DE102018100321B9 - Heart valve repair system - Google Patents

Abstract

A valve repair system (600) for repairing an endogenous valve of a patient during a non-open heart procedure, the valve repair system (600) comprising: a valve repair device (602) for attachment to an endogenous valve of a patient, the valve repair device (602) comprising : a pair of paddles (606a, 606b) movable between an open position and a closed position; a first gripping element (608a) and a second gripping element (608b), the paddles (606a, 606b) and the gripping elements (608a , 608b) are arranged in such a way that openings (614a, 614b) are present between the paddles (606a, 606b) and the gripping elements (608a, 608b), in which at least portions of the patient's own valve can be received; a gripper control mechanism (611) to move the first and second gripping elements (608a, 608b) independently of one another, characterized in that the gripper control mechanism (611) comprises a single line (2302), such as a suture or wire, releasably attached to the first and second gripping elements (608a, 608b), the single line (2302) at a connection point (615) between the first gripping element (608) and the second gripping element (608) is releasably fixed to the valve repair system (600), and wherein a movement of a first portion (2303) of the single line (2302) a width of the opening (614a) between the first Gripping element (608a) and the first paddle (606a) adjusts, but not a width of the opening (614b) between the second gripping element (608b) and the second paddle (606b), and wherein a movement of a second portion (2305) of each Line (2302) adjusts the width of the opening (614b) between the second gripping element (608b) and the second paddle (606b), but not the width of the opening (614a) between the first gripping element (608a) and the first paddle (606a) adapts.

Description

FIELD OF THE INVENTION

The present application relates to a valve repair system for repairing an endogenous valve of a patient during a non-open heart procedure.

BACKGROUND OF THE INVENTION

The body's own heart valves (i.e., the aortic valve, pulmonary valve, tricuspid valve, and mitral valve) serve vital functions by providing the forward flow of an adequate amount of blood through the cardiovascular system. These heart valves can be damaged by congenital malformations, inflammatory processes, infectious conditions or diseases and thus work less efficiently. Such damage to the valves can result in serious cardiovascular impairment or death. For many years, the primary treatment for such damaged valves has been surgical repair or replacement of the valve during open heart surgery. However, open heart surgery is highly invasive and prone to numerous complications. For this reason, such an intervention was often refrained from in elderly and frail patients with defective heart valves. Recently, transvascular techniques have been developed that allow prosthetic devices to be inserted and implanted in a manner that is much less invasive than open heart surgery. A special transvascular technique that is used to gain access to the body's own mitral valve and aortic valve is the transseptal technique. The transseptal technique involves inserting a catheter into the right femoral vein and advancing the inferior vena cava into the left atrium. The septum is then pierced and the catheter is inserted into the left atrium.

A healthy heart has a generally conical shape that tapers towards a lower apex. The heart has four chambers and includes the left atrium, the right atrium, the left ventricle, and the right ventricle. The left and right sides of the heart are separated by a wall commonly called the septum. The human heart's own mitral valve connects the left atrium with the left ventricle. The mitral valve has an anatomy that is very different from other endogenous heart valves. The mitral valve includes an annulus portion, which is an annular portion of the body's own valve tissue surrounding the mitral valve opening, and a pair of cuspis or leaflets that extend downward from the annulus into the left ventricle. The mitral valve annulus can have a “D” -shaped, oval or otherwise non-circular cross-sectional shape with a major and a minor axis. The forward leaflet can be larger than the aft leaflet, creating a generally "C" shaped border between the abutting free edges of the leaflets when they close against one another.

When functioning correctly, the anterior leaflet and the posterior leaflet work together as a one-way valve to allow blood to flow from the left atrium to the left ventricle only. The left atrium receives oxygenated blood from the pulmonary veins. When the muscles of the left atrium contract and the left ventricle relaxes (also known as "ventricular diastole" or "diastole"), the oxygen-rich blood that has accumulated in the left atrium flows into the left ventricle. When the muscles of the left atrium relax and the muscles of the left ventricle contract (also known as "ventricular systole" or "systole"), the increased blood pressure in the left ventricle squeezes the two leaflets, causing the one-way mitral valve to close so that the blood cannot flow back into the left atrium and is instead expelled from the left ventricle through the aortic valve. In order to prevent the two cusps from prolapsing under pressure and recoiling through the mitral annulus into the left atrium, several tendon threads, the so-called chordae tendineae, bind the cusps to the papillary muscles in the left ventricle.

Mitral regurgitation occurs when the body's mitral valve does not close properly and blood flows from the left ventricle into the left atrium during the systolic phase of the heart's contraction. Mitral regurgitation is the most common form of heart valve disease. Mitral regurgitation has various causes, such as leaflet prolapse, dysfunctional papillary muscles and / or stretching of the mitral valve annulus as a result of an expansion of the left ventricle. Mitral regurgitation at a midsection of the leaflets can be referred to as midstream mitral regurgitation, and mitral regurgitation closer to a commissure of the leaflets (i.e., where the leaflets meet) can be referred to as side beam mitral regurgitation. In central ray regurgitation, the edges of the cusps do not meet in the middle. Therefore the valves do not close and regurgitation occurs.

Some known techniques for treating mitral regurgitation in patients include stitching the edges of the body's own mitral valve leaflets directly together. A catheter-delivered clip was used to attempt to clip the edges of the leaflets together, similar to a surgical stapling procedure. However, this clip has disadvantages in that it can only be used to clip the central edges of the cusps together where they overlap by 2 mm or more. Alternatively, attempts have been made to use multiple clips on the mitral valve commissures where there may be a greater overlap. This results in longer surgery times and the patient's cusps are bandaged at the sides, restricting blood flow. It can be assumed that the surgical treatment and the clip treatment alike create stress on the patient's cusps.

Despite this available technique, there remains a need for improved devices and methods for treating mitral valve regurgitation.

STATE OF THE ART

The US patent application US 2015/0 105 804 A1 discloses devices, systems, and methods for tissue alignment and repair at treatment sites. The devices, systems and methods described herein find use in a variety of treatment procedures, including endovascular, minimally invasive and open surgical procedures, and can be used in various anatomical regions, including the abdomen, thorax, cardiovascular systems, heart, intestinal tract, stomach , urinary tract, bladder, lungs and other organs, vessels and tissues. These known devices each have gripper elements and paddles, each gripper element being able to be moved independently of one another via a thread-like element assigned to it.

The US patent applications US 2006/020 275 A1 and US 2011/0 004 227 A1 disclose devices of similar construction to the aforementioned US patent application US 2015/0105804 A1.

TASK

The object of the invention is to provide a flap repair device with paddles and gripping elements which makes it possible to control each of the gripping elements independently of the others with a small number of components.

The object is achieved by the features in claim 1. Further developments are given in the dependent claims.

OVERVIEW OF THE INVENTION

An exemplary valve repair system for repairing an autologous valve of a patient during a non-open heart procedure includes a delivery device, a valve repair device, and a grasper control mechanism. The feed device has at least one lumen. The valve repair device is designed to be attached to a patient's own valve. The valve repair device includes a pair of paddles and a pair of grasping elements. The paddles are movable between an open position and a closed position. The paddles and gripping elements are arranged in such a way that openings are present between the paddles and gripping elements, in which at least portions of the patient's own valve can be received. The gripper control mechanism is adapted to move the first and second gripping elements independently. The gripper control mechanism includes a single line, such as a suture or wire, that is releasably attached to the first and second gripping elements, the single line being releasably affixed to the valve repair system at a connection point between the first gripping element and the second gripping element. Movement of a first portion of the single line adjusts a width between the first gripping element and the first paddle, but not a width between the second gripping element and the paddle. Movement of a second portion of the single line adjusts the width between the second gripping element and the paddle, but not the width between the first gripping element and the first paddle.

With a view to a more detailed understanding of the present invention, its nature and its advantages are set out in the following description and in the claims, in particular in connection with the accompanying drawings, in which like parts have the same reference numerals.

Figure list

• 1 zeigt eine Schnittbildansicht des menschlichen Herzens in einer diastolischen Phase;
• 2 zeigt eine Schnittbildansicht des menschlichen Herzens in einer systolischen Phase;
• 3 zeigt eine gesunde Mitralklappe mit geschlossenen Segeln, von einer Vorhofseite der Mitralklappe aus betrachtet;
• 4 zeigt eine dysfunktionale Mitralklappe mit einem sichtbaren Spalt zwischen den Segeln, von einer Vorhofseite der Mitralklappe aus betrachtet;
• 4A zeigt eine Trikuspidalklappe, von einer Vorhofseite der Trikuspidalklappe aus betrachtet;
• 5 zeigt eine Schnittbildansicht des menschlichen Herzens in einer diastolischen Phase, in welcher gezeigt ist, wie durch die Chordae tendineae die Segel der Mitralklappe und der Trikuspidalklappe an den Ventrikelwänden befestigt sind;
• 6 zeigt eine Klappenreparaturvorrichtung mit Paddeln in einer offenen Stellung;
• 7 zeigt die Klappenreparaturvorrichtung aus 6, bei welcher sich die Paddel in der offenen Stellung befinden und die Greifelemente so bewegt sind, dass sie einen erweiterten Spalt zwischen den Greifelementen und den Paddeln schaffen;
• 8 zeigt die Klappenreparaturvorrichtung aus 6, bei welcher sich die Klappenreparaturvorrichtung in der in 7 gezeigten Stellung befindet, wobei Klappengewebe zwischen den Greifelementen und den Paddeln platziert ist;
• 9 zeigt die Klappenreparaturvorrichtung aus 6, bei welcher die Greifelemente so bewegt sind, dass sich der Spalt zwischen den Greifelementen und den Paddeln verringert;
• 10A - 10B zeigen die Bewegung der Paddel der Klappenreparaturvorrichtung aus 6 von der offenen Stellung in eine geschlossene Stellung;
• 11 zeigt die Klappenreparaturvorrichtung aus 6 in einer geschlossenen Stellung, bei welcher die Greifelemente mit Klappengewebe in Eingriff stehen;
• 12 zeigt die Klappenreparaturvorrichtung aus 6, nachdem sie von der Zuführeinrichtung gelöst worden ist und an Klappengewebe angebracht worden ist, wobei sich die Klappenreparaturvorrichtung in einem geschlossenen und verriegelten Zustand befindet;
• 13A zeigt eine beispielhafte Ausführungsform einer an dem vorderen Segel und dem hinteren Segel der Mitralklappe eines Patienten angebrachten Klappenreparaturvorrichtung, und zwar von dem linken Vorhof des Herzens des Patienten aus gezeigt, wobei die Klappenreparaturvorrichtung und das Segelgewebe auf der ventrikulären Seite mit verdeckten Linien gezeigt sind;
• 13B ist eine vergrößerte Version der 13A;
• 14A ist eine andere beispielhafte Ausführungsform einer an dem vorderen Segel und dem hinteren Segel der Mitralklappe eines Patienten angebrachten Klappenreparaturvorrichtung, und zwar von dem linken Vorhof des Herzens des Patienten aus gezeigt, wobei die Klappenreparaturvorrichtung und das Segelgewebe auf der ventrikulären Seite mit verdeckten Linien gezeigt sind;
• 14B ist eine andere beispielhafte Ausführungsform einer an dem vorderen Segel und dem hinteren Segel der Mitralklappe eines Patienten angebrachten Klappenreparaturvorrichtung, bei welcher die Klappenreparaturvorrichtung Paddel umfasst, welche sich biegen, um weniger Belastung auf das Mitralklappengewebe auszuüben, wobei die Klappenreparaturvorrichtung und das Segelgewebe auf der ventrikulären Seite mit verdeckten Linien gezeigt sind;
• 15A - 15B zeigen eine andere beispielhafte Ausführungsform einer Klappenreparaturvorrichtung, bei welcher die Klappenreparaturvorrichtung Paddel umfasst, welche sich entlang ihrer Länge biegen, um weniger Belastung auf das Klappengewebe auszuüben, wenn die Klappenreparaturvorrichtung an dem Klappengewebe angebracht wird;
• 16A - 16F zeigen eine andere beispielhafte Ausführungsform einer Klappenreparaturvorrichtung, bei welcher die Klappenreparaturvorrichtung komprimierbare Paddel einschließt, die eine beispielhafte Ausführungsform einer Drahtschlaufe umfassen;
• 16G - 16H zeigen eine andere beispielhafte Ausführungsform einer Klappenreparaturvorrichtung, bei welcher die Klappenreparaturvorrichtung komprimierbare Paddel einschließt, die eine andere beispielhafte Ausführungsform einer Drahtschlaufe umfassen;
• 16I - 16J zeigen eine andere beispielhafte Ausführungsform einer Klappenreparaturvorrichtung, bei welcher die Klappenreparaturvorrichtung komprimierbare Paddel einschließt, die eine andere beispielhafte Ausführungsform einer Drahtschlaufe umfassen;
• 17A - 17F zeigen eine andere beispielhafte Ausführungsform einer Klappenreparaturvorrichtung, bei welcher die Klappenreparaturvorrichtung komprimierbare Paddel mit einer Hufeisenform umfasst;
• 18A - 18D zeigen eine andere beispielhafte Ausführungsform einer Klappenreparaturvorrichtung, bei welcher die Klappenreparaturvorrichtung komprimierbare Paddel mit einer Hufeisenform umfasst;
• 18E und 18F zeigen ein komprimierbares Paddel, das dem in 18C und 18D ähnlich ist, abgesehen davon, dass die Schenkel des Paddels einander nicht überkreuzen, wenn das Paddel in einen Katheter eingebracht wird;
• 19A - 19D zeigen eine andere beispielhafte Ausführungsform einer Klappenreparaturvorrichtung, bei welcher die Klappenreparaturvorrichtung komprimierbare Gitterpaddel umfasst;
• 20A - 20B zeigen eine beispielhafte Ausführungsform einer Klappenreparaturvorrichtung, bei welcher das Paddel komprimierbar ist;
• 21A - 21B zeigen eine andere beispielhafte Ausführungsform einer Klappenreparaturvorrichtung, bei welcher die Paddel der Klappenreparaturvorrichtung ausfahrbar sind;
• 22 zeigt eine andere beispielhafte Ausführungsform einer Klappenreparaturanordnung, bei der ein Greifersteuerungsmechanismus derart ausgelegt ist, dass er jedes Greiferelement einer Klappenreparaturvorrichtung unabhängig ansteuert;
• 22A - 22D zeigen eine andere beispielhafte Ausführungsform einer Klappenreparaturanordnung, bei der eine beispielhafte Ausführungsform eines Greifersteuerungsmechanismus derart ausgelegt ist, dass sie vier Greiferelemente einer beispielhaften Ausführungsform einer Klappenreparaturvorrichtung unabhängig voneinander ansteuert;
• 23 zeigt eine andere beispielhafte Ausführungsform einer Klappenreparaturanordnung, bei der ein Greifersteuerungsmechanismus derart ausgelegt ist, dass er jedes Greiferelement einer Klappenreparaturvorrichtung unabhängig ansteuert;
• 24 zeigt eine beispielhafte Ausführungsform einer Verbindung zwischen einem Positionierschaft und einem Schaft des Paddelsteuerungsmechanismus der Klappenreparaturvorrichtung aus 23, bei welcher der Greifersteuerungsmechanismus an der Verbindung zwischen dem Positionierschaft und dem Schaft des Paddelsteuerungsmechanismus an der Klappenreparaturvorrichtung angebracht ist;
• 24A - 24B zeigen eine beispielhafte Ausführungsform einer Verbindung zwischen einem Positionierschaft und einem Schaft des Paddelsteuerungsmechanismus der Klappenreparaturvorrichtung aus 23, bei welcher der Greifersteuerungsmechanismus an der Verbindung zwischen dem Positionierschaft und dem Schaft der Klappenreparaturvorrichtung an besagter Klappenreparaturvorrichtung angebracht ist;
• 25 zeigt eine andere beispielhafte Ausführungsform einer Klappenreparaturanordnung, bei der ein Greifersteuerungsmechanismus derart ausgelegt ist, dass er jedes Greiferelement einer Klappenreparaturvorrichtung unabhängig voneinander ansteuert;
• 25A zeigt eine andere beispielhafte Ausführungsform eines Greifersteuerungsmechanismus, welcher derart ausgelegt ist, dass er jedes Greiferelement einer Klappenreparaturvorrichtung unabhängig voneinander ansteuert;
• 26 zeigt eine andere beispielhafte Ausführungsform einer Klappenreparaturanordnung, bei der ein Greifersteuerungsmechanismus derart ausgelegt ist, dass er jedes Greiferelement einer Klappenreparaturvorrichtung unabhängig voneinander ansteuert;
• 27A - 27C zeigen eine andere beispielhafte Ausführungsform einer Klappenreparaturvorrichtung, bei welcher jedes Paddel der Klappenreparaturvorrichtung unabhängig von einer offenen Stellung in eine geschlossene Stellung bewegt werden kann;
• 28A - 28F zeigen eine andere beispielhafte Ausführungsform einer Klappenreparaturvorrichtung, bei welcher jedes Paddel der Klappenreparaturvorrichtung unabhängig von einer offenen Stellung in eine geschlossene Stellung bewegt werden kann;
• 29A - 29B zeigen eine andere beispielhafte Ausführungsform einer Klappenreparaturvorrichtung, bei welcher jedes Paddel der Klappenreparaturvorrichtung unabhängig von einer offenen Stellung in eine geschlossene Stellung bewegt werden kann, die jeweils unabhängig voneinander sind;
• 30 zeigt eine Mitralklappe mit einem breiten Spalt zwischen dem hinteren Segel und dem vorderen Segel;
• 31A - 31B zeigen eine andere beispielhafte Ausführungsform einer Klappenreparaturvorrichtung, bei welcher die Paddel der Klappenreparaturvorrichtung zu einem breiten Spalt zum Aufnehmen von Klappengewebe erweitert sind;
• 32A - 32C zeigen eine andere beispielhafte Ausführungsform einer Klappenreparaturvorrichtung, bei welcher die Klappenreparaturvorrichtung derart ausgelegt ist, dass die Paddel der Klappenreparaturvorrichtung durch Schwenken und Aufspreizen zu einem breiten Spalt zum Aufnehmen von Klappengewebe erweitert sind;
• 33A - 33C zeigen eine andere beispielhafte Ausführungsform einer Klappenreparaturvorrichtung, bei welcher die Klappenreparaturvorrichtung derart ausgelegt ist, dass die Paddel der Klappenreparaturvorrichtung durch Aufspreizen und Verschwenken zu einem breiten Spalt zum Aufnehmen von Klappengewebe erweitert sind;
• 34A - 34B zeigen eine weitere beispielhafte Ausführungsform einer Klappenreparaturvorrichtung, bei welcher ein „W“-förmiger Mechanismus die Paddel der Klappenreparaturvorrichtung zu einem breiten Spalt erweitert;
• 35A - 35B zeigen eine weitere beispielhafte Ausführungsform einer Klappenreparaturvorrichtung, bei welcher ein „W“-förmiger Mechanismus Paddel der Klappenreparaturvorrichtung zu einem breiten Spalt zum Aufnehmen von Klappengewebe erweitert;
• 36A - 36B zeigen eine weitere beispielhafte Ausführungsform einer Klappenreparaturvorrichtung, bei welcher ein „W“-förmiger Mechanismus die Paddel der Klappenreparaturvorrichtung zu einem breiten Spalt erweitert;
• 36C zeigt eine beispielhafte Ausführungsform eines Paddelsteuerungsmechanismus für die Klappenreparaturvorrichtung aus den 36A - 36B;
• 36D - 36E zeigen eine weitere beispielhafte Ausführungsform einer Klappenreparaturvorrichtung, bei welcher ein „W“-förmiger Mechanismus die Paddel der Klappenreparaturvorrichtung zu einem breiten Spalt erweitert;
• 37A - 37D zeigen eine andere beispielhafte Ausführungsform einer Klappenreparaturvorrichtung mit Gitterpaddeln und einer Innennocke zum Auseinanderspreizen der Gitterpaddel zu einem breiten Spalt für voneinander beabstandete Klappengewebe;
• 38 zeigt eine beispielhafte Ausführungsform einer Klappenreparaturvorrichtung, die eine beispielhafte Ausführungsform eines Abstandselements umfasst, bei welcher die Klappenreparaturvorrichtung an einer Mitralklappe angebracht ist;
• 39 zeigt eine andere beispielhafte Ausführungsform einer Klappenreparaturvorrichtung, die eine beispielhafte Ausführungsform eines Abstandselements umfasst, und bei welcher die Klappenreparaturvorrichtung an einer Mitralklappe angebracht ist;
• 40A - 40B zeigen eine andere beispielhafte Ausführungsform einer Klappenreparaturvorrichtung, die eine beispielhafte Ausführungsform eines Abstandselements umfasst, bei welcher das Abstandselement an einem Schaft der Klappenreparaturvorrichtung angebracht ist;
• 41A - 41D zeigen eine andere beispielhafte Ausführungsform einer Klappenreparaturvorrichtung, die eine beispielhafte Ausführungsform eines Abstandselements umfasst, wobei ein erster Abschnitt an einem ersten Greiferelement der Klappenreparaturvorrichtung angebracht ist und ein zweiter Abschnitt an einem zweiten Greiferelement der Klappenreparaturvorrichtung angebracht ist;
• 42A - 42C zeigen die Klappenreparaturvorrichtung aus 40A - 40B, wobei das Abstandselement verschiedene Formen aufweist;
• 43A - 43C zeigen die Klappenreparaturvorrichtung aus 41A - 41B, wobei das Abstandselement verschiedene Formen aufweist;
• 44A - 44B zeigen eine weitere beispielhafte Ausführungsform einer Klappenreparaturvorrichtung, mit Paddeln, die sich weiter aufspreizen lassen, und mit einem erweiterbaren Abstandselement;
• 45A - 45C zeigen eine andere beispielhafte Ausführungsform einer Klappenreparaturvorrichtung mit einem vergrößerten Freigabewinkel zum Entfernen der Klappenreparaturvorrichtung;
• 46A - 46D zeigen eine andere beispielhafte Ausführungsform einer Klappenreparaturvorrichtung mit einem vergrößerten Freigabewinkel zum Entfernen der Klappenreparaturvorrichtung;
• 47A - 47B zeigen eine andere beispielhafte Ausführungsform einer Klappenreparaturvorrichtung mit einem Befestigungselement zum Verbinden der Paddel mit den Greifern, wenn sich die Klappenreparaturvorrichtung in einer geschlossenen Stellung befindet;
• 48 zeigt eine weitere beispielhafte Ausführungsform einer Klappenreparaturvorrichtung mit einem Federelement, welches dafür ausgelegt ist, die Paddel der Klappenreparaturvorrichtung in eine geschlossene Stellung vorzuspannen;
• 49 zeigt eine weitere beispielhafte Ausführungsform einer Klappenreparaturvorrichtung mit einem Gewindemechanismus, um die Klappenreparaturvorrichtung zwischen der offenen Stellung und der geschlossenen Stellung zu bewegen;
• 50 zeigt eine weitere beispielhafte Ausführungsform einer Klappenreparaturvorrichtung mit Greifelementen, die an den Paddeln angebracht sind;
• 51 zeigt eine weitere beispielhafte Ausführungsform einer Klappenreparaturvorrichtung, welche Greifelemente mit einer Einzelreihe von Widerhaken aufweist;
• 51A - 51E zeigen eine andere beispielhafte Ausführungsform eines Klappenreparatursystems, das eine Klappenreparaturanordnung mit einer Klappenreparaturvorrichtung aufweist, mit Greifelementen, die dafür ausgelegt sind, eine Spannkraft an das Klappengewebe anzulegen, wenn die Klappenreparaturvorrichtung an dem Klappengewebe angebracht wird;
• 51F - 51H zeigen eine andere beispielhafte Ausführungsform einer Klappenreparaturanordnung mit Greifelementen, die dafür ausgelegt sind, eine Spannkraft auf das Klappengewebe auszuüben, wenn die Klappenreparaturvorrichtung an dem Klappengewebe angebracht wird;
• 52 zeigt eine weitere beispielhafte Ausführungsform einer Klappenreparaturvorrichtung mit Greifelementen, die der Länge nach ausfahrbar sind;
• 53A - 53B zeigen eine weitere beispielhafte Ausführungsform einer Klappenreparaturvorrichtung mit Greifelementen, die flexibel sind; und
• 54 zeigt eine weitere beispielhafte Ausführungsform einer Klappenreparaturvorrichtung, bei welcher Greifelemente an einem separaten Federelement angebracht sind.

