Patent Description:
The human heart has a number of valves for maintaining the flow of blood through the body in the proper direction. The major valves of the heart are the atrioventricular (AV) valves, including the bicuspid (mitral) and the tricuspid valves, and the semilunar valves, including the aortic and the pulmonary valves. When healthy, each of these valves operates in a similar manner. The valve translates between an open state (that permits the flow of blood) and a closed state (that prevents the flow of blood) in response to pressure differentials that arise on opposite sides of the valve.

A patient's health can be placed at serious risk if any of these valves begin to malfunction. Although the malfunction can be due to a variety of reasons, it typically results in either a blood flow restricting stenosis or a regurgitation, where blood is permitted to flow in the wrong direction. If the deficiency is severe, then the heart valve may require replacement.

Substantial effort has been invested in the development of replacement heart valves, most notably replacement aortic and mitral valves. Replacement valves can be implanted percutaneously by way of a transfemorally or transapically introduced catheter, or can be implanted directly through open heart surgery. The replacement valves typically include an arrangement of valve leaflets that are fabricated from porcine tissue. These tissue leaflets are highly distensible or stretchable. Other replacement valves have been proposed where the leaflets are artificial polymeric structures. In both cases, the leaflets are often maintained in position by a stent or support structure that has a relatively high rigidity (in the case of open heart replacement valves) or expands into or is fixable in a highly rigid state (in the case of transcatheter valves) to provide maximum support for the leaflets. However, these highly rigid support structures are generally passive structures that, beyond support, provide little or no active benefit to the operation of the valve itself in controlling flow.

<CIT> discloses a polymeric heart valve including: a valve body having a central axis having a body fluid pathway extending along the central axis from an inflow end to an outflow end; a flexible stent disposed about an outer circumference of the body and including at least three flexible stent posts each extending in the axial direction to a tip; and at least three flexible leaflets extending from the stent, each of the leaflets having an attached edge defining an attachment curve along the stent extending between a respective pair of stent posts.

For these and other reasons, needs exist for improved prosthetic valves.

The invention is a prosthetic heart valve as defined in claim <NUM>. Provided herein are a number of example embodiments of prosthetic heart valves having two or more artificial leaflets and a synthetic, elastic support structure. In many example embodiments, the leaflets can have sufficient rigidity to transfer load to the elastic support structure during closing. The support structure is of an elastic nature that permits the support structure to store the transferred load as potential energy and then release it in the form of kinetic energy at an appropriate time to assist the leaflets in moving from the closed to the open state. In many embodiments, this transition by the support structure is precursory and occurs without the assistance of the leaflets. This precursory transition to the open state can result in a pressure wave that closely resembles that of a healthy native human heart valve. Example embodiments of related methods of use and manufacture of prosthetic valves are also described.

Other systems, devices, methods, features and advantages of the subject matter described herein will be or will become apparent to one with skill in the art upon examination of the following figures and detailed description.

The details of the subject matter set forth herein, both as to its structure and operation, may be apparent by study of the accompanying figures, in which like reference numerals refer to like parts. The components in the figures are not necessarily to scale, emphasis instead being placed upon illustrating the principles of the subject matter. Moreover, all illustrations are intended to convey concepts, where relative sizes, shapes and other detailed attributes may be illustrated schematically rather than literally or precisely.

Before the present subject matter is described in detail, it is to be understood that this disclosure is not limited to the particular embodiments described, as such may, of course, vary. It is also to be understood that the terminology used herein is for the purpose of describing particular embodiments only, and is not intended to be limiting, since the scope of the present disclosure will be limited only by the appended claims.

Example embodiments of systems, devices, kits, and methods are provided herein that relate to valve replacement in a human or animal subject. For ease of description, these embodiments of the prosthetic heart valve are three-leaflet valves implantable through open heart surgery, and thus are not compressible and expandable for trans-catheter delivery.

However, the present subject matter is not limited only to such embodiments, and the subject matter can be applied to trans-catheter implantable heart valves that have a first, radially compressed state for housing in a tubular catheter and delivery from the catheter's open distal end, and a second, radially expanded state for normal operation within the heart. Likewise, the subject matter can be applied to prosthetic heart valves having only two leaflets, or having more than three leaflets, whether implantable through open heart surgery or trans-catheter delivery. These prosthetics may also be used to replace valves in other locations in the patient's body outside of the heart.

<FIG> is a perspective view and <FIG> is a top down view of an example embodiment of prosthetic heart valve <NUM>. A support structure <NUM> is coupled with a plurality of valve leaflets <NUM>-<NUM>, <NUM>-<NUM>, and <NUM>-<NUM>. Each of leaflets <NUM> can be discrete from the others (as shown here) or can be portions of one unitary leaflet body.

When implanted, valve <NUM> is configured to allow or permit blood to flow in the direction indicated here along central axis <NUM>, which extends through an interior of valve <NUM>. Blood can flow from the valve's upstream (blood inlet) end <NUM> towards the downstream (blood outlet) end <NUM>, but is prevented (or substantially prevented) from flowing in the reverse direction by the presence of leaflets <NUM>.

Support structure <NUM>, which can also be referred to as a frame, includes an annular base portion <NUM> that can have a planar or flat upstream edge (or surface) <NUM> in a neutral position or that can have a curved or scalloped upstream edge in the neutral position (not shown). Examples of valves with scalloped upstream edges are depicted and described in <CIT>. Here, upstream edge <NUM> is also the terminus of valve <NUM>, and lies along a single flange <NUM> that extends radially outwardly from the sidewall of valve <NUM>. In other embodiments, flange <NUM> can be positioned further downstream on valve <NUM> so that it is not co-located with upstream edge <NUM>. Flange <NUM> can be used for attachment of a sewing cuff to the exterior of support structure <NUM>. Those of ordinary skill in the art will readily understand the design and appearance of a sewing cuff and how it can be coupled with support structure <NUM>. While multiple flanges <NUM> can be included, preferably only a single flange <NUM> is used to increase the flexibility of base <NUM>.

Support structure <NUM> also includes three projecting structures <NUM>-<NUM>, <NUM>-<NUM>, and <NUM>-<NUM>, which can be referred to herein as projections or extensions. Projections <NUM> project from annular base portion <NUM> towards downstream end <NUM> and one projection <NUM> is present between each pair of adjacent leaflets <NUM>, such that the leaflets <NUM> and projections <NUM> are arranged in alternating fashion around valve <NUM>. In embodiments with only two leaflets <NUM>, there would be only two projections <NUM>. Each projection <NUM> tapers to a downstream end <NUM>. Here, each downstream end <NUM> is also an apex or terminus of projection <NUM>.

