Patent Description:
Diseased or otherwise deficient cardiac valves can exhibit pathologies such as regurgitation and stenosis. Such valves can be repaired or replaced with prosthetic heart valves using a variety of techniques. For example, an open-heart surgical procedure can be conducted during which the heart can be stopped while blood flow is controlled by a heart-lung bypass machine. Altematively, a minimally invasive percutaneous technique can be used to repair or replace a cardiac valve. For example, in some percutaneous techniques, a valve assembly can be compressed and loaded into a delivery device. which is then passed through a body lumen of the patient to be delivered to the valve site. There is a continuous need for improved valve prostheses for use in such techniques. <CIT> and <CIT> relate to prosthetic heart vavles for replacing mitral valves.

The claimed subject-matter is defined in independent claim <NUM>. Further aspects and preferred embodiments are defined In the dependent claims. Aspects, embodiments and examples of the present disclosure which are not encompassed by the appended claims are not part of the claimed invention and are provided for illustrative purposes.

In some embodiments, a valve prosthesis for implantation into a native cardiac valve site of an individual can include a valve body and a frame supporting the valve body. The frame can include an inlet portion configured to engage the floor of the outflow tract of the native heart atrium and restrict movement of the valve prosthesis in a downstream direction of blood flow at the valve site. In some embodiments, the inlet portion can be substantially s-shaped.

In the claimed embodiments, a valve prosthesis includes a valve body and a frame supporting the valve body. The frame includes a central portion configured to fit securely within an annulus of the valve site, a support arm extending from the central portion and configured to extend over and secure a native valve leaflet, and a chordae guiding element extending from the support arm and configured to engage chordae of the valve site. The chordae guiding element is configured to angle the chordae so that the chordae are stretched to restrict movement of the valve prosthesis in an upstream direction of blood flow at the valve site. The chordae guiding element can be configured to reduce bending of the chordae to reduce stress on the chordae during the cardiac cycle.

In some embodiments, central portion can have an hourglass shape configured to pinch the annulus in order to provide axial fixation of the valve prosthesis within the valve site.

In some embodiments, a valve prosthesis can include a valve body including prosthetic leaflets and a frame secured to the valve body. The frame can include an inlet portion configured to engage the floor of an outflow tract of the native heart atrium and restrict movement of the frame In a downstream direction of blood flow at the valve site. The frame can also include a central portion connected to the inlet portion and configured to fit securely within the native valve annulus. Portions of the outflow end of the frame can be flared to provide a gap between an outflow end of the frame and an outflow end of the prosthetic leaflets when the prosthetic leaflets are fully opened.

The accompanying figures, which are incorporated herein, form part of the specification and illustrate embodiments of a valve prosthesis frame and delivery system. Together with the description, the figures further serve to explain the principles of and to enable a person skilled in the relevant art(s) to make, use, and implant the valve prosthesis described herein.

The claimed subject-matter may be best understood with the help of <FIG>.

The following detailed description refers to the accompanying figures which illustrate several embodiments. Other embodiments are possible. Modifications can be made to the embodiments described herein. Therefore, the following detailed description is not meant to be limiting.

<FIG> illustrates a front view of a simplified drawing of a heart valve prosthesis <NUM> implanted within a mitral valve annulus <NUM> of a mitral valve site <NUM>. Valve prosthesis <NUM> can be configured to be implanted in annulus <NUM> to replace the function of a native heart valve, such as the aortic, mitral, pulmonary, or tricuspid heart valve. In some embodiments, a single valve prosthesis <NUM> can be designed for use with multiple heart valves.