In order to clarify various aspects of embodiments of the present disclosure, a more detailed description of certain embodiments follows with reference to various aspects of the accompanying drawings. It is It should be noted that these drawings depict only typical embodiments of the present disclosure and are therefore not to be considered as limitations on the scope of the disclosure. In addition, the figures can be depicted true to scale in some embodiments, but the figures do not necessarily have to be true to scale for all embodiments. Embodiments of the present disclosure will be described and explained more specifically and in detail using the accompanying drawings.

• 1 Figure 4 shows a sectional view of the human heart in a diastolic phase;
• 2 Fig. 10 shows a sectional view of the human heart in a systolic phase;
• 3 Figure 12 shows a healthy mitral valve with closed leaflets viewed from an atrial side of the mitral valve;
• 4th Figure 12 shows a dysfunctional mitral valve with a visible gap between the leaflets, viewed from an atrial side of the mitral valve;
• 4A Figure 12 shows a tricuspid valve as viewed from an atrial side of the tricuspid valve;
• 5 Fig. 13 is a sectional view of the human heart in a diastolic phase, showing how the chordae tendineae attach the cusps of the mitral valve and tricuspid valve to the ventricular walls;
• 6th Figure 3 shows a valve repair device with paddles in an open position;
• 7th shows the valve repair device from 6th wherein the paddles are in the open position and the gripping elements are moved to create an enlarged gap between the gripping elements and the paddles;
• 8th shows the valve repair device from 6th , in which the valve repair device is located in the in 7th position shown is with valve tissue placed between the gripping elements and the paddles;
• 9 shows the valve repair device from 6th in which the gripping elements are moved so that the gap between the gripping elements and the paddles is reduced;
• 10A - 10B show the movement of the paddles of the valve repair device 6th from the open position to a closed position;
• 11 shows the valve repair device from 6th in a closed position in which the gripping elements are engaged with valve tissue;
• 12th shows the valve repair device from 6th after it has been released from the delivery device and attached to valve tissue, the valve repair device being in a closed and locked condition;
• 13A Figure 12 shows an exemplary embodiment of a valve repair device attached to the anterior leaflet and posterior leaflet of a patient's mitral valve, viewed from the left atrium of the patient's heart, the valve repair device and leaflet tissue on the ventricular side shown in hidden lines;
• 13B is an enlarged version of the 13A ;
• 14A Another exemplary embodiment of a valve repair device attached to the anterior leaflet and posterior leaflet of a patient's mitral valve is shown from the left atrium of the patient's heart, the valve repair device and leaflet tissue on the ventricular side being shown in hidden lines;
• 14B Figure 3 is another exemplary embodiment of one attached to the anterior leaflet and posterior leaflet of a patient's mitral valve A valve repair device wherein the valve repair device comprises paddles which flex to place less stress on the mitral valve tissue, the valve repair device and leaflet tissue on the ventricular side being shown in hidden lines;
• 15A - 15B Figure 13 shows another exemplary embodiment of a valve repair device in which the valve repair device includes paddles that flex along its length to place less stress on the valve tissue when the valve repair device is attached to the valve tissue;
• 16A - 16F Figure 13 shows another exemplary embodiment of a valve repair device in which the valve repair device includes compressible paddles that include an exemplary embodiment of a wire loop;
• 16G - 16H Figure 13 shows another exemplary embodiment of a valve repair device in which the valve repair device includes compressible paddles that comprise another exemplary embodiment of a wire loop;
• 16I - 16Y Figure 13 shows another exemplary embodiment of a valve repair device in which the valve repair device includes compressible paddles that comprise another exemplary embodiment of a wire loop;
• 17A - 17F Figure 13 shows another exemplary embodiment of a valve repair device in which the valve repair device includes compressible paddles having a horseshoe shape;
• 18A - 18D Figure 13 shows another exemplary embodiment of a valve repair device in which the valve repair device includes compressible paddles having a horseshoe shape;
• 18E and 18F show a compressible paddle similar to that in 18C and 18D is similar except that the legs of the paddle do not cross each other when the paddle is inserted into a catheter;
• 19A - 19D Figure 13 shows another exemplary embodiment of a valve repair device in which the valve repair device includes compressible mesh paddles;
• 20A - 20B show an exemplary embodiment of a valve repair device in which the paddle is compressible;
• 21A - 21B show another exemplary embodiment of a valve repair device in which the paddles of the valve repair device are extendable;
• 22nd 13 shows another exemplary embodiment of a flap repair assembly in which a gripper control mechanism is configured such that it independently controls each gripper element of a flap repair device;
• 22A - 22D show another exemplary embodiment of a flap repair arrangement in which an exemplary embodiment of a gripper control mechanism is designed such that it actuates four gripper elements of an exemplary embodiment of a flap repair device independently of one another;
• 23 13 shows another exemplary embodiment of a flap repair assembly in which a gripper control mechanism is configured such that it independently controls each gripper element of a flap repair device;
• 24 FIG. 13 shows an exemplary embodiment of a connection between a positioning shaft and a shaft of the paddle control mechanism of the valve repair device of FIG 23 wherein the gripper control mechanism is attached to the joint between the positioning shaft and the shaft of the paddle control mechanism on the valve repair device;
• 24A - 24B FIG. 10 shows an exemplary embodiment of a connection between a positioning shaft and a shaft of the paddle control mechanism of the valve repair device of FIG 23 wherein the gripper control mechanism is attached to the connection between the positioning shaft and the shaft of the valve repair device on said valve repair device;
• 25th shows another exemplary embodiment of a valve repair arrangement in which a gripper control mechanism is designed such that it controls each gripper element of a valve repair device independently of one another;
• 25A shows another exemplary embodiment of a gripper control mechanism which is designed such that it controls each gripper element of a flap repair device independently of one another;
• 26th shows another exemplary embodiment of a valve repair arrangement in which a gripper control mechanism is designed such that it controls each gripper element of a valve repair device independently of one another;
• 27A - 27C Figure 12 shows another exemplary embodiment of a valve repair device in which each paddle of the valve repair device can be moved to a closed position independently from an open position;
• 28A - 28F Figure 12 shows another exemplary embodiment of a valve repair device in which each paddle of the valve repair device can be moved to a closed position independently from an open position;
• 29A - 29B Figure 12 shows another exemplary embodiment of a valve repair device in which each paddle of the valve repair device changes from an open position to a closed position can be moved, each of which is independent of one another;
• 30th Figure 10 shows a mitral valve with a wide gap between the posterior leaflet and the anterior leaflet;
• 31A - 31B Figure 12 shows another exemplary embodiment of a valve repair device in which the paddles of the valve repair device are expanded into a wide gap for receiving valve tissue;
• 32A - 32C show another exemplary embodiment of a valve repair device in which the valve repair device is designed such that the paddles of the valve repair device are expanded by pivoting and spreading to form a wide gap for receiving valve tissue;
• 33A - 33C show another exemplary embodiment of a valve repair device, in which the valve repair device is designed such that the paddles of the valve repair device are expanded by spreading and pivoting to form a wide gap for receiving valve tissue;
• 34A - 34B Figure 12 shows another exemplary embodiment of a valve repair device in which a "W" shaped mechanism expands the paddles of the valve repair device to a wide gap;
• 35A - 35B Figure 12 shows another exemplary embodiment of a valve repair device in which a "W" shaped mechanism expands paddle of the valve repair device to a wide gap for receiving valve tissue;
• 36A - 36B Figure 12 shows another exemplary embodiment of a valve repair device in which a "W" shaped mechanism expands the paddles of the valve repair device to a wide gap;
• 36C FIG. 13 shows an exemplary embodiment of a paddle control mechanism for the valve repair device of FIG 36A - 36B ;
• 36D - 36E Figure 12 shows another exemplary embodiment of a valve repair device in which a "W" shaped mechanism expands the paddles of the valve repair device to a wide gap;
• 37A - 37D show another exemplary embodiment of a valve repair device having lattice paddles and an inner cam for spreading the lattice paddles into a wide gap for spaced apart valve tissue;
• 38 Figure 13 shows an exemplary embodiment of a valve repair device that includes an exemplary embodiment of a spacer wherein the valve repair device is attached to a mitral valve;
• 39 Figure 13 shows another exemplary embodiment of a valve repair device that includes an exemplary embodiment of a spacer and wherein the valve repair device is attached to a mitral valve;
• 40A - 40B Figure 13 shows another exemplary embodiment of a valve repair device including an exemplary embodiment of a spacer in which the spacer is attached to a shaft of the valve repair device;
• 41A - 41D Figure 12 shows another exemplary embodiment of a valve repair device including an exemplary embodiment of a spacer element, wherein a first portion is attached to a first gripper element of the valve repair device and a second portion is attached to a second gripper element of the valve repair device;
• 42A - 42C show the valve repair device 40A - 40B wherein the spacer has various shapes;
• 43A - 43C show the valve repair device 41A - 41B wherein the spacer has various shapes;
• 44A - 44B show another exemplary embodiment of a valve repair device, with paddles that can be spread further, and with an expandable spacer element;
• 45A - 45C Figure 12 shows another exemplary embodiment of a valve repair device having an enlarged release angle for removing the valve repair device;
• 46A - 46D Figure 12 shows another exemplary embodiment of a valve repair device having an enlarged release angle for removing the valve repair device;
• 47A - 47B Figure 12 shows another exemplary embodiment of a valve repair device having a fastener for connecting the paddles to the grippers when the valve repair device is in a closed position;
• 48 Fig. 10 shows another exemplary embodiment of a valve repair device with a spring element which is designed to bias the paddles of the valve repair device into a closed position;
• 49 Figure 13 shows another exemplary embodiment of a valve repair device having a threaded mechanism for moving the valve repair device between the open position and the closed position;
• 50 Fig. 10 shows another exemplary embodiment of a valve repair device with gripping elements attached to the paddles;
• 51 Fig. 13 shows another exemplary embodiment of a valve repair device having gripping elements with a single row of barbs;
• 51A - 51E Figure 12 shows another exemplary embodiment of a valve repair system that includes a valve repair assembly having a valve repair device with gripping elements adapted to apply a tensioning force to the valve tissue when the valve repair device is attached to the valve tissue;
• 51F - 51H Figure 12 shows another exemplary embodiment of a valve repair assembly having gripping elements adapted to exert a tensioning force on the valve tissue when the valve repair device is attached to the valve tissue;
• 52 Fig. 10 shows a further exemplary embodiment of a valve repair device with gripping elements which can be extended lengthwise;
• 53A - 53B Figure 12 shows another exemplary embodiment of a valve repair device having grasping elements that are flexible; and
• 54 shows a further exemplary embodiment of a valve repair device in which gripping elements are attached to a separate spring element.

DETAILED DESCRIPTION

The following description refers to the accompanying drawings which illustrate specific embodiments of the invention. Other embodiments with different structures and different functions do not depart from the scope of the present invention.

Exemplary embodiments of the present disclosure relate to devices and methods for repairing a defective heart valve. It should be noted that various embodiments of repair devices for endogenous valves and of corresponding delivery systems are disclosed and that these options, unless specifically excluded, can be combined with one another as desired. In other words, individual components of the disclosed devices and systems can be combined with one another, provided that these are not mutually exclusive or are otherwise physically incompatible.

1 and 2 each illustrate a sectional view of the human heart H in a diastolic or a systolic phase. The right ventricle RV and the left ventricle LV are each through the tricuspid valve TV and the mitral valve MV , ie, through the atrioventricular valves, from the right atrium RA and the left atrium LA Cut. In addition, the aortic valve separates AV the left ventricle LV from the ascending aorta AA , and the pulmonary valve PV separates the right ventricle from the pulmonary artery PA. Each of these flaps has flexible cusps (e.g. B. . in the 3 and 4th shown sails 302 , 304 ), which extend inwardly over the corresponding mouths and come together in the sense of a coaptation in the flow path in order to form the one-sided fluid-tight surfaces. The autologous valve repair systems of the present application are primarily related to the mitral valve MV described. Hence the left atrium LA and the left ventricle LV explained in more detail here in their anatomical structures. It goes without saying that the devices described here can also be used for the repair of other endogenous valves, e.g. B. . use the devices when repairing the tricuspid valve TV , the aortic valve AV and the pulmonary valve PV are used.

The left atrium LA receives oxygen-rich blood from the lungs. During the diastolic phase or diastole that occurs in 1 As can be seen, this moves previously (during the systolic phase) in the left atrium LA accumulated blood as a result of expansion of the left ventricle LV through the mitral valve MV through and into the left ventricle LV inside. In the systolic phase or systole that occurs in 2 can be seen, the left ventricle is contracting LV to get the blood through the aortic valve AV and the ascending aorta AA through into the Floating body. During systole, the cusps of the mitral valve close MV to prevent the blood from leaving the left ventricle LV back to the left atrium LA regurgitates and blood from the pulmonary vein is collected in the left atrium. In an exemplary embodiment, the devices described by the present application are used to prevent the function of a defective mitral valve MV to repair. That is, the devices are designed to assist in closing the cusps of the mitral valve to prevent blood from flowing from the left ventricle LV back to the left atrium LA regurgitated.

With reference to 1 - 5 includes the mitral valve MV two sails, the front sail 302 and the aft sail 304 . The mitral valve MV also includes an annulus 306 , which is a fiber ring of fabrics of different densities that make up the sails 302 , 304 encloses. With reference to 5 is the mitral valve MV through the chordae tendineae 501 on the wall of the left ventricle LV anchored. In the Chordae tendineae 501 it is cord-like tendons that the papillary muscles 503 (i.e., the muscles at the base of the chordae tendineae and inside the walls of the left ventricle) with the leaflets 302 , 304 the mitral valve MV connect. The papillary muscles serve to control the movements of the mitral valve MV to limit and prevent the mitral valve from turning over. The mitral valve MV opens and closes in response to changes in pressure in the left atrium LA and the left ventricle LV . The opening or closing of the mitral valve MV does not occur through the papillary muscles. The papillary muscles support the mitral valve MV rather, it is against the high pressure required to circulate blood around the body. Taken together, the papillary muscles and the chordae tendineae are known as the subvalvular apparatus, the function of which is to prevent the mitral valve from prolapsing MV in the left atrium LA to prevent it from entering when the mitral valve closes.

Various disease processes can impair the correct functioning of one or more of the body's own valves of the heart H. These disease processes include degenerative processes (e.g. B. . Möller-Barlow disease, fibroelastic degeneration), inflammatory processes (e.g. B. . Rheumatic heart disease) and infectious processes (e.g. B. . Endocarditis). In addition, there may be damage to the left ventricle LV or the right ventricle RV from previous heart attacks (i.e. myocardial infarction as a side effect of coronary artery disease) or other heart conditions (e.g. B. . Cardiomyopathy) distort the geometry of a body's valve, causing the body's valve to dysfunction. The vast majority of patients undergoing valve surgery, such as a mitral valve procedure MV , but has a degenerative disease that causes a sail to malfunction (e. B. . with the sails 302 , 304 ) a body's own valve (e.g. B. . the mitral valve MV ) causes prolapse and regurgitation.

In general, two types of malfunction can occur in the body's own valve. One possible malfunction is valve stenosis, which occurs when one of the body's own valves does not open completely, thereby creating an obstruction to the blood flow. Typically, valve stenosis is the result of calcification on the leaflets of a valve, causing the leaflets to thicken, affecting the ability of the valve to open fully and thereby allow forward blood flow.

Another possible malfunction is valve regurgitation, which occurs when the leaflets of the valve do not close completely, causing blood to flow back into the upstream chamber (e.g. B. . blood flows back from the left ventricle into the left atrium). There are three mechanisms by which the body's own valve can become regurgitant or impaired and which include malfunctions of type I, type II and type III according to the Carpentier classification. A Carpentier type 1 malfunction is present when the annulus is widened to such an extent that normally functioning cusps are pulled apart and a tight seal is no longer achieved (ie no more correct coaptation takes place). Such a malfunction of the Type I mechanism involves holes in the leaflets, such as those found in endocarditis. A Carpentier type II malfunction occurs when one or more leaflets of a body's own valve prolapse over a plane of coaptation. Carpentier type III malfunction occurs when the movement of one or more cusps of a body's valve is restricted so that the cusps below the level of the annulus are abnormally restricted. A restriction of the cusps can be caused by a rheumatic disease (Ma) or an enlargement of a ventricle (Illb).

With reference to 3 Achieve when there is a healthy mitral valve MV is in a closed position, the forward sail 302 and the aft sail 304 a coaptation, which prevents blood from leaving the left ventricle LV in the left atrium LA flows back. With reference to 4th regurgitation occurs when the forward sail 302 and / or the aft sail 304 the mitral valve MV in the left atrium during systole LA is / are moved into it. This non-existent coaptation creates a gap 408 between the forward sail 302 and the aft sail 304 causing blood to flow from the left ventricle during systole LV in the left atrium LA flows back into it. As stated above, there are several different ways in which a sail (e.g. B. . sail 302 , 304 the mitral valve MV ) may malfunction, which can lead to regurgitation.

Although the stenosis or regurgitation can basically affect any valve, the stenosis mainly occurs either with the aortic valve AV or the pulmonary valve PV before, while regurgitation is primarily related to either the mitral valve MV or the tricuspid valve TV occurs. Valve stenosis and valve regurgitation both increase the workload of the heart H and, if left untreated, can lead to very serious disease conditions such as endocarditis, heart failure, permanent heart damage, cardiac arrest and ultimately death. As the left side of the heart (i.e. the left atrium LA , the left ventricle LV , the mitral valve MV and the aortic valve AV ) is primarily responsible for circulating blood flow throughout the body is a malfunction of the mitral valve MV or the aortic valve AV particularly problematic and often life threatening. As a result, there is mitral valve dysfunction due to the much higher pressures on the left side of the heart MV or the aortic valve AV far more problematic.

The body's own heart valves that are malfunctioning can either be repaired or replaced. A repair usually means maintaining and correcting the patient's own valve. Replacement usually means replacing the patient's own valve with a biological or mechanical replacement device. The aortic valve AV and the pulmonary valve PV are usually more prone to stenosis. Since stenotic damage to the leaflets is irreversible, the most commonly used treatment for a stenotic aortic valve or a stenotic pulmonary valve consists in removing the valve and replacing it with a surgically implanted heart valve or in displacement of the valve by means of a transcatheter heart valve. The mitral valve MV and the tricuspid valve TV are more prone to leaflet deformation, which, as described above, prevents the mitral or tricuspid valve from closing properly, allowing regurgitation or backflow of blood from the ventricle to the atrium (e.g. B. . can have a deformed mitral valve MV regurgitation or backflow from the left ventricle LV in the left atrium LA allow). The regurgitation or return of blood from the ventricle into the atrium results in valve regurgitation. Deformations in the structure or shape of the mitral valve MV or the tricuspid valve TV can often be repaired. Regurgitation can also occur because the chordae tendineae 501 become dysfunctional (e.g. B. . the chordae tendineae may stretch or tear), thereby allowing the anterior leaflet 302 and the aft sail 304 turn over, leaving blood in the left atrium LA is regurgitated. Those due to dysfunctional chordae tendineae 501 Any problems that arise can be corrected by repairing the chordae tendineae or the structure of the mitral valve (e. B. . by fastening the sails 302 , 304 on the affected sections of the mitral valve).

