Methods and apparatus for transmyocardial direct coronary revascularization
First Claim
16-1. The method of claim 1 further comprising the step of:
- connecting an elastic closure member to cardiac tissue on either side of said transmyocardial bloodflow passageway, said elastic closure member being alternately transitionable between;
i) a stretched configuration whereby said transmyocardial bloodflow passageway is opened to permit blood to flow from said transmyocardial bloodflow passageway into said coronary vein; and
ii) a retracted configuration whereby said transmyocardial bloodflow passageway is substantially blocked so as to prevent blood from backflowing from said coronary vein into said transmyocardial bloodflow passageway.
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Accused Products
Abstract
Methods and apparatus for direct coronary revascularization wherein a transmyocardial passageway is formed between a chamber of the heart and a coronary blood vessel to permit blood to flow therebetween. In some embodiments, the transmyocardial passageway is formed between a chamber of the heart and a coronary vein. The invention includes unstented transmyocardial passageways, as well as transmyocardial passageways wherein protrusive stent devices extend from the transmyocardial passageway into an adjacent coronary vessel or chamber of the heart. The apparatus of the present invention include protrusive stent devices for stenting of transmyocardial passageways, intraluminal valving devices for valving of transmyocardial passageways, intracardiac valving devices for valving of transmyocardial passageways, endogenous tissue valves for valving of transmyocardial passageways, and ancillary apparatus for use in conjunction therewith.
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Citations
83 Claims
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16-1. The method of claim 1 further comprising the step of:
connecting an elastic closure member to cardiac tissue on either side of said transmyocardial bloodflow passageway, said elastic closure member being alternately transitionable between;
i) a stretched configuration whereby said transmyocardial bloodflow passageway is opened to permit blood to flow from said transmyocardial bloodflow passageway into said coronary vein; and
ii) a retracted configuration whereby said transmyocardial bloodflow passageway is substantially blocked so as to prevent blood from backflowing from said coronary vein into said transmyocardial bloodflow passageway.
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17-2. The method of claim 16 wherein said elastic closure member comprises a suture which is formed of elastic material, said suture being threaded through said myocardial tissue on opposite sides of said transmyocardial bloodflow passageway.
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18-3. The method of claim 1 further comprising the step of:
b) placing an intracardiac valving apparatus within the chamber of the heart, adjacent one end of said transmyocardial bloodflow passageway, said intracardiac valving apparatus being alternately deployable in;
i) an open position whereby bloodflow is permitted to pass through the transmyocardial bloodflow passageway in a first direction; and
,ii) a closed position whereby blood is prevented from backflowing through the transmyocardial bloodflow passageway, in a second direction, said second direction being opposite said first direction.
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29. A method for transmyocardial direct coronary revascularization, said method comprising the steps of:
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a) forming a transmyocardial bloodflow passageway from a chamber of the heart to a coronary blood vessel;
b) permitting blood to flow from the chamber of the heart, through said transmyocardial bloodflow passageway; and
c) into the coronary blood vessel, while said transmyocardial bloodflow passageway remains devoid of any stent positioned therewithin. - View Dependent Claims (30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47)
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48. An intraluminal valving apparatus which is operative to prevent blood from a backflowing from a coronary blood vessel into a transmyocardial bloodflow passageway which extends from a chamber of the heart to said coronary blood vessel, said apparatus comprising:
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a generally cylindrical body having an axial bore which extends longitudinally therethrough; and
,at least one occluder member positioned within said axial bore, said at least one occluder member being alternately moveable between;
i) an open position whereby systolic blood is permitted to pass from said transmyocardial bloodflow passageway, through the lumen of the coronary blood vessel; and
,ii) a closed position whereby blood is prevented from backflowing from the lumen of the coronary blood vessel into the transmyocardial bloodflow passageway. - View Dependent Claims (49, 50, 51, 52, 53, 54, 55, 56, 57, 58)
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59. An intracardiac valving apparatus which is operative to control bloodflow through a transmyocardial bloodflow passageway extending from a chamber of the heart to a coronary blood vessel, said intracardiac valving apparatus comprising:
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a valve body having an opening formed therethrough, said valve body being positionable in contact with the wall of the heart such that the opening of said valve body is in alignment with said transmyocardial bloodflow passageway;
at least on occluder member positioned within the opening of said valve body, said occluder member being alternately moveable between;
i) an open position whereby blood is permitted to pass through said transmyocardial bloodflow passageway in a first direction; and
,ii) a closed position whereby blood is prevented from flowing through said transmyocardial passageway in at least a second direction opposite said first direction. - View Dependent Claims (60, 61, 62, 63, 64, 65)
