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School of Peace Studies
Contact: Marisa Alioto
Phone: (619) 260-7929
Fax: (619) 849-8109
Location: KIPJ Room 113
Joan B. Kroc School of Peace Studies
5998 Alcala Park
San Diego, CA 92110
Students and Alumni
Class of 2014
Muhammad Aslam Khan Kakar
Muhammad Aslam Khan Kakar (MAPJ 2014) is a Fulbright scholar from the small village of Pishin, in Balochistan, Pakistan. He holds a B.A. in political science from Government College University Lahore, where he completed his studies on a fully funded federal scholarship from the Higher Education Commission. As a Global Undergraduate Exchange student through the U.S. State Department in 2011, Khan had the opportunity to study aspects of American politics at the University of Nebraska, Kearney. He is a member of the Human Rights Commission of Pakistan (HRCP) and the Institute for Peace and Secular Studies, aimed at defending religious freedom and security of human rights in his country. A committee member of the HRCP, Khan had the responsibility of uncovering evidence of hate literature in the Pakistani national educational curriculum. He is also the founder and president of Institute for Development, Education and Advocacy, a nonprofit organization which seeks to encourage social development in Pakistan through education and human rights advocacy. Khan is a writer, and through his short stories he explores pressing cultural, social and political issues.
Marilyn Brimo
Marilyn Brimo (MAPJ 2014) is most recently from Portland, Ore., but was born and raised in California. An alumna of Portland State University (PSU), Brimo holds bachelor's degrees in speech communication and anthropology and her M.S. work is in speech communication. After working as a graduate teaching assistant at PSU, she started teaching communication studies in community colleges, including as an adjunct faculty member at Mt. Hood Community College for 15 years. She teaches courses in intercultural communication and public speaking, and co-created and taught an interdisciplinary peace and conflict seminar. Brimo is an avid traveler, speaks French and is learning Arabic. In the master's program, she will concentrate on developing and expanding courses and curricula in peace education, intercultural communication and conflict, and human rights.
Christina Burhans
Christina Burhans (MAPJ 2014) was born and raised in San Diego and graduated from National University in 2012 with a B.A. in global studies and a minor in Arabic culture and history. She is certified as a Terrorism and Homeland Security Specialist, and is a California Peace Officer Standards and Training Master Instructor. For 18 years Burhans has been a police officer in San Diego, working to address criminal problems facing our local communities. Her most memorable experiences involve her efforts to improve community-police relations with the local Somali diaspora population. In her undergraduate project, "Establishing Trust and Partnerships among Public Safety Officers and Somali Refugees," she used forward-thinking police strategies to develop cooperation between the police and Somali diaspora communities. Burhans is also a columnist for a local newspaper where she provides the Muslim community a forum to ask questions, share concerns or simply offer suggestions on public safety.
Jenny Calvert
Jenny Calvert (MAPJ 2014) is a Northern California native, and graduated from the University of Southern California (USC) in 2009 with a B.A. in religion and minors in peace and conflict studies and natural sciences. Her encounters with peace activists while on a delegation to Israel and Palestine sparked her interest in peace issues. She was a founding member of RAYSE, a campus awareness organization that supported youth empowerment through the arts in Uganda, and helped coordinate USC's first Alternative Spring Break trip to Africa. After college, Calvert taught dance and English lessons at RAYSE's sister organization, Amagezi Gemaanyi Youth Association, in Kampala, Uganda. She has continued her work with youth in recent years through teaching, tutoring and counseling students through the college admissions process. Calvert is interested in post-conflict peacebuilding, interreligious dialogue and public policy.
Marta Cicálková
Marta Cicálková (MAPJ 2014) grew up in the Czech Republic and in 2013 received a first-class bachelor's degree (with Honors) in Cultural Anthropology and International Relations from the University of Aberdeen (United Kingdom). As part of her undergraduate studies she spent one year at the University of New Mexico. In the summer of 2012 Cicálková worked as an English teacher in a low-income neighborhood of Barranquilla, Colombia. She has also repeatedly volunteered in Taizé, an ecumenical community based in France which works toward reconciliation between Christians. Her capstone project discussed relational perspectives on trauma within the discipline of transitional justice. It drew heavily on her internship experience with a Peruvian organization Paz y Esperanza in the summer of 2014. Cicalkova currently serves as a Resident Minister at the University of San Diego. In January 2015 she co-led a University Ministry's Immersion Program to El Salvador that has profoundly deepened her understanding of solidarity, social justice and human-oriented approaches towards transitional justice practices. (Updated 1/15)
Dramane Coulibaly
Dramane Coulibaly (MAPJ 2014) is from Korhogo in the northern part of Côte d'Ivoire, but was born and raised in the capital of Abidjan. He taught English for 10 years and received a master's degree in English from the University of Abidjan in 2005. In 2004, Coulibaly joined the United Nations Operation in Côte d'Ivoire (UNOCI), which is focused on peacekeeping and peacebuilding, and worked there for ten years. He is fluent in Dioula, French and English, and brought extensive fieldwork experience to the master's program. His capstone research was a comparative analysis of the Truth and Reconciliation Commissions in Sierra Leone and Liberia and the policy implications for similar ongoing processes in Côte d'Ivoire. Upon graduation, Coulibaly returned to UNOCI to work in logistics and administration. His focus will be on conflict resolution and development in the post-conflict setting. (Updated 8/14)
Janie Dumbleton
Janie Dumbleton (MAPJ 2014) grew up in Atlanta, Georgia, and received a B.A. in English and Religion from the University of Georgia in 2011. While studying English, she emphasized in Multicultural American Literature providing her with a greater understanding of modern cultural issues and analytical understanding of the lived experiences of marginalized or oppressed voices in literature. She studied Islam, Arabic, and Intercultural dialogue in Morocco, which ignited her passion for inter-religious and inter-cultural dialogue, pertaining specifically to religious-based conflict and analysis. Her interest for social justice within marginalized communities as it applies to peace and justice was further fostered during her time in the Jesuit Volunteer Corps where she served as a teacher in Harlem, New York City. The Jesuit Volunteer Corps taught her the integral pieces of education, community, and social justice within peacebuilding and conflict analysis.
Kacie Forker
Kacie Forker (MAPJ 2014) was born and raised on Long Island, N.Y. In 2013 she received her B.A. in interdisciplinary humanities from the University of San Diego, with an emphasis in philosophy and a minor in peace and justice studies. Forker graduated with departmental honors and from the university's Honors Program, and during her time at USD was selected to attend Oxford University as a Blackfriars Scholar, where she studied philosophy and theology. Forker has served as USD president of Invisible Children, as a mentor and student tutor in low-income neighborhoods in San Diego, and as an intern for the New York Immigration Coalition. She completed her senior honors thesis on the reevaluation of the terms "crimes against humanity" and "acts of genocide" in international policy and law to prevent the acts and better protect victims. After she completes the master's program, she hopes to continue her education in law school and develop international policy to better address these ongoing issues throughout the world.
Steve Garber
Steve Garber (MAPJ 2014) is a native of San Diego, holds a B.A. in Biology from University of California, Santa Cruz (1980) and is the owner of a plumbing, steam and sauna business. As a result of teaching Aikido (a Japanese martial art), practicing Rinzai Zen Meditation, and reading numerous books on non-violent conflict resolution, Garber founded the Wisdom, Mediation and Dialogue (WMD) Foundation in 2008. Through this foundation, he has met and discussed with Archbishop Desmund Tutu the importance of post-conflict apologies, conducted conflict management workshops with international and domestic students, and continues to seek effective ways to reduce suffering through healing and reconciliation.
