Patent Description:
The human heart contains four valves: a tricuspid valve, a pulmonic valve, a mitral valve and an aortic valve. The main purpose of the valves is to maintain unimpeded forward flow of blood through the heart and the major blood vessels connected to the heart, for example, the pulmonary artery and the aorta. As a result of a number of disease processes, both acquired and congenital, any one of the four heart valves may malfunction and result in either stenosis (impeded forward flow) and/or backward flow (regurgitation). Either process burdens the heart and may lead to serious problems, for example, heart failure. Various procedures for fixing or replacing defective heart valves are known in the art. In some cases, artificial heart valves can be implanted in the heart of a patient to replace a diseased or damaged heart valve with a prosthetic equivalent to minimize stenosis and regurgitation.

Prosthetic heart valves can have a variety of designs. Two major types of prosthetic heart valves include mechanical heart valves and bioprosthetic heart valves. Mechanical heart valves can be made of synthetic materials, such as plastics or metals, while bioprosthetic heart valves can be made of biologic tissue mounted on a fabric covered plastic or metal frame. Bioprosthetic heart valves can include animal tissue, such as porcine or bovine tissue, that has been chemically treated to make the valve suitable for implantation in a human. Bioprosthetic valves do not generally require a patient to undergo anticoagulant therapy, which is typically required when using mechanical valves. But bioprosthetic valves can be more prone to device wear such as tears in the valve tissue that may require the valve to be replaced. There is therefore a need to further improve the design of bioprosthetic valves to retain its functionality during the life of the patient.

<CIT> describes devices and techniques for para-valve sealing of an expandable stent-valve.

The present invention is defined as set forth in the appended claims. Prosthetic heart valves provided herein can have a structure adapted to retain functionality during the life of the patient and to minimize stenosis and regurgitation by having an improved connection between different parts of the prosthetic heart valve.

The tubular seal according to the present invention is for use with a prosthetic heart valve and comprises an outflow end region and an inflow end region. The inflow end region is a portion of a polymeric web retaining a woven fabric, wherein the woven fabric has a non-linear edge defining an interface between the inflow end region and the outflow end region. Although tubular seals provided herein can be applied to a variety of prosthetic heart valves provided herein (and within the scope of the claims), additional details about the overall structure of an exemplary prosthetic heart valve are provided below.

<FIG> and <FIG> illustrate an exemplary prosthetic heart valve <NUM> provided herein. <FIG> and <FIG> are perspective views of prosthetic heart valve <NUM> connected to a deployment device <NUM>. <FIG> is a side view of prosthetic heart valve <NUM>. As shown in <FIG>, prosthetic heart valve <NUM> includes an expandable member <NUM>, three leaflets <NUM>, three anchor elements <NUM> that secure sleeve portions <NUM> of leaflets <NUM> to expandable member <NUM>, and a tubular seal <NUM> secured around a blood inflow end of prosthetic heart valve <NUM>. To facilitate better understanding, <FIG> does not show components that are located underneath tubular seal <NUM>, but <FIG> does show these components since tubular seal <NUM> can be made of transparent materials that would normally allow these components to be visible. Anchor elements <NUM> can include post leg compression elements <NUM> and clamping support structures <NUM> adapted to provide support along opposite sides of the sleeve portions <NUM>. Expandable member <NUM> in <FIG> is a braided stent (which can also be described as a braided anchor element), which is adapted to transition between a restricted state having a smaller diameter and an expanded state having a larger diameter. Expandable member <NUM> can be self-expanding, mechanically expanded, or a combination thereof.

<FIG> depict how an exemplary heart valve delivery system <NUM> can deliver and deploy prosthetic heart valve <NUM> provided herein within a blood vessel. System <NUM> can include a sheath <NUM> for retaining prosthetic heart valve <NUM> with the expandable member <NUM> in a restricted state. Tubular seals provided herein can have a uniform thickness or a thickness that has a non-linear interface between an inflow end region and an outflow end region to provide a transition zone between a thinner outflow end region to the thicker inflow end region that facilitates loading of prosthetic heart valve <NUM> into sheath <NUM>. For example, a substantially uniform thickness or a transition zone can reduce the probability for sections of the tubular seal to catch on an outer rim of sheath <NUM> during loading of prosthetic heart valve <NUM> in a restricted state. Additionally, tubular seals provided herein can allow for radial and/or axial expansion of the tubular seal in portions including non-elastic fibers, accordingly, a tubular seal used in prosthetic heart valves provided herein can have a non-expanded diameter that expands to the predetermined outer diameter of the expandable member and that stretches to an axially elongated but radially restricted configuration when prosthetic heart valve <NUM> is in a restricted state to further reduce the profile of prosthetic heart valve <NUM> within sheath <NUM>.

Within sheath <NUM>, anchor elements <NUM> (<FIG>) can be connected to pushing prongs <NUM> and a pull line <NUM> can be connected to a nose cap <NUM>, or end cap, which is positioned at the end of sheath <NUM>. As shown in <FIG> and <FIG>, the pull line <NUM> can extend through expandable member <NUM> and through the valve opening between the leaflets <NUM>. As shown by <FIG>, once a distal end of sheath <NUM> is delivered through the circulatory system to an appropriate location (e.g., within the heart), prosthetic heart valve <NUM> can be deployed. By advancing pushing prongs <NUM> and pull line <NUM> relative to sheath <NUM>, prosthetic heart valve <NUM> can be pushed out of sheath <NUM>. In some cases, expandable member <NUM> can self-expand upon exiting sheath <NUM>. In some cases, expandable member <NUM> can self-expand to a first intermediate diameter, and system <NUM> can mechanically expand expandable member <NUM> to a larger deployment diameter. For example, anchor elements <NUM> can include a locking mechanism to clip a portion of expandable member when the expandable member <NUM> is expanded to a predetermined locking diameter. In some cases, system <NUM> can mechanically expand expandable member <NUM> to a predetermined locking diameter. In some cases, system <NUM> can compress expandable member <NUM> between pushing prongs <NUM> and nose cap <NUM> by moving pull line <NUM> relative to pushing prongs <NUM>. The predetermined locking diameter can be adapted to set the diameter of prosthetic heart valve <NUM> during implantation. After prosthetic heart valve <NUM> is set, system <NUM> can move pull line <NUM> and nose cap <NUM> relative to pushing prongs <NUM> to move the end cap through the opening between leaflets <NUM> in prosthetic heart valve <NUM>. Pushing prongs <NUM> can then be retracted from anchor elements <NUM> and retracted into sheath <NUM>. In some cases, pushing prongs <NUM> can include a shape member material adapted to help radially expand expandable member <NUM> as the expandable member <NUM> exits sheath <NUM>. A control handle <NUM> can be used to control the relative movements of sheath <NUM>, pushing prongs <NUM>, and pull wire <NUM>. Prosthetic heart valves provided herein can be adapted to mitigate damage that may occur to valves during delivery and implantation.

