Patent Description:
Dilation of the annulus of a heart valve, such as that caused by ischemic heart disease, prevents the valve leaflets from fully coapting when the valve is closed. Regurgitation of blood from the ventricle into the atrium results in increased total stroke volume and decreased cardiac output, and ultimate weakening of the ventricle secondary to a volume overload and a pressure overload of the atrium.

<CIT> describes apparatus that includes an implant structure, which includes a contracting mechanism, which includes a rotatable structure, arranged such that rotation of the rotatable structure contracts the implant structure. A longitudinal member is coupled to the contracting mechanism. A tool for rotating the rotatable structure is configured to be guided along the longitudinal member, to engage the rotatable structure and to rotate the rotatable structure in response to a rotational force applied to the tool.

This summary is meant to provide some examples and is not intended to be limiting of the scope of the invention in any way. For example, any feature included in an example of this summary is not required by the claims, unless the claims explicitly recite the features. Also, the features described can be combined in a variety of ways. Various features and steps as described elsewhere in this disclosure can be included in the examples summarized here.

Some applications of the present invention and disclosure are directed to systems, apparatuses, and methods for adjusting a medical implant using an adjustment mechanism.

The adjustment mechanism can comprise a winch. For some applications, adjustment is achieved by using the winch to apply tension to a tether, the tether extending away from the winch
toward an end portion. The winch can comprise a spool coupled to the tether. The winch can be fixedly coupled to a mount having a driver interface, such that such that driving of the driver interface by a driver rotates the mount about a rotation axis, drawing the end portion of the tether toward the spool by winding the tether around the spool axis of the spool.

The spool can be coupled to the mount in a position and an orientation with respect to the rotation axis that facilitates the spool drawing the end portion of the tether toward the winch by winding of the tether around the spool in response to rotation of the mount in a forward rotational direction about the rotation axis. Further, the spool can be coupled to the mount in a position and an orientation with respect to the rotation axis that inhibits unwinding of the tether from the spool in response to pulling of the end portion away from the spool, by inhibiting the pulling from rotating the mount in a reverse rotational direction about the rotation axis.

That is, although the position and orientation of the spool facilitate the spool drawing the end portion of the tether toward the winch by winding of the tether around the spool in response to forward rotation of the mount about the rotation axis, this position and orientation typically inhibit pulling of the end portion away from the spool from causing reverse rotation of the mount and unwinding of the tether from the spool.

Generally, the spool (e.g., a spool axis defined by the spool) is not coaxial with the rotation axis.

For some applications, the spool can be disposed laterally from (e.g., parallel with) the rotation axis. For some such applications, the spool is entirely disposed laterally form the rotation axis, e.g., such that upon rotation of the mount about the rotation axis, the spool revolves around the rotation axis.

Optionally, the spool can be orthogonal to the rotation axis, e.g., such that the rotation axis passes through the spool, e.g., such that upon rotation of the mount about the rotation axis, the spool rotates about the rotation axis in a manner similar to that of a propeller on its axle.

For some applications, the adjustment mechanism includes at least one inclined guide coupled to the mount and disposed laterally from the rotation axis. The inclined guide can be positioned such that, upon rotation of the mount in the forward rotational direction, the guide guides the tether around the spool. For some such applications, driving of the driver interface by the driver moves the guide, with the mount, about the rotation axis.

For some applications, the adjustment mechanism includes a housing that houses the winch and is configured to facilitate rotation of the mount about the rotation axis with respect to the housing, the spool moving with the mount. The housing can define an aperture configured to facilitate passage of the tether from outside the winch to the spool as the spool draws the end portion of the tether toward the winch.

For some applications, the adjustment mechanism comprises at least one flange, configured to provide mechanical separation between the tether and the driver interface.

For some applications, the winch includes an eyelet that defines an aperture therethrough. The aperture can be configured to facilitate passage of the tether from outside the winch to the spool as the spool draws the end portion of the tether toward the winch. For some applications, the eyelet is mechanically engaged with the guide such that, upon rotation of the mount in the forward rotational direction, the inclined guide guides the tether around the spool by moving the eyelet longitudinally, parallel with the rotation axis, e.g., along a track, such as a track defined by the housing.

For some applications, at least one anchor is used to anchor the end portion of the tether to tissue of a subject. Some such applications include an annuloplasty structure that is configured such that the drawing of the end portion of the tether from the anchor toward the winch reduces a length of the structure. For example, the annuloplasty structure can comprise a longitudinal flexible sleeve defining an elongate lumen, coupled to the winch, and having a contracting portion along which the tether extends. Drawing of the end portion of the tether toward the winch can longitudinally contract the contracting portion.

There is therefore provided, in accordance with some applications, a system and/or an apparatus for use with a transcatheterally-advanceable driver, the system/apparatus including an implant. The implant can include a tether, having an end portion and a winch.

For some applications, the winch includes a driver interface, engageable and drivable by the driver and a mount, coupled to the driver interface such that driving of the driver interface by the driver rotates the mount about a rotation axis.

For some applications, the winch includes a spool coupled to the tether, the tether extending away from the winch toward the end portion and is fixedly coupled to the mount in a position and an orientation with respect to the rotation axis. For some applications, the position and the orientation facilitate the spool drawing the end portion of the tether toward the winch by winding of the tether around the spool in response to rotation of the mount in a forward rotational direction about the rotation axis; and inhibiting unwinding of the tether from the spool in response to pulling of the end portion away from the spool, by inhibiting the pulling from rotating the mount in a reverse rotational direction about the rotation axis.

In an application, the spool is fixedly coupled to the mount such that the spool is entirely disposed laterally from the rotation axis.

In an application, the spool is shaped to define an eye therethrough, the tether being threaded through the eye.

In an application, the spool is fixedly coupled to the mount in a position and an orientation that provides at least one stable rotational orientation of the mount at which the pulling is inhibited from rotating the mount in the reverse rotational direction about the rotation axis. In an application, the spool is fixedly coupled to the mount in a position and an orientation that provides exactly one stable rotational orientation of the mount at which the pulling is inhibited from rotating the mount in the reverse rotational direction about the rotation axis.

In an application, the spool is fixedly coupled to the mount in a position and an orientation that provides at least two stable rotational orientations of the mount at which pulling is inhibited from rotating the mount in the reverse rotational direction about the rotation axis. In an application, the spool is fixedly coupled to the mount in a position and an orientation that provides exactly two stable rotational orientations of the mount at which pulling is inhibited from rotating the mount in the reverse rotational direction about the rotation axis.

In an application, the winch includes at least one flange, the flange configured to provide mechanical separation between the tether and the driver interface. In an application, the mount is shaped to define the at least one flange.