Paige Goodlett
Paige Goodlett (MAPJ 2014) was born and raised in Charlotte, North Carolina and received her B.A. in Peace, War & Defense and Political Science with a minor in Italian from the University of North Carolina at Chapel Hill in May 2012. Throughout her undergraduate studies, she developed a heightened interest in peace-building efforts and humanitarian intervention – particularly in cases of genocide and ethnic cleansing - and wrote her Honor's Thesis on the development of Istrian identity in Croatia. Moreover, Paige spent six months living in Bologna, Italy during her junior year studying politics, literature and Italian and travelled to a number of countries throughout Europe and North Africa. Upon graduating in the spring of 2012, Paige returned to Italy for several months to gain experience working on organic farms, and in February of 2013 she moved to Boston to pursue an internship with the Boston Consortium on Gender, Security and Human Rights. Through her work on women's empowerment and security issues in South Asia, she unearthed a newfound and burning passion for advancing the field of gender, security and development. Through the Peace Studies Master's program at USD, Paige plans to dive deeper into these issues and hopes to become an advocate for women's rights and empowerment in developing countries, and is additionally interested in exploring how these issues intersect with sustainable development. Paige speaks Italian and Spanish and when not in the classroom can be found on her yoga mat or running on the beach.
Riana Hardin
Riana Hardin (MAPJ 2014) is from Encinitas, Calif. She received her bachelor's degree in human communications, with an emphasis in peace studies and a minor in Spanish, from California State University, Monterey Bay in 2011. During her undergraduate career, Hardin worked on projects devoted to promoting alternatives to incarceration of youth. Additionally, she formed S.A.D.E. (Student Awareness for Disability Empowerment), a disability culture awareness group. After graduating, she completed a policy internship with the American Civil Liberties Union, continuing research related to alternative education and English Language Learner programs and increasing civic engagement among the next generation of policymakers. Hardin is also pursuing a certificate in fundraising and development through the University of California, San Diego, in order to increase her understanding of the financial needs of the nonprofit sector. In order to put theory to practice, she interned with the National Conflict Resolution Center's Fund Development Department. Hardin also volunteers with Scripps Hospital in their Brain Injury Day Treatment Program, where she is conducting research related to the benefits of peer mentorship in the rehabilitation process. During her time in the master's program, Hardin hopes to enhance her perception of transitional justice and grassroots healing mechanisms and actors in the face of mass atrocities, and will specialize in human rights and conflict analysis and resolution.
Ignatius Kipchirchir
Father Ignatius Kipchirchir (MAPJ 2014) is a Catholic priest from Eldoret Diocese in Kenya. He is from Nandi County, in the Rift Valley province of Kenya. He went to Mother of Apostles Seminary for his secondary education and holds a B.A. in philosophy from Catholic University of Eastern Africa and a B.A. in sacred theology from Pontifical Urbaniana University. Kipchirchir has worked with the Justice and Peace Department of the Catholic Diocese of Eldoret; Peacenet-Kenya, a nongovernmental organization; and the Nandi County Peace Committee. He first became involved in peacebuilding while he was a seminarian in 2008, after severe post-election violence racked Kenya. He worked with internally displaced persons in camps in Eldoret, promoting peace and reconciliation among different tribes. In the master's program, Kipchirchir receive the 2013-2014 Africa Peace Scholarship and specialized in peacebuilding and conflict resolution. Kipchirchir speaks Nandi, Swahili and English.
For his capstone project, Father Kipchirchir returned to Kenya to do primary research on the role of the Catholic Church in peacebuilding in northern Kenya (grassroots dialogue for electoral violence prevention and the reduction of inter-tribal cattle rustling). In the process, he connected with fellow Kenya alumnus Daniel Nganga and IPJ Woman PeaceMaker Sara Akoru Lochodo, who are working on similar issues. Father Kipchirchir will be working at Our Lady of Mount Carmel parish in San Diego before returning to Kenya in fall 2015. (Updated 8/14)
Becca Mathias
Becca Mathias (MAPJ 2014) was born and raised in Nashville, Tenn., and graduated from The Johns Hopkins University in 2011 with a B.A. in anthropology and French and a minor in music. She spent a semester abroad in Senegal with the School for International Training, studying with local musicians and later completing an honors thesis in anthropology on the evolution of traditional West African music and its incorporation into modern forms. After graduation, her love of travel and people took her across the United States on two wheels with 4K for Cancer, a nonprofit that fundraises and inspires by organizing groups to cycle through cancer-affected communities. Mathias' interests lie in human rights and the role of women in development.
Jean Mendieta
Jean Mendieta (MAPJ 2014) was born and raised in Acapulco, Mexico. She holds a B.A. in business administration from Instituto Tecnologico de Estudios Superiores de Occidente (Iteso). She worked in sustainable development for Fundacion Leon XIII in Chiapas coordinating a fair trade project working with 250 women artisans. She has been a professor of social ethics and human development at the undergraduate and high school level. Since 2011 Mendieta has been actively involved in peacebuilding efforts in her hometown, specifically in the areas of social dialogue, networks and education for peace. Mendieta participated in Movimiento por la Paz con Justicia y Dignidad and in Acapulco por la Paz. During the program she focused on peacebuilding and conflict transformation as tools to understand and address Mexico's undergoing violence. After finishing the program, she documented and researched Mexico's Catholic Church peacebuilding pilot project located in Acapulco; the results of this participatory action research were published by Universidad Loyola of the Pacific, Catholic Relief Services (CRS) and Caritas Mexico. Mendieta is currently working on strengthening local capacities for peace, through training and education of actors such as governments, churches and civil society as well as doing research and consultancy for CRS Mexico. (updated 5/2015)
Lt. Cmdr. Aaron Miller
Lt. Cmdr. Aaron Miller (MAPJ 2014) is a Southern California native and completed his B.A. in religion at Vanguard University in 1996. After graduation he served as a Sheriff Special Officer with the Orange County Sheriff's Department, working in the Orange County jail system. He then returned to academia and received his master of divinity in pastoral counseling from Biola University's Talbot School of Theology in 2001. He was ordained by the Evangelical Church Alliance and Calvary Chapel and reported for active duty with the United States Navy as a Chaplain. His assignments have included staff chaplain at Naval Station Norfolk, battalion chaplain with the 1st Marine Division (with a combat deployment to Iraq in 2005), command chaplain at Naval Hospital Guam and deputy command chaplain at U.S. Coast Guard Training Center Cape May. Chaplain Miller earned an M.A. in psychology from Northcentral University in 2011 and is a graduate of the Air Force Command and Staff College, earning a diploma in Joint Professional Military Education in 2012.
Annette Natalia Moreno
Annette Moreno (MAPJ 2014) is a San Diego native. She earned her B. A. in intercultural studies, with a minor in biblical studies and a teaching credential in fundamental TESOL (Teachers of English to Students of Other Languages) from Biola University, and specialized in international business at the Autonomous University of Barcelona. Fluent in English and Spanish, Moreno has helped foster cross-cultural communication by working with international students in language learning. She has served as a co-director for Acting for Others, Inc., a nonprofit organization based in Rancho Santa Fe, Calif., that works to engage underprivileged children in the production of theatrical performances. In the master's program she will specialize in human rights advocacy and humanitarian aid.
Christina Murphy
Christina Murphy (MAPJ 2014) grew up in Columbus, Ohio and received her B.A. in peace studies and French from Goucher College in Baltimore, Md., in 2012. As an undergraduate student, Murphy worked with Baltimore City schoolchildren on non-violent communication skills and became involved in anti-genocide activism as a founder of Goucher's STAND chapter. She has worked with refugee resettlement and immigrant groups in France and the United States, most recently in the Baltimore office of the International Rescue Committee. Murphy is fluent in French. In the master's program she will focus on human rights and conflict analysis
Andy Paul
Andy Paul (MAPJ 2014) is a San Diego native and holds a B.A. in anthropology and human geography, and a certificate in peace and conflict studies, from the University of Colorado. His studies focused on contemporary migration and border-related conflict, specifically in South Asia. After interning at the Joan B. Kroc Institute for Peace & Justice in 2011, he volunteered at the Chhahari Youth Hostel orphanage in Kathmandu, Nepal, consulted with Youth Foundation Nepal, and investigated the reintegration of Maoist combatants into Nepali society. Paul has taught ESL courses to Iraqi refugees through the International Rescue Committee in San Diego, and recently traveled to northern Jordan and Egypt, where he met with different communities impacted by conflict and social movements. He is a Leave No Trace Master Educator and instructor with the National Outdoor Leadership School, where he teaches environmental education and leadership. Paul is fluent in Spanish. In the master's program he will focus on international development.