In some cases, one or more radiopaque markers can be secured to prosthetic heart valves provided herein. As shown in <FIG>, expandable member <NUM> includes a radiopaque marker <NUM>. Any suitable radiopaque material (such as platinum, palladium, gold, tantalum, or alloys thereof) can be used as the radiopaque material in radiopaque marker <NUM>. One or more radiopaque markers can be used with an imaging system to help a physician ensure that a valve is set in an appropriate location. In some cases, prosthetic heart valves provided herein include at least three radiopaque markers.

Referring to <FIG> and <FIG>, prosthetic heart valve <NUM> can include a plurality of leaflets <NUM>. In some cases, as shown, prosthetic heart valve <NUM> includes three leaflets <NUM>. In some cases, prosthetic heart valves provided herein can have any suitable number of leaflets, such as two, three, four, five, or more leaflets. In some cases, leaflets <NUM> are secured to one another. In some cases, leaflets <NUM> can be secured to one another by a suture (not shown) or a plurality of sutures. Leaflets <NUM> can be sutured alongside edges of a body portion of each leaflet. In some cases, prosthetic heart valves provided herein can include a single line of sutures, which can be adapted to minimize leaks, minimize the width of a seam, and/or minimize the profile of a replacement heart valve during a percutaneous insertion. In some cases, prosthetic heart valves provided herein can include multiple lines of sutures.

Expandable member <NUM> can have any suitable structure, arrangement, or material. In some cases, expandable member <NUM> can include a braided wire stent. For example, <CIT>, describes possible structures and materials for a braided wire stent, discloses a braided wire stent. In some cases, expandable member <NUM> includes a shape memory material (e.g., a nickel-titanium alloy or a cobalt-chromium alloy).

<FIG> provide illustrations of an exemplary leaflet <NUM> that includes a body portion <NUM> and sleeve portions <NUM>. In some cases, body portion <NUM> has a bottom edge <NUM>, a first side edge <NUM>, a second side edge <NUM>, and a free edge <NUM>. Leaflet <NUM> further includes a front (i.e., a side facing the blood inflow end of a prosthetic heart valve), a back (i.e., a side facing the blood outflow end), a first side adjacent to the first side edge <NUM>, and a second side adjacent to the second side edge <NUM>. In some cases, the front of leaflet <NUM> has a different texture than the back. In some cases, the back or front can have a non-textured or textured surface to mitigate calcium buildup on the surfaces. For example, in some cases, the back of leaflet <NUM> may be prone to calcium build due to a cusp-shaped, concave surface, thus it can be beneficial to have a textured surface on the back of leaflet <NUM> to mitigate calcification issues. Leaflets can be made of various synthetic or non-synthetic materials. In some cases, the leaflet <NUM> is made from tissue obtained from an animal, e.g., a pig or a cow. In some cases, leaflet <NUM> is made from bovine pericardium. In some cases, leaflets <NUM> can be made from a synthetic polymers or composites. Leaflets <NUM> can be assembled into a heart valve by aligning the opposite side regions of at least two adjacent leaflets <NUM> and stitching the leaflets <NUM> together along stitch line <NUM>, which is shown in <FIG>.

Still referring to <FIG>, leaflet <NUM> defines at least one notch <NUM>, <NUM> between at least one of the two side edges <NUM>, <NUM> and a corresponding adjacent sleeve portion <NUM>. Each notch <NUM>, <NUM> can be located along side edges <NUM>, <NUM> at a location adjacent to the sleeve portions <NUM>, e.g., at an "armpit" of leaflet <NUM> as depicted in <FIG>. In some cases, leaflet <NUM> can define a notch along the length of side edges <NUM>, <NUM>. In some cases, a notch can be defined along sleeve portion <NUM>. In some cases, multiple notches can be located along sleeve portion <NUM>, side edges <NUM>, <NUM>, and/or at the armpit of the leaflet <NUM>.

As shown in <FIG>, body portion <NUM> of leaflet <NUM> has a conical frustum shape defined by bottom edge <NUM>, first side edge <NUM>, second side edge <NUM>, and free edge <NUM>. Other suitable shapes for the body portion can include, but are not limited to, for example, a generally square, rectangular, triangular or trapezoidal shaped body portion.

The sleeve portions <NUM>, as shown in <FIG>, can extend outwardly from the body portion <NUM> of the leaflet <NUM>. Each sleeve portion <NUM> can oriented at an angle relative to a portion of the body portion, e.g., free edge <NUM> of body portion <NUM>. Sleeve portions <NUM>, as shown, can be generally rectangular-shaped extensions with lateral free ends. In some cases, sleeve portions <NUM> can have rounded free ends.

Still referring to <FIG>, notches <NUM>, <NUM> can be generally U-shaped. Other suitable notch shapes can include, but are not limited to, a V-shaped, rectangular-shaped, oval-shaped, and circular notch. In some cases, notches <NUM>, <NUM> can have rounded edges to smooth the transition between a notch <NUM>, <NUM> and side edges <NUM>, <NUM> of leaflet <NUM>. Notches <NUM>, <NUM> can have a length dimension that can range from about <NUM> millimeters (mm) to about <NUM>.

Referring to <FIG>, notches <NUM>, <NUM> can be shaped and sized to accommodate attachment of post leg compression elements <NUM>. Post leg compression elements <NUM> can be a part of anchor elements <NUM> (shown in <FIG>) that compress and restrain sleeve portions <NUM> along the same line as the stitch line <NUM>. As shown in <FIG>, suture <NUM> can be used to apply an appropriate and consistent compressive force between post leg compression elements <NUM> in order to prevent leakage through sleeve portions <NUM> of leaflets <NUM>. Since suture <NUM> pass through notches <NUM>, <NUM>, it does not need to pass through body portion <NUM> at or near the armpit of leaflet <NUM>. Sutures that pierce the body portion at or near the armpit of the leaflet can pull, stretch and abrade surrounding tissue areas, creating stress concentrations at or near the armpit of the leaflet. These stress concentrators can result in tears forming in the leaflet. The use of notches <NUM>, <NUM> with post leg compression elements <NUM>, therefore can minimize potential heart valve tearing that might be caused by sutures at or near the armpit location. Notches <NUM>, <NUM> create enlarged openings that suture <NUM> can pass therethrough without pulling or stretching the adjacent tissue. Accordingly, a notched leaflet <NUM> can improve valve opening capabilities and the reliability of prosthetic heart valves provided herein.