In an application, the position and the orientation inhibit unwinding of the tether from the spool in response to the pulling by limiting, to less than <NUM> degrees of reverse rotation, the rotation of the mount in the reverse rotational direction in response to the pulling. In an application, the position and the orientation inhibit unwinding of the tether from the spool in response to the pulling by limiting, to less than <NUM> degrees of reverse rotation, the rotation of the mount in the reverse rotational direction in response to the pulling. In an application, the position and the orientation inhibit unwinding of the tether from the spool in response to the pulling by limiting, to less than <NUM> degrees of reverse rotation, the rotation of the mount in the reverse rotational direction in response to the pulling.

In an application, the system/apparatus includes a housing that houses the winch, the housing configured to facilitate movement of the mount and the spool about the rotation axis, with respect to the housing.

In an application, the housing defines an aperture, the aperture configured to facilitate passage of the tether from outside the winch to the spool as the spool draws the end portion of the tether toward the winch.

In an application, the driver interface is accessible to the driver while the winch is housed within the housing.

In an application, the housing is shaped to define an aperture, and the tether extends from the spool, out of the winch via the aperture, and away from the winch toward the end portion.

In an application, the aperture defined by the housing is a circular aperture.

In an application, the aperture defined by the housing is an elongate aperture. In an application, the elongate aperture has a long axis that is disposed on an aperture plane that is transverse to the rotation axis.

In an application, the implant further includes at least one anchor configured to anchor the end portion of the tether to tissue of a subject.

In an application, the at least one anchor includes a plurality of anchors, the tether is slidable with respect to at least one of the anchors, and the winch is configured such that drawing the end portion of the tether toward the winch in response to rotation of the mount in the forward rotational direction causes at least one of the anchors to slide distally with respect to the tether.

In an application, the implant includes an annuloplasty structure, and is configured such that the drawing of the end portion of the tether toward the winch reduces a length of the structure.

In an application, the annuloplasty structure includes a longitudinal flexible sleeve: defining an elongate lumen, coupled to the winch, anchorable by the anchor to the tissue, such that the tether is anchored to the tissue by the sleeve being anchored to the tissue, and having a contracting portion along which the tether extends. In an application, the system/apparatus is configured such that the drawing of the end portion of the tether toward the winch longitudinally contracts the contracting portion.

In an application, the sleeve is coupled to the winch by stitches.

In an application, the winch is coupled to an outer, lateral surface of the sleeve.

In an application, a first portion of the tether extends along the contracting portion; and a second portion of the tether: exits the sleeve at an exit point and is coupled to the winch.

In an application, the system/apparatus includes a delivery tool for delivering the implant to a body of a subject, the delivery tool including a catheter, a distal portion of the catheter being advanceable into the body of the subject.

In an application, the catheter is a steerable transluminal catheter.

In an application, the system/apparatus includes the driver and a guide member, and in a delivery state of the system/apparatus: the implant is disposed at the distal portion of the catheter, and the guide member is coupled to the winch, and extends from the winch proximally through the catheter, to a proximal portion of the catheter, and the driver is slidable over and along the guide member.

In an application, the spool is fixedly coupled to the mount laterally from the rotation axis, such that, in a cross-section of the winch orthogonal to the rotation axis, a radius of the winch: extends radially outward from the rotation axis toward the spool, reaches the spool at a first surface point of the spool, passes through the spool, and passes out of the spool at a second surface point of the spool.

In an application, in the cross-section, the spool has a cross-sectional shape that is a trapezoid. In an application, in the cross-section, the spool has a cross-sectional shape that is a D-shape. In an application, the spool is shaped to define a spool axis, the spool axis being parallel with the rotation axis.

In an application, in the cross-section, the first surface point of the spool is a closest point of the spool to the rotation axis. In an application, in the cross-section, the first surface point of the spool is at least <NUM> from the rotation axis. In an application, in the cross-section, the first surface point of the spool is <NUM>-<NUM> from the rotation axis. In an application, in the cross-section, the first surface point of the spool is <NUM>-<NUM> from the rotation axis.

In an application, the spool is fixedly coupled to the mount orthogonally to the rotation axis.

In an application, the winch includes at least one inclined guide coupled to the mount, disposed laterally from the rotation axis, and positioned such that, upon rotation of the mount in the forward rotational direction, the at least one inclined guide guides the tether around the spool.

In an application, the at least one inclined guide is fixedly coupled to the mount such that, upon driving of the driver interface by the driver, the at least one inclined guide moves with the mount about the rotation axis.

In an application, the at least one inclined guide defines a guide surface that extends helically around and along the rotation axis.

In an application, the at least one inclined guide includes a first inclined guide and a second inclined guide, the first inclined guide is positioned such that, upon rotation of the mount in the forward rotational direction, the first inclined guide guides the tether to a second side of the spool, and the second inclined guide is positioned such that, upon rotation of the mount in the forward rotational direction, the second inclined guide guides the tether to a first side of the spool that is opposite the second side of the spool.

In an application, the winch defines a first shoulder at which the first inclined guide is coupled to a first end of the spool, and a second shoulder at which the second inclined guide is coupled to a second end of the spool, the first inclined guide is positioned such that, upon rotation of the mount in the forward rotational direction, the first inclined guide guides the tether over the first shoulder to the second side of the spool, and the second inclined guide is positioned such that, upon rotation of the mount in the forward rotational direction, the second inclined guide guides the tether over the second shoulder to the first side of the spool.

In an application, the winch further includes an eyelet that defines an aperture therethrough, the aperture configured to facilitate passage of the tether from outside the winch to the spool as the spool draws the end portion of the tether toward the winch, the eyelet mechanically engaged with the guide such that, upon rotation of the mount in the forward rotational direction, the at least one inclined guide guides the tether around the spool by moving the eyelet longitudinally, parallel with the rotation axis.

In an application, the housing defines a longitudinal track along a track axis, parallel with the rotation axis, the track configured to facilitate, upon rotation of the mount in the forward rotational direction, longitudinal movement of the eyelet along the track axis.

There is further provided, in accordance with some applications, a system and/or an apparatus for use with a transcatheterally-advanceable driver the system/apparatus including an implant, the implant including: a tether, having an end portion; and a winch.

For some applications, the winch includes a driver interface, engageable and drivable by the driver, and a mount, coupled to the driver interface such that driving of the driver interface by the driver rotates the mount about a rotation axis.

For some applications, the winch includes a spool: defining a spool axis, coupled to the tether, the tether extending away from the winch toward the end portion. The spool can be fixedly coupled to the mount such that: rotation of the mount about the rotation axis draws the end portion of the tether toward the spool by winding the tether around the spool axis of the spool, and the spool axis is non-coaxial with the rotation axis.

In an application, the spool axis is parallel with the rotation axis.

