Patent Description:
Existing frames for prosthetic heart valves typically comprise rows of angled struts and a plurality of axial frame members spaced apart around the circumference of the frame. The plurality of axial frame members may comprise a plurality of leaflet attachment members (for attaching to the commissures of the supported valvular structure) and a multitude of axially directed struts extending between the rows of angled struts. A frame usually has three or more axially directed struts for every leaflet attachment member, and generally has no more than two angled struts located in between adjacent struts or other axial frame members. Indeed, having a large number of axially directed struts is perceived to be necessary for preserving the structural stability of the stent and/or valve. Unfortunately, having a large number of axial struts can come at the expense of valve flexibility.

A need therefore exists for stents and prosthetic valves that can have a high degree of flexibility, without compromising mechanical integrity or function.

<CIT> discloses a delivery apparatus that includes a number of arms embedded within its body that hold a valve's stent during the delivery procedure when it is in the collapsed state. The arms are equipped with adjustable springs that are remotely controllable by the operator, and allow for robust radial expansion or deployment of the collapsed stent in increments. In use, the arms remain attached to the valve stent frame until the stent frame is fully deployed. If the stent/stent frame is not properly deployed, the arms, which are still releasably attached to the stent until intended release, can be used for partial contraction of the stent for repositioning purposes. When the stented valve is properly positioned as desired within the heart, the arms will be released from the stent, and return to their embedded/retracted positions within the apparatus. Then the entire apparatus is retracted.

<CIT> relates to a heart valve prosthesis valve frame and an intervened heart valve prosthesis using the valve frame. The valve frame is a cylindrical framework which can be retracted and expanded in the radial direction and comprises an annular inlet layer and an outlet layer which are arranged along the axial direction of the cylindrical framework at an interval and in parallel, an annular middle layer which is arranged between the inlet layer and the outlet layer in parallel, and a plurality of connection beams which are uniformly distributed along the peripheral direction and are parallel to the axial direction of the cylindrical framework, wherein the connection beams penetrate through the middle layer to be connected with the inlet layer and the outlet layer and comprise three main connection beams which are uniformly distributed along the peripheral direction; each layer is respectively provided with a plurality of continuous V-shaped units which are formed by connecting supporting rods which are the same in length and mutually form angles end to end; the length of each supporting rod of the middle layer and the angle between the supporting rods are greater than those of the inlet layer and the outlet layer; the connection beams are connected with all the layers by end points or middle points of the supporting rods.

In one aspect of the disclosure, a prosthetic device for implantation at a cardiac valve annulus has an annular frame with an inflow end, an outflow end, and a plurality of axial frame members bridging two circumferentially extending rows of angled struts, wherein the plurality of axial frame members comprises a plurality of axially extending leaflet attachment members and a plurality of axial struts in a <NUM>:<NUM> ratio.

In some embodiments, the device can further comprise a leaflet structure positioned within the frame, the leaflet structure having a plurality of commissures that are secured to the frame at the leaflet attachment members.

In some embodiments, at least three angled struts separate adjacent axial frame members along each of the two rows of angled struts.

In some embodiments, exactly six angled struts separate adjacent leaflet attachment members along each of the two rows of angled struts, and exactly three angled struts separate adjacent axial frame members along each of the two rows of angled struts, such that each axial strut is positioned halfway between adjacent leaflet attachment members.

In some embodiments, each axial frame member extends between locations defined by the convergence of adjacent angled struts.

In some embodiments, the device further comprises an inner skirt secured to an interior portion of the annular frame, and an outer skirt secured to an exterior portion of the annular frame.

In some embodiments, the frame comprises exactly four rows of angled struts.

In some embodiments, the valve member comprises exactly three leaflets arranged in a tricuspid configuration, wherein the frame comprises exactly three axial struts and exactly three leaflet attachment members, and wherein the exactly three angled struts separate adjacent axial frame members along each of the two rows of angled struts.

In another aspect of the disclosure, an annular frame for a prosthetic heart valve can comprise an inflow end, an outflow end, and a plurality of axial frame members spaced angularly around the circumference of the frame. The plurality of axial frame members can bridge two circumferentially extending rows of angled struts, wherein each of the two rows comprise at least three angled struts between adjacent axial frame members.

In some embodiments, each of the two rows comprises exactly three angled struts between adjacent axial frame members.

In some embodiments, the plurality of axial frame members comprises a plurality of axially extending leaflet attachment members, and each of the two rows comprises exactly six angled struts between adjacent leaflet attachment members.

In some embodiments, the plurality of axial frame members comprises a plurality of axially extending leaflet attachment members, wherein each of the two rows comprises four angled struts between adjacent axial frame members and eight angled struts between adjacent leaflet attachment members.

In some embodiments, the plurality of axial frame members comprises exactly three leaflet attachment members and exactly three axial struts.