Lindsey Rosenbaum
Lindsey Rosenbaum (MAPJ 2014) was born and raised in Fort Lauderdale, Fla., and graduated from the University of Central Florida in 2012 with a B.A. in legal studies and a minor in religious studies. After graduation, Rosenbaum joined the Miami chapter of AmeriCorps' Public Allies program, and worked with underserved youth and families in Liberty City with the Miami Children's Initiative, a nonprofit organization. In the master's program she will specialize in conflict analysis and resolution.
Jourdan Sanford
Jourdan Sanford (MAPJ 2014) is from Dallas, Texas and received her bachelor's degree in international studies, with a concentration in African studies, from Baylor University in 2012. For the past year she has been serving in AmeriCorps VISTA in Oakland, Calif., as community relations coordinator for Volunteers of America Northern California and Northern Nevada. The organization is one of the largest nonprofit providers of low-income housing in the United States. In Oakland, Sanford worked specifically with foster youth and ex-offenders. In 2011 she volunteered for two months in Gisenyi, Rwanda, with a local nongovernmental organization called Faith Victory Association, working at the Noel de Nyundo Orphanage, as well as a gender-based violence cooperative and one for women with HIV/AIDS. Sanford is fluent in French and is learning Portuguese.
Lisa Schmidt
Lisa Schmidt (MAPJ 2014) is a San Diego native, received a B.A. in sociology and a B.A. in psychology, with a minor in Spanish and Portuguese linguistic studies, from the University of Arizona. She studied abroad in Costa Rica at the Universidad Nacional and has done volunteer work in Mexico. Schmidt has participated in and hosted leadership conferences through Rotary International and various other organizations. She spent a year interning at a prosecuting county attorney's office and helped direct a trial run for a government-funded drug rehabilitation program through Tucson's Superior Court. In the master's program Schmidt will specialize in human security and conflict analysis and resolution.
Jayda Shuavarnnasri
Jayda Shuavarnnasri (MAPJ 2014) was born and raised in Anaheim, Calif. In high school she was involved in various philanthropic leadership roles, which led her to a bachelor of science degree in human services from California State University, Fullerton. At CSUF she was active in Chi Sigma Phi Sorority, which promotes empowerment and education among Asian women. She also served on the executive board of the Multi-Cultural Greek Council, which maintains community involvement and cross-cultural relationships among student leaders. Shuavarnnasri has worked with several nonprofit organizations in the Orange County region, such as the after-school program THINK Together, and Olive Crest, which runs group homes for teenage youth. For the last two years she has been a volunteer for Community Service Programs, Inc., serving as a sexual assault advocate for victims of rape or sexual assault. Shuavarnnasri has studied at Nelson Mandela Metropolitan University in South Africa, and taught English at the Isara Foundation in Thailand.
Lisa Vander
Lisa Vander (MAPJ 2014) lives in Carlsbad, Calif., and received her B.A. from Westmont College, specializing in sociology, anthropology and biology, and her M.Ed. in counseling in human services from the University of Idaho, where she later worked in drug counseling and child abuse prevention. She previously worked in real estate sales and property development, and launched her own company as an adult educator in investment theory. After the financial crash of 2008, she returned to school to study adult education, workforce development and policy analysis, with a specialization in creativity and innovation. After the master's program she would like to apply the skills of conflict resolution to the development of economic public policy and to complete her Ph.D. in leadership and policy analysis.
Ali Wolters
Ali (Wolters) Moore (MAPJ 2014) began working at the International Rescue Committee while wrapping up her capstone, Policy Symbolism to Policy Practice: Education Reforms in Mozambique to Bring Peace Education into the Classroom. When she first started at the IRC, Ali taught vocational ESL and transportation classes to newly arrived refugees. She later transitioned to working with high-school-age youth as the Work Readiness Trainer, preparing 16 to 24-year-old youth for successful employment, and the Peacemaker Coordinator, a program that supports refugee and immigrant youth as they share their stories about coming to America. Currently, Ali is also working at a consultant for Constant and Never Ending Improvement writing a restorative justice curriculum for Soledad Enrichment Action, a charter school in Los Angeles that supports youth in their transition from juvenile hall back into high school. Ali and her husband will be moving to Tokyo, Japan in early 2016, where she plans on continuing her peacebuilding work internationally. (updated 9/15)


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Ripon, WI – James Lazarcik, a 6'5 junior forward from La Crescent, Minnesota, has been named to the All-Midwest Conference Men's Basketball First Team. The Conference Office released the 2012-13 team today.
Steve McAfee, Jr., a 6'5 freshman guard/forward from Chicago, Illinois, was named Honorable Mention.
Lazarcik, who was an Honorable Mention All-MWC selection after the 2011-12 season, led the team in scoring (17.5), rebounding (11.3), blocked shots (1.3), field goal percentage (67.7%), free throw percentage (78.5%) and minutes played per game (30.3). He was first in the Conference in rebounding and field goal percentage and fourth in scoring and, as of the February 24 reporting date, continued to lead NCAA Division III in field goal percentage.
Named a Second Team Academic All-American last week, Lazarcik had 13 double-doubles on the season, with highs of 30 points at Knox College on December 8 and 16 rebounds vs. Wisconsin Lutheran College on January 7. He scored in double figures in 21 of the team's 23 games and had double figures in rebounding in 14 games.
McAfee was second on the team in both scoring (13.5) and rebounding (5.0) in his first collegiate season. He led or shared game scoring honors in seven games, with four games over 20 points and a high of 30 against Grinnell College on February 2 in Flood Arena. He also led the team in steals (0.9) and led the team with 24 three-pointers.
The Buccaneers finished the 2012-13 season 12-11 overall, 10-8 in the MWC. Their 12 victories were the most since the 2001-02 season while their 10 wins in Conference play were the most since the 1992-93 season. Only one player was lost to graduation heading into the 2013-14 season.

subset: commoncrawl


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This Is ESPNTuesday, September 4th, 2012
I've always enjoyed commercials produced by ESPN over the years. The "This Is SportsCenter" series are full of classic, memorable spots. Viewers can appreciate the commercials, even if they aren't sports fans; even if they aren't familiar with the particular athlete or team being represented. In recent years, promos for ESPN's College Game Day have become just as memorable. But what is it about these commercials that are so effective?
- Personality. The people on screen are charismatic. They're captivating. Forget for a moment that the news anchors, athletes, and coaches are celebrities. Think about how they present themselves on camera. They're relaxed. They're having fun. They're natural. They seem friendly. Whatever video project you're working on, make sure that the people on camera have personality. Your talent needs to connect personally with your audience.
- Juxtaposition. The "This is SportsCenter" campaign is a lesson in contrast, and that's part of the appeal. They take athletes, coaches, and mascots, pull them out of context, and place them within the confines of an ordinary, corporate office environment. Visually, it doesn't match up, which lends itself to some great comedic moments. At the same time, it perfectly captures what ESPN is all about – they live sports. How can you communicate the core identity of your business or service by meshing two seemingly contradictory ideas or visuals?
- Performance. The ESPN commercials are not centered on complex animation, bold graphics, intense music, or a stylized look. They are based on a solid idea, with strong copy, and excellent performances from the on-camera talent. A good video isn't built on a lot of sizzle and special effects. Those things can certainly enhance a video, but without a creative idea at its core, your message won't be communicated effectively. Start with the idea. Lean on a video production company to help you develop it into something unique. And rely on the performance(s) of talented individuals to give the video life and personality.
Here is one of the latest ESPN College GameDay commercials:


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|Publication number
|Publication type
|Application number
|Publication date
|25 Sep 2008
|Filing date
|3 Jun 2008
|Priority date
|23 Dec 2003
|Also published as
|Publication number
|Amr Salahieh, Brian D. Brandt, Dwight P. Morejohn, Ulrich R. Haug, Jean-Pierre Dueri, Hans F. Valencia, Robert A. Geshlider, Jeff Krolik
|Original Assignee
|Sadra Medical, Inc.
|Export Citation
|BiBTeX, EndNote, RefMan
|Referenced by (44), Classifications (21), Legal Events (3)
|External Links: USPTO, USPTO Assignment, Espacenet
This application is a continuation of U.S. application Ser. No. 10/746,887, filed Dec. 23, 2003, now U.S. Pat. No. 7,381,219; which application is incorporated by reference as if fully set forth herein.