In an application, the winch includes at least one flange, the flange configured to provide mechanical separation between the tether and the driver interface.

In an application, the mount is shaped to define the at least one flange.

In an application, the housing is shaped to define an aperture, the tether extends from the spool, out of the winch via the aperture, and away from the winch toward the end portion, and the aperture configured to facilitate passage of the tether into the winch as the spool draws the end portion of the tether toward the winch.

In an application, the housing defines the aperture as circular in shape. In an application, the housing defines the aperture as elongate in shape.

In an application, the housing defines the aperture to have a long axis that is disposed on an aperture plane that is transverse to the rotation axis.

In an application, the annuloplasty structure includes a longitudinal flexible sleeve: defining an elongate lumen, coupled to the winch, and having a contracting portion along which the tether extends, and the system/apparatus is configured such that the drawing of the end portion of the tether toward the winch longitudinally contracts the contracting portion.

In an application, in the cross-section, the spool has a cross-sectional shape that is a trapezoid. In an application, in the cross-section, the spool has a cross-sectional shape that is a D-shape.

In an application, the system/apparatus includes an eyelet that defines an aperture therethrough, the aperture configured to facilitate passage of the tether from outside the winch to the spool as the spool draws the end portion of the tether toward the winch, the eyelet mechanically engaged with the guide such that, upon rotation of the mount in the forward rotational direction, the at least one inclined guide guides the tether around the spool by moving the eyelet longitudinally, parallel with the rotation axis.

There is further provided, in accordance with some applications, a method, including: transcatheterally delivering an implant to tissue of a subject, the implant including a tether, having an end portion and a winch.

For some applications, the winch includes a driver interface and a mount, coupled to the driver interface such that driving of the driver interface rotates the mount about a rotation axis.

For some applications, the winch includes a spool: defining a spool axis that is non-coaxial with the rotation axis, coupled to the tether, the tether extending away from the winch toward the end portion, and fixedly coupled to the mount. For some applications, drawing the end portion of the tether toward the spool by winding the tether around the spool axis that is non-coaxial with the rotation axis by rotating the mount about the rotation axis.

In an application, the spool axis is parallel with the rotation axis, and winding the tether around the spool axis includes winding the tether around the spool axis that is parallel with the rotation axis.

In an application, the spool axis that is orthogonal to the rotation axis and winding the tether around the spool axis includes winding the tether around the spool axis that is orthogonal to the rotation axis.

In an application, the method includes engaging the driver interface with a driver and rotating the mount about the rotation axis includes rotating the mount about the rotation axis by driving the driver interface with the driver.

In an application, the method includes, subsequently to transcatheterally delivering the implant to the tissue of the subject, and prior to engaging the driver interface with the driver, transcatheterally advancing the driver to the driver interface.

This method can be performed on a simulation, such as on a cadaver, cadaver heart, simulator (e.g. with the body parts, tissue, etc. being simulated), etc..

There is further provided, in accordance with some applications, a method, including transcatheterally delivering an implant to tissue of a subject, the implant including: a tether, having an end portion; and a winch that includes a driver interface and a mount. The winch can also include a spool defining a spool axis.

For some applications, the method includes engaging the driver interface with a driver. For some applications, the method includes using the driver, tensioning the tether by winding the tether toward the winch by rotating the mount in a forward rotational direction about a rotation axis.

For some applications, without locking a discrete locking mechanism, the method includes disengaging the driver from the driver interface such that the mount is inhibited from rotating in a reverse rotational direction about the rotation axis in response to pulling from the tensioned tether.

In an application, the spool axis is parallel with the rotation axis, and winding the tether toward the winch includes winding the tether around the spool axis that is parallel with the rotation axis.

In an application, the spool axis that is orthogonal to the rotation axis, and winding the tether toward the winch includes winding the tether around the spool axis that is orthogonal to the rotation axis.

Reference is made to <FIG>, <FIG>, which are schematic illustrations showing prior art winches <NUM> and 10b. For some applications, and as shown in <FIG>, winch <NUM> comprises a spool <NUM> to which a tether <NUM>, comprising an elongate member (e.g. a wire, a ribbon, a rope, a cable, a thread, a filament, etc.) is affixed.

Winch <NUM> can further comprise a mount <NUM> to which spool <NUM> is fixedly attached, such that both the mount and the spool rotate together about a common rotation axis d18. In this way, and as shown in <FIG>, rotation of the mount and spool (indicated by solid arrow) about axis d18 winds tether <NUM> into the winch (indicated by a broken arrow), the tether winding around spool <NUM>.

Throughout this patent application, the direction of rotation of a winch (or the mount thereof) about its rotation axis that results in winding of the tether about the spool is defined as "forward rotation.

It is to be noted that mount <NUM> and spool <NUM> are coaxial.

As shown in <FIG>, in the absence of any inhibiting force or element, a pulling force applied to a distal end of tether <NUM> pulls the tether out of the winch, due to the pulling force rotating spool <NUM> in a reverse rotational direction (indicated by dotted arrow), in a direction opposite of that which accompanied winding of the tether about the spool, such that the tether unwinds from the spool. Throughout this disclosure, the direction of rotation of a winch that results in unwinding of the tether from about the spool is defined as "reverse rotation.

For some applications, it may be desirable to prevent unwinding of tether <NUM> in response to a pulling force applied to the distal end of the tether. For example, after applying tension to tether <NUM> during winding in the forward direction, it may be desirable to maintain this tension in the tether. <FIG> shows a prior art solution for this, in which a locking mechanism <NUM> is incorporated into winch <NUM>, resulting in a winch 10b. For example, and as shown, locking mechanism <NUM> can comprise a ratchet <NUM> and a pawl <NUM> affixed to mount <NUM>. Often, and as shown, ratchet <NUM> is affixed to mount <NUM> in a manner which enables rotational movement of both the mount and spool <NUM>, about axis d18. Further, ratchet <NUM> can be shaped to define teeth <NUM>, and pawl <NUM> is shaped to complimentarily fit teeth <NUM> of the ratchet. Pawl <NUM> can be biased (e.g., by a spring) to engage ratchet <NUM>, such that pawl abuts successive teeth <NUM> of the ratchet, as the ratchet rotates. Due to the shape of teeth <NUM> and pawl <NUM>, rotation of spool <NUM> in the forward direction (counter-clockwise, in <FIG>) results in the sliding of the pawl from a brake zone 28a of a first tooth <NUM>, along a ramp zone <NUM> of a second tooth, to a brake zone 28b of the second tooth.

