308 B have different sizes such that the auxiliary coaption elements  4306 ,  4308  increase in size from the proximal  4306 A,  4308 A to distal ends  4306 B,  4308 B as indicated by arrows  4310 . In certain embodiments, the proximal ends are larger than the distal ends. The varying width of the auxiliary coaption elements  4306 ,  4308  improves coaption between leaflets (not shown) and the device  4300  where the gaps between leaflets change in size from the proximal  4301  to distal  4303  ends of the device  4300 . 
     Referring now to  FIGS. 212A, 212B, 213A, 213B, 214, 215A, 215B, 216A, 216B, 217A, 217B, and 218  an example implantable prosthetic device  4400 , such as the devices described in the present application, is shown. Referring now to  FIGS. 212A, 212B, 213A, 213B, and 214 , the device  4400  includes a coaption or spacer element  4402 , anchors  4404 , and an attachment portion  4406 . The attachment portion  4406  is a threaded rod that extends from the coaption element  4402  to receive an auxiliary coaption or spacer element  4410 . The auxiliary coaption element  4410  has an inverted L-shape with an attachment opening  4412  and a spacer body  4414 . The attachment opening  4412  receives the attachment portion  4406  to attach the auxiliary coaption element  4410  to the device  4400 . The spacer body  4414  extends along one side of the coaption element  4402  to fill a gap (e.g., gaps  26 A,  26 B shown in  FIG. 208B ) between the leaflets. The auxiliary coaption element  4410  can have any suitable shape and can vary in width and size like the inflatable spacers  4106 ,  4108 ,  4306 , and  4308  described above. 
     Referring now to  FIG. 214 , the auxiliary coaption element  4410  is shown being assembled to the device  4400 . The auxiliary coaption element  4410  can be attached to the attachment portion  4406  of the device  4400  after the device  4400  has been implanted between the native leaflets (not shown) and anchored in place via the anchors  4404 . As can be seen in  FIGS. 215A and 215B , the auxiliary coaption element  4410  is secured to the attachment portion  4406  with a nut  4408  after being attached to the device  4400 . In certain embodiments, the attachment opening  4412  in the auxiliary coaption element  4410  is a slot to allow for lateral adjustment of the position of the auxiliary coaption element  4410  without fully removing the auxiliary coaption element  4410  from the device  4400 . That is, the nut  4408  can be loosened to allow the position of the auxiliary coaption element  4410  to be adjusted after assembly to the device  4400 . 
     Referring now to  FIGS. 216A, 216B, 217A, 217B , the device  4400  and auxiliary coaption element or spacer  4410  are shown with different means of attaching the auxiliary coaption element  4410  to the device  4400  than the threaded rod and nut  4408  described above. The device  4400  shown in  FIGS. 216A and 216B  includes a circular magnet  4407  surrounding the attachment portion  4406 . The auxiliary coaption element  4410  shown in  FIGS. 217A and 217B  includes a similarly shaped magnet  4413  surrounding the attachment opening  4412  (which is shown as a hole, rather than a slot). When the auxiliary coaption element  4410  is assembled to the device  4400  opposite poles two magnets  4407 ,  4413  face each other and are attracted to each other and retain the auxiliary coaption element  4410  on the device  4400  by way of magnetic attractive forces. In some embodiments, a plurality of magnets are provided on the device  4400  and/or the auxiliary coaption element  4410 . 
     Referring now to  FIG. 218 , a double-sided auxiliary coaption element  4420  for attachment to the device  4400  is shown. The auxiliary coaption element  4420  has an inverted U-shape with an attachment opening  4422  disposed between two coaption portions  4424 . Like the auxiliary coaption element  4410  described above, the attachment opening  4422  receives the attachment portion  4406  to attach the auxiliary coaption element  4420  to the device  4400 . The coaption portions  4424  extend along both sides of the coaption element  4402  to fill gaps (e.g., gaps  26 A,  26 B shown in  FIG. 208B ) between the leaflets. The auxiliary coaption element  4420  can have any suitable shape and can vary in width and size like the inflatable spacers  4106 ,  4108 ,  4306 , and  4308  described above. 
     Referring now to  FIGS. 219A, 219B , an example implantable prosthetic device  4500 , such as the devices described in the present application, is shown. The device  4500  includes a coaption or spacer element  4502  and attachment portions  4504  arranged on opposite sides of the coaption element  4502 . The attachment portions  4504  are configured to receive auxiliary coaption or spacer elements of varying shapes and sizes ( FIGS. 220A-220E ). In the illustrated embodiment, the attachment portions  4504  are shown as hoops that receive posts or pins  4512  of the auxiliary coaption elements ( FIGS. 220A-220E ). Like the spacers  4410  shown above, the auxiliary coaption elements  4510 A,  4510 B,  4520 A,  4520 B,  4530 A,  4530 B,  4540 A,  4540 B,  4550 A,  4550 B shown in  FIGS. 220A-220E  extend along one or both sides of the coaption element  4502  to fill a gap (e.g., gaps  26 A,  26 B shown in  FIG. 208B ) between the leaflets. To accommodate gaps of different sizes and shapes, the variety of auxiliary coaption elements  4510 A,  4510 B,  4520 A,  4520 B,  4530 A,  4530 B,  4540 A,  4540 B,  4550 A,  4550 B are provided with semi-circle, rounded triangular, or other suitable shapes in a range of sizes. Different size and shape auxiliary coaption elements  4510 A,  4510 B,  4520 A,  4520 B,  4530 A,  4530 B,  4540 A,  4540 B,  4550 A,  4550 B can be attached to the coaption element  4502  to accommodate gaps that are different shapes and sizes on opposite sides of the coaption element  4502 . 
     Referring now to  FIGS. 221-223 , an example implantable prosthetic device  4600  is shown. Referring now to  FIG. 221 , the device  4600  is shown cut from a flat sheet of material  4602 , such as Nitinol, into a lattice-like shape formed from a plurality of struts. The coaption portion  4604  of the device  4600  includes auxiliary coaption portions  4606  that expand outwards from the coaption element  4600  when the device  4600  is formed into a three-dimensional shape. The auxiliary coaption portions  4606  can be longer struts that are curved before the prosthetic device is expanded. Referring now to  FIG. 223 , when the device is expanded, the longer curved struts expand to form the auxiliary coaption portions  4606 . The expanded auxiliary coaption portions  4606  fill or partially fill gaps  26  between the native leaflets  20 ,  22  when the device  4600  is implanted between the native leaflets  20 ,  22 . In some embodiments, the coaption portion  4604  of the device is covered with a cover (not shown) can be a cloth material such as polyethylene cloth of a fine mesh. The cloth cover can provide a blood seal on the surface of the spacer, and/or promote rapid tissue ingrowth. 
     Referring now to  FIGS. 224-225 , an example implantable prosthetic device  4700  is shown. Referring now to  FIG. 224 , the device  4700  is shown cut from a flat sheet of material  4702 , such as Nitinol. The device  4700  includes coaption portions  4704 , inner paddle portions  4706 , outer paddle portions  4708 , and a middle portion  4710 . Referring now to  FIG. 225 , the device  4700  is shown folded into a three-dimensional shape. The material  4702  is folded at the middle portion  4710  so that the various portions of each side of the material  4702  align. When the coaption portions  4704  are aligned, a matrix of cut-outs in the material  4702  form the coaption portion  4704  into a three-dimensional shape similar to the shape of the coaption elements described above. 
     Referring now to  FIGS. 232-242 , an example embodiment of an implantable prosthetic device or prosthetic spacer device  4800  is shown. In the example illustrated by  FIGS. 232-242 , the two anchor portions  4806  can be opened both simultaneously and individually/independently. Optionally, in the example illustrated by  FIGS. 232-242 , the device can be opened and closed both by extending and retracting the overall length of the device as described above and without changing the overall length of the device. In one example embodiment, the two anchor portions  4806  can be opened individually/independently and/or simultaneously without changing the overall length of the device. In one example embodiment, the device  4800  can open and close the anchor portions  4806  simultaneously by extending and retracting the overall length of the device and can open and close the anchor portions  4806  either individually/independently or simultaneously, without extending or retracting the overall length of the device. The device  4800  can include any other features for an implantable prosthetic device discussed in the present application, and the device  4800  can be positioned to engage valve tissue  20 ,  22  as part of any suitable valve repair system (e.g., any valve repair system disclosed in the present application). In addition, any of the devices described herein can be operated and/or deployed in the same or similar manner that the device  4800  is actuated and/or deployed in  FIGS. 232-242 . 
     Referring now to  FIG. 232 , the prosthetic spacer or coaption device  4800  can be deployed from a delivery sheath or means for delivery  4802  by a pusher  4813 , such as a rod or tube as described above. The device  4800  can include a coaption portion  4804  and an anchor portion  4806 , the anchor portion  4806  including two or more anchors  4808 . The coaption portion  4804  includes a coaption element, coaption member, or spacer  4810 . The anchor portion  4806  includes a plurality of paddles  4820  (e.g., two in the illustrated embodiment), and a plurality of clasps  4830  (e.g., two in the illustrated embodiment). 
     A first or proximal collar  4811 , and a second collar or cap  4814  are used to move the coaption portion  4804  and the anchor portion  4806  relative to one another. Actuation of the actuator, actuation element or means for actuating  4812  (e.g., actuation wire, suture, line, shaft, etc.) opens and closes the anchor portion  4806  of the device  4800  to grasp the mitral valve leaflets during implantation in the manner described above. The actuator or actuation element  4812  can take a wide variety of different forms. For example, the actuation element can be threaded such that rotation of the actuation wire or shaft moves the anchor portion  4806  relative to the coaption portion  4804 . Or, the actuation element can be unthreaded, such that pushing or pulling the actuation element  4812  moves the anchor portion  4806  relative to the coaption portion  4804 . 