Heart valve prosthesis <NUM> includes a frame <NUM> that supports a prosthetic valve body (not shown). The valve body can be formed, for example, from one or more biocompatible synthetic materials, synthetic polymers, autograft tissue, homograft tissue, xenograft tissue, or one or more other suitable materials. In some embodiments, the valve body can be formed, for example, from bovine, porcine, equine, ovine, and/or other suitable animal tissues. In some embodiments, the valve body can be formed, for example, from heart valve tissue, pericardium, and/or other suitable tissue. In some embodiments, the valve body can comprise one or more valve leaflets. For example, the valve body can be in the form of a tri-leaflet bovine pericardium valve, a bi-leaflet valve, or another suitable valve. In some embodiments, the valve body can comprise three leaflets that are fastened together at enlarged lateral end regions to form commissural joints, with the unattached edges forming coaptation edges of the valve body. The leaflets can be fastened to a skirt, which in turn can be attached to the frame. The upper ends of the commissure points can define an outflow portion corresponding to an outflow end <NUM> of valve prosthesis <NUM>. The opposite end of the valve can define an inflow or distal portion corresponding to an inflow end <NUM> of valve prosthesis <NUM>. As used herein the terms "distal" or "outflow" are understood to mean downstream to the direction of blood flow. The terms "proximal" or "inflow" are understood to mean upstream to the direction of blood flow.

In some embodiments, frame <NUM> itself can be formed entirely or in part by a biocompatible material. In some embodiments, one or more portions of frame <NUM> can be self-expandable and/or balloon expandable. For example, one or more portions of frame <NUM> can be formed from a shape memory alloy, such as certain nitinol (nickel titanium) alloys that can, for example, exhibit shape memory and/or superelasticity.

The actual shape and configuration of valve prosthesis <NUM> can depend upon the valve being replaced. For example, with respect to mitral valves, during a conventional human cardiac cycle, the fibrous skeleton, anterior and posterior leaflets <NUM>, papillary muscles <NUM>, chordae tendinea <NUM>, atrial wall <NUM>, outflow tract <NUM>, and ventricular wall (not shown) can all interplay to render a competent valve. For example, the complex interaction between the leaflets <NUM>, papillary muscles <NUM>, and chordae <NUM> can help maintain the continuity between the atrio-ventricular ring and the ventricular muscle mass, which can help provide for normal functioning of the mitral valve.

In the claimed embodiments, frame <NUM> includes a support arm <NUM> extending from a central portion <NUM> of frame <NUM> and configured to extend over and secure leaflet <NUM>. In particular, upon implantation, support arm <NUM> can be configured to clamp and Immobilize a corresponding leaflet <NUM>, and hold leaflet <NUM> close to central portion <NUM>. In some embodiments, frame <NUM> can include multiple support arms <NUM> with each support arm <NUM> corresponding to a separate native leaflet <NUM>.

In some embodiments, proper seating of valve prosthesis <NUM> within annulus <NUM> can be achieved by capturing one or more native leaflets <NUM> with support arms <NUM>. Radial force generated by valve prosthesis <NUM> in the atrium against support arms <NUM> can create a "sandwich effect," which in some embodiments can seat valve prosthesis <NUM> by pinching leaflets <NUM> and atrial tissue against central portion <NUM>.

In some embodiments, support arm <NUM> can be coated and/or covered with a biocompatible polymer, such as, for example, expanded polyletrafluoroethylene (ePTFE). In some embodiments, a covering can be a biocompatible fabric or other biocompatible material, such as bovine or porcine pericardium tissue.

In some embodiments, support arm <NUM> can be sized or shaped to tension chordae <NUM>. Chordae <NUM> can connect to leaflets <NUM> and can act like "tie rods" in an engineering sense. In some patients. not only can chordae <NUM> help prevent prolapse of the native leaflets <NUM> during systole, they can also help support the left ventricular muscle mass throughout the cardiac cycle. In some embodiments, the tension between chordae <NUM> and leaflets <NUM> can serve to prevent frame <NUM> from lifting into the patient's atrium. In some embodiments, chordae tension can serve to substantially prevent paravalvular leakage. In some embodiments, paravalvular leakage can be substantially prevented by positioning a sealing surface of the valve between inflow end <NUM> and outflow end <NUM>.

