DELIVERY DEVICES

Cross-Reference to Related Applications

[01] This Non-Provisional Patent Application claims the benefit of the filing date of U.S. Provisional Patent Application Serial Number 62/307,665, filed March 14, 2016, entitled "STENTED PROSTHETIC HEART VALVE HAVING A WRAP AND DELIVERY DEVICES," the entire teachings of which are incorporated herein by reference.

Background

[02] The present disclosure relates to stented prosthetic heart valves having a paravalvular leakage prevention or mitigation wrap, as well as delivery devices and methods for selectively deploying the wrap.

[03] A human heart includes four heart valves that determine the pathway of blood flow through the heart: the mitral valve, the tricuspid valve, the aortic valve, and the pulmonary valve. The mitral and tricuspid valves are atrioventricular valves, which are between the atria and the ventricles, while the aortic and pulmonary valves are semilunar valves, which are in the arteries leaving the heart. Ideally, native leaflets of a heart valve move apart from each other when the valve is in an open position, and meet or "coapt" when the valve is in a closed position. Problems that may develop with valves include stenosis in which a valve does not open properly, and/or insufficiency or regurgitation in which a valve does not close properly. Stenosis and insufficiency may occur concomitantly in the same valve. The effects of valvular dysfunction vary, with regurgitation or backflow typically having relatively severe physiological consequences to the patient.

[04] Recently, flexible prosthetic valves supported by stent structures that can be delivered percutaneously using a catheter -based delivery system have been developed for heart and venous valve replacement. These prosthetic valves may include either self-expanding or balloon-expandable stent structures with valve leaflets attached to the interior of the stent structure. The prosthetic valve can be reduced in diameter, by crimping onto a balloon catheter or by being contained within a sheath component of a delivery catheter, and advanced through the venous or arterial vasculature. Once the prosthetic valve is positioned at the treatment site, for instance within an incompetent native valve, the stent structure may be expanded to hold the prosthetic valve firmly in place. One example of a stented prosthetic valve is disclosed in U.S. Pat. No. 5,957,949 to Leonhardt et al. entitled "Percutaneous Placement Valve Stent." Another example of a stented prosthetic valve for a percutaneous pulmonary valve replacement procedure is described in U.S. Patent Application Publication No. 2003/0199971 Al and U.S. Patent Application Publication No. 2003/0199963 Al, both filed by Tower et al.

[05] Although transcatheter delivery methods have provided safer and less invasive methods for replacing a defective native heart valve, leakage between the implanted prosthetic valve and the surrounding native tissue is a recurring problem. Leakage sometimes occurs due to the fact that minimally invasive and percutaneous replacement of cardiac valves typically does not involve actual physical removal of the diseased or injured heart valve. Rather, the replacement prosthetic valve is delivered in a compressed condition to the valve site, where it is expanded to its operational state within the native valve. Calcified or diseased native leaflets are pressed to the side walls of the native valve by the radial force of the stent frame of the prosthetic valve. These calcified leaflets can lead to incomplete conformance of the stent frame with the native valve and can be a source of paravalvular leakage ("PVL"). Significant pressure gradients across the valve cause blood to leak through the gaps between the implanted prosthetic valve and the calcified anatomy. When present, such paravalvular leakage is highly detrimental to the patient.

[06] The present disclosure addresses problems and limitations associated with the related art.

Summary

[07] As discussed above, stented prosthetic heart valves can leave paravalvular leakage pathways in some patients, particularly patients with very immobile or heavily calcified native valve leaflets. Disclosed embodiments include stented prosthetic heart valves having a stent frame with a wrap that can be optionally deployed, if paravalvular leakage is detected, to fill commissural paravalvular leakage pathways. In other words, the arrangement of the wrap is controlled independently of the configuration (i.e. expansion) of the stent frame. The wrap includes a body of flexible material positioned around an end of the stent frame. In disclosed embodiments, the wrap is configured so that in a deployed position, the wrap bulges outwardly from the stent frame as one end of the wrap is positioned closer to a second, opposing end of the wrap.