     The coaption element/member  4810  extends from a proximal portion  4819  assembled to the collar  4811  to a distal portion  4817  that connects to the anchors  4808 . The coaption element/member  4810  and the anchors  4808  can be coupled together in various ways. For example, as shown in the illustrated embodiment, the coaption element/member  4810  and the anchors  4808  can optionally be coupled together or connected by integrally forming the coaption element/member  4810  and the anchors  4808  as a single, unitary component. This can be accomplished, for example, by forming the coaption element/member  4810  and the anchors  4808  from a continuous strip of a braided or woven material, such as braided or woven nitinol wire (see, e.g.,  FIGS. 243-257 ). In some embodiments, the components are separately formed and are attached together. 
     The anchors  4808  are attached to the coaption element/member  4810  by inner flexible portions  4822  and to the cap  4814  by outer flexible portions  4821 . The anchors  4808  can comprise a pair of paddles  4820 . In some embodiments, the anchors  4808  can comprise inner and outer paddles joined by a flexible portion (e.g., the paddles  420 A,  422 A of the device  400 A joined by hinge portion  423 A). The paddles  4820  are attached to paddle frames  4824  that are flexibly attached to the cap  4814 . 
     The anchors  4808  can be configured to move between various configurations by axially moving the cap  4814  relative to the proximal collar  4811  and thus the anchors  4808  relative to the coaption element/member  4810  along a longitudinal axis extending between the cap  4814  and the proximal collar  4811 . For example, the anchors  4808  can be positioned in a straight configuration by moving the cap  4814  away from the coaption element/member  4810 . The anchors  4808  can also be positioned in a closed configuration (see  FIG. 232 ) by moving the cap  4814  toward the coaption element/member  4810 . When the cap  4814  is pulled all the way toward the coaption element/member  4810  by the actuation element or actuation wire  4812 , the paddles  4820  are closed against the coaption element  4810  and any native tissue (e.g., a valve leaflet, not shown) captured between the coaption element  4810  and the paddles  4820  is pinched so as to secure the device  4800  to the native tissue. 
     The clasps  4830  can comprise attachment or fixed portions  4832  and arm or moveable portions  4834 . The attachment or fixed portions  4832  can be coupled or connected to the paddle portions  4820  of the anchors  4808  in various ways such as with sutures, adhesive, fasteners, welding, stitching, swaging, friction fit and/or other means for coupling. The clasps  4830  can be similar to or the same as the clasps  430 . The fixed portions  4832  of the clasps  4830  are attached to the paddles  4820  such that a gap  4843  is formed between the clasp  4830  and the inner flexible portion  4822  and the inner flexible portion  4822  includes an area of slack  4844  (e.g.,  FIG. 233 ). That is, the inner flexible portion  4822  is longer than the minimum distance between the coaption element  4810  and the paddle portion  4820 . Thus, when the paddle portions  4820  are in the closed condition, the inner flexible portion  4822  is relatively relaxed and capable of movement. In some embodiments, the fixed portions  4832  of the clasps  4830  are attached near the outermost ends of the paddle portions  4820 , as can be seen in  FIG. 234 . 
     The moveable portions  4834  can be configured to move, flex, pivot, etc. relative to the fixed portions  4832  between an open configuration (e.g.,  FIG. 233 ) and a closed configuration (e.g.,  FIG. 232 ). In some embodiments, the clasps  4830  can be biased to the closed configuration by a connection portion  4838 . In the open configuration, the fixed portions  4832  and the moveable portions  4834  move, pivot, or flex away from each other such that native leaflets (see  FIGS. 236-242 ) can be positioned between the fixed portions  4832  and the moveable portions  4834 . In the closed configuration, the fixed portions  4832  and the moveable portions  4834  move, pivot, or flex toward each other, thereby clamping the native leaflets between the fixed portions  4832  and the moveable portions  4834 . 
     Each clasp  4830  can be opened separately by pulling on an attached actuator or actuation line  4816  that extends through the delivery sheath or means for delivery  4802  to the moveable portions  4834  of the clasps  4830 , while the push rod or tube  4813  holds the collar  4811  in place. The actuator(s) or actuation line(s)  4816  can take a wide variety of forms, such as, for example, one or more of a line, a suture, a wire, a rod, a catheter, or the like. The clasps  4830  can be spring loaded so that in the closed position the clasps  4830  continue to provide a pinching force on the grasped native leaflet. This pinching force remains constant regardless of the position of the paddle portions  4820 . Barbs or means for securing  4836  of the clasps  4830  can pierce the native leaflets to further secure the native leaflets. 
     Referring now to  FIGS. 233 and 234 , tension is applied to an actuator or actuation line  4816  to pull the moveable portion  4834  of one clasp  4830  in a retracting or proximal direction  4840  while the actuator, actuation element or means for actuating  4812  and the push rod or wire  4813  maintain the cap  4814  and the collar  4811  in a retracted condition that biases the paddles  4820  toward a closed condition. As the actuation line  4816  is retracted to pull the moveable portion  4834  of the clasp  4830  in the retracting direction  4840 , the fixed portion  4832  of the clasp  4830  remains attached to the paddle portion  4820 . The tension of the actuation line  4816  causes the clasp to open and pulls the hinge portion  4838  of the clasp toward the collar in the direction  4840 . Since the device  4800  is maintained in the unextended, closed condition, the paddle portion  4820  is prevented from moving in the direction  4840 , but the paddle frames  4824  can flex outward to allow the ends of the paddle portions  4820  and the fixed portions  4832  of the clasps  4830  to move outward. As such, the tension in the actuation line  4816  is transmitted through the movable portion  4834  of the clasp  4830  to move or pivot the end of the paddle portion  4820  outward against the biasing force of the paddle frame  4824 . The slack  4844  in the inner flexible portion  4822  is taken up to allow the paddle portion  4820  to move or pivot in the outward or opening direction  4842  in response to the tension applied to the clasp  4830 . The tension in the direction  4840  thereby causes both an opening movement of the paddle portion  4820  and the fixed portion  4832  to open relative to the moveable portion  4834  of the clasp  4830  without extending the actuation element  4812 . Consequently, one anchor  4808  of the anchor portion  4806  can be opened without opening the other anchor  4808 , as would typically occur when the actuation element  4812  is extended to open the anchor portion  4806 . As can be seen in  FIG. 234 , either anchor portion  4806  can be opened while the other anchor portion is left in the closed condition. 
     As can be seen in  FIG. 235 , while each clasp  4830  can be opened independent of the other, both clasps  4830  can also be opened at the same time by applying tension to both actuation lines  4816  without extending the actuation element  4812  to open the paddles. Because the clasps  4830  and/or the paddle frames  4824  are spring loaded, releasing tension on the actuation line(s)  4816  causes both the clasp(s)  4830  and the paddle portion(s) to close. That is, the spring force of the paddle frame  4824  causes the end of the paddle portion  4820  to move, pivot, etc. back toward the coaption element  4810  and return the slack to the inner paddle portion  4822 . The spring force of the hinge portion  4838  pulls the movable portion  4834  back down (in the direction opposite to the direction  4840 ) and closes the clasp  4830 . 
     Referring now to  FIGS. 236-238 , the implantable device of  FIGS. 232-235  is shown with one clasp  4830  being opened to capture a leaflet  20 ,  22  that remains uncaptured by the device  4830 . For example, the implantable device  4800  can be extended to open the anchor portions, positioned to capture both native valve leaflets, and then retracted to close the device and capture the native valve leaflets. However, if for some reason one of the native valve leaflets is properly captured by an anchor portion  4806  while the other native valve leaflet is improperly captured by the other anchor portion  4806  or not captured at all by the other anchor portion  4806 , the problem can be corrected without releasing the properly captured valve leaflet and/or without extending the device to open the device. For example, if one of the native valve leaflets are improperly captured, one anchor portion  4806  can be opened to release the improperly captured leaflet, without opening the other anchor portion  4806  and/or without extending the device. Then, the device can be repositioned, while the first leaflet remains properly captured by the first anchor portion, to properly position the second leaflet in the second clasp  4830 . Once the second leaflet is properly positioned, the second anchor portion  4806  is closed to properly capture the second leaflet. 
     Similarly, if one of the native valve leaflets is not captured at all, just the anchor portion  4806  that failed to capture a leaflet can be opened, without opening the other anchor portion  4806  and/or without extending the device. Then, the device can be repositioned, while the first leaflet remains properly captured by the first anchor portion, to properly position the second leaflet in the second clasp  4830 . Once the second leaflet is properly positioned, the second anchor portion  4806  is closed to properly capture the second leaflet. A properly captured native valve leaflet may be fully captured by one of the clasps  4830 , such that the edge of the captured leaflet is proximate the spring-loaded hinge portion  4838  of the clasp  4830  (as shown in  FIGS. 236-238 ). Additionally, a properly captured native valve leaflet may be only partially captured by one of the clasps  4830 , such that the edge of the captured leaflet does not extend completely into the clasp  4830 , but extends far enough to be properly captured and secured to the device  4800  (as shown in  FIG. 242 ). 
     Referring now to  FIG. 236 , the device  4800  is shown with both clasps  4830  in a closed condition. One leaflet  20 ,  22  is captured within one of the clasps  4830 , while the other leaflet  20 ,  22  remains un-captured. While not shown, it can also be the case that one leaflet is properly captured, while the other leaflet is improperly captured. 
