Methods of anchoring cardiac implants using knotless suture fasteners

A method for anchoring a cardiac implant to a native valve annulus, the implant having been advanced to the native valve annulus down a plurality of loops of suture that are preinstalled at the native valve annulus, the sutures having a thickness, comprising:

• providing an elongated delivery tool having a proximal end, a distal end, and a delivery tube therebetween having a lumen;
• positioning a suture locking device on the distal end of the delivery tool, the suture locking device having a bifurcated locking clamp including a pair of substantially similar clamp halves each having an exterior surface and an inner surface facing the inner surface of the other clamp half, the clamp halves being fixed axially with respect to one another while being connected for movement toward or away from each other to form a variable sized slot having a width between the inner surfaces through which the free ends extend, wherein the device further includes a biasing member that, in the absence of an object in the slot, urges the inner surfaces of the clamp halves together such that the slot has a width smaller than the suture thickness, wherein the device has a retention member positioned between the clamp halves against the force of the biasing member with a thickness that maintains the slot width large enough to permit passage of a suture therethrough;
• threading two free ends of one of the suture loops through the suture locking device;
• advancing each suture locking device on the distal end of the delivery tube down the free ends of the suture loop until the locking device contacts the implant;
• adjusting tension in the free ends of the suture loop passing through each locking device;
• proximally pulling the retention member from between the clamp halves of the locking device, thus enabling the biasing member to force the clamp halves toward and clamp onto the free ends of the corresponding suture loop;
• and
• repeating the preceding steps for each suture loop.

A method for anchoring a cardiac implant to a native aortic valve annulus, the implant having been advanced to the aortic valve annulus down a plurality of loops of suture that are preinstalled at three locations around the aortic valve annulus, the three locations being aligned with the two coronary ostia CO and the non-coronary sinus, the sutures having a thickness, comprising:

• providing three suture locking devices each having a bifurcated locking clamp including a pair of clamp halves fixed axially with respect to one another while being connected for movement toward or away from each other to form a variable sized slot having a width therebetween, each device further including a biasing member that urges the inner surfaces of the clamp halves together, each device further having a retention member positioned between the clamp halves against the force of the biasing member with a thickness that maintains the slot width large enough to permit passage of the suture free ends therethrough;
• providing a suture snare having a distal loop thereon extending distally through each suture locking device;
• threading two free ends of each of the suture loops through each of the plurality of suture locking devices by passing the two free ends through the distal loop of one of the snares and withdrawing the snare proximally through the corresponding suture locking device so as to pull the free ends therethrough;
• advancing the suture locking devices down the free ends of the suture loops until the locking devices contact the implant;
• adjusting tension in the free ends of the suture loop passing through each locking device;
• proximally pulling the retention member from between the clamp halves of each locking device, thus enabling the biasing member to force the clamp halves toward and clamp onto the free ends of the corresponding suture loop;
• and
• further anchoring the cardiac implant to the native aortic valve annulus without using sutures, the three suture loops being the only sutures used to anchor the implant.