Often, and as shown, locking mechanism <NUM> enables rotation of spool (solid arrow in <FIG>) about axis d18, accompanied by winding of tether <NUM> (dotted arrow in <FIG>). However, when a pulling force is applied to a distal end of tether <NUM> (solid arrow in <FIG>), spool <NUM> is largely prevented from rotating in the reverse direction (dotted arrow in <FIG>). That is, the pulling force pulls the spool in the reverse direction such that pawl <NUM> generally crosses a portion of a ramp zone <NUM>, until the pawl abuts a brake zone <NUM>, ceasing backward rotation of winch <NUM>. In this way, tether <NUM> can unwind for less than the rotational length of a tooth <NUM>, until the static abutment of pawl <NUM> against brake zone <NUM> prevents the tether from unwinding further. That is, locking mechanism <NUM> inhibits unwinding of tether <NUM> from spool <NUM> in response to pulling of the end portion of the tether away from the spool, by providing winch <NUM> with unidirectionality.

Other prior art solutions for inhibiting such unwinding of a tether from a spool include actuatable locking mechanisms, which are unlocked during winding in of the tether, and are subsequently locked to inhibit further rotation of the spool (e.g., in either direction). An example of such a locking mechanism is described in<CIT> (e.g., with reference to <FIG>).

Reference is made to <FIG>, <FIG>, which are schematic illustrations showing an adjustment mechanism <NUM> comprising a winch <NUM>, in accordance with some applications.

As shown in <FIG>, winch <NUM> comprises a mount <NUM>, a spool <NUM>, and a driver interface <NUM>. As shown in <FIG>, engaging and driving of the driver interface by a transcatheterally-advanceable driver <NUM> rotates mount <NUM> about a rotation axis d48 of the winch.

Spool <NUM> is generally shaped to define a longitudinal spool axis d50.

Whereas the mount and the spool of winch <NUM> are coaxial, in winch <NUM> spool <NUM> is not coaxial with rotation axis d48. Instead, and as described in more detail hereinbelow, spool <NUM> is disposed laterally from axis d48.

Similarly to winch <NUM>, for winch <NUM>, in response to rotation in a forward rotational direction, tether <NUM> is drawn into the winch and is wound around spool <NUM>. However, in contrast to winch <NUM>, the position and orientation at which spool <NUM> is coupled to mount <NUM> inhibits subsequent unwinding of tether <NUM> from the spool in response to pulling of the end portion away from the spool. That is, the position and orientation at which spool <NUM> is coupled to mount <NUM> at least in part obviates a need for adjustment mechanism <NUM> to comprise a discrete locking mechanism (e.g., a discrete actuatable locking mechanism). It is to be noted that, despite this, winch <NUM> is bidirectionally rotational by driver <NUM>.

For some applications, and as shown in <FIG>, adjustment mechanism <NUM> further comprises a housing <NUM> in which the winch is housed, such that mount <NUM> rotates about axis d48 with respect to the housing. Often, and as shown, housing <NUM> is shaped to define an aperture <NUM>, and tether <NUM> extends from spool <NUM>, out of winch <NUM> via the aperture, and away from the winch toward end portion <NUM>. For some applications, and as shown, aperture <NUM> is shaped to define an elongate shape, a long axis thereof being disposed on an aperture plane d38 that is transverse to spool axis d50.

As shown in <FIG>, for applications in which winch <NUM> is housed within housing <NUM>, driver interface <NUM> can be accessible to driver <NUM> from outside of the housing.

Tether <NUM> (e.g., a proximal end thereof) is fixedly attached (e.g. tied, crimped, soldered, brazed or welded) to spool <NUM>. For some applications, and as shown, spool <NUM> is shaped to define an eye <NUM> that is configured to facilitate this affixation.

For some applications, and as shown in <FIG>, winch <NUM> further comprises at least one flange <NUM>, e.g., two flanges <NUM>, one at each end of spool <NUM> (e.g., abutting the spool). For some applications, flanges <NUM> are defined by and/or are integral with mount <NUM>. Often, flange <NUM> is shaped to provide mechanical separation between spool <NUM> and driver interface <NUM>. It is therefore hypothesized that flange <NUM> inhibits tether <NUM> from slipping off of spool <NUM> and/or becoming trapped between elements of the adjustment mechanism.

As described hereinabove, in response to rotation of mount <NUM> in its forward rotational direction (solid arrow in <FIG>), tether <NUM> is drawn into the winch (broken arrow in <FIG>), and is wound around spool <NUM> - e.g., as shown by the transition between <FIG>. As also described hereinabove, the position and orientation at which spool <NUM> is coupled to mount <NUM> inhibits subsequent unwinding of tether <NUM> from the spool (represented by the absence of a rotational arrow in <FIG>) in response to pulling of tether <NUM> away from the spool (solid arrow in <FIG>). That is, pulling tether <NUM> does not rotate mount <NUM> in a reverse rotational direction about the rotation axis. In fact, in certain rotational positions of mount <NUM>, pulling tether <NUM> rotates the mount a little further in the forward rotational orientation (e.g., as shown by the transition between <FIG>), e.g., until the winch reaches a stable rotational orientation.

<FIG> illustrate transition of winch <NUM> from a dynamic rotational position (<FIG>) to a stable rotational orientation (<FIG>). In both the dynamic rotational position and the stable rotational orientation, the pulling force (solid arrow) is applied to tether <NUM> in the same direction. As denoted by the broken arrow in <FIG>, the pulling force rotates spool <NUM> in the forward rotational direction, until it reaches the stable rotational orientation shown in <FIG>. When winch <NUM> assumes its stable rotational orientation, further pulling of the tether does not: (i) unwind tether <NUM> from spool <NUM> in response to pulling of tether <NUM> away from the spool, nor (ii) rotate mount <NUM> about the rotation axis.

As described hereinabove, the stable rotational orientation that provides resistance to unwinding in response to pulling of the tether results from the position and orientation at which spool <NUM> is coupled to mount <NUM>. As shown, spool <NUM> is disposed laterally from axis d48, e.g., with spool axis d50 being non-coaxial with rotation axis d48. For example, and as shown, spool axis d50 can be parallel to rotation axis d48.

For some applications, spool <NUM> is entirely disposed laterally from the rotation axis. That is, a radius d52 of the winch extends radially outward from axis d48 toward spool <NUM>, reaches spool <NUM> at a first surface point <NUM>, passes through the spool, and passes out of the spool at a second surface point <NUM>. For some applications, spool <NUM> defines two opposing sides: (i) a first side <NUM> that includes surface point <NUM> and faces axis d48, and (ii) a second side <NUM> that includes surface point <NUM> and faces away from axis d48. Both sides <NUM> and <NUM> are disposed on the same lateral side of rotation axis d48, such that axis d48 does not pass through spool <NUM>.

Due to the position of spool <NUM> with respect to mount <NUM>, when the mount rotates about rotation axis d48, the spool revolves around the rotation axis d48 but typically does not meet the rotation axis. That is, spool axis d50 remains radially outward from rotation axis d48 during rotation of winch <NUM>.