All publications and patent applications mentioned in this specification are herein incorporated by reference to the same extent as if each individual publication or patent application was specifically and individually indicated to be incorporated by reference.
The present invention relates to methods and apparatus for endovascularly replacing a heart valve. More particularly, the present invention relates to methods and apparatus for endovascularly replacing a heart valve with a replacement valve using an expandable and retrievable anchor.
Heart valve surgery is used to repair or replace diseased heart valves. Valve surgery is an open-heart procedure conducted under general anesthesia. An incision is made through the patient's sternum (sternotomy), and the patient's heart is stopped while blood flow is rerouted through a heart-lung bypass machine.
Valve replacement may be indicated when there is a narrowing of the native heart valve, commonly referred to as stenosis, or when the native valve leaks or regurgitates. When replacing the valve, the native valve is excised and replaced with either a biologic or a mechanical valve. Mechanical valves require lifelong anticoagulant medication to prevent blood clot formation, and clicking of the valve often may be heard through the chest. Biologic tissue valves typically do not require such medication. Tissue valves may be obtained from cadavers or may be porcine or bovine, and are commonly attached to synthetic rings that are secured to the patient's heart.
Valve replacement surgery is a highly invasive operation with significant concomitant risk. Risks include bleeding, infection, stroke, heart attack, arrhythmia, renal failure, adverse reactions to the anesthesia medications, as well as sudden death. 2-5% of patients die during surgery.
Post-surgery, patients temporarily may be confused due to emboli and other factors associated with the heart-lung machine. The first 2-3 days following surgery are spent in an intensive care unit where heart functions can be closely monitored. The average hospital stay is between 1 to 2 weeks, with several more weeks to months required for complete recovery.
In recent years, advancements in minimally invasive surgery and interventional cardiology have encouraged some investigators to pursue percutaneous replacement of the aortic heart valve. Percutaneous Valve Technologies ("PVT") of Fort Lee, N.J., has developed a balloon-expandable stent integrated with a bioprosthetic valve. The stent/valve device is deployed across the native diseased valve to permanently hold the valve open, thereby alleviating a need to excise the native valve and to position the bioprosthetic valve in place of the native valve. PVT's device is designed for delivery in a cardiac catheterization laboratory under local anesthesia using fluoroscopic guidance, thereby avoiding general anesthesia and open-heart surgery. The device was first implanted in a patient in April of 2002.
PVT's device suffers from several drawbacks. Deployment of PVT's stent is not reversible, and the stent is not retrievable. This is a critical drawback because improper positioning too far up towards the aorta risks blocking the coronary ostia of the patient. Furthermore, a misplaced stent/valve in the other direction (away from the aorta, closer to the ventricle) will impinge on the mitral apparatus and eventually wear through the leaflet as the leaflet continuously rubs against the edge of the stent/valve.
Another drawback of the PVT device is its relatively large cross-sectional delivery profile. The PVT system's stent/valve combination is mounted onto a delivery balloon, making retrograde delivery through the aorta challenging. An antegrade transseptal approach may therefore be needed, requiring puncture of the septum and routing through the mitral valve, which significantly increases complexity and risk of the procedure. Very few cardiologists are currently trained in performing a transseptal puncture, which is a challenging procedure by itself.
Other prior art replacement heart valves use self-expanding stents as anchors. In the endovascular aortic valve replacement procedure, accurate placement of aortic valves relative to coronary ostia and the mitral valve is critical. Standard self-expanding systems have very poor accuracy in deployment, however. Often the proximal end of the stent is not released from the delivery system until accurate placement is verified by fluoroscopy, and the stent typically jumps once released. It is therefore often impossible to know where the ends of the stent will be with respect to the native valve, the coronary ostia and the mitral valve.
Also, visualization of the way the new valve is functioning prior to final deployment is very desirable. Visualization prior to final and irreversible deployment cannot be done with standard self-expanding systems, however, and the replacement valve is often not fully functional before final deployment.
Another drawback of prior art self-expanding replacement heart valve systems is their lack of radial strength. In order for self-expanding systems to be easily delivered through a delivery sheath, the metal needs to flex and bend inside the delivery catheter without being plastically deformed. In arterial stents, this is not a challenge, and there are many commercial arterial stent systems that apply adequate radial force against the vessel wall and yet can collapse to a small enough of a diameter to fit inside a delivery catheter without plastically deforming. However when the stent has a valve fastened inside it, as is the case in aortic valve replacement, the anchoring of the stent to vessel walls is significantly challenged during diastole. The force to hold back arterial pressure and prevent blood from going back inside the ventricle during diastole will be directly transferred to the stent/vessel wall interface. Therefore the amount of radial force required to keep the self expanding stent/valve in contact with the vessel wall and not sliding will be much higher than in stents that do not have valves inside of them. Moreover, a self-expanding stent without sufficient radial force will end up dilating and contracting with each heartbeat, thereby distorting the valve, affecting its function and possibly migrating and dislodging completely. Simply increasing strut thickness of the self-expanding stent is not a practical solution as it runs the risk of larger profile and/or plastic deformation of the self-expanding stent.
U.S. Patent Application No. 2002/0151970 to Garrison et al. describes a two-piece device for replacement of the aortic valve that is adapted for delivery through a patient's aorta. A stent is endovascularly placed across the native valve, then a replacement valve is positioned within the lumen of the stent. By separating the stent and the valve during delivery, a profile of the device's delivery system may be sufficiently reduced to allow aortic delivery without requiring a transseptal approach. Both the stent and a frame of the replacement valve may be balloon-expandable or self-expanding.
While providing for an aortic approach, devices described in the Garrison patent application suffer from several drawbacks. First, the stent portion of the device is delivered across the native valve as a single piece in a single step, which precludes dynamic repositioning of the stent during delivery. Stent foreshortening or migration during expansion may lead to improper alignment.
Additionally, Garrison's stent simply crushes the native valve leaflets against the heart wall and does not engage the leaflets in a manner that would provide positive registration of the device relative to the native position of the valve. This increases an immediate risk of blocking the coronary ostia, as well as a longer-term risk of migration of the device post-implantation. Further still, the stent comprises openings or gaps in which the replacement valve is seated post-delivery. Tissue may protrude through these gaps, thereby increasing a risk of improper seating of the valve within the stent.
In view of drawbacks associated with previously known techniques for endovascularly replacing a heart valve, it would be desirable to provide methods and apparatus that overcome those drawbacks.
One aspect of the invention provides an apparatus for endovascularly replacing a patient's heart valve, including: a delivery catheter having a diameter of 21 french or less; an expandable anchor disposed within the delivery catheter; and a replacement valve disposed within the delivery catheter. The replacement valve may be coupled to the anchor within the catheter, and the catheter may be adapted to deliver the anchor and replacement valve to an aortic valve along a retrograde approach. The apparatus may also include a deployment tool coupled to the anchor within the catheter and an expandable balloon disposed within the delivery catheter, the balloon being adapted to expand the anchor. In some embodiments the balloon is disposed within the catheter apart from the anchor and the replacement valve.
Another aspect of the invention provides a method for endovascularly replacing a heart valve of a patient. In some embodiments the method includes the steps of: inserting a catheter having a diameter no more than 21 french into the patient; endovascularly delivering a replacement valve and an expandable anchor to a vicinity of the heart valve through the catheter; and deploying the anchor and the replacement valve. In embodiments in which the heart valve is an aortic valve, the inserting step may include the step of inserting the catheter to the vicinity of the aortic valve along a retrograde approach. The method's deploying step may include the steps of endovascularly delivering an anchor deployment tool through the catheter and actuating the anchor with the deployment tool, such as by applying proximally or distally directed forces on the anchor. The method may also include the steps of endovascularly delivering an expandable balloon through the catheter to the vicinity of the heart valve and using the balloon to expand the anchor. The balloon may be delivered apart from the anchor. The anchor may be retrieved back into the catheter after having been expanded.
