Devices and methods for mitral valve annulus reformation

• US 20060212114A1
• Filed: 10/08/2003
• Published: 09/21/2006
• Est. Priority Date: 07/26/1999
• Status: Abandoned Application

• Current Assignee: CMI Holding Co. Inc. (Chase Medical Technologies LP)
• Original Assignee: Chase Medical LP
• Inventors: Menicanti, Lorenzo, Giannoble, Jill, Bachman, Alan, Corrao, Ernie, Suresh, Mitta
• Application Number:
  US10/530,938
• Publication Number:
  US 20060212114A1
• Time in Patent Office: Days
• US Class Current: 623/2.360
• 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 17/0218 for minimally invasive surgery A61B17/0281, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/0643 with separate closing member, e.g. for interlocking with staple
• CPC Class Codes: A61B 17/0644 penetrating the tissue, deformable to closed position
• CPC Class Codes: A61B 2017/00353 one mechanical instrument performing multiple functions, e.g. cutting and grasping channel for multiple instruments A61B2017/3445; instrument channel A61B2017/22072; replaceable heads A61B2017/2931; suction A61M1/00
• CPC Class Codes: A61B 2017/00783 Valvuloplasty
• CPC Class Codes: A61B 2017/0237 for heart surgery endoscopic heart surgery A61B2017/00243; endoscopic access devices, i.e. trocars, A61B17/34
• CPC Class Codes: A61B 2017/0404 Buttons
• CPC Class Codes: A61B 2017/0498 for advancing a suture filament along a helical path through tissue
• CPC Class Codes: A61B 2017/0647 having one single leg, e.g. tacks
• CPC Class Codes: A61B 2017/306 holding by means of suction
• CPC Class Codes: A61F 2/2445 Annuloplasty rings in direct contact with the valve annulus
• CPC Class Codes: A61F 2/2496 Devices for determining the dimensions of the prosthetic valve to be implanted, e.g. templates, sizers

Abstract

A method and apparatus to allow a user to quickly and inexpensively repair the dilation of the mitral annulus is presented. In some embodiments, the method and apparatus should allow the user to reduce the size of the annulus to a predetermined size and allow him to secure the annulus so that it remains at the selected size. An apparatus may include a retractor. The retractor may assist in positioning a portion of the annulus. The apparatus may be part of a system including one or more fasteners. The fasteners may inhibit deformation of the reduced diameter of the mitral valve annulus. In some embodiments, the method may include incising a portion proximate to the mitral valve annulus. The method may include positioning a device through the incision, attaching the device with a plurality of attachment members, and deforming the device while observing the annulus and a surrounding area.

Claims

1. A method for reducing a size of a mitral valve annulus, comprising:

positioning at least a portion of a retractor substantially adjacent a portion of a circumference of the annulus;

coupling one or more of a plurality of extendable members of the retractor to the portion of the circumference;

reducing the diameter of an opening in the distal end of the retractor, wherein the opening is at least partially defined by the portion of the retractor coupled to the portion of the circumference, and wherein reducing the diameter of the opening in the distal end of the retractor reduces the diameter; and

positioning at least a portion of one or more fasteners in the portion of the circumference to inhibit deformation of the reduced diameter of the portion of the circumference of the mitral valve annulus.

3. The method claim 1, wherein the retractor comprises:

a conduit, wherein the plurality of extendable members are at least partially positionable in the conduit, wherein the plurality of extendable members at least partially defines the opening in the distal end of the retractor, wherein extending the distal ends of the plurality of extendable members out of the conduit increases the corresponding diameter of the predetermined shape formed by the plurality of extendable members, and wherein retracting the distal ends of the plurality of extendable members out of the conduit decreases the corresponding diameter of the predetermined shape formed by the plurality of extendable members; and

a depression positioned towards the distal end of the outer surface of at least some of the plurality of extendable members;

wherein positioning the portion of the retractor adjacent the annulus comprises positioning the distal end of the retractor with retracted extendable members substantially in the annulus and extending the extendable members until the portion of the circumference of the annulus is positioned at least substantially in the depressions.

4. The method of claim 1, further comprising providing a vacuum through one or more openings positioned in one or more of the plurality of extendable members.

7. The method of claim 4, further comprising positioning a suture through the portions of the circumference coupled to the vacuum openings of the extendable members.

10. The method of claim 1, further comprising adhering the portion of the circumference to a depression positioned towards the distal end of the outer surface of at least some of the plurality of extendable members, wherein the depression comprises one or more surface irregularities to increase the coefficient of friction between the surface of the depression and the portion of the circumference.