<FIG> illustrates another exemplary leaflet <NUM>, which can be used in prosthetic heart valves provided herein. As shown in <FIG>, leaflet <NUM> can include a body portion <NUM> and at least two opposite sleeve portions <NUM>. The body portion <NUM> can be defined by at least two side edges <NUM>, <NUM> adjacent each sleeve portion <NUM>. Leaflet <NUM> can define two apertures <NUM> and <NUM>. Each aperture <NUM>, <NUM> can be positioned adjacent side edges <NUM>, <NUM> and the corresponding adjacent sleeve portion <NUM>.

Still referring to <FIG>, body portion <NUM> has a bottom edge <NUM>, a first side edge <NUM>, a second side edge <NUM>, and a free edge <NUM>. Leaflet <NUM> further includes a front, a back, a first side adjacent to the first side edge <NUM>, and a second side adjacent to the second side edge <NUM>. Leaflets <NUM> can be assembled into a heart valve by aligning the opposite side regions of at least two adjacent leaflets <NUM> and stitching the leaflets <NUM> together along stitch line <NUM>, as shown in <FIG>.

As shown in <FIG>, leaflet <NUM> defines apertures <NUM> and <NUM> adjacent side edges <NUM>, <NUM> and adjacent one of the sleeve portions <NUM>. Apertures <NUM> and <NUM> can be generally circular in shape. Other suitable aperture shapes can include, but are not limited to, for example, a rectangular, oval, triangular, or diamond-shaped aperture. In some cases, apertures <NUM>, <NUM> can have a length dimension or a diameter from about <NUM> to about <NUM>. In some cases, one or more apertures <NUM>, <NUM> can be located in the side edges <NUM>, <NUM> and/or the sleeve portions <NUM> of the leaflet <NUM>. In some cases, multiple apertures can be located in a region that is adjacent to the side edges <NUM>, <NUM> and the sleeve portions <NUM>.

Apertures <NUM>, <NUM> in the leaflets <NUM> can allow one leaflet to be secured to an adjacent leaflet. Similar to the notches discussed above, apertures <NUM> and <NUM> can be shaped and sized to accommodate attachment of post leg compression elements <NUM>. Referring back to <FIG>, post leg compression elements <NUM> can be a part of anchor elements <NUM> that compress and restrain sleeve portions <NUM> along the same line as the stitch line <NUM>. A suture <NUM> can be used to apply an appropriate and consistent compressive force between the post leg compression elements <NUM> in order to prevent leakage through sleeve portions <NUM> of the leaflets <NUM>. As already discussed herein, sutures that pierce the body portion <NUM> at or near the armpit of the leaflet can create stress concentrations at or near the armpit of the leaflet that may result in tearing. Apertures <NUM> and <NUM> and post leg compression elements <NUM>, however, can minimize this potential tearing caused by sutures near the armpit location by being positioned proximate to the post leg compression elements near the armpit. Apertures <NUM>, <NUM> create enlarged openings that allow suture <NUM> to pass therethrough without pulling or stretching adjacent tissue areas. Accordingly, leaflets <NUM> used in prosthetic heart valves provided herein can improve the reliability of prosthetic heart valves.

<FIG> depict how leaflets <NUM> can be connected (or jointed) with an improved stitch discussed herein. As shown, stitch <NUM> can be a single continuous line stitch traveling along a stitch line in a forward direction and back in a reverse direction. In some cases, stitch <NUM> can run along a leaflet from a bottom edge to a side edge of the leaflet (e.g., bottom edge <NUM> to side edge <NUM> of leaflet <NUM> in <FIG>). In some cases, stitch <NUM> can run from a side edge to a notch of a leaflet (e.g., side edge <NUM> to notch <NUM> of leaflet <NUM> in <FIG>).

As shown in <FIG>, stitch <NUM> can include a plurality of perpendicular loop segments <NUM> extending through an aperture in the two leaflets, around outer side edges of the two attached leaflets, and back through the aperture. Stitch <NUM> can include a plurality of parallel segments <NUM> extending between adjacent apertures along the stitch line. Stitch <NUM> can include two perpendicular loop segments <NUM> extending through apertures formed in the stitch line. In some cases, a first perpendicular loop segment <NUM> for a first aperture in the stitch line is formed when the stitch is formed in the forward direction and a second perpendicular loop segment <NUM> for the first aperture is formed in the reverse direction. In some cases, parallel segments <NUM> made in a forward direction alternate between opposite sides of the two leaflets between each aperture in the stitch line. In some cases, parallel segments <NUM> made in a reverse direction are formed on an opposite side of the two leaflets from parallel segments <NUM> made in a forward direction. In some cases, opposite parallel segments <NUM> made in the forward and reverse directions can provide a continuous compressive force along the entire length of the stitch line. Perpendicular loop segments <NUM> can provide compressive force to reinforce a seal formed between the two leaflets along the stitch line.

Stitch <NUM> can include any appropriate number of perpendicular loop segments formed through any appropriate number of apertures. As shown, stitch <NUM> includes six perpendicular loop segments formed through six apertures (two perpendicular loop segments per aperture). In some cases, stitch <NUM> can include up to twelve perpendicular loop segments formed through six or more apertures. In some cases, a stitch connecting side edge segments of leaflets can be formed using between <NUM> and <NUM> apertures and include between <NUM> and <NUM> perpendicular loop segments. In some cases, apertures can be positioned from about <NUM> to about <NUM> apart. In some cases, apertures can be positioned from about <NUM> to about <NUM> away from the side edges of the leaflets.

Stitch <NUM> can be formed in a process depicted in <FIG>. As shown in <FIG>, a thread needle <NUM> can be passed through aligned leaflet side edges 226a and 226b to create a first aperture at a location near bottom edges <NUM>, e.g., a location approximately <NUM> from the bottom edges <NUM>. The leaflet side edges 226a and 226b can be retained in a desired configuration by clamping the leaflets between clamp sides <NUM> and <NUM>. Needle <NUM> pulls a leading end <NUM> of a thread <NUM> through the first aperture. As shown in <FIG>, needle <NUM> can then form a second aperture adjacent to the first aperture along the stitch line (towards the leaflet sleeve portion) about <NUM> away from the first aperture to pull leading end <NUM> of thread <NUM> through the second aperture to form a first parallel segment. As shown in <FIG>, a perpendicular loop segment <NUM> can be made by guiding needle <NUM> around the leaflet side edges and re-enter the second aperture from a backside. Thread <NUM> can be pulled through the second aperture until it sits firmly against the leaflet material (e.g., leaflet pericardium tissue). <FIG> shows a second parallel segment, which can be made by pushing needle <NUM> through leaflet tissue along the stitch line to form a third aperture approximately <NUM> from the second aperture (towards the sleeve segments of the leaflet). As shown in <FIG>, a second perpendicular loop segment <NUM> can be formed by again having needle <NUM> loop around the leaflet side edges and reenter the third aperture through the backside. This is repeated up to notch <NUM> to form a total of six parallel segments <NUM> and six perpendicular loop segments <NUM> in a forward direction, as shown in <FIG>. The stitch pattern can then be repeated in a reverse direction towards the bottom edges <NUM> of the leaflets through the previously formed apertures. Accordingly, each aperture can include two perpendicular loop segments <NUM> and parallel segments on the opposite sides can be formed from the parallel segments that were created in the forward direction, as shown in <FIG>. The method and stitches depicted in <FIG> can be applicable to leaflets <NUM>, <NUM> discussed herein.

