ENDOVASCULAR SYSTEM FOR ARRESTING THE HEART
First Claim
1. A catheter device for partitioning a patient'"'"'s ascending aorta between the coronary ostia and the brachiocephalic artery, comprising:
- an elongated shaft having a distal end, a proximal end, a first inner lumen extending therebetween, an opening at the distal end in fluid communication with the first inner lumen; and
an expandable means near the distal end of the shaft proximal to the opening in the first inner lumen for occluding the ascending aorta between the coronary ostia and the brachiocephalic artery so as to block substantially all systolic and diastolic blood flow therethrough, said expandable means being expandable eccentrically such that said expandable means has a first side and a second side, said first side expanding to a larger size than said second side.
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Accused Products
Abstract
Devices and methods are provided for temporarily inducing cardioplegic arrest in the heart of a patient and for establishing cardiopulmonary bypass in order to facilitate surgical procedures on the heart and its related blood vessels. Specifically, a catheter based system is provided for isolating the heart and coronary blood vessels of a patient from the remainder of the arterial system and for infusing a cardioplegic agent into the patient'"'"'s coronary arteries to induce cardioplegic arrest in the heart. The system includes an endoaortic partitioning catheter having an expandable balloon at its distal end which is expanded within the ascending aorta to occlude the aortic lumen between the coronary ostia and the brachiocephalic artery. Means for centering the catheter tip within the ascending aorta include specially curved shaft configurations, eccentric or shaped occlusion balloons and a steerable catheter tip, which may be used separately or in combination. The shaft of the catheter may have a coaxial or multilumen construction. The catheter may further include piezoelectric pressure transducers at the distal tip of the catheter and within the occlusion balloon. Means to facilitate nonfluoroscopic placement of the catheter include fiberoptic transillumination of the aorta and a secondary balloon at the distal tip of the catheter for atraumatically contacting the aortic valve. The system further includes a dual purpose arterial bypass cannula and introducer sheath for introducing the catheter into a peripheral artery of the patient.
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Citations
112 Claims
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1. A catheter device for partitioning a patient'"'"'s ascending aorta between the coronary ostia and the brachiocephalic artery, comprising:
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an elongated shaft having a distal end, a proximal end, a first inner lumen extending therebetween, an opening at the distal end in fluid communication with the first inner lumen; and
an expandable means near the distal end of the shaft proximal to the opening in the first inner lumen for occluding the ascending aorta between the coronary ostia and the brachiocephalic artery so as to block substantially all systolic and diastolic blood flow therethrough, said expandable means being expandable eccentrically such that said expandable means has a first side and a second side, said first side expanding to a larger size than said second side. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12)
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13. A catheter device for partitioning a patient'"'"'s ascending aorta between the coronary ostia and the brachiocephalic artery, comprising:
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an elongated shaft having a distal end, a proximal end, a first inner lumen extending therebetween, and an opening at the distal end in fluid communication with the first inner lumen; and
an expandable means near the distal end of the shaft proximal to the opening in the first inner lumen for occluding the ascending aorta between the coronary ostia and the brachiocephalic artery so as to block substantially all systolic and diastolic blood flow therethrough, said expandable means having a distal occlusive means for occluding the ascending aorta and a proximal stabilizing means for stabilizing said expandable means in a desired position within the ascending aorta. - View Dependent Claims (14, 15, 16, 17, 18, 19)
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20. A catheter device for partitioning a patient'"'"'s ascending aorta between the coronary ostia and the brachiocephalic artery, comprising:
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an elongated shaft comprising an inner tubular member within an outer tubular member, said inner tubular member having a distal end, a proximal end, a first inner lumen extending therebetween, and an opening at the distal end in fluid communication with the first inner lumen, a flow passage between said inner tubular member and said outer tubular member and an inflatable balloon near the distal end of the shaft proximal to the opening in the first inner lumen for occluding the ascending aorta between the coronary ostia and the brachiocephalic artery so as to block substantially all systolic and diastolic blood flow therethrough, an interior space within said inflatable balloon being in fluid communication with said flow passage. - View Dependent Claims (21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35)