In some embodiments, the leaflet attachment members extend between locations defined by the convergence of the upper ends of adjacent angled struts of each row of angled struts, and the axial struts extend between locations defined by the convergence of the lower ends of adjacent angled struts of each row of angled struts.

In some embodiments, the two rows of angled struts can comprise a first row and a second row, wherein the first row is closer to the outflow end than the second row.

In some embodiments, the leaflet attachment members extend from locations defined by the convergence of the upper ends of adjacent angled struts along the first row of angled struts to locations defined by the convergence of the lower ends of adjacent angled struts along the second row of angled struts, and the axial struts extend between locations defined by the convergence of the lower ends of adjacent angled struts along the first row of angled struts to locations defined by the convergence of upper ends of adjacent angled struts along the second row of angled struts.

In some embodiments, the leaflet attachment members extend from locations defined by the convergence of the upper ends of adjacent angled struts along the first row of angled struts to locations defined by the convergence of the upper ends of adjacent angled struts along the second row of angled struts, and the axial struts extend between locations defined by the convergence of the lower ends of adjacent angled struts along the first row of angled struts to locations defined by the convergence of lower ends of adjacent angled struts along the second row of angled struts.

In another aspect of the disclosure, a prosthetic device for implantation at a cardiac valve annulus is provided, comprising an annular frame having an inflow end, an outflow end, at least four rows of circumferentially extending angled struts, and exactly six axial frame members bridging two rows of the four rows of circumferentially extending angled struts. The plurality of axial frame members can comprise exactly three axially extending leaflet attachment members and exactly three axial struts, wherein each of the two rows comprises exactly three angled struts between each adjacent pair of a leaflet attachment member and an axial strut, and exactly six angled struts between adjacent leaflet attachment members. The device can further comprise a tri-leaflet valve member positioned within the frame having commissures that are secured to the frame at the leaflet attachment members.

Disclosed herein are prosthetic heart valves and stents for use with such valves that are capable of a high degree of flexibility. This flexibility can be useful for delivery to the valve annulus (such as for crimping/expanding a transcatheter heart valve (THV)) and/or for accommodating movement of the valve during cardiac cycling. In particular embodiments, strategically selected locations around the circumference of the frame are without axial struts, resulting in the improved flexibility. In various embodiments, the flexibility of the commissures is enhanced as a result of an increase in the distance between each commissure and the nearest axial frame member (other than any support member located at the commissure such as a commissure support or window frame member). The frame can have one or more circumferentially extending rows of struts with three continuous angled struts between one or more pairs of axial supports. In some embodiments, these one or more rows of struts are located towards an outflow end of the frame. In some embodiments, the frame can have two rows of circumferentially extending struts (towards the outflow end of the valve) having three continuous angled struts between pairs of axial supports. In some embodiments, the frame has three continuous angled struts separating each commissure support (located at each commissure) from the nearest axial support. In another embodiment, there are four such angled struts separating each commissure support from the nearest axial strut.

As used herein, an "axial support" is a junction where at least three struts are connected, such as two angled struts connecting to a single axial strut or a junction of two angled struts and another axial member such as a commissure support. As used herein, an "axial frame member" is any axially extending support member that connects two (or more) circumferentially extending rows of angled struts. Thus, an axial frame member can be an axial support member that engages one or more leaflets, such as a commissure support. An axial frame member can also be a simple axial strut or other axial member that does not engage a leaflet. As used herein, a "commissure support" (also referred to as a "leaflet attachment member") is an axially extending support member configured to support a respective commissure of a prosthetic valve member. A commissure support can be a commissure "window frame member" configured to receive a commissure of a prosthetic valve member through an opening in the frame member, as further described below. A commissure support can also be an axial strut or other axial support member that does not include a window or other opening sized to receive a commissure. As such, a commissure can be supported by a leaflet attachment member using various techniques or mechanisms, such as by securing commissures to respective leaflet attachment members with sutures extending through suture openings in the leaflet attachment members.

<FIG> show a prosthetic heart valve <NUM>, according to one embodiment in side view and in perspective, respectively. The illustrated prosthetic valve is adapted to be implanted in the native aortic annulus, although in other embodiments it can be adapted to be implanted in the other native annuluses of the heart (i.e., the native mitral, pulmonary, and tricuspid valves) or in other tubular passageways in the body. The valve <NUM> can have four main components: a stent or frame <NUM>, a valvular structure <NUM>, an inner skirt <NUM>, and an outer skirt <NUM>. The frame <NUM> can have an inflow end <NUM> and an outflow end <NUM>.

The valvular structure <NUM> can comprise three leaflets <NUM>, collectively forming a leaflet structure, which can be arranged to collapse in a tricuspid arrangement. The leaflets <NUM> can be secured to one another at their adjacent sides to form commissures. The leaflets <NUM> can be formed of pericardial tissue (e.g., bovine pericardial tissue), biocompatible synthetic materials, or various other suitable natural or synthetic materials as known in the art and described in <CIT>.