Stitch <NUM> and other stitches provided herein can improve the reliability of a seal formed along a stitch line, create fewer apertures through the leaflets, and simplify the stitching operation. Having fewer apertures can help minimize the occurrence of blood leakage through the apertures. The single continuous line of stitch <NUM> using a single row of apertures can minimize a width of a side edge portion needed to form a continuous seal along the side edges of the leaflets, thus providing a reduced restricted profile for prosthetic heart valves provided herein. For example, <CIT> describes a variety of ways that leaflets can be sutured together using combinations of whip stitches and running stitches, but these stitches require additional apertures and multiple lines. Perpendicular loop segments <NUM> can stitch a plurality of leaflets together, similar to the whip stitches discussed in <CIT>. Parallel segments <NUM> can secure valve leaflets to one another, similar to the running stitches discussed in <CIT>. Although stitch <NUM> can provide an improved attachment between side edges of leaflets in prosthetic heart valves provided herein, some embodiments of prosthetic heart valves provided herein can use other stitch patterns, such as those described in <CIT>.

Important characteristics of a suture thread can include, but are not limited to, adequate tensile strength, abrasion resistance and creep rupture resistance characteristics that allow the device to be delivered into and sustain implantation within a human anatomy. The thread used for suturing together portions of the heart valve, e.g., side edges of the leaflets, can be composed of biocompatible materials that include, but are not limited to, polyethylene such as ultra high molecular weight polyethylene (UHMWPE), polyester (PET), and a combination thereof.

Referring back to <FIG>, tubular seal <NUM> of prosthetic heart valve <NUM> can be secured to bottom edges <NUM> (<FIG>) of body portion <NUM> of leaflet <NUM> by a circumferential running stitch <NUM>. In some cases, tubular seal <NUM> can be secured to expandable member <NUM> by fasteners, such as grommets <NUM>, and extended around the outside of expandable member <NUM> to provide a seal that minimizes blood leakage around the leaflets <NUM> of an implanted prosthetic heart valve <NUM>. The structure and materials of tubular seal <NUM> are further discussed with reference to <FIG> and <FIG>.

<FIG> provide an improved tubular seal stitching pattern can include a cross stitch <NUM> between tubular seal <NUM> and expandable member <NUM>. For example, a blood inlet side of expandable member <NUM> (e.g., braided anchor element) can be secured to a portion of the tubular seal having the woven fabric by a plurality of stitches (e.g., a plurality of cross stitches securing the seal to two crossing members of a braided stent). <FIG> illustrate how the tubular seal <NUM> can be secured to the expandable member <NUM>, e.g., a braided stent, by a plurality of cross stitches connecting the tubular seal <NUM> to a pair of overlapping wire members of the braided stent. As shown in <FIG> and <FIG>, expandable member <NUM> can be a braided stent including one or more wires having a first set of segments <NUM> extending helically in a first direction and a second set of segments <NUM> extending helically in a second direction such that the first set of segments <NUM> cross the second set of segments <NUM> at intersection points <NUM>. As shown, one or more wires can have inflow crowns <NUM> at an end of the braided stent where the wires transition from first segments <NUM> to second segments <NUM>. In some cases, cross stitches <NUM> secure tubular seal <NUM> at an intersection <NUM> to two crossing segments <NUM>, <NUM> of the braided stent. A separate circumferential running stitch <NUM> can be inserted into preformed apertures <NUM> to secure the adaptive seal to bottom edges <NUM> of leaflets <NUM> shown in <FIG> and <FIG>. Cross-stitches around the intersections <NUM> can increase the strength of an attachment of tubular seal <NUM> to the expandable member <NUM> while also allowing for improved load transfer to the expandable member <NUM>. In some cases, the cross stitches secure tubular seal <NUM> at intersections <NUM> located immediately above (proximal) the inflow crowns <NUM>. Cross stitches <NUM> can be formed by passing two stitches 132a, 132b of a suture in orthogonal directions over the intersections <NUM> and through the tubular seal <NUM>. In some cases, preformed apertures <NUM> for cross stitch <NUM> can be formed in the tubular seal <NUM>. In some cases, a portion of the tubular seal <NUM> that is sutured by cross stitch <NUM> includes an internal fabric, such as those discussed below. Each cross stitch <NUM> can be knotted independently. As shown in <FIG>, cross stitches <NUM> each include a separate knot <NUM>. Additionally, cross stitches <NUM> can be arranged to not pass through leaflets <NUM>. Cross stitches <NUM> can be repeated at a plurality of intersections <NUM> (<FIG>) circumferentially around an inflow end of a prosthetic heart valve provided herein such that an entire circumference of tubular seal <NUM> is securely attached. In some cases, each intersection <NUM> immediately adjacent to inflow crowns <NUM> is sutured to tubular seal <NUM> via a cross stitch provided herein. The tubular seal stitching pattern provided herein can increase the strength of the attachment between the tubular seal <NUM> and the expandable member <NUM> while also allowing for improved load transfer to the expandable member <NUM> through the use of the plurality of cross stitches.

Referring back to <FIG>, tubular seal <NUM> of prosthetic heart valve <NUM> can have various suitable structures, arrangements, or materials that allow tubular seal <NUM> to be secured to leaflets <NUM> within prosthetic heart valve <NUM>. Various suitable structures, arrangements, or materials of tubular seal <NUM> can be used to allow tubular seal <NUM> to extend around the outside of expandable tubular member <NUM> to prevent blood leakage around leaflets <NUM>.