The devices and procedures disclosed herein relate to repairing the structure of a mitral valve. It goes without saying, however, that the devices and concepts provided here can also be used to repair any desired endogenous valve and any desired component of an endogenous valve. With reference to 4th the devices and concepts provided here can all be used to develop the tricuspid valve TV to repair. The devices and concepts provided here can be used between any two of the front leaflets 4011 , the septal sail 4012 and the aft sail 4013 can be used to prevent regurgitation of blood from the right ventricle into the right atrium. In addition, the devices and concepts provided here can also be used on all three of the sails 4011 , 4012 , 4013 can be used together to prevent regurgitation of blood from the right ventricle to the right atrium. This means that the valve repair devices provided here can also be centered between the three leaflets 4011 , 4012 , 4013 are located.

6th - 13B illustrate a valve repair system 600 for repairing a patient's own valve. The valve repair system 600 closes a feeder 601 and a valve repair device 602 wherein the delivery device is adapted to deliver the valve repair device to the patient's own valve, and wherein the valve repair device is adapted to be attached to the leaflets of an endogenous valve to thereby repair the patient's own valve. The feeding device 601 may take any suitable form capable of the valve repair device 602 to a patient's own valve. According to certain embodiments, the valve repair system is 600 for feeding the valve repair device 602 designed to be a patient's own valve during a non-open heart procedure. As a suitable delivery means for percutaneous provision of the valve repair system 600 In the context of a minimally invasive procedure, insertion sleeves or insertion catheters are possible, which are inserted through small incisions in the patient's skin and, for example, through an endovascular (e. B. . transfemoral) path or a transapical path can be advanced to the implantation site.

The valve repair device 602 comprises a basic arrangement 604 , a pair of paddles 606 and a pair of gripping elements 608 . According to an exemplary embodiment, the paddles 606 be formed integrally with the base assembly. For example, the paddles 606 be designed as extensions of members of the base assembly. In the illustrated example, the basic arrangement 604 the valve repair device 602 on: a shaft 603 , a connector 605 designed to move along the shaft and a locking lock 607 which is designed to lock the connector in a fixed position on the shaft. The connector 605 is so mechanical with the paddles 606 connected that movement of the connector 605 along the shaft 603 causes the paddles to move between open and closed positions. In this way the connector serves 605 as a means to the paddle 606 mechanically with the shaft 603 to connect, and by moving along the shaft 603 to cause the paddle to move 606 move between their open and closed positions. According to certain embodiments, the gripping elements are 608 so pivotable with the base assembly 604 connected (e.g. B. . can use the gripping elements 608 pivotable with the shaft 603 or to any other suitable element of the base assembly) that the gripping elements can be moved to the width of the opening 614 between the paddles 606 and the gripping elements 608 adapt. The gripping element 608 may have a spiked section 609 for attaching the grasping elements to the valve tissue when the valve repair device 602 is attached to the valve tissue. The gripping element 608 forms a means for grasping the valve tissue (in particular the tissue of the valve leaflets) with a plug-in means or a plug-in section, such as the section provided with spikes 609 . When the paddles 606 are in the closed position, the paddles are so with the gripping elements 608 engaged that when the valve tissue is at the spiked portion 609 the gripping elements is attached, the paddles act as holding or locking means to hold the valve tissue on the gripping elements and the valve repair device 602 to attach to the valve fabric. According to some embodiments, the gripping elements are 608 designed to do so with the paddles 606 engage that the spiked section 609 with the valve fabric element and the paddles 608 engages the valve repair device 602 to attach to the flap fabric element. For example, it may be advantageous in certain situations to use the paddles 606 in an open position and hold the gripping elements 608 out to the paddles 606 to move towards with a valve fabric element and with the paddles 606 to intervene.

In the 6th - 13B The embodiment shown illustrates a pair of paddles 606 and a pair of gripping elements 608 , however, it should be understood that the valve repair device 602 may include any number of paddles and grasping elements. According to certain embodiments, the valve repair system comprises 600 a positioning body 613 , which is removable on the shaft 603 the basic arrangement 604 the valve repair device 602 is appropriate. After the valve repair device 602 has been attached to the valve tissue, the positioning shaft 613 from the shaft 603 removed to the valve repair device 602 from the rest of the valve repair system 600 take off, leaving the valve repair device 602 can remain attached to the valve tissue and the feed device 601 can be removed from the patient's body.

The valve repair system 600 can also have a paddle control mechanism 610 , a gripper control mechanism 611 , and a lock control mechanism 612 lock in. The paddle control mechanism 610 is mechanically on the connector 605 attached to move the connector along the shaft, causing the paddles to move 606 move between the open and closed positions. The paddle control mechanism 610 may take any suitable shape such as a shaft or a rod. For example, the paddle control mechanism can include a hollow shaft, catheter tube, or sleeve that extends over the positioning shaft 613 and the shaft 603 fits and with the connector 605 connected is. The gripper control mechanism 611 is designed to hold the gripping elements 608 move so that the width of the opening 614 between the gripping elements and the paddles 606 can be changed. The gripper control mechanism 611 may take any suitable form such as leash, suture or wire, rod, catheter, etc.

The lock lock control mechanism 612 is designed to lock and release the lock. The locking lock 607 serves as a locking means for locking the connector 605 in a fixed position with respect to the shaft 603 and can take many different forms and the type of lock lock control mechanism 612 can be specified by the type of locking lock used. According to one embodiment, the locking lock 607 the shape of a locking lock often used in grout guns. That is, the locking lock 607 comprises a pivoting plate with a hole, the shaft 603 the valve repair device 602 is arranged in the hole of the pivoting plate. According to this embodiment, when the pivotable plate is in the inclined position, the pivotable plate enters with the shaft 603 engaged to a position on the shaft 603 while, when the pivotable plate is in a substantially non-inclined position, the pivotable plate can be moved along the shaft (thereby allowing the connector to move 605 along the shaft 603 emotional). In other words, the connector 605 becomes involved in movement along the shaft 603 in direction Y (as in 10A shown) prevented when the pivoting plate of the locking lock 607 is in a tilted (or locked) position and the connector is able to move along the shaft 603 to move in direction Y when the pivoting plate is in a substantially non-inclined position (or release position). In embodiments in which the locking lock 607 includes a pivotable plate is the lock lock control mechanism 612 adapted to engage the pivotable plate to move the plate between the inclined position and the substantially non-inclined position. At the lock control mechanism 612 it can be, for example, a rod, a suture thread, a wire or any other element which is capable of a pivoting plate of the locking lock 607 to move between an inclined and a substantially non-inclined position. According to certain embodiments, the pivoting plate is the locking lock 607 biased to the inclined (or locked) position and the lock lock control mechanism 612 is used to move the plate from the inclined position to the substantially non-inclined position (or release position). According to other embodiments, the pivoting plate is the locking lock 607 biased to the substantially non-inclined position (or release position) and the lock lock control mechanism 612 is used to move the plate from the substantially non-inclined position to the inclined (or locked) position.

10A - 10B illustrate the valve repair device 602 when moving from an open position (in 10A shown) to a closed position (in 10B shown). The basic arrangement 604 comprises: a first link 1021 that stands out from point A. to point B. extends a second limb 1022 that stands out from point A. to point C. extends a third link 1023 that stands out from point B. to point D. extends a fourth link 1024 that stands out from point C. to point E. extends, and a fifth link 1025 that stands out from point D. to point E. extends. The connector 605 is movable on the shaft 603 attached and the shaft 603 is on the fifth link 1025 fixed. The first link 1021 and the second link 1022 are at point A. pivotable on the connector 605 attached so that movement of the connector 605 along the shaft 603 the location of the point A. moves and consequently the first link 1021 and the second link 1022 emotional. The first link 1021 and the third link 1023 are at point B. pivotally attached to each other and the second link 1022 and the fourth link 1024 are at point C. pivotally attached to each other. A paddle 606a is such on the first link 1021 appropriate that movement of the first limb 1021 causes the first paddle 606a moves, and the other paddle 606b is such on the second link 1022 attached that movement of the second limb 1022 causes the paddle to move 606b emotional. Alternatively, you can use the paddle 606a , 606b with the limbs 1023 , 1024 be connected or extensions of the limbs 1023 , 1024 represent.

To move the valve repair device from the open position (in 10A shown) to the closed position (in 10B shown) will move the connector 605 in direction Y the shaft 603 moved along, creating the pivot point A. for the first link 1021 and the second link 1022 is moved into a new position. The movement of the connector 605 (and the pivot point A. ) in direction Y causes a close to point A. located section of the first link 1021 moves in direction H and that is close to point B. located section of the first link 1021 moved in direction J. The paddle 606a is such on the first link 1021 attached that movement of the connector 605 Direction Y causes the paddle to move 606a moves in Z direction. In addition to this is the third link 1023 at point B. so pivotable on the first link 1021 attached that movement of the connector 605 in direction Y causes the third link 1023 moved in direction K. Similarly, it causes the connector to move 605 (and the pivot point A. ) in direction Y that is a close to point A. located section of the second link 1022 moves in the direction of L and is close to point C. located section of the second limb 1022 moved in direction M. The paddle 606b is such on the second link 1022 attached that movement of the connector 605 Direction Y causes the paddle to move 606b moved in direction V. In addition to this is the fourth link 1024 at point C. so pivotable on the second link 1022 attached that movement of the connector 605 in direction Y causes the fourth link 1024 moved in direction N. 10B illustrates the end position of the valve repair device 602 after the connector 605 as in 10A shown has been moved.

With reference to 7th is the valve repair device 602 shown in the open position (similar to that in 10A position shown) and is the gripper control mechanism 611 shown how he did the gripping elements 608 moved to at the opening 614 a wider gap between the gripping elements and the paddles 606 to provide. According to the illustrated embodiment, the gripper control mechanism comprises 611 a line, such as a suture, wire, etc., passed through an opening in one end of the gripper elements 608 is threaded through. Both ends of the line extend through the feed opening 716 the feeding device 601 through. When the leash in direction Y through the feed opening 716 is pulled through, the gripping elements move 608 inward in direction X, thereby causing the opening 614 between the gripping elements and the paddles 606 gets wider.

With reference to 8th is the valve repair device 602 shown in such a way that the valve tissue 820 in the opening 614 between the gripping elements 608 and the paddles 606 is arranged. With reference to 9 is after the valve tissue 820 between the gripping elements 608 and the paddles 606 has been arranged, the width of the opening 614 between the grasping elements and the paddles using the grasping control mechanism 611 decreased. That is, in the illustrated embodiment, the line of the gripper control mechanism 611 from the opening 716 of the insertion element is let out or pushed out in the direction H, whereby it the gripping elements 608 is enabled to move towards D. to move so as to the width of the opening 614 to reduce. It is shown here as the gripper control mechanism 611 the gripping elements 608 moved to the width of the opening 614 between the gripping elements and the paddles 606 ( 8th ), but it goes without saying that the gripping elements may not need to be moved around the valve tissue in the opening 614 to position. However, under certain circumstances it may be necessary to open the door 614 between the paddles 606 and the gripping elements 608 to be made wider to accommodate the valve tissue.

With reference to 11 is the valve repair device 602 in the closed position and on the valve tissue 820 attached. The valve repair device 602 is through the paddle 606a , 606b and the gripping elements 608a , 608b on the valve tissue 820 attached. In particular is the valve tissue 820 through the spiked section 609 the gripping elements 606a , 606b on the valve repair device 602 attached and kick the paddles 608a , 608b with the gripping elements 608 engaged to the valve repair device 602 on the valve tissue 820 to fix. To the valve repair device 602 To move from the open position to the closed position, the lock lock will move 607 by the lock control mechanism 612 moved to an unlocked state (as shown in 11 shown). As soon as the lock lock 607 is in the unlocked state, the connector 605 by the paddle control mechanism 610 the shaft 603 move along. In the illustrated embodiment, the paddle control mechanism moves 610 the connector 605 along the shaft in direction Y, causing a paddle to move 606a moves in direction X and the other paddle moves 606b moves in Z direction. The movement of the paddles 606a , 606b in direction X and in direction Z causes the paddles with the gripping elements 608a , 608b engage and thereby the valve repair device 602 on the valve tissue 820 attach.

With reference to 12th will after the paddle 606 moved to the closed position to release the valve repair device 602 on the valve tissue 820 to attach (like this in 11 shown), the locking lock 607 by the lock control mechanism 612 ( 11 ) moved to the locked state to the valve repair device 602 hold in the closed position. Once the valve repair device 602 through the lock 607 is held in the locked state, the valve repair device 602 from the feeder 601 removed by the stem 603 from the positioning body 613 is separated ( 11 ). In addition, the valve repair device 602 from the paddle control mechanism 610 ( 11 ), the Gripper control mechanism 611 ( 11 ) and the lock control mechanism 612 Cut. Removing the valve repair device 602 from the feeder 601 makes it possible for the valve repair device to work on the valve tissue 820 remains attached while the feeder 601 removed from the patient's body.

With reference to 13A - 13B is the mitral valve 1300 of a patient with a valve repair device 602 shown on the front sail 1301 and the aft sail 1302 the mitral valve is attached. 13A - 13B are views of the mitral valve shown from the atrial side 1300 , wherein portions of the valve repair device 602 and of the mitral valve leaflet tissue held by this on the ventricular side of the mitral valve are depicted with hidden lines. During the diastolic phase (as in 1 shown), the blood accumulated in the left atrium of the heart enters the mitral valve as a result of the expansion of the left ventricle of the heart 1300 a. The front sail 1301 and the aft sail 1302 open to allow blood flow from the left atrium to the left ventricle. In the systolic phase (as in 2 shown), the left ventricle contracts to force blood through the aortic valve into the ascending aorta and into the body. During systole, the cusps of the mitral valve close MV to prevent the blood from going back to the left atrium LA regurgitated. As described above, regurgitation of blood from the left ventricle into the left atrium occurs through the mitral valve when the anterior leaflet 1301 and the aft sail 1302 do not close completely so that there is a gap between the front sail and the rear sail. Around a mitral valve 1300 The valve repair device is used to repair and thus prevent regurgitation of blood through the mitral valve 602 with the forward sail 1301 and the aft sail 1302 connected to close the gap.

With reference to 13A is the mitral valve 1300 Shown from the left atrium of a patient's heart (e.g., from that by the line A - A in 5 specified viewing angle). According to the illustrated embodiment, the mitral valve is 1300 shown in an open position (ie, the position the mitral valve assumes during the diastolic phase). The valve repair device 602 is on the forward sail 1301 and the aft sail 1302 the mitral valve 1300 located in the left ventricle of the patient's heart and is in 13A - 13B shown in dashed lines to indicate the location of the valve repair device with respect to the mitral valve. As in 13A - 13B shown, the valve repair device occurs 602 with the forward sail 1301 and the aft sail 1302 engages and causes the forward leaflet and the aft leaflet to engage (ie, the valve repair device closes a portion of the gap between the forward leaflet and the aft leaflet). The valve repair device 602 can be placed where there is a gap between the front sail 1301 and the aft sail 1302 exists when the mitral valve 1301 is in a closed position (ie, the mitral valve position during the systolic phase) so that the valve repair device prevents the gap from occurring. The illustrated embodiment shows the mitral valve 1300 including valve repair device 602 during the diastolic phase. That is, during the diastolic phase, the valve repair device operates 602 that a portion of the mitral valve remains closed while those portions of the mitral valve that are not engaged by the valve repair device open such that gaps 1303 can be created to allow blood flow from the left atrium to the left ventricle.

With reference to 13B is the valve repair device 602 likewise on the forward sail 1301 and the aft sail 1302 appropriate. In particular is a section 1301a of the front sail 1301 between a paddle 606a and a gripping element 608a the valve repair device 602 attached, and is a section 1302b of the rear sail 1302 between another paddle 606b and another gripping element 608b attached to the valve repair device. The valve repair device 602 is on the mitral valve 1300 fastened and locked, as for example in 6th - 12th is shown.

14A - 14B illustrate exemplary embodiments of a valve repair device 602 attached to the forward sail 1301 and the aft sail 1302 a mitral valve 1300 are attached. The mitral valve 1300 is shown from the left atrium of a patient's heart (e.g., from that by the line A - A in 5 specified viewing angle). With reference to 14A - 14B includes the valve repair device 602 a first paddle 606a , a second paddle 606b , a first gripping element 608a and a second gripping element 608b . A section 1301a of the front sail 1301 is between the first paddle 606a and the first gripping element 608a the valve repair device 602 attached, and a section 1302b of the rear sail 1302 is between the second paddle 606b and the second gripping element 608b attached to the valve repair device. The first and second paddles 606a , 606b each comprise a main section 1404 and side sections 1405 . With reference to 14A is the valve repair device 602 designed such that the sections 1301a , 1302b the mitral valve 1300 to the shape of the paddle 606a , 606b adapt or that they generally adapt to them. That is, the valve leaflet sections 1301a , 1302b are through the gripping elements 608a , 608b pressed into the paddle in such a way that the valve leaflet sections 1301a , 1301b along a main section 1404 and along side sections 1405 the paddle 606a , 606b are arranged. According to the in 14A shown embodiment of the valve repair device 602 can the paddles 606a , 606b be made of a rigid material such as steel or a plastic molding, etc.

According to the through 14B The illustrated exemplary embodiment are the paddles 606a , 606b the valve repair device 602 designed to be flexible. When the valve repair device on the mitral valve 1300 attached, move the mitral valve tissue sections 1301a , 1302b because of this flexibility, the side sections 1405 the paddle in the by the arrows 1450 indicated manner, which compares the stress exerted on the mitral valve by the valve repair device with that by 14A illustrated embodiment. That is, the flexibility results in more gradual contouring of the mitral valve tissue by the paddles, while still providing secure attachment of the valve repair device 602 occurs on the mitral valve tissue. At the in 14B shown embodiment of the valve repair device 602 can the paddles 606a , 606b be made from a wide variety of different, pliable materials or rigid materials that are cut or otherwise processed to give them flexibility.

15A - 15B illustrate another exemplary embodiment of a valve repair device 602 . With reference to 15A is the valve repair device 602 in the open position and just doing it, with the valve tissue 820 (e.g., with the leaflets of a mitral valve) to engage. With reference to 15B is the valve repair device 602 in the closed position and on the valve tissue 820 attached. The valve repair device 602 can take any suitable form, such as any form described in the present application. The valve repair device 602 can be moved between the open and closed positions and can be applied to the valve tissue by a valve repair system, such as any valve repair system described in the present application 820 be attached. According to the illustrated embodiment, the valve repair device comprises 602 the paddles 606 and the gripping elements 608 . The gripping elements 608 include a spiked section 609 for attaching the gripping elements to the valve fabric 820 . With reference to 15A keep the paddles 606 when the valve repair device 602 is in the open position, an original shape. With reference to 15B the paddles bend 606 if they are with the valve tissue 820 engage, along their length L through. That is, a section of the paddle 606 flexes in an inward direction X and another portion of the paddle extends in an outward direction Z. This flexibility of the paddles 606 enables the paddles to conform to the shape of the valve tissue, which means that less stress is placed on the valve tissue.

With reference to 16A - 16F includes another exemplary embodiment of a valve repair device 602 the paddles 606 one that has a wire loop 1601 exhibit. The wire loop 1601 can for example be made from any suitable metal material, from laser-cut loops from a nitinol sheet, from a nitinol tube or from any other suitable material. According to some embodiments, the wire loop 1601 over the length of the wire loop 1601 have different dimensions in order to optimize the pinching force of the paddle and the crimping force of the paddle on a valve fabric when the paddle is engaged with the valve fabric. For example, certain parts of the wire loop 1601 thinner than other parts of the wire loop 1601 be. According to certain embodiments, the wire loop is 1601 the paddle 606 compressible, which allows the paddle to be used 606 in a feeding device 601 (e.g. a catheter), which with a view to delivery of the valve repair device 602 to a patient's own valve has a small diameter (as in 16E shown), and it also allows the paddle to move 606 (as in 16A - 16D shown) when they exit the feed device 601 expand so that the paddles 606 have a larger surface area to engage the patient's own valve. The valve repair device 602 can take any suitable form, such as any form described in the present application. The valve repair device 602 can be moved between the open and closed positions and can be attached to an endogenous valve by a valve repair system such as any valve repair system described in the present application.