Support structure <NUM> includes curved interfaces <NUM>, which are the locations where support structure <NUM> meets a base of leaflet <NUM>. The base of each leaflet <NUM> can be a physical edge such as would be present if leaflet <NUM> is manufactured separately from support structure <NUM> and then the two are later coupled together. In the embodiments described herein, valve <NUM> is manufactured with synthetic or artificial (i.e., not tissue) leaflets <NUM> and curved interface <NUM> can demarcate a seamless or uninterrupted boundary between support structure <NUM> and leaflet <NUM> such as would be the case if support structure <NUM> and leaflets <NUM> were formed in a monolithic or semi-monolithic manner, e.g., using various casting (e.g., dip casting, etc.) and molding procedures. Example embodiments of methods of manufacturing valve <NUM> are described elsewhere herein.

In operation, valve <NUM> moves cyclically between an open position that permits the flow of blood through the valve interior and a closed position where the leaflets <NUM> prevent the flow of blood through the valve interior. Each of these leaflets <NUM> has a free edge <NUM> that moves radially inwardly (towards the closed position) and radially outwardly (towards the open position). Each leaflet <NUM> also has an upstream end (or upstream-most location) <NUM>, which in this embodiment is also the upstream apex or terminus of the leaflet <NUM>.

<FIG> depict valve <NUM> with leaflets <NUM> in a neutral position, such as might be exhibited during casting or other formation of valve <NUM>. The neutral position is the same or similar to the at-rest position of valve <NUM>. <FIG> are perspective, top down, and side views, respectively, depicting an example embodiment of valve <NUM> in the open position. Here it can be seen, particularly in the top down view of <FIG>, that free edges <NUM> of leaflets <NUM> have moved radially outwards away from center axis <NUM> and have created a relatively large opening to permit the flow of blood. As will be discussed further herein, the movement of leaflets <NUM> towards this open position is not merely due to the pressure exerted by the blood but also by active movement of support structure <NUM> early in the cycle.

<FIG> are perspective, top down, and side views, respectively, depicting an example embodiment of valve <NUM> in the closed position where projections <NUM> (e.g., ends <NUM>) are radially closer to each other than in the open position. Here, free edges <NUM> of leaflets <NUM> have moved radially inwards towards center axis <NUM> (not shown) and are in contact with each other. In other words, free edge <NUM>-<NUM> is in contact with free edges <NUM>-<NUM> and <NUM>-<NUM>, free edge <NUM>-<NUM> is in contact with free edges <NUM>-<NUM> and <NUM>-<NUM>, and free edge <NUM>-<NUM> is in contact with free edges <NUM>-<NUM> and <NUM>-<NUM>. This position is referred to herein as a coapted state of leaflets <NUM>. In this state, the flow of blood in the reverse, improper direction (i.e., downstream-to-upstream) is (at least substantially) prevented. Certain embodiments of valve <NUM> can be configured with a convex leaflet-support structure interface as described in <CIT>.

Those of ordinary skill in the art will understand that, while reference is made to the leaflets being in a coapted state (or fully coapted state) preventing the flow of blood, this does not require absolute coaption nor absolute prevention of the flow of blood, as limited cases may exist where a minimal, negligible gap between leaflets is present when valve <NUM> is in the closed position. Thus, when valve <NUM> is in the closed position, at least the majority of free edges <NUM> will be in contact with each other, and in many embodiments the entirety of free edges <NUM> will be in contact with each other. Furthermore, in the brief time interval immediately before full coaption, the leaflet edges can begin to touch without being fully coapted. Such a state can be referred to as "partially coapted. " The leaflets can likewise be in a partially coapted state in the brief time interval after the leaflets have exited the fully coapted state and are transitioning to an open state.

<FIG> is a graph depicting an example representation of idealized transvalve blood (or other fluid, for example in testing) pressure across leaflets <NUM> during a portion of a cardiac cycle. This graph displays a simulation or a model of the transvalve pressure for a mitral valve and will be described in that context, although the graphed pressure is also applicable to the aortic valve. For the mitral valve, the transvalve pressure is generally the pressure in the left atrium minus the pressure in the left ventricle. For the aortic valve, the transvalve pressure is generally the pressure in the aorta minus the pressure in the left ventricle.

Region <NUM> indicates a period of time when there is a positive pressure across leaflets <NUM>, and generally corresponds to the period when the mitral valve is open (leaflets <NUM> are not coapted). In region <NUM>, the left ventricle relaxes and left atrial systole occurs further filling the left ventricle with blood. This period of time is generally relatively lengthy, but has been condensed for ease of illustration here. Region <NUM> extends to point A, where the transvalve pressure transitions from positive to zero and the blood stops moving in the proper upstream-to-downstream direction (left atrium-to-left ventricle).

Region <NUM> generally indicates a period of time starting at point A when the transvalve pressure is zero and then becomes negative and continues to decrease (becoming more negative). When negative the blood is being pressured to move in the reverse direction (downstream-to-upstream). As the pressure transitions from zero to negative the mitral valve begins to close. Region <NUM> ends at point B, which indicates the point in time where a peak negative pressure is exhibited across leaflets <NUM>. In region <NUM>, the aortic valve opens and isovolumic contraction of the left ventricle occurs.

Region <NUM> generally indicates a period of time from point B to point C where the peak negative pressure remains generally constant. At point B the mitral valve leaflets are fully coapted. Those of skill in the art will recognize that because <FIG> is a graph of idealized transvalve pressure, the pressure trace in regions <NUM>-<NUM> have generally constant slopes (or no slope as in the case of region <NUM>). In an actual heart these transvalve pressures would exhibit more variance as would be expected in a complex natural environment. Thus, the pressure in region <NUM> and others will vary in actual practice, and region <NUM> can be viewed as a transition region where the blood pressure exhibits either a discrete peak or a peak curve prior to becoming less negative.

Region <NUM> indicates the period of time beginning at point C where the pressure is steadily increasing (becoming less negative) until reaching zero at point D. In region <NUM> the isovolumic relaxation of the left ventricle occurs and the aortic valve closes and the native mitral valve remains closed.

Region <NUM> generally indicates the period of time beginning at point D where the pressure is increasing from zero and becoming more positive. When positive, the blood is being pressured to move in the proper direction (upstream-to-downstream). As the pressure transitions from zero to positive the native mitral valve begins to exit the coapted state. Region <NUM> generally corresponds to the beginning of a new cardiac cycle and is essentially a repeat of region <NUM>.

<FIG> is a graph depicting the potential energy and the kinetic energy against time of the support structure <NUM> itself during the idealized transvalve pressure cycle of <FIG>. The potential energy is indicated by trace <NUM> and the kinetic energy is indicated by trace <NUM>. The positions of points A-D from <FIG> are indicated along the time scale.