<FIG> shows an exemplary mandrel <NUM> that can be used to construct a tubular seal. The mandrel <NUM> includes a taper which results in a tubular seal having a slightly smaller diameter proximal end compared to the diameter of the distal end. In some cases, the diameter of the proximal end can include a diameter reduction of about <NUM>% to about <NUM>% as compared to the diameter of the distal end. The taper allows the tubular seal to be removed from the mandrel with relative ease upon completion of the fabrication process. The smaller proximal diameter of the tubular seal tends to cause the proximal projections to lie more firmly against an anchor element of the replacement heart valve. In some cases, the surface of the mandrel may be textured to create a tubular seal with a reduced contact area. In some cases, the mandrel can be textured using a bead blasting process. In combination with the selection of a relatively hard outer layer, a textured seal surface is believed to result in a lower friction surface.

<FIG> shows a tubular seal <NUM> that includes an inflow end region <NUM> and an outflow end region <NUM>. In some cases, at least a portion of tubular seal <NUM> can include a polymeric web. In some cases, the polymeric web can be a thin film, a porous layer, a mesh-like or net-like structure, or a porous network, e.g., a polymeric matrix. In some cases, for example, inflow end region <NUM> of tubular seal <NUM> can include a polymeric web. In some cases, inflow end region <NUM> can be a portion of a polymeric web retaining a fabric. In some cases, polymeric web can include an elastic material. In some cases, the polymeric web can include an elastomeric matrix.

In some cases, inflow end region <NUM> can be secured to bottom edges of a plurality of leaflets at an inflow end of a prosthetic heart valve provided herein, e.g., prosthetic heart valve <NUM>, and have outflow end region <NUM> extend around an outer surface of an expandable member (e.g., a braided stent) to restrict blood flow around the leaflets. In some cases, a fabric can be embedded within the polymeric web such that the polymeric web forms a polymeric matrix around the fabric. In some cases, the polymeric web can include an elastic material. In some cases, an elastic polymeric web can conform to adjacent surfaces of a prosthetic heart valve provided herein to prove a resilient seal. The elastomeric polymer matrix can furthermore conform to the expandable member as the expandable member changed between a restricted configuration and an expanded configuration. In some cases, an elastic material can allow the tubular seal to return to its original length when the expandable member returns to the restricted configuration without tearing.

In some cases, at least a portion of the tubular seal <NUM>, such as the polymeric web or matrix, can include one or more layers of an elastomeric polymer. In some cases, tubular seal <NUM> can include a polycarbonate, polyurethane, silicone, polytetrafluoroethylene (PTFE), or a combination thereof. Other suitable materials include, but are not limited to, natural and synthetic rubbers, including cis-<NUM>,<NUM>-polyisoprene rubber, styrene/butadiene copolymers, polybutadiene rubber, styrene/isoprene/butadiene rubber, butyl rubber, halobutyl rubber, polyurethane elastomers including elastomers based on both aromatic and aliphatic isocyanates, flexible polyolefins including flexible polyethylene and polypropylene homopolymers and copolymers, styrenic thermoplastic elastomers, polyamide elastomers, polyamide-ether elastomers, ester-ether or ester-ester elastomers, flexible ionomers, thermoplastic vulcanizates, flexible poly(vinyl chloride) homopolymers and copolymers, acrylic polymers, and a combination thereof. In some cases, tubular seal <NUM> can include an aliphatic polycarbonate-based thermoplastic urethane. In some cases, tubular seal <NUM> can include an elastomeric polymer having a hardness ranging from <NUM> MPa to <NUM> MPa, or a durometer ranging from <NUM> Shore A to <NUM> Shore D using ASTM standard D2240 in force on January <NUM>, <NUM>. In some cases, tubular seal <NUM> can include a polymeric material having the mechanical properties shown in Table I below. Notably, all of the listed ASTM standards refers to the standard in force on January <NUM>, <NUM>.

In some cases, referring back to <FIG> and <FIG>, tubular seal <NUM> can include attachment structures, e.g., grommets <NUM>, to improve the attachment of the tubular seal <NUM> to leaflets <NUM> and/or expandable member <NUM>.

In some cases, tubular seal <NUM> can include a fabric retained by a polymeric web such that the fabric reinforces the polymeric web to allow the tubular seal to be secured to a prosthetic heart valve provided herein. Referring to <FIG>, for example, inflow end region <NUM> of tubular seal <NUM> can include a fabric embedded within an elastomeric material. Also shown in <FIG>, outflow end region <NUM> of tubular seal <NUM> can include a plurality of grommets <NUM>. The fabric of inflow end region <NUM> can be a woven material. In some cases, the fabric can have warp threads and/or weft threads. In some cases, the fabric can be composed of fibers having an average thread diameter from about <NUM> microns to about <NUM> microns, more preferably from about <NUM> micron to about <NUM> microns. More preferably, in some cases, the fabric is composed of fibers having a thread diameter of about <NUM> microns.

In some cases, the fabric can include non-elastomeric fibers, or non-elastic fibers. Suitable non-elastomeric fiber materials include, but are not limited to, polyolefins, polyesters such as PES <NUM>/<NUM> manufactured by SaatiTech, and polyamides. More particularly, the polyolefins can include, for example, polyethylenes, polypropylenes, polybutenes, ethylene copolymers, propylene copolymers, butene copolymers, and combinations thereof. Because the fabric can include non-elastic fibers, inflow end region <NUM> and outflow end region <NUM> can have different overall elastic properties.

As shown in <FIG>, the fabric of a tubular seal has a non-linear edge defining an interface <NUM> between inflow end region <NUM> and the outflow end region <NUM>. The interface <NUM> between the inflow end region <NUM> and the outflow end region <NUM> is non-linear due to a non-linear edge of the fabric within inflow end region <NUM>. As shown in <FIG>, the non-linear edge can be sinusoidal <NUM>. In some cases, as shown in <FIG>, the non-linear edge can be a zigzagged edge <NUM>, a stepped edge <NUM>, or a scalloped edge <NUM>,<NUM>, <NUM>.