In some embodiments, support arms <NUM> can be sized or shaped to increase valve stability. Support arm <NUM> can, for example, serve to substantially prevent leaflets <NUM> from obstructing flow through outflow tract <NUM>. In some embodiments, support arms <NUM> can serve to prevent leaflets <NUM> from interacting with prosthetic leaflets of valve prosthesis <NUM>. In some embodiments, support arm <NUM> can position leaflet <NUM> to minimizing perivalvular leaks and/or maintain proper alignment of the valve prosthesis. In some embodiments, support arm <NUM> can serve to avoid systolic anterior mobility and/or maintain valve stability by preventing migration of the valve into the atrium or ventricle. In some embodiments, support arm <NUM> can be configured to enhance overall frame strength.

In some embodiments, frame <NUM> can include an inlet portion <NUM> configured to engage floor <NUM> of the outflow tract of the native heart atrium. In some embodiments, inlet portion <NUM> can restrict movement of valve prosthesis <NUM> in a downstream direction <NUM> of blood flow at valve site <NUM>.

In some embodiments, inlet portion <NUM> is configured to deform floor <NUM> of the outflow tract in an upstream direction of blood flow at the valve site. For example, the radial force of central portion <NUM> on annulus <NUM> can lift floor <NUM> in an upstream direction to follow the curvature of inlet portion <NUM>. In some embodiments, inlet portion <NUM> can be configured such lifted annulus <NUM> causes chordae <NUM> to be stretched without rupturing. In some embodiments, inlet portion <NUM> can be sized to contact the entirety of floor <NUM> and a portion of atrial wall <NUM>. One example of such a configuration is shown in <FIG>. In some embodiments, inlet portion <NUM> is sized to contact a substantial majority of floor <NUM>. Other suitable configurations can be used. In some embodiments, frame <NUM> can be smaller than annulus <NUM>. In some embodiments, such a configuration can serve to prevent radial force on frame <NUM> from annulus <NUM>, which can serve to maintain a desired shape of a prosthetic valve supported within frame <NUM>.

Because valve prosthesis <NUM> can be used in a portion of the body that undergoes substantial movement, it can be desirable for one or more portions of valve prosthesis <NUM>, such as frame <NUM> to be flexible. For example, in some embodiments, at least a portion of inlet portion <NUM> can have a flexibility from about <NUM> N/m to about <NUM> N/m. In some embodiments, at least a portion of inlet portion <NUM> can have a flexibility of about <NUM> N/m. In some embodiments, inlet portion <NUM> can include one or more diamond-shaped cells. In some embodiments, inlet portion <NUM> can be formed of twisted strands of nitinol.

Central portion <NUM> of frame <NUM>, which can be configured to conform to annulus <NUM>. In some embodiments, such a configuration can help anchor valve prosthesis <NUM> within annulus <NUM> to prevent lateral movement or migration of valve prosthesis <NUM> due to the normal movement during the cardiac cycle of the heart.

Central portion <NUM> can be shaped to adapt to the specific anatomy of an individual. For example, in some embodiments, central portion <NUM> is configured to flex and deform so as to mimic a natural cardiac movement of the heart through the cardiac cycle. In some embodiments, central portion <NUM> is substantially rigid to avoid flexing or deformation during the cardiac cycle.

The shape of central portion <NUM> can be configured to reduce the risk of valve prosthesis migration and perivalvular leakage. In some embodiments, central portion <NUM> can define a substantially circular, oval, elliptical, saddle-shaped, or non-geometric shape. In some embodiments, central portion <NUM> can be formed to have a substantially straight profile (for example, being substantially cylindrical and parallel to a longitudinal axis of frame <NUM>). Central portion <NUM> can have one or more flared portions (for example, diverging away from a longitudinal axis of frame <NUM>).

