DE19857887B4 - Verankerungsstütze für eine Herzklappenprothese - Google Patents
Verankerungsstütze für eine Herzklappenprothese Download PDFInfo
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- DE19857887B4 DE19857887B4 DE1998157887 DE19857887A DE19857887B4 DE 19857887 B4 DE19857887 B4 DE 19857887B4 DE 1998157887 DE1998157887 DE 1998157887 DE 19857887 A DE19857887 A DE 19857887A DE 19857887 B4 DE19857887 B4 DE 19857887B4
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- Prior art keywords
- anchoring
- heart valve
- valve prosthesis
- anchoring support
- support
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Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/24—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body
- A61F2/2412—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body with soft flexible valve members, e.g. tissue valves shaped like natural valves
- A61F2/2418—Scaffolds therefor, e.g. support stents
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
- A61F2230/0028—Shapes in the form of latin or greek characters
- A61F2230/0054—V-shaped
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- Health & Medical Sciences (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Cardiology (AREA)
- Oral & Maxillofacial Surgery (AREA)
- Transplantation (AREA)
- Heart & Thoracic Surgery (AREA)
- Vascular Medicine (AREA)
- Life Sciences & Earth Sciences (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Prostheses (AREA)
Abstract
Verankerungsstütze für eine Herzklappenprothese,
die aus einem, bei einer vorgebbaren Temperatur eine vorbestimmte
Form einnehmenden Formgedächtnismetall
besteht und die als ein einteiliger Körper, der aus stabförmigen Elementen
(1, 2, 3, 4, 5), die zumindest teilweise eine Gitterstruktur darstellen,
gebildet ist, dadurch gekennzeichnet, daß die stabförmigen Elemente (4) sägezahnförmig aneinandergereiht
sind und mindestens einen Stützring
(6) bilden, der als Vieleck mit mindestens acht Ecken ausgebildet
ist.
Description
- Die Erfindung betrifft eine Verankerungsstütze (Stent) für eine Herzklappenprothese, bei der ein Formgedächtnismetall, auch Memory-Metall genannt, verwendet wird, um eine Herzklappenprothese zu implantieren, ohne einen größeren operativen Eingriff, mit vollständiger Öffnung des Thorax durchführen zu müssen.
- So ist es neben anderem, beispielsweise aus der
DE 195 46 692 A1 bekannt, eine selbstexpandierende Herzklappenprothese mit einer Verankerungsstütze über ein Herzkathetersystem ohne Öffnung des Brustkorbes über die in der Leistengegend eines Menschens geöffnete Aorta einzuführen und bei Erreichen des gewünschten Ortes, in der Nähe des Herzens, vorzugsweise im Bereich der ursprünglichen Herzklappe zu positionieren und diese dort durch eine Selbstexpansion fest zu installieren. - Es hat sich jedoch gezeigt, daß das dort angedeutete Lösungsprinzip bisher nicht praktikabel umgesetzt werden konnte. Es konnte bisher kein Weg aufgezeigt werden, mit dem eine Verankerungsstütze für eine Herzklappenprothese einmal in einem Zustand so klein zusammengefaltet werden konnte, daß sie gemeinsam mit einem Katheter durch die Aorta und hier insbesondere durch den Aortenbogen zum Herzen geführt werden konnte. Eine solche Verankerungsstütze muß aber zusätzlich in der Lage sein, in einem zweiten Zustand eine Größe und Form zu erreichen, mit der gesichert ist, daß die Herzklappenfunktion über einen ausreichend langen Zeitraum wieder gesichert werden kann.
- Als ebenfalls nicht praktikabel hat sich der
DE 43 16 971 A1 entnehmbare Vorschlag erwiesen. Dort soll ein Memory-Material verwendet werden, das am Einsatzort auf rollbar bzw. aufweitbar sein soll. Der dort als Herzklappen-Verankerungsring bezeichnete Träger für eine künstliche Herzklappe soll im zusammengerollten Zustand, wie bereits erwähnt, mittels eines Katheters zum Herzen geführt und dort bei Erwärmung infolge der Aufwicklung des Verankerungsringes sich an die Aorteninnenwandung anlegen, wobei für die Verankerung zusätzlich Verankerungsmittel am Verankerungsring nach außen ragend, vorhanden sind. - Auch diese Lösung konnte bisher nicht praktikabel umgesetzt werden, da der spiralförmig aufgewickelte Körper in seinem Durchmesser immer noch zu groß ist, um durch eine Aorta problemlos zum Herzen geführt werden zu können. Außerdem muß eine entsprechende Einrichtung, wenn Sie in der Nähe des Herzens planiert werden soll, äußerst exakt positioniert werden, da die Öffnungen der Herzkranzgefäße in keiner Weise verschlossen werden dürfen.