Often, the position and orientation at which spool <NUM> is coupled to mount <NUM> is such that portions of tether <NUM> that are wound around the spool are disposed laterally from rotation axis d48 (e.g., on one side of line d94).

Often, spool <NUM> is fixedly coupled to mount <NUM> such that the spool is entirely disposed laterally from rotation axis d48. That is, often, a central line d94 (e.g., a diameter or a secant thereof) can be drawn transverse to rotation axis d48, without the line passing through the spool. For example, in the cross-section (as in <FIG>), first surface point <NUM> is a closest point of spool <NUM> to rotation axis d48, and is generally sufficiently distant from axis d48 to provide space for windings of the wire to be disposed between the spool and axis d48. First surface point <NUM> can be at least <NUM> (e.g. <NUM>-<NUM>, such as <NUM>-<NUM>) from rotation axis d48 and/or from line d94. Similarly, first side <NUM> can be entirely disposed at least <NUM> (e.g. <NUM>-<NUM>, such as <NUM>-<NUM>) from line d94. It is hypothesized that both the spool and the tether being disposed laterally from the rotation axis facilitates assumption of a stable rotational orientation by the winch, despite the pulling force upon the end portion of the tether.

For some applications, spool <NUM> has a cross-sectional shape that is circular. For some applications, and as shown, the cross-sectional shape of spool <NUM> is non-circular, e.g., such that first side <NUM> defines a long side of the spool. For example, the cross-sectional shape in the cross section (as in <FIG>), spool <NUM> can have a cross-sectional shape that is a trapezoid (e.g. wherein the longer of the parallel sides of the trapezoid is first side <NUM>). Optionally, in the cross section (as in <FIG>), spool <NUM> can have a cross-sectional shape that is a D-shape (e.g. wherein the curved side of the D-shape is the second side). The cross-sectional shape shown is configured to provide a relatively large circumference in order to wind in a relatively long length of tether <NUM> per revolution, while remaining entirely laterally from axis d48. These exemplary cross-sectional shapes of spool <NUM> are not meant to be exhaustive, and other shapes are contemplated.

Reference is made to <FIG>, <FIG>, <FIG>, and to <FIG>, <FIG>, which are schematic illustrations showing adjustment mechanisms <NUM> and <NUM>, respectively comprising winches <NUM> and <NUM>, in accordance with some applications. Features common to adjustment mechanisms <NUM> and <NUM> will be presented first, followed by description of aspects unique to each winch.

Whereas the mount and the spool of winch <NUM> are coaxial, in winches <NUM>, <NUM>, spool <NUM>, <NUM> is not coaxial with rotation axis d148, d248. Instead, and as described in more detail hereinbelow, spool <NUM>, <NUM> is disposed orthogonally to axis d148, d248. It is to be noted that, despite this, winch <NUM>, <NUM> are also bidirectionally rotational by driver <NUM>.

Tether <NUM> (e.g., a proximal end thereof) is fixedly attached (e.g. tied, crimped, soldered, brazed or welded) to spool <NUM>, <NUM>. For some applications, and as shown, spool <NUM>, <NUM> is shaped to define an eye <NUM>, <NUM> that facilitates this affixation.

Similarly to winch <NUM>, for winch <NUM>, <NUM>, in response to rotation in a forward rotational direction, tether <NUM> is drawn into the winch and is wound around the respective spool <NUM>, <NUM>. Further similarly to winch <NUM>, the position and orientation at which spool <NUM>, <NUM> is coupled to mount <NUM>, <NUM>, respectively, inhibits subsequent unwinding of tether <NUM> from the spool in response to pulling of the end portion away from the spool. In this way, pulling force applied to spool <NUM>, <NUM> does not result in substantial rotational movement, yielding a stable rotational orientation of winch <NUM>, <NUM>. That is, the position and orientation at which spool <NUM>, <NUM> is coupled, respectively, to mount <NUM>, <NUM> at least in part precludes the need for adjustment mechanism <NUM>, <NUM> to comprise a discrete locking mechanism (e.g., a discrete actuatable locking mechanism).

For some applications, spool <NUM> is fixedly coupled to mount <NUM> in a position and an orientation that provides at least one stable rotational orientation (e.g. exactly one stable rotational orientation) of the mount at which the pulling is inhibited from rotating the mount in the reverse rotational direction about rotation axis d48. That is, depending on an initial rotational orientation of winch <NUM>, application of a pulling force to end portion <NUM> of tether <NUM> can rotate the winch almost one complete turn until the winch reaches a stable position. In contrast, spool <NUM>, <NUM> is fixedly coupled to mount <NUM>, <NUM> in a position and an orientation that provides at least two stable rotational orientations of the mount at which pulling is inhibited from rotating the mount in the reverse rotational direction about rotation axis d148, d248. That is, depending on an initial rotational orientation of the winch, application of a pulling force to the end portion <NUM> of tether <NUM> can rotate the winch almost half a turn until the winch reaches a stable position.

Spool <NUM>, <NUM> is fixedly coupled to respective mount <NUM>, <NUM>. For some applications, and as shown, spool <NUM>, <NUM> is shaped to define a spool axis d150, d250 disposed orthogonally to rotation axis d148, d248 (e.g., passing through the rotation axis).

For some applications, winch <NUM>, <NUM> is housed within housing <NUM>, <NUM> such that mount <NUM>, <NUM> and spool <NUM>, <NUM> rotate about axis d148, d248 with respect to the housing. Further, driver interface <NUM>, <NUM> can be accessible to driver <NUM>, while winch <NUM>, <NUM> is housed within housing <NUM>, <NUM>. Accessibility of driver interface <NUM>, <NUM> while winch <NUM>, <NUM> is housed within housing <NUM>, <NUM> facilitates the engaging and driving of the winch, by driver <NUM>, while the winch is housed within the housing.

As shown in <FIG>, housing <NUM> is shaped to define an aperture <NUM> therethrough, the aperture configured to facilitate passage of tether <NUM> from outside winch <NUM> to spool <NUM> as the spool draws end portion <NUM> of the tether toward the winch.

For some applications, and as shown, winch <NUM>, <NUM> comprises at least one inclined guide <NUM>, <NUM>. Often, inclined guide <NUM>, <NUM> is coupled to mount <NUM>, <NUM>. For some applications, mount <NUM>, <NUM> is shaped to define guide <NUM>, <NUM>. For instance, guide <NUM>, <NUM> can be integral to mount <NUM>, <NUM> (i.e. molded from the same material). Often, and as shown, inclined guide <NUM>, <NUM> is coupled to mount <NUM>, <NUM> and disposed laterally from rotation axis d148, <NUM>. In this way, inclined guide <NUM>, <NUM> is positioned such that, upon rotation of mount <NUM>, <NUM> in the forward rotational direction, the inclined guide guides tether <NUM> around spool <NUM>, <NUM>.