In some embodiments, central portion <NUM> can be wider than the native valve at annulus <NUM>. In some embodiments, such a configuration can reduce the likelihood of migration of valve prosthesis <NUM> into the ventricle. In some embodiments, such a configuration can improve sealing of valve prosthesis <NUM> against atrial wall <NUM>. In some embodiments, frame <NUM> is designed to provide axial fixation by creating tension in the chordae <NUM>, which can hold inlet portion <NUM> of frame <NUM> against annulus <NUM>. A transition zone between an inflow portion and an outflow portion of frame <NUM> can provide sealing with the anatomy to prevent paravalvular leakage of frame <NUM>. In some embodiments, frame <NUM> is shaped and sized so as to anchor frame <NUM> within annulus <NUM> by itself or in combination with chordae <NUM>.

<FIG> illustrates a cross-sectional view of a frame <NUM> in accordance with an embodiment. Frame <NUM> can include a central portion <NUM> attached to an inlet portion <NUM>. In some embodiments, inlet portion <NUM> can be substantially S-shaped. For example, inlet portion <NUM> can include one or more curves, such as curves <NUM>, <NUM>, and <NUM>, which together can approximate an S-shape. For example, in some embodiments, inlet portion <NUM> includes extension <NUM> that protrudes in a radially outward direction from central portion <NUM> of frame <NUM>. The substantial "S" shape of inlet portion <NUM> can be formed by extension <NUM> bending in a first curve <NUM> from inflow end <NUM> towards outflow end <NUM>, and then bending in a second curve <NUM> back towards inflow end <NUM>. One embodiment of such an S-shape is shown for example in <FIG>. In some embodiments, extension <NUM> can additionally bend in a third curve <NUM> towards a radially inward direction.

In some embodiments, frame <NUM> can include an outer diameter <NUM> of approximately <NUM>, a valve diameter <NUM> of approximately <NUM>, a valve height <NUM> between an outflow end <NUM> of frame <NUM> and an inflow end <NUM> of frame <NUM> of approximately <NUM>, an effective valve height <NUM> between an outflow end <NUM> of frame <NUM> and curve <NUM> of approximately <NUM>, an upper s-shape dimension <NUM> between curve <NUM> and <NUM> of approximately <NUM>, and a lower s-shape dimension <NUM> between curve <NUM> and the first full node of the valve section from inflow end <NUM> of approximately <NUM>.

In some embodiments, inlet portion <NUM> can be configured to contact a patient's atrial anatomy at a lower point on frame <NUM> compared to conventional frame designs. In some embodiments, such a configuration can serve to increase chordal tension. In some embodiments, the shape and size of inlet portion <NUM> can be configured to conform to the shape of the native mitral annulus and left atrium. In some embodiments, such a configuration can result in varying degrees of deformation (e.g., a flattening) of inlet portion <NUM>, which can serve to create an excellent seal between inlet portion <NUM> and the native anatomy. In some embodiments, one or more of the above configurations can serve to reduce paravalvular leakage compared to other frame designs.

Inlet portion <NUM> can be configured to maintain contact throughout a patient's cardiac cycle. In some embodiments, changes in chordal tension can be accommodated by partially flattening inlet portion <NUM>. In some embodiments, the flattening of inlet portion <NUM> can hold a spring load. In some embodiments, as changes in the chordal tension throughout the cardiac cycle occur, the spring load can serve to maintain contact and sealing with the tissue despite the changing tension.

<FIG>, <FIG> illustrate a frame <NUM>. <FIG> illustrates a front view of frame <NUM>. <FIG> illustrates a view of frame <NUM> implanted in a native mitral valve site <NUM> and <FIG> illustrates an enlarged view of a portion of <FIG>. Valve site <NUM> includes an annulus <NUM>, native leaflets <NUM>, chordae <NUM>, and papillary muscles <NUM>.

Frame <NUM> includes support arms <NUM>, inlet portion <NUM>, and a central portion <NUM>. A partially hourglass-shaped central portion <NUM> of frame <NUM> is configured to pinch a muscular ridge of annulus <NUM> to provide axial fixation of frame <NUM> within valve site <NUM>. The hourglass shape portion of frame <NUM> can be located on central portion <NUM> corresponding to the location of the commissures of the native valve within the valve site. One example of such a configuration is shown in <FIG>. Other suitable configurations can be used. In some embodiments, a portion of central portion <NUM> is angled about <NUM> degrees from the angle of support arms <NUM>. Frame <NUM> can also provide axial fixation by creating chordal tension of chordae <NUM>.

