Devices and methods for heart valve repair

A method for constricting a heart valve annulus, the method comprising:

• introducing a tethered clip assembly to the annulus, the tethered clip assembly comprising a plurality of clips coupled with a tether, the tether comprising parallel segments, the plurality of clips comprising a first clip, an intermediate clip, and a terminal clip, wherein the first clip and a lead end of the tether are constructed to prevent the first clip from moving distally past the lead end of the tether, and wherein one or more of the remaining clips are slidably coupled to the tether;
• securing individual clips of the tethered clip assembly at circumferentially spaced-apart locations about at least a portion of the annulus, the parallel segments of the tether being coupled to at least the intermediate and terminal clips through first and second eyelets in the clips;
• cinching a tether through the clips to circumferentially tighten the annulus;
• and
• preventing the terminal clip from moving proximally past a chosen location along the tether after the cinching step by applying force to the first and second eyelets on the terminal clip to reduce the inner diameter of the first and second eyelets and secure the tether to the terminal clip.

A method for constricting a heart valve annulus, the method comprising:

• placing an instrument introduction device through an incision in the left atrial wall of the heart;
• introducing a tethered clip assembly to the annulus by advancing a tethered clip applicator through the instrument introduction device, the tethered clip assembly comprising a plurality of clips coupled with a tether, the plurality of clips comprising a first clip, an intermediate clip, and a terminal clip, wherein the first clip and a lead end of the tether are constructed to prevent the first clip from moving distally past the lead end of the tether, and wherein one or more of the remaining clips are slidably coupled to the tether;
• securing the introduction device to an epicardial surface of the heart wall before the advancing step;
• securing individual clips of the tethered clip assembly at circumferentially spaced-apart locations about at least a portion of the annulus;
• cinching the tether through the clips to circumferentially tighten the annulus;
• and
• preventing the terminal clip from moving proximally past a chosen location along the tether after the cinching step.

A method for constricting a heart valve annulus, the method comprising:

• introducing a tethered clip assembly to the annulus, the tethered clip assembly comprising a plurality of clips coupled with a tether, the plurality of clips comprising a first clip, an intermediate clip, and a terminal clip, wherein the first clip and a lead end of the tether are constructed to prevent the first clip from moving distally past the lead end of the tether, and wherein one or more of the remaining clips are slidably coupled to the tether;
• securing individual clips of the tethered clip assembly at circumferentially spaced-apart locations about at least a portion of the annulus;
• stabilizing the annulus prior to introducing the clips:
• wherein stabilizing comprises:
• introducing a first stabilizing ring beneath the valve leaflets, wherein the ring engages the intersection between the leaflets and the interior ventricular wall;
• and
• introducing a second stabilizing ring over the annulus, wherein the first and second stabilizing rings clamp and immobilize the annulus prior to the securing step;
• cinching the tether through the clips to circumferentially tighten the annulus;
• and
• preventing the terminal clip from moving proximally pst a chosen location along the tether after the cinching step.

A method for constricting a heart valve annulus in a beating heart, said method comprising;

• stabilizing the annulus;
• securing individual clips at circumferentially spaced-apart locations about at least a portion of the annulus while said remains stabilized;
• the stabilizing step comprising:
• introducing a first stabilizing ring beneath the valve leaflets, wherein the ring engages the intersection between the leaflets and the interior ventricular wall;
• and
• introducing a second stabilizing over the valve leaflets, wherein the first and second stabilizing rings clamp and immobilize the annulus prior to securing the clips;
• and
• cinching a tether through the clips to circumferentially tighten the annulus.