The manner in which tether <NUM> is guided around spool <NUM> is different from the manner in which the tether is guided around spool <NUM>, as described hereinbelow.

As shown in <FIG>, rotation of mount <NUM> about rotation axis d148 causes tether <NUM> to wind around the spool - i.e., around spool axis d150. Often, and as shown, inclined guide <NUM> is shaped such that, upon driving of driver interface <NUM> by driver <NUM>, the inclined guide rotates with the mount about rotation axis d148. For some applications, and as shown, inclined guide <NUM> defines a guide surface <NUM> that extends helically around and along rotation axis d148. Contact of tether <NUM> with guide surface <NUM> along a helical slope of inclined guide <NUM> facilitates translation of circular movement of mount <NUM> into wrapping of tether <NUM> about spool <NUM>.

For example, and as shown in <FIG>, winch <NUM> includes a first inclined guide 170a and a second inclined guide 170b. First inclined guide 170a is positioned such that, upon rotation of mount <NUM> in the forward rotational direction, the first inclined guide guides tether <NUM> to a second side 182b of spool <NUM>. Second inclined guide 170b is positioned such that, upon forward rotation of mount <NUM>, the second inclined guide guides tether <NUM> to a first side 182a of spool <NUM>. Often, first inclined guide 170a is disposed generally on first side 182a of the spool, and second inclined guide 170b is disposed generally on second side 182b of the spool.

In some applications, and as shown in <FIG>, guiding of tether <NUM>, by respective inclined guides 170a and 170b, to respective sides <NUM>, <NUM> of spool <NUM>, is facilitated by the winch being shaped to define two shoulders: a first shoulder 178a at which first inclined guide 170a is coupled to a second side 182b of spool <NUM>, and a second shoulder 178b at which second inclined guide 170b is coupled to a first side 182a of spool <NUM>.

For some applications, and as shown, inclined guides 170a, 170b are positioned such that, upon forward rotation of mount <NUM>, the first inclined guide guides tether <NUM> over first shoulder 178a to second side 182b of the spool, and the second inclined guide guides the tether over second shoulder 178b to the first side 182a of the spool.

For instance, as shown in <FIG>, forward rotation of winch <NUM> initially causes tether <NUM> to contact inclined guide 170a at guide surface 172a. Continued forward rotation of winch <NUM> causes tether <NUM> to be guided along guide surface 172a, towards first shoulder 178a. As shown in <FIG>, continued forward rotation of winch <NUM> causes tether <NUM> to be guided further, over first shoulder 178a, such that the tether becomes draped over second side 182b of spool <NUM>. As is evident in <FIG>, one half turn of forward rotation of winch <NUM> facilitates wrapping tether <NUM> about at least one half of a circumference of spool <NUM>.

As shown in <FIG>, continued forward rotation of winch <NUM> causes tether <NUM> to climb guide surface 172b, towards second shoulder 178b, such that the tether becomes draped over first side 182a of spool <NUM>. In this way, one full turn of forward rotation of winch <NUM> facilitates wrapping tether <NUM> about at least one full circumference of spool <NUM>.

As shown in <FIG>, when a rotational force is no longer applied to winch <NUM> (e.g., upon disengagement of driver <NUM> from the winch), if a pulling force (solid arrow in <FIG>) is applied to tether <NUM>, it is not significantly translated into reverse rotation of winch <NUM>, nor into unwinding of the tether. It is hypothesized that the pulling force is not significantly translated into reverse rotation of the winch at least in part since spool <NUM> is fixedly coupled to mount <NUM> orthogonally to rotation axis d148. That is, tension on tether <NUM> "attempts" to rotate spool <NUM> about spool axis d150 (represented by the broken arrow in <FIG>), but that axis is orthogonal to the axis d148 about which mount <NUM> is configured to rotate. Winch <NUM> is unable to rotate about axis d150 within housing <NUM> (represented by the striking out of the broken arrow in <FIG>). Therefore, tension applied to tether <NUM> during winding of the winch does not automatically unwind the winch upon subsequent disengagement of driver <NUM>.

It is further hypothesized that this at least in part obviates a need for an adjustment mechanism <NUM> to comprise a discrete locking mechanism (e.g., a discrete actuatable locking mechanism). It is further hypothesized that this thereby contributes to the simplicity and ease of use of winch <NUM>.

Reference is again made to <FIG>, <FIG>, which are schematic illustrations showing winch <NUM> comprising mount <NUM> and spool <NUM>, in accordance with some applications.

While the shape of inclined guides 270a, 270b of winch <NUM> is similar to that of inclined guide <NUM> of winch <NUM>, guides 270a, 270b of winch <NUM> are not configured to directly contact tether <NUM>, but instead are configured to indirectly guide the tether by guiding an eyelet <NUM> that defines an aperture <NUM> through which the tether passes. For some applications, aperture <NUM> is configured to facilitate passage of tether <NUM> from outside winch <NUM> to spool <NUM> as the spool draws the end portion <NUM> of the tether toward the winch.

Further for some applications, and as described in more detail hereinbelow, eyelet <NUM> is mechanically engaged with guide surfaces 272a, 272b of guides 270a, 270b such that, upon rotation of mount <NUM> in the forward rotational direction, the guides guide the eyelet linearly parallel to rotation axis d248.

As shown in <FIG>, C-D, winch <NUM> comprises inclined guides 270a, 270b that each extend helically around and along rotation axis d248, typically parallel with each other. For some applications, inclined guides 270a, 270b are coupled to mount <NUM>. For some applications, mount <NUM> is shaped to define guides 270a, 270b. For instance, guides 270a, 270b can be integral to mount <NUM> (i.e. molded from the same material).

For some applications, and as shown in <FIG>, adjustment mechanism <NUM> further comprises a housing <NUM> that houses winch <NUM>. For some applications, housing <NUM> is configured to facilitate rotation of mount <NUM> and spool <NUM> about rotation axis d248, with respect to the housing.

For some applications, adjustment mechanism <NUM> (e.g., housing <NUM> thereof) defines a track <NUM> along a track axis d286, which is typically parallel to rotation axis d248. Eyelet <NUM> is mechanically engaged with track <NUM>, such that the eyelet is linearly slidable along the track. The mechanical engagement of eyelet <NUM> with (i) guide surfaces 272a and 272b, and (ii) track <NUM>, translates rotation of winch <NUM> (including guides 270a and 270b) into reciprocating movement of the eyelet along the track.

