Patent Publication Number: US-2022218483-A1

Title: Valve repair using tissue anchors

Description:
RELATED APPLICATION 
     This application is a divisional of U.S. patent application Ser. No. 16/430,334, filed Jun. 3, 2019, now U.S. Pat. No. 11,285,004, which claims the benefit of U.S. Patent Application No. 62/680,852, filed on Jun. 5, 2019, the entire disclosures all of which are incorporated by reference for all purposes. 
    
    
     BACKGROUND 
     Technical Field 
     The present disclosure generally relates to the field of valve repair devices and processes. 
     Description of Related Art 
     Biological valves, such as heart valves, can become defective, which can present certain health risks. Valve replacement and/or repair procedures can improve function of a defective heart valve in some cases. 
     SUMMARY 
     An exemplary method for repairing a native valve of a patient during a non-open-heart procedure includes attaching a pair of attachment members to the native valve. The pair of attachment members include a first attachment member and a second attachment member, and both the first attachment member and the second attachment member have a securing portion and a suture portion. The suture portion is attached to the securing portion. The securing portion abuts a first side of the native valve and the suture portion extends from the securing portion, through the native valve, and outward from a second side of the native valve. The exemplary method further includes applying a force to the suture portions of both the first attachment member and the second attachment member, such that the first attachment member and the second attachment member are drawn relatively toward one another to a cinched position. In addition, the exemplary method includes attaching an anchor member to the suture portions of both the first attachment member and the second attachment member such that the first and second attachment members are secured in the cinched position. 
     An exemplary method for repairing the mitral valve of a patient during a non-open-heart procedure includes inserting a valve repair device into a heart of the patient, in which two or more attachment members are disposed in the valve repair device. Each attachment member has a securing portion. The exemplary method also includes engaging a first side of the annulus of the mitral valve with the valve repair device and attaching the two or more attachment members to the annulus such that the securing portion of each attachment member is disposed on a second side of the annulus. In addition, the exemplary method includes applying a force to each of the two or more attachment members to cause a cinching effect on at least a portion of the annulus. The exemplary method further includes securing the two or more attachment members with one or more anchor members, such that each of the two or more attachment members maintain the cinching effect. 
     Another exemplary method for repairing the mitral valve of a patient during a non-open-heart procedure includes inserting a valve repair device into a heart of the patient. The valve repair device has a delivery member, an advancement member, and a puncturing member. The delivery member has an outlet. The advancement member is configured to move two or more attachment members out of the outlet of the delivery member. The attachment members are connected by a suture. The exemplary method further includes puncturing a first location of the annulus of the mitral valve with the puncturing member, such that the outlet of the delivery member moves from a first side of the annulus to a second side of the annulus. In addition, the exemplary method includes deploying a first attachment member out of the outlet of the delivery member, such that the first attachment member abuts the second side of the annulus. The exemplary method then includes moving the outlet of the delivery member from the second side of the annulus to the first side of the annulus, such that the suture extends from the first attachment member, through the annulus, and outward from the first side of the annulus. The exemplary method further includes puncturing a second location of the annulus of the mitral valve with the puncturing member of the valve repair device, such that the outlet of the delivery member moves from the first side to the second side of the annulus, and such that the suture extends through the annulus and outward from the second side of the annulus. Subsequently, the exemplary method includes deploying a second attachment member out of the outlet of the delivery member, such that the second attachment member abuts the second side of the annulus. Next, the exemplary method includes moving the outlet of the delivery member from the second side to the first side of the annulus, such that the suture extends from the second attachment member, through the annulus, and outward from the first side of the annulus. The exemplary method further includes applying a force to the suture such that the two or more attachment members cause a cinching effect on at least a portion of the annulus of the mitral valve and securing the suture with one or more anchor members to maintain the cinching effect. 
     A further understanding of the nature and advantages disclosed herein 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 of the present disclosure will be described and explained with additional specificity and detail through the use of the accompanying drawings. 
         FIG. 1  is a cutaway view of the human heart in a diastolic phase. 
         FIG. 2  is a cutaway view of the human heart in a systolic phase. 
         FIG. 3  is a perspective view of a healthy mitral valve with the leaflets closed (See also  FIG. 67A ). 
         FIG. 4  is perspective view of a dysfunctional mitral valve with a visible gap between the leaflets. 
         FIG. 5  is a cutaway view of the human heart showing an exemplary embodiment of a valve repair device engaging a first location of the annulus of the mitral valve through the apex of the heart. 
         FIG. 6  illustrates the exemplary valve repair device engaging the first location of the annulus of the mitral valve, as shown in  FIG. 5 , after the valve repair device attaches an attachment member to the first location of the annulus. 
         FIGS. 7A, 7C and 7E  illustrate the mitral valve shown from the direction represented by line A-A  FIG. 6  during an exemplary process for repairing a first portion of the mitral valve using the exemplary valve repair device of  FIG. 5 . 
         FIGS. 7B, 7D and 7F  illustrate the mitral valve shown from the direction represented by line B-B  FIG. 6  during an exemplary process for repairing a first portion of the mitral valve using the exemplary valve repair device of  FIG. 5 . 
         FIG. 8  is a cutaway view of the human heart showing an exemplary embodiment of a valve repair device engaging a second location of the annulus of the mitral valve through the apex of the heart. 
         FIG. 9  illustrates the exemplary valve repair device engaging the second location of the annulus of the mitral valve, as shown in  FIG. 8 , after the valve repair device attaches an attachment member to the second location of the annulus. 
         FIGS. 10A, 10C and 10E  illustrate the mitral valve shown from the direction represented by line A-A  FIG. 9  during an exemplary process for repairing a first portion of the mitral valve using the exemplary valve repair device of  FIGS. 8 and 9 . 
         FIGS. 10B, 10D and 10F  illustrate the mitral valve shown from the direction represented by line B-B  FIG. 9  during an exemplary process for repairing a first portion of the mitral valve using the exemplary valve repair device of  FIGS. 8 and 9 . 
         FIG. 11  is a cutaway view of the human heart showing an embodiment of an exemplary valve repair device engaging a leaflet of the mitral valve through the apex of the heart. 
         FIG. 12  is a cutaway view of the human heart after the exemplary valve repair device of  FIG. 11  attaches an attachment member to the anterior leaflet of the mitral valve and anchors the anterior leaflet to an outer surface of the heart. 
         FIG. 13  illustrates the mitral valve shown from the perspective of line A-A in  FIG. 12  after the anterior leaflet is anchored to the outer surface of the heart. 
         FIG. 14  is a cutaway view of the human heart after the exemplary valve repair device of  FIG. 11  attaches an attachment member to the posterior leaflet of the mitral valve and anchors the posterior leaflet to an outer surface of the heart. 
         FIG. 15  illustrates the mitral valve shown from the perspective of line A-A in  FIG. 14  after the posterior leaflet is anchored to the outer surface of the heart. 
         FIGS. 16 and 16A  are cutaway views of the human heart showing an exemplary embodiment of a valve repair device engaging a first location of the annulus of the mitral valve through the atrial septum of the heart. 
         FIGS. 17A, 17C and 17E  illustrate the mitral valve shown from the direction represented by line A-A  FIG. 16  during an exemplary process for repairing a first portion of the mitral valve using the exemplary valve repair device of  FIG. 16 . 
         FIGS. 17B, 17D and 17F  illustrate the mitral valve shown from the direction represented by line B-B  FIG. 16  during an exemplary process for repairing a first portion of the mitral valve using the exemplary valve repair device of  FIG. 16 . 
         FIG. 18  is a cutaway view of the human heart showing an exemplary embodiment of a valve repair device engaging a second portion of the mitral valve through the atrial septum of the heart. 
         FIGS. 19A, 19C and 19E  illustrate the mitral valve shown from the direction represented by line A-A  FIG. 16  during an exemplary process for repairing a first portion of the mitral valve using the exemplary valve repair device of  FIG. 18 . 
         FIGS. 19B, 19D and 19F  illustrate the mitral valve shown from the direction represented by line B-B  FIG. 16  during an exemplary process for repairing a first portion of the mitral valve using the exemplary valve repair device of  FIG. 18 . 
         FIG. 20  is a cutaway view of the human heart showing an exemplary embodiment of a valve repair device engaging the annulus of the mitral valve through the apex of the heart. 
         FIG. 21  illustrates the exemplary valve repair device engaging the annulus of the mitral valve, as shown in  FIG. 20 , after the valve repair device attaches an attachment member to the annulus. 
         FIGS. 22A and 22C  illustrate the mitral valve shown from the direction represented by line A-A  FIG. 21  during an exemplary process for repairing a first portion of the mitral valve using the exemplary valve repair device of  FIG. 21 . 
         FIGS. 22B and 22D  illustrate the mitral valve shown from the direction represented by line B-B  FIG. 21  during an exemplary process for repairing a first portion of the mitral valve using the exemplary valve repair device of  FIG. 21 . 
         FIG. 23  illustrates an exemplary embodiment of an attachment member and suture configuration used to repair the mitral valve during the exemplary process shown in  FIGS. 22A-22D . 
         FIG. 24  illustrates another exemplary embodiment of an attachment member and suture configuration used to repair the mitral valve during the exemplary process shown in  FIGS. 22A-22D . 
         FIG. 25  is a cutaway view of the human heart showing an exemplary embodiment of a valve repair device engaging the annulus of the mitral valve through the atrial septum of the heart. 
         FIGS. 26A and 26C  illustrate the mitral valve shown from the direction represented by line A-A  FIG. 25  during an exemplary process for repairing a first portion of the mitral valve using the exemplary valve repair device of  FIG. 25 . 
         FIGS. 26B and 26D  illustrate the mitral valve shown from the direction represented by line B-B  FIG. 25  during an exemplary process for repairing a first portion of the mitral valve using the exemplary valve repair device of  FIG. 25 . 
         FIG. 27  illustrates another exemplary embodiment of a valve repair device. 
         FIG. 28  illustrates the exemplary valve repair device of  FIG. 27 , in which the valve repair device is configured to provide an exemplary embodiment of a pledget. 
         FIG. 29  illustrates the exemplary valve repair device of  FIG. 27 , in which the valve repair device is configured to provide another exemplary embodiment of a pledget. 
         FIG. 30  illustrates the exemplary embodiment of the valve repair device of  FIG. 27  engaging a tissue member to attach an exemplary embodiment of a pledget to the tissue member. 
         FIG. 31  illustrates the tissue member of  FIG. 31  after multiple pledgets have been attached to the tissue member by the exemplary valve repair device of  FIG. 27 . 
         FIG. 32  is a cutaway view of the human heart showing the exemplary embodiment of the valve repair device of  FIG. 27  engaging the mitral valve through the apex of the heart. 
         FIGS. 33A and 33C  illustrate the mitral valve shown from the direction represented by line A-A  FIG. 32  during an exemplary process for repairing a first portion of the mitral valve using the exemplary valve repair device of  FIG. 32 . 
         FIGS. 33B and 33D  illustrate the mitral valve shown from the direction represented by line B-B  FIG. 32  during an exemplary process for repairing a first portion of the mitral valve using the exemplary valve repair device of Figure. 
         FIG. 34  is a cutaway view of the human heart showing an exemplary embodiment of a valve repair device engaging the mitral valve through the atrial septum of the heart. 
         FIGS. 35A and 35C  illustrate the mitral valve shown from the direction represented by line A-A  FIG. 34  during an exemplary process for repairing a first portion of the mitral valve using the exemplary valve repair device of  FIG. 34 . 
         FIGS. 35B and 35D  illustrate the mitral valve shown from the direction represented by line B-B  FIG. 34  during an exemplary process for repairing a first portion of the mitral valve using the exemplary valve repair device of  FIG. 34 . 
         FIG. 36  is another exemplary embodiment of a valve repair device. 
         FIGS. 37A-37B  illustrate another exemplary embodiment of a valve repair device. 
         FIGS. 38A-38F  illustrate the exemplary valve repair device shown in  FIGS. 37A-37B  engaging a tissue member and attaching a pledget to the tissue member. 
         FIG. 39  illustrates another exemplary embodiment of an attachment member. 
         FIGS. 40A-40B  illustrate another exemplary embodiment of a valve repair device. 
         FIG. 41  is a cutaway view of the human heart showing the exemplary embodiment of the valve repair device of  FIGS. 40A-40B  engaging the annulus of the mitral valve through the apex of the heart. 
         FIGS. 42A and 42C  illustrate the mitral valve shown from either the perspective shown by line A-A  FIG. 41  during an exemplary process for repairing the mitral valve using the exemplary valve repair device of  FIGS. 40A-40B  and the exemplary attachment member of  FIG. 39 . 
         FIGS. 42B and 42D  illustrate the mitral valve shown from either the perspective shown by line B-B  FIG. 41  during an exemplary process for repairing the mitral valve using the exemplary valve repair device of  FIGS. 40A-40B  and the exemplary attachment member of  FIG. 39 . 
         FIG. 43  is a cutaway view of the human heart showing another exemplary embodiment of a valve repair device engaging the annulus of the mitral valve through the apex of the heart and attaching the exemplary attachment member of  FIG. 39  to the annulus. 
         FIGS. 44A and 44C  illustrate the mitral valve shown from either the perspective shown by line A-A in  FIG. 43  during an exemplary process for repairing the mitral valve using the exemplary valve repair device of  FIG. 43  and the exemplary attachment member of  FIG. 39 . 
         FIGS. 44B and 44D  illustrate the mitral valve shown from either the perspective shown by line B-B in  FIG. 43  during an exemplary process for repairing the mitral valve using the exemplary valve repair device of  FIG. 43  and the exemplary attachment member of  FIG. 39 . 
         FIGS. 45A-45B  illustrate an exemplary embodiment of an annuloplasty band. 
         FIGS. 46A-46B  illustrate an exemplary embodiment of a valve repair device attaching the exemplary embodiment of the annuloplasty band of  FIGS. 45A-45B  to a tissue member. 
         FIG. 47  is a cutaway view of the human heart showing the exemplary embodiment of the valve repair device of  FIGS. 46A-46B  engaging the annulus of the mitral valve through the apex of the heart and attaching the exemplary embodiment of the annuloplasty ring shown in  FIGS. 45A and 45B  to the annulus. 
         FIGS. 48A and 48C  illustrate the mitral valve shown from the perspective shown by line A-A in  FIG. 47  during an exemplary process for repairing the mitral valve using the exemplary valve repair device of  FIGS. 46A-46B  and the exemplary annuloplasty band of  FIGS. 45A-45B . 
         FIGS. 48B and 48D  illustrate the mitral valve shown from the perspective shown by line B-B in  FIG. 47  during an exemplary process for repairing the mitral valve using the exemplary valve repair device of  FIGS. 46A-46B  and the exemplary annuloplasty band of  FIGS. 45A-45B . 
         FIG. 49  is a cutaway view of the human heart showing another exemplary embodiment of the valve repair device engaging the annulus of the mitral valve through the apex of the heart and attaching the exemplary embodiment of the annuloplasty ring shown in  FIGS. 45A and 45B  to the annulus. 
         FIGS. 50A and 50C  illustrate the mitral valve shown from either the perspective shown by line A-A in  FIG. 49  during an exemplary process for repairing the mitral valve using the exemplary valve repair device of  FIG. 49  and the exemplary annuloplasty band of  FIGS. 45A-45B . 
         FIGS. 50B and 50D  illustrate the mitral valve shown from either the perspective shown by line B-B in  FIG. 49  during an exemplary process for repairing the mitral valve using the exemplary valve repair device of  FIG. 49  and the exemplary annuloplasty band of  FIGS. 45A-45B . 
         FIGS. 51A-51C  illustrate another exemplary embodiment of an annuloplasty band. 
         FIGS. 52A-52C  illustrate another exemplary embodiment of an annuloplasty band. 
         FIG. 53  is a cutaway view of the human heart showing another exemplary embodiment of a valve repair device engaging the annulus of the mitral valve through the apex of the heart and attaching the exemplary annuloplasty band of  FIGS. 51A-51C  to the annulus. 
         FIG. 54  is a cutaway view of the human heart after the exemplary annuloplasty band of  FIGS. 51A-51C  is attached to the annulus of the mitral valve. 
         FIG. 55  is a cross-sectional view of an exemplary attachment between the exemplary annuloplasty band of  FIGS. 51A-51C  and the annulus, in which the annuloplasty band is placed on a top surface of the annulus. 
         FIG. 56  is a cross-sectional view of an exemplary attachment between the exemplary annuloplasty band of  FIGS. 51A-51C  and the annulus, in which the annuloplasty band is placed on a bottom surface of the annulus. 
         FIG. 57  is a cross-sectional view of an exemplary attachment between the exemplary annuloplasty band of  FIGS. 52A-52C  and the annulus, in which the annuloplasty band is placed on a top surface of the annulus. 
         FIG. 58  is a cross-sectional view of an exemplary attachment between the exemplary annuloplasty band of  FIGS. 52A-52C  and the annulus, in which the annuloplasty band is placed on a bottom surface of the annulus. 
         FIG. 59A-59C  illustrate an exemplary embodiment of an anchor member. 
         FIG. 60A-60C  illustrates an exemplary procedure for securing an exemplary embodiment of an attachment member to a tissue member with the exemplary anchor member of  FIGS. 59A-59C . 
         FIG. 61A-61C  illustrates an exemplary procedure for securing an exemplary embodiment of an attachment member to a tissue member with the exemplary anchor member of  FIGS. 59A-59C . 
         FIG. 62-63  illustrate another exemplary embodiment of an anchor member. 
         FIGS. 64A-64E  illustrate an exemplary embodiment of a protecting member and an anchor member used for securing an attachment member to a tissue. 
         FIGS. 65A-65C  illustrate another exemplary embodiment of a protecting member and an anchor member for securing an attachment member to tissue. 
         FIG. 66  is a cutaway view of the human heart showing an exemplary embodiment of a valve repair device entering the left atrium through an outer wall of the heart. 
         FIGS. 67A-67B  illustrate the heart shown from the perspective shown by line A-A in  FIG. 66  after repairing the mitral valve using the exemplary valve repair device shown in  FIG. 66 . 
     
    
    
     DETAILED DESCRIPTION 
     The following description refers to the accompanying drawings, which illustrate specific embodiments. Other embodiments having different structures and operation do not depart from the scope of the disclosure. 
     Embodiments of the present disclosure relate to devices and methods for improving the function of a defective heart valve. Certain embodiments disclosed herein may be particularly well suited or adapted for reparations of a patient&#39;s native heart valve. 
     The function of the heart can be seriously impaired if any of the heart valves are not functioning properly. The heart valves may lose their ability to close properly due to, for example, annular dilation, ventricular dilation, or a failed native cord causing a prolapsing leaflet, with annular dilation being the most common. The leaflets may also have shrunk due to disease (e.g. rheumatic disease), and thereby leave a gap in the valve between the leaflets. The inability of the heart valve to close properly can cause a leak backwards (e.g., from the outflow to the inflow side), commonly referred to as regurgitation, through the valve. Heart valve regurgitation may seriously impair the function of the heart since more blood will have to be pumped through the regurgitating valve to maintain adequate circulation. Heart valve regurgitation decreases the efficiency of the heart, reduces blood circulation, and adds stress to the heart. In early stages, heart valve regurgitation leaves a person fatigued or short of breath. If left unchecked, the problem can lead to congestive heart failure, arrhythmias or death. 
     Heart valve disease, such as valve regurgitation, is typically treated by replacing or repairing the diseased valve during open-heart surgery. However, open-heart surgery is highly invasive and is therefore not an option for many patients. For high-risk patients, a less-invasive method for repair of heart valves is considered generally advantageous. 
     Exemplary 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. 
       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 (e.g., 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  302 ,  304  shown in  FIGS. 3 and 4 ) extending inward across the respective orifices that come together or “coapt” in the flowstream to form the one-way, fluid-occluding surfaces. The native valve repair devices 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. For example, the devices can be used in repairing either of the atrioventricular valves, such as the tricuspid valve TV, in addition to the mitral valve MV. In addition, in some embodiments the devices described herein can be used to repair the aortic valve AV, and/or 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 collects in the left atrium LA enters the mitral valve MV 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 PA into the body. In one exemplary embodiment, the devices described by the present application are used to repair the function of a defective mitral valve MV. During systole, the leaflets of the mitral valve MV close to prevent the blood from regurgitating back into the left atrium LA. 
     Referring to  FIGS. 1-4 , the mitral valve MV includes two leaflets, the anterior leaflet  302  and the posterior leaflet  304 . The mitral valve MV also includes an annulus  306 , which is a variably dense fibrous ring of tissues that encircles the leaflets  302 ,  304 . The mitral valve MV is anchored to the wall of the left ventricle LV ( FIGS. 1 and 2 ) by chordae tendineae (not shown), which are cord-like tendons that connect the papillary muscles (e.g., the muscles located at the base of the chordae tendineae and within the walls of the left ventricle) to the leaflets  302 ,  304 . Without the connection to the chordae tendineae and the papillary muscles, the mitral valve leaflets would revert or prolapse back toward and/or into the atrium, which is known as leaflet “flail.” The papillary muscles serve to limit the movements of the mitral valve MV leaflets and prevent the mitral valve leaflets from flailing. The mitral valve opens and closes in response to pressure changes in the left atrium LA and the left ventricle LV. 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 leaflets from flailing into the left atrium LA when the mitral valve closes. 
     Various disease processes can impair proper function of one or more of the valves 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 (e.g., 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  302 ,  304 ) 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. One possible malfunction is valve stenosis, which 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. 
     Another possible malfunction is valve regurgitation, which 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 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 1 malfunction involves the dilation of the annulus such that normally functioning leaflets are distracted from each other and fail to form a tight seal (e.g., do not coapt properly). Included in a type I mechanism malfunction are perforations of the leaflets, as in endocarditis. A Carpentier&#39;s type II malfunction involves prolapse of one or more leaflets of a native valve above a plane of coaptation. 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 (IIIa) or dilation of a ventricle (IIIb). 