     Referring now to  FIG. 237 , tension is applied to the actuation line  4816  connected to the empty clasp  4830  (or the clasp with an improperly positioned leaflet) to pull the moveable portion  4834  of the clasp  4830  in the retracting or proximal direction  4840 . The actuation element or means for actuating  4812  and the pusher rod or tube  4813  maintain the device in a retracted condition. As a result, one paddle  4820  is maintained in a closed condition on the properly captured leaflet and the other paddle  4820  is opened against the biasing force of the paddle frame  4824 . As the actuation line  4816  is retracted to pull the moveable portion  4834  of the clasp  4830  in the retracting direction  4840 , the fixed portion  4832  of the clasp  4830  remains attached to the paddle portion  4820 . The tension of the actuation line  4816  is transmitted through the clasp  4830  to open the paddle portion  4820  and take up the slack in the inner flexible portion  4822  as described above. Once the clasp  4830  is opened, the device  4800  is repositioned so that the missed or released leaflet  20 ,  22  is disposed between the fixed portion  4832  and the moveable portion  4834  of the open clasp  4830 . 
     Referring now to  FIG. 238 , tension on the actuation line  4816  is released, thereby allowing the actuation lines  4816  to move in a releasing direction  4841 . As tension on the actuation lines  4816  is released, the paddle frames  4824  and/or the spring-loaded hinge portions  4838  of the clasps  4830  cause the open paddle portion  4820  and the clasps  4830  to close as described above. As the clasps  4830  and paddle portions  4820  close, the leaflet  20 ,  22  is pinched within the closing clasp  4830  and the paddles  4820 . 
     Referring now to  FIGS. 239-242 , the implantable device of  FIGS. 232-235  is shown in a process in which both clasps  4830  are opened to capture leaflets  20 ,  22  of the native valve in an area of the heart that is space-constrained, for example, by the presence of an obstacle  24 . The obstacle can take a wide variety of different forms. For example, the obstacle can be inside the right or left ventricle, such as a ventricular wall, a papillary muscle, chordae, etc. However, the obstacle  24  can be any anatomic structure or a previously implanted device that would be contacted if the device were moved to an elongated state or another state during deployment. In one example embodiment, the device  4800  is moved to one or more of the positions illustrated by  FIGS. 239-242  in one of the atria of the heart. For example, the device  4800  can be deployed in an atrium from a catheter as described above. The device can be moved to and/or between one or more of the positions illustrated by  FIGS. 239-242  to avoid an obstacle. 
     In a limited space, the obstacle may prevent the actuation element  4812  from being extended enough to open the paddle portions  4820 , or the actuation element  4812  may not be able to extend enough without contacting the obstacle  24 . 
     Referring now to  FIG. 240 , tension is applied to the actuation lines  4816  connected to the clasps  4830  to pull the moveable portions  4834  of the clasps  4830  in the retracting or proximal direction  4840  while the actuation element or means for actuating  4812  and the pusher rod or tube maintain the device  4800  in a retracted condition. The paddles  4820  are opened against the biasing force of the paddle frames  4824  as described above, while the device  4800  is maintained in the shortened condition to avoid contacting the obstacle  24 . 
     As the actuation lines  4816  are retracted to pull the moveable portions  4834  of the clasps  4830  in the retracting direction  4840 , the clasps  4830  and the paddle portions  4820  are opened as described above, while the device is maintained in the retracted condition, since the cap  4814  and the collar  4811  are not moved relatively apart. 
     Referring now to  FIG. 241 , once the clasps  4830  are opened, the device  4800  is moved in a direction  4840  by retracting the pusher tube or rod  4813  into the catheter  4802  and or moving the catheter  4802  to position the leaflets  20 ,  22  between the fixed portions  4832  and the moveable portions  4834  of the open clasps  4830 . Once the device  4800  is in position to capture the leaflets  20 ,  22 , as is shown in  FIG. 241 , tension on the actuation lines  4816  is released, thereby allowing the actuation lines  4816  to move in a releasing direction  4841 . 
     Referring now to  FIG. 242 , as tension on the actuation lines  4816  is released, the biasing force of the paddle frames  4824  and/or the spring-loaded hinge portions  4838  of the clasps  4830  cause the paddle portions  4820  and the clasps  4830  to close as described above. As the paddle portions  4820  and the clasps  4830  close, the leaflets  20 ,  22  are captured by the clasps  4830  and paddles  4820  to secure the device  4800  to the native valve leaflets, without engaging the obstacle. 
     Referring now to  FIGS. 243-257 , an example embodiment of an implantable prosthetic device or prosthetic spacer device  4900  is shown. In the example illustrated by  FIGS. 243-257 , the two anchor portions  4906  can be opened both simultaneously and can also be opened individually/independently. Optionally, in the example illustrated by  FIGS. 243-257 , the device can be opened and closed both by extending and retracting the overall length of the device as described above and without changing the overall length of the device. In one example embodiment, the two anchor portions  4906  can be opened individually/independently and/or simultaneously without changing the overall length of the device. In one example embodiment, the device  4900  can open and close the anchor portions  4906  simultaneously by extending and retracting the overall length of the device and can open and close the anchor portions  4906  either individually/independently or simultaneously, without extending or retracting the overall length of the device. The device  4900  can include any other features for an implantable prosthetic device discussed in the present application, and the device  4900  can be positioned to engage valve tissue  20 ,  22  as part of any suitable valve repair system (e.g., any valve repair system disclosed in the present application). In addition, any of the devices described herein can be operated and/or deployed in the same or similar manner that the device  4900  is actuated and/or deployed in  FIGS. 243-257 . 
     Referring now to  FIGS. 243 and 244 , the device  4900  extends from a proximal portion  4905  to a distal portion  4907  and includes a coaption portion  4910 , paddle portions  4920 , outer flexible portions  4921 , inner flexible portions  4922 , and paddle frames  4924 . The proximal portion  4905  can include a first or proximal collar  4911  ( FIG. 245 ) for attaching a delivery device  4902  ( FIG. 246 ). For example, a pusher  4913  such as a rod or tube as described above can be attached to the collar for positioning the device  4900 . The distal portion  4907  can include a second collar or cap  4914  ( FIG. 245 ) that is attached to the outer flexible portions  4921  and is engaged by an actuation element  4912  (e.g., actuation wire, shaft, rod, etc.) (see  FIG. 246 ) to open and close the device  4900  to facilitate implantation in the mitral valve as described in the present application. 
     In the illustrated embodiment, the coaption element  4910  and paddle portions  4920  of the device  4900  are formed from a single, continuous strip of material  4901 . In some embodiments, such as some of the examples shown and described above, the coaption element  4910  and the paddle portions  4920  are formed from a single piece of material that is not a strip, or not all a strip. In some embodiments, the coaption element  4910  and the paddle portions  4920  are formed from discrete pieces. 
     The coaption element  4910  and the paddle portions  4920  can be made from a wide variety of different materials. The strip of material  4901  can be formed from a material that can be a metal fabric, such as a mesh, woven, braided, electrospun or formed in any other suitable way or a laser cut or otherwise cut flexible material. The material can be cloth, shape-memory alloy wire—such as Nitinol—to provide shape-setting capability, or any other flexible material suitable for implantation in the human body. In one example embodiment, the strip of material  4901  is made of a braided mesh of between 25 and 100 strands, such as between 40 and 85 strands, such as between 45 and 60 strands, such as about 48 Nitinol wires or 48 Nitinol wires. 
     In the example illustrated by  FIGS. 243-257 , the single, continuous strip of material  4901  extends between two ends  4901 A and is folded to form the coaption element, coaption member, or spacer  4910  and paddle portions  4920 . Some portions of the device  4900  are formed from multiple layers of the strip of material  4901 . For example, the strip of material  4901  is overlapped to form four layers in the area of the coaption element  4910 . As with the device  500 A described above, gaps are formed between portions of the device  4900  when the strip of material  4901  is folded into the desired shape which provide room for the strip of material  4901  to be attached to other components of the device  4900  (e.g., the collar  4911  or clasps  4930 ). 
     The coaption element/member  4910  extends from a proximal portion  4919  assembled to the collar  4911  to a distal portion  4917  that connects to the paddle portions  4920 . As can be seen in  FIG. 243 , the ends  4901 A of the strip of material  4901  are located near the distal portion  4917  of the coaption element  4910  in the embodiment illustrated by  FIGS. 243-257 . Thus, the inner flexible portions  4922  and the inner paddle portions are each formed from a single layer of the strip of material  4901 . 
     The operation of the device  4900  is similar to the operation of the device  500 A. The dimensions of the device  4900  are similar to those of the device  500 A described herein and listed in Tables D and E. However, since the inner flexible portions  4922  and the inner paddle portions are each formed from a single layer of the strip of material  4901 , the paddle portions  4920  and inner flexible portions  4922  of the device  4900  are thinner than the inner paddles  522 A and hinge portions  525 A of the device  500 A. Forming the inner flexible portions  4922  and paddle portions  4920  out of a single layer of the strip of material  4901  provides the inner flexible portions  4922  and paddle portions  4920  with greater flexibility. This enhanced flexibility can enable or assist the ability to independently open either one of the paddle portions  4920 , as is described below. 
     The coaption element  4910  and paddle portions  4920  are connected by the flexible portions of the strip of material  4901 . The coaption element  4910  is flexibly connected to the paddle portions  4920  by the inner flexible portion  4922 . The paddle portions  4920  can be flexibly connected to a distal portion  4927  by the outer flexible portions  4921 . The optional aperture  4929  in the distal portion  4927  engages the cap  4914 . 
     Referring now to  FIGS. 245 and 246 , the prosthetic spacer or coaption device  4900  can include a coaption portion  4904  and an anchor portion  4906 , the anchor portion  4906  including a plurality of anchors  4908 . The coaption portion  4904  includes a coaption element, coaption member, or spacer  4910 . The anchor portion  4906  includes a plurality of paddles  4920  (e.g., two in the illustrated embodiment), and a plurality of clasps  4930  (e.g., two in the illustrated embodiment). The first or proximal collar  4911 , and the second collar or cap  4914  are used to move the coaption portion  4904  and the anchor portion  4906  relative to one another. 