16A - 16B illustrate the valve repair device 602 in the open position and 16C - 16D illustrate the valve repair device in the closed position. With reference to 16A - 16B extend when the valve repair device 602 in the expanded and open position, the paddles 606 outwards to the wide opening 614 between the paddles 606 and the gripping elements 608 the valve repair device 602 to accomplish. With reference to 16C - 16D kick the paddles 606 when the valve repair device 602 is in the expanded and closed position, such with the gripping elements 608 engaged so that the valve tissue can be retained between the paddles and the gripping elements. The paddles 606 include a curved surface 1603 which is designed to place less stress on the valve tissue when the valve repair device 602 is attached to the valve tissue. When the paddles 606 are in the expanded state, the paddles have a width W. The width W can be, for example, between approximately 4 mm and approximately 21 mm, in particular between approximately 5 mm and approximately 20 mm, in particular between approximately 7.5 mm and approximately 17.5 mm, in particular between approximately 10 mm and approximately 15 mm. According to certain embodiments, the width W can be, for example, 5 mm or more, in particular approximately 7.5 mm or more, in particular approximately 10 mm or more, in particular approximately 15 mm or more, in particular approximately 20 mm or more. According to other embodiments, the width can also be less than 5 mm. According to certain embodiments, the paddles close 606 a material 1605 one that is above the wire loop 1601 is arranged to create a contact area in which the paddles can engage the valve tissue. With the material 1605 it can be any material such as woven material, electrospun material, or any other material capable of promoting tissue ingrowth and feeder inserts 601 ( 6th ) to protect while finding the way. According to certain embodiments, the material can be 1605 a blood-impermeable material, such as a PET material or a biocompatible cover material, in particular a material that is treated with a coating that is blood-impermeable, polyester or a treated biological material, in particular pericardium.

With reference to 16E are the paddles 606 in a compressed state when the paddles are in a feeder 601 are arranged. When the paddles 606 are in a compressed state, the paddles have a width H. The width H can for example be between approximately 4 mm and approximately 7 mm, in particular between approximately 5 mm and approximately 6 mm. According to alternative embodiments, the width H can also be less than 4 mm or more than 7 mm. According to certain embodiments, the width is H of the compressed paddles 606 substantially equal to a width D. the feed opening 716 the feeding device 601 . The ratio between the expanded width W of the paddles and the width H the paddle in the compressed state can for example be about 4 to 1 or less, in particular about 3 to 1 or less, in particular about 2 to 1 or less, in particular about 1.5 to 1, in particular about 1.25 to 1, in particular about 1 to Be 1. According to alternative embodiments, the ratio between the width W and the width H also be more than 4 to 1. With reference to 16F becomes a paddle 606 moved from the expanded state to the compressed state by compressing the paddle in the Y direction and stretching a length of the paddle in the X direction.

16G - 16H 10 illustrate another exemplary embodiment of a valve repair device 602 in the open position with the valve repair device having compressible paddles 606 with a wire loop 1601 includes. According to the illustrated embodiment, the paddles are 606 as a wire loop 1601 shown having which three lobes 1611 includes. With reference to 16I - 16Y includes another exemplary embodiment of a valve repair device 602 the paddles 606 who have favourited a wire loop 1601 with two lobes 1611 exhibit. In the 16G - 16H and 16I - 16Y Embodiments shown show the wire loop 1601 the paddle 606 each with three flaps or with two flaps, but it goes without saying that the valve repair device 602 also paddles 606 with a wire loop 1601 with any suitable number of lobes 1611 such as, for example, with two or more lobes, three or more lobes, four or more lobes, five or more lobes, etc. A paddle 606 that is a wire loop 1601 with flaps is advantageous because a paddle with flaps can more easily allow the chordae tendineae to assume their natural positions than would a single loop of wire which does not have any flaps. The chordae tendineae can move into the spaces between the multiple loops.

In the 16G - 16H and 16I - 16Y embodiments of the valve repair devices shown 602 can be any the one above in relation to 16A - 16F have the features described. For example, the in 16G - 16H and 16I - 16Y embodiments of the valve repair devices shown 602 include a width W, the width W for example between approximately 4 mm and approximately 21 mm, in particular between approximately 5 mm and approximately 20 mm, in particular between approximately 7.5 mm and approximately 17.5 mm, in particular between approximately 10 mm and approximately 15 mm. According to certain embodiments, the width W can be, for example, 5 mm or more, in particular approximately 7.5 mm or more, in particular approximately 10 mm or more, in particular approximately 15 mm or more, in particular approximately 20 mm or more. According to other embodiments, the width can also be less than 5 mm. In the 16G - 16H and 16I - 16Y shown embodiments of the paddle 606 may also contain a material that drapes over the wire loop 1601 is arranged to create a contact area in which the paddles can engage the valve tissue. The material can be any material such as a woven material, an electrospun material, or any other suitable material capable of promoting tissue ingrowth and feeder inserts 601 ( 6th ) to protect while finding the way. According to certain embodiments, the material can be 1605 a blood-impermeable material, such as a PET material or a biocompatible cover material, in particular a material that is treated with a coating that is blood-impermeable, polyester or a treated biological material, in particular pericardium. The embodiments for the in 16G - 16H and 16I - 16Y shown paddling 606 can also be compressed when in a feeder 601 be arranged (e.g. just like this in 16E with respect to the embodiment of in 16A - 16B shown paddling 606 shown). The ratio between the width W of the paddles 606 in the expanded state and the width of the paddles in the compressed state can be, for example, about 4 to 1 or less, in particular about 3 to 1 or less, in particular about 2 to 1 or less, in particular about 1.5 to 1, in particular about 1.25 to 1, in particular approximately 1 to 1. According to alternative embodiments, the ratio between the width W and the width H also be more than 4 to 1.

With reference to 17A - 17F includes another exemplary embodiment of a valve repair device 602 the paddles 606 who have favourited a horseshoe shape 1701 exhibit. According to certain embodiments, the shape is horseshoe 1701 the paddle 606 compressible, which allows the paddle to be used 606 in a feeding device 601 (e.g. a catheter), which with a view to delivery of the valve repair device 602 to a patient's own valve has a small diameter (as in 17F shown), and it also allows the paddle to move 606 (as in 17A - 17D shown) when they exit the feed device 601 expand so that the paddles 606 have a larger surface area to engage the patient's own valve. The valve repair device 602 can take any suitable form, such as any form described in the present application. The valve repair device 602 can be moved between the open and closed positions and can be attached to an endogenous valve by a valve repair system such as any valve repair system described in the present application.

17A - 17C illustrate the valve repair device 602 in the open position. With reference to 17A - 17B extend when the valve repair device 602 in the expanded and open position, the paddles 606 outwards to the wide opening 614 between the paddles 606 and the gripping elements 608 the valve repair device 602 to accomplish. In the illustrated embodiment, the horseshoe shape closes 1701 the paddle 606 Side elements 1707 one that differs from a base 1706 of the paddle 606 extend, and a central element 1709 that is different from the base 1706 extends and having a base assembly 604 the valve repair device 602 is connectable, the side elements 1707 form a horseshoe shape, as shown in, for example 17C is shown. According to certain embodiments, the paddles include paddles 606 a material 1705 that is above the horseshoe shape 1701 is arranged to provide a contact area in which the paddles can engage the valve tissue. With the material 1705 it can be any material such as woven material, electrospun material, or any other material capable of promoting tissue ingrowth and feeder inserts 601 ( 6th ) to protect while finding the way. According to certain embodiments, the material can be 1605 a blood-impermeable material, such as a PET material or a biocompatible cover material, in particular a material that is treated with a coating that is blood-impermeable, polyester or a treated biological material, in particular pericardium.

According to various embodiments, the paddles are 606 designed to be pliable to place less stress on the valve tissue when using the valve repair device 602 is attached to the valve tissue. When the paddles 606 are in the expanded state, the paddles have a width W. The width W can be, for example, between approximately 4 mm and approximately 21 mm, in particular between approximately 5 mm and approximately 20 mm, in particular between approximately 7.5 mm and approximately 17.5 mm, in particular between approximately 10 mm and approximately 15 mm. According to certain embodiments, the width W can be, for example, 5 mm or more, in particular approximately 7.5 mm or more, in particular approximately 10 mm or more, in particular approximately 15 mm or more, in particular approximately 20 mm or more. According to other embodiments, the width can also be less than 5 mm. With reference to 17D According to certain embodiments, the width T of the paddle is, for example, between approximately 0.3 mm and approximately 0.46 mm, in particular between approximately 0.32 mm and approximately 0.44 mm, in particular between approximately 0.34 mm and approximately 0.42 mm , in particular between approximately 0.36 mm and approximately 0.40 mm, in particular at approximately 0.38 mm. According to alternative embodiments, the width of the paddle can also be less than 0.3 mm or more than 0.46 mm.

With reference to 17E are the paddles 606 in a compressed state when the paddles are in a feeder 601 are arranged. When the paddles 606 are in a compressed state, the paddles have a width H on. The width H can for example be between approximately 4 mm and approximately 7 mm, in particular between approximately 5 mm and approximately 6 mm. According to alternative embodiments, the width H also be less than 4 mm or more than 7 mm. According to certain embodiments, the width is H the compressed paddle 606 equal to a width D. the feed opening 716 the feeding device 601 . The ratio between the expanded width W of the paddles and the width H the paddle in the compressed state can for example be about 4 to 1 or less, in particular about 3 to 1 or less, in particular about 2 to 1 or less, in particular about 1.5 to 1, in particular about 1.25 to 1, in particular about 1 to Be 1. According to alternative embodiments, the ratio between the width W and the width H also be more than 4 to 1. With reference to 17F becomes a paddle 606 moved from the expanded state to the compressed state by compressing the paddle in the Y direction and stretching a length of the paddle in the X direction. According to the illustrated embodiment, the side members 1707 of the paddle 606 stretched in length when the paddle is in the compressed state, the length of the central element 1709 however remains unchanged.

With reference to 18A - 18D includes another exemplary embodiment of a valve repair device 602 the paddles 606 who have favourited a different horseshoe shape 1801 exhibit. According to certain embodiments, the shape is horseshoe 1801 the paddle 606 compressible, which allows the paddle to be used 606 in a feeding device 601 (e.g. a catheter), which with a view to delivery of the valve repair device 602 to a patient's own valve has a small diameter (as in 18C shown), and it also allows the paddle to move 606 (as in 18A - 18B shown) when they exit the feed device 601 expand so that the paddles 606 have a larger surface area to engage the patient's own valve. The valve repair device 602 can take any suitable form, such as any form described in the present application. The valve repair device 602 can be moved between the open and closed positions and can be attached to an endogenous valve by a valve repair system such as any valve repair system described in the present application.

18A - 18B illustrate the valve repair device 602 in the open position. When the valve repair device 602 is in the open position, the paddles extend 606 outwards to the wide opening 614 between the paddles 606 and the gripping elements 608 the valve repair device 602 to accomplish. In the illustrated embodiment, the horseshoe shape comprises 1801 the paddle 606 Side elements 1807 that stand out from a base 1806 of the paddle 606 extend, and is the base 1806 at the base assembly 604 the valve repair device 602 appropriate. According to certain embodiments, the paddles include paddles 606 a material 1805 that is above the horseshoe shape 1801 is arranged to provide a contact area in which the paddles can engage the valve tissue. With the material 1805 it can be any material such as woven material, electrospun material, or any other material capable of promoting tissue ingrowth and feeder inserts 601 ( 6th ) to protect while finding the way. According to certain embodiments, the material can be 1605 a blood-impermeable material, such as a PET material or a biocompatible cover material, in particular a substance that is treated with a coating that is impermeable to blood, polyester or a treated biological material, in particular pericardium.

According to various embodiments, the paddles are 606 designed to be pliable to place less stress on the valve tissue when using the valve repair device 602 is attached to the valve tissue. When the paddles 606 are in the expanded state, the paddles have a width W. The width W can be, for example, between approximately 4 mm and approximately 21 mm, in particular between approximately 5 mm and approximately 20 mm, in particular between approximately 7.5 mm and approximately 17.5 mm, in particular between approximately 10 mm and approximately 15 mm. According to certain embodiments, the width W can be, for example, 5 mm or more, in particular approximately 7.5 mm or more, in particular approximately 10 mm or more, in particular approximately 15 mm or more, in particular approximately 20 mm or more. According to other embodiments, the width can also be less than 5 mm.

With reference to 18C are the paddles 606 in a compressed state when the paddles are in the feeder 601 are arranged. When the paddles 606 are in a compressed state, the paddles have a width H on. The width H can for example be between approximately 4 mm and approximately 7 mm, in particular between approximately 5 mm and approximately 6 mm. According to alternative embodiments, the width H also be less than 4 mm or more than 7 mm. According to certain embodiments, the width is H the compressed paddle 606 equal to a width D. the feed opening 716 the feeding device 601 . The ratio between the expanded width W of the paddles and the width H the paddle in the compressed state can for example be about 4 to 1 or less, in particular about 3 to 1 or less, in particular about 2 to 1 or less, in particular about 1.5 to 1, in particular about 1.25 to 1, in particular about 1 to Be 1. According to alternative embodiments, the ratio between the width W and the width H also be more than 4 to 1. With reference to 18D becomes a paddle 606 moved from the expanded state to the compressed state by compressing the paddle in the Y direction and stretching a length of the paddle in the X direction. According to the illustrated embodiment, the side members 1807 of the paddle 606 stretched in length when the paddle is in the compressed state. With reference to 18C cross over in certain embodiments when the paddles 606 in the compressed state in the feed device 601 are arranged, the side elements 1807 the paddles each other.

With reference to 19A - 19D includes another exemplary embodiment of a valve repair device 602 the paddles 606 that have a lattice structure 1901 exhibit. According to certain embodiments, the lattice structure is 1901 the paddle 606 compressible, which allows the paddle to be used 606 in a feeding device 601 (e.g. a catheter), which with a view to delivery of the valve repair device 602 to a patient's own valve has a small diameter (as in 19C shown), and it also allows the paddle to move 606 (as in 19A - 19B shown) when they exit the feed device 601 expand so that the paddles 606 have a larger surface area to engage the patient's own valve. The valve repair device 602 can take any suitable form, such as any form described in the present application. The valve repair device 602 can be moved between the open and closed positions and can be attached to an endogenous valve by a valve repair system such as any valve repair system described in the present application.

19A - 19B illustrate the valve repair device 602 in the open position. When the valve repair device 602 is in the expanded and open positions, the paddles extend 606 outwards to the wide opening 614 between the paddles 606 and the gripping elements 608 the valve repair device 602 to accomplish. According to certain embodiments, the paddles include paddles 606 one above the lattice structure 1901 disposed material, such as a woven material, an electrospun material, or any other material capable of promoting tissue ingrowth; and feeder inserts 601 ( 6th ) to protect while finding the way. According to certain embodiments, the material can be 1605 a blood-impermeable material, such as a PET material or a biocompatible cover material, in particular a material that is treated with a coating that is blood-impermeable, polyester or a treated biological material, in particular pericardium.

According to various embodiments, the paddles are 606 designed to be pliable to place less stress on the valve tissue when using the valve repair device 602 is attached to the valve tissue. When the paddles 606 are in the expanded state, the paddles have a width W. The width W can be, for example, between approximately 4 mm and approximately 21 mm, in particular between approximately 5 mm and approximately 20 mm, in particular between approximately 7.5 mm and approximately 17.5 mm, in particular between approximately 10 mm and approximately 15 mm. According to certain embodiments, the width W can be, for example, 5 mm or more, in particular approximately 7.5 mm or more, in particular approximately 10 mm or more, in particular approximately 15 mm or more, in particular approximately 20 mm or more. According to other embodiments, the width can also be less than 5 mm.

With reference to 19C are the paddles 606 in a compressed state when the paddles are in a feeder 601 are arranged. When the paddles 606 are in a compressed state, the paddles have a width H on. The width H can for example be between approximately 4 mm and approximately 7 mm, in particular between approximately 5 mm and approximately 6 mm. According to alternative embodiments, the width H also be less than 4 mm or more than 7 mm. According to certain embodiments, the width is H the compressed paddle 606 equal to a width D. the feed opening 716 the feeding device 601 . The ratio between the expanded width W of the paddles and the width H the paddle in the compressed state can for example be about 4 to 1 or less, in particular about 3 to 1 or less, in particular about 2 to 1 or less, in particular about 1.5 to 1, in particular about 1.25 to 1, in particular about 1 to Be 1. According to alternative embodiments, the ratio between the width W and the width H also be more than 4 to 1. With reference to 19D becomes a paddle 606 moved from the expanded state to the compressed state by compressing the paddle in the Y direction and stretching a length of the paddle in the X direction.

With reference to 20A - 20B Another exemplary embodiment of a valve repair device includes the paddles 606 , which are compressible, allowing the paddles to 606 in a feeding device 601 (e.g. B. . a catheter), which has a small diameter with a view to delivering the valve repair device to a patient's own valve (as in 20A shown), and it also allows the paddle to move 606 (as in 20B shown) when they exit the feed device 601 expand so that the paddles 606 have a larger surface area to engage the patient's own valve. The paddles 606 can on a valve repair device 602 which may take any suitable form, for example any form described in the present application. The valve repair device can (together with the paddles 606 ) can be attached to an endogenous valve by a valve repair system, such as any valve repair system described in the present application.

20A illustrates the paddle 606 in a compressed state in the interior of a feed device 601 . The paddle includes an opening 2001 which allows a section of the paddle to expand when it comes out of the feeder 601 is positioned out. When compressed, the paddle can 606 for example a width H between approximately 4 mm and approximately 7 mm, in particular between approximately 5 mm and approximately 6 mm. According to alternative embodiments, the width H also be less than 4 mm or more than 7 mm. According to certain embodiments, the width is H the compressed paddle 606 equal to a width D. the feed opening 716 the feeding device 601 . 20B illustrates the paddle 606 in an expanded state. In the expanded state, the paddle 606 for example have a width W between approximately 4 mm and approximately 21 mm, in particular between approximately 5 mm and approximately 20 mm, in particular between approximately 7.5 mm and approximately 17.5 mm, in particular between approximately 10 mm and approximately 15 mm. According to certain embodiments, the width W can be, for example, 5 mm or more, in particular approximately 7.5 mm or more, in particular approximately 10 mm or more, in particular approximately 15 mm or more, in particular approximately 20 mm or more. According to other embodiments, the width can also be less than 5 mm. The ratio between the expanded width W of the paddles and the width H the paddle in the compressed state can for example be about 4 to 1 or less, in particular about 3 to 1 or less, in particular about 2 to 1 or less, in particular about 1.5 to 1, in particular about 1.25 to 1, in particular about 1 to Be 1. According to alternative embodiments, the ratio between the width W and the width H also be more than 4 to 1. With reference to 20B becomes a paddle 606 moved from the expanded state to the compressed state by compressing the paddle in the Y direction. According to various embodiments, the paddles are 606 designed to be pliable to place less stress on the valve tissue when using the valve repair device 602 is attached to the valve tissue. According to certain embodiments, the paddles include paddles 606 one over the paddle 606 arranged material, such as for example any material capable of promoting tissue ingrowth and feeder inserts 601 ( 6th ) to protect while finding the way. According to certain embodiments, the material can be a blood-impermeable material, such as a PET material or a biocompatible cover material, in particular a material that is treated with a coating that is blood-impermeable, polyester or a treated biological material, in particular Pericardium, act.

21A - 21B illustrate another exemplary embodiment of a valve repair system 600 , in which the valve repair system 600 a valve repair device 602 includes extendable paddles. The valve repair system 600 can take any suitable form, such as any form described in the present application. According to the illustrated embodiment, the valve repair device comprises 602 the paddles 606 that are extendable so that a length L of the paddles can be changed. That is, the paddles 606 close a main section 2110 and an extendable section 2112 a. The extendable section 2112 can be inside the main section 2110 can be accommodated to paddles with a shorter length L (as in 21A shown) and the retractable section 2112 can be extended out of the main section to accommodate paddles with a longer length L (as in 21B shown). The ratio between the shorter length L (as in 21A shown) and the longer length L (as in 21B shown) can be, for example, 1.25 to 1 or more, in particular 1.5 to 1 or more, in particular 2 to 1 or more, in particular 3 to 1 or more, in particular 4 to 1 or more, in particular 5 to 1 or more.

According to one embodiment, it is the main section 2110 around a hollow tube with an opening and at the extendable section 2112 around a rod or tube designed to be housed in the opening of the hollow element. According to certain embodiments, the extendable portion is 2112 so spring loaded that the extendable section 2112 is biased towards the extended position, and a locking element is arranged in a locked position to the extendable portion 2112 in the non-extended position inside the main section 2110 to leave housed. A movement of the locking element from the locked position into the unlocked position causes the spring-loaded extendable section to move 2112 from the main section 2110 moved out to the extended position. In addition, the retractable section 2112 inside the main section 2110 be retracted into it and the locking element can then be moved from the unlocked position to the locked position in order to move the paddles from the extended position to the retracted position. The locking element can be moved between the locked position and the unlocked position by any suitable means, such as a rod which engages the locking element to move the locking element between the locked position and the unlocked position. According to an alternative embodiment, a suture or wire extends through the main section 2110 and occurs with the retractable section 2112 engaged to the extendable section 2112 in the non-extended position, and the removal of the suture or wire allows the spring-loaded, extendable section to separate from the main section 2110 moved out to the extended position.

With reference to 21A is the valve repair device 602 with the paddles 606 is shown in an undeployed position and the valve repair device is positioned to interfere with the valve tissue 820 intervenes. With reference to 21B after the valve repair device 602 has been positioned to match the valve tissue 820 to engage the extendable sections 2112 the paddle 606 extended so that more surface area is available for the paddles to engage the valve tissue. After the paddle 606 have been extended to a desired length L, the valve repair device 602 closed to the valve repair device on the valve tissue 820 to attach, and the valve repair device is from the valve repair system 600 away. According to certain embodiments, the valve repair device is 602 designed such that the extendable section 2112 the paddle can be extended or retracted after the valve repair device is attached to the valve tissue 820 has been attached so that the tension applied to the valve tissue can be increased or decreased depending on the patient and the circumstances of the procedure. For example, in embodiments in which the valve tissue 820 A patient's mitral valve, a valve with excessive damage to the leaflet or tendon sutures may require more tension to properly seal the mitral valve, or a valve with short leaflets that do not coaptate may require less tension to adequately seal the mitral valve . The valve repair device can be of any suitable type Such as, for example, in any manner described in the present application, from the open to a closed position and by the valve repair system 600 be removed.