- Problematisch dürfte sich zusätzlich auch die dort vorgeschlagene Lösung bezüglich der Erhöhung einer Thrombosegefahr erweisen.
- Auch die Verwendung von Ballonkathetern, für die hier bezweckte Applikation, hat bisher keine befriedigenden Ergebnisse gezeigt und so konnte auch das in WO 91/17720 A1 beschriebene System in der Praxis noch nicht eingesetzt werden. Dabei wird ein aus mehreren Metalldrähten zusammengesetztes und gebogenes Element verwendet, an dem eine Herzklappenprothese befestigt werden kann und das mit dem an dem Katheter vorhanden Ballon mechanisch aufgespannt wird. Die hierfür erforderliche Größe genügt jedoch den tatsächlich zur Verfügung stehenden räumlichen Verhältnissen in der Aorta nicht, und so ist es auch bisher nicht gelungen, einen entsprechenden operativen Eingriff mit Erfolg durchführen zu können.
- Daneben ist in
DE 195 32 846 A1 eine dort sogenannte Ventileinrichtung beschrieben, die insbesondere als Ersatz für eine Herzklappe verwendet werden kann. Bei dieser Lösung werden Spann- und Spreizbügel verwendet, an denen ein Segel, das die Funktion einer Herzklappenprothese übernehmen soll, taschenartig angenäht ist. - Ein sogenannter "Stent", der für die Aufweitung von einfachen Blutgefäßen verwendet werden kann, ist in
US 5,540,712 beschrieben. Dieser "Stent" wird durch eine drahtförmige Gitterstruktur, die aus einem Formgedächtnismetall besteht, gebildet, wobei nach Einführung dieses "Stents" und entsprechende Temperierung das Formgedächtnismetall eine Aufweitung dieses "Stents" bewirkt, so dass er an der Gefäßinnenwand anliegt. Für eine verbesserte Fixierung im Blutgefäß wird vorgeschlagen, Widerhaken auszubilden, die sich in der Gefäßwand verhaken oder eine Anpassung, durch entsprechende Einprägung unterschiedlicher Durchmesser an unterschiedliche Blutgefäßinnendurchmesser den Halt verbessern soll. - Es ist daher Aufgabe der Erfindung, eine Verankerungsstütze für eine Herzklappenprothese zur Verfügung zu stellen, die einfach herstellbar ist und mit der man in die Lage versetzt wird, diese gemeinsam mit einer Herzklappenprothese durch die Aorta bis in die unmittelbare Nähe des Herzens zu führen und dort mit Erfolg zu implantieren.
- Erfindungsgemäß wird diese Aufgabe mit den Merkmalen des Patentanspruchs 1 für die Verankerungsstütze gelöst. Vorteilhafte Ausgestaltungsformen und Weiterbildungen der Erfindung ergeben sich durch die in den untergeordneten Ansprüchen genannten Merkmale.
- Dabei geht die erfindungsgemäße Lösung von dem bekannten Gedanken, der Verwendung eines Memory-Materials aus und es wird demzufolge vorgeschlagen, eine Verankerungsstütze aus einem Formgedächtnismetall zu verwenden, das in der Lage ist, bei Erreichen einer bestimmten vorgebbaren Sprungtemperatur eine eingeprägte Form und Größe einzunehmen, die einen sicheren Halt, Dichtheit der Herzklappenprothese, geringe Thrombosegefahr und die Beachtung der Freihaltung der Herzkranzgefäßöffnungen ermöglicht. Die erfindungsgemäße Verankerungsstütze für eine Herzklappenprothese ist daher als einteiliger Körper ausgebildet, der aus einzelnen stabförmigen Elementen gebildet ist, die zumindest teilweise eine Gitterstruktur darstellen.
- Dabei wird die Dicke der stabförmigen Elemente so klein, wie möglich gewählt, um einmal eine ausreichende Festigkeit und Stabilität zu sichern und zum anderen jedoch die Thrombosegefahr entsprechend klein zu halten. Demzufolge liegt die Stärke der stabförmigen Elemente im Bereich zwischen 0,3 bis maximal 1 mm.
- Dadurch kann gesichert werden, daß der aus einem Halbzeug, das aus einem Formgedächtnismetall besteht, hergestellte Körper zum anderen sehr klein zusammengedrückt bzw. gefaltet werden kann und der bei der Positionierung des zusammengedrückten bzw. zusammengefalteten Körpers durch die Aorta nicht zu überschreitende freie Querschnitt von ca. 7 mm mit Sicherheit eingehalten werden kann.
