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Devices and methods are provided for surgical repair of dilated aortic root to restore aortic valve competence while preserving native leaflets. In one aspect of the invention an expandable annuloplasty ring is provided for external placement at the base of a dilated aortic root. The expandable ring

Devices and methods are provided for surgical repair of dilated aortic root to restore aortic valve competence while preserving native leaflets. In one aspect of the invention an expandable annuloplasty ring is provided for external placement at the base of a dilated aortic root. The expandable ring is capable of elastically expanding between a first diastolic diameter and a larger second systolic diameter to provide a physiologically representative surgical repair of the aortic root. In a further aspect of the invention, is provided a holder assembly for aortic annuloplasty ring and suitable for other cardiac valve prosthesis. The holder assembly consists of a holder body pivotingly coupled to a handle member through a ball-and-socket arrangement.

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1. A holder assembly for implanting a cardiac valve prosthesis, said holder assembly comprising: a holder body, said holder body configured and sized for holding said cardiac valve prosthesis, said holder body including a ball defined at least in part by an external spherical surface, said ball havi

1. A holder assembly for implanting a cardiac valve prosthesis, said holder assembly comprising: a holder body, said holder body configured and sized for holding said cardiac valve prosthesis, said holder body including a ball defined at least in part by an external spherical surface, said ball having an opening extending therethrough, said opening extending through a center of said ball and provided with a shoulder member restricting the size of said opening, said ball also having a slot extending from said external spherical surface inwardly towards said center of said ball to communicate with said opening; anda handle member, said handle member configured to be gripped during an implantation of said cardiac valve prosthesis, said handle member including a socket seat configured and sized to mate with said ball, said socket seat and said ball cooperating to define together a ball-and-socket arrangement, said handle member demountably coupled to said holder body through said ball-and-socket arrangement, said handle member further comprising an actuator movable between a first and second actuator configuration, said actuator being coupled to a translating member that is movable relative to said handle member when said actuator is actuated, said translating member having a shaft portion and a shaft spherical terminal end enlarged in size relative to said shaft portion, said shaft portion sized to be insertable through said slot in said ball to allow demountable coupling of said holder body to said handle member, said shaft spherical terminal end being sized with a diameter larger than said slot and configured to engage said shoulder member in said holder body in a manner that when said holder body is coupled to said handle member, said spherical terminal end is positioned concentric within said ball;wherein, in said first actuator configuration said holder body is pivotable relative to said handle member so as to be positionable in a desired spatial orientation through said ball-and-socket arrangement, and in said second actuator configuration said holder body being locked relative to said handle member in said desired spatial orientation by virtue of said translating member drawing said ball into progressively increasing frictional contact with said socket seat as said actuator is moved between said first and second actuator configuration. 2. The holder assembly of claim 1 wherein said handle member is elongate and defines a longitudinal axis, in said first actuator configuration said ball-and-socket arrangement allows pivoting of said holder body relative to said handle member about a first pivoting axis, said first pivoting axis being perpendicular to said handle member longitudinal axis, said shaft portion moving angularly through said slot whilst said shaft spherical terminal end remains positioned concentric within said ball while the holder body pivots about said first pivoting axis. 3. The holder assembly of claim 2 wherein said pivoting of said holder body about said first pivoting axis is within a pivoting range of 120 degrees +/−30 degrees. 4. The holder assembly of claim 2 wherein said actuator is operable to selectively lock said holder body in a fixed spatial relationship relative to said handle member longitudinal axis. 5. The holder assembly of claim 2 wherein said ball-and-socket arrangement allows rotation of said holder body relative to said longitudinal axis of said handle member, and said translating member is in tension when said actuator is in said second actuator configuration. 6. The holder assembly of claim 5 wherein said holder body rotation is within an angular range of 360 degrees. 7. The holder assembly of claim 5 wherein said ball-and-socket arrangement allows pivoting of said holder body about a second pivoting axis, said second pivoting axis being perpendicular to each of said first pivoting axis and said handle member longitudinal axis. 8. The holder assembly of claim 7 wherein, in said first actuator configuration, said handle member is movable relative to said holder body within a free range of orientations and, in said second actuator configuration said handle member is, lockable in a predetermined spatial position within said range of orientations, said range of orientations able to occur within a conical volume having an inclusive cone angle of 90 degrees+/−15 degrees and a vertex at a coupling point between said handle member and holder body, said handle member longitudinal axis being contained within said conical volume when said handle member is movable within said free range of orientations. 9. The holder assembly of claim 8 wherein said cardiac valve prosthesis defines an orifice through which blood will flow when said prosthesis is implanted and in use, said orifice defining a prosthesis plane, said conical volume defining a cone axis, said cone axis being normal to said prosthesis plane when said prosthesis is held by said holder body and said holder body is coupled to said handle member. 10. The holder assembly of claim 9 wherein said conical volume can be angularly swept in a manner to pivot about said first pivoting axis within a pivoting range of 120 degrees +/−30 degrees by virtue of said shaft portion moving angularly through said slot whilst said shaft spherical terminal end remains positioned concentric within said ball through said pivoting range. 11. The holder assembly of claim 8 wherein said free range of orientations is achieved by an articulation between said external spherical surface on said holder body and said socket seat on said handle member, and a simultaneous pivoting motion of said translating member relative to said ball, and whereby in said second actuator configuration, said shaft terminal end engages said shoulder member bringing into locked contact said ball and said socket seat thereby locking said holder body relative to said handle member in said predetermined spatial orientation, within said free range of orientations. 12. The holder assembly of claim 11 wherein said opening in said ball is a tapered hole and said translating member is a cable member, said shaft terminal end is an enlarged cable ball end, said shoulder member of said opening being formed by a minimum diameter of said tapered hole, said tapered hole minimum diameter being smaller in size than the diameter defining said enlarged cable ball end. 13. The holder assembly of claim 12 wherein said ball defines a first ball center, said cable ball end defines a second ball center, said first and second ball centers being concentric so as to define a pair of concentric ball-and-socket interfaces; a first ball-and-socket interface being disposed between said ball and said socket seat, a second ball-and-socket interface being disposed between said cable ball end and said shoulder member, said ball simultaneously cooperating with said socket seat, and with said cable ball end via said shoulder member, whereby said pair of concentric ball-and-socket interfaces act in parallel to allow said free range of orientations between said holder body and said handle member. 14. The holder assembly of claim 1 wherein said handle member is operable to selectively release said holder body during the implantation of said cardiac valve prosthesis. 15. The holder assembly of claim 1 wherein said handle member extends between a first end and a second end along a longitudinal axis, said actuator being disposed generally adjacent to said first end, said socket seat provided generally adjacent to said handle second end, said translating member movable generally along said longitudinal axis when said actuator is moved between said first and said second configuration, wherein in said second actuator configuration, said translating member secures said ball to said socket seat thereby locking said holder body to said handle member in said desired spatial orientation. 16. The holder assembly of claim 15 wherein said opening is a tapered hole, said shoulder member of said opening being formed by a minimum diameter of said tapered hole, said tapered hole minimum diameter being smaller in size than the diameter defining said enlarged shaft spherical terminal end, said translating member shaft portion extending beyond said second end, said translating member shaft portion being releasable from said ball by a releasing movement through said slot, said releasing movement simultaneously disengaging said shaft spherical terminal end from said shoulder member, and said external spherical surface from said socket seat, thereby allowing rapid changeover of said holder body from said handle member.