This movement of the eyelet <NUM> guides tether <NUM> around one side and then the other side of spool <NUM>. Thereby, (<NUM>) longitudinal motion of eyelet <NUM> and end portion <NUM> of tether <NUM> in relation to housing <NUM>, and (<NUM>) forward rotation of mount <NUM>, winds the tether around spool <NUM>.

Similarly to as described herein above in reference to winch <NUM>, when a rotational force is no longer applied to winch <NUM> (e.g., upon disengagement of driver <NUM> from the winch), if a pulling force is applied to tether <NUM>, it is not significantly translated into reverse rotation of winch <NUM>, nor into unwinding of the tether. As in winch <NUM>, spool axis d250 is orthogonal to the axis d248 about which mount <NUM> is configured to rotate. Therefore, pulling on tether <NUM> applies a pulling force to spool <NUM>, <NUM> but the pulling force is applied orthogonally to axis d148, d248, and does not result in rotational movement, yielding a stable rotational orientation, respectively of winch <NUM>, <NUM>. Thus, winch <NUM> is unable to rotate about axis d250 within housing <NUM>, similarly obviating both a locking mechanism and a locking-actuating mechanism from winch <NUM> and contributing to the simplicity and ease of use of the winch.

Reference is made to <FIG>, which is a schematic illustration of a multi-component system <NUM> comprising an implant <NUM>, and a delivery tool <NUM> for delivering the implant <NUM> to a heart <NUM> of a subject, in accordance with some applications.

Implant <NUM> comprises an adjustment mechanism <NUM> that comprises a winch. Adjustment mechanism <NUM> can comprise any of the other adjustment mechanisms described herein, but for the purpose of illustration, it is shown in <FIG> as comprising adjustment mechanism <NUM>.

<FIG> shows a distal portion of system <NUM> comprising annuloplasty structure <NUM> (e.g., an annuloplasty band), disposed partially within a catheter <NUM> of tool <NUM>. For some applications, and as shown, structure <NUM> comprises a sleeve <NUM> that defines an elongate lumen circumscribed by a lateral wall (e.g., the interior of structure <NUM> is shaped as an elongate lumen). For some applications, sleeve <NUM> defines an end wall <NUM> of annuloplasty structure <NUM>.

Sleeve <NUM> is often a flexible sleeve comprising a braided fabric mesh, e.g., comprising polyethylene terephthalate (such as Dacron (TM)). Sleeve <NUM> is often configured to be anchored partially or completely around a cardiac valve annulus <NUM>, and subsequently contracted so as to adjust a perimeter of the annulus (i.e., to circumferentially tighten the annulus).

Annuloplasty structure <NUM> comprises a flexible elongate tether <NUM> that extends, along at least a portion of sleeve <NUM>, e.g., to an end portion <NUM> of the tether. The portion of the sleeve along which the tether extends is thereby a contracting portion of the sleeve. For some applications, tether <NUM> generally corresponds to tether <NUM> described hereinabove, mutatis mutandis.

For some applications, and as shown in <FIG>, sleeve <NUM> (i.e. an outer, lateral surface thereof) is coupled to the winch of by a connector <NUM> (e.g., by stitches) such that drawing of end portion <NUM> of tether <NUM> toward and into the winch longitudinally contracts the contracting portion.

Tether <NUM> can comprise a wire, a ribbon, a rope, or a band, and can comprise a flexible and/or superelastic material, e.g., nitinol, polyester, stainless steel, or cobalt chrome. For some applications, the wire comprises a radiopaque material. For some applications, tether <NUM> comprises a braided polyester suture (e.g., Ticron). For some applications, tether <NUM> is coated with polytetrafluoroethylene (PTFE). For some applications, tether <NUM> comprises a plurality of wires that are intertwined to form a rope structure.

Adjustment mechanism <NUM> facilitates axial contracting (and re-expanding) of annuloplasty structure <NUM>. As described for other adjustment mechanisms described herein, adjustment mechanism <NUM> comprises a winch that comprises a spool, arranged such that rotation of the winch winds tether <NUM> around the spool, drawing the tether into the winch. This thereby contracts implant structure <NUM>. For some applications, adjustment mechanism <NUM> comprises a housing within which the winch is disposed, as described hereinabove. Adjustment mechanism <NUM> (e.g., the spool thereof) is coupled to tether <NUM>. When the winch of the adjustment mechanism is rotated (e.g., with respect to its housing), the winch adjusts a length of structure <NUM> by applying tension to tether <NUM> (or by releasing the tension). Particularly, drawing of end portion <NUM> of tether <NUM> toward adjustment mechanism <NUM> reduces a length of structure <NUM>.

System <NUM> often comprises a flexible, longitudinal guide member <NUM> (e.g., a wire) coupled to a portion of the winch. For example, in a delivery state shown in <FIG>, structure <NUM> is disposed at a distal portion of the catheter, and guide member <NUM> is coupled to the winch of adjustment mechanism <NUM>. For some applications, and as shown, guide member <NUM> extends from adjustment mechanism <NUM> (e.g., the driver interface thereof) and proximally through catheter <NUM> (e.g., through a parallel side-lumen of the catheter). For some applications, a proximal portion of guide member <NUM> is accessible from outside the body of the subject.

Reference is made to <FIG>, which are schematic illustrations showing use of adjustment mechanism <NUM> in system <NUM> comprising implant <NUM> and delivery tool <NUM>, in accordance with some applications.

For some applications, and as shown in <FIG>, delivery tool <NUM> comprises a catheter <NUM>, the distal portion of the catheter being advanceable (e.g., transluminally steerable) into the body of the subject. For some applications, structure <NUM> is advanced into left atrium <NUM> using catheter <NUM>. For some applications, and as shown, this is performed by advancing catheter <NUM> with structure <NUM> disposed therein. Optionally, catheter <NUM> can be advanced first, and structure <NUM> (or another implant) can be subsequently advanced through the catheter. While a transfemoral transseptal approach to the mitral valve is shown in <FIG>, the scope herein includes alternate approaches to the mitral valve, to the tricuspid valve, to other locations in (e.g., valves of) the heart, and to other locations in the body.

For some applications, and as shown, annuloplasty structure <NUM> can be advanced with an anchor deployment manipulator <NUM> disposed in an anchor channel <NUM>, within the interior of the annuloplasty structure. Optionally, anchor deployment manipulator <NUM> can be introduced into the interior after advancement of annuloplasty structure <NUM> (or another implant).

Subsequent to exposure of at least adjustment mechanism <NUM> (and typically at least end wall <NUM> of sleeve <NUM>) from catheter <NUM>, the winch is moved away from end wall <NUM> (<FIG>). For some applications, this is achieved by guide member <NUM> being moved proximally such that adjustment mechanism <NUM> (and the winch thereof) moves (e.g., translates, deflects, and/or rotates) away from the longitudinal axis of the sleeve, often to become disposed laterally from sleeve <NUM>.

