Methods and apparatus for transpericardial left atrial appendage closure

• US 20020049457A1
• Filed: 11/05/2001
• Published: 04/25/2002
• Est. Priority Date: 05/20/1999
• Status: Active Grant

• Current Assignee: SentreHEART Incorporated (Atricure, Inc.)
• Original Assignee: Aaron V. Kaplan
• Inventors: Kaplan, Aaron V., Bajor, Jordan T.
• Granted Patent: US 7,226,458 B2
• Time in Patent Office: Days
• US Class Current: 606/139
• CPC Class Codes: A61B 17/10 for applying or removing wound clamps, e.g. containing only one clamp or staple A61B17/076 takes precedence; containing multiple wound clamps A61B17/068; Wound clamp magazines containers, packaging elements or packages specially adapted for particular articles or with special means for dispensing contents B65D83/00, B65D85/00
• CPC Class Codes: A61B 17/12 for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord specially adapted for vas deferens or fallopian tubes A61F6/20; materials for ligaturing blood vessels A61L17/00
• CPC Class Codes: A61B 17/12013 for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 17/122 Clamps or clips , e.g. for the umbilical cord for the vas deferens A61F6/206
• CPC Class Codes: A61B 17/1285 for minimally invasive surgery
• CPC Class Codes: A61B 2017/00243 cardiac
• CPC Class Codes: A61B 2017/320048 Balloon dissectors

Abstract

Methods and apparatus for closing a left atrial appendage are described. The methods rely on introducing a closure tool from a location beneath the rib cage, over an epicardial surface, and to the exterior of the left atrial appendage. The closure device may then be used to close the left atrial appendage, preferably at its base, by any one of a variety of techniques. A specific technique using graspers and a closing loop is illustrated.

Claims

1. A method for closing a left atrial appendage of a patient'"'"'s heart, said method comprising:

positioning a closure instrument through a percutaneous passage beneath the rib cage, over an epicardial surface, and adjacent to the left atrial appendage; and

closing the left atrial appendage using the closure instrument.

2. A method as in claim 1, wherein positioning comprises making an incision between a costal cartilage and a xiphoid of the patient and placing an access sheath through the incision into a pericardial space.

3. A method as in claim 2, wherein positioning further comprises advancing a distal end of the closure instrument through the sheath, into the pericardial space, and over an epicardial surface to an atrioventricular groove of the heart.

4. A method as in claim 3, wherein closing comprises looping, suturing, stapling, clipping, riveting, clamping, or fusing the left atrial appendage at a neck region thereof.

5. A method as in claim 4, wherein closing further comprises grasping the left atrial appendage prior to closing the neck region thereof.

6. A method as in claim 1, wherein the method is performed while the patient'"'"'s heart is beating.

7. A method as in claim 6, wherein the method is performed while both lungs of the patient remain inflated.

8. A method as in claim 7, wherein the method is performed while the patient is under a local anesthetic.

26. A kit comprising:

a closure device; and

instructions for use setting forth a method as in claim 1.

27. A method as in claim 1, further comprising separating the parietal pericardium from the visceral pericardium near left atrial appendage prior to closing the left atrial appendage to create a space over the atrial appendage.

9. An improved method for closing a left atrial appendage of a heart, said method being of the type wherein a closure element is placed over an exterior of the appendage while the patient'"'"'s chest remains closed, wherein the improvement comprises advancing the closure element from beneath the rib cage over an epicardial surface to the exterior of the left atrial appendage prior to placing the closure element over the left atrial appendage.

10. A device for closing a left atrial appendage of a heart, said device comprising:

a shaft having a proximal end and a distal end, wherein the distal end is adapted to percutaneously enter a pericardial space, advance over an epicardial surface, and approach the exterior of the left atrial appendage; and

means carried by the shaft for closing the left atrial appendage when the distal end of the shaft is positioned adjacent to the left atrial appendage.

11. A device as in claim 10, wherein the shaft has a length in the range from 10 cm to 40 cm, a width in the range from 2 mm to 20 mm, and a thickness in the range from 1 mm to 10 mm.

12. A device as in claim 10, wherein the shaft is curved over its length.

13. A device as in claim 12, wherein the curvature of the shaft is adjustable.

14. A device as in claim 12, wherein the device has a crescent-shaped cross-section.

15. A device as in claim 10, wherein the distal end is configured to lie within an atrioventricular valve groove of the heart.

16. A device as in claim 15, wherein the shaft has at least one lumen which extends from the proximal end to exit ports spaced inwardly from the distal end by a distance in the range from 0.5 cm to 5 cm.

17. A device as in claim 16, wherein the closing means extends through the at least one lumen.

18. A device as in claim 17, wherein the closing means comprises a grasping tool which extends through one of the lumens, said grasping tool being adapted to temporarily grasp the left atrial appendage.

19. A device as in claim 18, wherein the closing means further comprises a closing tool adapted to permanently close the left atrial appendage while it is being temporarily closed with the grasping tool.

20. A device as in claim 12, wherein the shaft has at least a second lumen.

21. A device as in claim 20, further comprising a viewing scope positionable through the second lumen in the shaft.

22. A device as in claim 10, further comprising a handle attached to the proximal end of the shaft.

23. A device as in claim 21, wherein the shaft has at least a third lumen for irrigating the pericardial space.

24. A device as in claim 10, further comprising an expander for separating the pericardium in the region of the left atrial appendage.

25. A device as in claim 24, wherein the expander comprises an inflatable balloon.

28. A method as in claim 27, further comprising viewing the atrial appendage through the space.