[08] Actuation of the wrap can be accomplished in a variety of ways. For example, the delivery device can include a plurality of tethers that are connected to both a movable end of the wrap and a shaft assembly of the delivery device. The shaft assembly is configured to selectively position the tethers and, thus the wrap. Once the wrap is in the deployed position, coupling elements can be utilized to maintain the deployed position of the wrap. Exemplary coupling elements include a ratchet, hooks and barbs. In other embodiments, the wrap is constructed to be biased in the deployed position and will generally remain in the deployed position once forces overcoming the natural bias to maintain the wrap in the delivery position are released.

[09] After the wrap is maintained in the deployed position and the stented prosthetic heart valve hemodynamics and paravalvular leakage are assessed and deemed acceptable, the delivery device is disengaged from the wrap and the stented prosthetic heart valve so that the delivery device can be retracted from the patient.

Brief Description of the Drawings

[10] FIG. 1 is a perspective view of an illustrative delivery device.

[11] FIG. 2 is a partially exploded view of a stented prosthetic heart valve that can be delivered with the delivery device of FIG. 1; the stented prosthetic heart valve having a stent frame in an expanded arrangement. [12] FIG. 3 A is a schematic illustration of part of the delivery device of FIG. 1 having the stented prosthetic heart valve of FIG. 2 loaded thereto in a compressed arrangement; the stented prosthetic heart valve including a wrap in a delivery position.

[13] FIG. 3B is a schematic illustration of part of the delivery device of FIG. 3 A having the stent frame in the expanded arrangement and the wrap in the delivery position.

[14] FIG. 3C is a schematic illustration of part of the delivery device of FIGS. 3A-3B having the stent frame in the expanded arrangement and the wrap in a deployed position.

[15] FIG. 3D is a schematic illustration of part of the delivery device of FIGS. 3 A-3C having the stent frame in the expanded arrangement and the wrap in an alternate deployed position.

[16] FIG. 4A is a partial, schematic profile view of the stented prosthetic heart valve of FIG. 2 deployed at a native heart valve with the wrap (not visible) in the delivery position; wherein paravalvular leakage is occurring around the stented prosthetic heart valve.

[17] FIG. 4B is a schematic side view of the stented prosthetic heart valve of FIG. 4A deployed at the native heart valve; wherein paravalvular leakage is occurring around the stented prosthetic heart valve and the wrap, which is in the delivery position.

[18] FIG. 5 A is a schematic side view of the stented prosthetic heart valve of FIG. 2, in the expanded arrangement; the stented prosthetic heart valve having a wrap in a delivery position.

[19] FIG. 5B is a schematic profile view of the stented prosthetic heart valve of FIG.

5A; wherein the stent frame is in the expanded arrangement and the wrap is in the delivery position. [20] FIG. 5C is a partial, schematic side view of the stented prosthetic heart valve of FIGS. 5A-5B, in which the stent frame is in the expanded arrangement and the wrap is in a deployed position.

[21] FIG. 5D is a schematic profile view of the stented prosthetic heart valve of FIG.

5C; wherein the stent frame is in the expanded arrangement and the wrap is in the deployed position.

[22] FIG. 6A is a partial, schematic view of one way in which the delivery device of FIG. 1 can be modified to deliver the stented prosthetic heart valve of FIG. 2; wherein the wrap is in the delivery position.

[23] FIG. 6B is a partial, schematic view of the delivery device of FIG. 1 ; wherein the wrap is deployed with a plurality of tethers of the delivery device by pulling a distal end of the wrap proximally.

[24] FIG. 7A is a partial, schematic view of another way in which the delivery device of FIG. 1 can be modified to deliver the stented prosthetic heart valve of FIG. 2; wherein the wrap is in the delivery position.

[25] FIG. 7B is a partial, schematic view of the delivery device of FIG. 7 A; wherein the wrap is deployed with the plurality of tethers of the delivery device by pulling or pushing a proximal end of the wrap distally.

[26] FIG. 8A is a partial, schematic illustration of one tether, similar to the tethers of FIGS. 6A-7B, the tether having a pigtail curve that can releasably secure the tether to the wrap.

[27] FIG. 8B is a partial, schematic illustration of the pigtail curve of FIG. 8A having tension applied thereto in order to straighten the pigtail curve for release through an aperture in the wrap.