     The coaption element/member  4910  and the paddle portions  4920  can be coupled together in various ways. For example, as shown in the illustrated embodiment, the coaption element/member  4910  and the paddle portions  4920  can be coupled together by integrally forming the coaption element/member  4910  and the paddle portions  4920  as a single, unitary component. This can be accomplished, for example, by forming the coaption element/member  4910  and the paddle portions  4920  from the continuous strip  4901  of a braided or woven material, such as braided or woven nitinol wire, as shown in  FIGS. 243 and 244 . However, in some example embodiments, the paddle portions and the coaption element/member are formed from a single piece, but not a strip, or the paddle portion and the coaption element/member can be formed from separate pieces. 
     The paddle portions  4920  are attached to the coaption element/member  4910  by inner flexible portions  4922  and to the cap  4914  by outer flexible portions  4921 . In some embodiments, the paddle portions  4920  can comprise inner and outer paddles joined by a flexible portion (e.g., the paddles  420 A,  422 A of the device  400 A joined by hinge portion  423 A). The paddle portions  4920  are attached to paddle frames  4924  that are attached to the cap  4914 . In this manner, the anchors  4908  are configured similar to legs in that the inner flexible portions  4922  are like upper portions of the legs, the outer flexible portions  4921  are like lower portions of the legs. In the illustrated example, the inner flexible portion  4922 , and the outer flexible portion  4921  are formed from the continuous strip of fabric  4901 , such as a metal fabric. However, in some example embodiments, the inner and outer flexible portions are formed from separate components that are connected. 
     The clasps  4930  can comprise attachment or fixed portions  4932  and arm or moveable portions  4934 . The attachment or fixed portions  4932  can be coupled or connected to the paddle portions  4920  of the anchors  4908  in various ways such as with sutures, adhesive, fasteners, welding, stitching, swaging, friction fit and/or other means for coupling. The clasps  4930  can be similar to or the same as the clasps  430 . The fixed portions  4932  of the clasps  4930  are attached to the paddles  4920  such that a gap  4943  is formed between the clasp  4930  and the inner flexible portion  4922  and the inner flexible portion  4922  includes an area of slack  4944 . That is, the inner flexible portion  4922  is longer than the minimum distance between the coaption element  4910  and the paddle portion  4920 . Thus, when the paddle portions  4920  are in the closed condition, the inner flexible portion  4922  is relatively relaxed and capable of movement. In some embodiments, the fixed portions  4932  of the clasps  4930  are attached near the outermost ends of the paddle portions  4920 , as can be seen in  FIG. 245 . 
     The moveable portions  4934  can move, flex, pivot, etc. relative to the fixed portions  4932  between an open configuration (e.g.,  FIG. 247 ) and a closed configuration (e.g.,  FIG. 246 ). In some embodiments, the clasps  4930  can be biased to the closed configuration. In the open configuration, the fixed portions  4932  and the moveable portions  4934  move, pivot, or flex away from each other such that native leaflets (see  FIGS. 250-257 ) can be positioned between the fixed portions  4932  and the moveable portions  4934 . In the closed configuration, the fixed portions  4932  and the moveable portions  4934  move, pivot, or flex toward each other, thereby clamping the native leaflets between the fixed portions  4932  and the moveable portions  4934 . 
     Each clasp  4930  can be opened separately by pulling on an attached actuation line  4916  that extends through the delivery sheath or means for delivery  4902  to the moveable portions  4934  of the clasps  4930 , while the push rod or tube  4913  holds the collar  4911  in place. The actuation lines  4916  can take a wide variety of forms, such as, for example, a line, a suture, a wire, a rod, a catheter, or the like. The clasps  4930  can be spring loaded so that in the closed position the clasps  4930  continue to provide a pinching force on the grasped native leaflet. This pinching force remains constant regardless of the position of the paddle portions  4920 . Barbs or means for securing  4936  of the clasps  4930  can pierce the native leaflets to further secure the native leaflets. 
     Referring now to  FIGS. 247 and 248 , tension is applied to one actuation line  4916  to pull the moveable portion  4934  of one clasp  4930  in a retracting or proximal direction  4940  while the actuation element or means for actuating  4912  and the push rod or wire  4913  maintain the cap  4914  and the collar  4911  in a retracted condition that biases the paddles  4920  toward a closed condition. As the actuation line  4916  is retracted to pull the moveable portion  4934  of the clasp  4930  in the retracting direction  4940 , the fixed portion  4932  of the clasp  4930  remains attached to the paddle portion  4920 . The tension of the actuation line  4916  causes the clasp  4930  to open and pulls the hinge portion  4938  of the clasp toward the collar in the direction  4940 . Since the device  4900  is maintained in the unextended, closed condition, the paddle portion  4920  is prevented from moving in the direction  4940 , but the paddle frames  4924  can flex outward to allow the ends of the paddle portions  4920  and the fixed portions  4932  of the clasps  4930  to move outward. As such, the tension in the actuation line  4916  is transmitted through the movable portion  4934  of the clasp  4930  to move, flex, or pivot the end of the paddle portion  4920  outward against the biasing force of the paddle frame  4924 . The slack  4944  in the inner flexible portion  4922  is taken up to allow the paddle portion  4920  to move, flex, or pivot in the outward or opening direction  4942  in response to the tension applied to the clasp  4930 . The tension in the direction  4940  thereby causes both an opening movement of the paddle portion  4920  and the fixed portion  4932  to open relative to the moveable portion  4934  of the clasp  4930 , thereby causing the paddle  4920  to open without extending the actuation element  4912 . Consequently, one anchor  4908  of the anchor portion  4906  can be opened without opening the other anchor  4908 , as would typically occur when the actuation element  4912  is extended to open the anchor portion  4906 . 
     As can be seen in  FIG. 247 , either anchor portion  4906  can be opened while the other anchor portion is left in the closed condition. As can be seen in  FIG. 249 , while each clasp  4930  can be opened independent of the other, both clasps  4930  can also be opened at the same time by applying tension to both actuation lines  4916  without extending the actuation element  4912  to open the paddles. Because the clasps  4930  and/or the paddle frames  4924  are spring loaded, releasing tension on the actuation line(s)  4916  causes both the clasp(s)  4930  and the paddle portion(s) to close. That is, the spring force of the paddle frame  4924  causes the end of the paddle portion  4920  to move, flex, pivot, etc. back toward the coaption element  4910  and return the slack to the inner flexible portion  4922 . The spring force of the hinge portion  4938  pulls the movable portion  4934  back down (in the direction opposite to the direction  4940 ) and closes the clasp  4930 . 
     Referring now to  FIGS. 250-253 , the implantable device of  FIGS. 243-249  is shown with one clasp  4930  being opened to capture a leaflet  20 ,  22  that remains uncaptured by the device  4930 . For example, the implantable device  4900  can be extended to open the anchor portions, positioned to capture both native valve leaflets, and then retracted to close the device and capture the native valve leaflets. However, if for some reason one of the native valve leaflets is properly captured by an anchor portion  4906  while the other native valve leaflet is improperly captured by the other anchor portion  4906  or not captured at all by the other anchor portion  4906 , the problem can be corrected without releasing the properly captured valve leaflet and/or without extending the device to open the device. For example, if one of the native valve leaflets are improperly captured, one anchor portion  4906  can be opened to release the improperly captured leaflet, without opening the other anchor portion  4906  and/or without extending the device. Then, the device can be repositioned, while the first leaflet remains properly captured by the first anchor portion, to properly position the second leaflet in the second clasp  4930 . Once the second leaflet is properly positioned, the second anchor portion  4906  is closed to properly capture the second leaflet. A properly captured native valve leaflet may be fully captured by one of the clasps  4930 , such that the edge of the captured leaflet is proximate the spring-loaded hinge portion  4938  of the clasp  4930  (as shown in  FIGS. 236-238 ). Additionally, a properly captured native valve leaflet may be only partially captured by one of the clasps  4930 , such that the edge of the captured leaflet does not extend completely into the clasp  4930 , but extends far enough to be properly captured and secured to the device  4900  (as shown in  FIG. 242 ). 
     Similarly, if one of the native valve leaflets is not captured at all, just the anchor portion  4906  that failed to capture a leaflet can be opened, without opening the other anchor portion  4906  and/or without extending the device. Then, the device can be repositioned, while the first leaflet remains properly captured by the first anchor portion, to properly position the second leaflet in the second clasp  4930 . Once the second leaflet is properly positioned, the second anchor portion  4906  is closed to properly capture the second leaflet. 
     Referring now to  FIG. 246 , the device  4900  is shown with both clasps  4930  in a closed condition. One leaflet  20 ,  22  is captured within one of the clasps  4930 , while the other leaflet  20 ,  22  remains un-captured. While not shown, it can also be the case that one leaflet is properly captured, while the other leaflet is improperly captured. 
     Referring now to  FIG. 251 , tension is applied to the actuation line  4916  connected to the empty clasp  4930  (or the clasp with an improperly positioned leaflet) to pull the moveable portion  4934  of the clasp  4930  in the retracting or proximal direction  4940 . The actuation element or means for actuating  4912  and the pusher rod or tube  4913  maintain the device in a retracted condition. As a result, one paddle  4920  is maintained in a closed condition on the properly captured leaflet and the other paddle  4920  is opened against the biasing force of the paddle frame  4924 . 
     As the actuation line  4916  is retracted to pull the moveable portion  4934  of the clasp  4930  in the retracting direction  4940 , the fixed portion  4932  of the clasp  4930  remains attached to the paddle portion  4920 . The tension of the actuation line  4916  is transmitted through the clasp  4930  to open the paddle portion  4920  and take up the slack in the inner flexible portion  4922  as described above. Once the clasp  4930  is opened, the device  4900  is repositioned so that the missed or released leaflet  20 ,  22  is disposed between the fixed portion  4932  and the moveable portion  4934  of the open clasp  4930 , as can be seen in  FIG. 252 . 