For some applications, connectors <NUM> facilitate this technique by flexibly and/or articulatably coupling adjustment mechanism <NUM> to sleeve <NUM>. For some such applications, guide member <NUM> is also tensioned or relaxed in order to reposition the adjustment mechanism.

The movement of adjustment mechanism <NUM> (and the winch thereof) away from end wall <NUM> of sleeve <NUM> advantageously facilitates (<NUM>) advancement of the structure to the mitral valve while adjustment mechanism <NUM> is disposed on the longitudinal axis of sleeve <NUM> (e.g., collinearly with the sleeve), so as to maintain a small cross-sectional diameter of the structure for transluminal delivery; and (<NUM>) subsequently movement of the adjustment mechanism away from the longitudinal axis, e.g., so as to allow end wall <NUM> of the sleeve to be placed against the annulus, and/or so as to allow anchor <NUM> to be driven through the end wall of the sleeve (<FIG>).

For some applications, implant <NUM> comprises at least one anchor <NUM> configured to anchor tether <NUM> (e.g., end portion <NUM> thereof) to a tissue of the subject. For some applications, anchors <NUM> are deployed from a distal end of manipulator <NUM> into tissue of a subject. For example, and as shown in <FIG>, anchor deployment manipulator <NUM> is advanced into a lumen of sleeve <NUM> (typically within anchor channel <NUM>), and, from within the lumen, deploys the anchors through a wall of the sleeve and into cardiac tissue. This process is repeated for several anchors <NUM> along sleeve <NUM>, in order to anchor the sleeve around a portion of the valve annulus. For some applications, annuloplasty structure <NUM> is implanted using techniques described, mutatis mutandis, in one or more of the following publications:.

As shown in <FIG>, anchor <NUM> is implanted using manipulator <NUM> contained within sleeve <NUM> of annuloplasty structure <NUM> while at least a portion of annuloplasty structure <NUM> (e.g., a proximal portion) is contained within surrounding catheter <NUM>.

As shown in <FIG>, after anchor <NUM> is implanted, a successive portion of sleeve <NUM> is freed, and deployment manipulator <NUM> is repositioned along annulus <NUM> to a second site selected for deployment of a second one of anchors <NUM>.

<FIG> shows a second tissue anchor <NUM> (shown as a second tissue anchor 338b) being deployed through a portion of the lateral wall of sleeve <NUM>. The first one of anchors <NUM> deployed through end wall <NUM> is labeled as anchor 338a. Deployment manipulator <NUM> deploys the second tissue anchor by driving the anchor to penetrate and pass through the wall of sleeve <NUM> into cardiac tissue at the second site. As shown, anchor 338b is implanted while at least a portion of annuloplasty structure <NUM> (e.g., a proximal portion) is contained within surrounding catheter <NUM>.

As shown in <FIG>, a portion of the lateral wall of sleeve <NUM> is aligned against the tissue of in a manner in which a surface of the portion of the lateral wall is disposed in parallel with the planar surface of the tissue.

<FIG> shows the entire length of sleeve <NUM> having been anchored, via a plurality of anchors <NUM>, to annulus <NUM>, as described hereinabove. The deployment manipulator (i.e., deployment manipulator <NUM> described herein but not shown in <FIG>) can be repositioned along the annulus to additional sites, at which respective anchors are deployed, until the last anchor is deployed. Then, delivery tool <NUM> is removed, leaving behind annuloplasty structure <NUM>, typically with guide member <NUM> coupled thereto.

For some applications, driver <NUM> is slidable over and along guide member <NUM>. For example, <FIG> shows driver <NUM> having been advanced over and along guide member <NUM>. As described herein above, driver <NUM> typically comprises a rotation tool, and is configured to engage and drive (e.g., rotate) the winch of adjustment mechanism <NUM>, so as to tension tether <NUM>, and thereby axially contract sleeve <NUM>, in response to a rotational force applied to the winch.

After the degree of tension of tether <NUM> has been adjusted, driver <NUM> can be disengaged from the winch of adjustment mechanism <NUM>, typically without actuating or otherwise activating a locking mechanism. For some applications, as described herein above in reference to winches <NUM>, <NUM>, and <NUM>, adjustment mechanism <NUM> typically does not comprise a discrete locking mechanism (e.g., a discrete actuatable locking mechanism). As described herein above in reference to winches <NUM>, <NUM>, and <NUM>, after disengagement of driver <NUM> from adjustment mechanism <NUM>, if a pulling force is applied to tether <NUM>, the force is not significantly translated into reverse rotation of the winch of the adjustment mechanism, nor into unwinding of the tether, obviating a need for either a locking mechanism or a locking-actuating mechanism from implant <NUM>, and contributing to the simplicity and ease of use of the implant.

For some applications, implant <NUM> comprises a different type of annuloplasty structure to that shown hereinabove. For example, adjustment mechanism <NUM> can be used, mutatis mutandis, as a component of an annuloplasty structure described in one or more of the following publications:.

In the example shown, implant <NUM> is described as comprising an annuloplasty structure <NUM> that is anchored to tissue of an annulus of a native heart valve. However, it is to be noted that, for some applications, the systems, apparatuses, and techniques described herein can be used to facilitate adjustment of other implants, mutatis mutandis. For example, the adjustment mechanisms described herein can be used as a component of an artificial chorda tendinea structure, e.g., in order to adjust a length and/or tension of the artificial chorda tendinea structure. For example, the adjustment mechanisms described herein can be used instead of an adjustment mechanism of an artificial chorda tendinea structure described in one or more of the following publications:.

Claim 1:
A system comprising a medical implant (<NUM>), the implant (<NUM>) comprising:
a tether (<NUM>), having an end portion (<NUM>); and
a winch (<NUM>), comprising:
a driver interface (<NUM>), engageable and drivable by a transcatheterally-advanceable driver (<NUM>),
a mount (<NUM>), coupled to the driver interface (<NUM>) such that driving of the driver interface (<NUM>) by the driver (<NUM>) rotates the mount (<NUM>) about a rotation axis (d48), and
a spool (<NUM>):
defining a longitudinal spool axis (d50),
coupled to the tether (<NUM>), the tether (<NUM>) extending away from the winch (<NUM>) toward the end portion (<NUM>), and
fixedly coupled to the mount (<NUM>) such that:
rotation of the mount (<NUM>) about the rotation axis (d48) draws the end portion (<NUM>) of the tether (<NUM>) toward the spool (<NUM>) by winding the tether (<NUM>) around the longitudinal spool axis (d50) of the spool (<NUM>), and
the longitudinal spool axis (d50) is non-coaxial with the rotation axis (d48).