[28] FIG. 9A is a partial, schematic illustration of an alternate tether, similar to those previously disclosed, the tether having a compressible section that can releasably secure the tether to the wrap. [29] FIG. 9B is a partial, schematic illustration of the compressible section of FIG. 9A having tension applied thereto in order to compress the compressible section for release of the tether through the aperture in the wrap.

[30] FIG. 1 OA is a partial, schematic illustration of another way in which the delivery device of FIG. 1 can be modified to deliver the stented prosthetic heart valve of FIG. 2; wherein the wrap is in the delivery position.

[31] FIG. 1 OB is a partial, schematic view of the delivery device of FIG. 10A; wherein the wrap is deployed with the plurality of tethers that are actuated with a handle assembly (see also, FIG. 1).

[32] FIG. 11 A is a schematic illustration of a ratchet system that can be used to retain the wrap in the deployed position; wherein the wrap has not yet been deployed.

[33] FIG. 1 IB is schematic illustration of the ratchet system of FIG. 11 A in relation to the delivery device; wherein the wrap has not yet been deployed.

[34] FIG. 11C is a schematic illustration of the wrap of FIGS. 11 A-l IB in a partially- deployed position.

[35] FIG. 1 ID is a schematic illustration of the wrap in the deployed position.

[36] FIG. HE is a schematic illustration of the wrap deployed within the native heart valve.

[37] FIG. 12A is a schematic illustration of an alternate wrap design in a delivery position.

[38] FIG. 12B is a schematic illustration of the wrap of FIG. 12A in a deployed position; wherein the wrap is biased in the deployed position with a plurality of spines.

[39] FIG. 12C is partial, a schematic illustration of one spine of FIGS. 12A-12B connected to a tension member circumscribing the wrap. Detailed Description

[40] Specific embodiments of the present disclosure are now described with reference to the figures, wherein like reference numbers indicate identical or functionally similar elements. The terms "distal" and "proximal" are used in the following description with respect to a position or direction relative to the treating clinician. "Distal" or "distally" are a position distant from or in a direction away from the clinician. "Proximal" and "proximally" are a position near or in a direction toward the clinician.

[41] Certain aspects of the present disclosure relate to transcatheter stented prosthetic heart valve delivery devices that retain a stented prosthetic heart valve (hereinafter "prosthetic valve") in a compressed arrangement during delivery to a target site and allow the prosthetic valve to expand and deploy at a target site. By way of background, general components of one non-limiting example of a delivery device 10 with which the aspects of the present disclosure are useful is illustrated in FIG. 1. The delivery device 10 is arranged and configured for percutaneously delivering a prosthetic valve (e.g., the prosthetic valve 40 of FIG. 2) to a patient's defective heart valve (see also, FIGS. 4A-4B). The delivery device 10 includes an optional outer sheath assembly 12, a shaft assembly 14, and a handle assembly 16. The shaft assembly 14 includes a distal portion 22 and terminates at a tip 24. Where provided, the optional outer sheath assembly 12 includes a capsule 18 selectively disposed over the prosthetic valve 40 that sheathes the prosthetic valve 40 in the loaded or compressed arrangement and can be retracted by the handle assembly 16 to expose the prosthetic valve 40, thus allowing the prosthetic valve 40 to expand. In some constructions, the capsule 18 and the outer sheath assembly 12 are comprised of differing materials and/or constructions, with the capsule 18 having a longitudinal length approximating (e.g., slightly greater than) a length of the prosthetic valve 40 to be used with the delivery device 10. A material and thickness of the capsule 18 is selected to exhibit sufficient radial rigidity so as to overtly resist the expected expansive forces of the prosthetic valve 40 when compressed within the capsule 18. However, the capsule 18 exhibits sufficient longitudinal flexibility for ready passage through a patient's vasculature and into the native heart valve to be replaced. [42] One or more elongate tension members 20 can optionally be provided to constrain and compress the prosthetic valve 40. Suitable elongate tension members, include, but are not limited to sutures, chords, wires or filaments. The tension member(s) 20 can be considered part of the delivery device 10 in some embodiments or as part of the prosthetic valve 40 in other embodiments. The delivery device 10 provides a loaded delivery state (FIG. 3A) in which the prosthetic valve 40 is loaded over the shaft assembly 14 and is compressively retained on the distal portion 22 by the tension members 20. In some embodiments, compression of the prosthetic valve 40 is maintained and adjusted with the tension members 20. Once the loaded and compressed prosthetic valve 40 is located at a target site, tension in the tension members 20 is lessened or released to permit the prosthetic valve 40 to self-expand, partially releasing and ultimately fully deploying the prosthetic valve 40 from the shaft assembly 14. The tension members 20, if provided, can be configured to be released from the prosthetic valve 40 with the handle assembly 16 or the like. After deployment of the prosthetic valve 40 at the target site, paravalvular leakage can occur. Therefore, delivery devices 10 disclosed herein are configured to selectively actuate a paravalvular leakage prevention wrap 60 of the prosthetic valve 40, as will be discussed in further detail below.