     Referring now to  FIG. 253 , tension on the actuation line  4916  is released, thereby allowing the actuation lines  4916  to move in a releasing direction  4941 . As tension on the actuation lines  4916  is released, the paddle frames  4924  and/or the spring-loaded hinge portions  4938  of the clasps  4930  cause the open paddle portion  4820  and the open clasp  4930  to close as described above. As the clasps  4930  and the paddle portions  4920  close, the leaflet  20 ,  22  is pinched within the closing clasp  4930  and paddle  4920 . 
     Referring now to  FIGS. 254-257 , the implantable device of  FIGS. 243-249  is shown in a procedure in which both clasps  4930  are opened to capture leaflets  20 ,  22  of the native valve in an area of the heart that is space-constrained, for example, by the presence of an obstacle  24 . The obstacle can take a wide variety of different forms. For example, the obstacle can be inside the right or left ventricle, such as a ventricular wall, a papillary muscle, chordae, etc. However, the obstacle  24  can be any anatomic structure or a previously implanted device that would be contacted if the device were moved to an elongated state during deployment. In a limited space, the obstacle may prevent the actuation element or actuation wire  4912  from being extended enough to open the paddle portions  4920 , or the actuation element  4912  may not be able to extend enough without contacting the obstacle  24 . In one example embodiment, the device  4900  is moved to one or more of the positions illustrated by  FIGS. 254-257  in one of the atria of the heart. For example, the device  4900  can be deployed in an atrium from a catheter as described above. The device can be moved to and/or between one or more of the positions illustrated by  FIGS. 254-257  to avoid an obstacle. 
     Referring now to  FIG. 255 , tension is applied to the actuation lines  4916  connected to the clasps  4930  to pull the moveable portions  4934  of the clasps  4930  in the retracting or proximal direction  4940 . At the same time, the actuation element or means for actuating  4912  and the pusher rod or tube maintain the device  4900  in a retracted condition. The paddles  4920  are opened against the biasing force of the paddle frames  4824  as described above, while the device  4800  is maintained in the shortened condition to avoid contacting the obstacle  24 . 
     As the actuation lines  4916  are retracted to pull the moveable portions  4934  of the clasps  4930  in the retracting direction  4940 , the clasps  4830  and the paddle portions  4820  are opened as described above. Meanwhile, the device is maintained in the retracted condition, since the cap  4824  and the collar  4811  are not moved relatively apart. 
     Referring now to  FIG. 256 , once the clasps  4930  are opened, the device  4900  is moved in a direction  4940  by retracting the pusher tube or rod  4913  into the catheter  4902  and/or moving the catheter  4902  to position the leaflets  20 ,  22  between the fixed portions  4932  and the moveable portions  4934  of the open clasps  4930 . Once the device  4900  is in position to capture the leaflets  20 ,  22 , as is shown in  FIG. 241 , tension on the actuation lines  4916  is released, thereby allowing the actuation lines  4916  to move in a releasing direction  4941 . Referring now to  FIG. 257 , as tension on the actuation lines  4916  is released, the biasing force of the paddle frames  4824  and/or the spring-loaded hinge portions  4938  of the clasps  4930  cause the paddle portions  4920  and the clasps  4930  to close as described above. As the paddle portions  4820  and the clasps  4930  close, the leaflets  20 ,  22  are captured by the clasps  4930  and paddles  4920  to secure the device  4900  to the native valve leaflets, without engaging the obstacle. 
     Referring now to  FIGS. 258-261 , an example embodiment of an implantable prosthetic device or prosthetic spacer device  5000  is shown. The device  5000  can include any other features for an implantable prosthetic device discussed in the present application, and the device  5000  can be positioned to engage valve tissue  20 ,  22  as part of any suitable valve repair system (e.g., any valve repair system disclosed in the present application). In addition, any of the devices described herein can be operated and/or deployed in the same or similar manner that the device  5000  is actuated and/or deployed in  FIGS. 258-261 . 
     Referring now to  FIGS. 258-259 , the prosthetic spacer or coaption device  5000  can be deployed from a delivery sheath or means for delivery  5002  by a pusher  5013 , such as a rod or tube as described above. The device  5000  can include a coaption portion  5004  and an anchor portion  5006  having two or more anchors  5008 . The coaption portion  5004  includes a coaption element, coaption member, or spacer  5010 . Each anchor  5008  includes an outer paddle  5020  and a clasp  5030  that can each be opened and closed. 
     A first or proximal collar  5011 , and a second collar or cap  5014  are used to move the coaption portion  5004  and the anchor portion  5006  relative to one another. Actuation of the actuator, actuation element or means for actuating  5012  (e.g., actuation wire, shaft, rod, etc.) opens and closes the anchor portion  5006  of the device  5000  to grasp the mitral valve leaflets during implantation in the manner described above. The actuator, actuation element, wire, or shaft  5012  can take a wide variety of different forms. For example, the actuation element  5012  can be threaded such that rotation of the actuation element  5012  moves the anchor portion  5006  relative to the coaption portion  5004 . Or, the actuation element  5012  can be unthreaded, such that pushing or pulling the actuation element  5012  moves the anchor portion  5006  relative to the coaption portion  5004 . 
     The coaption element/member  5010  extends from a proximal portion  5019  assembled to the collar  5011  to a distal portion  5017  that connects to the anchors  5008 . The coaption element/member  5010  and the anchors  5008  can be coupled together in various ways. For example, as shown in the illustrated embodiment, the coaption element/member  5010  and the anchors  5008  can optionally be coupled together by integrally forming the coaption element/member  5010  and the anchors  5008  as a single, unitary component. This can be accomplished, for example, by forming the coaption element/member  5010  and the anchors  5008  from a continuous structure of a braided or woven material, such as braided or woven nitinol wire (see, e.g.,  FIGS. 243-257 ). In another embodiment, the components are separately formed and are attached together. 
     The anchors  5008  are attached to the coaption element/member  5010  by inner flexible portions or inner paddles  5022  and to the cap  5014  by outer flexible portions  5021 . The anchors  5008  can comprise a pair of outer paddles  5020 . In some embodiments, the anchors  5008  can comprise inner and outer paddles joined by a flexible portion. The paddles  5020  are attached to paddle frames  5024  that are attached to the cap  5014 . 
     The anchors  5008  can be configured to move between various configurations by axially moving the cap  5014  relative to the proximal collar  5011  and thus the anchors  5008  relative to the coaption element/member  5010  along a longitudinal axis extending between the cap  5014  and the proximal collar  5011 . For example, the anchors  5008  can be positioned into a straight configuration by moving the cap  5014  away from the coaption element/member  5010 . The anchors  5008  can also be positioned in a closed configuration (see  FIG. 258 ) by moving the cap  5014  toward the coaption element/member  5010 . When the cap  5014  is pulled all the way toward the coaption element/member  5010  by the actuation element  5012 , the paddles  5020  are closed against the coaption element  5010  and any native tissue (e.g., a valve leaflet, not shown) captured between the coaption element  5010  and the paddles  5020  is pinched so as to secure the device  5000  to the native tissue. 
     Each outer paddle  5020  includes an extendable portion  5023  that stretches from a resting position to an extended position. In the resting position, shown in  FIGS. 258 and 259 , the extendable portion  5023  has a first or resting width. When stretched to the extended position, shown in  FIGS. 260 and 261 , the extendable portion  5023  has a second width that is narrower than the first width. That is, the extendable portion  5023  has a width that is indirectly proportional to a length of the extendable portion; i.e., the width of the extendable portion  5023  decreases as a length of the extendable portion  5023  increases, and vice versa. The extendable portion  5023  can be formed integrally with the paddle  5020  or can be formed from a separate piece that is joined to the remainder of the paddle  5020 . 
     The extendable portion  5023  can be made from a braided or woven material that changes in width in response to changes in the length of the extendable portion  5023 . The braided or woven material can be a loosely braided or woven tube or a flat braid or weave. In some embodiments, the entire paddle is formed from a braided or woven tube of material and the braid is loosened in a segment of the outer paddle to form the extendable portion  5023 . As the extendable portion  5023  formed from braided or woven material is stretched, diagonal braid segments (not shown) move, pivot and/or slide relative to one another such that the slope angle of the braid segments increases, bringing the sides of the braided or woven material closer together (See  FIG. 261 ). The extendable portion  5023  can also be made from an elastomeric material that narrows when stretched, such as, for example, a tube or flattened tube. 
     The clasps  5030  can comprise attachment or fixed portions  5032  connected to arm or moveable portions  5034  by a hinge portion  5038 . The attachment or fixed portions  5032  can be coupled or connected to the paddle portions  5020  of the anchors  5008  in various ways such as with sutures, adhesive, fasteners, welding, stitching, swaging, friction fit and/or other means for coupling. The clasps  5030  can be similar to or the same as the clasps  430  that are described above. 
     The moveable portions  5034  can flex relative to the fixed portions  5032  between an open configuration (See  FIG. 51 ) and a closed configuration (See  FIG. 258 ). In some embodiments, the clasps  5030  can be biased to the closed configuration. In the open configuration, the fixed portions  5032  and the moveable portions  5034  flex away from each other such that native leaflets can be positioned between the fixed portions  5032  and the moveable portions  5034 . In the closed configuration, the fixed portions  5032  and the moveable portions  5034  flex toward each other, thereby clamping the native leaflets between the fixed portions  5032  and the moveable portions  5034 . 