<FIG> and <FIG> provide alternative embodiments of tubular seals <NUM>, <NUM> having scalloped, non-linear edges. As shown, the scalloped, non-linear edges define non-linear circumferential interfaces <NUM>, <NUM> between an inflow end region <NUM>, <NUM> and an outflow end region <NUM>, <NUM>. Interfaces <NUM>, <NUM>, as shown in <FIG> and <FIG>, have a scalloped shape defined by a major radius Ra, a minor radius Ri, a wavelength (λ) and a transition zone length (ℓ). In some cases, major radius Ra can be the radius proximate the inflow end region and minor radius Ri can be the radius proximate the outflow end region. In some cases, major radius Ra can be the radius proximate the outflow end region and minor radius Ri can be the radius proximate the inflow end region. As shown in <FIG> and <FIG>, major radius Ra is larger than the minor Ri. In some cases, major and minor radii Ra, Ri are equal and form a sinusoidal-shaped interface. In some cases, the ratio between major radius Ra and minor radius Ri can range from <NUM>:<NUM> to <NUM>:<NUM>, <NUM>:<NUM> to <NUM>:<NUM>, from <NUM>:<NUM> to <NUM>:<NUM>, or from <NUM>:<NUM> to <NUM>:<NUM>. In some cases, a necked region <NUM> (see <FIG>) can be formed between minor radius Ri and major radius Ra. In some cases, minor radius Ri can form bulbous ends, as shown in <FIG>, to increase the interface length and improve durability of tubular seal <NUM> at or near interface <NUM>. The interfaces described herein provide the benefit of preventing or minimizing tear propagation in the tubular seal while providing sufficient bond strength to maintain the bond between the inflow and outflow end regions of the tubular seal. In some cases, the interfaces described herein can prevent or minimize a tear from propagating further at the interface region by redirecting the tear or by providing a barrier to the tear.

In some cases, the major radius Ra and/or the minor radius Ri can range from about <NUM> millimeters to about <NUM> millimeters, from about <NUM> millimeters to about <NUM> millimeters, from about <NUM> millimeters to about <NUM> millimeters, or from about <NUM> millimeters to about <NUM> millimeters. In some cases, the major radius Ra and/or the minor radius Ri can range from about <NUM> millimeters to about <NUM> millimeters, from about <NUM> millimeters to about <NUM> millimeters, from about <NUM> millimeters to about <NUM> millimeters, from about <NUM> millimeters to about <NUM> millimeters, or from about <NUM> millimeters to about <NUM> millimeters. In some cases, the wavelength (λ) of the scalloped-shaped interface, or the length of one repeating scallop shape, can range from about <NUM> millimeters to about <NUM> millimeters, from about <NUM> millimeters to about <NUM> millimeters, or from about <NUM> millimeters to about <NUM> millimeters. There can be various suitable lengths of the transition zone length described herein. The transition zone length can be measured as a distance between the crest of the minor radius Ri and the trough of the major radius Ra. In some cases, the transition zone length can range from about <NUM> millimeters to about <NUM> millimeters, from about <NUM> millimeters to about <NUM> millimeters, from about <NUM> millimeters to about <NUM> millimeters, from about <NUM> millimeters to about <NUM> millimeters, from about <NUM> millimeters to about <NUM> millimeters, or from about <NUM> millimeters to about <NUM> millimeters.

Referring back to <FIG>, in some cases, inflow end region <NUM> can be thicker than outflow end region <NUM> because of the presence of a fabric within inflow end region <NUM>. In some cases, inflow end region <NUM> can have a thickness of about <NUM> microns. In some cases, outflow end region <NUM> can have a thickness of about <NUM> microns. Other suitable thicknesses for inflow end region <NUM> include thicknesses ranging from about <NUM> microns to about <NUM> microns, or more preferably, from about <NUM> microns to about <NUM> microns. Suitable thicknesses for outflow end region <NUM> include thicknesses ranging from about <NUM> microns to about <NUM> microns, or more preferably, from about <NUM> microns to about <NUM> microns. In some cases, suitable thickness ratios of inflow end region <NUM> relative to outflow end region <NUM> can range from <NUM>:<NUM> to <NUM>:<NUM>, from <NUM>:<NUM> to <NUM>:<NUM>, from <NUM>:<NUM> to <NUM>:<NUM>, and from <NUM>:<NUM> to <NUM>:<NUM>. A non-linear edge can providing a non-linear interface, e.g., interface <NUM>, between inflow end region <NUM> and outflow end region <NUM>. A prosthetic heart valve that has non-linear interface <NUM> may have an increased overall diameter that tapers more gradually than a prosthetic heart valve that has a linear interface. The non-linear edge of the fabric can gradually transition the change in elastic properties between the outflow end region <NUM> and inflow end region <NUM>, mitigating the formation of stress concentrators along an interface that can cause tearing in the tubular member. Additionally, the non-linear shape of interface <NUM> can minimize or prevent the propagation of tears.

Still referring to <FIG>, in some cases, the fabric can be arranged in inflow end region <NUM> to allow for the fabric within inflow end region <NUM> to stretch in axial and/or radial directions to allow tubular seal <NUM> to stretch along with an expandable member during implantation. When the fabric does not allow a tubular seal to adequately stretch, the seal can cause non-uniform crimping during manufacturing or damage the expandable member during device deployment. In some cases, a woven fabric can be arranged to have the warp and the waft extend in directions oblique to the axis of tubular seal <NUM>. This can allow the fabric to flex in radial and/or axial directions relative to the axis of tubular seal <NUM>, but limit the fabric from stretching in a direction oblique to the axis. In some cases, both the warp and the waft can extend at an angle between <NUM> degrees and <NUM> degrees with the axis of tubular seal <NUM>. In some cases, both the warp and the waft can extend at an angle between <NUM> degrees and <NUM> degrees with the axis of tubular seal <NUM>. In some cases, the warp and waft can be arranged within the tubular member <NUM> to form an angle of about <NUM> degrees with the axis of tubular seal <NUM>. In some cases, the fabric can be a knit fabric arranged to allow for a predetermined amount of stretch in the axial and/or radial directions. Limiting the fabric within inflow end region <NUM> from stretching in a direction oblique to the axis can prevent the fabric from bunching and minimize non-uniform crimping during manufacturing.

Additional exemplary tubular seals including a fabric and grommets are described in <CIT>. For example, <CIT> describes a seal that includes a multilayer, cylindrical seal body having projections alternating with recesses along the proximal edge of the seal body with proximal reinforcing grommets and a distal reinforcing band, which may be formed from a woven or nonwoven fabric and either incorporated within the interior of the multilayer seal body or adhered to the surface thereof.

In some cases, tubular seals described in <CIT> can be modified to include a fabric arrangement that allows a seal to stretch in axial and/or radial directions. In some cases, elastomeric materials provided herein can be incorporated into the tubular seals disclosed in <CIT>. In some cases, the tubular seals described in <CIT> can be modified to include the non-linear interface <NUM> provided herein.