[43] FIG. 2 illustrates, in detail, the non-limiting prosthetic valve 40 useful with systems and methods of the present disclosure. As a point of reference, the prosthetic valve 40 has a compressed, delivery configuration as is schematically illustrated in FIG. 3 A. The prosthetic valve 40 also has a normal, expanded arrangement as is shown in FIGS. 2 and 3B, for example. The prosthetic valve 40 includes a stent frame 42 and a valve structure 48. The stent frame 42 is generally tubular and has first and second ends 44, 46 and can assume any of the forms described herein, and is generally constructed so as to be self-expandable from the compressed arrangement of FIG. 3 A to the normal, expanded deployed arrangement of FIGS. 2 and 3B. In other embodiments, the stent frame 42 is expandable to the expanded arrangement by a separate device (e.g., a balloon internally located within the stent frame 42). The valve structure 48 is assembled to the stent frame 42 and provides two or more (typically three) leaflets 50. The valve structure 48 can assume any of the forms described herein, and can be assembled to the stent frame 42 in various manners, such as by sewing the valve structure 48 to the stent frame 42.

[44] The disclosed prosthetic valve 40, which may be of many configurations as discussed herein, includes a paravalvular leakage prevention and/or mitigation wrap 60 (schematically illustrated and shown apart from the prosthetic valve in FIG. 2 for ease of illustration). In some embodiments, the wrap 60 comprises a body 62 made of a thin metal mesh material, such as Nitinol™ mesh, a braided or laser cut elastomer such as polyurethane, C-FLEX® biomedical tubing available from Saint-Gobain North America, Malvern, Pennsylvania, silicone or a braided metal such as platinum iridium or cobalt chromium, for example. The body 62 can also be constructed of more than one material, for example, the body 62 can also include fabric, tissue (e.g., autologous tissue, xenograph material, treated pericardium, porcine, bovine, or equine tissue) or bioabsorbable mesh (e.g., poly(glycerol-co-sebacate), polylactic acid and polycaprolactone).

[45] The prosthetic valve 40 is configured so that the wrap 60 can be selectively deployed independent of the arrangement of the stent frame 42. For example, FIG. 3A schematically illustrates the stent frame 42 in a delivery arrangement in which the wrap 60 is in the delivery position and has approximately the same diameter as the stent frame 42, wherein the wrap diameter Dl is measured as a greatest distance between any two opposing points of the wrap 60. Turning now also to Fig. 3B, which illustrates the stent frame 42 in the expanded arrangement in which the wrap 60 has not yet been deployed. Therefore, in FIG. 3B the diameter D2 of the stent frame 42 is approximately the same as the diameter Dl of the wrap 60. In one exemplary deployment position, as illustrated in FIG. 3C, a first end 64 of the wrap 60 is moved toward a second end 66 of the wrap 60 causing the wrap 60 to bulge outwardly, thereby expanding the diameter Dl of the wrap 60 so that the diameter Dl of the wrap 60 is greater than the diameter D2 of the stent frame 42 (see also, FIGS. 5A-5D). In an alternate deployment position, illustrated in FIG. 3D, the second end 66 of the wrap 60 is moved toward the first end 64 to cause the wrap 60 to bulge outwardly, also resulting in the diameter Dl of the wrap 60 being greater than the diameter D2 of the stent frame 42 to mitigate or stop paravalvular leakage at a native heart valve. [46] The delivery device 10 and prosthetic valve 40 configurations disclosed herein are beneficial in that the diameter Dl of the wrap 60 can be selectively enlarged in situ. In this way, the clinician has the option of whether or not to deploy the wrap 60 based on the occurrence or lack of paravalvular leakage after the prosthetic valve 40 is deployed at a native heart valve V. For example, see FIGS. 4A-4B illustrating the deployed prosthetic valve 40 having the wrap 60 that has not yet been deployed. Paravalvular leakage PVL is occurring between the prosthetic valve 40 and the native valve V so it is likely that a clinician would opt to deploy the wrap 60 upon detection of the leakage PVL. If no paravalvular leakage is detected upon deployment of the prosthetic valve 40, the wrap 60 can be left in the first, delivery position in which the wrap 60 generally conforms to the stent frame 42.