The novel features of the invention are set forth with particularity in the appended claims. A better understanding of the features and advantages of the present invention will be obtained by reference to the following detailed description that sets forth illustrative embodiments, in which the principles of the invention are utilized, and the accompanying drawings of which:
While preferred embodiments of the present invention have been shown and described herein, it will be obvious to those skilled in the art that such embodiments are provided by way of example only. Numerous variations, changes, and substitutions will now occur to those skilled in the art without departing from the invention. It should be understood that various alternatives to the embodiments of the invention described herein may be employed in practicing the invention. It is intended that the following claims define the scope of the invention and that methods and structures within the scope of these claims and their equivalents be covered thereby.
With reference now to
Anchor 30 has a lip region 32, a skirt region 34 and a body region 36. First, second and third posts 38 a, 38 b and 38 c, respectively, are coupled to skirt region 34 and extend within lumen 31 of anchor 30. Posts 38 preferably are spaced 120� apart from one another about the circumference of anchor 30.
Anchor 30 preferably is fabricated by using self-expanding patterns (laser cut or chemically milled), braids and materials, such as a stainless steel, nickel-titanium ("Nitinol") or cobalt chromium but alternatively may be fabricated using balloon-expandable patterns where the anchor is designed to plastically deform to its final shape by means of balloon expansion. Replacement valve 20 is preferably from biologic tissues, e.g. porcine valve leaflets or bovine or equine pericardium tissues, alternatively it can be made from tissue engineered materials (such as extracellular matrix material from Small Intestinal Submucosa (SIS)) but alternatively may be prosthetic from an elastomeric polymer or silicone, Nitinol or stainless steel mesh or pattern (sputtered, chemically milled or laser cut). The leaflet may also be made of a composite of the elastomeric or silicone materials and metal alloys or other fibers such Kevlar or carbon. Annular base 22 of replacement valve 20 preferably is coupled to skirt region 34 of anchor 30, while commissures 24 of replacement valve leaflets 26 are coupled to posts 38.
Anchor 30 may be actuated using external non-hydraulic or non-pneumatic force to actively foreshorten in order to increase its radial strength. As shown below, the proximal and distal end regions of anchor 30 may be actuated independently. The anchor and valve may be placed and expanded in order to visualize their location with respect to the native valve and other anatomical features and to visualize operation of the valve. The anchor and valve may thereafter be repositioned and even retrieved into the delivery sheath or catheter. The apparatus may be delivered to the vicinity of the patient's aortic valve in a retrograde approach in a catheter having a diameter no more than 23 french, preferably no more than 21 french, more preferably no more than 19 french, or more preferably no more than 17 french. Upon deployment the anchor and replacement valve capture the native valve leaflets and positively lock to maintain configuration and position.
A deployment tool is used to actuate, reposition, lock and/or retrieve anchor 30. In order to avoid delivery of anchor 30 on a balloon for balloon expansion, a non-hydraulic or non-pneumatic anchor actuator is used. In this embodiment, the actuator is a deployment tool that includes distal region control wires 50, control rods or tubes 60 and proximal region control wires 62. Locks 40 include posts or arms 38 preferably with male interlocking elements 44 extending from skirt region 34 and mating female interlocking elements 42 in lip region 32. Male interlocking elements 44 have eyelets 45. Control wires 50 pass from a delivery system for apparatus 10 through female interlocking elements 42, through eyelets 45 of male interlocking elements 44, and back through female interlocking elements 42, such that a double strand of wire 50 passes through each female interlocking element 42 for manipulation by a medical practitioner external to the patient to actuate and control the anchor by changing the anchor's shape. Control wires 50 may comprise, for example, strands of suture.
Tubes 60 are reversibly coupled to apparatus 10 and may be used in conjunction with wires 50 to actuate anchor 30, e.g., to foreshorten and lock apparatus 10 in the fully deployed configuration. Tubes 60 also facilitate repositioning and retrieval of apparatus 10, as described hereinafter. For example, anchor 30 may be foreshortened and radially expanded by applying a distally directed force on tubes 60 while proximally retracting wires 50. As seen in
Deployment of apparatus 10 is fully reversible until lock 40 has been locked via mating of male interlocking elements 44 with female interlocking elements 42. Deployment is then completed by decoupling tubes 60 from lip section 32 of anchor 30 by retracting one end of each wire 62 relative to the other end of the wire, and by retracting one end of each wire 50 relative to the other end of the wire until each wire has been removed from eyelet 45 of its corresponding male interlocking element 44.
As best seen in
With reference now to
During foreshortening, tubes 60 push against lip region 32 of anchor 30, while wires 50 pull on posts 38 of the anchor. Wires 62 may be retracted along with wires 50 to enhance the distally-directed pushing force applied by tubes 60 to lip region 32. Continued retraction of wires 50 relative to tubes 60 would lock locks 40 and fully deploy apparatus 10 with replacement valve 20 properly seated within anchor 30, as in
Deployment of apparatus 10 is fully reversible until locks 40 have been actuated. For example, just prior to locking the position of the anchor and valve and the operation of the valve may be observed under fluoroscopy. If the position needs to be changed, by alternately relaxing and reapplying the proximally directed forces exerted by control wires 50 and/or control wires 62 and the distally directed forces exerted by tubes 60, expansion and contraction of the lip and skirt regions of anchor 30 may be independently controlled so that the anchor and valve can be moved to, e.g., avoid blocking the coronary ostia or impinging on the mitral valve. Apparatus 10 may also be completely retrieved within lumen 112 of sheath 110 by simultaneously proximally retracting wires 50 and tubes 60/wires 62 relative to sheath 110. Apparatus 10 then may be removed from the patient or repositioned for subsequent redeployment.
Referring now to
Referring to
Apparatus 10 is deployed from lumen 112 of sheath 110, for example, under fluoroscopic guidance, such that anchor 30 of apparatus 10 dynamically self-expands to a partially deployed configuration, as in
Once properly aligned, wires 50 are retracted relative to tubes 60 to impose foreshortening upon anchor 30 and expand apparatus 10 to the fully deployed configuration, as in
As seen in
With reference now to
Delivery system 100′ comprises leaflet engagement element 120, which preferably self-expands along with anchor 30. Engagement element 120 is disposed between tubes 60 of delivery system 100′ and lip region 32 of anchor 30. Element 120 releasably engages the anchor. As seen in
Alternatively, foreshortening may be imposed upon anchor 30 while element 120 is disposed proximal of the leaflets, as in
With reference to
Referring now to
As an alternative delivery method, anchor 30′ may be partially deployed via partial expansion of inflatable member 130. The inflatable member would then be advanced within replacement valve 20 prior to inflation of inflatable member 130 and full deployment of apparatus 10″. Inflation pressures used will range from about 3 to 6 atm, or more preferably from about 4 to 5 atm, though higher and lower atm pressures may also be used (e.g., greater than 3 atm, more preferably greater than 4 atm, more preferably greater than 5 atm, or more preferably greater than 6 atm). Advantageously, separation of inflatable member 130 from replacement valve 20, until partial deployment of apparatus 10″ at a treatment site, is expected to reduce a delivery profile of the apparatus, as compared to previously known apparatus. This profile reduction may facilitate retrograde delivery and deployment of apparatus 10″, even when anchor 30′ is balloon-expandable.
Although anchor 30′ has illustratively been described as fabricated from balloon-expandable materials, it should be understood that anchor 30′ alternatively may be fabricated from self-expanding materials whose expansion optionally may be balloon-assisted. In such a configuration, anchor 30′ would expand to a partially deployed configuration upon removal of outer sheath 110. If required, inflatable member 130 then would be advanced within replacement valve 20 prior to inflation. Inflatable member 130 would assist full deployment of apparatus 10″, for example, when the radial force required to overcome resistance from impinging tissue were too great to be overcome simply by manipulation of wires 50 and tubes 60. Advantageously, optional placement of inflatable member 130 within replacement valve 20, only after dynamic self-expansion of apparatus 10″ to the partially deployed configuration at a treatment site, is expected to reduce a delivery profile of the apparatus, as compared to previously known apparatus. This reduction may facilitate retrograde delivery and deployment of apparatus 10″.