With reference to 22nd - 26th is the gripper control mechanism in accordance with certain embodiments 611 designed to hold each of the gripping elements 608 to steer independently of the others. Independent control of each of the gripping elements 608 is advantageous because it eliminates the openings 614 between the paddles 606 and the gripping elements can be adjusted independently while the valve repair device 602 attached to the valve tissue (e.g., a patient's mitral valve). In addition, an independent gripper control is also advantageous in those situations in which a gripping element 608 and a paddle 606 the valve repair device 602 while adequately attaching to a first portion of a valve fabric, the other gripping element and the other paddle are not able to connect the valve repair device to a second valve fabric portion. In this situation, the gripper control mechanism 611 be used for this purpose, only that gripping element 608 to drive that is not yet connected to the valve tissue to open an opening 614 for receiving the second portion of the valve fabric, and once the second portion of the valve fabric is in place in the opening, the not yet attached gripping element and paddle can be closed to open the valve repair device 602 to attach to the second portion of the valve tissue.

With reference to 22nd - 26th includes an exemplary embodiment of a valve repair system 600 a feeding device 601 and a valve repair device 602 wherein the delivery device is adapted to deliver the valve repair device to a patient's own valve, and wherein the valve repair device is adapted to be attached to the leaflets of an endogenous valve to thereby repair the patient's own valve. The feeding device 601 may take any suitable form, such as that described in the present application, capable of serving the valve repair device 602 to a patient's own valve. The valve repair device 602 is similar to the valve repair device previously described and includes a base assembly 604 , a pair of paddles 606 and a pair of gripping elements 608 a. The basic arrangement 604 the valve repair device 602 has a shaft 603 , a connector 605 designed to move along the shaft and a locking lock 607 , which is designed to lock the connector in a fixed position on the shaft. The valve repair device 602 can take any suitable form, such as any form described in the present application. The valve repair system 600 can also have a paddle control mechanism 610 , a gripper control mechanism 611 , and a lock control mechanism 612 include. The paddle control mechanism 610 is mechanically on the connector 605 attached to the connector along the stem 603 to move, which causes the paddles to move 606 move between the open and closed positions. The paddle control mechanism 610 can take any suitable form, such as any form described in the present application. The lock lock control mechanism 612 is designed for the connector 605 to move between the locked state and the unlocked state. The lock lock control mechanism 612 can take any suitable form, such as any form described in the present application.

With reference to 22nd includes an exemplary embodiment of a gripper control mechanism 611 a first gripper control element 2202 and a second gripper control element 2204 . The first gripper control element 2202 is designed for the gripping element 608a to move in direction X, and the second gripper control element 2204 is designed for the gripping element 608b to move in Z direction. By moving the gripping element 608a in the X direction becomes the width W of the opening 614a between the gripping element 608a and the paddle 606a adjusted and by a movement of the gripping element 608b in direction Z becomes the width H the opening between the gripping element 608b and the paddle 606b customized. The gripper controls 2202 , 2204 can be of any suitable shape capable of engaging the gripping elements 608a , 608b move independently. In the illustrated embodiment, it is the gripper control elements 2202 , 2204 around lines, such as sutures, wires, etc., which can be detached from each of the gripper elements 608a , 608b are attached, with both ends of the line passing through the feed opening 716 the feeding device 601 extend through. The gripper controls 2202 , 2204 can be drawn into and released from the catheter independently of one another to adjust the positions of the gripping elements 608a , 608b independently controlled.

With reference to 22A - 22D is another exemplary embodiment a valve repair system 600 with another embodiment of a gripper control mechanism 611 shown which is used for the gripping elements 608a-d another exemplary embodiment of a valve repair device 602 to control. For purposes of illustration, the paddles are included 602 the valve repair device 606 in 22A - 22D not shown, but it should be noted that the valve repair device 602 also paddles 606 includes those with the gripping elements 608a-d interact with the valve repair device 602 to attach to the valve fabric, and that the paddle 606 may take any suitable form, for example any form described in the present application. 22A illustrates the valve repair system 600 , each of the four gripping elements 608a-d is in a first position, and 22C illustrates the valve repair system 600 , one of the gripping elements 608a has been moved to a second position. 22B is a (through the in 22A lines 22B-22B shown) top view of the valve repair system 600 , each of the gripping elements 608a-d is arranged in a first position. 22D is a (through the in 22C lines shown C - C specified) cross-sectional view of the valve repair system 600 , each of the gripping elements 608a is arranged in the second position. Each of the four gripping elements can be moved independently in the same way as for the gripping element 608a is illustrated.

The valve repair device 602 comprises a first gripping element 608a , a second gripping element 608b , a third gripping element 608c and a fourth gripping element 608d . The gripping elements 608a-d each include a spiked section 609a-d for attaching the gripping elements 608a-d on the valve tissue. The gripper control mechanism 611 comprises: a first gripper control element 2202a , which is designed to be the first gripping element 608a to control a second gripper control element 2202b , which is designed for the second gripping element 608b to control a third gripper control element 2202c , which is designed for the third gripping element 608c to control, and a fourth gripper control element 2202d , which is designed for the fourth gripping element 608d to control. In particular, the first is gripper control element 2202a designed for the gripping element 608a to move in direction X and is the second gripper control element 2202b designed for the second gripping element 608b move in direction X. In addition, is the third gripper control element 2202c designed for the gripping element 608c to move in direction Z, and is the fourth gripper control element 2202d designed for the fourth gripping element 608d to move in Z direction. By moving the gripping elements 608a-b in direction X becomes the width of the opening between the gripping elements 608a-b and the corresponding paddle 606 adjusted and by a movement of the gripping elements 608c-d in direction Z becomes the width of the opening between the gripping elements 608c-d and adapted to the corresponding paddle. The gripper control mechanism 611 is designed to hold each of the gripping elements 608a-d to move independently. The gripper controls 2202a-d can be of any suitable shape capable of engaging the gripping elements 608a-d move independently. In the illustrated embodiment, it is the gripper control elements 2202a-d around lines, such as sutures, wires, etc. which are detachable from each of the gripper elements 608a-d are attached, with both ends of the line passing through the feed opening 716 the feeding device 601 extend through. The gripper controls 2202a-d can be drawn into and released from the catheter independently of one another to adjust the positions of the gripping elements 608a-d independently controlled.

With reference to 22A and 22B are the gripping elements 608a-d each shown in an extended position. With reference to 22C and 22D is the first gripping element 608a shown after the first gripper control element 2202a of the grasper control mechanism was drawn into the catheter, thereby causing the first grasping element 608a in direction X inward to the shaft 603 moved towards, while the other gripping elements 608b-d in the in 22A and 22B position shown have remained. In other words, the illustrated embodiment shown in FIG 22A - 22D is shown shows how a first gripping element 608a in relation to the other gripping elements 608b-d is controlled independently. The illustrated embodiment shows how the first gripping element 608a is independently controlled, but it should be understood that each of the gripping elements 608a-d by the corresponding gripper control element 2202a-d the gripper control mechanism 611 can be controlled independently. Furthermore, it should be understood that while the illustrated embodiment is made from 22A - 22D a valve repair assembly 600 with four gripping elements 608a-d and four gripper control elements 2202a-d illustrates, however, that any suitable number of gripping elements and gripper control elements can be used and that any number of gripping elements can be controlled independently of one another by the gripper control mechanism. In addition, each of the gripping elements 608a-608d any of the in this application have disclosed designs and any of the control mechanisms 2202a - 2202d can have any of the forms disclosed in this application.

With reference to 23 includes another exemplary embodiment of a gripper control mechanism 611 a single line 2302 , such as a suture thread or a wire, which is detachable on the gripping elements 608a , 608b is attached and releasable between a positioning shaft 613 and a shaft 603 the valve repair device is fixed. The connection 615 between the positioning body 613 and a shaft 603 the valve repair device can be done in a variety of different positions. In the illustrated example, the connection is 615 at the ends of the gripping elements 608a , 608b aligned or substantially aligned with them. In other embodiments, the connection 615 however, it can also be located more distally, for example at a most proximal position, which the connecting piece 605 can achieve (see for example the through 45C and 46D illustrated release positions of the connector). The single line 2302 is so between the stem 613 and the shaft 603 connected to that single leash 2302 the gripping elements 608a , 608b can control independently. That is, by moving a first section 2303 the leash 2302 in the Y direction becomes the width W between the gripping member 608a and the paddle 606a adjusted, but it does not change the width H between the gripping element 608b and the paddle 606b customized. Similarly, moving a second section 2305 the leash 2302 in direction M the width H between the gripping element 608b and the paddle 606b adjusted, but it does not change the width W between the gripping element 608a and the paddle 606a customized. After the valve repair device 602 is in the closed position and attached to the valve tissue, the positioning shaft 613 from the shaft 603 the valve repair device 602 removed. Loosening the shaft 603 from the shaft 613 causes the line to be released. The leash 2302 can then be withdrawn into the catheter to release the gripping elements 608a , 608b release by one end of the leash 2302 is pulled into the catheter. By pulling one end of the line into the catheter, the other end of the line is held by the gripping elements 608a , 608b pulled through and then pulled into the catheter. Any of the lines described here can be withdrawn in this way.

With reference to 24 in certain embodiments it can be the positioning shaft 613 and the shaft 603 the device 602 act around a hollow body and this can be via a connecting shaft 2400 fit which the shafts 613 , 603 holds together. The shaft 603 and the device 602 can have a preceding section 2406 and a recessed receiving portion 2408 lock in. The positioning body 613 can have a protruding section 2407 and a recessed receiving portion 2409 lock in. When the stems 613 , 603 are coupled is the previous section 2406 of the shaft 603 in the receiving section 2409 of the shaft 613 arranged and is the protruding portion 2407 of the shaft 613 in the receiving section 2408 of the shaft 603 arranged. The shafts 613 , 603 can be linked together in a number of different ways. For example, the shaft 613 a hole or a channel 2411 include the one with a bore or channel 2413 of the shaft 602 aligned when the protruding sections 2406 , 2407 each in the corresponding receiving sections 2408 , 2409 are arranged. When the openings 2411 , 2413 are aligned with each other and the retaining shaft 2400 in direction X into the openings 2411 , 2413 is inserted, the shafts 613 , 603 held together thereby. When the positioning shaft is in the Z direction from the openings 2411 , 2413 removed, the preceding sections 2406 , 2407 from the receiving sections 2408 , 2409 removed so that the device 602 from the positioning body 613 solves.

With further reference to 24 will when the stems 613 , 603 are attached to each other, an opening 2415 at the contact surface 2417 between the shafts 613 , 603 created. The breakthrough 2415 is designed to hold the leash 2302 between the shafts 613 , 603 to attach to independent control of the gripping elements 608a , 608b to allow. That is, the breakthrough 2415 is designed so that the leash 2302 relative to the breakthrough 2416 not moving when the stems 613 , 603 are attached to each other. When loosening the shafts 613 , 603 becomes the leash 2302 from the breakthrough 2415 released and can be removed from the valve repair device 602 removed.

The leash 2302 can then be withdrawn into the catheter to release the grasping elements as described above.

With reference to 23 and 24A - 24B is according to an alternative embodiment of the leash 2302 the gripper control mechanism 610 by a threaded connection between the positioning shaft 613 and the shaft 603 attached to the gripper elements 608a , 608b independently controlled. With reference to 24A includes the positioning body 613 one with one External thread element 2419 , and the shaft 603 comprises an internally threaded element 2421 which is designed to be the externally threaded element 2419 of the positioning body 613 record. The external thread and the internal thread can, however, also be arranged in reverse. The positioning body 613 is attached to the shaft 603 attached by the externally threaded element 2419 into the internally threaded element 2421 of the shaft 603 is screwed in. The leash 2302 the gripper control mechanism 611 is so between the positioning shaft 613 and the shaft 603 arranged that when the positioning shaft 613 on the shaft 603 is attached to the leash 2302 (as shown by the reference character M) between the positioning shaft 613 and the shaft 603 is compressed. The compression of the leash 2302 between the positioning body 613 and the shaft 603 causes the leash 2302 relative to the point of engagement 2423 between the positioning body 613 , the shaft 603 and the leash 2302 not moving when the leash 2302 the gripping elements 608a , 608b controls. Consequently, it enables the compression M and the consequent retention of the line 2302 that leash 2302 the gripping elements 608a , 608b controls independently.

With reference to 25th includes another exemplary embodiment of a gripper control mechanism 611 a first gripper control element 2502 and a second gripper control element 2504 a. The first gripper control element 2502 is designed for the gripping element 608a to move bidirectionally in direction X, and the second gripper control element 2504 is designed for the gripping element 608b move bidirectionally in Z direction. By moving the gripping element 608a in the X direction becomes the width W of the opening 614a between the gripping element 608a and the paddle 606a adjusted and by a movement of the gripping element 608b in direction Z becomes the width H the opening between the gripping element 608b and the paddle 606b customized. In the illustrated embodiment, the gripper control elements close 2202 , 2204 one push and one tension member each 2503 , 2505 such as a catheter, flexible rod or stiff wire, and a connector 2506 , 2507 a. Every push and pull link 2503 , 2505 extends from the feeder 601 and is through a connector 2506 , 2507 removable on the corresponding gripping element 608a , 608b appropriate. The Member 2503 is designed to be pushed and pulled in the Y direction. One movement of the limb 2503 in the Y direction causes the gripping element 608a moved in direction X. The limb is similar to this 2505 designed to be pushed and pulled in the direction of M and causes movement of the catheter 2505 towards M that the catheter 2505 the gripping element 608b moved in direction H.

In another embodiment, the gripper control mechanism is 611 in 25A shown. According to this embodiment, the gripper control elements comprise 2202 , 2204 a suture 2511 , 2513 and a flexible wire 2503 , 2505 . According to this embodiment, the first flexible wire comprises 2503 a loop 2517 to start the first suture 2511 take up and around a gripping element 608a ( 25th ) to engage, and the second flexible wire 2505 includes a loop 2519 to start the first suture 2513 take up and around the gripping element 608b ( 25th ) to take action. The loops 2517 , 2519 are each removable on each of the gripper elements 608a , 608b attached, both ends of the line, as described above, through the feeder 601 extend through. Each of the wires 2503 , 2505 each extends from the feeder 601 and the loops 2517 , 2519 of the wires concerned 2503 , 2505 are able to move along the corresponding suture threads 2511 , 2513 to move that loops 2517 , 2519 each with the corresponding gripping element 608a , 608b can engage to move the gripping elements (e.g., the gripping elements as in relation to FIG 25th described to move). The wires 2503 , 2505 can for example be made of steel, NiTi, or another wire or a plastic material. According to certain embodiments, the wires 2503 , 2505 have a diameter of between approximately 0.1 mm and 0.35 mm, in particular between approximately 0.15 mm and 0.3 mm, in particular between approximately 0.2 and 0.25 mm.

With reference to 26th includes another exemplary embodiment of a gripper control mechanism 611 a first catheter 2603 , a second catheter 2605 and a single line 2604 such as a wire or suture. The first catheter 2603 and the leash 2604 are designed to hold the gripping element 608a move in direction X, and the second catheter 2605 and the leash 2604 are designed to hold the gripping element 608b to move in Z direction. By moving the gripping element 608a in the X direction becomes the width W of the opening 614a between the gripping element 608a and the paddle 606a adjusted and by a movement of the gripping element 608b in direction Z becomes the width H of the opening between the gripping element 608b and the paddle 606b customized. The leash 2604 extends from the feeder 601 through the catheter 2603 , 2605 through and is through openings in both gripping elements 608a , 608b threaded through. Any catheter 2603 , 2605 is designed for the corresponding gripping element 608a , 608b engaged too take and move. In particular, the catheter 2603 designed to be pushed in the Y direction while the leash 2604 from the catheter 2603 is issued or the tension in the line is reduced. The catheter 2603 is designed to be pulled in the Y direction while the leash 2604 into the catheter 2603 pulled in or the tension in the line increased. One movement of the catheter 2603 Direction Y causes the catheter 2603 the gripping element 608a moved in direction X. The catheter is similar 2605 designed to be pushed in the direction of M while holding the leash 2604 from the catheter 2605 is issued or the tension in the line is reduced. The catheter 2605 is designed to be pulled in the direction of M while the leash 2604 into the catheter 2605 pulled in or the tension in the line increased. One movement of the catheter 2505 in direction M causes the catheter 2505 the gripping element 608b moved in direction H. According to an alternative embodiment, the above in relation to 26th described gripper control mechanism 611 a first flexible wire with a loop (e.g. the one in 25A flexible wire shown 2503 with the loop 2517 ) and a second flexible wire with a loop (e.g. the one in 25A flexible wire shown 2505 with the loop 2519 ) enclose and extend the single line 2604 through the loop 2517 , 2519 of each of the wires 2503 through.

With reference to 27A - 29B are the valve repair device according to certain embodiments 602 and the paddle control mechanism 610 for a valve repair device 602 designed so that each of the paddles 606 can be controlled independently. Independent control of each of the paddles 606 is advantageous because it eliminates the openings 614 between the paddles and the gripping elements 608 can be adjusted independently while the valve repair device 602 attached to the valve tissue (e.g., a patient's mitral valve). In addition, an independent paddle control is also advantageous in those situations in which a gripping element 608 and a paddle 606 the valve repair device 602 while adequately attaching to a first portion of a valve fabric, the other gripping element and the other paddle are not able to connect the valve repair device to a second valve fabric portion. In this situation, the paddle control mechanism 610 to be used, just that paddle 606 to drive that is not yet connected to the valve tissue to open an opening 614 for receiving the second portion of the valve fabric, and once the second portion of the valve fabric is in place in the opening, the not yet attached gripping element and paddle can be closed to open the valve repair device 602 to attach to the second portion of the valve tissue.

With reference to 27A - 27C closes the basic arrangement 604 the valve repair device 602 a first shaft 603a , a second shaft 603b , a first connector 605a and a second connector 605b a. In addition, the paddle control mechanism closes 610 a first paddle control mechanism 2702 and a second paddle control mechanism 2704 a. The first paddle control mechanism 2702 is designed to be the first connector 605a along the shaft 603a to move and the second paddle control mechanism 2704 is designed to use the second connector 605b along the shaft 603b to move. A movement of the first link 605a along the shaft 603a causes the paddle to move 606a moved between an open position and a closed position; and movement of the second link 605b along the shaft 603a causes the paddle to move 606b moved between an open position and a closed position. According to an alternative embodiment, the basic arrangement 604 a single shaft, a first connector attached to the single shaft 605a and a second connector attached to the single shaft 605b include. According to this alternative embodiment, the paddle control mechanism 610 include: a first paddle control mechanism 2702 designed to be the first connector 605a move along the single shaft to cause the paddle to move 606a moved between an open position and a closed position, and a second paddle control mechanism 2704 , which is designed for the second connector 605b move along the single shaft to cause the paddle to move 606b moved between an open position and a closed position.

27A - 27C illustrate how the paddles of the valve repair device move between an open position and a closed position. The basic arrangement 604 the valve repair device 602 comprises: a first link 2721 that stands out from point A. extends to point B, a second link 2722 that stands out from point A. extends to point C, a third link 2723 that extends from point C to point D is a fourth link 2724 that extends from point D to point E. extends, and a fifth link 2725 that stands out from point E. extends to point F. The connector 605a is movable on the shaft 603a appropriate that Connector 605b is movable on the shaft 603b attached and the stems 603a , 603b are on the third link 2723 fixed. The first link 2721 is at point A. so pivotable on the connector 605a attached that movement of the connector 605a along the shaft 603a the location of the point A. moves and consequently the first link 2721 emotional. The fifth link is similar 2725 at point F so pivotable on the connector 605b attached that movement of the connector 605b along the shaft 603b moves the position of point F and consequently the fifth link 2725 emotional. The first link 2721 and the second link 2722 are pivotally attached to each other at point B and the fifth link 2725 and the fourth link 2724 are pivotally attached to each other at point E. A paddle 606a is such on the first link 2721 appropriate that movement of the first limb 2721 causes the first paddle 606a moves, and the other paddle 606b is such on the fifth link 2725 attached that movement of the fifth limb 2725 causes the paddle to move 606b emotional.

With reference to 27A , are the paddles 606a , 606b in the open position. With reference to 27A and 27B becomes the paddle 606b from the open position (in 27A shown) to the closed position (in 27B shown) when the second paddle control mechanism 2704 the second connector 605b in direction Y the shaft 603b moves along, causing a portion of the fifth link close to point F to move 2725 in the direction H moves and a portion of the fifth member close to point E. 2725 moved in direction J. The paddle 606b is such on the fifth link 2725 attached that movement of the second connector 605b Direction Y causes the paddle to move 606b moves in Z direction. In addition to this is the fourth link 2724 at point E. so pivotable on the fifth link 2725 attached that movement of the second connector 605b in direction Y causes the fourth link 2724 moved in direction K. With reference to 27B , the paddle moves 606b in direction Q as it moves from the open position to the closed position. According to an alternative embodiment, in which the pivot connection at point E. between the fourth link 2724 and the fifth link 2725 is significantly lower than the pivot connection at point F between the fifth link 2725 and the second connector 605b , acts a movement of the paddle 606b from the open position to the closed position as in the in 27A shown embodiment is shown, except that the fourth link 2724 initially in the direction substantially opposite to direction K while the paddle moves 606b is closed. According to any of the above-mentioned embodiments, the second paddle control mechanism 2704 take any suitable shape around the second connector 605b along the shaft 603b such as any form of paddle control mechanism described in the present application.