[47] FIGS. 5A-5D further illustrate the variable diameter Dl of the wrap 60. As noted above, the wrap 60 is configured to have a delivery position (FIGS. 5A-5B) and a deployed position (FIGS. 5C-5D) in which the diameter Dl of the wrap 60 increases as the wrap 60 bulges outwardly. In one illustrative embodiment, a maximum distance D3 that the wrap 60 bulges out from the stent frame 42 in the deployed position of FIGS. 5C-5D is about 3 mm to about 4 mm.

[48] Actuating selective movement of the wrap 60 from the delivery position of FIGS.

5A-5B to the deployed position of FIGS. 5C-5D can be accomplished in a variety of ways. In one such way, as generally depicted in FIGS. 6A-6B, the delivery device 10 includes a plurality of tethers 26 (e.g., three), such as cables, wires, sutures, chords, filaments, or tension members, that interconnect the tip 24 and the wrap 60. The tethers 26 can be routed inside the stent frame 42, outside the stent frame 42, or a combination of inside and outside the stent frame 42. In this embodiment, each tether 26 has a first end 28a secured to the tip 24 and a second end 28b secured to a second end 66 of the wrap 60 (only end of one tether 26 are referenced for ease of illustration). The delivery device 10 can be configured to have the second end 66 of the wrap 60 movable toward the first end 64 of the wrap 60, which is fixed to the stent frame 42. In this embodiment, deployment of the wrap 60 is actuated by proximally retracting the tip 24 past the second end 66 of the wrap 60 so that the second end 66 is brought closer to the first end 64, thus causing the wrap 60 to bulge outwardly. In further alternate embodiments which function and are operated similarly, the tether(s) 26 are secured to other locations on the shaft assembly 14.

[49] An alternate configuration and method of selectively actuating the wrap 60 is shown in FIGS. 7A-7B. In this embodiment, the first end 28a of each tether 26 is secured to the tip 24 and the second end 28b is secured to the first end 64 of the wrap 60 (only end of one tether 26 are referenced for ease of illustration). The tethers 26 can be routed inside the stent frame 42, outside the stent frame 42, or a combination of inside and outside the stent frame 42, as desired. The distal end 66 of the wrap is secured to the stent frame 42. Movement of the wrap 60 from the delivery position (FIG. 7A) to the deployed position (FIG. 7B) is actuated by pushing the tip 24 distally. As best seen in FIG. 7B, actuation of the wrap 60 is caused by extending the delivery device 10 further into the ventricle outflow tract T, past the second end 46 of the prosthetic valve 40, thus pulling the tethers 26 distally to subsequently pull the first end 64 of the wrap 60 toward the second end 66. In further alternate embodiments which function and are operated similarly, the tether(s) 26 are secured to other locations of the shaft assembly 14.

[50] Once the wrap 60 is maintained in the deployed position via any of the various methods disclosed herein and the prosthetic valve 40 hemodynamics and paravalvular leakage are assessed and deemed acceptable, the delivery device 10 is disengaged from the wrap 60 and the prosthetic valve 40 so that the delivery device 10 can be retracted from the patient. In one embodiment, illustrated in FIGS. 8A-8B, the wrap 60 includes one or more apertures 68 through which a respective one of one or more tethers 126 is threaded. A first end (see also FIGS. 6A-7B) of each tether 126 is secured to the delivery device 10 and a second end 128 of each tether 126 forms a flexible pigtail curve 150 that is sufficiently rigid to maintain the respective tether 126 to the wrap 60 as the wrap 60 is pulled into the deployed position of FIGS. 6B and 7B. After the wrap 60 is deployed, each tether 126 remains positioned within the aperture 68 unless sufficient pulling force is provided by the delivery device 10 via the shaft assembly 14 to straighten the pigtail curve 150 so that the tether 126 can be pulled through the aperture 68 to disengage from the wrap 60. All tethers 126 can be similarly configured or can have different configurations.

