Minimally-invasive devices and methods for treatment of congestive heart failure

• US 20040055608A1
• Filed: 09/17/2003
• Published: 03/25/2004
• Est. Priority Date: 02/22/1993
• Status: Active Grant

• Current Assignee: Ethicon Incorporated (Johnson & Johnson)
• Original Assignee: Ethicon Incorporated (Johnson & Johnson)
• Inventors: Gifford, Hanson S. III, Stevens, John H., Houle, Philip R., Bolduc, Lee R., Boyd, Stephen W., Rosenman, Daniel C., Donlon, Brian S.
• Granted Patent: US 7,213,601 B2
• Time in Patent Office: Days
• US Class Current: 128/898
• CPC Class Codes: A61B 17/00234 for minimally invasive surgery A61B17/0218, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/0057 Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect sutures A61B17/04; closing rectum or urethra near body surface A61F2/0009
• CPC Class Codes: A61B 17/0218 for minimally invasive surgery A61B17/0281, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/0293 with ring member to support retractor elements
• CPC Class Codes: A61B 17/0467 Instruments for cutting sutures surgical cutting instruments A61B17/32
• CPC Class Codes: A61B 17/0469 Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 17/06061 Holders for needles or sutures, e.g. racks, stands hand-held holding instruments A61B17/0483; holders for articles A61B50/20; racks for syringes or for hypodermic or infusion needles A61M5/008
• 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 17/29 Forceps for use in minimally invasive surgery
• CPC Class Codes: A61B 17/2909 Handles
• CPC Class Codes: A61B 17/3421 Cannulas
• CPC Class Codes: A61B 18/1492 having a flexible, catheter-like structure, e.g. for heart ablation A61B18/1477 takes precedence
• CPC Class Codes: A61B 2017/00053 Mapping
• CPC Class Codes: A61B 2017/00243 cardiac
• CPC Class Codes: A61B 2017/00247 Making holes in the wall of the heart, e.g. laser Myocardial revascularization
• CPC Class Codes: A61B 2017/00575 for closure at remote site, e.g. closing atrial septum defects
• CPC Class Codes: A61B 2017/00632 Occluding a cavity, i.e. closing a blind opening
• CPC Class Codes: A61B 2017/00867 shape memory effect
• CPC Class Codes: A61B 2017/00907 for light
• CPC Class Codes: A61B 2017/00946 malleable
• CPC Class Codes: A61B 2017/0237 : for heart surgery
• CPC Class Codes: A61B 2017/0243 : for immobilizing local areas of the heart, e.g. while it beats
• CPC Class Codes: A61B 2017/047 : having at least one proximally pointing needle located at the distal end of the instrument, e.g. for suturing trocar puncture wounds starting from inside the body
• CPC Class Codes: A61B 2017/0472 : Multiple-needled, e.g. double-needled, instruments
• CPC Class Codes: A61B 2017/0474 : Knot pushers
• CPC Class Codes: A61B 2017/0475 : using sutures having a slip knot
• CPC Class Codes: A61B 2017/0496 : for tensioning sutures
• CPC Class Codes: A61B 2017/2912 : transmission of forces to actuating rod or piston
• CPC Class Codes: A61B 2017/2926 : Details of heads or jaws
• CPC Class Codes: A61B 2017/2927 : the angular position of the head being adjustable with respect to the shaft
• CPC Class Codes: A61B 2017/2932 : Transmission of forces to jaw members
• CPC Class Codes: A61B 2017/2943 : Toothed members, e.g. rack and pinion
• CPC Class Codes: A61B 2017/306 : holding by means of suction
• CPC Class Codes: A61B 2017/308 : with suction cups
• CPC Class Codes: A61B 2017/3405 : using mechanical guide means
• CPC Class Codes: A61B 2017/3492 : against the outside of the body
• CPC Class Codes: A61B 2018/00214 : Expandable means emitting energy, e.g. by elements carried thereon
• CPC Class Codes: A61B 2018/00232 : having an irregular shape
• CPC Class Codes: A61B 2018/00261 : arranged in a line
• CPC Class Codes: A61B 2018/00291 : using suction
• CPC Class Codes: A61B 2018/00363 : Epicardium
• CPC Class Codes: A61B 2018/00392 : Transmyocardial revascularisation
• CPC Class Codes: A61B 2018/00577 : Ablation
• CPC Class Codes: A61B 2018/00982 : combined with or comprising means for visual or photographic inspections inside the body, e.g. endoscopes
• CPC Class Codes: A61B 2090/061 : for measuring dimensions, e.g. length
• CPC Class Codes: A61B 2090/306 : using optical fibres
• CPC Class Codes: A61B 90/36 : Image-producing devices or illumination devices not otherwise provided for
• CPC Class Codes: A61B 90/50 : Supports for surgical instruments, e.g. articulated arms
• CPC Class Codes: A61F 2/2442 : Annuloplasty rings or inserts for correcting the valve shape; Implants for improving the function of a native heart valve
• CPC Class Codes: A61F 2/2445 : Annuloplasty rings in direct contact with the valve annulus
• CPC Class Codes: A61F 2007/0001 : Body part
• CPC Class Codes: A61F 2007/0054 : with a closed fluid circuit, e.g. hot water
• CPC Class Codes: A61F 2007/101 : for cooling organs in the body before or during surgery
• CPC Class Codes: A61F 7/10 : Cooling bags, e.g. ice-bags
• CPC Class Codes: A61M 1/3621 : Extra-corporeal blood circuits single-needle circuits A61M1/30
• CPC Class Codes: A61M 2025/028 : having a mainly rigid support structure
• CPC Class Codes: A61M 2039/027 : having a particular valve, seal or septum
• CPC Class Codes: A61M 2039/0279 : for introducing medical instruments into the body, e.g. endoscope, surgical tools
• CPC Class Codes: A61M 2202/047 : cardioplegic
• CPC Class Codes: A61M 2205/3344 : Measuring or controlling pressure at the body treatment site
• CPC Class Codes: A61M 2205/3355 : Controlling downstream pump pressure
• CPC Class Codes: A61M 2205/366 : by liquid heat exchangers
• CPC Class Codes: A61M 25/1011 : Multiple balloon catheters
• CPC Class Codes: A61M 39/0247 : Semi-permanent or permanent transcutaneous or percutaneous access sites to the inside of the body peritoneal dialysis catheters A61M1/285; tracheostomy devices A61M16/0465; measuring pressure within the body A61B5/03; colostomy devices A61F5/445; gastrotomy feeding tubes A61J15/0015; means for fixing a feeding tube outside of the body A61J15/0053