     Referring to  FIG. 3 , when a healthy mitral valve MV is in a closed position, the anterior leaflet  302  and the posterior leaflet  304  coapt, which prevents blood from leaking from the left ventricle LV to the left atrium LA. Referring to  FIG. 4 , regurgitation occurs when the anterior leaflet  302  and/or the posterior leaflet  304  of the mitral valve MV is displaced into the left atrium LA during systole. This failure to coapt causes a gap  408  between the anterior leaflet  302  and the posterior leaflet  304 , 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  302 ,  304  of mitral valve MV) may malfunction, which can thereby lead to regurgitation. 
     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 (e.g., 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 much 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 treatment for a stenotic aortic valve or stenotic pulmonary valve is removal and replacement. 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. 
     Exemplary 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. The devices and procedures disclosed herein make reference to correcting the dilation of the annulus for a mitral valve. 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. 
     Referring to  FIGS. 5 through 10A-10F , an exemplary procedure for mitral annuloplasty is shown using an exemplary embodiment of a valve repair device  500 . The mitral annuloplasty procedure is used to correct a dysfunctional mitral valve MV. As described above, in certain situations, the anterior leaflet  705  and the posterior leaflet  706  of the mitral valve MV may not coapt (e.g., see mitral valve MV having gap  708  in  FIGS. 7A-7F ), which could lead to regurgitation of blood through the mitral valve. The exemplary mitral annuloplasty procedure provides annular support to the mitral valve by reducing the size of the annulus, which allows the leaflets to properly coapt. 
     Referring to  FIG. 5 , the valve repair device  500  enters the left ventricle LV through the apex A of the heart H. After the valve repair device  500  enters the left ventricle LV, the repair device engages the mitral valve MV. Referring to  FIG. 6 , the valve repair device  500  is configured to attach an attachment member  602  to the mitral valve MV. The valve repair device  500  may take any suitable form that is capable of entering the left ventricle LV through the apex A of the heart H and attaching an attachment member  602  to the mitral valve. For example, the valve repair device  500  can take the form of the devices described in U.S. Pat. No. 7,635,386 and U.S. Patent Application Publication No. 2014/0114404 A1, which are hereby incorporated by reference in their entirety. The attachment member  602  includes a securing portion  710  ( FIGS. 7A-7F ) and a suture portion  712  ( FIGS. 7A-7F ). In the illustrated embodiment, the securing portion  710  of the attachment member  602  is a knot. The securing portion  710  is configured to prevent the attachment member  602  from being removed from the annulus  700  when a force is applied to the suture portion  712 . In alternative embodiments, the attachment member  602  may take any suitable form that is capable of providing annular support to the mitral valve, such as, for example, any form described in the present application. 
     The exemplary mitral annuloplasty procedure includes attaching a pair of attachment members to one or more locations (e.g., location  504  in  FIGS. 5 through 7A-7F  and location  814  in  FIGS. 8 through 10A-10F ) of the annulus  700  ( FIGS. 7A-7F  and  FIGS. 10A-10F ). In addition, the exemplary procedure includes tensioning the attachment members and anchoring the attachment members of the pair of attachment members together with an anchor member to repair at least a portion of the mitral valve MV.  FIGS. 5 through 7A-7F  show the valve repair device  500  attaching attachment members  602 ,  703  to a first location  504  of the annulus  700  to repair a first portion  702  of the mitral valve MV.  FIGS. 7A, 7C, and 7E  illustrate the mitral valve MV from the perspective of line A-A shown in  FIG. 6  (e.g., illustrating the mitral valve MV from the left atrium LA), and  FIGS. 7B, 7D, and 7F  illustrate the mitral valve MV from the perspective of line B-B shown in  FIG. 6  (e.g., illustrating the mitral valve MV from the left ventricle). 
     In a first step of the exemplary mitral annuloplasty procedure (as shown by  FIGS. 7A and 7B ), the valve repair device  500  attaches a first attachment member  602  of a pair of attachment members to the first location  504  of the annulus  700 . Referring to  FIG. 7A , the first attachment member  602  includes a securing portion  710  that extends into the left atrium LA. Referring to  FIG. 7B , the first attachment member  602  includes a suture portion  712  that extends into the left ventricle LV. In a second step of the exemplary mitral annuloplasty procedure (as shown by  FIGS. 7C and 7D ), the valve repair device  500  attaches a second attachment member  703  of the pair of attachment members to the first location  504  of the annulus  700 . Referring to  FIG. 7C , the attachment member  703  includes a securing portion  716  that extends into the left atrium LA. Referring to  FIG. 7D , the attachment member  703  includes a suture portion  718  that extends into the left ventricle LV. In a third step of the exemplary mitral annuloplasty procedure (as shown by  FIGS. 7E  and  7 F), the suture portion  712  of the first attachment member  602  and the suture portion  718  of the second attachment member  703  are tensioned to create a cinching effect on the annulus  700 . That is, the attachment member  602  is tensioned in a direction X and the attachment member  703  is tensioned in a direction Y. The tensioning of the attachment members  602 ,  703  causes the anterior leaflet  705  and the posterior leaflet  706  on the first portion  702  mitral valve MV to coapt. Once the anterior leaflet  705  and the posterior leaflet  706  properly coapt, an anchor  720  ( FIG. 7F ) secures the attachment members  602 ,  703  together to remove the gap  708  on the first portion of the mitral valve MV. The second attachment member  703  of the pair of attachment members can be placed any suitable or desirable distance from the first attachment member  602 . The attachment members  602 ,  703  can be placed any distance apart from each other that allows the attachment members to be tensioned and secured together in order to repair at least a portion of the mitral valve MV. 
     The removal of the gap  708  on the first portion  702  of the mitral valve MV prevents regurgitation of blood from the left ventricle LV to the left atrium LA through the first portion  702  of the mitral valve MV. The attachment members  602 ,  703  can be tensioned, and the anchor  720  can be deployed, by the valve repair device  500  or a separate anchoring device (not shown). If a separate anchoring device is used, the anchoring device enters the left ventricle LV through the apex A of the heart H to engage the suture portions  712 ,  718  of the attachment members  602 ,  703 . The anchor  720  may take any suitable form that is capable of securing the first attachment member  602  to the second attachment member  703  to close the gap  708  on at least a portion of the mitral valve MV. For example, the anchor  720  can be a clip that clamps onto the suture portions  712 ,  718 , a knot tying the two suture portions  712 ,  718  together, any of the anchors described in this application, any other device capable of securing two sutures together, or the like, including one or more clasps, locks, fasteners, or similar device(s). 
     The term “suture” is used herein according to its broad and ordinary meaning and may refer to any elongate strip, strand, line, tie, string, ribbon, strap, or other type of material used in medical procedures. One having ordinary skill in the art will understand that a wire or other similar material may be used in place of a suture, and description herein of sutures or the like is applicable to wires or other similar materials. 
     In the illustrated embodiment, the first portion  702  of the mitral valve MV is closed by the attachment members  602 ,  703  attached at the first location  504  of the mitral valve MV. However, in this example, the attachment members  602 ,  703  did not completely close the gap  708  between the anterior leaflet  705  and the posterior leaflet  706 . That is, referring to  FIGS. 7E and 7F , the gap  708  remains between the anterior leaflet  705  and the posterior leaflet  706  at a second portion  814  of the mitral valve MV. 
     Referring to  FIGS. 8 through 10A-10F , the exemplary procedure for mitral annuloplasty further includes attaching another pair of attachment members to the annulus  700  at a second location  814  to close the remaining gap  708  (e.g., the gap  708  shown in  FIGS. 7E-7F  and  FIGS. 10A-10D ) between the anterior leaflet  705  and the posterior leaflet  706 . The second pair of attachment members can be attached to the annulus  700  by using the same valve repair device  500  that was used to attach the first pair of attachment members  602 ,  703 , or the second pair of attachment members can be attached to annulus by a separate valve repair device (not shown). In the illustrated embodiment, the second pair of attachment members are attached to the annulus using the same valve repair device  500  that was used to attach the first pair of attachment members  602 ,  703  to the annulus. In situations where multiple pairs of attachment members are attached to the annulus  700  of the mitral valve MV, it is advantageous to attach the multiple pairs of attachment members to the annulus by the same device because attaching the pairs of attachment members using the same device will allow for less insertions of devices through the apex A of the heart H. 
     Referring to  FIG. 8 , the valve repair device  500  enters the left ventricle LV through the apex A of the heart H. After the valve repair device  500  enters the left ventricle LV, the repair device engages the mitral valve MV. Referring to  FIG. 9 , the valve repair device  500  is configured to attach an attachment member  902  to the mitral valve MV. The attachment member  902  includes a securing portion  1010  ( FIGS. 10A-10F ) and a suture portion  1012  ( FIGS. 10A-10F ). In the illustrated embodiment, the securing portion  1010  of the attachment member  602  is a knot. The securing portion  1010  is configured to prevent the attachment member  902  from being removed from the annulus  700  when a force is applied to the suture portion  1012 . In alternative embodiments, the attachment member  902  may take any suitable form that is capable of providing annular support to the mitral valve, such as, for example, any form described in the present application. 
     As described above, the exemplary mitral annuloplasty procedure includes attaching a pair of attachment members to one or more locations (e.g., location  504  in  FIGS. 5 through 7A-7F  and location  814  in  FIGS. 8 through 10A-10F ) of the annulus  700  ( FIGS. 7A-7F  and  FIGS. 10A-10F ). In addition, the exemplary procedure includes tensioning the attachment members and anchoring the attachment members of a pair of attachment members together with an anchor member to repair at least a portion of the mitral valve MV.  FIGS. 8 through 10A-10F  show the valve repair device  500  attaching attachment members  902 ,  1003  to a second location  814  of the annulus  700  to repair a second portion  722  of the mitral valve MV.  FIGS. 10A, 10C, and 10E  illustrate the mitral valve MV from the perspective of line A-A shown in  FIG. 9  (e.g., illustrating the mitral valve MV from the left atrium LA), and  FIGS. 10B, 10D, and 10F  illustrate the mitral valve MV from the perspective of line B-B shown in  FIG. 9  (e.g., illustrating the mitral valve MV from the left ventricle). 
     In a fourth step of the illustrated exemplary mitral annuloplasty procedure (as shown by  FIGS. 10A and 10B ), the valve repair device  500  attaches a first attachment member  902  of a pair of attachment members to the second location  814  of the annulus  700 . Referring to  FIG. 10A , the first attachment member  902  includes a securing portion  1010  that extends into the left atrium LA. Referring to  FIG. 10B , the first attachment member  902  includes a suture portion  1012  that extends into the left ventricle LV. In a fifth step of the exemplary mitral annuloplasty procedure (as shown by  FIGS. 10C and 10D ), the valve repair device  500  attaches a second attachment member  1003  of the pair of attachment members to the second location  814  of the annulus  700 . Referring to  FIG. 10C , the attachment member  1003  includes a securing portion  1016  that extends into the left atrium LA. Referring to  FIG. 7D , the attachment member  1003  includes a suture portion  1018  that extends into the left ventricle LV. In a sixth step of the exemplary mitral annuloplasty procedure (as shown by  FIGS. 10E and 10F ), the suture portion  1012  of the first attachment member  902  and the suture portion  1018  of the second attachment member  1003  are tensioned to create a cinching effect on the annulus  700 . That is, the attachment member  902  is tensioned in a direction X and the attachment member  1003  is tensioned in a direction Y. The tensioning of the attachment members  902 ,  1003  causes the anterior leaflet  705  and the posterior leaflet  706  on the second portion  722  mitral valve MV to coapt. Once the anterior leaflet  705  and the posterior leaflet  706  properly coapt, an anchor  1020  ( FIG. 10F ) secures the attachment members  902 ,  1003  together to remove the gap  708  on the second portion  814  of the mitral valve MV. The attachment members  902 ,  1003  can be placed any distance apart from each other that allows the attachment members to be tensioned and secured together in order to repair at least a portion of the mitral valve MV. 
     The removal of the gap  708  on the second portion  722  of the mitral valve MV prevents regurgitation of blood from the left ventricle LV to the left atrium LA through the second portion  722  of the mitral valve MV. The attachment members  902 ,  1003  can be tensioned, and the anchor  1020  can be deployed, by the valve repair device  500  or a separate anchoring device (not shown). If a separate anchoring device is used, the anchoring device enters the left ventricle LV through the apex A of the heart H to engage the suture portions  1012 ,  1018  of the attachment members  902 ,  1003 . The anchor  1020  may take any suitable form that is capable of securing the first attachment member  602  to the second attachment member  703  to close the gap  708  on at least a portion of the mitral valve MV, such as, for example, any form described in the present application. In situations in which a separate anchoring device is used, each pair of attachment members can be attached to the annulus  700 , and, then, the anchoring device can be used to deploy an anchor member to each pair of attachment members. 
     While the example provided above (in  FIGS. 7A-7F and 10A-10F ) include using two pairs of attachment members to close the gap  708  between the anterior leaflet  705  and the posterior leaflet  706 , it should be understood that any number of pairs of attachment members can be used to close the gap  708 . In certain situations, only one pair of attachment members can be required to close the gap  708 , and, in other situations, more than two pairs of attachment members can be required to close the gap  708 . The pairs of attachment members can be attached to any location on the annulus  700  in order to cause the anterior leaflet  705  and the posterior leaflet  706  to properly coapt. 
     While the valve repair device  500  and the exemplary annuloplasty procedure provided above is described with reference to repairing the mitral valve MV, it should be understood that the valve repair device and the concepts used in the exemplary mitral annuloplasty procedure can be used to repair any native valve. For example, the valve repair device  500  and the concepts of the exemplary annuloplasty procedure described above can be used to repair the aortic valve AV, the tricuspid valve TV, and the pulmonary valve PV. 
     Referring to  FIGS. 11-15 , the valve repair device  500  may engage the anterior leaflet  705  ( FIGS. 13 and 15 ), the posterior leaflet  706  ( FIGS. 13 and 15 ), or both in order to attach an attachment member  1202  ( FIGS. 12-15 ) to the leaflet(s) and secure the leaflet(s) to an outer surface  1100  of the heart H or an inner surface of the heart, such as a papillary muscle of the heart. As described above, the anterior leaflet  705  and the posterior leaflet  706  are attached to the wall of the left ventricle LV by a plurality of chordae tendineae (not shown), which prevent the leaflet(s) from being flailing and allowing regurgitation of blood from the left ventricle LV to the left atrium LA. In certain circumstances, the chordae tendineae can become dysfunctional (e.g., the chordae tendineae may stretch or rupture), which allows the anterior leaflet  705  and/or the posterior leaflet  706  to revert and allow regurgitation of blood into the left atrium LA. The device  500  (shown in  FIGS. 11-15 ) attaches one or more attachment members  1202  to the anterior leaflet  705  and/or the posterior leaflet  706  and secures the leaflet(s) to the outer surface  1100  (or an interior surface such as a papillary muscle) of the heart H in order to prevent the leaflet(s) from reverting as a result of dysfunctional chordae tendineae. 
       FIGS. 11-13  illustrate an exemplary procedure for repairing the anterior leaflet  705  of the mitral valve MV. Referring to  FIG. 11 , the valve repair device  500  enters the left ventricle LV through the apex A of the heart H and engages the mitral valve MV. Referring to  FIGS. 12 and 13 , the valve repair device  500  is configured to attach an attachment member  1202  to the anterior leaflet  705  of the mitral valve MV. The attachment member  1202  includes a securing portion  1210  and a suture portion  1212 . In the illustrated embodiment, the securing portion  1210  of the attachment member  1202  is a knot. The securing portion  1210  is configured to prevent the attachment member  1202  from being removed from the anterior leaflet  705  or posterior leaflet  706  when a force is applied to the suture portion  1212 . In alternative embodiments, the attachment member  1202  may take any suitable form that is capable of securing the anterior leaflet  705  and/or the posterior leaflet  706  to the outer surface  1100  (or an interior surface, such as a papillary muscle) of the heart H, such as, for example, any form described in the present application. The suture portion  1212  of the attachment member  1202  is tensioned to prevent the anterior leaflet  705  from reverting and is attached to the outer surface  1100  (or an interior surface, such as a papillary muscle) of the heart using an anchor member  1220 . 
       FIGS. 11 and 14-15  illustrate an exemplary procedure for repairing the posterior leaflet  706  of the mitral valve MV. Referring to  FIG. 11 , the valve repair device  500  enters the left ventricle LV through the apex A of the heart H and engages the mitral valve MV. Referring to  FIGS. 14 and 15 , the valve repair device  500  is configured to attach an attachment member  1402  to the posterior leaflet  706  of the mitral valve MV. The attachment member  1402  includes a securing portion  1410  and a suture portion  1412 . In the illustrated embodiment, the securing portion  1410  of the attachment member  1402  is a knot. In alternative embodiments, the attachment member  1402  may take any suitable form that is capable of securing the anterior leaflet  705  and/or the posterior leaflet  706  to the outer surface  1100  (or an interior surface or anatomy, such as a papillary muscle) of the heart H, such as, for example, any form described in the present application. The suture portion  1412  of the attachment member  1402  is tensioned to prevent the posterior leaflet  706  from reverting and is attached to the outer surface  1100  (or an interior surface, such as a papillary muscle) of the heart using an anchor member  1220 . In the illustrated example, a single anchor member  1220  is used to attach both the attachment member  1202  attached to the anterior leaflet  705  and the attachment member  1402  attached to the posterior leaflet  706  to the outer surface  1100  (or an interior surface, such as a papillary muscle) of the heart H. In alternative situations, a separate anchor member can be used to attach each of the attachment members  1202 ,  1402  to the outer surface  1100  (or an interior surface, such as a papillary muscle) of the heart H. 
     Referring to  FIGS. 12-15 , an anchor  1220  can be deployed to attach the attachment members  1202 ,  1402  to the outer surface  1100  (or an interior surface, such as a papillary muscle) of the heart H by the valve repair device  500  or a separate anchoring device (not shown). If the valve repair device  500  is used, after the attachment members  1202 ,  1402  are attached to the leaflets  705 ,  706 , the device  500  is configured to tension the suture portions  1212 ,  1412  of the attachment members  1202 ,  1402  to prevent the leaflets  705 ,  706  from reverting, and the device  500  is configured to deploy the anchor member  1220 . If a separate anchoring device is used, the anchoring device enters the left ventricle LV through the apex A of the heart H to engage the suture portions  1212 ,  1412  of the attachment members  1202 ,  1402  and tension the suture portions  1212 ,  1412  to provide adequate support to prevent the leaflets  705 ,  706  from reverting. After adequate support is provided to the leaflet  705 ,  706 , the anchor  1220  is deployed to attach the suture portions  1212 ,  1412  to the outer surface  1100  (or an interior surface such, as a papillary muscle) of the heart H. The anchor  1220  may take any suitable form that is capable of anchoring one or more attachment members to the outer surface  1100  (or an interior surface, such as a papillary muscle) of the heart H. For example, the anchor  1220  can be a clip that clamps onto one or more suture portions, a knot tied at the end of a suture portion, a knot tying the two or more suture portions together, any of the anchors described in this application, any other device capable of securing a suture to an outer wall of the heart or internal tissue of the heart, such as papillary muscle tissue, or the like. 
     In the illustrated examples shown in  FIGS. 12-15 , the valve repair device  500  that is used to attach the attachment members  1202 ,  1402  to the leaflets  705 ,  706  is the same device that was used to attach the attachment members  602 ,  703 ,  902 ,  1003  to the annulus  700  (as shown in  FIGS. 5 through 10A-10F ). Having the same device  500  attach attachment members to both the annulus  700  and leaflets  705 ,  706  is advantageous because it allows for less insertions of devices through the apex A of the heart H. In other situations, a different device can be used to attach attachment members to the leaflets  705 ,  706  than is used to attach attachment members to the annulus  700 . 
     While the illustrated examples shown in  FIGS. 11-15  have a single attachment member  1202  attached to the anterior leaflet  705  and a single attachment member  1402  attached to the posterior leaflet  706 , it should be understood that one or more attachment members can be attached to the anterior leaflet and/or the posterior leaflet in order to repair the mitral valve MV. It should also be understood that the one of the anterior leaflet  705  and the posterior leaflet  706  may require more attachment members than the other of the anterior leaflet and the posterior leaflet in order to properly repair the mitral valve MV. In addition, it should be understood that one of the anterior leaflet  705  and the posterior leaflet  706  may require one or more attachment members, and the other of the anterior leaflet and the posterior leaflet may not require any attachment members, to properly repair the mitral valve MV. 
     Referring to  FIGS. 12-15 , the valve repair device  500  is shown repairing the leaflets  705 ,  706  (by attaching attachment members  1202 ,  1402  to the leaflets) after attachment members  602 ,  703 ,  902 ,  1003  have been attached to the annulus  700 . In the illustrated example, the mitral valve is repaired by attaching attachment members to both annulus  700  and the leaflets  705 ,  706 . In situations in which both the annulus  700  and leaflets  705 ,  706  need to be repaired, the exemplary procedure may include repairing the annulus  700 , and, subsequently, repairing the leaflets  705 , 706 , or vice versa. In the above example, it can be advantageous to repair the annulus  700  prior to repairing one or more of the leaflets  705 ,  706  because reducing the size of the annulus  700  can make it easier to repair the leaflets  705 ,  706 . In certain situations, only one of the annulus  700  or the leaflets  705 ,  706  may need to be repaired. The steps of the exemplary procedure shown in  FIGS. 5-15  can be completed in any suitable order to repair the mitral valve MV. 
     While the exemplary procedure described above refers to reparation of the mitral valve, it should be understood that the device  500  and/or the concepts for repairing the mitral valve  500  can be used to repair any native valve. For example, the valve repair device  500  and the concepts of the exemplary procedure described above can be used to repair the aortic valve AV, the tricuspid valve TV, and the pulmonary valve PV. 