[51] A similar alternate tether 226 that can be incorporated into a delivery device (e.g., the delivery device 10 of FIGS. 1 and 6A-7B) is illustrated in FIGS. 9A-9B. In this embodiment, a first end (see also FIGS. 6A-7B) of each tether 226 is secured to the delivery device 10 (e.g., to the tip 24 or elsewhere) and a second end 238 of the tether 226 includes a compressible section 250 that is sufficiently rigid to maintain the respective tether 226 within an aperture 68 of the wrap 60 as the wrap 60 is pulled into the deployed position (FIGS. 6B and 7B). After the wrap 60 is deployed, the tether 226 remains positioned within the aperture 68 of the wrap 60 unless sufficient pulling force is provided by the delivery device 10 (e.g., via the handle assembly 16) to compress the compressible section 250 within the aperture 68 so that the tether 226 can be pulled through the aperture 68 to disengage from the wrap 60.

[52] As generally depicted in FIGS. 10A-10B, an alternate configuration and method of selectively actuating the wrap 60 comprises having one end 28b of each tether secured to the second end 66 of the wrap 60 and the other end (not visible) of each tether 26 extends through a portion of the stent frame 42 proximal of the second end 66 and then extend distally to a respective opening 25 in the delivery device tip 24 or other portion of the shaft assembly 14 and then extends proximally through the shaft assembly 14 to handle assembly 16 (see also FIG. 1), wherein handle assembly 16 is configured to tension or shorten the length of each tether 26 in a proximal direction to deploy the wrap 60 as shown in FIG. 10B. As with prior embodiments, the tethers 26 can be routed inside the stent frame 42, outside the stent frame 42, or a combination of inside and outside the stent frame 42. Once the wrap 60 has been deployed, the tethers 26 can be removed from the wrap 60 via a variety of methods. For example, one end of each tether 26 can be released and the entirety of the tether 26 can be withdrawn from the patient. Alternatively, the tethers 26 can be cut from the delivery device 10 and left within the patient or released in other ways discussed above. [53] Similar to that described with respect to FIGS. 6A-6B and 10A-10B, a further alternate configuration and method of selectively actuating the wrap 60 comprises having one end 28b of each tether 26 secured to the first end 64 of the wrap 60 and the other end (not visible) of each tether 26 extends distally to a respective opening 25 in the delivery device tip 24 or other portion of the shaft assembly 14 and then extends proximally through the shaft assembly 14 to the handle assembly 16 (see also, FIG. 1). The handle assembly 16 is configured to tension or shorten the length of each tether 26 in a proximal direction to deploy the wrap 60 to a position substantially similar to what is shown in FIG. 7B. As desired, the tethers 26 can be routed inside the stent frame 42, outside the stent frame 42, or a combination of inside and outside the stent frame 42. Once the wrap 60 has been deployed, the tethers 26 can be removed from the wrap 60 in ways discussed above, for example. In further alternate configurations and methods (not shown) of selectively actuating the wrap 60 comprises having each tether 26 loop through one end of the wrap 60 while both ends of each tether 26 extend back to the handle assembly 16, wherein the handle assembly 16 can tension or shorten the length of each tether 26 in a proximal direction to deploy the wrap 60. Once the wrap 60 has been deployed, the tethers 26 can be removed from the wrap 60 in any of the ways discussed above, for example.

