Prosthetic heart valve with upper and lower skirts

Apparatus for use at a native atrioventricular valve of a heart of a subject, the apparatus comprising a prosthetic valve structure that comprises:

• a leaflet frame, circumscribing a longitudinal axis of the prosthetic valve structure;
• prosthetic leaflets, coupled to the leaflet frame, and configured to facilitate upstream-to-downstream bloodflow longitudinally through the prosthetic valve structure;
• an upper skirt, having an upstream perimeter;
• and
• a lower skirt, downstream of the upper skirt, and having a downstream perimeter,
• wherein:
• (1) the upper skirt:
• extends away from the lower skirt, in an upstream direction and radially outward toward the upstream perimeter, and
• is configured to rest against an atrial surface of the native atrioventricular valve,
• (2) the lower skirt:
• extends away from the upper skirt, in a downstream direction and radially outward toward the downstream perimeter, and
• is configured to rest against a ventricular surface of the native atrioventricular valve, and
• (3) a downstream portion of the leaflet frame is disposed downstream of at least part of the downstream perimeter of the lower skirt, and
• wherein:
• the prosthetic valve structure defines a narrowed waist on a plane that is perpendicular to the longitudinal axis, longitudinally between the upper skirt and the lower skirt;
• the prosthetic valve structure further comprises joints, distributed circumferentially around the longitudinal axis on the plane;
• and
• each of the joints comprises a respective connecting element that connects metal segments of the prosthetic valve structure by being inserted into a respective hole of the prosthetic valve structure.

Apparatus for use at a native atrioventricular valve of a heart of a subject, the apparatus comprising a prosthetic valve structure that comprises:

• a leaflet frame, circumscribing a longitudinal axis of the prosthetic valve structure;
• prosthetic leaflets, coupled to the leaflet frame, and configured to facilitate upstream-to-downstream bloodflow longitudinally through the prosthetic valve structure;
• an upper skirt, having an upstream perimeter;
• a lower skirt, downstream of the upper skirt, and having a downstream perimeter;
• and
• downstream of the upper skirt and upstream of the lower skirt, a plurality of metal segments forming a waist of the prosthetic valve structure,
• wherein:
• (1) the upper skirt:
• extends away from the lower skirt, in an upstream direction and radially outward toward the upstream perimeter, and
• is configured to rest against an atrial surface of the native atrioventricular valve,
• (2) the lower skirt:
• (a) extends away from the upper skirt, in a downstream direction and radially outward toward the downstream perimeter,
• (b) comprises a lower skirt frame and fabric coupled to the lower skirt frame, wherein the lower skirt frame:
• (i) is shaped to define a plurality of lower-skirt petals, each petal having an ascending portion and a descending portion such that the lower skirt frame defines a plurality of ascending portions and descending portions, each of the lower-skirt petals extending radially outward and in a downstream direction from the upper skirt, adjacent ascending and descending portions forming respective upstream peaks of the lower skirt frame, each upstream peak being disposed downstream of the waist, and
• (ii) has an outer edge that defines a path circumferentially around the longitudinal axis along which the plurality of ascending portions and descending portions of the lower skirt frame are disposed,
• wherein the plurality of ascending portions and descending portions of the lower skirt frame are disposed radially outward and distanced from the leaflet frame, and
• (c) is configured to rest against a ventricular surface of the native atrioventricular valve, and
• (3) a downstream portion of each of the prosthetic leaflets is disposed downstream of at least part of the downstream perimeter of the lower skirt.

Apparatus for use at a native atrioventricular valve of a heart of a subject, the apparatus comprising a prosthetic valve structure that comprises:

• a leaflet frame, circumscribing a longitudinal axis of the prosthetic valve structure;
• prosthetic leaflets, coupled to the leaflet frame, and configured to facilitate upstream-to-downstream bloodflow longitudinally through the prosthetic valve structure;
• an upper skirt, having an upstream perimeter;
• and
• a lower skirt, downstream of the upper skirt, and having a downstream perimeter,
• wherein:
• (1) the upper skirt:
• extends away from the lower skirt, in an upstream direction and radially outward toward the upstream perimeter, and
• is configured to rest against an atrial surface of the native atrioventricular valve,
• (2) the lower skirt:
• extends away from the upper skirt, in a downstream direction and radially outward toward the downstream perimeter, and
• is configured to rest against a ventricular surface of the native atrioventricular valve, and
• (3) a downstream portion of each of the prosthetic leaflets is disposed downstream of at least part of the downstream perimeter of the lower skirt, and
• wherein:
• the prosthetic valve structure defines a narrowed waist on a plane that is perpendicular to the longitudinal axis, longitudinally between the upper skirt and the lower skirt;
• the prosthetic valve structure further comprises joints, distributed circumferentially around the longitudinal axis on the plane;
• and
• each of the joints comprises a respective connecting element that connects metal segments of the prosthetic valve structure by being inserted into a respective hole of the prosthetic valve structure.

