Apparatus and method for the ligation of tissue

• US 20060253129A1
• Filed: 04/07/2006
• Published: 11/09/2006
• Est. Priority Date: 04/07/2005
• Status: Active Grant

• Current Assignee: SentreHeart, LLC (Atricure, Inc.)
• Original Assignee: SentreHEART Incorporated (Atricure, Inc.)
• Inventors: Cohn, William E., Liddicoat, John R.
• Granted Patent: US 7,918,865 B2
• Time in Patent Office: Days
• US Class Current: 606/139
• 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 17/12013 for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 2017/00243 cardiac

Abstract

A novel catheter-based system that ligates the left atrial appendage (LAA) on the outside of the heart, preferably using a combination of catheters and/or instruments, e.g., a guide catheter inserted into the interior of the left atrial appendage that may assist in locating the left atrial appendage and/or assist in the optimal placement of a ligature or constricting element on the outside of the appendage, and a ligating catheter and/or instrument outside the heart in the pericardial space to set the ligature or constricting element at the neck of the left atrial appendage.

Claims

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

providing an elongate member having a proximal end, a distal end, and an expandable element located near the distal end;

making an incision on the patient and advancing the elongate member through the incision to a position adjacent the left atrial appendage;

inserting the elongate member through the epicardial tissue of the left atrial appendage into the interior of the left atrial appendage and advancing the elongate member to position the expandable element within the interior of the left atrial appendage;

expanding the expandable element within the interior of the left atrial appendage;

positioning a constricting element around a neck of the left atrial appendage; and

closing the constricting element around the neck of the left atrial appendage.

2. The method of claim 1, further comprising the steps of:

collapsing the expandable element of the guide catheter; and

withdrawing the guide catheter from the left atrial appendage.

3. The method of claim 2, further comprising the step of:

tightening the constricting element around the neck after the guide catheter has been withdrawn.

4. The method of claim 1, wherein the elongate member is advanced to a position adjacent the left atrial appendage using a visualization technique.

5. The method of claim 1, wherein the guide catheter comprises a radiopaque material and wherein the positioning of the guide catheter is accomplished using fluoroscopy.

6. The method of claim 1, wherein the guide catheter is positioned using a guidewire.

7. The method of claim 1, wherein the neck of the left atrial appendage is where the left atrial appendage meets the left atrium.

8. The method of claim 1, further comprising the step of:

applying suction to a tip of the left atrial appendage.

9. The method of claim 1, wherein the constricting element is a suture.

10. The method of claim 1, wherein the constricting element is a string.

11. The method of claim 1, wherein the constricting element is a clip.

12. The method of claim 1, wherein the incision on the patient is made below the zyphoid process of the sternum.

13. The method of claim 1, wherein the elongate member is advanced over a guidewire to a position adjacent the left atrial appendage.

14. The method of claim 1, wherein expanding the expandable element within the interior of the left atrial appendage alters the shape of the left atrial appendage.

15. The method of claim 1, wherein the step of positioning the constricting element around the neck is performed before the step of expanding the expandable element in the interior of the left atrial appendage.

16. A device for closing a left atrial appendage of a patient'"'"'s heart, comprising:

an elongate tubular member having a proximal end, a distal end, and a balloon located near the distal end;

an elongate instrument carrying a closure element for placement around a neck of the left atrial appendage; and

an elongate outer sheath having a proximal end, a distal end, and a lumen therebetween, the lumen adapted to slideably receive the elongate tubular member, the elongate instrument, and the closure element.

17. The device of claim 16, wherein the elongate tubular member is a guide catheter.

18. The device of claim 16, wherein the closure element is a string.

19. The device of claim 16, wherein the closure element is a suture.

20. The device of claim 16, wherein the closure element is a clip.

21. The device of claim 16, wherein the elongate tubular member comprises a radiopaque material.

22. The device of claim 16, further comprising a guidewire adaptable to be slideably received in a lumen of the elongate tubular member.

23. The device of claim 16, further comprising:

a second elongate tubular member having a proximal end, a distal end, and a lumen therebetween; and

a vacuum source in communication with the lumen of the elongate tubular member.