<FIG> depicts a characteristic of certain example embodiments of valve <NUM> where artificial leaflets <NUM>, as they are moving radially inwardly towards the coapted state, transfer or shed load to the elastic support structure <NUM>, which then stores that transferred load as potential energy. Tissue (i.e., non-artificial) leaflets are too distensible to transfer load in the same manner. The potential energy stored in support structure <NUM> while in the closed position can then be released in the form of kinetic energy, such as when the transvalve pressure is becoming less negative.

Embodiments of support structure <NUM> are thus capable of moving from the closed position towards the open position well before the transvalve pressure becomes positive, as is the case for a native valve. This may be referred to as a "spring back" or an "active spring back" characteristic of support structure <NUM>, where support structure <NUM> recoils from the closed position back to the open position prior to (or "early" as compared to a native valve), and in many cases well in advance of, the transvalve pressure becoming positive (prior to normal blood flow). Thus, the precursory transition occurs without the support structure's movement being initiated by the leaflets (e.g., the support structure being pulled or dragged by the leaflets) and without the support structure being initially forced open by a positive back pressure or the flow of blood through the valve.

In <FIG>, potential energy <NUM> and kinetic energy <NUM> of support structure <NUM> are generally minimal while the transvalve pressure is in region <NUM>. As the transvalve pressure shifts from zero and becomes more negative in region <NUM>, potential energy <NUM> begins to increase at a comparable but inverse slope to the pressure decrease (<FIG>). As the pressure becomes more negative, leaflets <NUM> bear a higher load from the fluid and accelerate radially inwardly towards the coapted position. The increase in potential energy <NUM> in region <NUM> is primarily due to the transfer or shedding of this load from leaflets <NUM> to support structure <NUM>, which stores the potential energy in the form of elastic deformation of the material body of support structure <NUM>.

As the transvalve pressure goes from zero and becomes more negative in region <NUM>, kinetic energy <NUM> exhibits a spike <NUM> corresponding to the initial rapid movement of support structure <NUM> from the open position towards the closed position. At <NUM>, potential energy <NUM> increases from zero and kinetic energy <NUM> decreases at a non-constant decreasing rate as support structure <NUM> elastically deforms towards the closed position.

At point B, leaflets <NUM> touch and enter the fully coapted state. This corresponds to a steep drop <NUM> in kinetic energy <NUM>, indicating that support structure <NUM> has essentially reached the closed position. Some continual reduction in kinetic energy occurs in region <NUM> to point C as support structure <NUM> settles into the closed position. Potential energy <NUM> has reached its maximum in region <NUM> and remains generally constant corresponding to the generally constant peak negative transvalve pressure.

At point C, the transvalve pressure is at its peak negative pressure and immediately thereafter the transvalve pressure becomes less negative (increases). In this embodiment, the stored potential energy <NUM> begins to unload from support structure <NUM> in the form of kinetic energy <NUM>. Thus, a steep increase <NUM> in kinetic energy <NUM> occurs immediately after point C, or upon the transvalve pressure decreasing from the peak negative pressure. Kinetic energy <NUM> reaches a transition energy <NUM> where kinetic energy initially plateaus, and then gradually increases as potential energy <NUM> continues to decrease through region <NUM>. In this embodiment, kinetic energy <NUM> can be described as behaving substantially like a step function both at point B and point C.

The increase <NUM> in kinetic energy <NUM> corresponds to a precursory movement of support structure back towards the open position (further details of this movement are described later). At point C, leaflets <NUM> are still fully coapted. Leaflets <NUM> exit the fully coapted state as the pressure becomes less negative towards point D. In some embodiments, valve <NUM> can be <NUM>% open or greater at point D (i.e., valve <NUM> permits <NUM>% or greater of its fluid flow in the normal open state), in other embodiments, valve <NUM> can be fully open at or prior to reaching point D, and in still other embodiments valve <NUM> is fully open upon reaching the peak positive pressure of the subsequent cycle. This increase <NUM> in kinetic energy is driven by the unloading of the potential energy <NUM> stored in the form of elastic deformation of support structure <NUM>. Thus, support structure <NUM> has the advantage of a precursory or active transition (e.g., rebound or spring back) to or towards its open position before leaflets <NUM> exit the fully coapted state and before blood begins to flow through the interior of valve <NUM>. The benefits of this precursory transition <NUM> can include a significantly reduced pressure gradient or resistance to opening, which in turn can result in a lower effective orifice area (EOA) and an increased effective forward blood flow.

As mentioned above, in actual operation of valve <NUM> the transvalve pressure may not exhibit a constant peak negative pressure as shown in region <NUM> of <FIG>. Instead, the transvalve pressure may exhibit a curved or parabolic behavior with the peak negative pressure at the apex. In some embodiments, the peak negative transvalve pressure is approximately <NUM> mmHg, although it is stressed that this is strictly an example and other peak negative pressures can be exhibited. In the embodiment described with respect to <FIG>, the precursory transition <NUM> initiates immediately when the transvalve pressure becomes less negative after the peak negative pressure.

However, in other embodiments, support structure <NUM> can be configured such that this precursory transition initiates at a later time. In some example embodiments, the precursory transition can occur when the transvalve pressure is <NUM>-<NUM>% of the peak transvalve pressure, when the transvalve pressure is <NUM>-<NUM>% of the peak transvalve pressure, when the transvalve pressure is <NUM>-<NUM>% of the peak transvalve pressure, when the transvalve pressure is <NUM>-<NUM>% of the peak transvalve pressure, or when the transvalve pressure is <NUM>-<NUM>% of the peak transvalve pressure.

<FIG> is a partial side view depicting an example embodiment of support structure <NUM> with vectors simulating the relative velocities across the surface of elastic support structure <NUM> when structure <NUM> is transitioning from the closed to open position. In this example, the velocity vectors are at the time when the precursory transition initiates (e.g., immediately after point C in <FIG>). Here, only the front half of support structure <NUM> is shown and leaflets <NUM> (although present) have been omitted for ease of illustration. The position where upstream end <NUM>-<NUM> of leaflet <NUM>-<NUM> would lie is indicated with an arrow.

Support structure <NUM> has multiple first locations <NUM> and second locations <NUM> aligned with the downstream ends <NUM> of projections <NUM> and the upstream ends <NUM> of leaflets <NUM>. In <FIG>, the position of first locations <NUM>-<NUM> and <NUM>-<NUM> are indicated directly upstream from downstream ends <NUM>-<NUM> and <NUM>-<NUM>, respectively. The position of second location <NUM>-<NUM> is indicated directly upstream from upstream leaflet end <NUM>-<NUM>. First location <NUM>-<NUM> is directly upstream from downstream end <NUM>-<NUM> beneath the sidewall of projection <NUM>-<NUM> and along flange <NUM> as it extends radially outward in alignment with end <NUM>-<NUM>. Although some asymmetries can be present in various embodiments, under normal operation, the embodiments of valve <NUM> operate in a symmetrical manner, where each leaflet <NUM> and projection <NUM> generally moves in the same manner back and forth between the open and closed positions.