     Each clasp  5030  can be opened separately by pulling on an attached actuator or actuation line  5016  that extends through the delivery sheath or means for delivery  5002  to the moveable portions  5034  of the clasps  5030 , while the push rod or tube  5013  holds the collar  5011  in place. The actuator or actuation lines  5016  can take a wide variety of forms, such as, for example, a line, a suture, a wire, a rod, a catheter, or the like. The clasps  5030  can be spring loaded so that in the closed position the clasps  5030  continue to provide a pinching force on the grasped native leaflet. This pinching force remains constant regardless of the position of the paddle portions  5020 . Barbs or means for securing  5036  of the clasps  5030  can pierce the native leaflets to further secure the native leaflets. 
     Referring now to  FIGS. 260 and 261 , force is applied to the actuation element  5012  to push the cap  5014  away from the collar  5011  while simultaneously maintaining tension on the actuation lines  5016 . Movement of the cap  5014  away from the collar  5011  pulls down on the flexible portions  5021  which in turn apply a tensile force to the outer paddles  5020 . The force applied to the actuation lines  5016  can be less than the force required to open the clasps  5030  while still being sufficient to maintain the position of the clasps  5030  as the actuation element  5012  is extended. Consequently, the portion of the inner paddle  5022  attached to the clasp  5030  and the proximal end of the paddle frame  5024  are also restrained from moving. Thus, the outer paddle  5020  is stretched between the cap  5014  and the paddle frame  5024  so that the extendable portion  5023  is extended from the resting position shown in  FIGS. 258 and 259  to the extended position shown in  FIGS. 260 and 261 . As described above, the extendable portion  5023  narrows as the length of the extendable portion  5023  is increased. Accordingly, the width of the extendable portion  5023  can be adjusted by stretching the paddle  5020  to change the length of the extendable portion  5023 . In some embodiments, the frames  5024  also narrow when stretched such that the extendable portion  5023  and frames  5024  have a decreased width when the implantable prosthetic device  5000  is partially opened and the paddles  5020  and frames  5024  are subjected to tensile forces. 
     During the implantation procedure, native heart structures (e.g., numerous and/or densely packed chordae) can interfere with capture of the leaflets. That is, portions of the implantable prosthetic device  5000  may contact the chordae such that the connected leaflet is pushed away as the surgeon attempts to move the implantable prosthetic device  5000  toward the leaflet for capture. Enabling the adjustment of the width of the implantable prosthetic device  5000  improves maneuverability of the implantable prosthetic device  5000  when configured in a “capture ready” configuration during the implantation procedure. When such native structures are encountered, the implantable prosthetic device  5000  can be partially extended to extend the extendable portion  5023  and reduce the width of the paddles  5020  and/or paddle frames  5024 , thereby avoiding the native heart structures and enabling capture of the leaflet. The paddles  5020  widen when the implantable prosthetic device  5000  is closed to capture the leaflet which provides an increased pinching surface to better secure the leaflet within the implantable prosthetic device  5000 . 
     Referring now to  FIGS. 262-265 , an example embodiment of an implantable prosthetic device or prosthetic spacer device  5100  is shown. The device  5100  can include any other features for an implantable prosthetic device discussed in the present application, and the device  5100  can be positioned to engage valve tissue  20 ,  22  as part of any suitable valve repair system (e.g., any valve repair system disclosed in the present application). In addition, any of the devices described herein can be operated and/or deployed in the same or similar manner that the device  5100  is actuated and/or deployed in  FIGS. 262-265 . 
     Referring now to  FIGS. 262-265 , the prosthetic spacer or coaption device  5100  can be deployed from a delivery sheath or means for delivery  5102  by a pusher  5113 , such as a rod or tube as described above. The device  5100  can include a coaption portion  5104  and an anchor portion  5106  having two or more anchors  5108 . The coaption portion  5104  includes a coaption element, coaption member, or spacer  5110 . Each anchor  5108  includes an outer paddle  5120  and a clasp  5130  that can each be opened and closed. 
     A first or proximal collar  5111 , and a second collar or cap  5114  are used to move the coaption portion  5104  and the anchor portion  5106  relative to one another. Actuation of the actuator, actuation element or means for actuating  5112  (e.g., actuation wire, shaft, etc.) opens and closes the anchor portion  5106  of the device  5100  to grasp the mitral valve leaflets during implantation in the manner described above. The actuator, or actuation element  5112  can take a wide variety of different forms. For example, the actuation element  5112  can be threaded such that rotation of the actuation element  5112  moves the anchor portion  5106  relative to the coaption portion  5104 . Or, the actuation element  5112  can be unthreaded, such that pushing or pulling the actuation element  5112  moves the anchor portion  5106  relative to the coaption portion  5104 . 
     The coaption element/member  5110  extends from a proximal portion  5119  assembled to the collar  5111  to a distal portion  5117  that connects to the anchors  5108 . The coaption element/member  5110  and the anchors  5108  can be coupled together in various ways. For example, as shown in the illustrated embodiment, the coaption element/member  5110  and the anchors  5108  can optionally be coupled together by integrally forming the coaption element/member  5110  and the anchors  5108  as a single, unitary component. This can be accomplished, for example, by forming the coaption element/member  5110  and the anchors  5108  from a continuous structure of a braided or woven material, such as braided or woven nitinol wire (see, e.g.,  FIGS. 243-257 ). In another embodiment, the components are separately formed and are attached together. 
     The anchors  5108  are attached to the coaption element/member  5110  by inner flexible portions or inner paddles  5122  and to the cap  5114  by outer flexible portions  5121 . The anchors  5108  can comprise a pair of outer paddles  5120 . In some embodiments, the anchors  5108  can comprise inner and outer paddles joined by a flexible portion. The paddles  5120  are attached to paddle frames  5124  that are attached to the cap  5114 . 
     The anchors  5108  can be configured to move between various configurations by axially moving the cap  5114  relative to the proximal collar  5111  and thus the anchors  5108  relative to the coaption element/member  5110  along a longitudinal axis extending between the cap  5114  and the proximal collar  5111 . For example, the anchors  5108  can be positioned in a straight configuration by moving the cap  5114  away from the coaption element/member  5110 . The anchors  5108  can also be positioned in a closed configuration (see  FIG. 262 ) by moving the cap  5114  toward the coaption element/member  5110 . When the cap  5114  is pulled all the way toward the coaption element/member  5110  by the actuation element  5112 , the paddles  5120  are closed against the coaption element  5110  and any native tissue (e.g., a valve leaflet, not shown) captured between the coaption element  5110  and the paddles  5120  is pinched so as to secure the device  5100  to the native tissue. 
     Each outer paddle  5120  includes two extendable portions  5123  that curve outward from each other and define a paddle expansion space  5125 . Each of the extendable portions  5123  stretch from a resting position to an extended position. In the resting position, shown in  FIGS. 262 and 263 , the extendable portions  5123  have a first or resting width between the respective outer edges of each extendable portion  5123 . When stretched to the extended position, shown in  FIGS. 264 and 265 , the extendable portions  5123  straighten and have a second width between the respective outer edges of each extendable portion  5123  that is narrower than the first width. That is, the extendable portions  5123  together have a width that is indirectly proportional to a length of the extendable portions  5123 ; i.e., the combined width of the extendable portions  5123  decreases as a length of the extendable portions  5123  increases, and vice versa. The extendable portions  5123  can be formed integrally with the paddle  5120  or can be formed from separate pieces that are joined to the remainder of the paddle  5120 . 
     The extendable portions  5123  can be made from a shape-memory alloy such that the extendable portions  5123  return to the resting position ( FIGS. 262 and 263 ) from the extended position ( FIGS. 264 and 265 ) after tension applied to the paddles  5120  is relieved. The extendable portions  5123  can also be made from any material that elastically deforms to straighten out when stretched and returns to an initial resting position when tension is relieved. In some embodiments, the entire paddle  5120  is formed from a braided or woven tube of material and the braid is split into two separate braids in a segment of the outer paddle to form the extendable portions  5123 . 
     The clasps  5130  can comprise attachment or fixed portions  5132  connected to arm or moveable portions  5134  by a hinge portion  5138 . The attachment or fixed portions  5132  can be coupled or connected to the paddle portions  5120  of the anchors  5108  in various ways such as with sutures, adhesive, fasteners, welding, stitching, swaging, friction fit and/or other means for coupling. The clasps  5130  can be similar to or the same as the clasps  430 . 
     The moveable portions  5134  can move, flex, pivot, etc. relative to the fixed portions  5132  between an open configuration and a closed configuration (see  FIG. 232 ). In some embodiments, the clasps  5130  can be biased to the closed configuration. In the open configuration, the fixed portions  5132  and the moveable portions  5134  move, pivot, flex, etc. away from each other such that native leaflets can be positioned between the fixed portions  5132  and the moveable portions  5134 . In the closed configuration, the fixed portions  5132  and the moveable portions  5134  move, pivot, flex, etc. toward each other, thereby clamping the native leaflets between the fixed portions  5132  and the moveable portions  5134 . 
     Each clasp  5130  can be opened separately by pulling on an attached actuator or actuation line  5116  that extends through the delivery sheath or means for delivery  5102  to the moveable portions  5134  of the clasps  5130 , while the push rod or tube  5113  holds the collar  5111  in place. The actuator or actuation lines  5116  can take a wide variety of forms, such as, for example, a line, a suture, a wire, a rod, a catheter, or the like. The clasps  5130  can be spring loaded so that in the closed position the clasps  5130  continue to provide a pinching force on the grasped native leaflet. This pinching force remains constant regardless of the position of the paddle portions  5120 . Barbs or means for securing  5136  of the clasps  5130  can pierce the native leaflets to further secure the native leaflets. 