Apparatus for use at a native atrioventricular valve of a heart of a subject, the apparatus comprising a prosthetic valve structure that comprises:

• a leaflet frame, circumscribing a longitudinal axis of the prosthetic valve structure;
• prosthetic leaflets, coupled to the leaflet frame, and configured to facilitate upstream-to-downstream bloodflow longitudinally through the prosthetic valve structure;
• an upper skirt, having an upstream perimeter;
• a lower skirt, downstream of the upper skirt, and having a downstream perimeter that shapes the lower skirt to define a plurality of lower-skirt petals, each of the lower-skirt petals extending radially outward and in a downstream direction from the upper skirt;
• and
• downstream of the upper skirt and upstream of the lower skirt, a plurality of metal segments forming a waist of the prosthetic valve structure,
• wherein:
• (1) the upper skirt:
• extends away from the lower skirt, in an upstream direction and radially outward toward the upstream perimeter, and
• is configured to rest against an atrial surface of the native atrioventricular valve,
• (2) the lower skirt:
• (a) extends away from the upper skirt, in a downstream direction and radially outward toward the downstream perimeter,
• (b) comprises a lower skirt frame and fabric coupled to the lower skirt frame, wherein the lower skirt frame:
• (i) is shaped to define the plurality of lower-skirt petals, each petal having an ascending portion and a descending portion such that the lower skirt frame defines a plurality of ascending portions and descending portions, adjacent ascending and descending portions forming respective upstream peaks of the lower skirt frame, each upstream peak being disposed downstream of the waist, and
• (ii) has an outer edge that defines a path circumferentially around the longitudinal axis along which the plurality of ascending portions and descending portions of the lower skirt frame are disposed,
• wherein the plurality of ascending portions and descending portions of the lower skirt frame are disposed radially outward and distanced from the leaflet frame, and
• (c) is configured to rest against a ventricular surface of the native atrioventricular valve, and
• (3) a downstream portion of the leaflet frame is disposed downstream of at least part of the downstream perimeter of the lower skirt.

Apparatus for use at a native atrioventricular valve of a heart of a subject, the apparatus comprising a prosthetic valve structure that comprises:

• a leaflet frame, circumscribing a longitudinal axis of the prosthetic valve structure;
• prosthetic leaflets, coupled to the leaflet frame, and configured to facilitate upstream-to-downstream bloodflow longitudinally through the prosthetic valve structure;
• an upper skirt, having an upstream perimeter;
• a lower skirt, downstream of the upper skirt, and having a downstream perimeter;
• and
• downstream of the upper skirt and upstream of the lower skirt, a plurality of metal segments forming a waist of the prosthetic valve structure,
• wherein:
• (1) the upper skirt:
• extends away from the lower skirt, in an upstream direction and radially outward toward the upstream perimeter, and
• is configured to rest against an atrial surface of the native atrioventricular valve,
• (2) the lower skirt:
• (a) extends away from the upper skirt, in a downstream direction and radially outward toward the downstream perimeter,
• (b) comprises a lower skirt frame and fabric coupled to the lower skirt frame, wherein the lower skirt frame:
• (i) is shaped to define a plurality of ascending portions and descending portions, adjacent ascending and descending portions forming respective upstream peaks of the lower skirt frame, each upstream peak being disposed downstream of the waist,
• (ii) has an outer edge that defines a path circumferentially around the longitudinal axis along which the plurality of ascending portions and descending portions of the lower skirt frame are disposed,
• wherein the plurality of ascending portions and descending portions of the lower skirt frame are disposed radially outward and distanced from the waist of the prosthetic valve structure, and
• (c) is configured to rest against a ventricular surface of the native atrioventricular valve, and
• (3) a downstream portion of the leaflet frame is disposed downstream of at least part of the downstream perimeter of the lower skirt.