The longer the velocity vector the greater the magnitude of instantaneous velocity. As can be seen here, the relatively highest instantaneous velocities occur along projections <NUM>, particularly at and in proximity with downstream ends <NUM>, as these are the regions with the highest amount of elastic deformation in the closed position.

In many embodiments, the elastic upstream edge <NUM> also exhibits movement when support structure <NUM> initiates the precursory transition from the closed to open position. In the embodiment of <FIG>, upstream edge <NUM> moves in an upstream direction at each of first locations <NUM>, and upstream edge <NUM> simultaneously moves in a downstream direction at each of second locations <NUM>.

This characteristic is shown in <FIG>, where flange <NUM> is shown with corresponding velocity vectors, the magnitudes of which have been increased as compared to <FIG> for ease of illustration. The remainder of support structure <NUM> is shown in outline without the remaining velocity vectors (see <FIG>) and leaflets <NUM> are again not shown for clarity.

In <FIG> the velocity vectors have a generally sinusoidal distribution along upstream edge <NUM> around the entire periphery of valve <NUM> that translates to sinusoidal displacement. For example, the region surrounding each first location <NUM> has velocity vectors in the downstream direction with the greatest magnitude at or near the first location <NUM> itself, and generally lessening or tapering as the distance from first location <NUM> increases on both sides. Conversely, the region surrounding each second location <NUM> has velocity vectors in the upstream direction with the greatest magnitude at or near the second location <NUM> itself, and generally lessening or tapering as the distance from second location <NUM> increases on both sides. Approximately halfway between each first location <NUM> and it's immediately adjacent second location <NUM> is a third location <NUM>, which is where the velocity vectors reach zero indicating no motion at that location and at this point in time. Locations <NUM> are pivot points interposed between the oscillating sections. For each location around the periphery of upstream edge <NUM>, the velocity vectors become relatively greater as one proceeds radially outwards from the interior edge of flange <NUM> to the exterior edge of flange <NUM> (indicated by the three concentric rows of vectors in <FIG>).

Thus, in many embodiments when viewing edge <NUM> as a whole, the velocity and motion profile is generally sinusoidal, where a particular point along upstream edge <NUM> can alternate from full upstream displacement, to neutral displacement, to full downstream displacement, back to neutral displacement, and so forth, depending on the location of the point along upstream edge <NUM> being examined. In the closed position, upstream edge <NUM> has a sinusoidally-shaped surface with locations <NUM> being displaced relatively downstream and locations <NUM> being displaced relatively upstream. In the open position, upstream edge <NUM> also has a sinusoidally-shaped surface but with a complementary or reversed profile, with locations <NUM> being displaced relatively upstream and locations <NUM> being displaced relatively downstream. In the embodiment shown here, pivot point locations <NUM> do not incur relative displacement as valve <NUM> transitions between the open and closed positions.

Also, in this embodiment base edge <NUM> does not have a sinusoidal shape in the neutral position, but is planar or flat. In alternative embodiments where base edge <NUM> is not planar in the neutral position, such as aortic configurations where base edge <NUM> is scalloped, then the sinusoidal displacement is from the scalloped neutral position as opposed to the planar neutral position. Although the velocities and displacements are described as sinusoidally-shaped, these velocities and displacements can also be substantially sinusoidally-shaped, and those of ordinary skill in the art, after reading this description, will readily recognize those shapes that are substantially sinusoidal. In any event, those of skill in the art understand that sine functions can vary in amplitude and frequency. They also understand that the manufacture and use of prosthetic valves can result in deviations due to manufacturing variances, variances caused by implantation, variances caused by the length of time the valve is implanted (e.g., accumulation of material such as calcification, etc.) and/or noise, and the effects these deviations have on sine functions are within the scope of the term sinusoidal as used herein.

<FIG> depict the instantaneous velocities on support structure <NUM> at the time when the precursory transition initiates, which can be immediately following point C of <FIG>, or other times as noted elsewhere herein. Motion in these directions continue at ultimately decreasing velocities until support structure <NUM> reaches its open position (see <FIG>), which can occur at any number of times. For example, if support structure <NUM> reaches its open position when the transvalve pressure becomes positive, then motion in the directions indicated by these vectors can continue from the initiation of the precursory transition (e.g., just after point C of <FIG>, when the pressure is <NUM>-<NUM>% of the peak, <NUM>-<NUM>% of the peak, <NUM>-<NUM>% of the peak, <NUM>-<NUM>% of the peak, or <NUM>-<NUM>% of the peak, etc.) until that time when transvalve pressure becomes positive. Similarly, if support structure <NUM> reaches its fully open position when maximum fluid flow in the downstream direction occurs (e.g., a peak positive pressure), then motion in the directions indicated by these vectors can continue from the initiation of the precursory transition until that time when transvalve pressure becomes positive.

<FIG> depict the velocities as support structure <NUM> moves from the closed position (see, e.g., <FIG>) towards the open position (see, e.g., <FIG>). In these embodiments a similar but opposite movement occurs (not illustrated) as support structure <NUM> moves from the open position to the closed position. Thus, for example, the velocity vector directions in <FIG> can each be reversed to depict the direction of movement when support structure <NUM> moves from the open to closed position (e.g., projections <NUM> move radially inwardly, first locations <NUM> move in an upstream direction, second locations <NUM> move in a downstream direction, and so forth). The magnitude of instantaneous velocities would be relatively less than those depicted in <FIG> since the peak positive transvalve pressure (e.g., approximately <NUM> mmHg) is generally significantly less than the peak negative transvalve pressure (e.g., approximately <NUM> mmHg).

In many embodiments, downstream ends <NUM> of support structure <NUM> exhibit the greatest displacement when structure <NUM> transitions between the closed and open positions. Downstream ends <NUM> of support structure also exhibit relatively high instantaneous velocities as support structure <NUM> leaves the open or the closed position.

Embodiments of valve <NUM> can have different maximum displacements as measured from the valve's neutral position (see, e.g., <FIG>) to the open position or the closed position depending on the size of the valve. The following paragraphs describe embodiments having various displacements and velocities that were obtained from example mitral and aortic configurations. The example mitral configuration had a <NUM> millimeter diameter and a projection length <NUM> of <NUM> measured along a central longitudinal axis of the projection from a position in-line with leaflet base edges <NUM> (see <FIG>). The example aortic configuration had a <NUM> millimeter diameter and a projection length <NUM> of <NUM>. The velocities and displacements described herein scale in a substantially linear manner between sizes. Various sizes for mitral and aortic embodiments are described in greater detail below.