- Erfindungsgemäß wird die Verankerungsstütze aus einem aus einem Formgedächtnismetall bestehenden Halbzeug hergestellt, in dem die eigentliche Struktur mit den stabförmigen Elementen ausgeschnitten bzw. ausgestanzt wird. Beim Ausschneiden hat sich besonders vorteilhaft ein Laserschneidverfahren herausgestellt, mit dem man in die Lage versetzt ist, sehr genau und exakt die gewünschten Strukturen in den relativ kleinen Wandstärken auszubilden.
- Nachdem die gewünschte Struktur ausgebildet ist, wird die Verankerungsstütze in die gewünschte Form und Größe für den implantierten Zustand gebracht und gleichzeitig bei einer Wärmebehandlung, unter Berücksichtigung der einzustellenden Sprungtemperatur, die vorteilhaft im Bereich von ca. 37 °C liegen sollte, eingeprägt.
- Als Halbzeug kann ein entsprechend ausgebildetes plattenförmiges Element, bevorzugt aber ein rohrförmiges Halbzeug verwendet werden. Für den Fall, daß ein plattenförmiges Element verwendet wird, muß dieses für das Einprägen der gewünschten Form und Größe nicht nur aufgeweitet, sondern auch entsprechend, zumindest annähernd in eine kreisrunde Form gebogen werden.
- Nach dem Einprägen der Form und Größe der erfindungsgemäßen Verankerungsstütze kann an ihr die Herzklappenprothese befestigt werden. Die Herzklappenprothese kann von außen von einer Seite auf die Verankerungsstütze übergestülpt und gegebenenfalls zusätzlich angenäht werden, wobei dieser Teil der Verankerungsstütze so geformt und dimensioniert ist, daß die Kommissuren einer biologischen Herzklappenprothese, die z.B. von einem Schweineherz entnommen sein kann und in präparierter Form zur Verfügung gestellt wird, berücksichtigt wird. Eine solche Herzklappenprothese kann aber auch durch die Verankerungsstütze geführt sein und von innen an der entsprechend ausgebildeten Gitterstruktur oder bogenförmigen Elementes befestigt werden. In ähnlicher Weise kann aber auch eine künstliche Herzklappenprothese aus hierfür geeigneten Materialien eingesetzt werden.
- Als Formgedächtnismetall kann eine Nickel-Titanlegierung, die z.B. unter der Bezeichnung "Nitinol" kommerziell erhältlich ist, verwendet werden. Nach der Ausbildung der Struktur und dem Einprägen der gewünschten Form und Größe im implantierten Zustand, kann die Verankerungsstütze mittels bekannter Oberflächenbehandlungsverfahren, wie z.B. dem Elektropolieren an ihrer Oberfläche veredelt und geglättet werden, so daß auch hierdurch der Thrombosegefahr entgegengewirkt werden kann.
- Bei der erfindungsgemäßen Verankerungsstütze wird eine Gitterstruktur ausgebildet, bei der stabförmige Elemente zum Teil mäanderförmig ausgebildet sind und in ihrer Ausrichtung mindestens einen Stützring bilden, der sich als solcher im implantierten Zustand an der Aorteninnenwandung anlegen kann. An dem einen aber auch an mehreren solcher mit den stabförmigen Elementen gebildeten Stützringen können Verankerungshaken ausgebildet sein, die ebenfalls aus dem verwendeten Formgedächtnismetall bestehen. Diesen Verankerungshaken wird beim Einprägen jedoch eine radial nach außen aufgerichtete Stellung eingestellt, so daß sie sich im implantierten Zustand in der Aorteninnenwandung verhaken und die Verankerungsstütze entsprechend sicher gehalten werden kann und die Verhakung zusätzlich zur Spannkraft der expandierten Veranke rungsstütze wirken kann.
- Vorteilhaft ist es, wenn den Verankerungshaken verschiedene Aufrichtrichtungen eingeprägt werden, die jeweils in entgegengesetzten Richtungen in bezug zur Längsachse der Verankerungsstütze in einem Winkel ungleich 90° liegen, so daß eine sichere Verankerung in beiden möglichen Bewegungsrichtungen einer Verankerungsstütze erreicht werden kann. Die Verankerungshaken sollten eine Länge von mindestens 1 und maximal 5 mm aufweisen, so daß eine vollständige Durchtrennung der Aortenwandung vermieden werden kann.
- Wird eine Verankerungsstütze mit mehr als einem Stützring verwendet, können diese Stützringe mittels Verbindungsstegen zwischen nebeneinander angeordneten Mäandern, die durch die stabförmigen Elemente der Stützringe gebildet sind, erreicht werden.