     Referring to  FIGS. 16-18 and 19A-19F , another exemplary procedure for mitral annuloplasty is shown using an exemplary embodiment of a valve repair device  1600 . The mitral annuloplasty procedure is used to correct a dysfunctional mitral valve MV. As described above, in certain situations, the anterior leaflet  705  and the posterior leaflet  706  of the mitral valve MV may not coapt (e.g., see mitral valve MV having gap  1708  in  FIGS. 17A-17F ), which could lead to regurgitation of blood through the mitral valve. The exemplary mitral annuloplasty procedure provides annular support to the mitral valve by reducing the size of the annulus, which allows the leaflets to properly coapt. 
     Referring to  FIGS. 16 and 18 , the valve repair device  1600  enters the left atrium LA through the atrial septum (not shown) of the heart H. After the valve repair device  1600  enters the left atrium LA, the repair device engages the mitral valve MV. The valve repair device  1600  is configured to attach one or more attachment members to the mitral valve MV. The valve repair device  1600  may take any suitable form that is capable of entering the left atrium LA through the atrial septum of the heart H and attaching one or more attachment members to the mitral valve. For example, the valve repair device  1600  can take the form of the devices described in U.S. Pat. No. 7,635,386 and U.S. Patent Application Publication No. 2014/0114404 A1, which are hereby incorporated by reference in their entirety. 
     Referring to  FIGS. 17A-17F and 19A-19F , the exemplary mitral annuloplasty procedure includes attaching a pair of attachment members (e.g., attachment members  1702 ,  1703 ,  1902 ,  1903 ) to one or more locations (e.g., location  1704  in  FIGS. 17A-17F  and location  1914  in  FIGS. 19A-19F ) of the annulus  700  ( FIGS. 17A-17F  and  FIGS. 19A-19F ). In addition, the exemplary procedure includes tensioning the attachment members and anchoring the attachment members of the pair of attachment members together with an anchor member (e.g., anchor members  1720 ,  1920 ) to repair at least a portion of the mitral valve MV. Each of the attachment members includes a securing portion and a suture portion. In the illustrated embodiment, the securing portion of each attachment member is a knot. The securing portion is configured to prevent the attachment member from being removed from the annulus  700  when a force is applied to the suture portion. In alternative embodiments, the attachment members may take any suitable form that is capable of providing annular support to the mitral valve, such as, for example, any form described in the present application. 
       FIGS. 16 and 17A-17F  show the valve repair device  1600  attaching attachment members  1702 ,  1703  to a first location  1704  of the annulus  700  to repair a first portion  1701  of the mitral valve MV.  FIGS. 17A, 17C, and 17E  illustrate the mitral valve MV from the perspective of line A-A shown in  FIG. 16  (e.g., illustrating the mitral valve MV from the left atrium LA), and  FIGS. 17B, 17D, and 17F  illustrate the mitral valve MV from the perspective of line B-B shown in  FIG. 16  (e.g., illustrating the mitral valve MV from the left ventricle).  FIGS. 18 and 19A-19F  show the valve repair device  1600  attaching attachment members  1902 ,  1903  to a second location  1904  of the annulus  700  to repair a second portion  1901  of the mitral valve MV.  FIGS. 19A, 19C, and 19E  illustrate the mitral valve MV from the perspective of line A-A shown in  FIG. 18  (e.g., illustrating the mitral valve MV from the left atrium LA), and  FIGS. 19B, 19D, and 19F  illustrate the mitral valve MV from the perspective of line B-B shown in  FIG. 18  (e.g., illustrating the mitral valve MV from the left ventricle). 
     In a first step of the exemplary mitral annuloplasty procedure (as shown by  FIGS. 17A and 17B ), the valve device  1600  attaches a first attachment member  1702  of a pair of attachment members to the first location  1704  of the annulus  700 . Referring to  FIG. 17A , the first attachment member  1702  includes a suture portion  1712  that extends into the left atrium LA. Referring to  FIG. 17B , the first attachment member  1702  includes a securing portion  1710  that extends into the left ventricle LV. In a second step of the exemplary mitral annuloplasty procedure (as shown by  FIGS. 17C and 17D ), the valve device  1600  attaches a second attachment member  1703  of the pair of attachment members to the first location  1704  of the annulus  700 . Referring to  FIG. 17C , the attachment member  1703  includes a suture portion  1718  that extends into the left atrium LA. Referring to  FIG. 17D , the attachment member  1703  includes a securing portion  1716  that extends into the left ventricle LV. In a third step of the exemplary mitral annuloplasty procedure (as shown by  FIGS. 17E and 17F ), the suture portion  1712  of the first attachment member  1702  and the suture portion  1718  of the second attachment member  1703  are tensioned to create a cinching effect on the annulus  700 . That is, the attachment member  1702  is tensioned in a direction X and the attachment member  1703  is tensioned in a direction Y. The tensioning of the attachment members  1702 ,  1703  causes the anterior leaflet  705  and the posterior leaflet  706  on the first portion  1701  of the mitral valve MV to coapt. Once the anterior leaflet  705  and the posterior leaflet  706  properly coapt, an anchor  1720  ( FIG. 17E ) secures the attachment members  1702 ,  1703  together to remove the gap  1708  on the first portion  1701  of the mitral valve MV. The attachment members  1702 ,  1703  can be placed any distance apart from each other that allows the attachment members to be tensioned and secured together in order to repair at least a portion of the mitral valve MV. 
     The removal of the gap  1708  on the first portion  1701  of the mitral valve MV prevents regurgitation of blood from the left ventricle LV to the left atrium LA through the first portion  1701  of the mitral valve MV. The attachment members  1702 ,  1703  can be tensioned, and the anchor  1720  can be deployed, by the valve repair device  1600  or a separate anchoring device (not shown). If a separate anchoring device is used, the anchoring device enters the left atrium LA through the atrial septum of the heart H to engage the suture portions  1712 ,  1718  of the attachment members  1702 ,  1703 . The anchor  1720  may take any suitable form that is capable of securing the first attachment member  1702  to the second attachment member  1703  to close the gap on at least a portion of the mitral valve MV. For example, the anchor  1720  can be a clip that clamps onto the suture portions  1712 ,  1718 , a knot tying the two suture portions  1712 ,  1718  together, any of the anchors described in this application, any other device capable of securing two sutures together, or the like, including one or more clasps, locks, fasteners, or similar device(s). 
     In the illustrated embodiment, the first portion  1702  of the mitral valve MV is closed by the attachment members  1702 ,  1703  attached at the first location  1704  of the mitral valve MV. However, in this example, the attachment members  1702 ,  1703  did not completely close the gap  1708  between the anterior leaflet  705  and the posterior leaflet  706 . That is, referring to  FIGS. 17E and 17F , the gap  708  remains between the anterior leaflet  705  and the posterior leaflet  706  at a second portion  1  of the mitral valve MV. 
     Referring to  FIGS. 18 and 19A-19F , the exemplary procedure for mitral annuloplasty further includes attaching another pair of attachment members to the annulus  700  at a second location  1914  to close the remaining gap  1708  (e.g., the gap  1708  shown in  FIGS. 17E-17F  and  FIGS. 19A-19D ) between the anterior leaflet  705  and the posterior leaflet  706 . The second pair of attachment members  1902 ,  1903  can be attached to the annulus  700  by using the same valve repair device  1600  that was used to attach the first pair of attachment members  1702 ,  1703 , or the second pair of attachment members can be attached to annulus by a separate valve repair device (not shown). In the illustrated embodiment, the second pair of attachment members  1902 ,  1903  are attached to the annulus  700  using the same valve repair device  1600  that was used to attach the first pair of attachment members  1702 ,  1703  to the annulus  700 . In situations where multiple pairs of attachment members are attached to the annulus  700  of the mitral valve MV, it is advantageous to attach the multiple pairs of attachment members to the annulus by the same device because attaching the pairs of attachment members using the same device will allow for less insertions of devices through the atrial septum of the heart H. 
     Referring to  FIGS. 19A and 19B , in a fourth step of the illustrated exemplary mitral annuloplasty procedure, the valve device  1600  attaches a first attachment member  1902  of a pair of attachment members to the second location  1914  of the annulus  700 . Referring to  FIG. 19A , the first attachment member  1902  includes a suture portion  1912  that extends into the left atrium LA. Referring to  FIG. 19B , the first attachment member  1902  includes a securing portion  1910  that extends into the left ventricle LV. In a fifth step of the exemplary mitral annuloplasty procedure (as shown by  FIGS. 19C and 19D ), the valve device  1600  attaches a second attachment member  1903  of the pair of attachment members to the second location  1914  of the annulus  700 . Referring to  FIG. 19C , the attachment member  1903  includes a suture portion  1918  that extends into the left atrium LA. Referring to  FIG. 19D , the attachment member  1903  includes a securing portion  1916  that extends into the left ventricle LV. In a sixth step of the exemplary mitral annuloplasty procedure (as shown by  FIGS. 19E and 19F ), the suture portion  1912  of the first attachment member  1902  and the suture portion  1918  of the second attachment member  1903  are tensioned to create a cinching effect on the annulus  700 . That is, the attachment member  1902  is tensioned in a direction X and the attachment member  1903  is tensioned in a direction Y. The tensioning of the attachment members  1902 ,  1903  causes the anterior leaflet  705  and the posterior leaflet  706  on the second portion  1722  of the mitral valve MV to coapt. Once the anterior leaflet  705  and the posterior leaflet  706  properly coapt, an anchor  1920  ( FIG. 19E ) secures the attachment members  1902 ,  1903  together to remove the gap  1708  on the second portion  1722  of the mitral valve MV. The attachment members  1902 ,  1903  can be placed any distance apart from each other that allows the attachment members to be tensioned and secured together in order to repair at least a portion of the mitral valve MV. 
     The removal of the gap  1708  on the second portion  1722  of the mitral valve MV prevents regurgitation of blood from the left ventricle LV to the left atrium LA through the second portion  1722  of the mitral valve MV. The attachment members  1902 ,  1903  can be tensioned, and the anchor  1920  can be deployed, by the valve repair device  1600  or a separate anchoring device (not shown). If a separate anchoring device is used, the anchoring device enters the left atrium LA through the atrial septum of the heart H to engage the suture portions  1912 ,  1918  of the attachment members  1902 ,  1903 . The anchor  1920  may take any suitable form that is capable of securing the first attachment member  1902  to the second attachment member  1903  to close the gap  1708  on at least a portion of the mitral valve MV, such as, for example, any form described in the present application. In situations in which a separate anchoring device is used, each pair of attachment members can be attached to the annulus  700 , and, then, the anchoring device can be used to deploy an anchor member to each pair of attachment members. 
     While the example provided above (in  FIGS. 17A-17F and 19A-19F ) include using two pairs of attachment members to close the gap  1708  between the anterior leaflet  705  and the posterior leaflet  706 , it should be understood that any number of pairs of attachment members can be used to close the gap  1708 . In certain situations, only one pair of attachment members can be required to close the gap  1708 , and, in other situations, more than two pairs of attachment members can be required to close the gap  1708 . The pairs of attachment members can be attached to any location on the annulus  700  in order to cause the anterior leaflet  705  and the posterior leaflet  706  to properly coapt. 
     Referring to  FIG. 16A , in certain embodiments, the exemplary procedure for mitral annuloplasty shown in  FIGS. 16-18 and 19A-19F  can be completed with a transatrial procedure using valve repair device  1600 ′. Referring to  FIG. 16A , the valve repair device  1600 ′ enters the left atrium LA through an outer wall of the heart H. After the valve repair device  1600 ′ enters the left atrium LA, the repair device engages the mitral valve MV. The valve repair device  1600 ′ is configured to attach one or more attachment members (e.g., any of the attachment members described in the present application) to the mitral valve MV. The valve repair device  1600 ′ may take any suitable form that is capable of entering the left atrium LA through an outer wall of the heart H and attaching one or more attachment members to the mitral valve. For example, the valve repair device  1600 ′ can take the form of the devices described in U.S. Pat. No. 7,635,386 and U.S. Patent Application Publication No. 2014/0114404 A1, which are hereby incorporated by reference in their entirety. 
     While the valve repair devices  1600 ,  1600 ′ and the exemplary annuloplasty procedure provided above is described with reference to repairing the mitral valve MV, it should be understood that the valve repair device and the concepts used in the exemplary mitral annuloplasty procedure can be used to repair any native valve. For example, the valve repair devices  1600 ,  1600 ′ and the concepts of the exemplary annuloplasty procedure described above can be used to repair the aortic valve AV, the tricuspid valve TV, and the pulmonary valve PV. 
     Referring to  FIGS. 20 through 22A-22D , another exemplary procedure for mitral annuloplasty is shown using an exemplary embodiment of a valve repair device  2000 . The mitral annuloplasty procedure is used to correct a dysfunctional mitral valve MV. As described above, in certain situations, the anterior leaflet  705  and the posterior leaflet  706  of the mitral valve MV may not coapt (e.g., see mitral valve MV having gap  2208  in  FIGS. 22A-22D ), which could lead to regurgitation of blood through the mitral valve. The exemplary mitral annuloplasty procedure provides annular support to the mitral valve by reducing the size of the annulus, which allows the leaflets to properly coapt. 
     Referring to  FIG. 20 , the valve repair device  2000  enters the left ventricle LV through the apex A of the heart H. After the valve repair device  2000  enters the left ventricle LV, the repair device engages the mitral valve MV. Referring to  FIG. 21 , the valve repair device  2000  is configured to attach an attachment member  2102  to the mitral valve MV. The valve repair device  2000  may take any suitable form that is capable of entering the left ventricle LV through the apex A of the heart H and attaching an attachment member  2102  to the mitral valve. For example, the valve repair device  2000  can take the form of the devices described in U.S. Pat. No. 7,635,386 and U.S. Patent Application Publication No. 2014/0114404 A1, which are hereby incorporated by reference in their entirety. 
     The attachment member  2102  includes an atrial portion  2210  ( FIGS. 22A and 22C ) and a ventricular portion  2212  ( FIGS. 22B and 22D ). The atrial portion  2210  and the ventricular portion  2212  are connected together to secure each atrial portion  2210  and ventricular portion  2212  pair to the native valve annulus  700 . The atrial portions  2210  and the ventricular portion can be connected together in a wide variety of different ways. For example, the atrial portion  2210  and the ventricular portion can be connected together by a fixed-length suture. As another example, the atrial portion  2210  is fixed to the end of a suture and the ventricular portion  2012  is slideably disposed on the suture and can be secured on the suture relative to the atrial portion  2210  by an anchor (See, for example, anchor  5900  in  FIGS. 61A-61C ). In the illustrated embodiment, the atrial portion  2210  and the ventricular portion  2212  of the attachment member  2102  are knots. The knots can take a wide variety of different forms. For example, the knots can take any of the forms shown and described in U.S. Patent Application Publication No. 2014/0114404 A1, which is incorporated herein by reference in its entirety. In the illustrated embodiment, the atrial portion  2210  includes two loops  2250  that are connected together at a center  2252  and the ventricular portion  2212  includes two loops  2260  (See  FIG. 23 ). 
     The atrial portion  2210  is configured to prevent the attachment member  2102  from being removed from the annulus  700  when a force is applied to the ventricular portion  2212 . The ventricular portion  2212  is configured to prevent the attachment member  2102  from being removed from the annulus  700  when a force is applied to the atrial portion  2210 . 
     The exemplary mitral annuloplasty procedure includes attaching two or more attachment members  2102  to the annulus  700 , in which the two or more attachment members are connected by a suture  2216 . The two or more attachment members  2102  can be connected by a suture  2216  prior to being attached to the annulus  700 , or the two or more attachment members  2102  can be connected by a suture  2216  after being attached to the annulus  700 . In addition, the exemplary procedure includes tensioning the suture  2216  (and, as a result, the two or more attachment members  2102 ) to reduce the size of the annulus, and, subsequently, fixing the suture once a desired reduction of the size of the annulus is achieved. The suture  2216  can be made of an ePTFE suture, a braid of suture, or any other suitable material.  FIGS. 22A and 22C  illustrate the mitral valve MV from the perspective of line A-A shown in  FIG. 21  (e.g., illustrating the mitral valve MV from the left atrium LA), and  FIGS. 22B and 22D  illustrate the mitral valve MV from the perspective of line B-B shown in  FIG. 21  (e.g., illustrating the mitral valve MV from the left ventricle). 
     Referring to  FIGS. 22A and 22B , in a first step of the exemplary mitral annuloplasty procedure, the valve device  2000  attaches the two or more attachment members  2102  to the annulus  700 . In the illustrated embodiment, the device  2000  attaches nine attachment members to the annulus  700 . In alternative embodiments, between 2 attachment members and 20 attachment members can be attached to the annulus  700 , such as between 4 attachment members and 18 attachment members, such as between 6 attachment members and 16 attachment members, such as between 8 attachment members and 14 attachment members, such as between 10 attachment members and 12 attachment members, such as 11 attachment members. In certain embodiments, the device can attach more than 20 attachment members to the annulus. In an exemplary procedure, the device  2000  attaches twelve attachment members to the annulus  700 . Referring to  FIG. 22A , each of the attachment members  2102  includes an atrial portion  2210  that extends into the left atrium LA. Referring to  FIG. 22B , each of the attachment members  2102  includes a ventricular portion  2212  that extends into the left ventricle LV, and a suture  2216  links each of the ventricular portions  2212  of the attachment members  2102 , such that providing a tension to the suture  2216  will cause the attachment members  2102  to reduce the size of the annulus  700 . In the illustrated example, the ventricular portions  2212  of the attachment members  2102  are knots, and the suture  2216  is fixed to one attachment member  2102  and runs through the knots of each of the other attachment members. In addition, the suture  2216  includes an excess portion  2218  that is used to tension the suture. 
     Referring to  FIGS. 22C and 22D , in a second step of the exemplary mitral annuloplasty procedure, a force is applied to the excess portion  2218  of the suture  2216  in the direction X ( FIG. 22D ) to create a cinching effect on the annulus  700 . The force applied to the suture  2216  causes a reduction in size of the annulus  700 , which causes the anterior leaflet  705  and the posterior leaflet  706  to coapt (e.g., the force causes the gap  2208  to close, as shown in  FIGS. 22C and 22D ). Once the anterior leaflet  705  and the posterior leaflet  706  properly coapt, the suture  2216  is fixed such that the size of the annulus remains in the reduced state. In one example, the suture  2216  can be fixed to an interior wall  2101  ( FIG. 21 ) of the left ventricle LV. For example, the suture  2216  can be fixed on an interior wall  2101  near the location of insertion by the valve repair device  2000  (or other tensioning device) through the apex A so that suture  2216  is conveniently accessible by the valve repair device (or other tensioning device) if the amount of force applied on the suture  2216  needs to be altered to reduce or expand the size of the annulus. In alternative examples, the suture  2216  can be fixed on any other location of the interior wall  2101  of the left ventricle LA that is accessible by the valve repair device  2000  (or other tensioning device), or the suture may be fixed to the last attachment member  2102  in the series of attachment members by an anchor (See, for example, anchor  5900  in  FIGS. 61A-61C ). 
     Adjacent attachment members  2102  can be placed any distance apart from each other that allows the attachment members to be tensioned and secured together in order to repair at least a portion of the mitral valve MV. In certain embodiments, the attachment members  2102  are placed between one trigone (not shown) to another trigone. 
     The removal of the gap  2208  between the anterior leaflet  705  and the posterior leaflet  706  prevents regurgitation of blood from the left ventricle LV to the left atrium LA through the mitral valve MV. The suture  2216  can be tensioned and fixed by the valve repair device  2000  or a separate tensioning device (not shown). If a separate tensioning device is used, the tensioning device enters the left ventricle LV through the apex A of the heart H to engage the suture  2216 . 
     The links between the attachment members  2102  and the suture  2216  may take several different forms. Referring to  FIGS. 23 and 24 , in an exemplary embodiment, each of the attachment members  2102  have an atrial portion  2210 , a ventricular portion  2212 , and a central portion  2300  that connects the atrial portion to the ventricular portion. Referring to  FIG. 23 , in one embodiment, the attachment members  2102  are linked by a single suture  2216  that is used to tension the annulus with the attachment members (e.g., a force is applied to the excess portion  2218  of the suture  2216  to provide a tension to the annulus  700  by the attachment members  2102 ). In this embodiment, the suture  2216  is fixed to the central portion  2300  of an attachment member  2102  that is at a first end of the sequence. For example, the sequence provided in  FIG. 23  has a first end  2302  and a second end  2304 , and the suture  2216  is fixed to the central portion  2300  of the attachment member  2102  located at the first end  2302  of the sequence. The suture is then slideably coupled to the attachment members  2102  between the first end  2302  and the second end  2304 . For example, the suture  2216  can be threaded through loops  2260  of the attachment members  2102  between the first end  2302  and the second end  2304 . In addition, in this example, the ventricular portions  2212  of the attachment members  2102  are the portions that are linked by the suture  2216 . In an alternative example, the atrial portions  2210  can be the portions that are linked by the suture  2216 . A single suture  2216  that links the attachment members in the manner illustrated by  FIG. 23  can be used in situations where an even distribution of force or substantially even distribution of force is desired across the annulus to repair the mitral valve. 