With reference to
The angioplasty balloon catheter or inflatable member 130 then is advanced within the replacement valve, as in
As will be apparent to those of skill in the art, the order of imposed foreshortening and balloon expansion described in
Referring now to
Advantageously, providing multiple arrowheads 46 along posts 38 yields a ratchet that facilitates in-vivo determination of a degree of foreshortening imposed upon apparatus of the present invention. Furthermore, optionally constraining appendages 48 of arrowheads 46 via eyelets 49 prevents actuation of lock 40″ (and thus deployment of apparatus of the present invention) even after male element 44′ has been advanced through female element 42. Only after a medical practitioner has removed the wire constraining appendages 48 is lock 40″ fully engaged and deployment no longer reversible.
Lock 40′″ of
With reference to
With reference now to
Referring to
With reference to
With reference to
As seen in
As seen in
As will be apparent to those of skill in the art, lip region 472 optionally may be expanded prior to expansion of skirt region 474. As yet another alternative, lip region 472 and skirt region 474 optionally may be expanded simultaneously, in parallel, in a step-wise fashion or sequentially. Advantageously, delivery of apparatus 450 is fully reversible until lip region 472 or skirt region 474 has been locked in the expanded configuration.
With reference now to
Body region 476 a comprises male interlocking element 482 of lip lock 480, while body region 476 b comprises female interlocking element 484 of lip lock 480. Male element 482 comprises eyelet 483. Wire 424 b passes from female interlocking element 484 through eyelet 483 and back through female interlocking element 484, such that there is a double strand of wire 424 b that passes through lumen 422 of catheter 420 for manipulation by a medical practitioner external to the patient. Body region 476 b further comprises male interlocking element 492 of skirt lock 490, while body region 476 c comprises female interlocking element 494 of the skirt lock. Wire 424 a passes from female interlocking element 494 through eyelet 493 of male interlocking element 492, and back through female interlocking element 494. Lip lock 480 is configured to maintain expansion of lip region 472, while skirt lock 490 is configured to maintain expansion of skirt region 474.
With reference to
Referring to
Once properly positioned, wires 424 a are retracted to expand skirt region 474 of anchor 470 within left ventricle LV. Skirt region 474 is locked in the expanded configuration via skirt lock 490, as previously described with respect to
Wires 424 b are then actuated external to the patient in order to expand lip region 472, as previously described in
As seen in
With reference to
When replacing a patient's aortic valve, apparatus 510 preferably may be delivered through the patient's aorta without requiring a transseptal approach, thereby reducing patient trauma, complications and recovery time. Furthermore, apparatus 510 enables dynamic repositioning of anchor piece 550 during delivery and facilitates positive registration of apparatus 510 relative to the native position of the patient's valve, thereby reducing a risk of device migration and reducing a risk of blocking or impeding flow to the patient's coronary ostia. Furthermore, the expanded deployed configuration of apparatus 510, as seen in
As seen in
Groove section 570 of anchor piece 550 is adapted to engage an expandable frame portion, described hereinbelow, of valve piece 600 to couple anchor piece 550 to valve piece 600. As compared to previously known apparatus, groove section 570 comprises additional material and reduced openings or gaps G, which is expected to reduce tissue protrusion through the gaps upon deployment, thereby facilitating proper seating of the valve within the anchor. Groove section 570 optionally may be covered or coated with biocompatible film B (see
Finally, skirt section 580 of anchor piece 550 maintains proper positioning of composite anchor/valve apparatus 510 post-deployment by precluding proximal migration. When replacing a patient's aortic valve, skirt section 580 is deployed within the patient's left ventricle. As with lip section 560 and groove section 570, skirt section 580 optionally may be covered or coated with biocompatible film B (see
The basic anchor cell structure seen in
If balloon expandable, anchor piece 550 would be formed from an appropriate material, such as stainless steel, and then crimped onto a balloon delivery catheter in a collapsed delivery configuration. If self-expanding and formed from a shape-memory material, such as a nickel-titanium alloy ("Nitinol"), the anchor piece would be heat-set such that it could be constrained within a sheath in the collapsed delivery configuration, and then would dynamically self-expand to the expanded deployed configuration upon removal of the sheath. Likewise, if anchor piece 550 were formed from a wire mesh or braid, such as a spring steel braid, the anchor would be constrained within a sheath in the delivery configuration and dynamically expanded to the deployed configuration upon removal of the sheath.
Referring again to
Anchor piece 550 and valve piece 600 of apparatus 510 preferably are spaced apart and releasably coupled to a single delivery catheter while disposed in their reduced delivery configurations. Spacing the anchor and valve apart reduces a delivery profile of the device, thereby enabling delivery through a patient's aorta without requiring a transseptal approach. With reference to
Delivery system 700 comprises delivery catheter 710 having inner tube 720, middle distal tube 730, and outer tube 740. Inner tube 720 comprises lumen 722 adapted for advancement over a standard guide wire, per se known. Middle distal tube 730 is coaxially disposed about a distal region of inner tube 720 and is coupled to a distal end 724 of the inner tube, thereby forming proximally-oriented annular bore 732 between inner tube 720 and middle tube 730 at a distal region of delivery catheter 710. Outer tube 740 is coaxially disposed about inner tube 720 and extends from a proximal region of the inner tube to a position at least partially coaxially overlapping middle distal tube 730. Outer tube 740 preferably comprises distal step 742, wherein lumen 743 of outer tube 740 is of increased diameter. Distal step 742 may overlap middle distal tube 730 and may also facilitate deployment of valve piece 600, as described hereinbelow with respect to
Proximally-oriented annular bore 732 between inner tube 720 and middle distal tube 730 is adapted to receive skirt section 580 and groove section 570 of anchor piece 550 in the reduced delivery configuration. Annular space 744 formed at the overlap between middle distal tube 730 and outer tube 740 is adapted to receive lip section 560 of anchor piece 550 in the reduced delivery configuration. More proximal annular space 746 between inner tube 720 and outer tube 740 may be adapted to receive replacement valve 610 and expandable frame 620 of valve piece 600 in the reduced delivery configuration.
Inner tube 720 optionally may comprise retainer elements 726 a and 726 b to reduce migration of valve piece 600. Retainer elements 726 preferably are fabricated from a radiopaque material, such as platinum-iridium or gold, to facilitate deployment of valve piece 600, as well as coupling of the valve piece to anchor piece 550. Additional or alternative radiopaque elements may be disposed at other locations about delivery system 700 or apparatus 510, for example, in the vicinity of anchor piece 550.
With reference now to
Delivery catheter 710′ is substantially equivalent to catheter 710 described hereinabove, except that catheter 710′ does not comprise retainer elements 726, and annular space 746 does not receive valve piece 600. Rather, valve piece 600 is received within catheter 760 in the collapsed delivery configuration. Catheter 760 comprises inner tube 770 and outer tube 780. Inner tube 770 comprises lumen 772 for advancement of catheter 760 over a guide wire. The inner tube optionally may also comprise retainer elements 774 a and 774 b, e.g. radiopaque retainer elements 774, to reduce migration of valve piece 600. Outer tube 780 is coaxially disposed about inner tuber 770 and preferably comprises distal step 782 to facilitate deployment and coupling of valve piece 600 to anchor piece 550, as described hereinbelow. Valve piece 600 may be received in annular space 776 between inner tube 770 and outer tube 780, and more preferably may be received within annular space 776 between retainer elements 774.
Referring now to
With reference now to
Aortic valve AV comprises native valve leaflets L attached to valve annulus An. Coronary ostia O are disposed just proximal of diseased aortic valve AV. Coronary ostia O connect the patient's coronary arteries to aorta A and are the conduits through which the patient's heart muscle receives oxygenated blood. As such, it is critical that the ostia remain unobstructed post-deployment of apparatus 510.
Lip section 560 may be dynamically repositioned until it properly engages the valve leaflets, thereby ensuring proper positioning of anchor piece 550 relative to the native coronary ostia O, as well as the valve annulus An, prior to deployment of groove section 570 and skirt section 580. Such multi-step deployment of anchor piece 550 enables positive registration and dynamic repositioning of the anchor piece. This is in contrast to previously known percutaneous valve replacement apparatus.