For the mitral valve configuration going from the neutral position to the closed position, in some embodiments, the maximum radial inward displacement (DMRI) of downstream ends <NUM> is <NUM> millimeters (mm) or greater, in some embodiments DMRI is <NUM> or greater, in some embodiments DMRI is <NUM> or greater, in some embodiments DMRI is <NUM> or greater, in some embodiments DMRI is <NUM> or greater, and in some embodiments DMRI is <NUM> or greater. Although dependent upon the actual implementation, in certain example embodiments DMRI does not exceed <NUM>, and in other embodiments DMRI does not exceed <NUM>.

For the mitral valve configuration going from the neutral position to the open position, in some embodiments, the maximum radial outward displacement (DMRO) of downstream ends <NUM> is <NUM> or greater, in some embodiments DMRO is <NUM> or greater, and in some embodiments DMRO is <NUM> or greater. Although dependent upon the actual implementation, in certain example embodiments, DMRO does not exceed <NUM>, and in other example embodiments, DMRO does not exceed <NUM>.

For the aortic valve configuration going from the neutral position to the closed position, in some embodiments, the maximum radial inward displacement (DMRI) of downstream ends <NUM> is <NUM> millimeters (mm) or greater, in some embodiments DMRI is <NUM> or greater, in some embodiments DMRI is <NUM> or greater, in some embodiments DMRI is <NUM> or greater, in some embodiments DMRI is <NUM> or greater, and in some embodiments DMRI is <NUM> or greater. Although dependent upon the actual implementation, in certain example embodiments, DMRI does not exceed <NUM>, and in other example embodiments, DMRI does not exceed <NUM>.

In many embodiments, downstream ends <NUM> of support structure <NUM> also exhibit particular instantaneous velocities when structure <NUM> initiates the precursory transition from the closed position to the open position. For the mitral valve configuration going from the closed position to the open position, in some embodiments, the instantaneous velocity of each downstream end <NUM> when initiating the precursory transition (Vico) is <NUM> millimeters/second (mm/s) or greater, in some embodiments Vico is <NUM>/s or greater, in some embodiments Vico is <NUM>/s or greater, in some embodiments VICO is <NUM>/s or greater, in some embodiments VICO is <NUM>/s or greater, in some embodiments Vico is <NUM>/s or greater, in some embodiments VICO is <NUM>/s or greater, in some embodiments VICO is <NUM>/s or greater, in some embodiments VICO is <NUM>/s or greater, in some embodiments VICO is <NUM>/s or greater, in some embodiments VICO is <NUM>/s or greater, in some embodiments Vico is <NUM>/s or greater, in some embodiments Vico is <NUM>/s or greater, and in some embodiments VICO is <NUM>/s or greater. Although dependent upon the actual implementation, in certain example embodiments, VICO does not exceed <NUM>/s, and in other example embodiments, VICO does not exceed <NUM>/s.

For the mitral valve configuration going from the open position to the closed position, in some embodiments, in some embodiments, the instantaneous velocity of each downstream end <NUM> when initiating the precursory transition (Vioc) is <NUM>/s or greater, in some embodiments Vioc is <NUM>/s or greater, in some embodiments Vioc is <NUM>/s or greater, in some embodiments Vioc is <NUM>/s or greater, and in some embodiments Vioc is <NUM>/s or greater. Although dependent upon the actual implementation, in certain example embodiments, VIOC does not exceed <NUM>/s, and in other example embodiments, VIOC does not exceed <NUM>/s.

For the aortic valve configuration going from the closed position to the open position, in some embodiments, VICO is <NUM> millimeters/second (mm/s) or greater, in some embodiments VICO is <NUM>/s or greater, in some embodiments Vico is <NUM>/s or greater, in some embodiments VICO is <NUM>/s or greater, in some embodiments Vico is <NUM>/s or greater, in some embodiments VICO is <NUM>/s or greater, and in some embodiments VICO is <NUM>/s or greater. Although dependent upon the actual implementation, in certain example embodiments, VICO does not exceed <NUM>/s, and in other example embodiments, VICO does not exceed <NUM>/s.

For the aortic valve configuration going from the open position to the closed position, in some embodiments, in some embodiments, VIOC is <NUM>/s or greater, in some embodiments VIOC is <NUM>/s or greater, in some embodiments VIOC is <NUM>/s or greater, in some embodiments VIOC is <NUM>/s or greater, and in some embodiments VIOC is <NUM>/s or greater. Although dependent upon the actual implementation, in certain example embodiments, VIOC does not exceed <NUM>/s, and in other example embodiments, VIOC does not exceed <NUM>/s.

The characteristics of the aforementioned embodiments are achieved by a balanced use of materials, cross-sections, rigidities, and elasticities for both leaflets <NUM> and support structure <NUM>. For example, if a support structure was made from a plastically deformable material it would not respond in such a manner. Rather, the support structure would take the deformed shape defined from the load shed by the leaflet, but progressively the support structure material would relax and lose its elasticity to recover to the nominal geometry.

Conversely, if the leaflets where less structurally competent each leaflet would deform substantially and significantly reduce the amount of load shed to the support structure and hence significantly reduce the potential energy stored in the support structure for a precursory transition. This is often the case for tissue-based prosthetic heart valves, where the leaflets are made from predominantly bovine or porcine pericardial tissue, which is very deformable with a very low modulus of elasticity. These tissue-based valves have support structures that are often made from relatively rigid substrates such as elgiloy wires or thick curved sections of delrin or acetal polymers that have large rigidity due to the inertia of the cross-sections.

The amount of stretch in the leaflet also impacts the mechanism. If the support structure sees very little of the fully closed load there would be no stored potential energy to drive a precursory transition mechanism, thus as the minimum pressure becomes less negative, the leaflets will elastically recover but not open the valve until the pressure becomes positive as the support structure has no recovery.

In the embodiments described herein, as leaflets <NUM> coapt they shed load onto support structure <NUM>, which in turn deforms. The magnitude of deformation can ensure that there is no additional stretch in-plane of leaflets <NUM> and allows the precursory transition mechanism to occur. Also, in many embodiments, base <NUM> (and upstream base edge <NUM>) is flexible and permits significant movement. If the base was rigidly restrained or prevented from freely deforming, as can be the case for a substantially rigid double flange configuration, the resulting strain energy in the system to facilitate precursory transition would be reduced and the maximum stress level would considerably increase.