[54] To maintain the wrap 60 of any of the disclosed embodiments in the deployed position, the stent frame 42 and/or the wrap 60 can include one or more coupling elements 70 such as a ratchet system or the like. As is generally illustrated in FIGS. 11A-11E one such coupling element or ratchet system 70 includes at least one forward facing barb 72a connected to the stent frame 42 and angled toward the first end 44 of the stent frame 42. Also proximate the first end 44 of the stent frame 42 is a reverse barb 72b that is angled either perpendicular from the stent frame 42 or toward the second end 46 of the stent frame 42. As the wrap 60 is deployed by the delivery device 10, in this embodiment, the tether 26 is pulling the first end 64 of the wrap 60 toward the second end 66, over the forward facing barb(s) 72a. If the force applied to the wrap 60 is greater than the force required to release the tether 26, the tether 26 will release from the wrap 60. Otherwise, the reverse barb 72b will force the release of the tether 26 from the wrap 60 by restricting further movement of the tether 26 in the proximal direction, thus increasing tension on the tether 26. When the wrap 60 contacts the reverse barb 72b and is pulled in the direction therepast, the tension on the tether 26 increases, thereby releasing the tether 26. A hook (not shown) or other similar structure can be arranged on the stent frame 42 to function in a similar fashion as the reverse barb 72b. Once the wrap 60 released from the tether 26, the forward facing barbs 72a maintain the wrap 60 in the deployed position of FIGS. 6B, 7B, 10B and 1 IE. If the wrap 60 is to be deployed, the tethers 26 are moved proximally as illustrated in FIG. 1 1B. During this process, if there are gaps between the stent frame 42 and the patient's anatomy (see also, FIG. 4A), the wrap 60 ratchets proximally down the stent frame 42, billowing out and filling those gaps, if there are no gaps between the stent frame 42 and the patient's anatomy, then the wrap 60 does not billow out and cannot ratchet down the stent frame 42. During this process, the force required to move the wrap 60 is configured to be greater than the force required to release the tether 26 so that the tether(s) 26 releases from the wrap 60. If the force required to move the wrap 60 is less than that to release the tether 26 from the wrap 60, the reverse barb 72b will force the release of the tether 26 from the wrap 60 when the wrap 60 is pulled in a direction of the second end 66. This function highlights the importance of the reverse barb 72b that ensures that, when tethers 126, 226 are used as illustrated in FIGS. 8A-9B, for example, the pigtail curves 150 or compressible sections 228 uncouple the respective tether 126, 266 from the wrap 60 before the wrap 60 is pulled below the second end 66 of the stent frame 42. In this embodiment, the wrap 60 can include a ring or other attachment 78 configured to engage the barbs 72a, 72b. The wrap 60 can also include a second ring 80 at the second end, if desired. It is noted that the ratchet system 70 can be oriented in the opposite direction on the stent frame 42 when the wrap 60 is configured to move proximally into the deployed position as discussed with respect to FIGS. 6A-6B or 10A-10B, for example. The ratchet system 70, if oriented in the opposite direction on the stent frame 42, could be configured to function in a similar manner to maintain the wrap 60 in the deployed position.

In further alternate embodiments, the prosthetic valve 40 includes an alternate wrap 160 that self-transitions from a delivery position (FIG. 12A) to a deployed position (FIG. 12B). This self-transitioning function is provided by a plurality of flexible spines 180 spaced about the wrap 160 between first and second ends 164, 166. The spines 180 are configured to be biased into the form of FIG. 12B. Therefore, if both of the first or second ends 164 or 166 of the wrap 160 are secured to the stent frame 42 and then one of those ends 164 or 166 is released from the stent frame 42, the wrap 160 will naturally flex and bow outwardly to the deployed position of FIG. 12B due to the biasing force of the spines 180. In this embodiment, the spines 180 can optionally include apertures 182 at the movable end (e.g., the first end 164, however the second end 166 could be the movable end as generally depicted in FIG. 3D) through which an elongate tension member 120 can be threaded as shown in FIG. 12C. The tension member 120 can optionally be utilized with the delivery device 10 to compress the prosthetic valve (not shown, see also FIGS. 2-3 A) and can also be released from the prosthetic valve 40 by the delivery device 10, without the need for tethers 26 (see also, e.g., FIGS. 6A-7B), to deploy the wrap 160 as once the tension member 120 interconnecting the first, movable end 164 to the stent frame 42 (see also FIGS. 6A-7B) is released, the wrap 160 naturally transitions to the deployed position of FIG. 12B.