- Die Herzklappenprothese kann an einem stirnseitig angeordneten geschlossenen Kreisring oder einem aus einem Vieleck gebildeten Ring anliegen.
- Es besteht aber auch die Möglichkeit, an dieser Stirnseite der Verankerungsstütze drei bogenförmige Elemente für die Fixierung der Herzklappenprothese auszubilden. Dabei liegen diese bogenförmigen Elemente im implantierten Zustand an der Aorteninnenwand an. Mit den bogenförmigen Elementen kann im Gegensatz zu einem geschlossenen Ring eine höhere Elastizität bei der Selbstexpansion und gleichzeitig eine Anpassung an die Form der Kommissuren einer Herzklappenprothese erreicht werden.
- Neben einer Röhrenform kann die erfindungsgemäße Ver ankerungsstütze auch in Form eines Vieleckes ausgebildet sein, wobei dieses aber mindestens über acht Ecken verfügen sollte. Die letztgenannte Form hat einen erhöhten Selbstarretiereffekt, da die Eckkanten und die für die Verbindung von mehreren Stützringen verwendeten stabförmigen Elemente nicht parallel zur Längsachse der Verankerungsstütze ausgerichtet sein können. Daher kan ein erhöhter Formschluß für den sicheren Halt der Verankerungsstütze in der Aorta erreicht werden.
- Nach der Befestigung der Herzklappenprothese an der erfindungsgemäßen Verankerungsstütze kann beides gemeinsam zusammengedrückt bzw. -gefaltet und in einer Tasche, die an einem Katheter befestigt ist, untergebracht werden. Dabei ist die Tasche mit einem Kühlsystem verbunden, durch das entsprechend gekühlte Kochsalzlösung geführt wird, so daß die Verankerungsstütze unterhalb der Sprungtemperatur gehalten wird.
- Das Katheter kann dann in bekannter Form, an einem Draht durch die Aorta bis in die unmittelbare Nähe des Herzens geführt werden. Nach dem Erreichen der gewünschten Position und Überprüfung der Lage bezüglich der Herzkranzgefäßöffnungen kann die schützende Kappe entfernt oder zerstört werden und bei Erreichen der Sprungtemperatur stellt sich infolge von Selbstexpansion die für die Implantation gewünschte Form und Größe der Verankerungsstütze ein, wobei sich gleichzeitig die Verankerungshaken aufrichten und in der Aorteninnenwandung verklammern.
- Im Anschluß hieran können Führungsdraht und Katheter wieder entfernt werden und die Herzklappenprothese, die Funktion der natürlichen Herzklappe übernehmen.
- Nachfolgend soll die Erfindung beispielhaft, anhand von Ausführungsbeispielen näher erläutert werden.
- Dabei zeigen:
-
1 ein Beispiel einer erfindungsgemäßen Verankerungsstütze mit einer Herzklappenprothese in implantierter Form und Größe und -
2 eine Gitterstruktur eines Beispiels einer Verankerungsstütze in einer Abwicklung. - Bei dem in
1 gezeigten Beispiel verfügt die Verankerungsstütze über zwei aus sägezahnförmig aneinandergereihten stabförmigen Elementen4 gebildete Stützringe6 , die mit Verbindungsstegen3 miteinander verbunden sind. Außerdem sind ein Dicht- und Befestigungsring1 für die Herzklappenprothese2 , der hier eine Kreisringform aufweist sowie weitere stabförmige Elemente vorhanden sind, die die Verbindung zu den Stützringen6 darstellen und die Form und Größe der Kommissuren von Herzklappenprothesen berücksichtigen. - Außerdem sind an den Stützringen
6 zusätzlich Verankerungshaken5 vorhanden, die sich, wie im allgemeinen Teil der Beschreibung bereits erwähnt, bei Überschreiten der durch Prägung vorgegebenen Sprungtemperatur radial nach außen aufrichten. - Bei dem in
2 gezeigten Beispiel einer erfindungsgemäßen Verankerungsstütze, wurde die Darstellungsform einer Abwicklung gewählt, um die im Formgedächtnismetall ausgebildete Struktur deutlicher erkennen zu können. Bei diesem Beispiel wurden wiederum zwei Stützringe6 , durch sägezahnförmige Ausbildung von stabförmigen Elementen4 , an denen wiederum Verankerungshaken5 vorhanden sind, gewählt. Die beiden Stützringe6 sind außerdem wieder mit Verbindungsstegen3 verbunden, die für einen gegebenenfalls erforderlichen Längenausgleich teilweise schlaufenartig abgebogen sind. - Im Bereich der Verankerungsstütze, an dem die Herzklappenprothese positioniert und fixiert werden soll, sind bei diesem Beispiel drei bogenförmige Elemente
7 ausgebildet, an denen die Herzklappenprothese anliegen kann und befestigt wird. Die Form der bogenförmigen Elemente7 berücksichtigt die Form und Größe der Kommissuren einer biologischen Herzklappenprothese.