Support structure <NUM> can be fabricated from one or more materials (e.g., a core structure of one material with a coating of the same or another material). The materials are preferably polymeric materials such as polyether ether ketones (PEEK), polyurethanes, a polyetherimides (PEI) such as ULTEM, any of the materials used to form leaflets <NUM>, and others. Leaflets <NUM> are also preferably fabricated from polymeric materials, including any biostable polyurethanes and polyurethane compositions (e.g., polysiloxane-containing polyurethanes, etc.) known in the art. Examples of polyurethane-containing leaflets are described in <CIT>, <CIT>, <CIT>, <CIT>, and <NPL>). Materials that approach ideal isotropic non-creeping characteristics are particularly suitable for use in many embodiments.

While many materials can be used, it is preferable that the selected material have the appropriate modulus of elasticity to permit the load shedding and elastic deformation characteristics described herein. In many example embodiments, the modulus of elasticity for leaflets <NUM> is in the range of <NUM>-<NUM> MegaPascals (MPa). In certain example embodiments, the modulus of elasticity for leaflets <NUM> is in the range of <NUM>-<NUM><NUM> MPa, while in certain other example embodiments the modulus of elasticity for leaflets <NUM> is in the range of <NUM>-<NUM> MPa, while in still other example embodiments the modulus of elasticity for leaflets <NUM> is in the range of <NUM>-<NUM> MPa. In many example embodiments, the modulus of elasticity for support structure <NUM> is in the range of <NUM>-<NUM> MPa. In certain example embodiments, the modulus of elasticity for support structure <NUM> is in the range of <NUM>-<NUM> MPa.

The embodiments of support structure <NUM> are relatively less rigid than the "rigid" valves of the prior art. In many embodiments, support structure <NUM> has a rigidity per unit force (RUF) (square mm) of <NUM> to <NUM>. In other embodiments, support structure <NUM> has an RUF of <NUM>-<NUM>, and in still other embodiments support structure <NUM> has an RUF of <NUM>-<NUM>. Projections <NUM> can be modeled as an elastic beam and RUF can be calculated according to (<NUM>): <MAT> where E is Young's modulus, I is the section inertia, P is the force at downstream end <NUM>, L is the length <NUM> of projection <NUM>, and δ is the displacement at downstream end <NUM>.

In certain embodiments, support structure <NUM> can include a core frame. Leaflets <NUM> can be seamlessly formed on this core frame, such as through a casting (e.g., dip casting) or molding process, or others. An example dip casting process that is suitable for formation of the leaflets is described here. A core frame can be fabricated from a suitable material such as those described herein. This can be done by machining or injection molding. The core frame can then be placed on a dipping mandrel that has the shape of the interior surface of the support structure and leaflets. The mandrel can be inserted into a polymeric solution with forming equipment that envelops the core frame and casts the leaflets in the desired form.

The core frame and mandrel can be dipped in a polymeric solution under both high temperature and humidity and then withdrawn. Although the methods disclosed herein are not limited to such, in some example embodiments, the relative humidity (RH) can be in the range of <NUM>-<NUM>% and the temperature can be in the range of <NUM>-<NUM> degrees C. This step can result in a manifestation of support structure <NUM> and leaflets <NUM> together in an integrally formed but unfinished state.

The dipping step can be performed only once to arrive at the fully formed (but unfinished) valve, or can be performed multiple times (e.g., two times, three times, or as many times as desired). In one embodiment, the core frame is fabricated from a first material (e.g., PEEK) different than the polymeric material from which the leaflets are fabricated. In that case it may be desirable to form the leaflets to the core frame only after the core frame has been pre-coated by the leaflet polymer to provide for greater cohesion. The core frame can be pre-coated by first dipping the core frame in the leaflet polymer having a first viscosity. This can be done with or without the mandrel. If done with the mandrel, the resulting leaflets can be removed. The pre-coated core frame can then be placed on the mandrel and dipped again, this time in the leaflet polymer with the same or a relatively higher viscosity. This second dipping can result in the formation of the full leaflet bodies integrally formed with the support structure. Use of a low viscosity followed by a higher viscosity can allow for formation of a thin pre-coating that does not significantly distort the shape of the underlying core frame followed by formation of the leaflets having the desired thickness.

Support structure <NUM> and leaflets <NUM> can then be trimmed and otherwise finished to achieve accurate and precise edges and surface smoothness. This can occur, for example, through laser cutting, ultrasonic trimming, water knife, a mechanical clam shell cutter, and the like. A sewing cuff can be coupled with support structure <NUM> (using any flange <NUM> if present) and the final device can be packaged in the desired sterile container.

Those of ordinary skill in the art will readily recognize, in light of this description, the many variations of suitable dip casting procedures, pressures, and temperatures that are not stated here yet are suitable to fabricate the prosthetic heart valves described herein. Likewise, those of ordinary skill in the art will also recognize, in light of this description, the alternatives to dip casting that can be used to fabricate the prosthetic heart valves described herein.

The embodiments of valve <NUM> described herein are suitable for implantation in the body of a subject (human or animal). This can be done using any number of medical procedures. Preferably, these embodiments of valve <NUM> are for direct implantation to, for example, the mitral or aortic annulus, using open heart surgery.

In one such example open heart implantation procedure, the appropriate size replacement valve can be determined and then an open heart access procedure is performed by a surgeon to gain access to the malfunctioning valve of the heart that will be replaced. The surgeon can then position the selected prosthetic heart valve <NUM> in position over the malfunctioning valve and attach valve <NUM> to the surrounding tissue. The attachment can occur, for instance, by fastening the sewing cuff to the tissue with one or more sutures. Prior to attachment, if the surgeon determines that the selected valve size is not optimal, then a different valve having a different size can be selected and placed in position within the heart. In some other embodiments, the malfunctioning valve can be removed prior to positioning valve <NUM> in the intended location. Once valve <NUM> is attached, the open heart cavity is closed and the procedure is ended.

The embodiments of valve <NUM> used for open heart surgery are not radially collapsible for insertion into an intravascular delivery device (e.g., a catheter) nor a transapical delivery device. However, in other embodiments, valve <NUM> can be configured with a radially collapsible support structure that allows the lateral dimension of valve <NUM> to be reduced by a degree sufficient to permit the insertion into an appropriately sized intravascular or transapical delivery device.

For most aortic valve replacement configurations, valve <NUM> can be implemented to fit the aortic tissue annulus in the following sizes: <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, and <NUM>. Other sizes can be implemented, including: <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, and <NUM>, and non-integer sizes between those listed, of which there are many. This dimension is also commonly referred to as the inner diameter or "ID" of the valve, and refers to the lateral dimension of the valve at a position commensurate with leaflets <NUM>. The valve may have an even larger diameter elsewhere, such as the location of flange <NUM>. For most mitral valve replacement configurations, valve <NUM> can be implemented with any of the following IDs: <NUM>, <NUM>, <NUM>, <NUM>, and <NUM>. Other sizes can be implemented, including: <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, and non-integer sizes between those listed, of which there are many.