[56] In alternate embodiments, largely similar to that of FIGS. 12A-12C, a body 162 of the wrap 160 can be made of a memory shape material so that the biased deployment arrangement of FIG. 12B is achieved and maintained with only the body 162 itself (i.e. the spines 180 can optionally be omitted). In such an embodiment, one of the first and second ends 164, 166 of the wrap 160 is releasably secured with the tension member 120 or the like to the stent frame 42 while the other opposing end 164 or 166 is secured to the stent frame 42. Once the releasably connected end 164 or 166 is released from the stent frame 42, the wrap 160 will naturally transition to its biased form, which is configured to bulge outwardly similar to previously disclosed embodiments (see FIG. 12B as one example).

[57] As referred to herein, stented prosthetic heart valves or prosthetic valves 40 that can be modified to incorporate wraps (e.g., wraps 60, 160) disclosed above and delivered and deployed with devices and methods of the present disclosure may assume a wide variety of different configurations. For example, the prosthetic heart valves can be a biostented prosthetic heart valve having tissue leaflets or a synthetic heart valve having polymeric, metallic, or tissue-engineered leaflets, and can be specifically configured for replacing any heart valve. Thus, the prosthetic valves 40 can be generally used for replacement of a native aortic, mitral, pulmonic, or tricuspid valve, for use as a venous valve, or to replace a failed bioprosthesis, such as in the area of an aortic valve or mitral valve, for example.

[58] In general terms, the stents or stent frames 42 of the present disclosure are generally tubular support structures having an internal area in which valve structure 48 leaflets 50 will be secured. The leaflets 50 can be formed from a variety of materials, such as autologous tissue, homologous material, xenograph material, or synthetics as are known in the art. The leaflets may be provided as a homogenous, biological valve structure, such as porcine, bovine, or equine valves. Alternatively, the leaflets 50 can be provided independent of one another (e.g., bovine, porcine or equine pericardial leaflets) and subsequently assembled to the support structure of the stent frame. In another alternative, the stent frame and leaflets can be fabricated at the same time, such as may be accomplished using high -strength nano-manufactured NiTi films produced at Advance BioProsthetic Surfaces (ABPS), for example. The stent frame support structures are generally configured to accommodate at least two (typically three) leaflets; however, replacement prosthetic valves of the types described herein can incorporate more or less than three leaflets.

[59] Some embodiments of the stent frame 42 can be a series of wires or wire segments arranged such that they are capable of self-transitioning from a compressed or collapsed arrangement to the normal, radially expanded arrangement. In some constructions, a number of individual wires comprising the stent frame support structure can be formed of a metal or other material. These wires are arranged in such a way that the stent frame support structure allows for folding or compressing or crimping to the compressed arrangement in which the internal diameter is smaller than the internal diameter when in the normal, expanded arrangement. In the compressed arrangement, such a stent frame support structure with attached leaflets can be mounted onto a delivery device, (e.g., the delivery device 10). The stent frame support structures are configured so that they can be changed to their normal, expanded arrangement when desired, such as by the relative movement of one or more sheaths relative to a length of the stent frame.

[60] The wires of the stent frame support structures in embodiments of the present disclosure can be formed from a shape memory material such as a nickel titanium alloy (e.g., Nitinol™). With this material, the support structure is self-expandable from the compressed arrangement to the normal, expanded arrangement, such as by the application of heat, energy, and the like, or by the removal of external forces (e.g., compressive forces). This stent frame support structure can also be compressed and re-expanded multiple times without damaging the structure of the stent frame. In addition, the stent frame support structure of such an embodiment may be laser-cut from a single piece of material or may be assembled from a number of different components.

[61] The prosthetic valve 40 is configured for replacing an aortic valve. Alternatively, other shapes are also envisioned, adapted for the specific anatomy of the valve to be replaced (e.g., prosthetic valves in accordance with the present disclosure can alternatively be shaped and/or sized for replacing a native mitral, pulmonic, or tricuspid valve). Regardless, the valve structure 48 can be arranged to extend less than an entire length of the stent frame 42. In particular, the valve structure 48 can be assembled to, and extend along, the first end 44 of the prosthetic valve 40, whereas the second end 46 can be free of the valve structure 48 material. A wide variety of other constructions are also acceptable and within the scope of the present disclosure. For example, the valve structure 48 can be sized and shaped to extend along an entirety, or a near entirety, of a length of the stent frame 42.

[62] Although the present disclosure has been described with reference to preferred embodiments, workers skilled in the art will recognize that changes can be made in form and detail without departing from the spirit and scope of the present disclosure.