     Referring to  FIG. 24 , in another example, multiple sutures  2216  are used to provide different levels of tension/cinching around the annulus by the attachment members  2102  (e.g., separate forces are applied to the excess portions  2218  to provide varying tension/cinching to different parts of the annulus where the attachment members  2102  are located). In this example, separate sutures  2216  are attached to three of the five attachment members  2102  and are slideably coupled to other attachment members. In alternative embodiments, individual sutures  2216  can be attached to any number of attachment members  2102  and optionally slideably coupled to none or any number of attachment members in a sequence of attachment members. As such, more or less tensioning/cinching can be tailored to the deficiency of the native valve annulus. In the example illustrated by  FIG. 24 , the sequence of attachment members  2102  has a first end  2402  and a second end  2404 . Each suture  2216  can be slideably coupled to attachment members  2102  that are downstream in the sequence from the connection point with the corresponding attachment member  2102 . For example, each suture can thread through one or both loops  2260  of downstream attachment members. The three illustrated sutures  2216  can be independently pulled and anchored. For example, pulling of the top illustrated suture  2218  pulls the fourth attachment member and the attachment member at the second end  2404  relatively together. Pulling of the middle illustrated suture  2218  pulls the second, third, fourth and the attachment member at the second end  2404  relatively together. Pulling of the bottom illustrated suture pulls all five of the attachment members relatively together. However, the attachment members  2102  and sutures  2218  can be tailored to correct regurgitation of individual mitral valves. 
     Referring to  FIGS. 25 through 26A-26D , another exemplary procedure for mitral annuloplasty is shown using an exemplary embodiment of a valve repair device  2500 . The mitral annuloplasty procedure is used to correct a dysfunctional mitral valve MV. As described above, in certain situations, the anterior leaflet  705  and the posterior leaflet  706  of the mitral valve MV may not coapt (e.g., see mitral valve MV having gap  2608  in  FIGS. 26A and 26B ), which could lead to regurgitation of blood through the mitral valve. The exemplary mitral annuloplasty procedure provides annular support to the mitral valve by reducing the size of the annulus, which allows the leaflets to properly coapt. 
     Referring to  FIG. 25 , the valve repair device  2500  enters the left atrium LA through the atrial septum (not shown) of the heart H. After the valve repair device  2000  enters the left ventricle LV, the repair device engages the mitral valve MV. The valve repair device  2500  is configured to attach an attachment member  2502  to the mitral valve MV. The valve repair device  2500  may take any suitable form that is capable of entering the left atrium LA through the atrial septum of the heart H and attaching an attachment member  2502  to the mitral valve. For example, the valve repair device  2500  can take the form of the devices described in U.S. Pat. No. 7,635,386 and U.S. Patent Application Publication No. 2014/0114404 A1, which are hereby incorporated by reference in their entirety. 
     The attachment member  2502  includes an atrial portion  2610  ( FIGS. 22A and 22C ) and a ventricular portion  2612  ( FIGS. 22B and 22D ). The atrial portion  2610  and the ventricular portion  2612  are connected together to secure each atrial portion  2610  and ventricular portion  2612  pair to the native valve annulus  700 . The atrial portions  2610  and the ventricular portion  2612  can be connected together in a wide variety of different ways. For example, the atrial portion  2610  and the ventricular portion can be connected together by a fixed length suture. As another example, the ventricular portion  2612  is fixed to the end of a suture and the atrial portion  2610  is slideably disposed on the suture and can be secured on the suture relative to the ventricular portion  2612  by an anchor (See, for example, anchor  5900  in  FIGS. 61A-61C ). 
     In the illustrated embodiment, the atrial portion  2610  and the ventricular portion  2612  of the attachment member  2102  are knots. The knots can take a wide variety of different forms. For example, the knots can take any of the forms shown and described in U.S. Patent Application Publication No. 2014/0114404 A1. In the illustrated embodiment, the atrial portion  2610  includes two loops  2650  and the ventricular portion  2612  includes two loops  2660 . 
     The atrial portion  2610  is configured to prevent the attachment member  2502  from being removed from the annulus  700  when a force is applied to the ventricular portion  2612 . The ventricular portion  2612  is configured to prevent the attachment member  2502  from being removed from the annulus  700  when a force is applied to the atrial portion  2610 . 
     The exemplary mitral annuloplasty procedure includes attaching two or more attachment members  2502  to the annulus  700 , in which the two or more attachment members are linked by a suture  2616 . The two or more attachment members  2502  can be linked by a suture  2616  prior to being attached to the annulus  700 , or the two or more attachment members  2502  can be connected by a suture  2616  after being attached to the annulus  700 . In addition, the exemplary procedure includes tensioning the suture  2616  (and, as a result, the two or more attachment members  2502 ) to reduce the size of the annulus, and, subsequently, fixing the suture once a desired reduction of the size of the annulus is achieved. The suture  2616  can be made of an ePTFE suture, a braid of suture, or any other suitable material.  FIGS. 26A and 26C  illustrate the mitral valve MV from the perspective of line A-A shown in  FIG. 25  (e.g., illustrating the mitral valve MV from the left atrium LA), and  FIGS. 26B and 26D  illustrate the mitral valve MV from the perspective of line B-B shown in  FIG. 25  (e.g., illustrating the mitral valve MV from the left ventricle). 
     Referring to  FIGS. 26A and 26B , in a first step of the exemplary mitral annuloplasty procedure, the valve device  2500  attaches the two or more attachment members  2502  to the annulus  700 . In the illustrated embodiment, the device  2500  attaches nine attachment members to the annulus  700 . In alternative embodiments, between 2 attachment members and 20 attachment members can be attached to the annulus  700 . Referring to  FIG. 26A , each of the attachment members  2502  includes an atrial portion  2610  that extends into the left atrium LA. Referring to  FIG. 26B , each of the attachment members  2502  includes a ventricular portion  2612  that extends into the left ventricle LV. A suture  2616  links each of the atrial portions  2610  of the attachment members  2502 , such that providing a tension to the suture  2616  will cause the attachment members  2502  to reduce the size of the annulus  700 . In the illustrated example, the atrial portions  2610  of the attachment members  2102  are knots, and the suture  2616  is fixed to one attachment member  2102  and runs through the knots of each of the other attachment members. In addition, the suture  2216  includes an excess portion  2218  that is used to apply tension to the suture. 
     Referring to  FIGS. 26C and 26D , in a second step of the exemplary mitral annuloplasty procedure, a force is applied to the excess portion  2618  of the suture  2616  in the direction X ( FIG. 26C ) to create a cinching effect on the annulus  700 . The force applied to the suture  2216  causes a reduction in size of the annulus  700 , which causes the anterior leaflet  705  and the posterior leaflet  706  to coapt (e.g., the force causes the gap  2608  to close, as shown in  FIGS. 26C and 26D ). Once the anterior leaflet  705  and the posterior leaflet  706  properly coapt, the suture  2616  is fixed such that the size of the annulus remains in the reduced state. In one example, the suture  2616  can be fixed to an interior wall of the left atrium LA. Alternatively, the suture  2616  the suture may be fixed to the last attachment member  2502  in the series of attachment members by an anchor (See, for example, anchor  5900  in  FIGS. 61A-61C ). 
     Adjacent attachment members  2502  can be placed any distance apart from each other that allows the attachment members to be tensioned and secured together in order to repair at least a portion of the mitral valve MV. In certain embodiments, the attachment members  2102  are placed between one trigone (not shown) to another trigone). 
     The removal of the gap  2608  between the anterior leaflet  705  and the posterior leaflet  706  prevents regurgitation of blood from the left ventricle LV to the left atrium LA through the mitral valve MV. The suture  2616  can be tensioned and fixed by the valve repair device  2500  or a separate tensioning device (not shown). 
     The link(s) between the attachment members  2502  and the suture  2616  may take several different forms, such as, for example, any form described in the present application. In certain embodiments, multiple sutures  2616  can be used to tension the annulus, as shown in  FIG. 24 . 
     Referring to  FIG. 16A , in certain embodiments, the exemplary procedure for mitral annuloplasty shown in  FIGS. 25 and 26A-26D  can be completed with a transatrial procedure using valve repair device  1600 ′. Referring to  FIG. 16A , the valve repair device  1600 ′ enters the left atrium LA through an outer wall of the heart H. After the valve repair device  1600 ′ enters the left atrium LA, the repair device engages the mitral valve MV. The valve repair device  1600 ′ is configured to attach one or more attachment members (e.g., any of the attachment members described in the present application) to the mitral valve MV. The valve repair device  1600 ′ may take any suitable form that is capable of entering the left atrium LA through an outer wall of the heart H and attaching one or more attachment members to the mitral valve. For example, the valve repair device  1600 ′ can take the form of the devices described in U.S. Pat. No. 7,635,386 and U.S. Patent Application Publication No. 2014/0114404 A1, which are hereby incorporated by reference in their entirety. 
     While the example provided above (in  FIGS. 22A-22D and 26A-26D ) include using two or more attachment members connected or linked by one or more sutures to close the gap  2208 ,  2608  between the anterior leaflet  705  and the posterior leaflet  706 , it should be understood that any number of attachment members connected or linked by sutures can be used. In certain situations, only one sequence of attachment members connected or linked by a suture can be required to close the gap  2208 ,  2608 . In other situations, more than one sequence of attachment members connected or linked by one or more suture can be used to close the gap  2208 ,  2608 . The attachment members can be attached to any location on the annulus  700  in order to cause the anterior leaflet  705  and the posterior leaflet  706  to properly coapt. 
     While the valve repair devices  2000 ,  2500 ,  1600 ′ and the exemplary annuloplasty procedures provided above are described with reference to repairing the mitral valve MV, it should be understood that the valve repair devices and the concepts used in the exemplary mitral annuloplasty procedures can be used to repair any native valve. For example, the valve repair devices  2000 ,  2500 ,  1600 ′ and the concepts of the exemplary annuloplasty procedures described above can be used to repair the aortic valve AV, the tricuspid valve TV, and the pulmonary valve PV. 
     Referring to  FIGS. 27-29 , an exemplary valve repair device  2700  for repairing the mitral valve includes a delivery member  2701  and an advancement member (not shown). The delivery member  2701  can optionally include a suction device for holding valve tissue, such as valve annulus tissue, against the valve repair device  2700 . Details of one suction device that can be used are disclosed in U.S. Patent Application No. 62/326,609, filed on Apr. 22, 2016, entitled “Catheter with a Collapsible Funnel-Shaped Suction Cup for Placing Prosthetic Chords for a Heart Valve,” the disclosure of which is incorporated herein by reference in its entirety. 
     The advancement member is configured to move one or more pledgets  2702  (e.g., one or more attachment members), such that the pledgets can be deployed through an outlet  2703  of the delivery member  2701 . In certain embodiments, the delivery member  2701  of the valve repair device  2700  includes a puncturing member  2704  that is configured to puncture tissue member (e.g., the annulus of the mitral valve, the leaflets of the mitral valve, etc.). For example, the delivery member  2701  can be a hollow needle. The valve repair device  2700  is configured to deploy one or more pledgets  2702  (by the advancement member) out of the outlet  2703  of the delivery member  2701  and attach the pledgets to a tissue member. The pledgets  2702  can be linked in a wide variety of different ways. For example, the pledgets  2702  can be linked in any of the ways the attachment members  2502  can be linked, as described above. In the illustrated embodiment, the pledgets  2702  are linked to each other by a suture  2816  ( FIGS. 28 and 29 ). The pledgets  2702  can be configured to be crimped and compressed to occupy less space in the shaft  2706  of the of the delivery member  2701 . In the example illustrated by  FIG. 27 , rectangular pledgets  2702  are rolled into a cylindrical configuration. However, the pledgets  2702  can have any compressed configuration and any expanded configuration. 
     Upon being deployed through the outlet  2703  of the delivery member  2701 , the pledgets  2702  are configured to expand. The pledgets  2702  can be made out of, for example, fabric, such as, cotton, PTFE, etc. fabric, expandable foam, shape memory alloy material, such as nitinol, a mesh, a mesh of shape memory allow material, such as Nitinol, any other compressible material that is capable of adequately securing the pledget against a tissue, or any combination thereof. In certain embodiments, the pledgets  2702  have radiopaque markers that are visible on echocardiography and fluoroscopy, which allows the location of the pledgets to be identified. 
     Referring to  FIG. 28 , in one embodiment, an individual suture  2816  is attached to each of the pledgets  2702  in a single location  2805 . Referring to  FIG. 29 , in another embodiment, one suture  2816  is attached a first the pledget at a first location  2905 , is threaded over the pledget, and is threaded back through the pledget at a second location  2906 . In this example, subsequent pledgets  2702  are slideably disposed on the suture  2816  by threading the suture  2816  through each pledget at the first and second locations  2905 ,  2906 . In the embodiment shown in  FIG. 29 , the suture  2816  includes a tensioning portion  3026  (See  FIGS. 30 and 31  below) attached to a top surface of the pledget  2702  that can be tensioned to help the pledget provide a force on a tissue member on which the pledget is attached. In alternative embodiments, the suture  2816  is attached to the pledgets at more than two locations. The suture  2816  can be attached to the pledgets  2702  by any manner that allows the pledgets to be attached to a tissue member and provide a force to the tissue member. 
     Referring to  FIGS. 30 and 31 , the valve repair device  2700  is configured to attach one or more pledgets  2702  to a tissue member  3001  (e.g., the annulus of the mitral valve, the leaflets of the mitral valve, etc.). The tissue member  3001  has a first side  3002  and a second side  3003 . In the illustrated example, the device  2700  is penetrating the tissue member (from the first side  3002  to the second side  3003 ) in order to attach the pledgets  2702  to the second side  3003  of the tissue member  3001 . Referring to  FIG. 30 , the device  2700  attached a first pledget  2702   a  (e.g., the starting pledget of the sequence) to the tissue member  3001  and is in the process of deploying a second pledget  2702   b  to attach to the tissue member  3001 . The first pledget  2702   a  and the second pledget  2702   b  are coupled by a suture  2816 . 
     Still referring to  FIG. 30 , to attach the first pledget  2702   a , the device  2700  penetrated the tissue member (e.g., using the puncturing member  2704  shown in  FIG. 27 ) and deployed the first pledget  2702   a  out of the outlet  2703  of the delivery member  2701  and attaches to the second side  3003  of the tissue member  3001  by a connection member  3024 . The connection member  3024  can be, for example, a stitch or a knot, or a fastener. The suture member  2816  extends from the connection member  3024 , through the pledget  2702   a , above the pledget, and through a second location on the pledget, such that a tensioning portion  3026  of the suture  2816  exists on a top surface of the pledget  2702   a . After deployment of the first pledget  2702   a , the device  2700  returned through the tissue member  3001  such that a return portion  3020  of the suture  2816  extends from the second side  3003  to the first side  3002  of the tissue member  3001 . Subsequently, the device  2700  penetrates the tissue member  3001  to deploy the second pledget  2702   b , and, during this penetration, a penetrating portion  3021  of the suture  2816  extends from the first side  3002  to the second side  3003  of the tissue member  3001 . In between the return portion  3020  of the suture  2816  from a pledget  2702   a - 2702   d  and the penetrating portion  3021  of the suture  2816  of an adjacent subsequent pledget  2702   a - 2702   d  is a tightening portion  3022  of the suture  2816 . 
     Referring to  FIG. 31 , the device  2700  was used to complete the sequence of attaching four pledgets  2702   a - 2702   d  to the tissue member  3001 , and the four pledgets are attached by suture  2816 . The sequence of pledgets starts with the first pledget  2702   a  and ends with the fourth pledget  2702   d . The first pledget  2702   a  is attached to the second side  3003  of the tissue member  3001  by the connection member  3024  and the return portion  3020  of the suture  2816 . The second pledget  2702   b , third pledget  2702   c , and fourth pledget  2702   d  are attached to the second side  3003  of the tissue member  3001  by the corresponding penetrating portions  3021  and the return portions  3020  of the suture  2816 . The suture  2816  extends past the fourth pledget  2702   d , such that an excess suture  3118  exists at the end of the suture  2816 . That is, after the return portion  3020  of the suture  2816  attaches the fourth pledget  2702   d  to the tissue member  3001 , an excess suture  3118  extends below the first side  3002  of the tissue member  3001 . In addition, a tensioning portion  3026  exists above each of the pledgets  2702   a - 2702   d , and a tightening portion exists on the first side  3002  of the tissue member  3001  and in between each of the pledgets  2702   a - 2702   d.    
     The pledgets  2702   a - 2702   d  are disposed on the suture  2816  such that the suture is fixed to the pledget  2702  and is slideably movable in relation to the pledgets  2702   b - 2702   d . The movement of the suture  2816  in relation to the pledgets  2702   a - 2702   d  allows each of the pledgets to be attached to the tissue member  3001  at different distances from each other. For example, the distance D 1  between the first pledget  2702   a  and the second pledget  2702   b  can be the same or different from the distance D 2  between the second pledget  2702   b  and the third pledget  2702   c . Similarly, the distance D 3  between the third pledget  2702   c  and the fourth pledget  2702   d  can be the same or different from the distances D 1  and/or D 2 . 
     The movability of the pledgets  2702   a - 2702   d  with respect to the suture  2816  also allows force F to be applied to the tissue member  3001  by the pledgets  2702   a - 2702   d . The tensioning portion  3026  and the tightening portion  3022  of the suture  2816  is in a loosened state when the pledgets  2702   a - 2702   d  are initially attached to the tissue member  3001 . When a pulling force is applied to the excess portion  3118  of the suture  1816 , the tensioning portion  3026  and the tightening portion  3022  change from a loosened state to a taut state, which makes the amount of force F applied by the pledgets  2702   a - 2702   d  and the amount of force T applied by the suture  2816  larger. The force F applied by the pledgets  2702   a - 2702   d  and the force T applied by the suture  2816  create a cinching effect on the tissue member  3001 . 
     While the above example shows a sequence having four pledgets to provide a cinching effect on the tissue member  3001 , it should be understood that a sequence having any number of pledgets can be used to cinch a tissue member. For example, a sequence may include between 2 pledgets and 20 pledgets, such as, between 4 pledgets and 18 pledgets, such as between 6 pledgets and 16 pledgets, such as between 8 pledgets and 14 pledgets, such as between 10 pledgets and 12 pledgets, such as 11 pledgets. In an exemplary procedure, 14 pledgets can be used to cinch a tissue member  3001 . In alternative examples, more than 20 pledgets can be used to cinch a tissue member  3001 . 
     Referring to  FIGS. 32 and 33A-33D , another exemplary procedure for mitral annuloplasty is shown using the exemplary valve repair device  2700  ( FIGS. 27-31 ). The mitral annuloplasty procedure is used to correct a dysfunctional mitral valve MV. As described above, in certain situations, the anterior leaflet  705  and the posterior leaflet  706  of the mitral valve MV may not coapt (e.g., see mitral valve MV having gap  3308  in  FIGS. 33A-33D ), which could lead to regurgitation of blood through the mitral valve. The exemplary mitral annuloplasty procedure provides annular support to the mitral valve by reducing the size of the annulus, which allows the leaflets to properly coapt. 
     Referring to  FIG. 32 , the valve repair device  2700  enters the left ventricle LV through the apex A of the heart H. After the valve repair device  2700  enters the left ventricle LV, the repair device engages the mitral valve MV. The valve repair device  2700  is configured to attach a pledget  2702  to the mitral valve MV. That is, similar to the exemplary procedure shown in  FIGS. 30 and 31 , the valve repair device  2700  is configured to engage the annulus of the mitral valve MV from the left ventricle LV, penetrate the annulus, and attach a pledget  2702  to the annulus in the left atrium LA. The valve repair device  2700  may take any suitable form that is capable of entering the left ventricle LV through the apex A of the heart H and attaching a pledget  2702  to the mitral valve. For example, in addition to the features of the valve repair device  2700  described with reference to  FIGS. 27-31 , the valve repair device  2700  may include the features of the devices described in U.S. Pat. No. 7,635,386 and U.S. Patent Application Publication No. 2014/0114404 A1, which are hereby incorporated by reference in their entirety. The pledget  2702  may take any suitable form that is capable of being deployed against heart tissue, such as the annulus of a heart valve, and providing support for a suture that extends through the heart valve tissue, such as, for example, any form described in the present application. While the pledgets  2702  are illustrated as being deployed on only one side of the heart tissue, in other embodiments, pledgets can be provided on both sides of the heart tissue to provide reinforcement for the suture  2816  on both sides of the tissue. 
     The exemplary mitral annuloplasty procedure includes attaching two or more pledgets  2702  to the annulus  700 , in which the two or more pledgets are connected by a suture  2816 . In addition, the exemplary procedure includes tensioning the suture  2816  (and, as a result, the two or more pledgets  2702 ) to reduce the size of the annulus, and, subsequently, fixing the suture once a desired reduction of the size of the annulus is achieved. The suture  2816  can be made of an ePTFE suture, a braid of suture, or any other suitable material.  FIGS. 33A and 33C  illustrate the mitral valve MV from the perspective of line A-A shown in  FIG. 32  (e.g., illustrating the mitral valve MV from the left atrium LA), and  FIGS. 33B and 33D  illustrate the mitral valve MV from the perspective of line B-B shown in  FIG. 32  (e.g., illustrating the mitral valve MV from the left ventricle LV). 
     Referring to  FIGS. 33A and 33B , in a first step of the exemplary mitral annuloplasty procedure, the valve device  2700  attaches the two or more pledgets  2702  to the annulus  700 . In the illustrated embodiment, the device  2700  attaches nine pledgets  2702  to the annulus  700 . In alternative embodiments, between 2 pledgets and 20 pledgets can be attached to the annulus  700 , such as between 4 pledgets and 18 pledgets, such as between 6 pledgets and 16 pledgets, such as between 8 pledgets and 14 pledgets, such as between 10 pledgets and 12 pledgets, such as 11 pledgets. In certain embodiments, the device  2700  can attach more than 20 pledgets to the annulus. In an exemplary procedure, the device  2700  attaches twelve pledgets  2702  to the annulus  700 . Referring to  FIG. 33A , each of the pledgets  2702  are attached to the annulus  700  in the left atrium LA. Referring to  FIG. 33B , each of the pledgets  2702  are attached to the annulus  700  by a suture  2816 , such that providing a pulling force to the excess portion  3118  of the suture  2816  will cause the pledgets  2702  to reduce the size of the annulus  700 . 