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36. A catheter device for partitioning a patient'"'"'s ascending aorta between the coronary ostia and the brachiocephalic artery, comprising:
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an elongated shaft having a distal end, a proximal end, a first inner lumen extending therebetween, and an opening at the distal end in fluid communication with the first inner lumen; and
an expandable means near the distal end of the shaft proximal to the opening in the first inner lumen for occluding the ascending aorta between the coronary ostia and the brachiocephalic artery so as to block substantially all systolic and diastolic blood flow therethrough; and
a pressure transducer means for measuring fluid pressure mounted on said elongated shaft. - View Dependent Claims (37, 38, 39)
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40. A balloon catheter comprising:
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an elongated shaft comprising an inner tubular member within an outer tubular member, said inner tubular member having a distal end, a proximal end, a first inner lumen and a second inner lumen extending therebetween, a first opening at the distal end in fluid communication with the first inner lumen, and a second opening at the distal end in fluid communication with the second inner lumen; and
an inflatable balloon near the distal end of the shaft, an interior space within said inflatable balloon being in fluid communication with an inflation lumen defined by a space between said inner tubular member and said outer tubular member. - View Dependent Claims (41)
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42. A catheter device for partitioning a patient'"'"'s ascending aorta between the coronary ostia and the brachiocephalic artery, comprising:
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an elongated shaft having a distal end, a proximal end, a first inner lumen extending therebetween, and an opening at the distal end in fluid communication with the first inner lumen;
a first expandable means near the distal end of the shaft proximal to the opening in the first inner lumen for occluding the ascending aorta between the coronary ostia and the brachiocephalic artery so as to block substantially all systolic and diastolic blood flow therethrough; and
a second expandable means near the distal end of the shaft distal to the first expandable means for protecting the distal end of the shaft from contact with an inner surface of the ascending aorta. - View Dependent Claims (43, 44, 45)
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46. A catheter device for partitioning a patient'"'"'s ascending aorta between the coronary ostia and the brachiocephalic artery, comprising:
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an elongated shaft having a distal end, a proximal end, a first inner lumen extending therebetween, an opening at the distal end in fluid communication with the first inner lumen, and a preshaped distal portion having a curvature which subtends an angle of about 225°
to about 315°
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expandable means near the distal end of the shaft proximal to the opening in the first inner lumen for occluding the ascending aorta between the coronary ostia and the brachiocephalic artery so as to block substantially all systolic and diastolic blood flow therethrough. - View Dependent Claims (47, 48, 49, 50, 51, 52, 53, 54)
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55. A catheter device for partitioning a patient'"'"'s ascending aorta between the coronary ostia and the brachiocephalic artery, comprising:
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an elongated shaft having a distal end, a proximal end, and an inflation lumen extending therebetween; and
an inflatable balloon near the distal end of the shaft for occluding the ascending aorta between the coronary ostia and the brachiocephalic artery so as to block substantially all systolic and diastolic blood flow therethrough, an interior space within said inflatable balloon being in fluid communication with said inflation lumen, said inflation lumen being configured to allow inflation of said interior space of said inflatable balloon to a volume of about 40 cc with an aqueous inflation medium in a time of less than about 40 seconds. - View Dependent Claims (56, 57, 58, 59, 60, 61, 62)
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63. A catheter device for partitioning a patient'"'"'s ascending aorta between the coronary ostia and the brachiocephalic artery, comprising:
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an elongated shaft having a distal end, a proximal end, a first inner lumen extending therebetween, an opening at the distal end in fluid communication with the first inner lumen, and a preshaped distal portion configured to conform generally to the patient'"'"'s aortic arch such that the distal end is positionable within the ascending aorta with the distal end of the elongated shaft in proximity to an anterior wall of the ascending aorta; and
an expandable means near the distal end of the shaft proximal to the opening in the first inner lumen for occluding the ascending aorta between the coronary ostia and the brachiocephalic artery so as to block substantially all systolic and diastolic blood flow therethrough.