As seen in
With anchor piece 550 deployed and native aortic valve AV displaced, valve piece 600 may be deployed and coupled to the anchor piece to achieve percutaneous aortic valve replacement. Outer tube 740 is further proximally retracted relative to inner tube 720 such that valve piece 600 is partially deployed from annular space 746 between inner tube 720 and outer tube 740, as seen in
Subsequent re-advancement of outer tube 740 relative to inner tube 720 causes distal step 742 to distally advance valve piece 600 within anchor piece 550 until tips 622 of expandable frame 620 engage groove section 570 of anchor piece 550, as seen in
Hoop 624 friction locks within groove section 570 of anchor piece 550, thereby coupling the anchor piece to the valve piece and forming composite two-piece apparatus 510, which provides a percutaneous valve replacement. As seen in
Referring now to
When anchor piece 550′ is self-expanding and collapsed in the delivery configuration, guideposts 653 may be deployed with skirt section 580′, in which case guideposts 653 would rotate upward with respect to anchor piece 550′ into the deployed configuration of
Sleeves 655 of second portion 654 of alignment/locking mechanism 650 comprise lumens 656 sized for coaxial disposal of sleeves 655 about guideposts 653 of first portion 652. Upon deployment, sleeves 655 may friction lock to guideposts 653 to ensure proper radial and longitudinal alignment of anchor piece 550′ with valve piece 600′, as well as to provide a secondary lock of the anchor piece to the valve piece. The secondary lock enhances the primary friction lock formed by groove section 570′ of the anchor piece with hoop 624′ of expandable frame 620′ of the valve piece.
To facilitate coupling of the anchor piece to the valve piece, suture or thread may pass from optional eyelets 651 a of guideposts 653 through lumens 656 of sleeves 655 to a proximal end of the delivery catheter (see
Referring now to
With reference now to
Female guides 672 are translatable about male posts 670, but are constrained by flared ends 671 of the male posts. In this manner, anchor piece 550′″ and valve piece 600′″ remain coupled and in radial alignment with one another at all times—including delivery—but may be longitudinally separated from one another during delivery. This facilitates percutaneous delivery without requiring a transseptal approach, while mitigating a risk of inadvertent deployment of the anchor and valve pieces in an uncoupled configuration. Additional alignment/locking mechanisms will be apparent in view of the mechanisms described with respect to
Prior to implantation of one of the replacement valves described above, it may be desirable to perform a valvoplasty on the diseased valve by inserting a balloon into the valve and expanding it using saline mixed with a contrast agent. In addition to preparing the valve site for implant, fluoroscopic viewing of the valvoplasty will help determine the appropriate size of replacement valve implant to use.
|Citing Patent
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|Publication date
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|Sadra Medical, Inc.
|Methods and apparatus for endovascular heart valve replacement comprising tissue grasping elements
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|Two-part package for medical implant
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|31 Jul 2012
|Sadra Medical, Inc.
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|21 Aug 2012
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|Methods and apparatus for endovascularly replacing a patient's heart valve
|8 Feb 2008
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|Methods and apparatus for endovascularly replacing a patient's heart valve
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|U.S. Classification
|International Classification
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|14 Jul 2008
Owner name: SADRA MEDICAL, INC., CALIFORNIA
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Owner name: SADRA MEDICAL, INC., CALIFORNIA
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:SALAHIEH, AMR;BRANDT, BRIAN D.;MOREJOHN, DWIGHT P.;AND OTHERS;SIGNING DATES FROM 20040301 TO 20040414;REEL/FRAME:021234/0367
|15 Apr 2015
|Fee payment
Year of fee payment: 4
|2 Jul 2015
Owner name: BOSTON SCIENTIFIC SCIMED, INC., MINNESOTA
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Ron Artest participated in one of the worst events in the history of sports.
As a member of the Indiana Pacer professional basketball team, Artest and two other players went into the stands to physically confront fans of the Detroit Pistons who were verbally harassing the players.
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Whether you need to replace a broken appliance or you're refinishing your entire kitchen, The Home Depot has you covered with the latest refrigerators, gas ranges, electric ranges, ovens, cooktops, dishwashers and microwaves by the brands you know and trust. We make it easy by offering free delivery on appliance purchases $396 or more, and The Home Depot Protection Plan on most major appliances both online and in-store.
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SAN FRANCISCO (MarketWatch) — A slew of tax rules are waiting to trip you up when it comes time to move money or cash out your retirement savings — and getting it wrong will cost you.
IRAs and taxes: Time for a Roth?
What's your tax rate going to be when you retire, and is a Roth IRA for you? In this edition of MarketWatch's Retirement Adviser, Andrea Coombes talks with Ed Slott, host of IRAHelp.com, and Jack Nuckolls, head of private client tax services at BDO.
At a recent MarketWatch Retirement Adviser event in San Francisco, two retirement-plan experts offered their insights on how to make sure taxes don't crack your nest egg.
One common mistake made by retirement savers? Getting it wrong when it comes time to take minimum required distributions from an individual retirement account, or IRA, at age 70 ½.
"If you don't take that minimum distribution amount, the failure to make it is a 50% penalty for the under-distributed amount," said Jack Nuckolls, national director of private client tax services for accounting firm BDO and one of the panelists at the Retirement Adviser event. "That can be devastating." Read Retirement Adviser, the full special report, here.
Ed Slott, a certified public accountant founder of IRAHelp.com, and also a panelist at the event, agreed that failure to take distributions often trips up IRA owners. "And it applies to beneficiaries, too, who are not, maybe, in the loop like their parents were who they inherited from."
Big tax bills can devastate your retirement savings. MarketWatch's Robert Powell and Andrea Coombes talk about strategies to employ before and during retirement to lower your taxes.
Check out the new
MarketWatch Retirement
RetireMentors: In-the-trenches advice
Ways to boost Social Security payout
Retire here, not there: California
10 things your 401(k) plan won't tell you
"Whenever you're dealing with retirement money, you're dealing with a different kind of money," Slott said. "Money that's infested, loaded with taxes and strangled with a labyrinth of tax rules."
"Any time you move retirement money — 401(k) to an IRA, IRA to an IRA — it's like an eggshell. You break it, it's over," he said.
Rollover regrets
Mistakes are often made with rollovers, too, Slott said.
"Somebody has $500,000, they worked all their life, they're moving it from a 401(k) to an IRA. Maybe it never got there, maybe they moved it the wrong way," Slott said.
"The best way is a direct trustee-to-trustee transfer. Maybe they took it out as a rollover — right away they get hit with 20% mandatory withholding because they did it that way and then they only have 60 days to get it into an IRA," he said. "It sounds like a lot of time, but there are hundreds and hundreds of rulings on the books with IRS for people who couldn't make it in time or it went to a different account or they didn't check that it got there."
Often, too, retirement savers don't realize there is a limit of one IRA-to-IRA rollover per year; after that, the rollover is considered a distribution and is fully taxable.
"We had a case once, a guy had $1 million in an IRA," Slott said. "He rolled it over about 20 times in the year. He never told anybody." The client was chasing higher rates on certificates of deposit, or CDs.
"He lost the whole IRA," Slott said. "He made $12 more in interest, but he lost a $1 million IRA."
If you want to move money around, use a direct transfer — there's no annual limit on those, Slott said.
Who will inherit your IRA?
You'd think we'd all know to do this, but one of the most common mistakes is failing to name a beneficiary for retirement-savings accounts, the two experts said. Read: 10 ways to get the most out of your IRA.


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On Wednesday, President Barack Obama surrounded himself with children masquerading as human theater props, announcing that he will issue a fistful of edicts aimed at eradicating gun violence. But critics of his proposals have often noted that criminals who have no problem committing murder will not somehow suddenly bend their violent will to the will of the president.
One state legislator in Missouri recognizes the federal anti-gun policy for what it is: an unconstitutional, illogical, and ill-fated gun grab.
On Tuesday, January 15, Missouri State Representative Casey Guernsey (R-Bethany) introduced a bill that would prevent the president from seizing weapons owned by citizens of the Show Me State. He said of his measure,
It is simply legislation to protect the basic Second Amendment rights given to Missouri citizens in the Constitution to keep and bear arms in their homes. The real problem and the real issue and one I found people don't seem to focus on is the fact that we got an administration willing to cut into our Second Amendment right by executive order which, by view of a lot of people in Missouri that I've been talking to over the last couple months, is unconstitutional in and of itself.