     Referring to  FIGS. 33C and 33D , in a second step of the exemplary mitral annuloplasty procedure, a force is applied to the excess portion  3118  of the suture  2816  in the direction X ( FIG. 33D ) to create a cinching effect on the annulus  700 . The force applied to the suture  2816  causes a reduction in size of the annulus  700 , which causes the anterior leaflet  705  and the posterior leaflet  706  to coapt (e.g., the force causes the gap  3308  to close, as shown in  FIGS. 33C and 33D ). Once the anterior leaflet  705  and the posterior leaflet  706  properly coapt, the suture  2816  is fixed such that the size of the annulus remains in the reduced state. In one example, the suture  2816  can be fixed to an interior wall  3201  ( FIG. 32 ) of the left ventricle LV. For example, the suture  2816  can be fixed on an interior wall  3201  near the location of insertion by the valve repair device  2700  (or other tensioning device) through the apex A so that suture  2816  is conveniently accessible by the valve repair device (or other tensioning device) if the amount of force applied on the suture  2816  needs to be altered to reduce or expand the size of the annulus. In alternative examples, the suture  2816  can be fixed on any other location of the interior wall  3201  of the left ventricle LV that is accessible by the valve repair device  2700  (or other tensioning device), or the suture may be fixed by an anchor  5900  that is seated against the valve annulus on the ventricular side, opposite the last pledget  2702  in the series. 
     Adjacent pledgets  2702  can be placed any distance apart from each other that allows the pledgets  2702  to be tensioned to repair at least a portion of the mitral valve MV. In certain exemplary procedures, the adjacent pledgets  2702  may be positioned at different distances apart from each other as compared to other adjacent pledgets. In certain embodiments, the pledgets  2702  are placed between one trigone (not shown) and another trigone. 
     The removal of the gap  3308  between the anterior leaflet  705  and the posterior leaflet  706  prevents regurgitation of blood from the left ventricle LV to the left atrium LA through the mitral valve MV. The suture  2816  can be tensioned and fixed by the valve repair device  2700  or a separate tensioning device (not shown). If a separate tensioning device is used, the tensioning device enters the left ventricle LV through the apex A of the heart H to engage the suture  2816 . 
     Referring to  FIGS. 34 and 35A-35D , another exemplary procedure for mitral annuloplasty is shown using the exemplary valve repair device  3400 . The valve repair device  3400  has the same features as the valve repair device  2700  ( FIGS. 27-31 ), except that it is configured to enter the left atrium LA through the atrial septum of the heart H. For example, in addition to the features of the valve repair device  2700 , the valve repair device  3400  may include the features of the devices described in U.S. Pat. No. 7,635,386 and U.S. Patent Application Publication No. 2014/0114404 A1, which are hereby incorporated by reference in their entirety. The mitral annuloplasty procedure is used to correct a dysfunctional mitral valve MV. As described above, in certain situations, the anterior leaflet  705  and the posterior leaflet  706  of the mitral valve MV may not coapt (e.g., see mitral valve MV having gap  3508  in  FIGS. 35A-35D ), which could lead to regurgitation of blood through the mitral valve. The exemplary mitral annuloplasty procedure provides annular support to the mitral valve by reducing the size of the annulus, which allows the leaflets to properly coapt. 
     Referring to  FIG. 34 , the valve repair device  3400  enters the left atrium LA through the atrial septum of the heart H. After the valve repair device  3400  enters the left atrium LA, the repair device  3400  engages the mitral valve MV. The valve repair device  3400  is configured to attach a pledget  2702  to the mitral valve MV. That is, similar to the exemplary procedure shown in  FIGS. 30 and 31 , the valve repair device  3400  is configured to engage the annulus of the mitral valve MV from the left atrium LA, penetrate the annulus, and attach a pledget  2702  to the annulus in the left ventricle LV. The pledget  2702  may take any suitable form that is capable of providing annular support to the mitral valve, such as, for example, any form described in the present application. 
     The exemplary mitral annuloplasty procedure includes attaching two or more pledgets  2702  to the annulus  700 , in which the two or more pledgets are connected by a suture  2816 . In addition, the exemplary procedure includes tensioning the suture  2816  (and, as a result, the two or more pledgets  2702 ) to reduce the size of the annulus, and, subsequently, fixing the suture once a desired reduction of the size of the annulus is achieved. The suture  2816  can be made of an ePTFE suture, a braid of suture, or any other suitable material.  FIGS. 35A and 35C  illustrate the mitral valve MV from the perspective of line A-A shown in  FIG. 34  (e.g., illustrating the mitral valve MV from the left atrium LA), and  FIGS. 35B and 35D  illustrate the mitral valve MV from the perspective of line B-B shown in  FIG. 34  (e.g., illustrating the mitral valve MV from the left ventricle LV). 
     Referring to  FIGS. 35A and 35B , in a first step of the exemplary mitral annuloplasty procedure, the valve device  3400  attaches the two or more pledgets  2702  to the annulus  700 . In the illustrated embodiment, the device  3400  attaches nine pledgets  2702  to the annulus  700 . In alternative embodiments, between 2 pledgets and 20 pledgets can be attached to the annulus  700 , such as between 4 pledgets and 18 pledgets, such as between 6 pledgets and 16 pledgets, such as between 8 pledgets and 14 pledgets, such as between 10 pledgets and 12 pledgets, such as 11 pledgets. In certain embodiments, the device  3400  can attach more than 20 pledgets to the annulus. In an exemplary procedure, the device  3400  attaches twelve pledgets  2702  to the annulus  700 . Referring to  FIG. 35B , each of the pledgets  2702  are attached to the annulus  700  in the left atrium LA. Referring to  FIG. 35A , each of the pledgets  2702  are attached to the annulus  700  by a suture  2816 , such that providing a pulling force to the excess portion  3118  of the suture  2816  will cause the pledgets  2702  to reduce the size of the annulus  700 . 
     Referring to  FIGS. 35C and 35D , in a second step of the exemplary mitral annuloplasty procedure, a force is applied to the excess portion  3118  of the suture  2816  in the direction X ( FIG. 35C ) to create a cinching effect on the annulus  700 . The force applied to the suture  2816  causes a reduction in size of the annulus  700 , which causes the anterior leaflet  705  and the posterior leaflet  706  to coapt (e.g., the force causes the gap  3508  to close, as shown in  FIGS. 35C and 35D ). Once the anterior leaflet  705  and the posterior leaflet  706  properly coapt, the suture  2816  is fixed such that the size of the annulus remains in the reduced state. In one example, the suture  2816  can be fixed to an interior wall  3401  ( FIG. 34 ) of the left atrium LA. For example, the suture  2816  can be fixed on an interior wall  3401  near the location of insertion by the valve repair device  3400  (or other tensioning device) through the atrial septum so that suture  2816  is conveniently accessible by the valve repair device (or other tensioning device) if the amount of force applied on the suture  2816  needs to be altered to reduce or expand the size of the annulus. In alternative examples, the suture  2816  can be fixed on any other location of the interior wall  3401  of the left atrium LA that is accessible by the valve repair device  3400  (or other tensioning device), or the suture may be fixed by an anchor  5900  that is seated against the valve annulus on the atrial side, opposite the last pledget  2702  in the series. 
     Adjacent pledgets  2702  can be placed any distance apart from each other that allows the pledgets  2702  to be tensioned to repair at least a portion of the mitral valve MV. In certain exemplary procedures, the adjacent pledgets  2702  may be positioned at different distances apart from each other as compared to other adjacent pledgets. In certain embodiments, the pledgets  2702  are placed between one trigone (not shown) and another trigone. 
     The removal of the gap  3508  between the anterior leaflet  705  and the posterior leaflet  706  prevents regurgitation of blood from the left ventricle LV to the left atrium LA through the mitral valve MV. The suture  2816  can be tensioned and fixed by the valve repair device  3400  or a separate tensioning device (not shown). If a separate tensioning device is used, the tensioning device enters the left atrium LA through the atrial septum of the heart H to engage the suture  2816 . 
     Referring to  FIG. 16A , in certain embodiments, the exemplary procedure for mitral annuloplasty shown in  FIGS. 34 and 35A-35D  can be completed with a transatrial procedure using valve repair device  1600 ′. Referring to  FIG. 16A , the valve repair device  1600 ′ enters the left atrium LA through an outer wall of the heart H. After the valve repair device  1600 ′ enters the left atrium LA, the repair device engages the mitral valve MV. The valve repair device  1600 ′ is configured to attach one or more pledgets  2702  to the mitral valve MV. The valve repair device  1600 ′ may take any suitable form that is capable of entering the left atrium LA through an outer wall of the heart H and attaching one or more pledgets to the mitral valve. For example, in addition to the features of the valve repair device  2700 , the valve repair device  1600 ′ can include the features of the devices described in U.S. Pat. No. 7,635,386 and U.S. Patent Application Publication No. 2014/0114404 A1, which are hereby incorporated by reference in their entirety. For example, the valve repair device  1600 ′ can take the form of the devices described in U.S. Pat. No. 7,635,386 and U.S. Patent Application Publication No. 2014/0114404 A1, which are hereby incorporated by reference in their entirety. 
     While the example provided above (in  FIGS. 33A-33D and 35A-35D ) include using two or more pledgets  2702  connected by a suture  2816  to close the gap  3308 ,  3508  between the anterior leaflet  705  and the posterior leaflet  706 , it should be understood that any number of pledgets connected by a suture can be used. In certain situations, only one sequence of pledgets connected by a suture can be required to close the gap  3308 ,  3508 . In other situations, more than one sequence of pledgets connected by one or more sutures can be used to close the gap  3308 ,  3508 . The pledgets can be attached to any location on the annulus  700  in order to cause the anterior leaflet  705  and the posterior leaflet  706  to properly coapt. 
     While the valve repair devices  2700 ,  3400 ,  1600 ′ and the exemplary annuloplasty procedures provided above are described with reference to repairing the mitral valve MV, it should be understood that the valve repair devices and the concepts used in the exemplary mitral annuloplasty procedures can be used to repair any native valve. For example, the valve repair devices  2700 ,  3400 ,  1600 ′ and the concepts of the exemplary annuloplasty procedures described above can be used to repair the aortic valve AV, the tricuspid valve TV, and the pulmonary valve PV. 
     Referring to  FIG. 36 , another exemplary valve repair device  3600  for repairing the mitral valve includes a delivery member  3601  and an advancement member  3650 . The advancement member  3650  is disposed in the delivery member  3601  with one or more pledgets  2702 . The advancement member  3650  is configured to push  3650  one or more pledgets  2702  through an outlet  3603  of the delivery member  3601 . An optional puncturing member  3604  is attached to the end  3605  of the delivery member  3601  of the valve repair device  3600 . The puncturing member  3604  is configured to puncture a tissue member (e.g., the annulus of the mitral valve, the leaflets of the mitral valve, etc.). The puncturing member  3604  can be, for example, a solid tapered tip, a needle, or the like. The outlet  3603  is located proximal to the puncturing member  3604  and in a side surface  3609  of the delivery member  3601 . It is advantageous to have a valve repair device  3600  with a puncturing member  3604  that is separated from the outlet  3603  of the delivery member  3601  because the puncturing member  3604  can be configured to more accurately puncture a tissue member. 
     The valve repair device  3600  is configured to deploy one or more pledgets  2702  (by the advancement member) out of the outlet  3603  of the delivery member  3601  and attach the pledgets to a tissue member. In the illustrated embodiment, the pledgets  2702  ( FIGS. 38E and 38F ) are attached to each other by a suture  2816  ( FIGS. 38E and 38F ). The pledgets  2702  can be configured to be crimped and compressed to occupy less space in the shaft  3606  of the of the delivery member  3601 . Upon being deployed through the outlet  3603  of the delivery member  3601 , the pledgets  2702  are optionally configured to expand or return to an unconstrained shape. 
     Referring to  FIGS. 37A and 37B , in certain embodiments, the puncturing member  3604  of the valve repair device  3600  includes an extendable and retractable blade or a sharp point  3704 . Referring to  FIG. 37A , the puncturing member  3604  may include an opening  3705 , and the blade or sharp point  3704  may be housed in the puncturing member  3604  and configured to exit the opening  3705  of the puncturing member  3604  as desired. Referring to  FIG. 38A , the device  3600  can be controlled such that, when desired, the blade or sharp point  3704  is extended through the opening  3705 . For example, the blade or sharp point  3704  is spring-loaded and extended by releasing the spring. The tip  3707  of the puncturing member  3604  can be blunt when the blade is in a disengaged state (as shown in  FIG. 37A ). 
       FIGS. 38A-38F  illustrate the exemplary valve repair device  3600  with the retractable blade or sharp point  3704  attaching a pledget  2702  to a tissue member  3801  (e.g., the annulus of the mitral valve, the leaflets of the mitral valve, etc.). In one exemplary embodiment, the valve repair device includes a device for holding the tissue as the sharp point  3704  is extended. For example, a suction device can be used. One such suction device is disclosed in U.S. Provisional Application No. 62/326,609.  FIG. 38A  illustrates the device  3600  prior to engaging the tissue member  3801 .  FIG. 38B  illustrates the device engaging a first side  3802  of the tissue member  3801 . The tip  3707  ( FIGS. 37A and 37B ) of the puncturing member  3604  is the first member of the device  3600  to engage the tissue member  3801 . If the tip  3707  of the puncturing member  3604  is blunt, the tip  3707  can be moved around while engaging the tissue member  3801  without causing trauma the tissue member  3801 , which allows for the proper location for puncturing the tissue member  3801  to be found without puncturing the tissue member in an undesired location. Referring to  FIG. 38C , once the proper location for puncturing the tissue member is found, the blade or sharp point  3704  can be ejected from the puncturing member  3604  to puncture the tissue member. Referring to  FIG. 38D , after the tissue member  3801  is punctured by the blade or sharp point  3704 , the device  3600  is moved through the tissue member such that the opening  3603  of the device moves from the first side  3802  of the tissue member to the second side  3803  of the tissue member. Any time after puncturing the tissue member  3801 , the blade or sharp point  3704  may be retracted through the opening  3705  ( FIGS. 37A and 37B ) of the puncturing member  3604 . Referring to  FIG. 38E , when the opening  3603  is on the second side  3803  of the tissue member  3801 , the device  3600  deploys a pledget  2702  attached to a suture  2816 . Referring to  FIG. 38F , after deploying the pledget  2702 , the device  3600  is moved from the second side  3803  of the tissue member  3801  back to the first side  3802  of the tissue member such that a return portion  3820  of the suture  2816  extends from the pledget  2702  on the second side  3803  of the tissue member  3801 , through the tissue member  3801 , and extends past the first side  3802  of the tissue member  3801 . After the device  3600  is moved back through the tissue member  3801 , the pledget  2702  is attached to the second side  3803  of the tissue member  3801 . 
     While  FIGS. 38A-38F  show the device  3600  attaching a single pledget  2702  to a tissue member  3801 , it should be understood that the device  3600  can be used in the procedures shown in  FIGS. 30 through 35A-35D . In addition, the features of device  3600  ( FIGS. 36 through 38A-38F ) and device  2700  ( FIG. 27  through  FIGS. 35A-35D ) can be used in any other procedure disclosed in the present application. 
     Referring to  FIG. 39 , another exemplary embodiment of an attachment member  3902  that may be used to repair the mitral valve includes a main body portion  3904 , a tab portion  3906 , and an aperture  3908 . The attachment member  3902  is configured to be deployed by a valve repair device  4000  (e.g., the valve repair device  4000  shown in  FIGS. 40A and 40B , the valve repair device  4300  shown in  FIG. 43 , etc.) and attached to a tissue member (e.g., the annulus of the mitral valve, the leaflets of the mitral valve, etc.) in order to apply a force to the tissue member. The main body  3904  is configured to engage the tissue member when the attachment member  3902  is attached to the tissue member. In certain embodiments, the main body  3904  has a round cross section. In these embodiments, the diameter of the main body can be, for example, between about 0.5 mm and about 2.5 mm, such as between about 0.75 mm and about 2 mm, such as between about 1 mm and about 2 mm, such as between about 1.5 mm. In an exemplary embodiment, the diameter of the main body is about 1.1 mm. In some other embodiments, the main body  3904  has a flat surface, and the attachment member  3902  is configured such that the flat surface engages the tissue member when the attachment member is attached to the tissue member. The main body  3904  of the attachment member  3902  may have any suitable length L. For example, the length L can be between about 4 mm and about 10 mm, such as between about 5 mm and about 9 mm, such as between about 6 mm and about 8 mm, such as about 7 mm. In one embodiment, the length L is about 7.6 mm. The tab portion  3906  is configured such that, when the attachment member  3902  is attached to a tissue member, the attachment member  3902  provides a substantially even load distribution. The aperture  3908  is configured to attach the attachment member  3902  to a suture (e.g., the suture  4016  shown in  FIGS. 40A and 40B ). The attachment members  3902  can be made of, for example, implantable polymers such as PET, PTFE, etc. In additional embodiments, the attachment members  3902  can be made from implantable metals, implantable ceramics, or other suitable implant-grade materials. 
     Referring to  FIGS. 40A and 40B , another exemplary embodiment of a valve repair device  4000  for repairing the mitral valve includes a delivery member  4001  and an advancement member  4002 . The advancement member  4002  is configured to move one or more attachment members  3902 , such that the attachment members can be deployed through an outlet  4003  of the delivery member  4001 . The delivery member  4001  of the valve repair device  4000  includes a puncturing member  4004  that is configured to puncture a tissue member (e.g., the annulus of the mitral valve, the leaflets of the mitral valve, etc.). The delivery member  4001  can be a hollow needle, any of the puncturing devices disclosed herein, or any other suitable device. The attachment members  3902  are attached to each other by a suture  4016 . 
     Referring to  FIGS. 39 and 40A-40B , in certain embodiments, the attachment members  3902  include a tongue portion  3910  and a groove portion  3912 . The tongue portion  3910  and groove portion  3912  are configured such that the tongue portion  3910  of one attachment member engages the groove portion  3912  of an adjacent attachment member. For example, as shown in  FIGS. 40A and 40B , when the attachment members  3902  are stacked within the repair device  4000 , the attachment members engage adjacent attachment members. During this engagement, the tongue portions  3910  of the attachment members  3902  engage the groove member  3912  of adjacent attachment members. 
     Still referring to  FIGS. 39 and 40A-40B , in certain embodiments, the attachment members  3902  have recesses  3914  located on each end of the tab portion  3906 . The recesses  3914  are configured to provide space for the suture  4016  when the attachment members  3902  and the suture  4016  are in the repair device  4000 . For example, referring to  FIGS. 40A and 40B , the recesses  3914  of adjacent attachment members  3902  are aligned such that an open space  4020  exists between the tab portions  3906  of adjacent attachment members  3902 , and the suture  4016  is disposed in this open space prior to being deployed by the device  4000 . 
     Referring to  FIGS. 40A and 40B , the advancement member  4002  is configured to engage and move one or more attachment members  3902  through the outlet  4003  of the delivery member  4001 . In the illustrated embodiment, the advancement member  4002  is a pusher that engages the last attachment member  3902  in a sequence of stacked attachment members in order to push the attachment members  3902  out of the outlet  4003 . Referring to  FIG. 40A , the illustrated sequence of attachment members  3902  includes four attachment members, and each of the four attachment members remain in the delivery portion  4001  of the device  4000  (e.g., none of the attachment members have been moved out of the outlet  4003 ). Referring to  FIG. 40B , one of the attachment members  3902  has been pushed out of the outlet  4003 . That is, a force is created by the advancement member  4002  in the X direction, which causes an attachment member  3902  to move out of the outlet  4003  of the device  4000 . As shown in the illustrated embodiment, the advancement member  4002  can be configured to engage with the attachment members  3902 . For example, the advancement member has an engagement surface  4022  and an extended portion  4024 . The engagement surface  4022  engages the main body  3904  ( FIG. 39 ) of the attachment member  3902 , and the extended portion fits into the recess  3914  ( FIG. 39 ) of the attachment member  3902 . While, in the illustrated embodiment, the advancement member  4002  is shown as being a pusher, it should be understood that the advancement member  4002  can take any suitable form that is capable of moving the attachment members  3902  through the delivery member  4001  and out of the outlet  4003 . 
     Still referring to  FIGS. 40A and 40B , the device  4000  can be configured such that there is an interference between the attachment members  3902  and the delivery member  4001  that prevents the attachment members from pre-deploying. That is, the device  4000  can be configured such that the attachment members  3902  are prevented from exiting the outlet  4003  unless an additional force (such as a force provided by the advancement member  4002 ) causes the attachment members  3902  to exit the outlet  4003 . In the illustrated embodiment, the device  4000  includes a protruding member  4026  that engages the attachment members  3902  prior to deployment. The force applied by the advancement member  4002  to the attachment members  3902  is sufficient to move the attachment members  3902  past the protruding member  4026  and out of the outlet  4003  of the device  4000 . 
     In certain embodiments, the device  4000  is configured to deploy the attachment members  3902  such that the attachment members rotate upon being deployed. For example, the delivery portion  4001  of the device  4000  may have an arched (or declining) surface  4028  that causes the attachment members  3902  to move in alignment with the arched surface  4028 . The arched surface  4028  can extend to the outlet  4003  of the device  4000 . Referring to  FIGS. 40A and 40B , as an attachment member  3902  is being moved to the outlet  4003  of the device  4000 , a first end  4030  of the main body portion  3904  ( FIG. 39 ) of the attachment member  3902  engages the arched surface  4028 , which causes a first end  4030  of the attachment member to move in alignment with the arched surface  4028 . As the attachment member  3902  continues to move toward the outlet  4003 , the tab portion  3906  engages the protruding member  4026 , which causes the attachment member  3902  to rotate as it exits the outlet  4003 . The arched surface  4028  of the device  4000  is configured to allow for the attachment member  3902  to exit the outlet  4003  upon being moved by the advancement member  4002 . In certain embodiments, the arched surface  4028  acts as a spring door such that, when the advancement member  4002  moves an attachment member  3902  to engage the arches surface  4028 , the arched surface  4028  deflects to an open position to allow the attachment member  4002  to exit the outlet  4003 . The arched surface  4028  moves in a direction Y between its original position to the open position. 