With reference to 27A and 27C becomes the paddle 606a from the open position (in 27A shown) to the closed position (in 27C shown) when the first paddle control mechanism 2702 the first connector 605a in direction N the shaft 603a moves along, causing a close to point A. located section of the first link 2721 moves in direction L and comes close to point B. located section of the first link 2721 moved in direction I. The paddle 606a is such on the first link 2721 attached that movement of the first connector 605a Direction N causes the paddle to move 606a moved in direction V. In addition to this is the second link 2722 at point B. so pivotable on the first link 2721 attached that movement of the first connector 605a in direction N causes the second link 2722 moved in direction R. With reference to 27C , the paddle moves 606a in direction T as it moves from the open position to the closed position. According to an alternative embodiment, in which the pivot connection at point B. between the first link 2721 and the second link 2722 is significantly lower than the pivot connection at point A. between the first link 2721 and the first connector 605a , acts a movement of the paddle 606a from the open position to the closed position as in the in 27A shown embodiment is shown, except that the second link 2722 initially moves in the direction substantially opposite to direction R while the paddle moves 606b is closed. According to any of the above-mentioned embodiments, the first paddle control mechanism 2702 take any suitable shape around the first connector 605a along the shaft 603a such as any form of paddle control mechanism described in the present application.

With reference to 28A - 28C In accordance with certain embodiments, includes the paddle control mechanism 610 a rack and pinion mechanism 2802 that is designed to hold the paddle 606a , 606b selectively with the shaft 603 to couple and to decouple from this. The rack and pinion mechanism 2802 includes: a first element 2804 that on the shaft 603 attached, and a toothed element 2806a , 2806b that on each of the paddles 606a , 606b attached and at the connection points A. , B. pivotable with the base element 2801 connected is. The first element 2804 is designed so that the paddle 606a , 606b can be moved independently between the open position and the closed position. In the illustrated embodiment, the first element 2804 a ribbed section 2805 and an open section 2807 on. If the toothed element (s) 2806a , 2806b with the ribbed section 2805 of the first element 2804 is / are aligned, is / are the toothed element (s) 2806a , 2806b designed to be so with the ribbed section 2805 to engage that movement of the shaft relative to the base member 2801 in the Y direction causes the toothed element 2806a around the connection point A. moved around in the direction of M to the paddle 606a in the direction H to move between an open position and a closed position, and that the toothed element 2806b around the connection point B. moved around in direction N to get the paddle 606a to move in direction Z between an open position and a closed position. When the open section 2807 of the first element 2804 with one or the other of the toothed elements 2806a or 2806b is aligned, that toothed element becomes that with the open section 2807 aligned, not from the ribbed section 2805 of the paddle 606a or 606b engaged. Consequently there is movement of the shaft 603 in direction Y has no effect on the position of the paddle 606a or 606b .

28A - 28B illustrate the corkscrew mechanism 2802 in a first position. In the first position are the toothed elements 2806a , 2806b for both paddles 606a , 606b with the ribbed section 2805 of the first element 2804 aligned. With reference to 28A kick when the stem 603 is moved in the Y direction, the toothed elements 2806a , 2806b equally with the ribbed section 2805 of the first member engaging, causing both paddles 606a , 606b moved between the open and closed positions. 28C - 28D illustrate the corkscrew mechanism 2802 in a second position. The toothed element is in the second position 2806a with the open section 2807 of the first element 2804 aligned and is the toothed element 2806b with the ribbed section 2806 of the first element 2804 aligned. With reference to 28C occurs when the stem 603 is moved in the Y direction, the toothed element 2806b with the ribbed section 2805 of the first element 2804 engaged, causing the paddle 606b is moved between the open and closed positions and enters the toothed element 2806a does not engage the first element, thereby causing the paddle 606a remains in its current position. 28E - 28F illustrate the corkscrew mechanism 2802 in a third position. The toothed element is in the third position 2806b with the open section 2807 of the first element 2804 aligned and is the toothed element 2806a with the ribbed section 2806 of the first element 2804 aligned. With reference to 28E occurs when the stem 603 is moved in the Y direction, the toothed element 2806a with the ribbed section 2805 of the first element 2804 engaged, causing the paddle 606a is moved between the open and closed positions and enters the toothed element 2806b does not engage the first element, thereby causing the paddle 606b remains in its current position. According to certain embodiments, the rack and pinion mechanism 2802 by turning the shaft 603 between the in 28A - 28F positions shown. According to various embodiments, the rack and pinion mechanism closes 2802 a mechanism that is designed to hold the paddles 606a , 606b to hold in a desired nominal position when the paddle is with the open section 2807 of the first element 2804 but is also designed to allow the paddles to move when the paddles are with the ribbed section 2805 of the first element 2804 are aligned. The mechanism can take any suitable form such as a clutch mechanism, a biasing element, a friction element, etc.

With reference to 29A - 29B is the paddle control mechanism 610 designed to be a connector 605 along a shaft 603 to move to the paddle 606a , 606b to move between the open and closed positions (similar to the in 6th - 12th embodiment shown), and is a locking mechanism 207 designed to use the connector 605 on the shaft 603 to lock to the paddle 606a , 606b to hold in a desired position. According to certain embodiments, as shown in FIG 29A - 29B shown each of the paddles 606a , 606b a pen 2902a , 2902b and a slot 2904a , 2904b a. The pencil 2902a is designed to sit in the slot 2904a to move and the pen 2902b is designed to sit in the slot 2904b to move. The pencils 2902a , 2902b are also designed to fit in the slots 2904a , 2904b to be locked. If a pen 2902a , 2902b in a slot 2904a , 2904b is released, the corresponding paddle remains 606a , 606b in a current position when the paddle control mechanism 610 the connector 605 along the shaft 603 emotional. If a pen 2902a , 2902b in a slot 2904a , 2904b is locked, the corresponding paddle moves 606a , 606b between an open and a closed position when the paddle control mechanism 610 the connector 605 along the shaft 603 emotional.

29A Figure 3 illustrates the valve repair device 602 with the paddles 606a , 606b in an open position. 29B Figure 3 illustrates the valve repair device 602 , with the pen 2902a in the slot 2904a is released and the pen 2902b in the slot 2904b is locked. With reference to 29B the locking lock is located 607 in an unlocked state so that the connector 605 along the shaft 603 can be moved. One movement of the connector 605 along the shaft 603 in direction Y causes the paddle 606b so around the locked pin 2902b the paddle is swung around 606b moved in direction Z to a closed position. It also causes the connector to move 605 in the Y direction does not mean that the paddle is 606a moves as the pen moves 2902a in the slot 2904a is in an unlocked state. Instead it causes the connector to move 605 in the Y direction that the pin is 2902a in the slot 2904a emotional. Alternatively, the pen could 2902a in the slot 2904a be locked and the pin could 2902b in the slot 2904b be released so that movement of the connector 605 in direction Y would cause the paddle to move 606a would move to a closed position and that the paddle 606b would remain in the open position (by moving the pin 2902b in the slot 2904b emotional). In addition, the pen could 2902a in the slot 2904a be locked and the pin could 2902b in the slot 2904b be locked so that movement of the connector 605 in direction Y would cause both paddles to move 606a , 606b would move to the closed position. The pencils 2902a , 2902b can by any suitable means, such as by any herein with respect to the latch lock 607 described means, in the slots 2904a , 2904b be locked.

With reference to 30th can the mitral valve 3001 a patient a wide gap in certain situations 3002 between the forward sail 3003 and the aft sail 3004 when the mitral valve is in a closed position (ie, during the systolic phase). For example, the gap 3002 have a width W between approximately 2.5 mm and approximately 17.5 mm, in particular between approximately 5 mm and approximately 15 mm, in particular between approximately 7.5 mm and approximately 12.5 mm, in particular approximately 10 mm. In some situations, the gap can 3002 have a width W of more than 15 mm. In any of the situations noted above, a valve repair device that is capable of working with the forward leaflet is desirable 3003 and the aft sail 3004 engage to the gap 3002 to close and so regurgitation of blood through the mitral valve 3001 to prevent through.

31A - 37D Various designs of valve repair devices are available 602 ready that are designed to leave a wide gap 3002 ( 30th ) between the front sail 3003 and the aft sail 3004 a mitral valve 3001 close. With reference to 31A - 31B includes an exemplary embodiment of a valve repair device 602 the paddles 606 and the gripping elements 608 . In addition, the valve repair device 602 and may include any other feature discussed in the present application for a valve repair device, the valve repair device 602 be positioned so that they have valve tissue 820 as part of a suitable valve repair system (e.g., any valve repair system disclosed in the present application). With reference to 31A become the paddles 606 the valve repair device 602 pivoted outward in direction X to an opening 614 between the paddles 606 and the gripping elements 608 with a width W to create. The width W can, for example, be between approximately 5 mm and approximately 15 mm, in particular between approximately 7.5 mm and approximately 12.5 mm, in particular approximately 10 mm. According to alternative embodiments, the width can also be less than 5 mm or more than 15 mm. With reference to 31 B become the paddles 606 the valve repair device 602 so moved outward in direction Z that the opening 614 a width H having. The width H can for example be between approximately 10 mm and approximately 25 mm, in particular between approximately 10 mm and approximately 20 mm, in particular between approximately 12.5 mm and approximately 17.5 mm, in particular approximately 15 mm. According to alternative embodiments, the width H also be less than 10 mm or more than 25 mm. According to certain embodiments, the ratio between the width H and the width W, for example, approximately 5 to 1 or less, in particular approximately 4 to 1 or less, in particular approximately 3 to 1 or less, in particular approximately 2 to 1 or less, in particular approximately 1.5 to 1, in particular approximately 1.25 to 1, in particular approximately 1 to 1. The valve repair device 602 can be designed so that the paddles 606 be pivoted outward in direction X and then moved outward in direction Z. be to the opening 614 with a width H between the paddles 606 and the gripping elements 608 to accomplish. Alternatively, the valve repair device 602 be designed such that the paddles are moved outward in direction Z and then pivoted outward in direction X to the width H between the paddles 606 and the gripping elements 608 to accomplish. In addition, the valve repair device 602 be designed so that the paddle 606 be pivoted outward in direction X and simultaneously moved outward in direction Z to the width H between the paddles 606 and the gripping elements 608 to accomplish.

32A - 32C illustrate a valve repair device 602 at which the paddles 606 be pivoted outward in direction X and then moved outward in direction Z to make a wider opening 614 to accomplish. 32A Figure 11 illustrates a valve repair device 602 in a closed position so that the paddles 606 with the gripping elements 608 are engaged. With reference to 32B become the paddles 606 pivoted outward in direction X to an opening 614 with a width W to accommodate valve tissue. With reference to 32C be after the paddle 606 have been pivoted outward in direction X, the paddles 606 so moved outward in direction Z that the opening 614 a width H having. After the valve tissue in the openings 614 between the paddles 606 and the gripping elements 608 has been included, the valve repair device (as in 32A shown) moved back to the closed position to open the valve repair device 602 to attach to the valve fabric. The valve repair device 602 may include any other feature discussed in the present application for a valve repair device, and may include the valve repair device 602 be positioned so that they have valve tissue 820 as part of a suitable valve repair system (e.g. B. . any valve repair system disclosed in the present application).

33A - 33C illustrate a valve repair device 602 at which the paddles 606 be moved outward in direction Z and then pivoted outward in direction X to a wider opening 614 to accomplish. 33A Figure 11 illustrates a valve repair device 602 in a closed position so that the paddles 606 with the gripping elements 608 are engaged. With reference to 33B become the paddles 606 moved outward in direction Z to an opening 614 with a width W to accommodate valve tissue. With reference to 33C be after the paddle 606 the paddles have been moved outwards in direction Z. 606 pivoted outward in direction X in such a way that the opening 614 a width H having. After the valve tissue in the openings 614 between the paddles 606 and the gripping elements 608 has been included, the valve repair device (as in 33A shown) moved back to the closed position to open the valve repair device 602 to attach to the valve fabric. The valve repair device 602 may include any other feature discussed in the present application for a valve repair device, and may include the valve repair device 602 be positioned so that they have valve tissue 820 as part of a suitable valve repair system (e.g. B. . any valve repair system disclosed in the present application).

While 32A - 32C a valve repair device 602 illustrate at which the paddles 606 are pivoted and then spread apart, and 33A - 33C a valve repair device 602 illustrate at which the paddles 606 can be spread apart and then pivoted, a valve repair device can in alternative embodiments 602 paddle 606 include that can be spread apart and pivoted at the same time. In addition, in certain embodiments, the paddles 606 be spread apart and pivoted independently of each other. This means that the in 32A - 32C and 33A - 33C shown embodiments for the valve repair device 602 as well as in the embodiment in which the spreading apart and pivoting of each paddle take place 606 simultaneously performs the paddle 606 can be controlled independently of each other.

With reference to 34A - 34B comprises another embodiment of a valve repair device 602 that is designed to leave a wide gap 3002 ( 30th ) between the front sail 3003 and the aft sail 3004 to close a W-shaped mechanism. In particular, includes the valve repair device 602 a connector 605 that is designed to move along a shaft 603 to move and paddle 606 that are pivotable on the connector 605 are attached. The paddles 606 include an inner link 3402 and an outer link 3404 . The inner link 3402 of every paddle 606 is pivotable on the connector 605 attached and the outer link 3404 of every paddle 606 is pivotable on the corresponding inner link 3402 appropriate. With reference to 34A is the valve repair device 602 shown in a closed position. Under with reference to 34B causes the connector to move 605 in the Y direction that the inner links 3402 the paddle 606 extend in an outward direction X. In the example illustrated, the inner links are kicking 3402 with a cam element 3403 engaging which the inner links 3402 forces it to open in the X direction. The illustrated embodiment shows a valve repair device 602 with generally linear terms 3402 , 3404 that create a W-shaped mechanism, however, it is understood that the links 3402 , 3404 can take any suitable form that allows the valve repair device 602 as in 34A - 34B works. In embodiments in which the links 3402 , 3404 Taking nonlinear shapes (e.g., a curved shape), the valve repair device may not have a W-shaped mechanism, but the valve repair device may include similar connections such that the valve repair device may still be as shown in FIG 34A - 34B shown works.

The outer links 3404 can be brought into the illustrated, more open position in a number of different ways in the Z direction. For example, the outer links can be moved using any of the lock control assemblies described herein. For example, the movement of the outer links 3404 using any of the in 22nd - 26th lock control assemblies shown and / or any of the paddle control assemblies described herein. In one embodiment, referring to FIG 34C - 34D , a limb 3411 such at the pivot connection between the inner link 3402 and the connector 605 and at the pivot connection between the inner link 3402 and the outer link 3404 attached that movement of the connector 605 in direction Y causes a first end 3413 of the limb 3411 with the swivel connection 3475 rotates in direction M causing a second end to turn 3415 of the limb 3411 with the swivel connection 3477 rotates in direction N. The twist of the second end 3415 of the limb 3411 in direction N causes the outer link 3404 moved in direction Z to an open position.

For illustrative purposes, the in 34C - 34D embodiment shown a link 3411 for one of the paddles 606 However, it is understood that another link 3411 interacts with the other paddle in the same manner as previously described to cause the outer member to move 3404 of the other paddle is moved in the Z direction to an open position. According to an alternative embodiment, a four-bar chain can be used to hold the paddles 606 to move to an open position. According to an alternative embodiment, a suture thread can be detachably attached to the outer links 3404 the paddle 606 be attached and the suture can be controlled so that it the outer links 3404 the paddle 606 moved in direction Z to an open position.

According to certain embodiments, the valve repair device comprises 602 a biasing element 3410 (e.g. a spring) by means of which the inner links 3402 the paddle 606 attached to each other. The biasing element 3410 holds the inner links 3402 in a closed position (as in 34A and 34C shown) until the inner links 3402 with the cam element 3403 engage (as in 34B and 34D shown). The valve repair device 602 may include any other feature discussed in the present application for a valve repair device and the valve repair device 602 can be positioned to have valve tissue 820 as part of a suitable Valve repair system (e.g., any valve repair system disclosed in the present application).

With reference to 35A - 35B comprises another embodiment of a valve repair device 602 that is designed to leave a wide gap 3002 ( 30th ) between the front sail 3003 and the aft sail 3004 to close a W-shaped mechanism. In particular, includes the valve repair device 602 a connector 605 that is designed to run along a shaft 603 to be moved, and paddles 606 that are pivotable on the shaft and on the connector 605 are attached. The lower ends 3501 of every paddle 606 the valve repair device 602 are at the point A. pivotally connected to the shaft. Each of the paddles 606 comprises an intermediate element 3502 holding the paddles at the pivot point B. pivotable on the connector 605 attaches. With reference to 35A is the valve repair device 602 shown in a closed position. With reference to 35B causes the connector to move 605 in the Y direction that the intermediate elements 3502 the paddle 606 pivot in such a way that there is a lower end 3503 the intermediate elements 3502 extends in an outward direction X, causing the paddles to expand 606 move in direction Z to an open position. The valve repair device 602 may include any other feature discussed in the present application for a valve repair device and the valve repair device 602 can be positioned to have valve tissue 820 as part of a suitable valve repair system (e.g., any valve repair system disclosed in the present application).

With reference to 36A - 36B comprises another embodiment of a valve repair device 602 that is designed to leave a wide gap 3002 ( 30th ) between the front sail 3003 and the aft sail 3004 to close a W-shaped mechanism. In particular, includes the valve repair device 602 paddle 606 that are a concatenation 3602 have with which the paddle 606 pivotable on a shaft 603 the valve repair device 602 are attached. The concatenation 3602 includes an inner member 3603 and an outer link 3605 . The inner link 3603 is pivotable on the shaft 603 attached and pivotable on the outer link 3605 appropriate. The outer link 3605 is pivotable on the inner link 3603 attached and pivotable on the paddle 606 appropriate. The paddles 606 are also on one link 3608 the valve repair device 602 appropriate. A paddle control mechanism 610 is designed to use the swivel connection at point A. between the inner link 3603 and the outer link 3605 the concatenation 3602 move in direction Y, which causes the paddles to move 606 between an open position (as in 36B shown) and a closed position (as in 36A shown).

With further reference to 36A and 36B it goes without saying, although the paddle control mechanism is at the pivot connection point A. shown attached is the paddle control mechanism 610 also on any other or more of the members of the valve repair device 602 may be appropriate. For example, the paddle control mechanism 610 with the paddle 606 , the limb 3605 and / or the limb 3603 be coupled. The paddle control mechanism 610 may take any suitable form such as a control wire or any other form described in the present application. For example, the paddle control device 610 the shape of any of the in 6th - 8th and 22nd - 26th adopt gripper control devices shown. The valve repair device 602 may include any other valve repair device feature discussed in the present application.

With reference to 36C can the paddle control mechanism 610 the in 36A and 36B illustrated embodiment a coil 3620 and a leash 3622 (e.g., a suture, wire, etc.) and the line is attached to and wrapped around the spool. In this embodiment, creating an effect on the leash 3622 force acting in direction Z that moves the coil 3620 turns and the leash 3622 is unwound from the spool. In this embodiment it causes the spool to rotate 3620 that the paddle control mechanism 610 moves in direction Y and the valve repair device moves 602 (as in 36B shown) to the open position.

With reference to 36D - 36E comprises another embodiment of a valve repair device 602 that is designed to leave a wide gap 3002 ( 30th ) between the front sail 3003 and the aft sail 3004 to close, a semi-rigid, W-shaped mechanism. In particular, the valve repair device 602 a concatenation 3602 on with which the paddle 606 flexible on one shaft 603 the valve repair device 602 are attached. The concatenation 3602 includes a rigid inner member 3603 and a rigid outer link 3605 . The rigid inner link 3603 is by a flexible element or a flexible section 3613 flexible on the shaft 603 attached and is by a flexible member or section 3611 flexible on the rigid outer link 3506 attached and the rigid outer link 3506 is by a flexible element or a flexible section 3615 flexible on the paddle 606 appropriate. The paddles 606 are also by a flexible element or a flexible section 3617 flexible on one link 3608 the valve repair device 602 appropriate. The rigid limbs 3603 , 3605 can for example be made of steel or nitinol. The flexible elements 3611 , 3613 , 3615 , 3617 can for example be made of nitinol. A paddle control mechanism 610 is designed to use the swivel connection at point A. between the inner link 3603 and the outer link 3605 the concatenation 3602 move in direction Y, which causes the paddles to move 606 between an open position (as in 36D shown) and a closed position (as in 36C shown). The paddle control mechanism 610 may also be attached to any other or more of the members of the valve repair device. For example, the paddle control mechanism 610 with the paddle 606 , the limb 3605 and / or the limb 3603 be coupled. The paddle control mechanism 610 may take any suitable form such as a control wire or any other form described in the present application. For example, the paddle control device 610 the shape of any of the in 6th - 8th and 22nd - 26th adopt gripper control devices shown. The valve repair device 602 may include any other valve repair device feature discussed in the present application.

With reference to 37A - 37D comprises another embodiment of a valve repair device 602 that is designed to leave a wide gap 3002 ( 30th ) between the front sail 3003 and the aft sail 3004 to close, wireframe paddle 606 and an inside cam 3702 that is designed to use the lattice paddle 606 to push apart. The inside cam 3702 is so rotatable on the shaft 603 attached so that the cam is between a first position (in 37A - 37B shown) and a second position (in 37C - 37D shown) can be moved. 37B Fig. 3 is a plan view showing the inner cam 3702 in the first position shown along the lines B - B in 37A illustrated. 37D Fig. 3 is a plan view showing the inner cam 3702 in the second position shown along the lines D - D in 37C illustrated.