The bill — HB 170, appropriately titled the Second Amendment Preservation Act — would nullify all acts of Congress, executive orders, and regulations that infringe on the right of the individual to own and possess guns and ammunition.
In relevant part, Guernsey's bill reads:
Any official, agent, or employee of the federal government who enforces or attempts to enforce any act, order, law, statute, rule, or regulation of the federal government upon a personal firearm, a firearm accessory, or ammunition that is owned or manufactured commercially or privately in the state of Missouri and that remains exclusively within the borders of the state of Missouri shall be guilty of a class D felony.
Conviction of a class D felony in Missouri carries a possible sentence of four years in prison.
Nullification is a concept of constitutional law recognizing the right of each state to nullify, or invalidate, any federal measure that exceeds the few and defined powers allowed the federal government as enumerated in the Constitution.
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text: Nickey O'Daniel | IBDB: The official source for Broadway Information IBDB: The official source for Broadway Information Official Broadway League sites: - sites - broadway.org broadwayleague.com broadwayfanclub.com kidsnightonbroadway.com stagespecs.org tonyawards.com Quick Search For: In This Category: All Show People/Org. Theatre Season Nickey O'Daniel Performer Female Productions ProductionsDate of ProductionsHarlem Cavalcade[Musical, Revue, Original] Performer: Nickey O'Daniel [Harper Harlemaniac]May 01, 1942 - May 23, 1942 Find out where Nickey O'Daniel and are credited together © 2001-2015, The Broadway League, All Rights Reserved. (Copyright and Disclaimer)


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15 U.S. Code § 1821 - Definitions
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As used in this chapter unless the context otherwise requires:
(1) The term "management" means any person who organizes, exercises control over, or administers or who is responsible for organizing, directing, or administering.
(3) The term "sore" when used to describe a horse means that—
(A) an irritating or blistering agent has been applied, internally or externally, by a person to any limb of a horse,
(C) any tack, nail, screw, or chemical agent has been injected by a person into or used by a person on any limb of a horse, or
(D) any other substance or device has been used by a person on any limb of a horse or a person has engaged in a practice involving a horse,
and, as a result of such application, infliction, injection, use, or practice, such horse suffers, or can reasonably be expected to suffer, physical pain or distress, inflammation, or lameness when walking, trotting, or otherwise moving, except that such term does not include such an application, infliction, injection, use, or practice in connection with the therapeutic treatment of a horse by or under the supervision of a person licensed to practice veterinary medicine in the State in which such treatment was given.
Source(Pub. L. 91–540, § 2,Dec. 9, 1970, 84 Stat. 1404; Pub. L. 94–360, § 3,July 13, 1976, 90 Stat. 915.)
1976—Pub. L. 94–360added pars. (1) and (2), redesignated subsec. (a), defining "sore" as meaning that certain substances or devices had been applied to any limb of a horse prior to Dec. 9, 1970, resulting in, or reasonably likely to result in, such horse suffering physical pain or distress when walking or trotting, as par. (3) and, as so redesignated, struck out requirement that such substance or device had to have been applied prior to Dec. 9, 1970 in order for a horse to be considered "sored" for purposes of this chapter, and substituted par. (4) defining "State" for subsec. (b) defining "commerce" as between a point in any State or possession of the United States and any point outside thereof, or between points within the same State or possession of the United States but through any place outside thereof, or within the District of Columbia, or from any foreign country to any point within the United States.
Short Title of 1976 Amendment
Pub. L. 94–360, § 1(a),July 13, 1976, 90 Stat. 915, provided that: "This Act [amending this section and sections 1822 to 1825, 1827, 1830, and 1831 of this title and enacting provisions set out as notes under this section and section 1831 of this title] may be cited as the 'Horse Protection Act Amendments of 1976'."
Short Title
Pub. L. 91–540, § 1,Dec. 9, 1970, 84 Stat. 1404, as amended by Pub. L. 94–360, § 2,July 13, 1976, 90 Stat. 915, provided: "That this Act [enacting this chapter] may be cited as the 'Horse Protection Act'."
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Let the Great World Spinby Colum McCann
2009 National Book Award for Fiction
Staff Pick
McCann chooses to describe one day in the life of New York City, the day in 1974 that the aerialist walked between the not-quite-finished Twin Towers. The chasm between rich and poor, the joy of connection, and the inevitability of our mortality are told through the lives of six different New Yorkers, including that incredible man dancing on that thin wire who epitomizes joy and triumph, if only for a short and precarious time. If you love New York, you've got to read this book. If you love the human journey towards the possible, you've got to read this book.
Synopses & Reviews
Publisher Comments:
In the dawning light of a late-summer morning, the people of lower Manhattan stand hushed, staring up in disbelief at the Twin Towers. It is August 1974, and a mysterious tightrope walker is running, dancing, leaping between the towers, suspended a quarter mile above the ground. In the streets below, a slew of ordinary lives become extraordinary in bestselling novelist Colum McCann's stunningly intricate portrait of a city and its people.
Let the Great World Spin is the critically acclaimed author's most ambitious novel yet: a dazzlingly rich vision of the pain, loveliness, mystery, and promise of New York City in the 1970s.
Corrigan, a radical young Irish monk, struggles with his own demons as he lives among the prostitutes in the middle of the burning Bronx. A group of mothers gather in a Park Avenue apartment to mourn their sons who died in Vietnam, only to discover just how much divides them even in grief. A young artist finds herself at the scene of a hit-and-run that sends her own life careening sideways. Tillie, a thirty-eight-year-old grandmother, turns tricks alongside her teenage daughter, determined not only to take care of her family but to prove her own worth.
Elegantly weaving together these and other seemingly disparate lives, McCann's powerful allegory comes alive in the unforgettable voices of the city's people, unexpectedly drawn together by hope, beauty, and the artistic crime of the century. A sweeping and radical social novel, Let the Great World Spin captures the spirit of America in a time of transition, extraordinary promise, and, in hindsight, heartbreaking innocence. Hailed as "a fiercely original talent" (San Francisco Chronicle), award-winning novelist McCann has delivered a triumphantly American masterpiece that awakens in us a sense of what the novel can achieve, confront, and even heal.
"[S]himmering, shattering....In McCann's wise and elegiac novel of origins and consequences, each of his finely drawn, unexpectedly connected characters balances above an abyss, evincing great courage with every step." Booklist (starred review)
"One of the most electric, profound novels I have read in years.... It is a mark of the novel's soaring and largely fulfilled ambition that McCann just keeps rolling out new people, deftly linking each to the next, as his story moves toward its surprising and deeply affecting conclusion." Jonathan Mahler, The New York Times Book Review
"McCann gives a superb account of the walker's long practicing....And if some of his other attempts to elevate work into myth are strained, he succeeds with his image of a flight that lifts the heaviness of a whole city." The Boston Globe
"McCann has written more than a supremely woven tapestry of imagined lives; through their struggles, he clears a path for healing and redemption from the cataclysm of a later time." Milwaukee Journal Sentinel
"This is a gorgeous book, multilayered and deeply felt, and it's a damned lot of fun to read, too. Leave it to an Irishman to write one of the greatest-ever novels about New York. There's so much passion and humor and pure lifeforce on every page of Let the Great World Spin that you'll find yourself giddy, dizzy, overwhelmed." Dave Eggers, editor of McSweeney's and author of What Is the What
McCann's most ambitious work to date offers a dazzling and hauntingly rich vision of the loveliness, pain, and mystery of life in New York City in the 1970s.
About the Author
Colum McCann is the internationally bestselling author of the novels Zoli, Dancer, This Side of Brightness, and Songdogs, as well as two critically acclaimed story collections. His fiction has been published in thirty languages. He has been a finalist for the International IMPAC Dublin Literary Award and was the inaugural winner of the Ireland Fund of Monaco Literary Award in Memory of Princess Grace. He has been named one of Esquire's "Best and Brightest," and his short film Everything in This Country Must was nominated for an Oscar in 2005. A contributor to The New Yorker, The New York Times Magazine, The Atlantic Monthly, and The Paris Review, he teaches in the Hunter College MFA Creative Writing Program. He lives in New York City with his wife and their three children.
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