<FIG> illustrate a valve prosthesis <NUM>. <FIG> illustrates a front view of a valve prosthesis <NUM>. <FIG> illustrates a top view of valve prosthesis <NUM>. Valve prosthesis <NUM> includes a valve body <NUM> supported within a frame <NUM>. Frame <NUM> includes an inlet portion <NUM>, an hourglass shaped central portion <NUM> and support arms <NUM>. Support arms <NUM> can be configured to capture leaflets during delivery of prosthesis <NUM>. Central portion <NUM> can pinch a muscular ridge of the native annulus. The hourglass shape of frame <NUM> can be located on central portion <NUM> around the entire circumference of frame <NUM>. One example of such a configuration is shown in <FIG>. Other suitable configurations can be used. Frame <NUM> can also provide axial fixation by creating chordal tension of chordae.

<FIG>, <FIG>, and <FIG> illustrate a frame <NUM>. <FIG> illustrates a front view of a frame <NUM>. <FIG> illustrates a top view of a valve prosthesis <NUM> including a valve body <NUM> supported by frame <NUM>. <FIG> illustrates a view of valve prosthesis <NUM> implanted in a native valve site <NUM>. <FIG> is an enlarged view of a portion of <FIG>. Valve site <NUM> includes annulus <NUM>, chordae <NUM>, and papillary muscles <NUM>.

Frame <NUM> includes an inlet portion <NUM>, an hourglass shaped central portion <NUM> and support arms <NUM>. Support arms <NUM> are configured to capture leaflets during device delivery. Axial fixation of frame <NUM> can be achieved through the hourglass shaped central portion <NUM> pinching a muscular ridge of the native annulus. Frame <NUM> can have an elliptical outflow end <NUM>. The larger diameter of the ellipse can be positioned near the mitral valve commissures of the native valve. The shorter part of the ellipse can be near the aorto-mitral fibrous continuity of the native valve. Although outflow end <NUM> can be elliptical, valve body <NUM> of frame <NUM> can remain cylindrical. One example of such a configuration is shown in <FIG>. Other suitable configurations can be used. Frame <NUM> can also provide axial fixation by creating chordal tension of chordae <NUM>.

<FIG> illustrate a valve prosthesis <NUM>. <FIG> illustrates bottom-front perspective view of valve prosthesis <NUM> in an open position. <FIG> illustrates a bottom-front view of valve prosthesis <NUM> in a closed position. Valve prosthesis <NUM> includes a frame <NUM> along with a valve body including prosthetic leaflets <NUM>. An outflow end <NUM> of frame <NUM> flares outwardly to allow for gaps <NUM> between an outflow end <NUM> of leaflets <NUM> and outflow end <NUM> of frame <NUM>.

<FIG> illustrate a valve prosthesis <NUM>. <FIG> illustrates a bottom-front view of valve prosthesis <NUM> in an open position. <FIG> illustrates a bottom view of valve prosthesis <NUM>. Valve prosthesis <NUM> includes a frame <NUM> along with a valve body including prosthetic leaflets <NUM>. As shown, for example in <FIG>, a cross-section of a valve outlet <NUM> is a rounded triangle with each vertex <NUM> of the triangle aligned with a corresponding leaflet <NUM> of the valve body to provide gaps <NUM> between an outflow end <NUM> of frame <NUM> and the outflow end <NUM> of leaflet <NUM> when leaflet <NUM> is fully open. In some embodiments, the mid-section of sides <NUM> of frame <NUM> are aligned with corresponding commissures <NUM> of the valve body.

The cross-section of a valve base <NUM> can be a rounded triangular and rotated about <NUM> degrees relative to the cross-section of valve outlet <NUM> so that the body forms a roughly cylindrical shape. One example of such a configuration is shown in <FIG>. Other suitable configurations can be used.