Claims (8)
- Verankerungsstütze für eine Herzklappenprothese, die aus einem, bei einer vorgebbaren Temperatur eine vorbestimmte Form einnehmenden Formgedächtnismetall besteht und die als ein einteiliger Körper, der aus stabförmigen Elementen (
1 ,2 ,3 ,4 ,5 ), die zumindest teilweise eine Gitterstruktur darstellen, gebildet ist, dadurch gekennzeichnet, daß die stabförmigen Elemente (4 ) sägezahnförmig aneinandergereiht sind und mindestens einen Stützring (6 ) bilden, der als Vieleck mit mindestens acht Ecken ausgebildet ist. - Verankerungsstütze nach Anspruch 1, dadurch gekennzeichnet, daß Verankerungshaken (
5 ), die sich bei Erreichen der Sprungtemperatur des Formgedächtnismetalls radial nach außen aufrichten, am/an dem/den Stützring(en) (6 ) vorhanden sind. - Verankerungsstütze nach Anspruch 2, dadurch gekennzeichnet, daß die Verankerungshaken (
5 ) eine Länge von mindestens 1 mm aufweisen. - Verankerungsstütze nach einem der Ansprüche 2 oder 3, dadurch gekennzeichnet, daß Verankerungshaken (
5 ), die sich in Bezug zur Längsachse der Verankerungsstütze in entgegengesetzten Richtungen in einem Winkel ungleich 90° radial nach außen aufrichten, vorhanden sind. - Verankerungsstütze nach einem der Ansprüche 1 bis 4, dadurch gekennzeichnet, daß die Stützringe (
6 ) mittels Verbindungsstegen (3 ) verbunden sind. - Verankerungsstütze nach einem der Ansprüche 1 bis 5, dadurch gekennzeichnet, daß an der Seite, an der die Herzklappenprothese fixiert ist, drei bogenförmige Elemente (
7 ) zur Fixierung der Herzklappenprothese (2 ) ausgebildet sind, die an der Aorteninnenwand anliegen. - Verankerungsstütze nach einem der Ansprüche 1 bis 6, dadurch gekennzeichnet, daß sämtliche stabförmigen Elemente (
1 ,3 ,4 ,5 ) eine(n) Breite/Durchmesser von maximal 1 mm aufweisen. - Verankerungsstütze nach einem der Ansprüche 1 bis 7, dadurch gekennzeichnet, daß die Gitterstruktur, die Größe und Lage der Herzkranzgefäßöffnungen berücksichtigend, ausgebildet sind.
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| DE1998157887 DE19857887B4 (de) | 1998-12-15 | 1998-12-15 | Verankerungsstütze für eine Herzklappenprothese |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| DE1998157887 DE19857887B4 (de) | 1998-12-15 | 1998-12-15 | Verankerungsstütze für eine Herzklappenprothese |
Publications (2)
| Publication Number | Publication Date |
|---|---|
| DE19857887A1 DE19857887A1 (de) | 2000-07-06 |
| DE19857887B4 true DE19857887B4 (de) | 2005-05-04 |
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| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| DE1998157887 Expired - Lifetime DE19857887B4 (de) | 1998-12-15 | 1998-12-15 | Verankerungsstütze für eine Herzklappenprothese |
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| US7914569B2 (en) | 2005-05-13 | 2011-03-29 | Medtronics Corevalve Llc | Heart valve prosthesis and methods of manufacture and use |
| US7993392B2 (en) | 2006-12-19 | 2011-08-09 | Sorin Biomedica Cardio S.R.L. | Instrument and method for in situ deployment of cardiac valve prostheses |
| US7993394B2 (en) | 2008-06-06 | 2011-08-09 | Ilia Hariton | Low profile transcatheter heart valve |
| US8016877B2 (en) | 1999-11-17 | 2011-09-13 | Medtronic Corevalve Llc | Prosthetic valve for transluminal delivery |
| US8052749B2 (en) | 2003-12-23 | 2011-11-08 | Sadra Medical, Inc. | Methods and apparatus for endovascular heart valve replacement comprising tissue grasping elements |
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| Publication number | Publication date |
|---|---|
| DE19857887A1 (de) | 2000-07-06 |
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