Still referring to <FIG>, tubular seal <NUM> can be created by producing one or more layers of elastomeric polymer, applying the fabric and grommets <NUM> to the one or more layers of elastomeric polymer, and overcoating the fabric and grommets <NUM> with one or more additional layers of elastomeric material. In some cases, different layers can have different elastomeric properties. In some cases, tubular seals (e.g., <NUM>, <NUM>, or <NUM>) can include a radially innermost layer including at least one elastomeric polymer, e.g., a polycarbonate and a polyurethane; a radially outermost layer including at least one elastomeric polymer, e.g., a polycarbonate and a polyurethane; and at least one inner layer disposed between the radially outermost layer and a radially innermost layer. In some cases, the modulus of elasticity of the innermost layer is less than the modulus of elasticity of the radially innermost outer layer and the modulus of elasticity of the radially outermost outer layer. In some cases, the elongation to break of the inner layer is greater than the elongation to break of the radially innermost outer layer and the elongation to break of the radially outermost outer layer. Although the radially innermost outer layer and the radially outermost outer layer have been depicted as including the same material, it will be appreciated that they may be compositionally the same or different.

The multilayer tubular seals provided herein (e.g., <NUM>, <NUM>, <NUM>) may be formed in a variety of ways. In some cases, multilayer tubular seals provided herein may be formed by successive applications of a polymer solution to an appropriately shaped mandrel, such as that illustrated in <FIG>. Following a careful cleaning of the mandrel <NUM>, the mandrel may be mounted to an appropriate holding fixture in a spray booth. A first coating composition including a carrier and at least one polymer may be applied to the mandrel <NUM> and subsequently dried to form a first coated mandrel. In some cases, the first coating composition includes one or more elastomeric polymers, e. g, polycarbonate and/or a polyurethane, and a volatile carrier. The coating composition may be applied as a single layer or multiple layers to achieve the desired dried coating thickness. The grommets <NUM> (<FIG>) and the fabric may be positioned on the first coated mandrel by inserting locating pins <NUM> in apertures <NUM> in the tapered mandrel <NUM> of <FIG> that align with corresponding perforations <NUM> provided in the grommets <NUM>, <NUM>, <NUM> and the fabric <NUM>. In <FIG>, only one pin <NUM> has been illustrated for clarity. In some instances, it may be desirable to secure the plurality of grommets <NUM> and the fabric to the mandrel or to an underlying coating layer by applying a drop of a first coating composition, or other adhesive composition, to each item to ensure that it remains properly positioned during subsequent processing. The fabric can be cut to a suitable shape having a non-linear edge using any suitable method. In some cases, the fabric can be die cut. In some cases, the fabric can be cut with a blade. In some cases, the fabric can be cut using a femtosecond laser. In some cases, a femtosecond laser cut fabric mitigates the chances of forming stress concentrators along the edge of the fabric.

A second coating composition including a carrier and at least one polymer may be applied to the first coated mandrel, the fabric, and the plurality of grommets. In some cases, the second coating composition includes one or more elastomeric polymers, e. g, polycarbonate and/or a polyurethane, and a volatile carrier. The carrier of the second coating composition may be removed, thereby forming a second coated mandrel. The second coating composition may be applied as a single layer or as multiple layers to achieve the desired dried coating thickness. In some cases, the second coating composition may be different from the first coating composition. In some cases, the second coating composition may be composed of the same material as the first coating composition.

In some cases, a third coating composition including a carrier and at least one polymer may be applied to the second coated mandrel. In some cases, the third coating composition includes one or more elastomeric polymers, e. g, polycarbonate and/or a polyurethane, and a volatile carrier. The carrier of the third coating composition may be removed thereby forming a tubular seal precursor. The third coating composition may be applied as a single layer or as multiple layers to achieve the desired dried coating thickness. In some cases, the third coating composition may be different from the first coating composition. In some cases, the third coating composition may be the same as the first coating composition. In some cases, the third coating composition may be different from the second coating composition. In some cases, the third coating composition may be the same as the second coating composition. Following removal of the carrier from the third coating composition, the tubular seal precursor may be inspected to ensure that it is fully formed and meets dimensional specifications, such as a thickness specification. In some cases, a suitable thickness for the tubular seal precursor can range from about <NUM> microns to about <NUM> microns or from about <NUM> microns to about <NUM> microns. Other suitable thicknesses for the tubular seal precursor include a range from about <NUM> microns to about <NUM> microns, about <NUM> microns to about <NUM> microns, about <NUM> microns to about <NUM> microns, about <NUM> microns to about <NUM> microns, about <NUM> microns to about <NUM> microns, about <NUM> microns to about <NUM> microns, about <NUM> microns to about <NUM> microns, as well as any thickness value within any of the listed ranges.

In some cases, the tubular seal precursor may be inspected to ensure that it meets certain functional specifications, e.g., tensile and frictional specifications. The tubular seal precursor may then be trimmed by laser cutting, or blade cutting, to conform to dimensional specifications and removed from the tapered seal-forming mandrel as a formed tubular seal. In some cases, at least some preformed apertures for suturing tubular seal to expandable member <NUM> and/or leaflets <NUM> (see <FIG> and <FIG>) can be performed by laser cutting. In some cases, at least some of the grommets may be formed by a laser cutting operation performed on a tubular seal precursor. In some cases, grommets <NUM> of <FIG> may be added to the multilayer, generally cylindrical seal, in a step not illustrated, as a proximal band. Subsequent laser cutting of the tubular seal precursor would then simultaneously form grommets <NUM> by removing the portions of the proximal band located between the projections.

In some cases, coating compositions may be selected to provide a relatively stiff dried polymer such as a dried polymer having a Shore D hardness of about <NUM>, or a hardness of about <NUM> Megapascals (MPa). In some cases, coating compositions may be selected to provide a relatively elastomeric dried polymer such as a dried polymer having a Shore A hardness of about <NUM>, or a hardness of about <NUM> MPa. In some cases, the first and third dried polymer layers may have a Shore D hardness of <NUM>, or a hardness of <NUM> MPa, and the second layer may have a Shore A hardness of <NUM>, or a hardness of <NUM> MPa.

Although in some cases described above, three polymer layers were employed, it will be appreciated that a greater or lesser number of layers may be employed and that each of the three or more layers may include two or more sublayers. In some cases, the plurality of grommets and the fabric can be positioned between the first and second coating layers. In some cases, the plurality of grommets and the fabric can be positioned elsewhere within the tubular seal, e.g., within a layer, or on the radially innermost or radially outermost surface of the tubular seal.

As shown in <FIG>, a tubular seal <NUM> can include a woven or non-woven fabric embedded throughout a polymer or metal matrix structure. In some cases, at least one leaflet of the heart valve can be secured to the tubular seal in a portion of the tubular seal including the woven or non-woven fabric to minimize blood leakage between the tubular seal and the leaflets.