<FIG> illustrate a valve prosthesis <NUM>. <FIG> illustrates valve prosthesis <NUM> in an open position. <FIG> illustrates a bottom view of valve prosthesis <NUM>. Valve prosthesis <NUM> includes a frame <NUM> along with a valve body including prosthetic leaflets <NUM>. Frame <NUM> is configured to allow for gaps <NUM> between an outflow end <NUM> of leaflets <NUM> and an outflow end <NUM> of frame <NUM> when leaflets <NUM> are fully open. In some embodiments, gaps <NUM> can be sized and shaped to minimize or eliminate contact between leaflets <NUM> and frame <NUM>. In some embodiments, gaps <NUM> can be up to <NUM> millimeters wide. In some embodiments, gaps <NUM> can be larger than <NUM> millimeters. In some embodiments, the mid-section of sides <NUM> are aligned with corresponding commissures <NUM> of the valve body.

Sides <NUM> of the rounded triangle of valve outlet <NUM> curve inward. The overall shape of the cross-section of valve outlet <NUM> can be described as clover-leaf shaped. In addition, sides <NUM> of the rounded triangle of valve base <NUM> curve inward and can also be described as clover-leaf shaped. The cross-section of valve base <NUM> can be rotated about <NUM> degrees relative to the cross-section of valve outlet <NUM> so that the valve forms a roughly cylindrical shape. In some embodiments, valve base <NUM> can be substantially cylindrical and valve outlet <NUM> can flare out from valve base <NUM>. In some embodiments, leaflets <NUM> can be attached at valve base <NUM>. Other suitable configurations can be used.

<FIG> illustrates a frame <NUM>. A non-planar shape of one or more of the various frames described herein can be achieved by changing the location of nodes formed within the frame. For example, a laser cut pattern of a frame can be modified, along with new fixtures for heat seating to achieve such a configuration. In particular, frame <NUM> includes nodes <NUM> arranged in a sinusoidal pattern. In some embodiments, such a configuration can have the effect of changing the shape of frame <NUM> when frame <NUM> is expanded. The sinusoidal pattern of nodes <NUM> within frame <NUM> can, for example, result in a three dimensional saddle shape <NUM> of frame <NUM>, shown for example in <FIG>, that can mimic the native anatomy at a mitral annulus. In some embodiments, frame <NUM> can include a modified inflow section <NUM> and an unmodified valve section <NUM>.

<FIG> illustrate a frame <NUM> for a valve prosthesis. <FIG> illustrates a front view of frame <NUM>. <FIG> illustrates a top view of frame <NUM>. Frame <NUM> includes central portion <NUM>, inlet portion <NUM>, and chordae guiding element <NUM>. Chordae guiding element <NUM> extends from support arm <NUM> and is configured to engage chordae of the native valve site. As described above, chordae can connect to native leaflets and act like "tie rods" in an engineering sense. Not only can the chordae help prevent prolapse of the native leaflets during systole, they can also help support the left ventricular muscle mass throughout the cardiac cycle. In some embodiments, it can be desirable to impart tension onto the chordae with support arms, such as support arms <NUM>. However, excessive tension can cause the chordae to rupture which can reduce the effectiveness of valve prosthesis <NUM>. In some embodiments, the shape and location of support arms <NUM> on frame <NUM> can reduce tension imparted onto the chordae by support arms <NUM>.

In some embodiments, chordae guiding element <NUM> can be formed by a rigid wire material and can be shaped to avoid hard angles and/or sharp edges. In some embodiments, chordae guiding element <NUM> can be the same thickness and material as support arm <NUM>. In some embodiments, chordae guiding element <NUM> can be bent in the shape of a semi-circle, oval, lobe, or other suitable shape. Chordae guiding element <NUM> can be configured to angle chordae <NUM> so that the chordae are stretched to restrict movement of valve prosthesis <NUM> in a downstream direction of blood flow at valve site <NUM>.