The bare frame <NUM> is shown in <FIG> in a side view, a perspective view, and an unrolled and flattened configuration, respectively. The frame <NUM> can be formed with a plurality of circumferentially spaced slots, or commissure windows <NUM> (three in the illustrated embodiment), that are adapted to mount the commissures of the valvular structure <NUM> to the frame, as described in greater detail below. The frame <NUM> can be made of any of various suitable plastically-expandable materials (e.g., stainless steel, etc.) or self-expanding materials (e.g., nitinol) as known in the art.

Suitable plastically-expandable materials that can be used to form the frame <NUM> can include, without limitation, stainless steel, a cobalt-chromium or a nickel-cobalt-chromium alloy. In particular embodiments, the frame <NUM> can be made of a nickel-cobalt-chromium-molybdenum alloy, such as MP35N® alloy (SPS Technologies), which is equivalent to UNS R30035 alloy (covered by ASTM F562-<NUM>). MP35N®/UNS R30035 alloy comprises <NUM>% nickel, <NUM>% cobalt, <NUM>% chromium, and <NUM>% molybdenum, by weight. It has been found that the use of MP35N® alloy to form the frame <NUM> can provide superior structural results over stainless steel. In particular, when MP35N® alloy is used as the frame material, less material is needed to achieve the same or better performance in radial and crush force resistance, fatigue resistances, and corrosion resistance. Moreover, since less material is required, the crimped profile of the frame <NUM> can be reduced, thereby providing a lower profile valve assembly for percutaneous delivery to the treatment location in the body.

When constructed of a plastically-expandable material, the frame <NUM> (and thus the valve <NUM>) can be crimped to a radially compressed state on a delivery catheter and then expanded inside a patient by an inflatable balloon or equivalent expansion mechanism. When constructed of a self-expandable material, the frame <NUM> (and thus the valve <NUM>) can be crimped to a radially compressed state and restrained in the compressed state by insertion into a sheath or equivalent mechanism of a delivery catheter. Once inside the body, the valve can be advanced from the delivery sheath, which allows the valve to expand to its functional size.

Referring to <FIG>, the frame <NUM> (shown in a flattened configuration) in the illustrated embodiment comprises a first, lower row I of angled struts <NUM> arranged end-to-end and extending circumferentially at the inflow end of the frame; a second row II of circumferentially extending, angled struts <NUM>; a third row III of circumferentially extending, angled struts <NUM>; a fourth row IV of circumferentially extending, angled struts <NUM>; and a fifth row V of circumferentially extending, angled struts <NUM> at the outflow end <NUM>. A plurality of substantially straight, axially extending struts <NUM> can be used to interconnect the struts <NUM> of the first row I with the struts <NUM> of the second row II. The fifth row V of angled struts <NUM> are connected to the fourth row IV of angled struts <NUM> by a plurality of axially extending window frame portions <NUM> (which define the commissure windows <NUM>) and a plurality of axially extending struts <NUM>.

Each commissure window frame portion <NUM> mounts a respective commissure of the valvular structure <NUM>. As can be seen, each window frame portion <NUM> is secured at its upper and lower ends to the adjacent rows of angled struts to provide a robust configuration that enhances fatigue resistance under cyclic loading of the valve compared with known frames using cantilevered struts for supporting the commissures of the leaflet structure. This configuration enables a reduction in the frame wall thickness to achieve a smaller crimped diameter of the valve. In particular embodiments, the thickness of the frame <NUM> as measured between the inner diameter and outer diameter is about <NUM> or less.

As best shown in <FIG>, the struts and frame portions of the frame collectively define a plurality of open cells of the frame. At the inflow end of the frame <NUM>, struts <NUM>, struts <NUM>, and struts <NUM> define a lower row of cells defining openings <NUM>. The second, third, and fourth rows of struts <NUM>, <NUM>, and <NUM> define two intermediate rows of cells defining openings <NUM>. The fourth and fifth rows of struts <NUM> and <NUM>, along with window frame portions <NUM> and struts <NUM>, define an upper row of cells defining openings <NUM>. The openings <NUM> are relatively large and are sized to allow portions of the valvular structure <NUM> to protrude, or bulge, into and/or through the openings <NUM> when the frame <NUM> is crimped in order to minimize the crimping profile.

In some embodiments, there are fewer than three axially extending struts <NUM> between adjacent window frame portions <NUM>, along the length of the rows, such as only two axially extending struts <NUM> or only one axially extending strut <NUM>. In some embodiments, there is only one axially extending strut <NUM> in between adjacent window frame portions <NUM>, which can be located halfway in between the window frame portions <NUM>. Thus, in various embodiments, the frame can be specifically constructed to integrate window frame portions <NUM> and axially extending struts <NUM> in a <NUM>:<NUM> ratio.