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64. A method of partitioning a patient'"'"'s ascending aorta between the patient'"'"'s coronary ostia and the patient'"'"'s brachiocephalic artery, comprising:
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introducing a distal end of a shaft of an aortic partitioning device into a blood vessel downstream of the patient'"'"'s ascending aorta;
transluminally positioning the shaft so that the distal end of the shaft is in the ascending aorta and an expandable occluding member attached to the shaft near the distal end is disposed between the coronary ostia and the brachiocephalic artery; and
expanding the occluding member eccentrically about the shaft of the aortic partitioning device within the ascending aorta to completely block blood flow therethrough. - View Dependent Claims (65, 66, 67, 68)
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69. A method of partitioning a patient'"'"'s ascending aorta between the patient'"'"'s coronary ostia and the patient'"'"'s brachiocephalic artery, comprising:
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introducing a distal end of a shaft of an aortic partitioning device into a blood vessel downstream of the patient'"'"'s ascending aorta;
transluminally positioning the shaft so that the distal end of the shaft is in the ascending aorta and an expandable occluding member attached to the shaft near the distal end is disposed between the coronary ostia and the brachiocephalic artery and a nonocclusive stabilizing member is positioned downstream of the occluding member; and
expanding the occluding member within the ascending aorta to completely block blood flow therethrough and expanding the stabilizing member to contact an inner wall of the aorta. - View Dependent Claims (70, 71, 72, 73)
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74. A method of partitioning a patient'"'"'s ascending aorta between the patient'"'"'s coronary ostia and the patient'"'"'s brachiocephalic artery, comprising:
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introducing a distal end of a shaft of an aortic partitioning device into a blood vessel downstream of the patient'"'"'s ascending aorta, the shaft comprising an inner tubular member within an outer tubular member;
transluminally positioning the shaft so that the distal end of the shaft is in the ascending aorta and an expandable occluding member attached to the shaft near the distal end is disposed between the coronary ostia and the brachiocephalic artery; and
expanding the occluding member within the ascending aorta to completely block blood flow therethrough. - View Dependent Claims (75, 76, 77, 78, 79, 80, 81)
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82. A method of partitioning a patient'"'"'s ascending aorta between the patient'"'"'s coronary ostia and the patient'"'"'s brachiocephalic artery, comprising:
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introducing a distal end of a shaft of an aortic partitioning device into a blood vessel downstream of the patient'"'"'s ascending aorta, the shaft comprising an inner tubular member within an outer tubular member;
advancing the shaft so that the distal end of the shaft is in the aorta and expanding a distal expandable member attached to the shaft near the distal end of the shaft to protect the distal end of the shaft from contact with an inner surface of the aorta; and
transluminally positioning the shaft so that the distal end of the shaft is in the ascending aorta and an expandable occluding member attached to the shaft proximal to the distal expandable member is disposed between the coronary ostia and the brachiocephalic artery; and
expanding the occluding member within the ascending aorta to completely block blood flow therethrough. - View Dependent Claims (83)
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84. A method of partitioning a patient'"'"'s ascending aorta between the patient'"'"'s coronary ostia and the patient'"'"'s brachiocephalic artery, comprising:
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introducing a distal end of a shaft of an aortic partitioning device into a blood vessel downstream of the patient'"'"'s ascending aorta;
transluminally positioning the shaft so that the distal end of the shaft is in the ascending aorta with the distal end of the elongated shaft in proximity to a wall of the ascending aorta which is most elevated and an expandable occluding member attached to the shaft near the distal end is disposed between the coronary ostia and the brachiocephalic artery; and
expanding the occluding member within the ascending aorta to completely block blood flow therethrough. - View Dependent Claims (85, 86)
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87. A cannula adapted to permit passage therethrough of a catheter for percutaneous insertion in the body of a patient, said cannula comprising:
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a cannula body having a proximal end, a distal end and a cannula lumen, a first leg connected to said proximal end of said cannula body, said first leg having a blood flow lumen in fluid communication with said cannula lumen, a second leg having a proximal end and a distal end, said distal end of said second leg being connected to said proximal end of said cannula body, said second leg having a catheter insertion lumen in fluid communication with said cannula lumen, a first hemostasis means for selectively preventing fluid flow between said cannula lumen and said catheter insertion lumen, and a second hemostasis means for preventing fluid flow from the proximal end of said catheter insertion lumen, said second hemostasis means being spaced apart from said first hemostasis means to create a catheter insertion chamber within said catheter insertion lumen. - View Dependent Claims (88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, 100, 101, 102, 103, 104)
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105. An adapter for proximal attachment to a cannula for placement in a blood vessel comprising:
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a first leg having a proximal end, a distal end and a first lumen therebetween;
a second leg having having a proximal end, a distal end and a second lumen therebetween, the distal end of the second arm being attached to the first arm such that the second lumen is in fluid communication with the first lumen;
a first hemostasis means in a distal portion of the first arm for selectively preventing fluid flow through the first lumen;
a second hemostasis means in a proximal portion of the first arm for selectively preventing fluid flow through the first lumen; and
means for attaching the adapter to a proximal end of the cannula.
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106. A repositionable securing device for securing an elongated medical instrument in a selected position, said repositionable securing device comprising:
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a tubular member having a lumen therethrough to slidably receive said elongated medical instrument therein, said lumen having a high friction material on an inner surface of said lumen; and
means for compressing said tubular member around said elongated medical instrument to frictionally secure said tubular member to said elongated medical instrument. - View Dependent Claims (107, 108, 109, 110, 111, 112)
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Specification