Abstract

A method of treatment of congestive heart failure comprises the steps of introducing an aortic occlusion catheter through a patient'"'"'s peripheral artery, the aortic occlusion catheter having an occluding member movable from a collapsed position to an expanded position; positioning the occluding member in the patient'"'"'s ascending aorta; moving the occluding member from the collapsed shape to the expanded shape after the positioning step; introducing cardioplegic fluid into the patient'"'"'s coronary blood vessels to arrest the patient'"'"'s heart; maintaining circulation of oxygenated blood through the patient'"'"'s arterial system; and reshaping an outer wall of the patient'"'"'s heart while the heart is arrested so as to reduce the transverse dimension of the left ventricle. The ascending aorta may be occluded and cardioplegic fluid delivered by means of an occlusion balloon attached to the distal end of an elongated catheter positioned transluminally in the aorta from a femoral, subclavian, or other appropriate peripheral artery.

Claims

1. A method of reshaping a patient'"'"'s heart comprising:

gauging the size of the left ventricle;

determining the amount by which the left ventricle should be reduced from the gauging of its size; and

reducing the dimension of the left ventricle in accordance with the determined amount.

2. The method according to claim 1, wherein gauging the size of the left ventricle comprises encircling the heart closely with an adjustable length band, and determining the size of the ventricle with reference to the length of the band.

3. The method according to claim 1, wherein gauging the size of the left ventricle comprises inserting an expansible member into the left ventricle, and expanding the expansible member.

4. The method according to claim 3, wherein the expansible member is a balloon, and expanding the balloon is accomplished by the introduction of fluid into an interior of the balloon.

5. The method according to claim 4, wherein gauging the size of the left ventricle further comprises measuring the volume of fluid introduced into the interior of the balloon.

6. The method according to claim 1, wherein reducing the dimension of the left ventricle comprises creating an opening the in the left ventricular wall.

7. The method according to claim 6, wherein reducing the dimension of the left ventricle further comprises removing a portion of the myocardial tissue.

8. The method according to claim 6, wherein creating an opening the in the left ventricular wall comprises creating perforation in the left ventricle extending to the apex of the heart.

9. The method according to claim 6, wherein reducing the dimension of the left ventricle further comprises hemostatically closing the left ventricle.

10. A method of reshaping a patient'"'"'s heart comprising:

introducing an expansible member into the left ventricle of a patient'"'"'s heart, the expansible member being at least partially collapsed;

expanding the expansible member within the left ventricle of a patient'"'"'s heart; and

reducing the volume of the left ventricle by an amount based upon the expanded volume of the expansible member.

11. The method according to claim 10, wherein the amount of volume reduction of the patient'"'"'s left ventricle is determined by the expanded volume of the expansible member compared to a desired volume of the left ventricle.

12. The method according to claim 10, wherein expanding the expansible member comprises the introduction of fluid into the interior of the expansible member.

13. The method according to claim 10, wherein reducing the dimension of the left ventricle comprises creating an opening the in the left ventricular wall.

14. The method according to claim 13, wherein reducing the dimension of the left ventricle further comprises removing a portion of the myocardial tissue.

15. The method according to claim 13, wherein creating an opening the in the left ventricular wall comprises creating perforation in the left ventricle extending to the apex of the heart.

16. The method according to claim 13, wherein reducing the dimension of the left ventricle further comprises hemostatically closing the left ventricle.

18. The method according to claim 13, wherein reducing the dimension of the left ventricle comprises creating an opening the in the left ventricular wall.

19. The method according to claim 13, wherein reducing the dimension of the left ventricle further comprises removing a portion of the myocardial tissue.

20. The method according to claim 13, wherein creating an opening the in the left ventricular wall comprises creating perforation in the left ventricle extending to the apex of the heart.

21. The method according to claim 13, wherein reducing the dimension of the left ventricle further comprises hemostatically closing the left ventricle.

17. A method of reshaping a patient'"'"'s heart comprising:

encircling the heart closely with an adjustable length band;

determining the size of the left ventricle with reference to the length of the band; and

reducing the volume of the left ventricle by an amount based upon the determined size of the left ventricle.