In some embodiments, one or more of the above configurations can be used in combination with other coatings, coverings, or configurations to reduce chordal abrasion or rupture. In some embodiments, the comers of one or both of support arm <NUM> and chordae guiding elements <NUM> can be rounded. which in some embodiments can avoid sharp corners that can cause chordal abrasion or rupture.

In some embodiments, chordae guiding element <NUM> is positioned such that chordae <NUM> are stretched to prevent movement of valve prosthesis <NUM> relative to the native valve over the course of the cardiac cycle, without rupturing chordae <NUM>. In some embodiments, such a configuration can provide added stability to valve prosthesis <NUM> while preventing damage to chordae <NUM>.

In some embodiments, chordae guiding element <NUM> can be directly attached to support arm <NUM> and can extend outward from the leaflet securing arm. A first end and a second end of chordae guiding element <NUM> can be attached to a central portion <NUM> of frame <NUM>. In some embodiments. one end of chordae guiding element <NUM> can be directly attached to support arm <NUM> and a second end of chordae guiding element <NUM> can be directly attached to central portion <NUM>. In some embodiments, chordae guiding element <NUM> can reduce bending of the native chordae by redistributing the force applied by support arm <NUM> to chordae <NUM>.

In some embodiments, an outflow end <NUM> of support arm <NUM> is longitudinally offset from an outflow end <NUM> of chordae guiding element <NUM> by a distance to reduce the bending of chordae <NUM>. The longitudinal offset can, for example, be from about <NUM> to about <NUM> in the longitudinal direction.

In some embodiments, outflow end <NUM> of support arm <NUM> is laterally offset from outflow end <NUM> of chordae guiding element <NUM> by a distance to reduce the bending of chordae <NUM>. The lateral offset can, for example, be from about <NUM> to about <NUM> in the lateral direction.

In some embodiments, chordae guiding element <NUM> can be configured to create a tapered entry for chordae. In some embodiments, a longitudinal and/or lateral offset between support arms <NUM> and chordae guiding element <NUM> can be configured to guide chordae substantially along a portion of an arc, such as along a portion of parabolic arc <NUM> (shown in broken lines) in <FIG>. In some embodiments, arc <NUM> can be circular rather than parabolic, stepped, or another desired shape. In some embodiments, arc <NUM> can guide chordae exiting support arm <NUM> and chordae guiding element <NUM> to approximate a native anatomical angle. In some embodiments, such a configuration can reduce abrasion of the chordae and/or maintain a desired chordal tension. In some embodiments, a desired chordal tension is sufficient to prevent frame <NUM> from lifting into the atrium. In some embodiments, a desired chordal tension is sufficient to substantially prevent frame <NUM> from moving and/or rocking during the cardiac cycle.

In some embodiments, the angle formed by arc <NUM> can serve to decrease an angle of entry of the chordae into support arm <NUM>, which can reduce chordal abrasion forces acting on the chordae from frame <NUM>. In some embodiments, support arms <NUM> and chordae guiding element <NUM> are configured to substantially eliminate bending of the chordae. In some embodiments, support arms <NUM> and chordae guiding element <NUM> are configured to bend the chordae less than approximately <NUM> degrees. In some embodiments, chordae are guided solely by chordae guiding element <NUM> and are guided by chordae guiding element so as not to touch support arms <NUM>. In some embodiments, a second support arm <NUM> can connect to and extend from central portion <NUM> and can be configured to extend over and engage a second native leaflet of the native valve. A second chordae guiding element can also be connected to second support arm <NUM> and can be configured similarly to first support arm <NUM>.

<FIG> illustrates a simplified drawing of a support arm <NUM>. Support arm <NUM> can include a first end <NUM> and a second end <NUM>. One or both of first end <NUM> and second end <NUM> can be connected to the same or different portions of the frame (not shown). Support arm <NUM> includes a first and second chordae guiding element <NUM>, which can function similarly to the chordae guiding elements described above. Each chordae guiding element <NUM> can include a first end <NUM> attached to support arm <NUM> and a second end <NUM> attached to the frame. In some embodiments, first end <NUM> can be connected to the frame. In some embodiments, both first end <NUM> and second end <NUM> can be connected to support arm <NUM>.