With reference to 37A and 37B occurs when the inner cam 3702 is in the first position, the inner cam not with the paddles 606 is engaged and the valve repair device is left in a closed position. With reference to 37C and 37D occurs when the inner cam 3702 in the second position, the inner cam with the paddles 606 engaged to move the paddles in an outward direction X to an open position. The valve repair device 602 is moved from the open position to the closed position by the inner cam 3702 is moved from the second position to the first position.

In some embodiments, referring to FIG 37E - 37F who have favourited paddles 606 of the valve repair device each have a flexible element or a flexible portion 3711 which bias the paddles towards the closed position or the open position. The flexible element or section 3711 can be designed to flex when off the cam 3702 is engaged to allow the paddle to move 606 move to the open position. The flexible element or section 3711 is also designed to extend the reach of the paddle 606 to widen when the paddles are in the open position. Any suitable other mechanism, such as a spring loaded mechanism, may also be used to bias the paddles toward the closed position and / or to extend the reach of the paddles 606 to widen when the paddles are in the open position. The valve repair device 602 may include any other feature discussed in the present application for a valve repair device and the valve repair device 602 can be positioned to have valve tissue 820 as part of a suitable valve repair system (e.g., any valve repair system disclosed in the present application). The lattice paddles 606 can be made of any suitable material supported by the inner cam 3702 expandable, such as nitinol, stainless steel, or any braided or electrospun material.

With reference to 38 - 39 can the mitral valve 3001 a patient a wide gap in certain situations 3002 between the forward sail 3003 and the aft sail 3004 when the mitral valve is in a closed position (ie, during the systolic phase). For example, the gap 3002 have a width W between approximately 2.5 mm and approximately 17.5 mm, in particular between approximately 5 mm and approximately 15 mm, in particular between approximately 7.5 mm and approximately 12.5 mm, in particular approximately 10 mm. In some situations, the gap can 3002 have a width W of more than 15 mm. In any of the situations noted above, it is desirable to have a valve repair device that fills a sufficient volume to allow the gap to be opened 3002 closes or inflates without putting a great deal of stress on the sails 3003 , 3004 exercise. For example, the valve repair device can be a spacer 3800 include.

With reference to 39 is the spacer element in certain embodiments 3800 such on the valve repair device 602 appropriate that when the paddle 606 and the gripping elements 608 the valve repair device 602 on the mitral valve 3001 attach the spacer 3800 in the gap 3002 between the forward sail 3003 and the aft sail 3004 is arranged. The spacer 3800 can be made from any suitable material such as wire mesh, cloth, biocompatible material, foam, pericardial tissue, any material disclosed herein, etc.

With reference to 40A - 40B comprises an exemplary embodiment of a valve repair device 602 a spacer 3800 on that to the shaft 603 is attached to the valve repair device. The spacer 3800 can, as illustrated here, over the outer edges 4001 the gripping elements 3800 extend beyond to provide additional surface area to close the gap 3002 ( 38 - 39 ) a mitral valve 301 to provide. According to an alternative embodiment, the connecting piece 605 the shape of the spacer 3800 accept. That is, a single element can act as a connector 605 which causes the paddle to move 606 move between the open and closed positions, and act as a spacer 3800 which is the gap between the sails 3003 , 3004 closes when the valve repair device 602 attached to the sails. The valve repair device 602 may include any other feature discussed in the present application for a valve repair device and the valve repair device 602 can be positioned to have valve tissue 820 as part of a suitable valve repair system (e.g., any valve repair system disclosed in the present application).

With reference to 42A - 42C can that in 40A - 40B shown spacer 3800 take a variety of different forms. With reference to 42A includes an exemplary embodiment of a spacer element 3800 a base body 4210a that is between the gripping elements 608 and over the edges 4201 extending beyond the gripping elements, and extension portions 4212a that differ from the main body 4210a extend. The extension sections 4212a allow sections of the gap 3002 ( 38 - 39 ) the mitral valve between the anterior leaflet 3003 and the aft sail 3004 that is adjacent to the valve repair device 602 are filled when the valve repair device is in a closed position. Namely, if a valve repair device 602 When attached to a mitral valve to prevent regurgitation of blood through the mitral valve, the portions of the mitral valve located adjacent the valve repair device may include openings from the tissue of the mitral valve that extend around the valve repair device. The extension sections 4212a are designed to be adjacent to the valve repair device 602 to fill or plug located openings. According to the illustrated embodiment, the length is L of the extension portions 4212a larger than the width W of the extension portions.

With reference to 42B includes another exemplary embodiment of a spacer 3800 a base body 4210b that is between the gripping elements 608 extends, and extension sections 4212b that differ from the main body 4210b extend. According to the illustrated embodiment, the extension portions 4212b a semicircular shape. The extension sections 4212b are designed to fill the openings formed in the tissue of the mitral valve extending around the valve repair device adjacent the valve repair device 602 surrender.

With reference to 42C includes another exemplary embodiment of a spacer 3800 a main basic arrangement 4210c between the gripping elements 608 , first extension sections 4212c that differ from the main body 4210c extend, and second extension sections 4214c extending from the first extension sections 4212c extend, extend. According to the illustrated embodiment, the first extension sections 4212c have a semicircular shape and have the second extension portions 4214c a length L which is greater than its width W. The extension sections 4212b are designed to fill the openings formed in the tissue of the mitral valve extending around the valve repair device adjacent the valve repair device 602 surrender.

With reference to 41A - 41D FIG. 4 shows another exemplary embodiment of a valve repair device 602 a spacer 3800 on that on the gripping elements 608a , 608b is attached to the valve repair device. The spacer 3800 includes a first section 4102 on a gripping element 608a attached, and a second section 4104 on the other gripping element 608b is appropriate. With reference to 41C is the valve repair device 602 shown in the closed position. When the valve repair device 602 is in the closed position, kick the first section 4102 of the spacer 3800 and the second section 4104 of the spacer 3800 engage with each other and surround the shaft 603 (like this in 41B shown). With reference to 41D is the valve repair device 602 shown in the open position, with the first section 4102 of the spacer 3800 with the gripping element 608a moves and the second section moves 4104 of the spacer 3800 with the gripping element 608b emotional. A spacer 3800 with multiple sections 4102 , 4104 makes the gripping elements 608a , 608b movable to the width of the opening between the paddles 606 and to adapt the gripping elements when attaching the valve repair device 602 to the valve tissue 820 is beneficial. With reference to 41B the spacer extends 3800 as illustrated here, over the outer edges 4001 the gripping elements 3800 addition to an additional surface area to fill in the gap 3002 ( 38 - 39 ) a mitral valve 301 to provide. The valve repair device 602 may include any other valve repair device feature discussed in the present application and the Valve repair device 602 can be positioned to have valve tissue 820 as part of a suitable valve repair system (e.g., any valve repair system disclosed in the present application).

With reference to 43A - 43C can that in 41A - 41D shown spacer 3800 take a variety of different forms. With reference to 43A includes an exemplary embodiment of a spacer element 3800 a base body in a closed position 4310a that is between the gripping elements 608 and over the edges 4201 extending beyond the gripping elements, and extension portions 4312a that differ from the main body 4310a extend. The extension sections 4312a allow sections of the gap 3002 ( 38 - 39 ) the mitral valve between the anterior leaflet 3003 and the aft sail 3004 that is adjacent to the valve repair device 602 are filled when the valve repair device is in a closed position. Namely, if a valve repair device 602 is attached to a mitral valve to prevent regurgitation of blood through the mitral valve, portions of the mitral valve adjacent to the valve repair device may have tissue openings in the mitral valve extending around the valve repair device. The extension sections 4312a are designed to be adjacent to the valve repair device 602 to fill the openings. According to the illustrated embodiment, the length is L of the extension portions 4312a larger than the width W of the extension portions.

With reference to 43B includes another exemplary embodiment of a spacer 3800 a base body in the closed position 4310b that is between the gripping elements 608 extends, and extension sections 4312b that differ from the main body 4310b extend. According to the illustrated embodiment, the extension portions 4312b a semicircular shape. The extension sections 4312b are designed to fill the openings formed in the tissue of the mitral valve extending around the valve repair device adjacent the valve repair device 602 surrender.

With reference to 43C includes another exemplary embodiment of a spacer 3800 a main basic arrangement 4310c between the gripping elements 608 , first extension sections 4312c that differ from the main body 4310c extend, and second extension sections 4314c extending from the first extension sections 4312c extend, extend. According to the illustrated embodiment, the first extension sections 4312c have a semicircular shape and have the second extension portions 4314c a length L which is greater than its width W. The extension sections 4312b are designed to fill the openings formed in the tissue of the mitral valve extending around the valve repair device adjacent the valve repair device 602 surrender.

With reference to 44A - 44B is an expandable spacer in certain embodiments 3800 integral with the valve repair device 602 educated. The expandable spacer 3800 is designed to expand while the paddles 606 close (as in 44 shown). With reference to 44A is the valve repair device 602 in an open position so that valve tissue is in the opening 614 between the expandable spacer 3800 and the paddles 606 can be included. With reference to 44B is the valve repair device 602 in the closed position in which the paddles are 606 and the extended spacer 3800 are engaged to secure the valve repair device to the valve tissue. When the spacers 3800 and the paddles 606 are engaged, the spacer expands 3800 to have a larger surface area to close the gap 3002 ( 38 ) between the front sail 3003 and the aft sail 3004 a mitral valve 3001 to provide. According to the illustrated embodiment, the valve repair device takes 602 the shape of the valve repair device 602 in 35A - 35B at. However, any valve repair device described in the present application can be used 602 an expandable spacer 3800 exhibit. The valve repair device 602 may include any other feature discussed in the present application for a valve repair device and the valve repair device 602 can be positioned to have valve tissue 820 as part of a suitable valve repair system (e.g., any valve repair system disclosed in the present application).

With reference to 45A - 46D needs the valve repair device in certain situations 602 detached from the body's own valve and removed from the patient's body. In these situations it is advantageous to have a valve repair device that can be flattened and placed (in a release position) such that the valve repair device can be more easily removed from the patient's body without affecting the valve tissue of a patient's heart. With reference to 45A - 45C comprises the basic arrangement 604 an exemplary embodiment of a valve repair device 602 : a first link 4521 that extends from point A to point B. extends a second limb 4522 that stands out from point A. extends to point C, a third link 4523 that extends from point B to point D is a fourth link 4524 that extends from point C to point E. extends, and a fifth link 4525 that extends from point D to point E. extends. A connector 605 is movable on a shaft 603 attached and the shaft 603 is on the fifth link 4525 fixed. The first link 4521 and the second link 4522 are at point A. pivotable on the connector 605 attached so that movement of the connector 605 along the shaft 603 the location of the point A. moves and consequently the first link 4521 and the second link 4522 emotional. The first link 4521 and the third link 4523 are pivotally attached to each other at point B and the second link 4522 and the fourth link 4524 are pivotably attached to each other at point C. A paddle 606a is such on the first link 4521 appropriate that movement of the first limb 4521 causes the first paddle 606a moves, and the other paddle 606b is such on the second link 4522 attached that movement of the second limb 4522 causes the paddle to move 606b emotional.

To the valve repair device 602 from the closed position (in 45A shown) in the release position (in 45C shown) will move the connector 605 in direction Y the shaft 603 moved along, creating the pivot point A. for the first link 4521 and the second link 4522 is moved into a new position. With reference to 45A is the valve repair device 602 shown in a closed position with an angle α between the paddle 606 and the shaft 603 . The angle α can for example be between approximately 0 degrees and approximately 45 degrees, in particular between approximately 5 degrees and approximately 40 degrees, in particular between approximately 15 degrees and approximately 30 degrees, in particular between approximately 20 degrees and approximately 25 degrees. With reference to 45B becomes the valve repair device 602 moved to the open position by the connector 605 along the shaft 603 is moved in the Y direction. One movement of the connector 605 in direction Y causes the first link 4521 so around the point A. is swung around that the first link 4521 and the second link 4522 move outward in direction Y, causing the paddles to move 606a , 606b in the direction H move down and out. With reference to 45C becomes the valve repair device 602 moved into the release position by the connector 605 along the shaft 603 is moved further in direction Y. The continued movement of the connector 605 in direction Y causes the first link 4521 and the second link 4522 move inward in direction M, causing the paddles to move 606a , 606b move in direction N down and in. With further reference to 45C has the valve repair device 602 in a release position an angle β between the paddles 606 and the shaft 603 on. The angle β can for example be greater than or equal to 120 degrees, in particular greater than or equal to 130 degrees, in particular greater than or equal to 140 degrees, in particular greater than or equal to 150 degrees, in particular greater than or equal to 160 degrees.

With reference to 46A - 46D comprises the basic arrangement 604 another exemplary embodiment of a valve repair device 602 : a first link 4621 that stands out from point A. extends to point B, a second link 4622 that stands out from point A. extends to point C, a third link 4623 that extends from point B to point D is a fourth link 4624 that extends from point C to point E. extends a fifth link 4625 that extends from point D to point F, and a sixth link 4626 that stands out from point E. extends to point F. A connector 605 is movable on a shaft 603 attached and the shaft 603 is at point F on the fifth link 4625 and the sixth link 4626 appropriate. The first link 4621 and the second link 4622 are at point A. pivotable on the connector 605 attached so that movement of the connector 605 along the shaft 603 the location of the point A. moves and consequently the first link 4621 and the second link 4622 emotional. The fifth link 4625 and the sixth link 4626 are pivotally mounted on the shaft at point F such that movement of the shaft moves the location of point F and consequently the fifth link 4625 and the sixth link 4626 emotional. A locking element 4631 is designed to be the fifth link 4625 and the sixth link 4626 at point F so selectively to lock on the shaft that the fifth link 4625 and the sixth link 4626 relative to the shaft 603 are not pivotable when the locking element 4631 is in the locked position. When the locking element 4631 however, in the unlocked position are the fifth link 4625 and the sixth link 4626 around the shaft 603 pivotable around when the shaft moves the location of point F. The first link 4621 and the third link 4623 are pivotally attached to each other at point B and the second link 4622 and the fourth link 4624 are pivotably attached to each other at point C. A paddle 606a is such on the first link 4621 appropriate that movement of the first limb 4621 causes itself the first paddle 606a moves, and the other paddle 606b is such on the second link 4622 attached that movement of the second limb 4622 causes the paddle to move 606b emotional.

To the valve repair device 602 from the closed position (in 46A shown) in a release position (in 46C shown), the locking element 4631 held in a locked position and becomes the connector 605 in direction Y the shaft 603 moved along, creating the pivot point A. for the first link 4621 and the second link 4622 is moved into a new position. To the valve repair device 602 from the release position to the folded release position (in 46D shown), the locking element 4631 moved to an unlocked position and the shaft 603 is going towards D. moved, creating the pivot point F for the fifth link 4625 and the sixth link 4626 is moved into a new position which causes the fifth link 4625 and the sixth link 4626 around the shaft 603 be swiveled around.

With reference to 46A is the valve repair device 602 shown in a closed position with an angle α between the paddle 606 and the shaft 603 . The angle α can for example be between approximately 0 degrees and approximately 45 degrees, in particular between approximately 5 degrees and approximately 40 degrees, in particular between approximately 15 degrees and approximately 30 degrees, in particular between approximately 20 degrees and approximately 25 degrees. With reference to 46B becomes the valve repair device 602 moved to the open position by the connector 605 along the shaft 603 is moved in the Y direction. One movement of the connector 605 in direction Y causes the first link 4621 and the second link 4622 move outward in direction Z, causing the paddles to move 606a , 606b in the direction H move down and out. The locking element 4631 is held in the locked position when the valve repair device 602 from the closed position (in 46A shown) to the open position (in 46B shown) is moved.

With reference to 46C becomes the valve repair device 602 moved into the release position by the connector 605 along the shaft 603 is moved further in direction Y. The continued movement of the connector 605 in direction Y causes the first link 4621 and the second link 4622 move inward in direction M, causing the paddles to move 606a , 606b move in direction N down and in. With further reference to 45C has the valve repair device 602 in a release position an angle β between the paddles 606 and the shaft 603 on. The angle β can for example be greater than or equal to 120 degrees, in particular greater than or equal to 130 degrees, in particular greater than or equal to 140 degrees, in particular greater than or equal to 150 degrees, in particular greater than or equal to 160 degrees. The locking element 4631 is held in the locked position when the valve repair device 602 from the open position (in 46B shown) in the release position (in 46C shown) is moved.

With reference to 46D becomes the valve repair device 602 moved from the release position to the folded position by the locking element 4631 is moved to an unlocked position and removing the stem 603 in the direction D. is moved, causing the fifth link to move 4625 and the sixth link 4626 pivots about connection point F and moves upward in direction J causing the third link to move 4623 and the fourth link 4624 move in and down in direction Q, causing the paddles to move 606a , 606b move in direction Q down and in. With further reference to 46D has the valve repair device 602 in the folded release position an angle µ between the paddles 606 and the shaft 603 on. The angle μ can be greater than or equal to 120 degrees, in particular greater than or equal to 130 degrees, in particular greater than or equal to 140 degrees, in particular greater than or equal to 150 degrees, in particular greater than or equal to 160 degrees, in particular greater than or equal to 170 degrees.

It is advantageous to have a valve repair device that has features that ensure that the valve repair device remains in a closed position after the valve repair device is attached to a patient's own valve. In other words, it is advantageous to have a valve repair device that has features that prevent the valve repair device from becoming detached from a patient's own valve after the valve repair device has been inserted into the patient's body, which could cause problems (e.g. B. regurgitation of blood through the mitral valve). Examples of further features which prevent a valve repair device from becoming detached from an endogenous valve are shown in FIG 47A - 49 shown.

With reference to 47A - 47B includes an exemplary embodiment of a valve repair device 602 a locking element 4701 that on the paddles 606 is attached, the locking element 4701 for this is designed the paddle 606 on the gripping elements 608 to be installed with the valve repair device in the closed position. The valve repair device 602 may include any other feature discussed in the present application for a valve repair device and the valve repair device 602 can be positioned to have valve tissue 820 as part of a suitable valve repair system (e.g., any valve repair system disclosed in the present application). In the illustrated embodiment, the valve repair device comprises 602 an optional locking lock 607 that is designed to be a connector 605 in a locked state on the shaft 603 to keep. If, however, the optional locking lock 607 if the connector fails, the connector could become damaged 605 on the shaft 603 move and cause the valve repair device to move to an open position. The locking element 4701 is designed to use the valve repair device 602 to hold in the closed position in case the lock lock 607 fails.

With reference to 47A is the valve repair device 602 in an open position, with valve tissue 820 in the opening 614 between the paddles 606 and the gripping elements 608 is arranged. With reference to 47B is the valve repair device 602 has been moved to the closed position so that the valve tissue 820 between the paddles 606 and the gripping elements 608 is attached to the valve repair device. The valve repair device 602 can be moved to the closed position in any suitable manner, for example in any manner described in the present application. When the valve repair device 602 has been moved to the closed position pierces the locking element 4701 the valve tissue 820 and the gripping element 608 to attach the paddle to the gripping element. The locking element 4701 can take any suitable form, such as metals, plastics, etc., capable of making the paddles 606 on the gripping elements 608 to fix.

With reference to 48 includes another exemplary embodiment of a valve repair system 600 a feeding device 601 and a valve repair device 602 wherein the delivery device is adapted to deliver the valve repair device to a patient's own valve, and wherein the valve repair device is adapted to be attached to the leaflets of an endogenous valve to thereby repair the patient's own valve. The feeding device 601 may take any suitable form, such as that described in the present application, capable of serving the valve repair device 602 to a patient's own valve. The valve repair device 602 comprises a basic arrangement 604 , a pair of paddles 606 and a pair of gripping elements 608 . The basic arrangement 604 the valve repair device 602 has a shaft 603 and a connector 605 that is designed to move along the shaft. The connector 605 is mechanically connected to the paddles such that movement of the connector along the shaft 603 causes the paddles to move between open and closed positions. In the closed position, the paddles kick 606 and the gripping elements 608 with the valve tissue and with each other to provide the valve repair device 602 to attach to the valve fabric. The valve repair device 602 also includes a biasing element 4807 (e.g. a spring) designed to hold the connector 605 bias against the stem such that the valve repair device 602 is in a closed position.

According to certain embodiments, the valve repair system comprises 600 a positioning body 613 , which is removable on the shaft 603 the basic arrangement 604 the valve repair device 602 is appropriate. After the valve repair device 602 has been attached to the valve tissue, the positioning shaft 613 from the shaft 603 removed to the valve repair device 602 from the valve repair system 600 take off, leaving the valve repair device 602 can remain attached to the valve tissue and the feed device 601 can be removed from the patient's body. After the valve repair device 602 has been attached to the valve tissue and the valve repair system 600 has been removed from the patient's body holds the biasing element 4807 the valve repair device in a closed position to prevent the valve repair device from becoming detached from the valve tissue. The valve repair device 602 may include any other feature discussed in the present application for a valve repair device and the valve repair device 602 can be positioned to have valve tissue 820 as part of a suitable valve repair system (e.g., any valve repair system disclosed in the present application).

With reference to 49 includes another exemplary embodiment of a valve repair system 600 a feeding device 601 and a valve repair device 602 wherein the delivery device is adapted to deliver the valve repair device to a patient's own valve, and wherein the valve repair device is adapted to be attached to the leaflets of an endogenous valve to thereby repair the patient's own valve. The feeding device 601 may take any suitable form, such as that described in the present application, capable of serving the valve repair device 602 to a patient's own valve. The valve repair device 602 comprises a basic arrangement 604 , a pair of paddles 606 and a pair of gripping elements 608 . The basic arrangement 604 the valve repair device 602 has a shaft 603 and a connector 605 that is designed to move along the shaft. According to the illustrated embodiment, the shaft comprises 603 a threaded section 4902 and the connector 605 is designed to get the threaded section 4902 to move along the shaft. That is, by turning the shaft 603 will cause the connector 605 the shaft 603 moves up and down. The connector 605 is mechanically connected to the paddles such that movement of the connector along the shaft 603 causes the paddles to move between open and closed positions. In the closed position, the paddles kick 606 and the gripping elements 608 with the valve tissue and with each other to provide the valve repair device 602 to attach to the valve fabric.