     Referring now to  FIGS. 264 and 265 , force is applied to the actuation element  5112  to push the cap  5114  away from the collar  5111  while simultaneously maintaining tension on the actuation lines  5116 . Movement of the cap  5114  away from the collar  5111  pulls down on the flexible portions  5121  which in turn apply a tensile force to the outer paddles  5120 . The force applied to the actuation lines  5116  can be less than the force required to open the clasps  5130  while still being sufficient to maintain the position of the clasps  5130  as the actuation element  5112  is extended. Consequently, the portion of the inner paddle  5122  attached to the clasp  5130  and the proximal end of the paddle frame  5124  are also restrained from moving. Thus, the outer paddle  5120  is stretched between the cap  5114  and the paddle frame  5124  so that the extendable portions  5123  are extended from the resting position shown in  FIGS. 262 and 263  to the extended position shown in  FIGS. 264 and 265 . As described above, the extendable portions  5123  move toward each other to reduce the overall paddle width as the length of the extendable portions  5123  is increased. Accordingly, the width of the paddle  5120  can be adjusted by stretching the paddle  5120  to change the length of the extendable portions  5123 . In some embodiments, the frames  5124  also narrow when stretched such that the extendable portions  5123  and frames  5124  together have a decreased width when the implantable prosthetic device  5100  is partially opened and the paddles  5120  and frames  5124  are subjected to tension forces. 
     During the implantation procedure, native heart structures (e.g., numerous and/or densely packed chordae) can interfere with capture of the leaflets. That is, portions of the implantable prosthetic device  5100  may contact the chordae such that the connected leaflet is pushed away as the surgeon attempts to move the implantable prosthetic device  5100  toward the leaflet for capture. Enabling the adjustment of the width of the implantable prosthetic device  5100  improves maneuverability of the implantable prosthetic device  5100  when configured in a “capture ready” configuration during the implantation procedure. When such native structures are encountered, the implantable prosthetic device  5100  can be partially extended to extend the extendable portions  5123  and reduce the width of the paddles  5120 , thereby avoiding the native heart structures and enabling capture of the leaflet. The paddles  5120  widen when the implantable prosthetic device  5100  is closed to capture the leaflet which provides an increased pinching surface to better secure the leaflet within the implantable prosthetic device  5100 . 
     Referring now to  FIGS. 266-289 , an example embodiment of an implantable prosthetic device or prosthetic spacer device  5200  is shown. The device  5200  can include any other features for an implantable prosthetic device discussed in the present application, and the device  5200  can be positioned to engage valve tissue  20 ,  22  as part of any suitable valve repair system (e.g., any valve repair system disclosed in the present application). In addition, any of the devices described herein can be operated and/or deployed in the same or similar manner that the device  5200  is actuated and/or deployed in  FIGS. 266-289 . 
     Referring now to  FIGS. 266-289 , the prosthetic spacer or coaption device  5200  can be deployed from a delivery sheath or means for delivery (not shown) by a pusher (not shown), such as a rod or tube as described above. The device  5200  can include a coaption portion  5204  and an anchor portion  5206  having two or more anchors  5208 . The coaption portion  5204  includes a coaption element, coaption member, or spacer  5210 . Each anchor  5208  includes an outer paddle  5220  and a clasp (not shown) that can each be opened and closed. The clasps of the device  5200  can be any of the clasps described herein. 
     A first or proximal collar  5211 , and a second collar or cap  5214  are used to move the coaption portion  5204  and the anchor portion  5206  relative to one another. Actuation of an actuator, actuation element or means for actuating (not shown) opens and closes the anchor portion  5206  of the device  5200  to grasp the mitral valve leaflets during implantation in the manner described above. The actuator or actuation element can take a wide variety of different forms. For example, the actuation element can be threaded such that rotation of the actuation element moves the anchor portion  5206  relative to the coaption portion  5204 . Or, the actuation element can be unthreaded, such that pushing or pulling the actuation element moves the anchor portion  5006  relative to the coaption portion  5004 . 
     The coaption element/member  5210  extends from a proximal portion  5219  assembled to the collar  5211  to a distal portion  5217  that connects to the anchors  5208 . The coaption element/member  5210  and the anchors  5208  can be coupled together in various ways. For example, as shown in the illustrated embodiment, the coaption element/member  5210  and the anchors  5208  can optionally be coupled together by integrally forming the coaption element/member  5210  and the anchors  5208  as a single, unitary component. This can be accomplished, for example, by forming the coaption element/member  5210  and the anchors  5208  from a single braided or woven material, such as braided or woven nitinol wire (see, e.g.,  FIGS. 243-257 ). In another embodiment, the components are separately formed and are attached together. 
     The anchors  5208  are attached to the coaption element/member  5210  by inner flexible portions or inner paddles  5222  and to the cap  5214  by outer flexible portions  5221 . The anchors  5208  can comprise a pair of outer paddles  5220 . In some embodiments, the anchors  5208  can comprise inner and outer paddles joined by a flexible portion. The paddles  5220  are attached to paddle frames  5224  that are flexibly attached to the cap  5214 . 
     The anchors  5208  can be configured to move between various configurations by axially moving the cap  5214  relative to the proximal collar  5211  and thus the anchors  5208  relative to the coaption element/member  5210  along a longitudinal axis extending between the cap  5214  and the proximal collar  5211 . For example, the anchors  5208  can be positioned in a straight configuration by moving the cap  5214  away from the coaption element/member  5210 . The anchors  5208  can also be positioned in a closed configuration (see  FIG. 266 ) by moving the cap  5214  toward the coaption element/member  5210 . When the cap  5214  is pulled all the way toward the coaption element/member  5210  by the actuation element (not shown), the paddles  5220  are closed against the coaption element  5210  and any native tissue (e.g., a valve leaflet, not shown) captured between the coaption element  5210  and the paddles  5220  is pinched so as to secure the device  5200  to the native tissue. 
     Each outer paddle  5220  includes an extendable portion  5223  that stretches from a resting position to an extended position. In the resting position, shown in  FIGS. 266-271 and 278-283 , the extendable portion  5223  has a first or resting width. When stretched to the extended position, shown in  FIGS. 272-277 and 284-289 , the extendable portion  5223  has a second width that is narrower than the first width. That is, the extendable portion  5223  has a width that is related to a length of the extendable portion; i.e., the width of the extendable portion  5223  decreases as a length of the extendable portion  5223  increases, and vice versa. The extendable portion  5223  can be formed integrally with the paddle  5220  or can be formed from a separate piece that is joined to the remainder of the paddle  5220 . 
     The extendable portion  5223  can be made from a braided or woven material that changes in width in proportion to changes in the length of the extendable portion  5223 . The braided or woven material can be a loosely braided or woven tube or a flat braid. In some embodiments, the entire paddle  5220  is formed from a braided or woven tube of material and the braid is loosened in a segment of the outer paddle to form the extendable portion  5223 . As the extendable portion  5223  formed from braided or woven material is stretched, diagonal braid segments (not shown) move or pivot before elastically deforming such that the slope angle of the braid segments increases, bringing the sides of the braided or woven material closer together. The extendable portion  5223  can also be made from an elastomeric material that narrows when stretched, such as, for example, a tube or flattened tube. 
     Referring now to  FIGS. 272-277 , force is applied to the actuation element (not shown) to push the cap  5214  away from the collar  5211  while simultaneously maintaining tension on the actuation lines (not shown). Movement of the cap  5214  away from the collar  5211  pulls down on the flexible portions  5221  which in turn apply a tensile force to the outer paddles  5220 . The force applied to the actuation lines can be less than the force required to open the clasps (not shown) while still being sufficient to maintain the position of the clasps as the actuation element is extended. Consequently, the portion of the inner paddle  5222  attached to the clasp and the proximal end of the paddle frame  5224  are also restrained from moving. Thus, the outer paddle  5220  is stretched between the cap  5214  and the paddle frame  5224  so that the extendable portion  5223  is extended from the resting position shown in  FIGS. 266-271  to the extended position shown in  FIGS. 272-277 . As described above, the extendable portion  5223  narrows as the length of the extendable portion  5223  is increased. Accordingly, the width of the extendable portion  5223  can be adjusted by stretching the outer paddle  5220  to change the length of the extendable portion  5223 . In some embodiments, the paddle frames  5224  also narrow when stretched such that the extendable portion  5223  and paddle frames  5224  have a decreased width when the implantable prosthetic device  5200  is partially opened and the outer paddles  5220  and paddle frames  5224  are subjected to tension forces. 
     During the implantation procedure, native heart structures (e.g., numerous and/or densely packed chordae) can interfere with capture of the leaflets. That is, portions of the implantable prosthetic device  5200  may contact the chordae such that the connected leaflet is pushed away as the surgeon attempts to move the implantable prosthetic device  5200  toward the leaflet for capture. Enabling the adjustment of the width of the implantable prosthetic device  5200  improves maneuverability of the implantable prosthetic device  5200  when configured in a “capture ready” configuration during the implantation procedure. When such native structures are encountered, the implantable prosthetic device  5200  can be partially extended to extend the extendable portion  5223  and reduce the width of the paddles  5220 , thereby avoiding the native heart structures and enabling capture of the leaflet. The paddles  5220  widen when the implantable prosthetic device  5200  is closed to capture the leaflet which provides an increased pinching surface to better secure the leaflet within the implantable prosthetic device  5200 . 
     Referring now to  FIGS. 290-313 , an example embodiment of an implantable prosthetic device or prosthetic spacer device  5300  is shown. The device  5300  can include any other features for an implantable prosthetic device discussed in the present application, and the device  5300  can be positioned to engage valve tissue  20 ,  22  as part of any suitable valve repair system (e.g., any valve repair system disclosed in the present application). In addition, any of the devices described herein can be operated and/or deployed in the same or similar manner that the device  5300  is actuated and/or deployed in  FIGS. 296-301 . 