In one embodiment illustrated in <FIG>, there are exactly three window frame portions <NUM> and exactly three axial struts <NUM>. Minimizing or reducing the number of axially extending struts <NUM> between window frame portions <NUM> promotes more compact crimping of the prosthetic valve. This also maximizes or increases the size of openings <NUM>, which, for example, is advantageous in cases where the outflow end <NUM> of the prosthetic valve extends higher than the level of the coronary ostia. In such cases, the larger openings <NUM> can provide access to the coronary arteries for future procedures, such as procedures requiring catheterization of the coronary arteries.

Each window frame portion <NUM> and/or each axially extending strut <NUM> can each extend between locations <NUM> characterized by the convergence of the lower ends of two angled struts <NUM> (of row V, at the outflow end <NUM>) to locations or nodes <NUM> defined by the convergence of the upper ends of two angled struts <NUM> (of row IV). There can be two angled struts <NUM> along row V from one location <NUM> to the next location <NUM>, and two angled struts <NUM> along row IV from one location <NUM> to the next location <NUM>.

The frame <NUM> can comprise an axially extending frame member (i.e., a frame portion <NUM> or a strut <NUM>) at every other such pair of such locations <NUM>, <NUM> along the rows V and VI, respectively. The frame <NUM> can have a window frame portion <NUM> every four such locations, and spaced equally apart around the circumference of the frame <NUM>, which can provide for a total of three window frame portions <NUM> (corresponding to the three commissures in a tri-leaflet valve). Thus, the frame <NUM> can comprise, in sequence along the row V, a window frame portion <NUM> extending between a pair of such locations <NUM>, <NUM> followed next by a second pair of locations <NUM>, <NUM> lacking an axially extending strut or frame member extending therebetween, followed then by an axially extending strut <NUM> extending between a third pair of locations <NUM>, <NUM>, followed then by a fourth pair of locations <NUM>, <NUM> again lacking an axially extending strut or frame member, followed by another window frame portion <NUM> extending between a pair of such locations <NUM>, <NUM> (and thus re-starting the sequence of struts and frame portions). With two angled struts (along each of rows IV and V) between each set of locations <NUM>, <NUM>, this embodiment can thus have sets of eight angled struts between adjacent window frame portions <NUM>, along each row, with four continuous angled struts between each window frame portion <NUM> and its adjacent axial struts <NUM> (i.e., no other axial frame members in between).

After the prosthetic heart valve <NUM> is properly implanted at the valve annulus, the prosthetic valve <NUM> can cycle between open and closed states to permit or restrict the flow of blood. In various embodiments, the frame <NUM> of the prosthetic heart valve <NUM> provides a measure of damping during valve closure by bending inwards during diastole, which relieves stress on the leaflets. For example, forces that pull the commissures of the leaflets <NUM> radially inwards (such as during valve closure) can also pull areas of the frame immediately adjacent the commissures (such as the window frame portions <NUM>) radially inward, while the axial struts <NUM> can be urged radially outward. In various embodiments, this damping effect (including pulling of the frame portions <NUM> radially inward and pushing of the axial struts <NUM> radially outward) is enhanced by reducing the number of axial struts present along the top rungs (between rows IV and V in valve <NUM>) as disclosed herein, relative to frames having a greater number of axial frame members (e.g., greater number of axial struts).

The main functions of the inner skirt <NUM> are to assist in securing the valvular structure <NUM> to the frame <NUM> and to assist in forming a good seal between the valve <NUM> and the native annulus by blocking the flow of blood through the open cells of the frame <NUM> below the lower edge of the leaflets <NUM>. The inner skirt <NUM> desirably comprises a tough, tear resistant material such as polyethylene terephthalate (PET), although various other synthetic or natural materials can be used. The inner skirt <NUM> can be secured to the inside of the frame <NUM> via sutures. The valvular structure <NUM> can be attached to the inner skirt <NUM> with the assistance of one or more thin PET reinforcing strips (which collectively can form a sleeve, not pictured), which can enable secure suturing and protect the pericardial tissue of the leaflet structure from tearing. The valvular structure <NUM> can be sandwiched between the inner skirt <NUM> and the thin PET strips.

The upper edge portion of the inner skirt <NUM> can be formed with a plurality of projections that define an undulating shape that generally follows the shape of the fourth row of struts <NUM> (row IV) immediately adjacent the lower ends of axial struts <NUM>. In this manner, as best shown in <FIG>, the upper edge of inner skirt <NUM> can be tightly secured to struts <NUM> with suture <NUM>. The inner skirt <NUM> can also be secured to the first, second, and/or third rows of struts <NUM>, <NUM>, and <NUM> (rows I-III), respectively, with suture <NUM>.