According to certain embodiments, the valve repair system comprises 600 a positioning body 613 , which is removable on the shaft 603 the basic arrangement 604 the valve repair device 602 is appropriate. After the valve repair device 602 has been attached to the valve tissue, the positioning shaft 613 from the shaft 603 removed to the valve repair device 602 from the valve repair system 600 take off, leaving the valve repair device 602 can remain attached to the valve tissue and the feed device 601 can be removed from the patient's body. After the valve repair device 602 has been attached to the valve tissue and the valve repair system 600 has been removed from the patient's body, detachment of the valve repair device from the valve tissue is prevented, since the connecting piece is only activated by rotating the shaft 603 can be moved. The valve repair device 602 may include any other feature discussed in the present application for a valve repair device and the valve repair device 602 can be positioned to have valve tissue 820 as part of a suitable valve repair system (e.g., any valve repair system disclosed in the present application).

With reference to 50 - 54 include embodiments of valve repair systems 600 a feeding device 601 and a valve repair device 602 wherein the delivery device is adapted to deliver the valve repair device to a patient's own valve, and wherein the valve repair device is adapted to be attached to the leaflets of an endogenous valve to thereby repair the patient's own valve. The feeding device 601 may take any suitable form, such as that described in the present application, capable of serving the valve repair device 602 to a patient's own valve. The valve repair device 602 is similar to the valve repair devices described above and includes a base assembly 604 , a pair of paddles 606 and a pair of gripping elements 608 . The basic arrangement 604 the valve repair device 602 has a shaft 603 and a connector 605 that is designed to move along the shaft. The connector 605 is mechanically connected to the paddles such that movement of the connector along the shaft 603 causes the paddles to move between open and closed positions. According to some embodiments, the valve repair device comprises 602 a locking lock 607 that is designed to be the connector 605 to be locked in a desired position on the shaft (as in 50 - 53B shown). According to alternative embodiments, the valve repair device comprises 602 a biasing element 4807 that is designed to be the connector 605 in a desired position on the shaft 603 hold in position (as in 54 shown). In the closed position, the paddles kick 606 and the gripping elements 608 with the valve tissue and with each other to provide the valve repair device 602 to attach to the valve fabric. According to certain embodiments, the valve repair system comprises 600 a positioning body 613 , which is removable on the shaft 603 the basic arrangement 604 the valve repair device 602 is appropriate. After the valve repair device 602 has been attached to the valve tissue, the positioning shaft 613 from the shaft 603 removed to the valve repair device 602 from the valve repair system 600 take off, leaving the valve repair device 602 can remain attached to the valve tissue and the feed device 601 can be removed from the patient's body. The valve repair device 602 may include any other feature discussed in the present application for a valve repair device and the valve repair device 602 can be positioned to have valve tissue 820 as part of a suitable valve repair system (e.g. B. . any valve repair system disclosed in the present application).

With reference to 50 are, according to some embodiments, the gripping elements 608 on the paddles 606 appropriate. The in 50 illustrated example include the gripping elements 608 an attachment portion 5010 , a hinge or bending section 5012 and a grasping or spike portion 5014 . The attachment section 5010 can take any form that would permit attachment of the gripping element to the paddle 606 allowed. The hinge or bending section 5012 can take many different forms. For example, the hinge or bending section can be designed for the gripping or spike section 5014 to the attachment portion 5010 to pretension. According to an exemplary embodiment, the hinge or bending section tensions 5012 the grasping or sting section 5014 to a fully closed position in which the grasping or spike portion with the attachment portion 5010 and / or the paddle 606 intervenes. If flap tissue between the paddle 606 and the gripping section 5014 is positioned, the hinge or bending portion tensions the gripping portion 5014 in front of the valve tissue between the grasping or spine section 5014 and clamp the paddle. That through 50 illustrated gripping element 608 moves together with the paddle 606 . The hinge or bending section 5012 allows the gripping section 5014 in by the arrows 5020 direction indicated moves, and may allow the gripping portion in the direction indicated by the arrows 5022 indicated direction is pulled.

According to certain embodiments, it is advantageous if the section provided with spikes 609 to a proximal end of the gripping elements 608 is arranged towards, as this makes it easier to detach the gripping elements 608 is made possible by the valve tissue. With reference to 51 comprise, according to one embodiment, the gripping elements 608 a single row of spines 5102 that are designed to work with the valve tissue and the paddles 606 to engage to secure the valve repair device to the valve tissue. The single row of spines 5102 facilitates the detachment of the gripping section 5014 from the valve tissue. According to an alternative embodiment, the gripping elements 608 also two or more rows of spines 5102 include at a proximal end of the gripping elements 608 are arranged. According to further embodiments, the spines 5102 also in any other configuration at a proximal end of the gripping elements 608 be arranged to facilitate detachment of the gripping elements 608 to allow from the valve tissue.

According to some embodiments, as shown in FIG 51A - 51E shown the gripping element 608 designed to apply tension to the valve tissue when the valve repair device (e.g., any valve repair device described in the present application 602 ) is attached to the valve tissue. The gripping element 608 can be moved with the paddle 606 connected that the gripping element 608 can be moved along the paddle in direction X. For example, a gripper control mechanism 611 to be used, the gripping element 608 along the paddle 606 to move in direction X, the gripper control mechanism 611 can also be used for the gripping element 608 between the closed position (in 51A shown) and the open position (in 51B shown) to move. The gripper control mechanism 611 can take any form described in the present application. According to certain embodiments, the valve repair device comprises 602 an optional biasing element 5122 (e.g. a spring) designed to hold the gripping element 608 in a desired position along the paddle 606 (e.g. in the in 51A - 51E position shown) in position. According to the illustrated embodiment, the gripping element comprises 608 a single row of spines 609 at a proximal end of the gripping elements (as e.g. in the in 51 shown embodiment of the valve repair device 602 is shown), however, it is to be understood that the here in relation to 51A - 51E features described can be used with any of the embodiments of the valve repair device described in the present application.

With reference to 51A is the gripping element 608 in a first position on the paddle 606 and shown in a closed position. With reference to 51B is the gripping element 608 shown after it through the gripper control mechanism 611 has been moved in the Z direction to an open position. With reference to 51C is the gripping element 608 shown after it along the paddle 606 has been moved in direction D to a second position. According to certain embodiments, the gripping element 608 by the gripper control mechanism 611 or moved along the paddle in direction D by a separate mechanism. In embodiments which the biasing element 5122 must have sufficient force on the gripping element 608 be used to move the gripping element in direction D, whereby the pretensioning element is stretched and a tensioning force acting in direction B is applied to the gripping element 608 generated. It is true that the illustrated embodiment shows how the gripping element 608 to an open position (in 51B shown) is moved before the gripping element 608 along the paddle 606 in direction D to the second position (in 51C shown) is moved, but it is understood that the gripping element 608 can just as well be moved in the direction D into the second position before the gripping element 608 is moved in direction Z into an open position, or these movements can also take place simultaneously. With reference to 51D becomes the gripping element 608 by the gripper control mechanism 611 moved in direction Y to a closed position around the spiked section 609 of the gripping element 608 to attach to the valve fabric (not shown). In the in 51D The position shown is the biasing element 5122 held in a stretched position (e.g., due to the force exerted by the gripper control mechanism (or some other mechanism) on the gripping element 608 is exerted to hold the gripping element in the second position), which means that the biasing element 5122 a clamping force acting in direction B on the gripping element 608 exercises. With reference to 51 E. will after the spiked section 609 of the gripping element 608 has been attached to the valve tissue, the force exerted by the grasping element 608 holds in the second position, thereby causing the by the biasing element 5122 applied clamping force the gripping element 608 along the paddle 606 moved in direction M. The movement of the gripping element 608 in direction M causes the spiked section 609 a tension force acting in direction T is generated on the valve tissue. This tensioning force exerted on the valve tissue enables the valve repair device to be kept securely connected 602 with the valve tissue.

According to another embodiment, as in FIG 51F - 51G shown the gripping element 608 a spiked section 609 and a less developed portion or bending portion 5103 . The spiked section 609 is on a first page 5111 of the less developed section 5103 arranged. According to the illustrated embodiment, the spiked portion comprises 609 a single row of spines, however, it should be understood that any configuration of spines can be used, such as any configuration described in the present application. In the case of the less developed section or bending section 5103 it can, for example, be a recess in the gripping element, one compared to the rest of the gripping element 608 be different material or any other shape that allows the weaker formed portion or bending portion 5103 weaker or more flexible than the rest of the gripping element 608 is. According to other embodiments, however, a weaker section or bending section can be used 5103 can also be omitted and the link described below 5107 including leash 5105 is still able to cut the spiked section as in 51 F. - 51H illustrates bending.

With reference to 51F - 51H includes the gripper control mechanism 611 a leash 5105 (e.g. a suture) and a push and pull link 5107 that is designed to hold the leash 5105 record. For example, it can be the push and pull member 5107 around a catheter, a wire with a loop (as in 25A shown) or any other link capable of pulling the leash 5105 take up and the gripping element 608 to push or pull. A first ending 5125 the leash 5105 extends from a feeder (e.g. any feeder described in the present application 601 ) and is releasable on the gripping element 608 attached to a first connection point A. on a first page 5111 of the less developed section or bending section 5103 . The leash 5105 also extends from the connection point A. and is on a second page 5113 of the less developed section or bending section 5103 at a second connection point B. on the gripping element 608 appropriate. In addition, the leash extends 5105 from the second connection point B. by the push and pull link 5107 .

With reference to 51F is the gripping element 608 shown in an open position, wherein a valve fabric element 820 in an opening 614 between the gripping element 608 and a paddle (not shown) is arranged. By pulling on the leash 5105 the gripping element can be moved to the open position. With reference to 51G become the link 5107 and the limb 5105 the gripper control mechanism 611 used the gripping element 608 in direction X to move to the closed position and the section 609 to bend towards Y. The first ending 5125 the leash 5105 is pulled in a direction Y such that the first side 5111 of the gripping element 608 around the less developed section 5103 is swung around or bent. This bending causes the spiked section 609 moved in the U and Y directions to a bent position. With further reference to 51G become the link 5107 and the leash 5105 moved so that the spiked portion 609 the valve tissue 820 punctures while the spiked portion is in the flexed position.

With reference to 51H becomes the leash 5105 released, which causes the first end 5111 of the gripping element 608 around the weaker formed section or bending section 5103 is swung around. This causes the spiked section 609 through the valve tissue 820 moved therethrough causing the spiked portion 609 the valve repair device exerts a tension force acting in direction D on the valve tissue 820 generated. After the gripping element 608 on the valve tissue 820 (as in 51H shown) will be the limb 5107 and the leash 5105 of the gripping element 608 away.

With reference to 52 comprise the gripping elements according to various embodiments 608 a stretchable section 5202 to move towards 5204 to enable. The movement towards 5204 ensures a clean detachment from the valve tissue. According to some embodiments, the stretchable portion is 5202 designed to be moved in such a way that the spines 5102 emerge from the valve tissue in a direction which is essentially opposite to the direction in which the spines have penetrated the valve tissue. Alternatively, the gripping elements 608 also be expandable in other ways in order to ensure detachment from the valve tissue without tearing the valve tissue. For example, as mentioned above, the hinge elements 5012 be designed to allow the gripping sections 5014 the gripping elements 608 in the direction 5204 to be pulled.

With reference to 53A - 53B are, according to some embodiments, the gripping elements 608 made of a flexible material. With reference to 53A is the valve repair device 602 in a closed position and on the valve tissue 820 shown attached. With reference to 53B become the gripping elements 608 by the gripper control mechanism 611 moved to the gripping elements 608 from the valve tissue 820 to remove. In particular, it causes the movement of the gripper control mechanism 611 in the Y direction that the gripping elements 608 step out of the valve tissue again in a peeling movement in the Z direction. The flexible material of the gripping elements 608 ensures this peeling release of the gripping elements 608 when the gripping elements from the valve tissue 820 removed. The peeling loosening of the gripping elements 608 is advantageous in that it occurs when pulling the gripping elements out of the valve tissue 820 has a supportive effect so that there is no damage to the valve tissue. According to certain embodiments, the flexible gripping elements make it possible 608 that the spiked section 609 the gripping elements 608 is removed from the valve tissue in a direction which is substantially opposite to the direction in which the spines have penetrated the valve tissue.

With reference to 54 are, according to certain embodiments, the gripping elements 608 by a separate preload element 5410 Connected to each other (e.g. by a spring), which is designed to hold the gripping elements in a desired position so that when the paddles 606 are in an open position, there is a width W between the paddles and the gripping elements. The width W can be adjusted by engaging the gripping elements 608 with the gripper control mechanism 611 be adjusted. That is, the movement of the gripper control mechanism 611 in direction Z into the feed device causes the pretensioning element 5410 bends and the paddles move in the X inward direction. The disengagement of the gripping elements by the gripper control mechanism 611 causes the biasing element 5410 (as in 54 shown) moved to the desired position. The gripper control mechanism 611 can be any suitable form for controlling the gripping elements 608 take, for example, any form described in the present application. In addition, when kicking the paddle 606 moved into the closed position, the paddles with the gripping elements 608 into engagement, causing the biasing elements to flex and the gripping elements to move in the inward direction X. The paddles 608 can be moved from the open position to the closed position in any suitable manner, for example in any manner described in the present application. Although the devices described in the present application relate to engaging and repairing the mitral valve, it is understood that these devices can also be used in repairing other endogenous valves (e.g. the tricuspid valve, the pulmonary valve, the aortic valve) or any other part of the heart can be used. In addition, it goes without saying that various features of the various embodiments for the devices described here can also be used in combination with one another.

While the preferred embodiments of the invention have been fully described, various alternatives, modifications, and equivalents may be used. Moreover, it is obvious that certain other modifications can also be implemented within the scope of the attached patent claims.

Claims (24)

A valve repair system (600) for repairing an autologous valve of a patient during a non-open heart procedure, the valve repair system (600) comprising: a valve repair device (602) for attachment to an autologous valve of a patient, the valve repair device (602) comprising : a pair of paddles (606a, 606b) movable between an open position and a closed position; a first gripping element (608a) and a second gripping element (608b), wherein the paddles (606a, 606b) and the gripping elements (608a, 608b) are arranged so that openings (614a, 614b) between the paddles (606a, 606b) and the gripping elements (608a, 608b) are present, in which at least portions of the patient's own valve can be received; a gripper control mechanism (611) for moving the first and second gripping elements (608a, 608b) independently of one another, characterized in that the gripper control mechanism (611) comprises a single line (2302), such as a suture or wire, which is releasably attached to the first and second gripping elements (608a, 608b), the single line (2302) being releasably fixed to the valve repair system (600) at a connection point (615) between the first gripping element (608) and the second gripping element (608) and wherein movement of a first portion (2303) of the single line (2302) adjusts a width of the opening (614a) between the first gripping element (608a) and the first paddle (606a), but not a width of the opening (614b) between the second gripping member (608b) and the second paddle (606b), and wherein movement of a second portion (2305) of the single line (2302) intermediate the width of the opening (614b) the second gripping element (608b) and the second paddle (606b), but not adjusting the width of the opening (614a) between the first gripping element (608a) and the first paddle (606a). Valve repair system (600) Claim 1 further comprising a base assembly (604) comprising: a shaft (603); and a connector (605) movably attached to the shaft (603) such that the connector (605) can be moved along the shaft (603); wherein the pair of paddles (606a, 606b) are pivotally attached to the connector (605); wherein movement of the connector (605) in a first direction along the shaft (603) causes the pair of paddles (606a, 606b) to move to the closed position and causes movement of the connector (605) in a second direction that the pair of paddles (606a, 606b) move to the open position. Valve repair system (600) Claim 2 further comprising a positioning shaft (613) detachably attached to the shaft (603) of the base assembly (604) of the valve repair device (602). Valve repair system (600) according to one of the Claims 2 to 3 , wherein the valve repair device (603) further comprises a locking lock (607) which is movable between a locked state and an unlocked state, wherein the locking lock (607) is adapted to hold the connecting piece (605) in a fixed position on the shaft ( 603) when the lock (607) is in the locked state. Valve repair system (600) Claim 4 , further comprising a lock lock control mechanism (612) for moving the lock lock (607) between the locked state and the unlocked state. Valve repair system (600) according to one of the Claims 1 to 5 wherein the first and second gripping elements (608a, 608b) each comprise a spiked portion (609) for attaching the first and second gripping element (608a, 608b) to a patient's endogenous valve. Valve repair system (600) according to one of the Claims 1 to 6th wherein the single line (2302) is between a paddle control mechanism (610) of the valve repair system (600) and a connector (605) of the valve repair device (602) adapted to interact with the pair of paddles (606a, 606b) , is releasably attached to the valve repair system (600), and wherein the single line (2302) is released when the paddle control mechanism (610) is removed from the connector (605). Valve repair system (600) Claim 7 wherein the paddle control mechanism (610) comprises a hollow shaft, wherein the connector (605) comprises a hollow shaft attached to a Connection point (2417) is detachably connected to the hollow shaft of the paddle control mechanism (610), and wherein the single line (2302) is releasably attached to the connection point (2417) between the hollow shaft of the paddle control mechanism (610) and the hollow shaft of the connector (605). Valve repair system (600) according to one of the Claims 1 to 8th wherein the pair of paddles (606a, 606b) of the valve repair device (602) are adapted to flex when attached to the patient's own valve. Valve repair system (600) according to one of the Claims 1 to 9 further comprising a paddle control mechanism (610) configured to move the paddles (606a, 606b) between the open position and the closed position. Valve repair system (600) Claim 10 wherein the paddle control mechanism (610) is adapted to independently control each of the pair of paddles (606a, 606b). Valve repair system (600) according to one of the Claims 1 to 11 wherein the paddles (606a, 606b) are adapted to move in a linear direction and pivot as the paddles (606a, 606b) are moved from the closed position to the open position. Valve repair system (600) according to one of the Claims 1 to 12th wherein the valve repair device (602) comprises a W-shaped mechanism for moving the paddles (606a, 606b) between the open position and the closed position, each paddle having an inner link (3402) pivotably attached to a connector (605) and an outer link (3404) pivotally attached to the inner link (3402). Valve repair system (600) according to one of the Claims 1 and 6th to 11 wherein the paddles (606a, 606b) comprise a mesh material, and wherein an inner cam (3702) is used to move the paddles (606a, 606b) between the open position and the closed position. Valve repair system (600) according to one of the Claims 1 to 14th wherein the valve repair device (602) further comprises a spacer element (3800) configured to close a gap in the patient's (3002) endogenous valve when the valve repair device (602) is attached to the endogenous valve. Valve repair system (600) according to one of the Claims 2 to 15th wherein the valve repair device (602) is adapted to move to a release position to remove the valve repair device (602) from the patient's body, wherein when the valve repair device (602) is in the release position, an angle between each paddle ( 606a, 606b) and a shaft (603) of the base arrangement (604) is greater than or equal to 120 degrees. Valve repair system (600) according to one of the Claims 1 to 16 wherein the paddles (606a, 606b) comprise a locking element (4701) for attaching the paddles (606a, 606b) to a corresponding one of the first and second gripping elements (608a, 608b) when the paddles (606a, 606b) are in the closed position. Valve repair system (600) according to one of the Claims 1 to 2 and 6th to 17th wherein the valve repair device (602) further comprises a biasing element (4807) to maintain the paddles (606a, 606b) in a closed position when the valve repair device (602) is removed from the valve repair system (600). Valve repair system (600) according to one of the Claims 1 and 6th to 18th further comprising a base assembly (604) comprising: a shaft (603) having a threaded portion (4902); and a connector (605) movably attached to the shaft (603) such that the connector (605) can be moved along the threaded portion (4902) of the shaft (603); wherein the pair of paddles (606a, 606b) are pivotally attached to the connector (605); wherein movement of the connector (605) in a first direction along the shaft (603) causes the pair of paddles (606a, 606b) to move to the closed position and causes movement of the connector (605) in a second direction that the pair of paddles (606a, 606b) move to the open position. Valve repair system (600) according to one of the Claims 1 to 19th wherein the first and second gripping elements (608a, 608b) are attached directly to a corresponding one of the pair of paddles (606a, 606b). Valve repair system (600) according to one of the Claims 6 to 20th wherein the spiked portion (609) has only a single row of spikes (5102) for each of the first and second gripping members (608a, 608b). Valve repair system (600) according to one of the Claims 1 to 21st wherein each gripping element of the first and second gripping elements (608a, 608b) is longitudinally extendable to prevent tearing of the patient's endogenous valve when the first and second gripping elements (608a, 608b) are removed from the endogenous flap will. Valve repair system (600) according to one of the Claims 1 to 22nd wherein the first and second gripping elements (608a, 608b) comprise a flexible material, so that the first and second gripping elements (608a, 608b) can be pulled away from the tissue of the endogenous valve when the first and second gripping elements (608a , 608b) can be removed from the tissue of the body's own valve. Valve repair system (600) according to one of the Claims 1 to 23 wherein the first and second gripping elements (608a, 608b) are connected to one another by a biasing element (5410) which is adapted to hold the first and second gripping elements (608a, 608b) in a desired position.

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