METHOD FOR CARDIAC RESTAINT

• US 20060229490A1
• Filed: 01/06/2003
• Published: 10/12/2006
• Est. Priority Date: 08/10/1999
• Status: Active Grant

• Current Assignee: Maquet Cardiovascular LLC (Getinge AB)
• Original Assignee: Albert K. Chin
• Inventors: Chin, Albert K.
• Granted Patent: US 7,214,180 B2
• Time in Patent Office: Days
• US Class Current: 600/37
• CPC Class Codes: A61B 1/00154 using guiding arrangements for insertion
• CPC Class Codes: A61B 17/00008 Vein tendon strippers tube strippers A61M1/83
• CPC Class Codes: A61B 17/06109 Big needles, either gripped by hand or connectable to a handle
• CPC Class Codes: A61B 17/3403 Needle locating or guiding means guides for suture needles A61B17/0482; guiding or tracking by nuclear magnetic resonance G01R33/285
• CPC Class Codes: A61B 17/3417 Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating syringe needles A61M5/32; dilators A61M29/00
• CPC Class Codes: A61B 17/3421 Cannulas
• CPC Class Codes: A61B 17/3468 for implanting or removing devices, e.g. prostheses, implants, seeds, wires devices for implanting seeds A61M37/0069
• CPC Class Codes: A61B 17/3478 Endoscopic needles, e.g. for infusion biopsy needles A61B10/0233; catheters with injection needles A61M25/0067
• CPC Class Codes: A61B 18/1482 having a long rigid shaft for accessing the inner body transcutaneously in minimal invasive surgery, e.g. laparoscopy
• 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 2017/061 hollow or tubular suture extending inside a hollow needle A61B2017/06052; hollow sutures A61B2017/06185
• CPC Class Codes: A61B 2017/22077 with a part piercing the tissue A61B2017/22044 takes precedence
• CPC Class Codes: A61B 2017/306 holding by means of suction
• CPC Class Codes: A61B 2017/320044 Blunt dissectors blunt suture needles A61B2017/06085
• CPC Class Codes: A61B 2017/3445 used as instrument channel for multiple instruments catheters A61B2017/22072
• CPC Class Codes: A61B 2017/3488 Fixation to inner organ or inner body tissue
• CPC Class Codes: A61B 2018/00291 using suction
• CPC Class Codes: A61B 2018/00392 Transmyocardial revascularisation
• 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 2090/036 : abutting on tissue or skin
• CPC Class Codes: A61B 2090/062 : penetration depth
• CPC Class Codes: A61B 90/11 : with guides for needles or instruments, e.g. arcuate slides or ball joints
• CPC Class Codes: A61B 90/39 : Markers, e.g. radio-opaque or breast lesions markers
• CPC Class Codes: A61F 2/2481 : Devices outside the heart wall, e.g. bags, strips or bands
• CPC Class Codes: A61F 2002/2484 : Delivery devices therefor
• CPC Class Codes: A61N 1/0587 : Epicardial electrode systems; Endocardial electrodes piercing the pericardium
• CPC Class Codes: A61N 2001/0578 : having means for removal or extraction

Abstract

Apparatus and methods for using the apparatus are disclosed for cardiac restraint. More specifically, the apparatus and methods are directed to accessing the pericardium, accessing the heart within the pericardium, and restraining the heart by at least partially enclosing the heart with the apparatus. An embodiment of a cardiac restraint apparatus according to the present invention comprises a jacket, the jacket having a rim which defines an opening for receiving a heart. The apparatus also comprises a knot pusher that has a hollow elongate body, as well as a strand that extends around the rim of the jacket and is tied into a slipknot. The strand is positioned such that at least one end portion of the strand extends through the knot pusher such that a distal end of the knot pusher can be moved into engagement with the slipknot, whereby pulling the end portion of the strand away from the heart while pushing the knot pusher against the slipknot and reducing the diameter of the opening defined by the rim. In addition, the apparatus comprises one or more guide elements that are attached to the jacket.

Claims

1. A method for constraining expansion of the heart comprising the steps for:

forming a subxiphoid entry incision;

introducing through the subxiphoid entry incision an endoscopic cannula having at least one lumen extending therethrough;

advancing the endoscopic cannula toward the pericardium;

introducing through a lumen of the endoscopic cannula a pericardial entry instrument to form an aperture near the apical pericardium into the intrapericardial space about the heart;

advancing the endoscopic cannula through the aperture;

introducing cardiac restraint apparatus through a lumen of the endoscopic cannula into engagement with the heart; and

manipulating the cardiac restraint apparatus within the intrapericardial space into substantially surrounding engagement about at least a portion of the heart.

2. The method according to claim 1 in which advancing the endoscopic cannula includes dissecting the linea alba and forming a passage posterior to the sternum toward the apex of the heart.

3. The method according to claim 1 in which introducing the cardiac restraint apparatus includes configuring the cardiac restraint apparatus within a volume dimensioned to pass through a lumen within the endoscopic cannula and through the pericardial aperture into the intrapericardial space about the heart.

4. The method according to claim 3 in which manipulating the cardiac restraint apparatus includes expanding within the intrapericardial space the cardiac restraint apparatus from the confined configuration thereof for positioning the unconfined cardiac restraint apparatus about a portion of the heart within the intrapericardial space.

5. The method according to claim 4 in which the cardiac restraint apparatus includes a jacket having a rim defining an opening for receiving a heart and including attached to the rim at least one guide handle of sufficient length to extend from the heart out through the subxiphoid entry incision, the jacket and rim and guide handle being configured within the dimension to pass through a lumen of the endoscopic cannula, and the method further comprising the step for:

positioning the rim of the jacket substantially about the heart within the intrapericardial space in response to manual manipulation of the guide handle from outside the subxiphoid entry incision.

6. The method according to claim 5 further comprising the steps for:

selectively tightening the rim about the heart; and

detaching the guide handle from the rim for removal of the guide handle through the lumen of the endoscopic cannula.

7. The method according to claim 4 in which the cardiac restraint apparatus includes an elastic band for encircling the heart, the method further comprising the steps for:

introducing the elastic band through the lumen of the endoscopic cannula into the intrapericardial space; and

positioning the elastic band substantially encircling the heart.