One or more of the valve prostheses described herein can be implanted into an annulus of a native cardiac valve through a suitable delivery method. For example, the valve prosthesis can be implanted through conventional open-heart surgery techniques. In some embodiments, the valve prosthesis can be delivered percutaneously. For example, in some percutaneous techniques, valve prosthesis can be compacted and loaded onto a delivery device for advancement through a patient's vasculature. The valve prosthesis can be delivered through an artery or vein, a femoral artery, a femoral vein, a jugular vein, a subclavian artery, an axillary artery, an aorta, an atrium, and/or a ventricle. The valve prosthesis may be delivered via a transfemoral, transapical, transseptal, transatrial, transventrical, or transaortic procedure.

In some embodiments, the valve prosthesis can be delivered transfemorally. In such a delivery, the delivery device and the valve prosthesis can be advanced in a retrograde manner through the femoral artery and into the patient's descending aorta. A catheter can then be advanced under fluoroscopic guidance over the aortic arch, through the ascending aorta, into the left ventricle, and mid-way across the defective mitral valve. Once positioning of the catheter is confirmed, the delivery device can deploy the valve prosthesis within the annulus. The valve prosthesis can then expand against and align the prosthesis within the annulus. In some embodiments, as the valve prosthesis is expanded, it can trap leaflets against the annulus, which can retain the native valve in a permanently open state.

In some embodiments, the valve prosthesis can be delivered via a transapical procedure. In a transapical procedure, a trocar or overtube can be inserted into a patient's left ventricle through an incision created in the apex of the patient's heart. A dilator can be used to aid in the insertion of the trocar. In this approach, the native valve (for example, the mitral valve) can be approached from the downstream relative to the blood flow. The trocar can be retracted sufficiently to release the self-expanding valve prosthesis. The dilator can be presented between the leaflets. The trocar can be rotated and adjusted to align the valve prosthesis in a desired alignment. The dilator can be advanced into the left atrium to begin disengaging the proximal section of the valve prosthesis from the dilator.

In some embodiments, the valve prosthesis can be delivered via a transatrial procedure. In such a procedure, a dilator and trocar can be inserted through an incision made in the wall of the left atrium of the heart. The dilator and trocar can then be advanced through the native valve and into the left ventricle of heart. The dilator can then be withdrawn from the trocar. A guide wire can be advanced through the trocar to the point where the valve prosthesis comes to the end of the trocar. The valve prosthesis can be advanced sufficiently to release the self-expanding frame from the trocar. The trocar can be rotated and adjusted to align the valve prosthesis in a desired alignment. The trocar can be withdrawn completely from the heart such that the valve prosthesis self-expands into position and can assume the function of the native valve.

The choice of materials for the various valve prostheses described herein can be informed by the requirements of mechanical properties, temperature sensitivity, biocompatibility, moldability properties, or other factors apparent to a person having ordinary skill in the art. For example, one more of the parts (or a portion of one of the parts) can be made from suitable plastics, such as a suitable thermoplastic, suitable metals, and/or other suitable materials.

Claim 1:
A valve prosthesis (<NUM>) for implantation into a native cardiac valve site of an individual, the valve prosthesis comprising:
a valve body; and
a frame (<NUM>) supporting the valve body, the frame comprising:
a central portion (<NUM>) configured to fit securely within an annulus of the valve site;
a support arm (<NUM>) extending from the central portion and configured to extend over and secure a native valve leaflet; and
a chordae guiding element (<NUM>) extending from the support arm and configured to engage chordae of the valve site,
wherein the chordae guiding element is configured to angle the chordae so that the chordae are stretched to restrict movement of the valve prosthesis in an upstream direction of blood flow at the valve site, and
wherein the chordae guiding element is configured to reduce bending of the chordae to reduce stress on the chordae during the cardiac cycle.