     The device  4000  can be configured such that the puncturing member  4004  is retractable. That is, the puncturing member  4004  is housed in the device  4000  such that it is not capable of puncturing a tissue member until the puncturing member  4004  is moved into an engageable position (as shown in  FIGS. 40A and 40B ). For example, referring to  FIGS. 40A and 40B , the device  4000  has a housing  4032 , and the puncturing member  4004  is movable in the directions D so that the puncturing member  4004  can be moved in and out of the housing  4032 . When the puncturing member  4004  is in the housing  4032 , the device  4000  can be moved, for example, through a patient&#39;s heart without causing trauma to any tissue member within the patient&#39;s heart. Once the device  4000  is located in a position to puncture a tissue member, the puncturing member  4004  can be moved out of the housing  4032  to engage the tissue member. 
     Referring to  FIGS. 41 and 42A-42D , another exemplary procedure for mitral annuloplasty is shown using the exemplary valve repair device  4000  ( FIGS. 40A and 40B ). The mitral annuloplasty procedure is used to correct a dysfunctional mitral valve MV. As described above, in certain situations, the anterior leaflet  705  and the posterior leaflet  706  of the mitral valve MV may not coapt (e.g., see mitral valve MV having gap  4208  in  FIGS. 42A-42D ), which could lead to regurgitation of blood through the mitral valve. The exemplary mitral annuloplasty procedure provides annular support to the mitral valve by reducing the size of the annulus, which allows the leaflets to properly coapt. 
     Referring to  FIG. 41 , the valve repair device  4000  enters the left ventricle LV through the apex A of the heart H. After the valve repair device  4000  enters the left ventricle LV, the repair device engages the mitral valve MV. The valve repair device  4000  is configured to attach one or more attachment members  3902  to the mitral valve MV (as shown in  FIGS. 42A-42D ). That is, similar to the exemplary procedure shown in  FIGS. 30 and 31 , the valve repair device  4000  is configured to engage the annulus of the mitral valve MV from the left ventricle LV, penetrate the annulus, and attach an attachment member  3902  to the annulus in the left atrium LA. The valve repair device  4000  may take any suitable form that is capable of entering the left ventricle LV through the apex A of the heart H and attaching an attachment member  3902  to the mitral valve. For example, in addition to the features of the valve repair device  4000  described with reference to  FIGS. 40A and 40B , the valve repair device  4000  may include the features of the devices described in U.S. Pat. No. 7,635,386 and U.S. Patent Application Publication No. 2014/0114404 A1, which are hereby incorporated by reference in their entirety. The attachment member  3902  may take any suitable form that is capable of providing annular support to the mitral valve, such as, for example, any form described in the present application. 
     The exemplary mitral annuloplasty procedure includes attaching two or more attachment members  3902  to the annulus  700 , in which the two or more attachment members  3902  are linked by a suture  4016 . The attachment members  3902  can be linked in a wide variety of different ways. For example, the attachment members  3902  can be inked in any of the ways the attachment members  2502  and  2702  can be linked, as described above. In addition, the exemplary procedure includes tensioning the suture  4016  (and, as a result, the two or more attachment members  3902 ) to reduce the size of the annulus, and, subsequently, fixing the suture once a desired reduction of the size of the annulus is achieved. The suture  4016  can be made of an ePTFE suture, a braid of suture, or any other suitable material.  FIGS. 42A and 42C  illustrate the mitral valve MV from the perspective of line A-A shown in  FIG. 41  (e.g., illustrating the mitral valve MV from the left atrium LA), and  FIGS. 42B and 42D  illustrate the mitral valve MV from the perspective of line B-B shown in  FIG. 41  (e.g., illustrating the mitral valve MV from the left ventricle LV). 
     Referring to  FIGS. 42A and 42B , in a first step of the exemplary mitral annuloplasty procedure, the valve repair device  4000  attaches the two or more attachment members  3902  to the annulus  700 . In the illustrated embodiment, the device  4000  attaches nine attachment members  3902  to the annulus  700 . In alternative embodiments, between 2 attachment members and 20 attachment members can be attached to the annulus  700 , such as between 4 attachment members and 18 attachment members, such as between 6 attachment members and 16 attachment members, such as between 8 attachment members and 14 attachment members, such as between 10 attachment members and 12 attachment members, such as 11 attachment members. In certain embodiments, the device  4000  can attach more than 20 attachment members to the annulus. In an exemplary procedure, the device  2700  attaches twelve attachment members  3902  to the annulus  700 . Referring to  FIG. 42A , each of the attachment members  3902  are attached to the annulus  700  in the left atrium LA. Referring to  FIG. 42B , each of the attachment members  3902  are attached to the annulus  700  by a suture  4016 , such that providing a pulling force to the excess portion  4218  of the suture  4016  will cause the attachment members  3902  to reduce the size of the annulus  700 . 
     Referring to  FIGS. 42C and 42D , in a second step of the exemplary mitral annuloplasty procedure, a force is applied to the excess portion  4218  of the suture  4016  in the direction X ( FIG. 42D ) to create a cinching effect on the annulus  700 . The force applied to the suture  4016  causes a reduction in size of the annulus  700 , which causes the anterior leaflet  705  and the posterior leaflet  706  to coapt (e.g., the force causes the gap  4208  to close, as shown in  FIGS. 42C and 42D ). Once the anterior leaflet  705  and the posterior leaflet  706  properly coapt, the suture  4016  is fixed such that the size of the annulus remains in the reduced state. In one example, the suture  4016  can be fixed to an interior wall  4101  ( FIG. 41 ) of the left ventricle LV. For example, the suture  4016  can be fixed on an interior wall  4101  near the location of insertion by the valve repair device  4300  (or other tensioning device) through the apex A so that suture  4016  is conveniently accessible by the valve repair device (or other tensioning device) if the amount of force applied on the suture  4016  needs to be altered to reduce or expand the size of the annulus. In alternative examples, the suture  4016  can be fixed on any other location of the interior wall  4101  of the left ventricle LV that is accessible by the valve repair device  4000  (or other tensioning device), or the suture may be fixed by an anchor  5900  that is seated against the valve annulus on the ventricular side, opposite the last attachment member  3902  in the series. 
     Adjacent attachment members  3902  can be placed any distance apart from each other that allows the attachment members  3902  to be tensioned to repair at least a portion of the mitral valve MV. In certain exemplary procedures, the adjacent attachment members  3902  may be positioned at different distances apart from each other as compared to other adjacent attachment members. The distance between adjacent attachment members  3902  can, for example, be between about 1 mm and about 20 mm, such as between about 4 mm and about 12 mm, such as between about 6 mm and about 10 mm, such as about 8 mm. In certain embodiments, the adjacent attachment members  3902  at the ends of a group of attachment members are a smaller distance apart than the other adjacent attachment members in the group of attachment members. In this embodiment, the distance between the adjacent attachment members  3902  at the ends of the group of attachment members is between about 1 mm and about 2 mm. In certain embodiments, the attachment members  3902  are placed between one trigone (not shown) and another trigone (not shown). In some embodiments, the spacing between adjacent attachment members  3902  proximate the trigones is smaller than the distance between the other adjacent attachment members. In these embodiments, the distance between the adjacent advancement members  3902  proximate the trigones are between about 1 mm and about 2 mm. 
     The removal of the gap  4208  between the anterior leaflet  705  and the posterior leaflet  706  prevents regurgitation of blood from the left ventricle LV to the left atrium LA through the mitral valve MV. The suture  4016  can be tensioned and fixed by the valve repair device  4000  or a separate tensioning device (not shown). If a separate tensioning device is used, the tensioning device enters the left ventricle LV through the apex A of the heart H to engage the suture  4016 . 
     Referring to  FIGS. 43 and 44A-44D , another exemplary procedure for mitral annuloplasty is shown using the exemplary valve repair device  4300 . The valve repair device  4300  has the same features as the valve repair device  4000  ( FIGS. 40A and 40B ), except that it is configured to enter the left atrium LA through the atrial septum of the heart H. For example, in addition to the features of the valve repair device  4000 , the valve repair device  4300  may include the features of the devices described in U.S. Pat. No. 7,635,386 and U.S. Patent Application Publication No. 2014/0114404 A1, which are hereby incorporated by reference in their entirety. The mitral annuloplasty procedure is used to correct a dysfunctional mitral valve MV. As described above, in certain situations, the anterior leaflet  705  and the posterior leaflet  706  of the mitral valve MV may not coapt (e.g., see mitral valve MV having gap  4408  in  FIGS. 44A-44D ), which could lead to regurgitation of blood through the mitral valve. The exemplary mitral annuloplasty procedure provides annular support to the mitral valve by reducing the size of the annulus, which allows the leaflets to properly coapt. 
     Referring to  FIG. 43 , the valve repair device  4300  enters the left atrium LA through the atrial septum of the heart H. After the valve repair device  4300  enters the left atrium LA, the repair device  4300  engages the mitral valve MV. The valve repair device  4300  is configured to attach an attachment member  3902  to the mitral valve MV. That is, similar to the exemplary procedure shown in  FIGS. 30 and 31 , the valve repair device  4300  is configured to engage the annulus of the mitral valve MV from the left atrium LA, penetrate the annulus, and attach an attachment member  3902  to the annulus in the left ventricle LV. The attachment member  3902  may take any suitable form that is capable of providing annular support to the mitral valve, such as, for example, any form described in the present application. 
     The exemplary mitral annuloplasty procedure includes attaching two or more attachment members  3902  to the annulus  700 , in which the two or more attachment members  3902  are linked by a suture  4016 . In addition, the exemplary procedure includes tensioning the suture  4016  (and, as a result, the two or more attachment members  3902 ) to reduce the size of the annulus, and, subsequently, fixing the suture once a desired reduction of the size of the annulus is achieved. The suture  4016  can be made of an ePTFE suture, a braid of suture, or any other suitable material.  FIGS. 44A and 44C  illustrate the mitral valve MV from the perspective of line A-A shown in  FIG. 43  (e.g., illustrating the mitral valve MV from the left atrium LA), and  FIGS. 44B and 44D  illustrate the mitral valve MV from the perspective of line B-B shown in  FIG. 43  (e.g., illustrating the mitral valve MV from the left ventricle LV). 
     Referring to  FIGS. 44A and 44B , in a first step of the exemplary mitral annuloplasty procedure, the valve device  4300  attaches the two or more attachment members  3902  to the annulus  700 . In the illustrated embodiment, the device  4300  attaches nine attachment members  3902  to the annulus  700 . In alternative embodiments, between 2 attachment members and 20 attachment members can be attached to the annulus  700 , such as between 4 attachment members and 18 attachment members, such as between 6 attachment members and 16 attachment members, such as between 8 attachment members and 14 attachment members, such as between 10 attachment members and 12 attachment members, such as 11 attachment members. In certain embodiments, the device  4300  can attach more than 20 attachment members  3902  to the annulus. In an exemplary procedure, the device  4300  attaches twelve attachment members  3902  to the annulus  700 . Referring to  FIG. 44B , each of the attachment members  3902  are attached to the annulus  700  in the left ventricle LV. Referring to  FIG. 44A , each of the attachment members  3902  are attached to the annulus  700  by a suture  4016 , such that providing a pulling force to the excess portion  4418  of the suture  4016  will cause the attachment members  3902  to reduce the size of the annulus  700 . 
     Referring to  FIGS. 44C and 44D , in a second step of the exemplary mitral annuloplasty procedure, a force is applied to the excess portion  4418  of the suture  4016  in the direction X ( FIG. 44C ) to create a cinching effect on the annulus  700 . The force applied to the suture  4016  causes a reduction in size of the annulus  700 , which causes the anterior leaflet  705  and the posterior leaflet  706  to coapt (e.g., the force causes the gap  4408  to close, as shown in  FIGS. 44C and 44D ). Once the anterior leaflet  705  and the posterior leaflet  706  properly coapt, the suture  4016  is fixed such that the size of the annulus remains in the reduced state. In one example, the suture  4016  can be fixed to an interior wall  4301  ( FIG. 43 ) of the left atrium LA. For example, the suture  4016  can be fixed on an interior wall  4301  near the location of insertion by the valve repair device  4300  (or other tensioning device) through the atrial septum so that suture  4016  is conveniently accessible by the valve repair device (or other tensioning device) if the amount of force applied on the suture  4016  needs to be altered to reduce or expand the circumference of the annulus. In alternative examples, the suture  4016  can be fixed on any other location of the interior wall  4301  of the left atrium LA that is accessible by the valve repair device  4300  (or other tensioning device), or the suture may be fixed by an anchor  5900  that is seated against the valve annulus on the atrial side, opposite the last attachment member  3902  in the series. 
     Adjacent attachment members  3902  can be placed any distance apart from each other that allows the attachment members  3902  to be tensioned to repair at least a portion of the mitral valve MV. In certain exemplary procedures, the adjacent attachment members  3902  may be positioned at different distances apart from each other as compared to other adjacent attachment members. The distance between adjacent attachment members  3902  can, for example, be between about 1 mm and about 20 mm, such as between about 4 mm and about 12 mm, such as between about 6 mm and about 10 mm, such as about 8 mm. In certain embodiments, the adjacent attachment members  3902  at the ends of a group of attachment members are a smaller distance apart than the other adjacent attachment members in the group of attachment members. In this embodiment, the distance between the adjacent attachment members  3902  at the ends of the group of attachment members is between about 1 mm and about 2 mm. In certain embodiments, the attachment members  3902  are placed between one trigone (not shown) and another trigone (not shown). In some embodiments, the spacing between adjacent attachment members  3902  proximate the trigones is smaller than the distance between the other adjacent attachment members. In these embodiments, the distance between the adjacent advancement members  3902  proximate the trigones are between about 1 mm and about 2 mm. 
     The removal of the gap  4408  between the anterior leaflet  705  and the posterior leaflet  706  prevents regurgitation of blood from the left ventricle LV to the left atrium LA through the mitral valve MV. The suture  4016  can be tensioned and fixed by the valve repair device  4300  or a separate tensioning device (not shown). If a separate tensioning device is used, the tensioning device enters the left atrium LA through the atrial septum of the heart H to engage the suture  4016 . 
     Referring to  FIG. 16A , in certain embodiments, the exemplary procedure for mitral annuloplasty shown in  FIGS. 43 and 44A-44D  can be completed with a transatrial procedure using valve repair device  1600 ′. Referring to  FIG. 16A , the valve repair device  1600 ′ enters the left atrium LA through an outer wall of the heart H. After the valve repair device  1600 ′ enters the left atrium LA, the repair device engages the mitral valve MV. The valve repair device  1600 ′ is configured to attach one or more attachment members (e.g., any of the attachment members described in the present application) to the mitral valve MV. The valve repair device  1600 ′ may take any suitable form that is capable of entering the left atrium LA through an outer wall of the heart H and attaching one or more attachment members to the mitral valve. For example, the valve repair device  1600 ′ can take the form of the devices described in U.S. Pat. No. 7,635,386 and U.S. Patent Application Publication No. 2014/0114404 A1, which are hereby incorporated by reference in their entirety. 
     While the example provided above (in  FIGS. 42A-42D and 44A-44D ) include using two or more attachment members  3902  linked by a suture  4016  to close the gap  4208 ,  4408  between the anterior leaflet  705  and the posterior leaflet  706 , it should be understood that any number of attachment members  3902  linked by a suture can be used. In certain situations, only one sequence of attachment members  3902  linked by a suture can be required to close the gap  4208 ,  4408 . In other situations, more than one sequence of attachment members  3902  linked by one or more sutures can be used to close the gap  4208 ,  4408 . The attachment members  3902  can be attached to any location on the annulus  700  in order to cause the anterior leaflet  705  and the posterior leaflet  706  to properly coapt. 
     While the valve repair devices  4000 ,  4300 ,  1600 ′ and the exemplary annuloplasty procedures provided above are described with reference to repairing the mitral valve MV, it should be understood that the valve repair devices and the concepts used in the exemplary mitral annuloplasty procedures can be used to repair any native valve. For example, the valve repair devices  4000 ,  4300 ,  1600 ′ and the concepts of the exemplary annuloplasty procedures described above can be used to repair the aortic valve AV, the tricuspid valve TV, and the pulmonary valve PV. 
     Referring to  FIGS. 45A-45B , an exemplary embodiment of an annuloplasty band  4500  includes a plurality of adjustable chords  4501 , a main chord  4502 , and a cover  4503 . Referring to  FIG. 45A , the adjustable chords  4501  branch from the main chord  4502  at evenly spaced increments having a width W. The width may be, for example, between about 0.5 mm and about 1.5 mm, such as between about 0.75 mm and about 1.25 mm, such as about 1 mm. In an alternative embodiment, the adjustable chords may be unevenly spaced apart. Referring to  FIG. 45B , upon applying a force in the direction X to the main chord  4502  causes the adjustable chords  4501  to tighten or shorten the annuloplasty band  4500 . That is, applying a force in the direction X to the main chord causes a cinching effect of the annuloplasty band  4500 . 
     Referring to  FIGS. 46A and 46B , an exemplary embodiment of a valve repair device  4600  is shown attaching the annuloplasty band  4500  of  FIGS. 45A-45B  to a tissue member  4601  (e.g., the annulus of the mitral valve, the annulus of the tricuspid valve, etc.). The valve repair device  4600  is configured to attach the annuloplasty band  4500  to the tissue member by an attachment member  4602 . In the illustrated embodiment, the attachment member  4602  includes a securing portion  4610  and a suture portion  4612  (e.g., similar to the attachment member  602  having a securing portion  710  and the suture portion  712  shown in  FIGS. 5 through 19E ). In the illustrated embodiment, the securing portion  4610  of the attachment member  4602  is a knot. The securing portion  4610  is configured to prevent the attachment member  4602  from being removed from the tissue member and/or the annuloplasty band  4500  when a force is applied to the suture portion  4612 . In alternative embodiments, the attachment member  4602  may take any suitable form that is capable of attaching the annuloplasty band  4500  to the tissue member, such as, for example, any form described in the present application. 
     In the illustrated example, the valve repair device  4600  is configured to both incrementally deploy the annuloplasty band  4500  against the tissue member  4601  and deploy the attachment members  4602 . In another exemplary embodiment, two separate devices are used to deploy the annuloplasty band  4500  and the attachment members  4502 . In the illustrated embodiment, the main chord  4502  of the annuloplasty band  4500  is connected to the device  4600 . After the annuloplasty band  4500  is attached to the tissue member  4601 , the device  4600  can be used to apply a force to the main chord  4502  to cause a cinching effect of the annuloplasty band  4500  and, as a result, the tissue member  4801 . The annuloplasty band  4500  can be deployed by any suitable means, such as, for example, by the means used by the devices disclosed in U.S. Pat. Nos. 8,518,107, 8,911,494, 9,402,732, U.S. Patent Application Publication No. 2016/008132 A1, and U.S. Patent Application Publication No. 2014/0309661 A1, which are hereby incorporated by reference in their entirety. The device  4600  is configured to attach an attachment member  4602  to the tissue member  4601  by deploying the securing portion  4610  of the attachment member  4602  through the annuloplasty band  4500  and through the tissue member  4601 , such that the suture portion  4612  of the attachment member extends from the securing portion  4610  through tissue member  4601  and through the annuloplasty band  4500 . The device  4600  can take any suitable form that is capable of attaching the annuloplasty band  4500  to the tissue member  4601  by an attachment member  4602 . For example, the attachment member portion of the device  4600  can take the form of the devices described in U.S. Pat. No. 7,635,386 and U.S. Patent Application Publication No. 2014/0114404 A1, which are hereby incorporated by reference in their entirety. The device  4600  can deploy the attachment members  4602  in any of the manners that any of the attachment members or pledgets described herein are deployed. 
     Referring to  FIG. 46A , a first portion of the annuloplasty band  4500  is deployed from the device  4600  such that the portion of the band  4500  is abutting a first side  4603  of the tissue member  4601 . In addition, the main chord  4502  of the band  4500  is shown extending from the band  4500  to the band portion of the repair device  4600 . Still referring to  FIG. 46A , after the portion of the band  4500  is abutting the tissue member  4601 , the device  4600  deploys an attachment member  4602  through the band  4500  and the tissue member  4601 , such that the securing portion  4610  of the attachment member  4602  is attached to a second side  4605  of the tissue member  4601 , and such that the suture portion  4612  of the attachment member extends from the securing portion  4610  through the tissue member  4601  and the band  4500 . As shown in  FIG. 46A , after the device  4600  attaches the securing portion  4610  of the attachment member  4602  to the second side  4605  of the tissue member  4601 , the suture portion  4612  remains attached to the device  4600 . Once the attachment member  4602  attaches the portion of the annuloplasty band  4500  to the tissue member  4601 , the device  4500  is configured to cut the suture portion  4612  of the attachment member  4602 , such that the suture portion  4612  extends below band  4500 . In other exemplary embodiments, the suture portion  4612  is not cut. 
     Referring to  FIG. 46B , the device  4600  is configured to continue deploying the annuloplasty band  4500  until the entire band is abutting the tissue member  4601 . In addition, the device  4600  is configured to attach the band  4500  to the tissue member  4601  by attaching one or more attachment members through the band  4500  and the tissue member  4601 .  FIG. 46B  illustrates a portion of the band  4500  connected to the tissue member  4601  by three attachment members  4602 . The attachment member  4602  is locked in position by attaching an anchor  4620  to each suture portion  4612 . The anchor  4620  may take any suitable form that is capable of securing an attachment member  4602  to the band  4500  and tissue member  4601 . For example, the anchor  4620  can take any of the forms described in the present application (See, for example,  FIGS. 59-61 ). In certain embodiments, the suture portions  4612  of adjacent attachment members are tensioned together using a single anchor (e.g., similar to the cinching of sutures  712  of the pairs of attachment members  602  disclosed in  FIGS. 5 through 10A-10F ). In yet another exemplary embodiment, the suture is not cut between attachment members and an anchor  4620  is provided only after the last attachment member  4602  is deployed (See  FIGS. 33A-33D and 44A-44D ) 
     After the annuloplasty band  4500  is attached to the tissue member  4601  by one or more attachment members  4602 , a pulling force is applied to the main chord  4502  of the band  4500 , which causes a cinching effect on the band  4500 . The cinching of the band  4500  causes the attachment member  4602  to provide a force on the tissue member  4601 , such that the cinching effect occurs with the tissue member  4601 . Once the tissue member  4601  is reduced by a desired amount, the main chord  4502  of the band is fixed to keep the tissue member in the desired reduced state. 