The inner skirt <NUM> can be sutured to the frame <NUM> at locations away from the suture line attaching the lower edges of the leaflets <NUM> to the inner skirt <NUM>, which both reduces concentration of stress at the leaflet-suture-line and increases pliability to the skirt in that area.

As shown in <FIG>, a plurality of flexible connectors <NUM> can be used to interconnect each pair of adjacent edges of the leaflets <NUM> and to mount the leaflets <NUM> to the commissure window frame portions <NUM>. The flexible connectors <NUM> can be made from a piece of woven PET fabric, although other synthetic and/or natural materials can be used. Each commissure can comprise two tab portions of two adjacent leaflets. Each commissure can be secured to the frame, for example, by inserting the tab portions through the commissure windows <NUM> of the window frame portions <NUM>, and suturing the tab portions to a connector <NUM> outside of the frame <NUM>.

The outer skirt <NUM> can be laser cut or otherwise formed from a strong, durable piece of material, such as woven PET, although other synthetic or natural materials can be used. The outer skirt <NUM> can have a substantially straight lower edge and an upper edge defining a plurality of alternating projections <NUM> and notches <NUM>. The lower edge of the outer skirt <NUM> can be sutured to the lower edge of the inner skirt <NUM> at the inflow end of the valve <NUM>. In other embodiments, the inner skirt <NUM> and outer skirt <NUM> are integrally manufactured as a single component. As shown in <FIG>, each projection <NUM> can be affixed to the second rung II of struts <NUM> of the frame <NUM> with sutures <NUM>.

Additional details relevant to the securing of the valve member <NUM>, inner skirt <NUM> and outer skirt <NUM> to the frame <NUM> are provided in <CIT>.

In various embodiments, a frame can be constructed to have greater or fewer rows of angled struts than in frame <NUM>, such as four or six rows of angled struts. In various other frame embodiments, each window frame portion and/or each axially extending strut can extend between two locations each defined by the convergence of the upper ends of angled struts. In various embodiments, each window frame portion and/or each axially extending strut can extend between two locations each defined by the convergence of the lower ends of angled struts.

The invention is defined by embodiments of <FIG>. <FIG> shows a perspective view of another exemplary prosthetic valve <NUM> with an inner skirt <NUM>, an outer skirt <NUM>, and a valve member <NUM> mounted within a stent <NUM>. The valve member <NUM> can have a set of three leaflets <NUM>. A plurality of flexible connectors <NUM> can be used to interconnect pairs of adjacent edges of the leaflets <NUM> and to mount the leaflets <NUM> to the commissure window frame portions <NUM>.

<FIG> show perspective and flattened, unrolled views of the bare stent <NUM> having an inflow end <NUM>, an outflow end <NUM>, and four rows (I-IV) of struts <NUM>, <NUM>, <NUM>, <NUM> (instead of five rows as shown in <FIG>). The fourth row IV of angled struts <NUM> can be connected to the third row IV of angled struts <NUM> by a plurality of axially extending window frame portions <NUM> (which define commissure windows <NUM>) and a plurality of axially extending struts <NUM>.

Thus, each window frame portion <NUM> and each axially extending strut <NUM> can extend between the two rows of angled struts that are closest to the outflow end <NUM>. In particular, each window frame portion <NUM> can extend between a location <NUM> defined by the convergence of the upper ends of two angled struts <NUM> and a location <NUM> defined by the convergence of the upper ends of two angled struts <NUM>. Each axially extending strut <NUM> can extend between another location <NUM> defined by the convergence of the lower ends of two angled struts <NUM> and another location <NUM> defined by the convergence of the lower ends of two angled struts <NUM>.

The frame <NUM> can comprise three window frame portions <NUM> spaced equally apart around the circumference of the frame <NUM>. As shown, the frame <NUM> can be constructed to have six angled struts (along each of rows III and IV) between the window frame portions <NUM> along each row. The frame can be constructed to have three angled struts between each window frame portion <NUM> and the adjacent axial struts <NUM>. Thus, each axial strut <NUM> can be located halfway between adjacent window frame portions <NUM>, and the frame <NUM> can be constructed to integrate window frame portions and axially extending struts in a <NUM>:<NUM> ratio. In the illustrated embodiment, there are exactly three window frame portions <NUM> and exactly three axial struts <NUM>.

In particular, the frame <NUM> can comprise, in sequence along the rows III and IV, a window frame portion <NUM> extending between a pair of locations <NUM>, <NUM>, followed by a pair of locations <NUM>, <NUM> lacking an axially extending member, followed by a pair of locations <NUM>, <NUM> lacking an axially extending member, followed by an axially extending strut <NUM> extending between a pair of locations <NUM>, <NUM>, followed by a pair of locations <NUM>, <NUM> lacking an axially extending member, followed by a pair of locations <NUM>, <NUM> lacking an axially extending member, followed by another window frame portion <NUM> extending between a pair of locations <NUM>, <NUM> (and thus re-starting the sequence of window frame portions <NUM> and axially extending struts <NUM>).

