A prosthetic heart valve comprising: an outer frame assembly having an atrium portion configured to be disposed in an atrium of a heart, an opposite, ventricle portion configured to be disposed in a ventricle of the heart and an annulus portion (114, 814) configured to be disposed in an annulus of the heart; an inner valve assembly, the inner valve assembly disposed within and coupled to the outer frame assembly, the inner valve assembly and the outer frame assembly defining therebetween an annular region with an open atrium end portion; the outer frame assembly further including an outer frame having an hourglass shaped annulus portion, the annulus portion of the outer frame configured to be disposed at least partially within the annulus of the heart valve, a ventricle portion of the outer frame having a maximum perimeter larger than a maximum perimeter of the annulus portion and the ventricle portion having a minimum perimeter smaller than a minimum perimeter of the annulus portion, and an inner covering disposed about an inner periphery of the outer frame and defining in part the annular region, the inner covering formed of a material substantially impermeable to blood, the inner valve assembly including an inner frame, a covering disposed about a periphery of the inner frame, and a valve leaflet assembly supported on the inner frame, the covering of the inner valve assembly defining in part the annular region and formed of a material substantially impermeable to blood; and a pocket closure coupled between an inner surface of the outer frame assembly and an outer surface of the inner valve assembly and extending between the outer frame assembly and the inner valve assembly to enclose the open atrium end portion of the annular region, forming a thrombus retaining pocket, the pocket closure formed of a material having a porosity that is sufficiently large to allow red blood cells to pass through the pocket closure into the pocket and that is sufficiently small to prevent thrombus formed from the red blood cells to pass through the pocket closure from the pocket, the covering of the inner valve assembly coupled to the inner covering of the outer frame assembly closing a ventricle end of the annular region, opposite the pocket closure an outer frame assembly having an atrium portion configured to be disposed in an atrium of a heart, an opposite, ventricle portion configured to be disposed in a ventricle of the heart and an annulus portion (114, 814) configured to be disposed in an annulus of the heart; an inner valve assembly, the inner valve assembly disposed within and coupled to the outer frame assembly, the inner valve assembly and the outer frame assembly defining therebetween an annular region with an open atrium end portion; the outer frame assembly further including an outer frame having an hourglass shaped annulus portion, the annulus portion of the outer frame configured to be disposed at least partially within the annulus of the heart valve, a ventricle portion of the outer frame having a maximum perimeter larger than a maximum perimeter of the annulus portion and the ventricle portion having a minimum perimeter smaller than a minimum perimeter of the annulus portion, and an inner covering disposed about an inner periphery of the outer frame and defining in part the annular region, the inner covering formed of a material substantially impermeable to blood, the inner valve assembly including an inner frame, a covering disposed about a periphery of the inner frame, and a valve leaflet assembly supported on the inner frame, the covering of the inner valve assembly defining in part the annular region and formed of a material substantially impermeable to blood; and a pocket closure coupled between an inner surface of the outer frame assembly and an outer surface of the inner valve assembly and extending between the outer frame assembly and the inner valve assembly to enclose the open atrium end portion of the annular region, forming a thrombus retaining pocket, the pocket closure formed of a material having a porosity that is sufficiently large to allow red blood cells to pass through the pocket closure into the pocket and that is sufficiently small to prevent thrombus formed from the red blood cells to pass through the pocket closure from the pocket, the covering of the inner valve assembly coupled to the inner covering of the outer frame assembly closing a ventricle end of the annular region, opposite the pocket closure