     The attachment members  4602  can be disposed such that the distance D between each of the attachment members  4602  is the same or different. In exemplary procedures, the distance D can be between about 3 mm and about 30 mm, such as between about 8 mm and about 25 mm, such as between about 13 mm and about 20 mm, such as about 15 mm. In certain embodiments, the distance D is between about 5 mm and about 15 mm, such as between about 8 mm and about 12 mm, such as about 10 mm. If an even load distribution is desired, the distance D between each of the attachment members  4602  should be substantially the same. If an uneven load is desired, the distance D between each of the attachment members  4602  can be different. In one exemplary embodiment, the distance D between the attachment members  4602  disposed at the ends of the annuloplasty band  4500  is smaller than the distance D between the attachment members disposed on the middle portion of the annuloplasty band. 
     Referring to  FIGS. 47 and 48A-48D , another exemplary procedure for mitral annuloplasty is shown using the exemplary valve repair device  4600  ( FIGS. 46A and 46B ). The mitral annuloplasty procedure is used to correct a dysfunctional mitral valve MV. As described above, in certain situations, the anterior leaflet  705  and the posterior leaflet  706  of the mitral valve MV may not coapt (e.g., see mitral valve MV having gap  4808  in  FIGS. 48A-48D ), which could lead to regurgitation of blood through the mitral valve. The exemplary mitral annuloplasty procedure provides annular support to the mitral valve by reducing the size of the annulus, which allows the leaflets to properly coapt. 
     Referring to  FIG. 47 , the valve repair device  4600  enters the left ventricle LV through the apex A of the heart H. After the valve repair device  4600  enters the left ventricle LV, the repair device engages the mitral valve MV. The valve repair device  4300  is configured to attach an annuloplasty band  4500  to the mitral valve MV by one or more attachment members  4602  (as shown in  FIGS. 48A-48D ). The valve repair device  4600  may take any suitable form that is capable of entering the left ventricle LV through the apex A of the heart H and attaching an annuloplasty band  4500  to the mitral valve MV by one or more attachment members  4602 , such as, for example, any form described in the present application. The attachment member  4602  may take any suitable form that is capable of attaching the annuloplasty band  4500  to the mitral valve, such as, for example, any form described in the present application. 
     The exemplary mitral annuloplasty procedure includes attaching the annuloplasty band  4500  to the annulus  700  of the mitral valve with one or more attachment members  4602 . In addition, the exemplary procedure includes tensioning a main chord  4502  ( FIGS. 45A-45B ) of the band  4500  (and, as a result, the one or more attachment members  4602 ) to reduce the size of the annulus, and, subsequently, fixing the main chord  4502  of the band  4500  once a desired reduction of the size of the annulus is achieved. That is, similar to the exemplary procedure shown in  FIGS. 46A and 46B , the valve repair device  4500  is configured to engage the annulus of the mitral valve MV from the left ventricle LV, attach an annuloplasty band  4500  to the annulus by one or more attachment members  4602 , and applying a force to the main chord  4502  of the band  4500  to reduce the size of the annulus. The main chord  4502  can be made of an ePTFE suture, a braid of suture, or any other suitable material.  FIGS. 48A and 48C  illustrate the mitral valve MV from the perspective of line A-A shown in  FIG. 47  (e.g., illustrating the mitral valve MV from the left atrium LA), and  FIGS. 48B and 48D  illustrate the mitral valve MV from the perspective of line B-B shown in  FIG. 47  (e.g., illustrating the mitral valve MV from the left ventricle LV). 
     Referring to  FIGS. 48A and 48B , in a first step of the exemplary mitral annuloplasty procedure, the valve device  4600  attaches the annuloplasty band  4500  to the annulus  700  by two or more attachment members  4602 . In the illustrated embodiment, the device  4000  attaches the band  4500  to the annulus  700  with nine attachment members  4602 . In alternative embodiments, between 2 attachment members and 20 attachment members can be used, such as between 4 attachment members and 18 attachment members, such as between 6 attachment members and 16 attachment members, such as between 8 attachment members and 14 attachment members, such as between 10 attachment members and 12 attachment members, such as 11 attachment members. In certain embodiments, the device  4600  can attach the band  4500  to the annulus  700  by more than 20 attachment members. Referring to  FIG. 48A , the securing portions  4610  ( FIGS. 46A-46B ) of the attachment members  4602  extend into the left atrium LA. Referring to  FIG. 48B , the annuloplasty band  4500  is attached to the annulus  700  in the left ventricle LV, and the attachment members  4602  are locked to the annulus  700  and the band  4500  by anchors  4620 . In addition, the band  4500  is attached to the annulus such that providing a pulling force to the main chord  4502  of the band  4500  will cause the band  4500  and attachment members  4602  to reduce the size of the annulus  700 . 
     Referring to  FIGS. 48C and 48D , in a second step of the exemplary mitral annuloplasty procedure, a force is applied to the main chord  4502  of the band  4500  in the direction X ( FIG. 48D ) to create a cinching effect on the annulus  700 . The force applied to the main chord  4502  causes a reduction in size of the annulus  700 , which causes the anterior leaflet  705  and the posterior leaflet  706  to coapt (e.g., the force causes the gap  4808  to close, as shown in  FIGS. 48C and 48D ). The proper coaptation between the anterior leaflet  705  and the posterior leaflet  706  prevents regurgitation of blood from the left ventricle LV to the left atrium LA through the mitral valve MV. Once the anterior leaflet  705  and the posterior leaflet  706  properly coapt, the main chord  4502  is fixed such that the size of the annulus remains in the reduced state. In one example, the main chord  4502  can be fixed to an interior wall  4701  ( FIG. 47 ) of the left ventricle LV. For example, the main chord  4502  can be fixed on an interior wall  4701  near the location of insertion by the valve repair device  4600  through the apex A so that main chord  4502  is conveniently accessible by the valve repair device if the amount of force applied on the main chord  4502  needs to be altered to reduce or expand the size of the annulus. In alternative examples, the main chord  4502  can be fixed on any other location of the interior wall  4701  of the left ventricle LV that is accessible by the valve repair device  4600 , or the suture may be fixed to the end of the band  4500  by an anchor  5900  (See, for example,  FIGS. 61A-61C ). 
     Adjacent attachment members  4602  can be placed any distance apart from each other that allows the attachment members  4602  to attach the annuloplasty band  4500  to the annulus  700  and be tensioned to repair at least a portion of the mitral valve MV. In certain exemplary procedures, the adjacent attachment members  4602  can be positioned at different distances apart from each other as compared to other adjacent attachment members. 
     Referring to  FIGS. 49 and 50A-50D , another exemplary procedure for mitral annuloplasty is shown using the exemplary valve repair device  4900 . The mitral annuloplasty procedure is used to correct a dysfunctional mitral valve MV. The valve repair device  4900  has the same features as the valve repair device  4600  ( FIGS. 46A and 46B ), except that it is configured to enter the left atrium LA through the atrial septum of the heart H. For example, in addition to the features of the valve repair device  4600 , the valve repair device  4900  may include the features of the devices described in U.S. Pat. No. 7,635,386 and U.S. Patent Application Publication No. 2014/0114404 A1, which are hereby incorporated by reference in their entirety. The mitral annuloplasty procedure is used to correct a dysfunctional mitral valve MV. As described above, in certain situations, the anterior leaflet  705  and the posterior leaflet  706  of the mitral valve MV may not coapt (e.g., see mitral valve MV having gap  5008  in  FIGS. 50A-50D ), which could lead to regurgitation of blood through the mitral valve. The exemplary mitral annuloplasty procedure provides annular support to the mitral valve by reducing the size of the annulus, which allows the leaflets to properly coapt. 
     Referring to  FIG. 49 , the valve repair device  4900  enters the left atrium LA through the atrial septum of the heart H. After the valve repair device  4900  enters the left atrium LA, the repair device engages the mitral valve MV. The valve repair device  4900  is configured to attach an annuloplasty band  4500  to the mitral valve MV by one or more attachment members  4602  (as shown in  FIGS. 50A-50D ). The attachment member  4602  may take any suitable form that is capable of attaching the annuloplasty band  4500  to the mitral valve, such as, for example, any form described in the present application. 
     The exemplary mitral annuloplasty procedure includes attaching the annuloplasty band  4500  to the annulus  700  of the mitral valve with one or more attachment members  4602 . In addition, the exemplary procedure includes tensioning a main chord  4502  ( FIGS. 45A-45B ) of the band  4500  (and, as a result, the one or more attachment members  4602 ) to reduce the size of the annulus, and, subsequently, fixing the main chord  4502  of the band  4500  once a desired reduction of the size of the annulus is achieved. That is, similar to the exemplary procedure shown in  FIGS. 46A and 46B , the valve repair device  4900  is configured to engage the annulus of the mitral valve MV from the left atrium LA, attach an annuloplasty band  4500  to the annulus by one or more attachment members  4602 , and applying a force to the main chord  4502  of the band  4500  to reduce the size of the annulus. The chord  4502  can be made of an ePTFE suture, a braid of suture, or any other suitable material.  FIGS. 50A and 50C  illustrate the mitral valve MV from the perspective of line A-A shown in  FIG. 49  (e.g., illustrating the mitral valve MV from the left atrium LA), and  FIGS. 50B and 50D  illustrate the mitral valve MV from the perspective of line B-B shown in  FIG. 49  (e.g., illustrating the mitral valve MV from the left ventricle LV). 
     Referring to  FIGS. 50A and 50B , in a first step of the exemplary mitral annuloplasty procedure, the valve device  4900  attaches the annuloplasty band  4500  to the annulus  700  by two or more attachment members  4602 . In the illustrated embodiment, the device  4900  attaches the band  4500  to the annulus  700  with nine attachment members  4602 . In alternative embodiments, between 2 attachment members and 20 attachment members can be used, such as between 4 attachment members and 18 attachment members, such as between 6 attachment members and 16 attachment members, such as between 8 attachment members and 14 attachment members, such as between 10 attachment members and 12 attachment members, such as 11 attachment members. In certain embodiments, the device  4900  can attach the band  4500  to the annulus  700  by more than 20 attachment members. Referring to  FIG. 50B , the securing portions  4610  ( FIGS. 46A-46B ) of the attachment members  4602  extend into the left atrium LA. Referring to  FIG. 50A , the annuloplasty band  4500  is attached to the annulus  700  in the left ventricle LV, and the attachment members  4602  are locked to the annulus  700  and the band  4500  by anchors  4620 . In addition, the band  4500  is attached to the annulus such that providing a pulling force to the main chord  4502  of the band  4500  will cause the band  4500  and attachment members  4602  to reduce the size of the annulus  700 . 
     Referring to  FIGS. 50C and 50D , in a second step of the exemplary mitral annuloplasty procedure, a force is applied to the main chord  4502  of the band  4500  in the direction X ( FIG. 50C ) to create a cinching effect on the annulus  700 . The force applied to the main chord  4502  causes a reduction in size of the annulus  700 , which causes the anterior leaflet  705  and the posterior leaflet  706  to coapt (e.g., the force causes the gap  5008  to close, as shown in  FIGS. 50C and 50D ). The proper coaptation between the anterior leaflet  705  and the posterior leaflet  706  prevents regurgitation of blood from the left ventricle LV to the left atrium LA through the mitral valve MV. Once the anterior leaflet  705  and the posterior leaflet  706  properly coapt, the main chord  4502  is fixed such that the size of the annulus remains in the reduced state. In one example, the main chord  4502  can be fixed to an interior wall  4901  ( FIG. 49 ) of the left atrium LA. For example, the main chord  4502  can be fixed on an interior wall  4901  near the location of insertion by the valve repair device  4900  through the atrial septum so that main chord  4502  is conveniently accessible by the valve repair device if the amount of force applied on the main chord  4502  needs to be altered to reduce or expand the size of the annulus. In alternative examples, the main chord  4502  can be fixed on any other location of the interior wall  4901  of the left atrium LA that is accessible by the valve repair device  4900 , or the suture may be fixed to the end of the band  4500  by an anchor  5900  (See, for example,  FIGS. 61A-61C ). 
     Adjacent attachment members  4602  can be placed any distance apart from each other that allows the attachment members  4602  to attach the annuloplasty band  4500  to the annulus  700  and be tensioned to repair at least a portion of the mitral valve MV. In certain exemplary procedures, the adjacent attachment members  4602  can be positioned at different distances apart from each other as compared to other adjacent attachment members. 
     Referring to  FIG. 16A , in certain embodiments, the exemplary procedure for mitral annuloplasty shown in  FIGS. 49 and 50A-50D  can be completed with a transatrial procedure using valve repair device  1600 ′. Referring to  FIG. 16A , the valve repair device  1600 ′ enters the left atrium LA through an outer wall of the heart H. After the valve repair device  1600 ′ enters the left atrium LA, the repair device engages the mitral valve MV. The valve repair device  1600 ′ is configured to attach an annuloplasty band  4500  to the mitral valve MV by one or more attachment members  4602  (as shown in  FIGS. 50A-50D ). The attachment member  4602  may take any suitable form that is capable of attaching the annuloplasty band  4500  to the mitral valve, such as, for example, any form described in the present application. The valve repair device  1600 ′ may take any suitable form that is capable of entering the left atrium LA through an outer wall of the heart H and attaching the annuloplasty band  4500  to the mitral valve by one or more attachment members. For example, the valve repair device  1600 ′ can take the form of the devices described in U.S. Pat. No. 7,635,386 and U.S. Patent Application Publication No. 2014/0114404 A1, which are hereby incorporated by reference in their entirety. 
     While the valve repair devices  4600 ,  4900 ,  1600 ′ and the exemplary annuloplasty procedures provided above are described with reference to repairing the mitral valve MV, it should be understood that the valve repair devices and the concepts used in the exemplary mitral annuloplasty procedures can be used to repair any native valve. For example, the valve repair devices  4600 ,  4900 ,  1600 ′ and the concepts of the exemplary annuloplasty procedures described above can be used to repair the aortic valve AV, the tricuspid valve TV, and the pulmonary valve PV. 
     Referring to  FIGS. 51A-51C , another exemplary embodiment of an annuloplasty band  5100  includes a first end  5102  and a second end  5104 . The band  5100  is capable of being configured so that the band  5100  matches the shape of the annulus of the patient. That is, referring to  FIG. 51A , the band  5100  has an original shape that matches the annulus of the patient. The band  5100  is made of an elastic material that allows the band to be placed through a small tube (e.g., a tube of a valve repair device) that causes the band to take the form of the tube, and the band  5100  is configured to return to its original shape upon being deployed out of the small tube. For example, the band  5100  can be made of Nitinol or another shape memory alloy. In the illustrated embodiment, the band  5100  includes an inner wire  5106 , an outer wire  5108 , and a cover  5110  that extends over the inner wire and the outer wire. The inner wire  5106  and the outer wire  5108  can be made of a metal material, such as, for example, Nitinol or another shape memory alloy. The cover  5110  can be made out of, for example, a knit cloth, a woven cloth, PTFE, ePTFE, etc. 
       FIG. 51B  is a cross-sectional view of the band  5100  shown from the perspective of lines A-A. Referring to  FIG. 51B , in certain embodiments, the first end  5102  and the second end  5104  of the band  5100  overlap when the band  5100  when the band is in its original shape.  FIG. 51C  is a cross-sectional view of the band  5100  shown from the perspective of lines B-B. 
     Referring to  FIGS. 52A-52C , another exemplary embodiment of an annuloplasty band  5200  includes a first end  5202  and a second end  5204 . The band  5200  is capable of being configured so that the band  5200  matches at least a portion of the shape of the annulus of the patient. That is, referring to the embodiment illustrated in  FIG. 52A , the band  5200  has an original shape that substantially matches the annulus of the patient&#39;s mitral valve. In alternative embodiments, the original shape of the band  5200  can match a portion of the shape of the annulus of the patient (e.g., the band  5200  can match only half of the patient&#39;s annulus). The band  5200  is made of an elastic material that allows the band to be placed through a small tube (e.g., a tube of a valve repair device) that causes the band to take the form of the tube, and the band  5200  is configured to return to its original shape upon being deployed out of the small tube. For example, the band  5200  can be made of Nitinol or another shape memory alloy. In the illustrated embodiment, the band  5200  includes an inner wire  5206 , an outer wire  5208 , and a cover  5210  that extends over the inner wire and the outer wire. The inner wire  5206  and the outer wire  5208  can be made of a metal material, such as, for example, Nitinol. The cover  5210  can be made out of, for example, a knit fabric, a woven cloth, PTFE, ePTFE, etc. 
       FIG. 52B  is a cross-sectional view of the band  5200  shown from the perspective of lines A-A. Referring to  FIG. 52B , in certain embodiments, the first end  5102  and the second end  5104  of the band  5100  do not overlap when the band  5200  when the band is in its original shape.  FIG. 52C  is a cross-sectional view of the band  5200  shown from the perspective of lines B-B. 
     Referring to  FIGS. 53-58 , another exemplary procedure for mitral annuloplasty is shown using an exemplary embodiment of a valve repair device  5300 . The mitral annuloplasty procedure is used to correct a dysfunctional mitral valve MV. As described above, in certain situations, the anterior leaflet and the posterior leaflet of the mitral valve MV may not coapt, which could lead to regurgitation of blood through the mitral valve. The exemplary mitral annuloplasty procedure provides annular support to the mitral valve by reducing the size of the annulus, which allows the leaflets to properly coapt. 
     Referring to  FIGS. 53 and 54 , the valve repair device  5300  enters the left ventricle LV through the apex A of the heart H. After the valve repair device  5300  enters the left ventricle LV, the repair device engages the mitral valve MV. The valve repair device  5300  is configured to attach the exemplary annuloplasty band  5100  shown in  FIGS. 51A-51C  to the mitral valve MV by one or more attachment members  5402  ( FIG. 54 ). In an alternative procedure, the device  5300  is configured to attach the exemplary annuloplasty band  5200  shown in  FIGS. 52A-52C  to the mitral valve by one or more attachment members. The valve repair device  5300  may take any suitable form that is capable of entering the left ventricle LV through the apex A of the heart H and attaching an annuloplasty band  5100  (or, alternatively, annuloplasty band  5200 ) to the mitral valve MV by one or more attachment members  5402 . For example, the device  5300  may take a similar form to the device  4600  shown in  FIGS. 46A and 46B , or the form of any device described in the present application. The attachment member  5402  may take any suitable form that is capable of attaching the annuloplasty band  5100  (or band  5200 ) to the mitral valve, such as, for example, any form described in the present application. 
     The exemplary mitral annuloplasty procedure includes attaching the annuloplasty band  5100  to the annulus of the mitral valve MV with one or more attachment members  5402 . The band  5100  (or band  5200 ) is deployed by the valve repair device  5300  such that the band is abutting the annulus. The band  5100  is maintained on the annulus by a holding tool (not shown) of the device  5300  to allow the device  5300  to attach the one or more attachment members to the band  5100  and the annulus. In an alternative procedure, a separate holding tool (e.g., a holding tool that is not a part of the device  5300 ) is used to maintain the band  5100  on the annulus. The holding tool of the device  5300  (or the separate holding tool) can be, for example, an L-shaped tool, a vacuum tool, a suction tool, a lanyard, etc. In certain procedures, the band  5100  (or band  5200 ) is maintained on the annulus by friction. 
     As described above, the annuloplasty band  5100  (and annuloplasty band  5200 ) is made of an elastic material and/or a shape memory material that is configured to return to its original shape upon being deployed by the device  5300 . The original shape of the band  5100  is made such that, when the band is attached to the annulus, the band has a shaping effect on the annulus, which corrects the size and/or shape of the annulus. Referring to  FIG. 54 , the annuloplasty band  5100  (or annuloplasty band  5200 ) is attached to a top surface of the annulus. In an alternative embodiment, the annuloplasty band can be attached to a bottom surface of the annulus. 
     Referring to  FIGS. 55-58 , the annuloplasty band  5100  ( FIGS. 51A-51C and 55-56 ) or the annuloplasty band  5200  ( FIGS. 52A-52C and 57-58 ) is shown after it is attached to the annulus  700  by an exemplary embodiment of an attachment member  5402 . The attachment member  5402  includes an atrial portion  5510  that attaches above the top surface  5501  of the annulus  700  and extends into the left atrium LA. In addition, the attachment member  5402  includes a ventricular portion  5512  below the bottom surface  5503  of the annulus  700  and extends into the left ventricle. In certain embodiments, the attachment member  5402  can be similar to the attachment member  2102  shown in  FIGS. 21-24 . In the illustrated embodiment, the atrial portion  5510  and the ventricular portion  5512  of the attachment member  5402  are knots that are connected by a suture portion  5516 . The atrial portion  5510  is configured to prevent the attachment member  5402  from being removed from the annulus  700  when a force is applied to the ventricular portion  5512 , and the ventricular portion  5512  is configured to prevent the attachment member  5402  from being removed from the annulus when a force is applied to the atrial portion  5510 . The attachment members  5402  attach the annuloplasty band  5100 ,  5200  to the annulus  700  by a valve repair device  5300 , which may take any suitable form, such as, for example, any form described in the present application. The valve repair device  5300  may enter the left atrium LA or the left ventricle LV, such as, for example, by any means provided in the present application, in order to attach the attachment members  5402  to the band  5100 ,  5200  and the annulus  700 . 