Once the prosthetic heart valve <NUM> is properly installed at the valve annulus, the valve <NUM> can cycle between open and closed states to permit or restrict the flow of blood. As discussed with respect to prosthetic valve <NUM>, forces that pull the commissures radially inwards during cycling can also pull the window frame portions <NUM> radially inward to relieve stress on the leaflets during valve closure. Meanwhile, the axial struts <NUM> can be urged radially outward.

The frame <NUM> can be capable of assuming a collapsed configuration (such as for delivery on or within a catheter) and an expanded configuration (i.e., functional configuration at the valve annulus). In various embodiments, in the collapsed configuration, the plurality of axial struts is positioned radially outwards relative to the leaflet attachment members and/or commissures. In one embodiment, in the process of transitioning from an expanded configuration to a collapsed configuration and/or from an collapsed configuration to an expanded configuration, the valve <NUM> can assume an intermediate configuration in which only those struts <NUM> of row IV that are adjacent to an axially extending strut <NUM> are brought together to extend axially (side-by-side and in substantial axial alignment with struts <NUM>).

In another embodiment, as shown in <FIG>, a frame <NUM> can have axial window frame members <NUM> extending between locations <NUM> defined by the convergence of the upper ends of two angled struts <NUM> and locations <NUM> defined by the convergence of the lower ends of two angled struts <NUM>. The frame <NUM> can have axially extending struts <NUM> extending between locations <NUM> defined by the convergence of the lower ends of two angled struts <NUM> and locations <NUM> defined by the convergence of the upper ends of two angled struts <NUM>.

Frame <NUM> is similar to frame <NUM> except that the first three rows of angled struts (rows I, II, and III) are shifted <NUM> degrees relative to the same rows of frame <NUM>. Thus, each window frame member <NUM> is axially aligned with a location <NUM> defined by the convergence of the lower ends of two angled struts <NUM> of row III. Each window frame member <NUM> can comprise a lower strut portion <NUM> below the level of the commissure window <NUM> (towards the inflow end of the stent <NUM>). This lower strut portion <NUM> extends from the lower end of a window frame member <NUM> to a location <NUM> defined by the convergence of the lower ends of two angled struts <NUM>. The lower strut portion <NUM> provides added length to the window frame member <NUM> and allows the frame member <NUM> to effectively bridge the larger distance between locations <NUM>, <NUM> in this embodiment. Other features and components of frame <NUM> can be similar to as described above for frame <NUM>.

<FIG> shows a portion of a frame <NUM>, according to another embodiment. In <FIG>, only one-third of the circumference of the two upper rows of angled struts (the rows closest to the outflow end) is shown. The frame <NUM> can have axial window frame members <NUM> extending between locations <NUM> defined by the convergence of the lower ends of two angled struts <NUM> and locations <NUM> defined by the convergence of the lower ends of two angled struts <NUM>. The frame <NUM> can have axially extending struts <NUM> extending between locations <NUM> defined by the convergence of the upper ends of two angled struts <NUM> and locations <NUM> defined by the convergence of the upper ends of two angled struts <NUM>.

The two upper rows of angled struts includes a total of three axial window frame members <NUM> and a total of three axially extending struts <NUM> located equidistant between the window frame members <NUM> with three angled struts <NUM> and three angled struts <NUM> extending between a window frame member <NUM> and an adjacent axially extending strut <NUM>. The frame <NUM> can also include three additional rows of angled struts located at the inflow end of the frame (not shown in <FIG>), similar to embodiments discussed above. The lower end of each window frame member <NUM> can be connected to the upper ends of two angled struts of an adjacent row (the third row from the outflow end of the frame) at a location <NUM>. Thus, in this embodiment, the lower end of each axially extending strut <NUM> is not connected to any struts of the adjacent row.

<FIG> shows a portion of a frame <NUM>, according to another embodiment. In <FIG>, only one-third of the circumference two upper rows of angled struts (the rows closest to the outflow end) are shown. The frame <NUM> can have axial window frame members <NUM> extending between locations <NUM> defined by the convergence of the lower ends of two angled struts <NUM> and locations <NUM> defined by the convergence of the upper ends of two angled struts <NUM>. The frame <NUM> can have axially extending struts <NUM> extending between locations <NUM> defined by the convergence of the upper ends of two angled struts <NUM> and locations <NUM> defined by the convergence of the lower ends of two angled struts <NUM>. The axially extending struts <NUM> in this embodiment can be longer than the window frame members <NUM> to account for the greater distance between locations <NUM>, <NUM> compared to the distance between locations <NUM>, <NUM>.

