Minimally invasive annuloplasty procedure and apparatus

DETAILED DESCRIPTION Methods and apparatus embodying this invention with which the above and other objects can be accomplished are characterized as causing clips of a self-closing type to penetrate the tissue around the annulus.
Such a clip is typically U-shaped, having two end points, when it is constrained to be in an open configuration but is made of a wire of a shape memory material such that it tends to coil up to assume its naturally closed configuration.
Thus, if a plurality of such clips in open configurations penetrate the tissue around the annulus circumferentially and then the constraint keeping them in the open configuration is removed, they pull the tissue together between their two end points, and this tends to reduce the diameter of the annulus.
Such clips may be deployed each in the form of a clip assembly, having one of its end points connected to a tissue-piecing needle through a flexible member such as a suture and a release mechanism by which the clip can be easily released.
The clip is then caused to penetrate the tissue at two circumferentially separated positions one after the other.
Alternatively, a clip delivery device may be used with a plurality of clips loaded to a clip-holder serving to keep these clips in their open configurations.
A pusher is provided for pushing a specified number of such clips out of the device at a time.
Clip assemblies of this invention can be effectively used in ring annuloplasty and valve replacement procedures by placing clips circumferentially around a ring or a mitral prosthesis sewing cuff.
Cumbersome problems associated with suture management and suture knotting can be thereby obviated.