While support structure <NUM> can take various non-cylindrical shapes, in all the embodiments described herein, support structure <NUM> can be substantially cylindrical or cylindrical. As those of ordinary skill in the art understand, being "cylindrical" does not require support structure <NUM> to be in the form of a full geometric cylinder (e.g., vertical walls oriented at a right angle to a circular cross-section), but rather requires support structure <NUM> to lie along a part of a hypothetical geometric cylinder (with only minor deviation). For example, the entire inner lumen surface (the surface directly adjacent the flow of blood) of support structure <NUM> can be cylindrical as that term is used herein. Similarly, those of ordinary skill in the art understand that a support structure <NUM> that is "substantially cylindrical" is permitted greater deviation from a mathematical cylinder than simply "a cylindrical support structure" and would readily recognize those support structures that qualify as being substantially cylindrical.

While the entirety of support structure <NUM> can be cylindrical or substantially cylindrical, it is also the case that only part of support structure <NUM> can be cylindrical or substantially cylindrical, with the remaining part of support structure <NUM> being non-cylindrical. For example, in certain embodiments, only the portion of support structure <NUM> along curved interfaces <NUM> may be cylindrical or substantially cylindrical.

When support structure <NUM> is formed from a core frame coated in polymer, then in some embodiments, only the core frame (either the entirety or a portion thereof) can be cylindrical or substantially cylindrical, while the outer surface of the polymer coating is not cylindrical or not substantially cylindrical. For example, in some embodiments the inner lumen surface of a core frame is cylindrical and the outer surface of the polymer coating (along the inner lumen of the core frame) is substantially cylindrical (or even non-cylindrical) due to variations in the coating thickness.

All of the embodiments of valve <NUM> described herein can also be provided to a medical professional (or retained by a medical professional) as part of a kit (or a set) of prosthetic valves being sized for various tissue annulus dimensions. The sizes can include any combination of two or more of the following: <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, and <NUM>.

While the embodiments described herein can exhibit active assistance in the opening and closing of the valve through the storage and release of energy in response to pressure differentials in the bloodstream, these valve embodiments, when considered as a whole, can be characterized as "passive" devices that are not actively powered by an artificial power source. Some examples of actively powered devices include machines used for cardiopulmonary bypass (e.g., heart-lung machines) and implantable artificial hearts.

The behavior of valve <NUM> can be assessed in various ways. For example, the behavior of valve <NUM> can be observed after implantation of valve <NUM> in a subject. The transvalve pressure can be measured directly in the subject by, e.g., placing catheter-based pressure sensors on opposite sides of the valve. Alternatively, the behavior of valve <NUM> can be assessed by testing valve <NUM> in a test apparatus that applies fluid pressure in a manner that simulates the transvalve pressure for a subject. Still further, the behavior of valve <NUM> can be assessed by a computer simulation applying an idealized model of transvalve pressure for a subject, such as that described with respect to <FIG>.

Various aspects of the present subject matter are set forth below, in review of, and/or in supplementation to, the embodiments described thus far, with the emphasis here being on the interrelation and interchangeability of the following embodiments. In other words, an emphasis is on the fact that each feature of the embodiments can be combined with each and every other feature unless explicitly stated otherwise or logically implausible.

In many embodiments, a prosthetic heart valve is provided that comprises a plurality of synthetic leaflets and a support structure, which comprises a plurality of projections coupled with the plurality of leaflets and a base upstream of the plurality of projections, wherein the plurality of projections and the base are elastic. The prosthetic heart valve can have a closed position and an open position and the plurality of leaflets and the support structure move between the closed position and the open position.

In certain embodiments, the prosthetic heart valve can be configured to permit fluid flow in a proper upstream to downstream direction when a transvalve fluid pressure is positive, and configured such that the plurality of leaflets are in a coapted state when the transvalve fluid pressure is a peak negative pressure. The prosthetic heart valve can be configured such that, when the transvalve fluid pressure is negative value less than the peak negative pressure, the plurality of projections automatically begin movement from the closed position to the open position.

In certain embodiments, the support structure has a periphery and the base comprises an edge that extends around the periphery of the support structure. Each leaflet of the plurality of leaflets can have an upstream end, and each projection of the plurality of projections can have a downstream end. In certain embodiments, the edge can include: a first location directly upstream from each downstream end of the plurality of projections such that a plurality of first locations are present on the edge; and a second location directly upstream from each upstream end of the plurality of leaflets such that a plurality of second locations are present on the edge, wherein, at a first time during movement of the support structure from the closed position to the open position, each first location moves in a upstream direction and each second location moves in an downstream direction.

In certain embodiments, the first time is when the transvalve fluid pressure is <NUM>-<NUM>% of the peak negative pressure, <NUM>-<NUM>% of the peak negative pressure, or <NUM>-<NUM>% of the peak negative pressure. The first time can be when the transvalve fluid pressure is at the negative value. In certain embodiments, each first location of the edge moves in a downstream direction and each second location of the edge moves in an upstream direction continually as the transvalve fluid pressure transitions from <NUM>% of the peak negative pressure to zero. In certain embodiments, each first location of the edge moves in a downstream direction and each second location of the edge moves in an upstream direction in immediate response to the transvalve fluid pressure transitioning from the peak negative pressure to a less negative pressure. The plurality of leaflets can begin to exit the coapted state at the first time. Also, at the first time, each downstream end of the plurality of projections can move in a radially outward direction.

In certain embodiments, the support structure comprises a sewing cuff and no more than one sewing cuff flange.

In certain embodiments, the heart valve is an aortic replacement valve or a mitral replacement valve, the heart valve comprising exactly three synthetic leaflets. In certain embodiments, the heart valve is a mitral replacement valve comprising exactly two synthetic leaflets.

In certain embodiments, the support structure is not radially collapsible for placement in an intravascular delivery device. In certain embodiments, the support structure is not radially collapsible for placement in a trans-apical delivery device.

In certain embodiments, the support structure and the plurality of leaflets are formed of the same material. In certain embodiments, the support structure comprises a coating and the plurality of leaflets are a continuation of the coating. The plurality of leaflets can be polymeric.

In certain embodiments, the plurality of leaflets are not sewn to the support structure. The plurality of leaflets can be seamlessly coupled to the support structure. The plurality of leaflets and the support structure can be a monolithic body.

In many embodiments, the prosthetic heart valve is not part of a cardiopulmonary bypass machine nor an implantable artificial heart, nor is the prosthetic heart valve powered by an artificial power source.

In certain embodiments, the support structure has an inner diameter selected from the group consisting of: a <NUM> millimeters (mm), <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, and <NUM>.