12. The method of claim 1, further comprising extending one or more suture needles positioned in a conduit in one or more of the extendable members through a depression positioned towards the distal end of the outer surface of the extendable member and the portion of the circumference of the annulus positioned in the depression, wherein extending the suture needles through the depression and the portion of the circumference comprises forming a suture loop extending through the portion of the circumference.

13. The method of claim 12, further comprising positioning a second suture through the plurality of suture loops.

14. The method of claim 1, further comprising extending one or more suture needles positioned in a conduit in one or more of the extendable members through a depression positioned towards the distal end of the outer surface of the extendable member, the portion of the circumference of the annulus positioned in the depression, and an opening in a coupler positioned toward the distal end of the depression, wherein extending the suture needles through the depression, the portion of the circumference, and the opening in the coupler comprises forming a suture loop extending through the portion of the circumference, the opening in the coupler and around a coupling member, and wherein the coupling member inhibits the suture loop from retracting through the opening in the coupler.

15. The method of claim 14, wherein the formed suture loop extends through a second opening in a second coupler positioned toward the proximal end of the depression.

16. The method of claim 15, further comprising inhibiting movement of the proximal end of the suture loop with the second coupler.

17. The method of claim 1, further comprising extending one or more coupling members of a first clip positioned in a conduit in one or more of the extendable members through a depression positioned towards the distal end of the outer surface of the extendable member, the portion of the circumference of the annulus positioned in the depression, and an opening in a second clip positioned toward the distal end of the depression.

18. The method of claim 17, further comprising inhibiting retraction of the distal end of the coupling member with the opening in the second clip.

21. The method of claim 1, further comprising activating one or more collars comprising extending one or more inactivated collars positioned in a conduit in one or more of the extendable members through a depression positioned towards the distal end of the outer surface of the extendable member and the portion of the circumference of the annulus positioned in the depression, wherein the depression facilitates activation of the extending inactivated collars, wherein the activated collars comprise a loop extending through the circumference of the annulus.

22. The method of claim 21, wherein the loop of the activated collars extends around one or more sutures.

23. The method of claim 1, further comprising extending one or more first clips positioned in a conduit in one or more of the extendable members through a first opening in a first plate positioned toward the proximal end of a depression, the depression positioned towards the distal end of the outer surface of the extendable member, the portion of the circumference of the annulus positioned in the depression, and a first opening in a second plate positioned toward the distal end of the depression, wherein extending the first clip couples the first plate, the portion of the circumference of the annulus, and the second plate to each other.

24. The method of claim 23, further comprising positioning one or more first clips through a second opening in the first plate, the portion of the circumference of the annulus, and a second opening in the second plate, wherein extending the first clip couples the first plate, the portion of the circumference of the annulus, and the second plate to each other.

2. (canceled)

5. (canceled)

6. (canceled)

8. (canceled)

9. (canceled)

11. (canceled)

19. (canceled)

20. (canceled)

25. (canceled)

26. A method for reducing a size of a mitral valve annulus, comprising:

positioning at least a portion of two or more support members of a retractor substantially adjacent a posterior leaflet;

using the support members to position the posterior leaflet such that a portion of the mitral valve annulus is substantially exposed;

positioning at least a portion of one or more fasteners in the portion of the circumference; and

activating the fasteners to reduce the diameter of the portion of the circumference when activated.

27. The method of claim 26, further comprising:

positioning a first support member and a second support member substantially on a first side of the posterior leaflet, and wherein the second support member is adjacent the posterior leaflet;

positioning a third support member on a second side of the posterior leaflet, wherein the second side is opposite the first side, and wherein the second side is adjacent the mitral valve annulus; and

moving the second support member toward the third support member such that the posterior leaflet is inhibited from moving, and moving the second and third support members away from the first support member such that at least a portion of the posterior leaflet is pulled away from the mitral valve annulus to use the support members to position the posterior leaflet.

37. The method of claim 26, wherein the fasteners comprises one or more sutures.

28-36. -36. (canceled)

38-42. -42. (canceled)

43. A method for reducing a size of a mitral valve annulus, comprising:

positioning at least a portion of an inactivated fastener substantially in a portion of a circumference of the annulus;

activating the inactivated fastener reducing the diameter of the portion of the circumference, wherein the activated fastener inhibits deformation of the reduced diameter of the portion of the circumference of the mitral valve annulus.

44-70. -70. (canceled)