       FIGS. 55 and 56  illustrate the annuloplasty band  5100  ( FIGS. 51A-51C ) shown from the perspective of line C-C ( FIG. 51A ) after the band  5100  is attached to the annulus  700  by an attachment member  5402 . That is, the first end  5102  of the band  5100  is overlapped with the second end  5104  of the band  5100 , and an attachment member  5402  is attaching the first end  5102  and second end  5104  of the band  5100  to the annulus  700  in order to secure the band  5100  to the annulus  700 . Referring to  FIG. 55 , the band  5100  is attached to the top surface  5501  of the annulus  700 . Referring to  FIG. 56 , the band  5100  is attached to the bottom surface  5503  of the annulus  700 . While the band  5100  is described as being attached to the annulus  700  at the first end  5102  and the second end  5104  of the band  5100 , in certain embodiments, one or more attachment members  5402  are also attached throughout the remainder of the band  5100  in order to secure the band  5100  to the annulus  700 . 
       FIGS. 57 and 58  illustrate the annuloplasty band  5200  ( FIGS. 52A-52C ) shown from the perspective of line C-C ( FIG. 52A ) after the band  5200  is attached to the annulus  700  by an attachment member  5402 . That is, the first end  5202  of the band  5200  is attached to the annulus  700  by an attachment member  5402  in order to secure the band  5200  to the annulus  700 . In addition, although not shown in the illustrated embodiment, the second end  5204  of the band  5200  is attached to the annulus by another attachment member  5402 . Referring to  FIG. 57 , the band  5200  is attached to the top surface  5501  of the annulus  700 . Referring to  FIG. 58 , the band  5200  is attached to the bottom surface  5503  of the annulus  700 . While the band  5200  is described as being attached to the annulus  700  at the first end  5202  and the second end  5204  of the band  5200 , in certain embodiments, one or more attachment members  5402  are also attached throughout the remainder of the band  5200  in order to secure the band  5200  to the annulus  700 . 
     The shapes of the annuloplasty bands  5100 ,  5200  can optionally be adjusted after they have been attached to an annulus. For example, the bands  5100 ,  5200  may include a chord  4502  (See  FIGS. 45A-45B ) that is used to change the size and/or shape of the band  5100 ,  5200  and attached annulus. In other exemplary embodiments, the annuloplasty bands  5100 ,  5200  include other mechanisms for changing the shape and/or size of the annulus  700 . 
     In alternative embodiments, the annuloplasty bands  5100 ,  5200  are attached by attachment members  5402  that require an anchor member to be secured to the annulus  700 . For example, the attachment member  5402  can include a securing portion (not shown) and a suture portion (not shown), such as, for example, the attachment member  602  shown in  FIGS. 5 through 19A-19F ; an attachment member having a securing portion, a suture portion, and a ring (e.g., see  FIGS. 63A-63B and 64 ); a T-shaped attachment member (e.g., see  FIGS. 61A-61B and 62 ), or any other embodiment of an attachment member that requires an anchor member to be secured to the annulus  700 . The anchor member can take any suitable form that is capable of securing the attachment member  5402  to the annulus  700 , such as, for example, any form described in U.S. Pat. No. 9,078,645, which is herein incorporated by reference in its entirety or any of the anchors disclosed in this application. 
     Referring to  FIGS. 59A-59B and 60 , another exemplary embodiment of an anchor member  5900  includes a compression portion  5902 , an abutment portion  5904 , a placement member  5906 , and an opening  5910  that extends through the abutment portion  5904  and the compression portion  5902 . The opening  5910  is configured to receive a suture portion  5915  of an attachment member. The compression portion  5902  is configured to compress the suture portion  5906  of an attachment member to prevent the attachment member from moving. The placement member  5906  is configured to expand the compression portion  5902  so that the opening  5910  has a larger diameter D than the diameter X of the suture portion  5915 . The placement member  5906  allows the anchor member  5900  to be moved along the suture portion  5915  so that the anchor member  5900  can be placed in a desired location on the suture portion  5915 . Once the anchor member  5900  is placed in a desired location, the placement member  5906  can be removed from the anchor member  5900 , which causes at least a portion of the compression member  5902  to compress such that the diameter D of at least a portion of the opening  5910  is less than the diameter X of the suture portion  5915 . That is, the compression portion  5902  is made of an elastic material or a shape memory material, such as, for example, plastic, steel, shape memory alloy material, such as Nitinol, any combination of these materials, and the like. The compression portion  5902  is made so that it has an original shape (e.g., the shape of the compression portion  5902  that is shown in  FIG. 59C ). The original shape of the compression portion  5902  makes at least a portion of the opening  5910  have a smaller diameter D than the diameter X of the suture portion  5915 . The placement member  5906  is configured to expand the compression portion  5902  such that the entire opening  5910  has a diameter D that is larger than the diameter X of the suture portion  5915 , which allows the anchor member  5900  to be moved up and down the suture portion  5915 . For example, the placement member  5906  may be a cylindrical sleeve. Upon removing the placement member  5906 , the compression portion  5902  moves back to its original shape, which causes at least a portion of the compression portion  5902  to compress and secure the suture portion  5915  in a desired position/location with respect to the compression portion  5902 . Referring to  FIG. 59C , in the illustrated embodiment, the anchor member  5900  is configured such that a lower portion  5908  of the compression portion  5902  is configured to compress the suture portion  5915 . In alternative embodiments, any other portion of the compression portion may be used to compress the suture portion  5915 , or the entire compression portion  5902  can compress the suture  5915 . The abutment portion  5904  is configured to abut against an object that the attachment member is attached to, such as, for example, the annulus, an annuloplasty band, or any other object that the attachment member is attached to. The anchor member  5900  can be made of, for example, plastic, metal, steel, shape memory alloys, combinations of these materials, and the like. The placement member  5906  can be removed by holding the anchor in place and pulling the placement member  5906  or holding the placement member in place and advancing the anchor. 
       FIGS. 60A-60C  illustrate the exemplary anchor member  5900  attaching an exemplary embodiment of an attachment member  5402  to a tissue member  6001  (e.g., the annulus of the mitral valve, the annulus of the tricuspid valve, etc.). In the illustrated embodiment, the attachment member  5402  is a T-shaped attachment member that includes a securing portion  6010  and a suture portion  6015 . The securing portion  6010  abuts a second side  6003  of the tissue member  6001 , and the suture portion extends through the tissue member  6001  to a first side  6002  of the tissue member  6001 . After the attachment member  5402  is attached to the tissue member  6001 , the attachment member  5402  is secured to the tissue member  6001  by the anchor member  5900 . Referring to  FIG. 60A , the anchor member  5900  is moved along the suture portion  6015  with the placement member  5906  maintaining the opening  5910  in an expanded state. Referring to  FIG. 60B , the anchor member  5900  is placed in a desired location in which the abutment portion  5904  of the anchor member  5900  is abutting the first side  6002  of the tissue member  6001 . Referring to  FIG. 60C , after the anchor member  5900  is placed in a desired location, the placement member  5906  is removed, which causes a lower portion  5908  of the compression portion to compress against the suture portion  6015 . The compression by the compression portion  5902  on the suture portion  6015  secures the attachment member  5402  to the tissue member  6001 . 
       FIGS. 61A-61C  illustrate the exemplary anchor member  5900  attaching an exemplary embodiment of an attachment member  5402  to a tissue member  6101  (e.g., the annulus of the mitral valve, the annulus of the tricuspid valve, etc.). In the illustrated embodiment, the attachment member  5402  includes a first securing portion  6110 , a second securing portion  6111 , a suture portion  6115 , and a ring  6112 . The suture portion  6115  is fixed to the first securing portion  6110 . The first securing portion  6110  abuts a second side  6103  of the tissue member  6101 , and the suture portion  6115  extends through the tissue member  6101  to a first side  6102  of the tissue member  6101 . The second securing portion  6111  is slideably coupled to the suture portion  6115  by the ring  6112 . The second securing portion  6111  and ring  6112  is located on a first side  6102  of the tissue member  6101 . After the attachment member  5402  is attached to the tissue member  6101 , the attachment member  5402  is secured to the tissue member  6101  by the anchor member  5900 . Referring to  FIG. 61A , the anchor member  5900  is moved along the suture portion  6115  with the placement member  5906  maintaining the opening  5910  in an expanded state. Referring to  FIG. 61B , the anchor member  5900  is placed in a desired location in which the abutment portion  5904  of the anchor member  5900  is abutting the second securing portion  6111 , which causes the second securing portion  6111  to compress the ring  6112  against the first side  6102  of the tissue member  6101 . Referring to  FIG. 61C , after the anchor member  5900  is placed in a desired location, the placement member  5906  is removed, which causes a lower portion  5908  of the compression portion to compress against the suture portion  6115 . The compression by the compression portion  5902  on the suture portion  6115  secures the attachment member  5402  to the tissue member  6101 . 
     Referring to  FIGS. 62 and 63 , another exemplary embodiment of an anchor member  6200  includes three or more flap members  6202 . The illustrated embodiment shows an anchor member  6220  that has three flap members  6202 . In alternative embodiments, the anchor member  6200  can have four flap members, five flap members, etc. The flap members  6202  are deflectable, such that each of the flap members  6202  can move from an open position ( FIG. 62 ) to a closed position ( FIG. 63 ). For example, a set shape of the flap members can be the closed position and the flap members can be help in the open position by a placement member. When the placement member is removed, the flap members can spring back toward the closed position from the open position. 
     An opening  6204  is provided at a center location between the flap members  6202 . When one or more of the flap members  6202  are in the open position, the opening  6204  is configured such that the anchor member  6200  can be moved along a suture portion of an attachment member. When all of the flap members  6202  are in the closed position, the opening  6204  is configured to compress the suture portion of an attachment member such that the suture portion is constrained in a radial direction. The anchor member  6200  is deployed in the open position and moved to a desired location on a suture portion of an attachment member. Once the anchor member  6200  is in the desired position, the flap members  6202  are simultaneously moved from the open position to the closed position. The flap members  6202  provide a force in the radial direction to secure the attachment member to a tissue member (e.g., to secure the attachment member to the annulus of the mitral valve). Alternatively, the flap members  6202  can be moved from the open position to the closed position in a sequential order or random order. During this alternative procedure, a tortuous path is created with multiple holding points on the suture portion of the attachment member, which will increase the holding force on suture portions that have higher surface lubricities. The holding forces applied by the anchor member  6202 , in effect, create a tourniquet around the suture portion. The anchor can be made from a wide variety of different materials. For example, the anchor member  6202  can be made from plastic, metal, such as steel, shape memory alloys, such as Nitinol, any combination of these materials, and the like. The anchor member can be deployed by any suitable device, such as, for example, any of the valve repair devices disclosed in the present application. 
     The anchor members  5900 ,  6200 , as well as any other anchor members described in the present application, can be used to secure any of the attachment members described in the present application, and can be used in any of the procedures described in the present application. The anchor members  5900 ,  6200  can also be used in a wide variety of additional procedures. For example, the anchor members  5900 ,  6200  can be used in any procedure that involves approximating a tissue member. In addition, the anchor members  5900 ,  6200  can be used in any application that involves anchoring a suture member in a desired position. The anchor members  5900 ,  6200  can also be used with any type of suture member, such as, for example, any suture member described in the present application. The anchor members  5900 ,  6200  can be used in various applications for repairing or replacing native heart valves. 
     Referring to  FIGS. 64A-64E and 65A-65C , in certain embodiments, the anchor member  6200  can be used with a protecting member  6400 ,  6500 . The protecting member  6400 ,  6500  is configured to prevent friction between the anchor member  6200  and tissue  6403  (e.g., the annulus of the mitral valve), which prevents damage to the tissue. The protecting member  6400 ,  6500  also prevents surface damage to a suture portion  6405  of an attachment member (e.g., any of the attachment members described in the present application) as the attachment member is being held by the anchor member  6200 . 
     Referring to  FIG. 64A , an exemplary embodiment of a device  6401  is shown securing an attachment member  6402  (e.g., any attachment member described in the present application), a protecting member  6400 , and an anchor member  6200  to tissue  6403 . The protecting member  6400  includes a first portion  6407 , a second portion  6408 , and a channel  6410  that extends through the first portion and the second portion. After an attachment member  6402  is placed in a desired position, the device  6401  is used to place the protecting member  6400  on the suture portion  6405  such that the suture portion extends through the channel  6410  and the protecting member can be moved along the suture portion  6405 . That is, the channel  6410  of the protecting member  6400  is configured such that the protecting member can be moved along the suture portion  6405 . The first portion  6407  of the protecting member  6400  is configured to engage the tissue  6403  in order to prevent potential damage to the tissue. The second portion  6408  of the protecting member  6400  is configured to be engaged by the anchor member  6200  to fix the protecting member in a desired location on the suture portion  6405 . In certain embodiments, the protecting member  6400  is made from a compressive material that is able to be adequately compressed to retain the protecting member at a desired location on the suture portion  6405 . For example, the protecting member  6400  is made from a material such that, when the anchor member engages the second portion  6408  of the protecting member, the anchor member  6200  compresses the channel  6410  such that the protecting member  6400  is prevented from moving along the suture portion  6405 . 
     The device  6401  includes a placement member  6406  that is configured to maintain the anchor member  6200  in an open position as the device  6401  moves the anchor member and protecting member  6400  along the suture portion  6405  to a desired position (e.g., a position in which the protecting member is abutting the tissue  6403 ). Once the anchor member  6200  and the protecting member  6400  are in the desired position, the device  6401  allows a user to remove the placement member  6406  from engagement with the anchor member  6200  such that the anchor member is deployed from the device  6401  and moved from the open position to the closed position. Referring to  FIG. 64B , the anchor member  6200  is shown in the closed position and engaging the second portion  6408  of the protecting member  6400  such that the protecting member is maintained in a desired position. 
     Referring to  FIG. 64C , the anchor member  6200  is shown engaging the second portion  6408  of the protecting member  6400  such that a tortuous path is created with multiple holding points A, B on the suture portion  6405  of the attachment member  6402 . The tortuous path increases the holding force on suture portions that have higher surface lubricities. Referring to  FIG. 64D , in certain embodiments, two anchor members  6200  can be used to maintain the protecting member  6400  in a desired location on the suture portion  6405  of the attachment member  6402 . 
     Referring to  FIG. 64E , in some embodiments, the protecting member  6400  is configured to span a tissue wall  6403 . That is, the protecting member  6400  may include a spanning portion  6411  that extends through the tissue wall and a third portion  6409  that is configured to engage the side of the tissue wall  6403  that is opposite the side of the tissue wall that the first portion  6407  engages. The spanning portion  6411  protects the tissue wall from abrasion or other damage by the suture. The third portion  6409  and the first portion  6407  “sandwich” the tissue wall  6403  to prevent relative movement between the protecting member and the tissue wall  6403 . 
     Referring to  FIGS. 65A and 65B , an exemplary embodiment of a device  6501  is shown securing an attachment member  6402  (e.g., any attachment member described in the present application), another exemplary embodiment of a protecting member  6500 , and an anchor member  6200  to a tissue member  6403 . After an attachment member  6402  is placed in a desired position, the device  6501  is used to place the protecting member  6500  on the suture portion  6405  such that the suture portion extends through one or more apertures  6510  and the protecting member can be moved along the suture portion  6405 . That is, the protecting member  6500  has one or more apertures  6510  that are configured to allow the protecting member to be moved along the suture portion  6405 . In the illustrated embodiment, the protecting member  6500  has two apertures  6510 . In alternative embodiments, the protecting member  6500  may have three apertures, four apertures, five apertures, etc. In some embodiments, side slots (not shown) can be incorporated into the apertures  6510  such that the protecting member  6500  can be installed on sutures with conventional knots or with alternative anchor members (e.g., any anchor member described in the present application. The protecting member  6500  is configured to redirect the tension on the suture portion  6405  away from the anchor member  6200  and onto the protecting member  6500 . The protecting member  6500  can be designed with various support forms to assist in redirecting the tension on the suture portion. In certain embodiments, the protecting member  6500  is made from a lubricious material (e.g., ePTFE or the like) such that movement of the protecting member over the suture portion  6405  will not damage the suture portion. 
     The device  6501  includes a placement member  6506  that is configured to maintain the anchor member  6200  in an open position as the device  6501  moves the anchor member and protecting member  6500  along the suture portion  6405  to a desired position (e.g., a position in which the protecting member is abutting the tissue member  6403 ). Once the anchor member  6200  and the protecting member  6500  are in the desired position, the device  6501  allows a user to remove the placement member  6506  from engagement with the anchor member  6200  such that the anchor member is deployed from the device  6501  and moved from the open position to the closed position. Referring to  FIG. 65C , the anchor member  6200  is shown in the closed position and engaging the suture portion  6405  such that the protecting member  6500  is maintained in a desired position. 
     While the protecting members  6400 ,  6500  are shown being used with anchor member  6200 , it should be understood that the protecting members  6400 ,  6500  can be used with any suitable anchor member. For example, the protecting members  6400  can be used with any anchor member described in the present application. 
     Referring to  FIGS. 66 and 67A-67B , an exemplary procedure for mitral annuloplasty is a transatrial procedure using valve repair device  6600  to attach one or more attachment members  6702  to the heart H. Referring to  FIG. 67A , in certain embodiments, the attachment member  6702  includes a securing portion  6710  and a suture portion  6705 , and the suture portion is attached to the outer wall  6703  of the left atrium LA using an anchoring member  6704 . In this embodiment, the anchoring member  6704  attaches the suture portion  6705  to the outer wall  6703  such that a force is applied to the securing portion  6710  of the attachment member  6702  to improve coaptation of the mitral valve MV and prevent regurgitation though the mitral valve MV. Referring to  FIG. 67B , in some situations, more than one attachment member  6702  can be used to improve coaptation of the mitral valve and prevent regurgitation through the mitral valve MV. In the illustrate embodiment, two attachment members  6702  are used during the exemplary mitral annuloplasty procedure. The procedure, however, can include using any number of attachment members  6702 , such as, for example, three attachment members, four attachment members, five attachment members, etc. Referring again to  FIG. 67B , in this embodiment, the suture portion  6705  of both attachment members  6702  are attached to the outer wall  6703  of the left atrium LA using a single anchoring member  6704 . In alternative embodiments, each attachment member  6702  may be secured to the outer wall of the left atrium LA by separate anchoring members  6704 , or some attachment members  6702  may be secured by the same anchoring member  6704  and some attachment members may be secured by a separate anchoring member. The attachment members  6702  may take any suitable form, such as, for example, any form described in the present application. The anchoring members  6704  may take any suitable form, such as, for example, any form described in the present application. 
     Referring to  FIG. 66 , the valve repair device  6600  enters the left atrium LA through an outer wall  6703  of the heart H. After the valve repair device  6600  enters the left atrium LA, the repair device engages the atrial septum  6707  ( FIGS. 67A and 67B ) and/or the anterior wall  6709  ( FIGS. 67A and 67B ) of the left atrium. The valve repair device  6600  is configured to attach one or more attachment members to the heart H. The attachment members  6702  can be attached to the atrial septum  6707  in the right atrium RA and/or could terminate in the anterior wall  6709  of the left atrium LA. The valve repair device  6600  may take any suitable form that is capable of entering the left atrium LA through an outer wall  6703  of the heart H and attaching one or more attachment members to the heart H. For example, the valve repair device  6600  can take the form of the devices described in U.S. Pat. No. 7,635,386 and U.S. Patent Application Publication No. 2014/0114404 A1, which are hereby incorporated by reference in their entirety. In one embodiment, the device  6600  can take the form of the devices described in U.S. Patent Application Publication No. 2016/0008132 A1, which is incorporated herein by reference in its entirety, and the attachment member  6702  can be attached to the heart in any form described in this incorporated reference. 
     Referring to  FIG. 67A , a single attachment member  6702  is used to repair the mitral valve MV. In this example, the securing portion  6710  of the attachment member  6702  is attached to the atrial septum  6707  and is disposed in the right atrium RA of the heart H. The suture portion  6705  of the attachment member extends from the securing portion  6710 , through the atrial septum  6707 , and through the outer wall  6709  of the left atrium LA. The suture portion  6705  is then secured to the outer wall  6703  of the left atrium LA of the heart H by an anchoring member  6704 . The suture portion  6705  is secured such that a force is applied in the direction X to improve coaptation of the mitral valve MV and prevent regurgitation through the mitral valve MV. 
     Referring to  FIG. 67B , one attachment member  6702  is attached to the atrial septum  6707  and disposed in the right atrium RA of the heart H, and another attachment member  6702  is terminated in the anterior wall  6709  of the left atrium LA of the heart H. The suture portion  6705  of each of these attachment members are secured to the outer wall  6703  of the left atrium LA by a single anchoring member  6704 . In an alternative embodiment, the attachment members  6702  are secured by separate anchoring members. In the embodiment shown in  FIG. 67B , one attachment member  6702  is secured such that a force is applied in the direction X, and the other attachment member  6702  is secured such that a force is applied in the direction Y. These forces improve coaptation of the mitral valve MV and prevent regurgitation through the mitral valve. 
     While the various devices and procedures described in the present application refer to engaging and repairing the mitral valve, or procedures for mitral annuloplasty, it should be understood that these devices and procedures can be used in repairing any other native valves (e.g., the tricuspid valve, the pulmonary valve, the aortic valve) or any other portion of the heart. 
     While the exemplary procedures provided in the present application may refer to a first step, a second step, etc., it should be understood that the steps of the procedure can be rearranged and/or intermediate steps can be included in the procedures. 
     While the foregoing is a complete description of the preferred embodiments, various alternatives, modifications, and equivalents can be used. Moreover, it will be obvious that certain other modifications can be practiced within the scope of the appended claims.