<FIG> are illustrations of an exemplary tubular seal <NUM> secured to an exemplary prosthetic heart valve provided herein. Tubular seal <NUM>, as shown in <FIG>, includes a non-linear edge interface <NUM> between an inflow end region <NUM> and an outflow end region <NUM>. <FIG> shows tubular seal <NUM> advancing from a distal end of a deployment device provided herein and expanding radially. <FIG> provides an illustration of tubular seal <NUM> in a further radially expanded and deployed state. <FIG> provides a close up illustration of non-linear interface <NUM> of tubular seal <NUM>.

Referring to <FIG> and <FIG>, tubular seal <NUM> includes a fabric in inflow end region <NUM> that has a non-linear edge defining a non-linear circumferential interface <NUM> between inflow end region <NUM> and outflow end region <NUM>. As shown in <FIG>, the non-linear edge of the fabric forms a scalloped-shaped interface <NUM>. In some cases, the non-linear edge can form a sinusoidal, scalloped, or zigzagged shaped interface. The non-linear interface between inflow end region <NUM> and outflow end region <NUM> can disperse stress that forms along the interface during stretching of the tubular seal, limit or redirect tear propagation in outflow end region <NUM> back towards inflow end region <NUM>, and provide a transition zone where the overall outer diameter of the tubular member transitions between a thinner outflow end region thickness to a thicker inflow end region thickness. Variations in thickness between inflow end region <NUM> and outflow end region <NUM> can be due to the presence of the fabric within inflow end region <NUM>. In some cases, a tubular seal having a non-linear interface can exhibit a different tensile failure mode than a tubular seal with a linear interface, because the tear propagation has been limited or redirected at interface <NUM>. Advantages of having non-linear interface <NUM> thus includes increasing the durability of tubular seal <NUM> at interface <NUM>.

In some cases, prosthetic heart valves provided herein include a tubular seal including a woven fabric within an elastomeric matrix where the woven fabric has a non-linear edge within the elastomeric matrix around the circumference of the tubular seal. In some cases, the matrix structure can be made of elastomeric material. In some cases, tubular seal <NUM> can be made of the fabric alone.

Still referring to <FIG>, non-elastic fibers <NUM> can be part of a knit fabric used in tubular seals provided herein. In some cases, the fabric is a woven or nonwoven fabric having non-elastic fibers <NUM> arranged to allow the seal radially expand. The fabric can, for example, include non-elastic fiber <NUM> arranged to allow a portion of tubular seal <NUM> to stretch in axial and/or radial directions relative to the axis of the tubular seal <NUM>. In some cases, the woven fabric having non-elastic fiber <NUM> can be positioned along a front edge of a tubular seal positioned to be secured to an expandable member. In some cases, the non-elastic fiber <NUM> can be arranged at an of between <NUM> degrees and <NUM> degrees relative to a central axis of the tubular seal such that the non-elastic fiber <NUM> allow for a limited stretching of the tubular seal in an axial direction and/or a radial direction. For example, the non-elastic fiber <NUM> can be part of a woven fabric having fiber in a warp direction and fibers in a waft direction each oriented at an angle of between <NUM> degrees and <NUM> degrees relative to a central axis of the tubular seal. Although the non-elastic fiber <NUM> do not individually stretch, a woven structure can be stretched in directions non-parallel with the orientation of the fiber <NUM>. In some cases, the non-elastic fiber <NUM> can be arranged within the tubular member <NUM> to form an angle of about <NUM> degrees with the axis of the tubular seal. In some cases, the fabric can be a knit fabric arranged to allow for a predetermined amount of stretch in the axial and/or radial directions.

In some cases, fibers <NUM> of the fabric can allow for the expandable member to be secured to the leaflets and/or to the expandable member. For example, stitches or sutures can extend around the non-elastic fiber <NUM> within the matrix to ensure that the stitches or sutures do not cause the tubular seal to tear. Tears in the tubular seal can result in leakage of blood past a prosthetic heart valve, which can result in heart failure.

In some cases, the non-elastic fiber <NUM> within the tubular seal can be dispersed throughout a matrix structure, e.g., an elastomeric polymer matrix. In some cases, a fabric of the non-elastic fiber <NUM> can be throughout the tubular seal. The fabric within the matrix, e.g., an elastomeric polymer matrix, can be arranged to allow for a limited amount of expansion of the tubular seal in a radial direction and/or an axial direction. As discussed below in further detail, non-elastic fiber <NUM> dispersed throughout the tubular seal can simplify the production of the tubular seal, allow for sutures to be used to attach any section of the tubular seal to one or more other portions of a prosthetic heart valve provided herein, and provide a substantially uniform thickness. A tubular seal having a uniform thickness can facilitate loading of a prosthetic heart valve provided herein into a delivery sheath because non-uniform sections of a seal can catch on a delivery sheath and potentially tear the tubular seal.

In some cases, a tubular seal provided herein can include an inflow end region and an outflow end region with the inflow end region including a fabric of non-elastic fiber <NUM>. The inflow end region can be secured to the bottom edges of leaflets and/or an inflow end of the expandable member by stitches and/or sutures. In some cases, an outflow end region can include grommets for attachment to an outer surface of the expandable member. In some cases, the fabric can be arranged to allow for the inflow end region to be expanded in a radial and/or axial direction, which can mitigate the transition in elasticity at the interface between an inflow end region and the outflow end region. An abrupt transition in elasticity between the inflow end region and the outflow end region can result in a stress concentrator along the interface, which can result in a tear along the interface. By having a fabric oriented in the inflow end region to allow axial and/or radial expansion of the inflow end region can disperse stresses formed along the interface during stretching of the tubular seal.

In some cases, the fabric can be made of polymeric materials that include, but are not limited to, polyesters, polyolefins such as polyethylene and polypropylene, polyamides, nylons, and combinations thereof. In some cases, the fabric can have a thickness ranging from about <NUM> to about <NUM> microns. In some cases, the fabric can be woven such that spacings between individual fiber <NUM> create openings in the fabric that together constitutes from about <NUM>% to about <NUM>% of a fabric surface.

Claim 1:
A tubular seal (<NUM>, <NUM>, <NUM>, <NUM>) for use with a prosthetic heart valve, the tubular seal comprising an outflow end region (<NUM>, <NUM>, <NUM>, <NUM>) and an inflow end region (<NUM>, <NUM>, <NUM>, <NUM>), the inflow end region (<NUM>, <NUM>, <NUM>, <NUM>) being a portion of a polymeric web retaining a woven fabric, characterized in that the woven fabric has a non-linear edge defining an interface (<NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>) between the inflow end region (<NUM>, <NUM>, <NUM>, <NUM>) and the outflow end region (<NUM>, <NUM>, <NUM>, <NUM>).