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66. A protrusive stent apparatus for stenting a transmyocardial passageway which extends from a chamber of the heart to a coronary blood vessel, said apparatus comprising:
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a tubular body which is alternately configurable in;
i) a radially collapsed configuration of a first diameter;
ii) a radially expanded configuration of a second diameter, said second diameter being at least as large as the diameter of the transmyocardial passageway;
said protrusive stenting apparatus having a length which is longer than the length of the transmyocardial passageway, such that said apparatus may be positioned within said transmyocardial passageway from said cardiac chamber to said coronary blood vessel, with a portion of said apparatus protruding into said coronary blood vessel. - View Dependent Claims (67, 68, 69, 70, 71, 72)
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73. A method for transmyocardial coronary revascularization of a coronary artery having an occlusion formed therein, said method comprising the steps of:
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a) providing a passageway-forming catheter comprising an elongate pliable catheter body having at least one tissue-penetrating element which is passable from the catheter body to form an interstitial passageway through tissue;
b) inserting the passageway-forming catheter into the venous vasculature and advancing the catheter until a distal portion of the catheter is located within a coronary vein adjacent the coronary artery wherein the obstruction is present;
c) orienting the passageway-forming catheter such that the tissue-penetrating element is directed toward the coronary artery at a site downstream of the obstruction;
d) passing the tissue-penetrating element from the passageway-forming catheter, through the wall of the coronary vein wherein the catheter is positioned, through any tissue located between the coronary vein and the coronary artery, through the wall of the coronary artery and into the coronary artery, downstream of the obstruction, thereby forming an arterio-venous passageway between said coronary artery and said coronary vein;
e) advancing the passageway-forming catheter through the arterio-venous passageway and into the coronary artery, downstream of the obstruction;
f) orienting the passageway-forming catheter such that the tissue-penetrating element is directed toward a chamber of the heart;
g) passing the tissue-penetrating element from the passageway-forming catheter, through the wall of the coronary artery, through the myocardium and into a chamber of the heart, thereby forming a transmyocardial passageway through which blood may flow from the chamber of the heart and into the coronary artery, downstream of the obstruction;
h) removing the passageway-forming catheter from the body;
i) closing the arterio-venous passageway which had been formed in step d. - View Dependent Claims (74, 75, 76)
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77. A method for treating myocardial ischemia, said method comprising the steps of:
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a) providing a intravascular valving apparatus, said apparatus comprising a frame which is engageable with a surrounding vascular wall and at least one occluder mounted in said frame, said occluder being alternately moveable between a closed position wherein said occluder will block the flow of blood in an outflow direction through said coronary vein, in an open position wherein said occluder will permit blood to flow in said outflow direction through said coronary vein, said occluder being biased to its closed position but being moveable to its open position when the pressure of blood within the coronary vein exceeds a predetermined maximum pressure;
b) implanting the intervascular valving apparatus at a first location within the coronary venous vasculature such that the occluder member of said valving apparatus will prevent the flow of blood in an outflow direction from at least one coronary vein until such time as the pressure of blood within that coronary vein exceeds said predetermined maximum pressure. - View Dependent Claims (78, 79, 80, 81)
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82. A method for performing an intraluminal medical procedure within the lumen of an obstructed coronary artery, at a site downstream of the obstruction, said method comprising the steps of:
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a) providing a passageway-forming catheter comprising an elongate pliable catheter body having at least one tissue-penetrating element which is passable from the catheter body to form an interstitial passageway through tissue;
b) inserting the passageway-forming catheter into the venous vasculature and advancing the catheter until a distal portion of the catheter is located within a coronary vein adjacent the coronary artery wherein the obstruction is present;
c) orienting the passageway-forming catheter such that the tissue-penetrating element is directed toward the coronary artery at a site downstream of the obstruction;
d) passing the tissue-penetrating element from the passageway-forming catheter, through the wall of the coronary vein wherein the catheter is positioned, through any tissue located between the coronary vein and the coronary artery, through the wall of the coronary artery and into the coronary artery, downstream of the obstruction, thereby forming an arterio-venous passageway between said coronary artery and said coronary vein;
e) passing an apparatus through said arterio-venous passageway and into the lumen of the coronary, downstream of the obstruction, and utilizing said apparatus to perform said intraluminal procedure;
f) removing the apparatus from the coronary artery, through said arterio-venous passageway; and
closing the arterio-venous passageway which had been formed in step d. - View Dependent Claims (83)
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Specification