     Referring now to  FIGS. 290-313 , the prosthetic spacer or coaption device  5300  can be deployed from a delivery sheath or means for delivery (not shown) by a pusher (not shown), such as a rod or tube as described above. The device  5300  can include a coaption portion  5304  and an anchor portion  5306  having two or more anchors  5308 . The coaption portion  5304  includes a coaption element, coaption member, or spacer  5310 . Each anchor  5308  includes an outer paddle  5320  and a clasp (not shown) that can each be opened and closed. The clasps of the device  5300  can be any of the clasps described herein. 
     A first or proximal collar  5311 , and a second collar or cap  5314  are used to move the coaption portion  5304  and the anchor portion  5306  relative to one another. Actuation of the actuator, actuation element or means for actuating (not shown) opens and closes the anchor portion  5306  of the device  5300  to grasp the mitral valve leaflets during implantation in the manner described above. The actuator or actuation element (e.g., wire, shaft, etc.) can take a wide variety of different forms. For example, the actuation wire or shaft can be threaded such that rotation of the actuation element moves the anchor portion  5306  relative to the coaption portion  5304 . Or, the actuation element can be unthreaded, such that pushing or pulling the actuation element moves the anchor portion  5306  relative to the coaption portion  5304 . 
     The coaption element/member  5310  extends from a proximal portion  5319  assembled to the collar  5111  to a distal portion  5317  that connects to the anchors  5308 . The coaption element/member  5310  and the anchors  5308  can be coupled together in various ways. For example, as shown in the illustrated embodiment, the coaption element/member  5310  and the anchors  5308  can optionally be coupled together by integrally forming the coaption element/member  5310  and the anchors  5308  as a single, unitary component. This can be accomplished, for example, by forming the coaption element/member  5310  and the anchors  5308  from a single braided or woven material, such as braided or woven nitinol wire (see, e.g.,  FIGS. 243-257 ). In some embodiments, the components are separately formed and are attached together. 
     The anchors  5308  are attached to the coaption element/member  5310  by inner flexible portions or inner paddles  5322  and to the cap  5314  by outer flexible portions  5321 . The anchors  5308  can each comprise a pair of spaced apart outer paddles  5320  and a pair of spaced apart inner paddles  5322 . In some embodiments, the four inner and outer paddles are joined by a flexible portion. The paddles  5320  are optionally attached to paddle frames  5324  that are flexibly attached to the cap  5314 . The outer flexible portions  5321  of the left and right paddles can be connected to each other through openings in the cap  5314 . Though optionally, outer flexible portions  5321  on the left side can be joined together within the cap  5314  and the outer flexible portions on the right side can also be joined together within the cap. 
     The anchors  5308  can be configured to move between various configurations by axially moving the cap  5314  relative to the proximal collar  5311  and thus the anchors  5308  relative to the coaption element/member  5310  along a longitudinal axis extending between the cap  5314  and the proximal collar  5311 . For example, the anchors  5308  can be positioned in a straight configuration by moving the cap  5314  away from the coaption element/member  5310 . The anchors  5308  can also be positioned in a closed configuration (see  FIG. 290 ) by moving the cap  5314  toward the coaption element/member  5310 . When the cap  5314  is pulled all the way toward the coaption element/member  5310  by the actuation element (not shown), the paddles  5320  are closed against the coaption element  5310  and any native tissue (e.g., a valve leaflet, not shown) captured between the coaption element  5310  and the paddles  5320  is pinched so as to secure the device  5300  to the native tissue. 
     Each outer paddle  5320  includes two extendable portions  5323  that curve outward from each other and define a paddle expansion space  5325 . Each of the extendable portions  5323  stretch from a resting position to an extended position. In the resting position, shown in  FIGS. 290-295 and 302-307 , the extendable portions  5323  have a first or resting width between the respective outer edges of each extendable portion  5323 . When stretched to the extended position, shown in  FIGS. 296-301 and 308-313 , the extendable portions  5323  straighten and have a second width between the respective outer edges of each extendable portion  5323  that is narrower than the first width. That is, the extendable portions  5323  together have a width that is indirectly proportional to a length of the extendable portions  5323 ; i.e., the width of the extendable portions  5323  decreases as a length of the extendable portions  5323  increases, and vice versa. The extendable portions  5323  can be formed integrally with the paddle  5320  or can be formed from separate pieces that are joined to the remainder of the paddle  5320 . 
     The extendable portions  5323  can be made from a shape-memory alloy such that the extendable portions  5323  return to the resting position ( FIGS. 290-295 and 302-307 ) from the extended position ( FIGS. 296-301 and 308-313 ) after tension applied to the paddles  5320  is relieved. The extendable portions  5323  can also be made from any material that elastically deforms to straighten out when stretched and returns to an initial resting position when tension is relieved. In some embodiments, the entire paddle is formed from a braided or woven tube of material and the braid is split into two separate braids in a segment of the outer paddle to form the extendable portions  5323 . In some embodiments, the coaption element/member  5310  and the anchors  5308  can optionally be coupled together by integrally forming the coaption element/member  5310  and the anchors  5308  as a single, unitary component. This can be accomplished, for example, by forming the coaption element/member  5310  and the anchors  5308  from a continuous structure of a braided or woven tube of material, such as a braided or woven nitinol wire tube. For example, the coaption element/member  5310  and the anchors  5308  may be formed from two halves of a single braided or woven tube joined together in any suitable manner, such as, by welding, with adhesives, or the like, and the paddles  5320  may be formed by splitting the tube of material into two separate segments to form the extendable portions  5323  of the paddles  5320 . The two halves of the braided or woven tube may be joined together along the vertical front-to-back plane  550  (see  FIG. 70 ) of the device  5300 , the vertical side-to-side plane  552  (see  FIG. 70 ) of the device  5300 , or any other radial plane of the device.  5300 . In another embodiment, the components are separately formed and are attached together. 
     Referring now to  FIGS. 296-301 , force is applied to the actuation element (not shown) to push the cap  5314  away from the collar  5311  while simultaneously maintaining tension on the actuation lines (not shown). Movement of the cap  5314  away from the collar  5311  pulls down on the flexible portions  5321  which in turn apply a tensile force to the outer paddles  5320 . The force applied to the actuation lines can be less than the force required to open the clasps (not shown) while still being sufficient to maintain the position of the clasps as the actuation element is extended. Consequently, the portion of the inner paddle  5322  attached to the clasp and the proximal end of the paddle frame  5324  are also restrained from moving. Thus, the outer paddle  5320  is stretched between the cap  5314  and the paddle frame  5324  so that the extendable portions  5323  are extended from the resting position shown in  FIGS. 290-295  to the extended position shown in  FIGS. 296-301 . As described above, the extendable portions  5323  move toward each other to reduce the overall width of the outer paddle  5320  as the length of the extendable portions  5323  is increased. Accordingly, the width of the outer paddle  5320  can be adjusted by stretching the outer paddle  5320  to change the length of the extendable portions  5323 . In some embodiments, the frames  5324  also narrow when stretched such that the extendable portions  5323  and frames  5324  together have a decreased width when the implantable prosthetic device  5300  is partially opened and the paddles outer  5320  and paddle frames  5324  are subjected to tension forces. 
     During the implantation procedure, native heart structures (e.g., numerous and/or densely packed chordae) can interfere with capture of the leaflets. That is, portions of the implantable prosthetic device  5300  may contact the chordae such that the connected leaflet is pushed away as the surgeon attempts to move the implantable prosthetic device  5300  toward the leaflet for capture. Enabling the adjustment of the width of the implantable prosthetic device  5300  improves maneuverability of the implantable prosthetic device  5300  when configured in a “capture ready” configuration during the implantation procedure. When such native structures are encountered, the implantable prosthetic device  5300  can be partially extended to extend the extendable portions  5323  and reduce the width of the paddles  5320 , thereby avoiding the native heart structures and enabling capture of the leaflet. The paddles  5320  widen when the implantable prosthetic device  5300  is closed to capture the leaflet which provides an increased pinching surface to better secure the leaflet within the implantable prosthetic device  5300 . 
     While various inventive aspects, concepts and features of the disclosures may be described and illustrated herein as embodied in combination in the example embodiments, these various aspects, concepts, and features may be used in many alternative embodiments, either individually or in various combinations and sub-combinations thereof. Unless expressly excluded herein all such combinations and sub-combinations are intended to be within the scope of the present application. Still further, while various alternative embodiments as to the various aspects, concepts, and features of the disclosures—such as alternative materials, structures, configurations, methods, devices, and components, alternatives as to form, fit, and function, and so on—may be described herein, such descriptions are not intended to be a complete or exhaustive list of available alternative embodiments, whether presently known or later developed. Those skilled in the art may readily adopt one or more of the inventive aspects, concepts, or features into additional embodiments and uses within the scope of the present application even if such embodiments are not expressly disclosed herein. 
     Additionally, even though some features, concepts, or aspects of the disclosures may be described herein as being a preferred arrangement or method, such description is not intended to suggest that such feature is required or necessary unless expressly so stated. Still further, example or representative values and ranges may be included to assist in understanding the present application, however, such values and ranges are not to be construed in a limiting sense and are intended to be critical values or ranges only if so expressly stated. 
     Moreover, while various aspects, features and concepts may be expressly identified herein as being inventive or forming part of a disclosure, such identification is not intended to be exclusive, but rather there may be inventive aspects, concepts, and features that are fully described herein without being expressly identified as such or as part of a specific disclosure, the disclosures instead being set forth in the appended claims. Descriptions of example methods or processes are not limited to inclusion of all steps as being required in all cases, nor is the order that the steps are presented to be construed as required or necessary unless expressly so stated. Further, the treatment techniques, methods, operations, steps, etc. described or suggested herein can be performed on a living animal or on a non-living simulation, such as on a cadaver, cadaver heart, simulator (e.g., with the body parts, tissue, etc. being simulated), etc. The words used in the claims have their full ordinary meanings and are not limited in any way by the description of the embodiments in the specification, unless expressly stated.