The two upper rows of angled struts includes a total of three axial window frame members <NUM> and a total of three axially extending struts <NUM> located equidistant between the window frame members <NUM> with three angled struts <NUM> and three angled struts <NUM> extending between a window frame member <NUM> and an adjacent axially extending strut <NUM>. The frame <NUM> can also include three additional rows of angled struts located at the inflow end of the frame (not shown in <FIG>), similar to embodiments discussed above. The lower end of each axially extending strut <NUM> can be connected to the upper ends of two angled struts of an adjacent row (the third row from the outflow end of the frame) at a location <NUM>. Thus, in this embodiment, the lower end of each window frame member <NUM> is not connected to any angled struts of the adjacent row.

<FIG> shows a portion of a frame <NUM>, according to another embodiment. In <FIG>, only one-third of the circumference of the two upper rows of angled struts (the rows closest to the outflow end) is shown. The frame <NUM> can have axial window frame members <NUM> extending between locations <NUM> defined by the convergence of the upper ends of two angled struts <NUM> and locations <NUM> defined by the convergence of the upper ends of two angled struts <NUM>. The frame <NUM> can have axially extending struts <NUM> extending between locations <NUM> defined by the convergence of the lower ends of two angled struts <NUM> and locations <NUM> defined by the convergence of the lower ends of two angled struts <NUM>.

In the embodiment of <FIG>, there are two such axially extending struts <NUM> spaced between each pair of window frame members <NUM>. In particular, for each pair of window frame members, there are three angles struts <NUM> and three angles struts <NUM> between each window frame member <NUM> and the closest axially extending strut <NUM>, and two angles struts <NUM> and two angles struts <NUM> between the two axially extending struts <NUM>. Thus, for the entire frame <NUM>, the two upper rows of angled struts includes a total of three axial window frame members <NUM> and a total of six axially extending struts <NUM>.

The frame <NUM> can also include three additional rows of angled struts located at the inflow end of the frame (not shown in <FIG>), similar to embodiments discussed above. The lower end of each axially extending strut <NUM> can be connected to the upper ends of two angled struts of an adjacent row (the third row from the outflow end of the frame) at a location <NUM>. Thus, in this embodiment, the lower end of each window frame member <NUM> is not connected to any struts of the adjacent row.

<FIG> shows a portion of a frame <NUM>, according to another embodiment. In <FIG>, only one-third of the circumference of the two upper rows of angled struts (the rows closest to the outflow end) is shown. The frame <NUM> can have axial window frame members <NUM> extending between locations <NUM> defined by the convergence of the lower ends of two angled struts <NUM> and locations <NUM> defined by the convergence of the upper ends of two angled struts <NUM>. The frame <NUM> can have axially extending struts <NUM> extending between locations <NUM> defined by the convergence of the upper ends of two angled struts <NUM> and locations <NUM> defined by the convergence of the lower ends of two angled struts <NUM>.

In the embodiment of <FIG>, there are two such axially extending struts <NUM> spaced between each pair of window frame members <NUM>. In particular, for each pair of window frame members, there are three angles struts <NUM> and three angles struts <NUM> between each window frame member <NUM> and the closest axially extending strut <NUM>, and two angles struts <NUM> and two angles struts <NUM> between the two axially extending struts <NUM>. Thus, for the entire frame <NUM>, the two upper rows of angled struts includes a total of three axial window frame members <NUM> and a total of six axially extending struts <NUM>. Also, struts <NUM> can be longer than window frame members <NUM> to account for the greater distance between locations <NUM>, <NUM> compared to the distance between locations <NUM>, <NUM>.

The prosthetic valve embodiments disclosed herein can be surgically implanted and/or can be delivered using a delivery apparatus, such as a catheter. The prosthetic valve can be mounted in a crimped state on or adjacent an inflatable balloon or equivalent expansion mechanism of the delivery apparatus. The delivery apparatus and crimped prosthetic valve can be inserted into the patient's vasculature and advanced through the patient's body using known techniques.

In one implementation, the prosthetic valve is delivered in a transfemoral procedure in which the delivery apparatus is inserted into a femoral artery and advanced through the aorta to the native aortic valve (or another native valve of the heart). In another implementation, the prosthetic valve can be delivered in a transventricular procedure in which the delivery apparatus is inserted through a small surgical opening in the chest and another surgical opening in the wall of the heart, such as the wall of the left ventricle. In another implementation, the prosthetic valve can be delivered in a transaortic procedure in which the delivery apparatus is inserted through a small surgical opening in the chest and another surgical opening in the ascending aorta, at a location above the aortic valve. In another implementation, the prosthetic valve is a replacement venous valve for implantation in a vein, or a replacement for another valve with a lower flow rate relative to the aortic valve.

