Techniques for percutaneous mitral valve replacement and sealing

Apparatus for use with a native valve of a heart of a subject, the native valve having an annulus and being disposed between an atrium of the heart and a ventricle of the heart, the apparatus comprising:

• a sheath, configured to be transluminally advanced to the atrium of the heart;
• a plurality of tubular longitudinal members, configured to be advanced through the sheath;
• a plurality of tissue anchors, configured to be advanced through the sheath and into the ventricle and there to be anchored to heart tissue, each of the tissue anchors being reversibly couplable to a respective tubular longitudinal member;
• a prosthetic valve support comprising an annular element:
• shaped to define a plurality of holes that are configured to receive a respective tubular longitudinal member, such that the upstream support portion is slidable over the plurality of tubular longitudinal members,
• configured to be transluminally advanced toward the native valve in a subsequent act of advancement, separately from the advancing of the tissue anchors, and
• configured to be coupled to an atrial surface of the annulus by being coupled to the tissue anchors while the tissue anchors are anchored in the ventricle;
• and
• a prosthetic valve configured to be transluminally advanced to the native valve, and to be intracorporeally coupled to the annular element by at least part of the prosthetic valve being expanded while disposed within an opening defined by the annular element.

A method for use with a native valve of a heart of the subject, the native valve having an annulus and being disposed between an atrium of the heart and a ventricle of the heart, the method comprising:

• through a sheath, transluminally advancing at least one tissue anchor into the ventricle of the heart, and there anchoring the tissue anchor to heart tissue;
• in a subsequent act of advancement, separately from the advancing of the at least one tissue anchor, transluminally advancing an annular element of a prosthetic valve support toward the atrium of the subject;
• subsequently, coupling the annular element to an atrial surface of the annulus by coupling the annular element to the at least one tissue anchor;
• transluminally advancing a prosthetic valve toward the native valve of the subject;
• and
• intracorporeally coupling the prosthetic valve to the annular element by placing at least part of the prosthetic valve within an opening defined by the annular element, and expanding the prosthetic valve.