In certain embodiments, the plurality of leaflets have a first elasticity and the support structure has a second elasticity, the first elasticity can be in the range of <NUM>-<NUM> MegaPascals (MPa). In certain embodiments, the first elasticity can be in the range of <NUM>-<NUM> MPa. In certain embodiments, the first elasticity can be in the range of <NUM>-<NUM> MPa. In certain embodiments, the second elasticity can be in the range of <NUM>-<NUM> MPa. In certain embodiments, the second elasticity can be in the range of <NUM>-<NUM> MPa.

In certain embodiments, the support structure can have a rigidity per unit force of between <NUM> and <NUM> square millimeters. In certain embodiments, the support structure can have a rigidity per unit force of between <NUM> and <NUM> square millimeters. In certain embodiments, the support structure can have a rigidity per unit force of between <NUM> and <NUM> square millimeters.

The plurality of projections can each have a downstream end. In certain mitral embodiments, wherein upon transitioning from the closed position to the open position, the downstream ends can each exhibit an instantaneous velocity (VICO) of <NUM> millimeters/second (mm/s) or greater. In various embodiments, Vico can be any of multiple values and ranges between <NUM>/s and <NUM>/s. In certain embodiments, upon transitioning from the open position to the closed position, the downstream ends can each exhibit an instantaneous velocity (VIOC) of <NUM> millimeters/second (mm/s) or greater. In various embodiments, VIOC can be any of multiple values and ranges between <NUM>/s and <NUM>/s.

In certain aortic embodiments, wherein upon transitioning from the closed position to the open position, the downstream ends can each exhibit an instantaneous velocity (Vico) of <NUM> millimeters/second (mm/s) or greater. In various embodiments, Vico can be any of multiple values and ranges between <NUM>/s and <NUM>/s. In certain embodiments, wherein upon transitioning from the open position to the closed position, the downstream ends can each exhibit an instantaneous velocity (VIOC) of <NUM> millimeters/second (mm/s) or greater. In various embodiments, VIOC can be any of multiple values and ranges between <NUM>/s and <NUM>/s.

The prosthetic heart valve can have a closed position, a neutral position, and an open position and the plurality of leaflets and the support structure transition between the closed position, the neutral position, and the open position during valve operation. In certain mitral embodiments, the downstream ends can each move inwardly by <NUM> millimeters (mm) or greater in the transition from the neutral position to the closed position. In various embodiments, the downstream ends can each move inwardly by between <NUM> and <NUM>. In certain aortic embodiments, the downstream ends can each move inwardly by <NUM> millimeters (mm) or greater in the transition from the neutral position to the closed position. In various embodiments, the downstream ends can each move inwardly by between <NUM> and <NUM>.

Where a range of values is provided, each intervening value, to the tenth of the unit of the lower limit unless the context clearly dictates otherwise, between the upper and lower limit of that range and any other stated or intervening value in that stated range, is encompassed within the disclosure and can be claimed as a sole value or as a smaller range. Where the stated range includes one or both of the limits, ranges excluding either or both of those included limits are also included in the disclosure.

Where a discrete value or range of values is provided, that value or range of values may be claimed more broadly than as a discrete number or range of numbers, unless indicated otherwise. For example, each value or range of values provided herein may be claimed as an approximation and this paragraph serves as antecedent basis and written support for the introduction of claims, at any time, that recite each such value or range of values as "approximately" that value, "approximately" that range of values, "about" that value, and/or "about" that range of values. Conversely, if a value or range of values is stated as an approximation or generalization, e.g., approximately X or about X, then that value or range of values can be claimed discretely without using such a broadening term.

However, in no way should this specification be interpreted as implying that the subject matter disclosed herein is limited to a particular value or range of values absent explicit recitation of that value or range of values in the claims. Values and ranges of values are provided herein merely as examples.

All features, elements, components, functions, and steps described with respect to any embodiment provided herein are intended to be freely combinable and substitutable with those from any other embodiment. If a certain feature, element, component, function, or step is described with respect to only one embodiment, then it should be understood that that feature, element, component, function, or step can be used with every other embodiment described herein unless explicitly stated otherwise. This paragraph therefore serves as antecedent basis and written support for the introduction of claims, at any time, that combine features, elements, components, functions, and steps from different embodiments, or that substitute features, elements, components, functions, and steps from one embodiment with those of another, even if the following description does not explicitly state, in a particular instance, that such combinations or substitutions are possible. It is explicitly acknowledged that express recitation of every possible combination and substitution is overly burdensome, especially given that the permissibility of each and every such combination and substitution will be readily recognized by those of ordinary skill in the art.

As used herein and in the appended claims, the singular forms "a," "an," and "the" include plural referents unless the context clearly dictates otherwise.

Claim 1:
A prosthetic heart valve (<NUM>) having a plurality of leaflets (<NUM>) each having an upstream end (<NUM>), wherein each leaflet (<NUM>) is synthetic and has a modulus of elasticity in the range of <NUM>-<NUM> MegaPascals (MPa); and a support structure (<NUM>) wherein the prosthetic heart valve (<NUM>) has a closed position and an open position and the plurality of leaflets (<NUM>) and the support structure (<NUM>) moves between the closed position and the open position comprising:
a plurality of projections (<NUM>) having a downstream end (<NUM>) and coupled with the plurality of leaflets (<NUM>); and
an annular base (<NUM>) about the periphery of the support structure (<NUM>) integral with the plurality of leaflets (<NUM>) upstream of the plurality of projections (<NUM>), wherein the plurality of projections (<NUM>) and the base are elastic, and the support structure (<NUM>) has a modulus of elasticity between <NUM> and <NUM> MPa and the upstream base (<NUM>) has an upstream edge (<NUM>) that is sinusoidally-shaped in the closed positions and a reversed-profile sinusoidally shaped in the open position and wherein the upstream edge (<NUM>) has a first location (<NUM>) directly upstream from each downstream end (<NUM>) of the plurality of projections (<NUM>) such that a plurality of first locations (<NUM>) are present on the upstream edge (<NUM>); and
a second location (<NUM>) directly upstream from each upstream end (<NUM>) of the plurality of leaflets (<NUM>) such that a plurality of second locations (<NUM>) are present on the upstream edge (<NUM>),
wherein, at a first time during movement of the support structure (<NUM>) from the closed position to the open position, each first location (<NUM>) moves in a upstream direction and each second location (<NUM>) moves in an downstream direction;
wherein the prosthetic heart valve (<NUM>) is configured to permit fluid flow in an upstream to downstream direction when a transvalve fluid pressure is positive, and configured such that the plurality of leaflets (<NUM>) are in a coapted state when the transvalve fluid pressure is a peak negative pressure.