When the prosthetic valve is positioned at the desired deployment location (e.g., within the native aortic valve), the balloon of the delivery apparatus can be inflated to radially expand the prosthetic valve. In some embodiments, upon full expansion of the prosthetic valve, the outer skirt of the prosthetic valve can be forced into contact with the surrounding tissue of the native valve, establishing a seal between the outer surface of the frame and the surrounding tissue. The frame of the prosthetic valve, when in the radially compressed, mounted configuration, can comprise an inflow end portion that has an outer diameter that is smaller than the outer diameter of the outflow end portion of the frame.

When constructed of a self-expanding material, the prosthetic valve can be crimped to a radially compressed state and restrained in the compressed state by insertion into a sheath or equivalent mechanism of a delivery catheter. After the delivery apparatus is inserted into the body and advanced to position the prosthetic valve at the desired deployment location, the prosthetic valve can be advanced from the delivery sheath. As the prosthetic valve is deployed from the delivery sheath, the prosthetic valve can radially self-expand to its functional size.

The prosthetic heart valve can comprise commissure portions of the leaflets extending radially outwardly through corresponding window frame portions to locations outside of the frame and sutured to the side struts of the commissure window frame. To minimize the crimp profile of the prosthetic valve, the window frame portions can be depressed radially inwardly relative to the surrounding portions of the frame, such as the frame portions extending between adjacent commissure windows, when the prosthetic valve is radially compressed to the collapsed configuration on a catheter.

For example, the commissure windows of the frame can be depressed inwardly a radial distance, such as between <NUM> and <NUM>, relative to the portions of the frame extending between adjacent commissure windows when the prosthetic valve is radially collapsed. In this way, the outer diameter of the outflow end portion the prosthetic valve comprising the commissure portions can be generally consistent, as opposed to the commissure portions jutting outward from the surrounding portions of the prosthetic valve, which could hinder delivery of the prosthetic valve into the body. Even with the radially depressed commissure window frames, the outer diameter of the inflow end portion of the frame can still be smaller than, or about equal to, the outer diameter of the outflow end portion of the frame when the prosthetic valve is radially collapsed on the catheter, allowing for a minimal or reduced maximum overall diameter of the prosthetic valve. By minimizing or reducing the diameter of the prosthetic valve when mounted on the delivery catheter, the diameter of a delivery catheter through which the prosthetic valve is advanced can also be minimized or reduced. This allows the prosthetic valve to be delivered through smaller vessels in the body, making the delivery procedure less invasive, in general.

Additional details relevant to delivery of the prosthetic heart valves disclosed herein are provided in <CIT>.

For purposes of this description, certain aspects, advantages, and novel features of the embodiments of this disclosure are described herein. The disclosed methods, apparatuses, and systems should not be construed as limiting in any way. Instead, the present disclosure is directed toward all novel and nonobvious features and aspects of the various disclosed embodiments, alone and in various combinations and sub-combinations with one another. The methods, apparatuses, and systems are not limited to any specific aspect or feature or combination thereof, nor do the disclosed embodiments require that any one or more specific advantages be present or problems be solved.

Although the operations of some of the disclosed methods are described in a particular, sequential order for convenient presentation, it should be understood that this manner of description encompasses rearrangement, unless a particular ordering is required by specific language. Moreover, for the sake of simplicity, the attached drawings may not show the various ways in which the disclosed methods can be used in conjunction with other methods. As used herein, the terms "a", "an", and "at least one" encompass one or more of the specified element. That is, if two of a particular element are present, one of these elements is also present and thus "an" element is present. The terms "a plurality of" and "plural" mean two or more of the specified element.

As used herein, the term "and/or" used between the last two of a list of elements means any one or more of the listed elements. For example, the phrase "A, B, and/or C" means "A", "B", "C", "A and B", "A and C", "B and C", or "A, B, and C".

Claim 1:
A frame (<NUM>; <NUM>; <NUM>; <NUM>; <NUM>; <NUM>; <NUM>) for a prosthetic heart valve, the frame (<NUM>; <NUM>; <NUM>; <NUM>; <NUM>; <NUM>; <NUM>) being formed of stainless steel and/or a cobalt-chromium alloy or a nickel-cobalt-chromium alloy or a nickel-cobalt-chromium-molybdenum alloy, and comprising:
- an inflow end (<NUM>; <NUM>) and an outflow end (<NUM>; <NUM>),
- an upper row with outflow cells formed by a total of eight struts, the upper row being arranged at the outflow end (<NUM>; <NUM>) and comprising:
- a first row of angled struts and a second row of angled struts that each are arranged along a circumference of the frame (<NUM>; <NUM>; <NUM>; <NUM>; <NUM>; <NUM>; <NUM>), and
- axial frame members (<NUM>, <NUM>; <NUM>, <NUM>; <NUM>, <NUM>; <NUM>, <NUM>; <NUM>, <NUM>; <NUM>, <NUM>; <NUM>, <NUM>) bridging the first row of angled struts and the second row of angled struts and extending only between the first row of angled struts and the second row of angled struts.