Method and apparatus for resecting and replacing an aortic valve

• US 20070185513A1
• Filed: 04/06/2007
• Published: 08/09/2007
• Est. Priority Date: 06/29/2001
• Status: Active Grant

• Current Assignee: Daniel Taylor, Richard Streeter, Steven Woolfson, William Cohn
• Original Assignee: Daniel Taylor, Richard Streeter, Steven Woolfson, William Cohn
• Inventors: Cohn, William, Streeter, Richard, Woolfson, Steven, Taylor, Daniel
• Granted Patent: US 8,771,302 B2
• Time in Patent Office: Days
• US Class Current: 606/108
• CPC Class Codes: A61B 10/06 Biopsy forceps , e.g. with cup-shaped jaws
• CPC Class Codes: A61B 17/32002 with continuously rotating, oscillating or reciprocating cutting instruments
• CPC Class Codes: A61B 17/32053 Punch like cutting instruments, e.g. using a cylindrical or oval knife A61B17/326 takes precedence; trepans A61B17/1695; for use on the cornea A61F9/007
• CPC Class Codes: A61B 17/320725 with radially expandable cutting or abrading elements A61B17/32075 takes precedence
• CPC Class Codes: A61B 17/320783 through side-hole, e.g. sliding or rotating cutter inside catheter
• CPC Class Codes: A61B 2017/00243 cardiac
• CPC Class Codes: A61B 2017/00349 Needle-like instruments having hook or barb-like gripping means, e.g. for grasping suture or tissue A61B17/06066 takes precedence
• CPC Class Codes: A61B 2017/00685 Archimedes screw
• CPC Class Codes: A61B 2017/00783 Valvuloplasty
• CPC Class Codes: A61B 2017/22097 Valve removal in veins
• CPC Class Codes: A61B 2017/320004 abrasive
• CPC Class Codes: A61B 2017/32006 with a cutting strip, band or chain, e.g. like a chainsaw
• CPC Class Codes: A61B 2017/320064 with tissue or sample retaining means
• CPC Class Codes: A61F 2/2427 Devices for manipulating or deploying heart valves during implantation

Abstract

Apparatus for resecting a diseased heart valve, the apparatus comprising: a body portion; a first handle and a second handle; a cutting blade; a set of retaining arms; a pass-off tool having a first attachment device configured to selectively engage the first handle attached to the body portion so as to allow placement of the second handle of the body portion adjacent to the diseased heart valve, and a controller tool having a second attachment device at the distal end thereof, the second attachment device configured to selectively engage the second handle attached to the body portion so as to allow positioning of the body portion adjacent to the diseased heart valve, a cutting blade actuator configured to cause the cutting blade to selectively rotate, and a retaining arm actuator configured to selectively position the set of retaining arms from the contracted state to the expanded state.

Claims

1. Apparatus for resecting a diseased heart valve of a heart, the apparatus comprising:

an elongate member to allow the apparatus to be positioned in the heart, the elongate member having a longitudinal axis and a distal end;

a selectively expandable portion having a proximal end and a distal end, wherein the selectively expandable portion is positioned at the distal end of the elongate member, the selectively expandable portion defines a longitudinal axis from the proximal end to the distal end and is selectively expandable from a first position having a given width in a perpendicular direction to the longitudinal axis to a second position having a larger width in the perpendicular direction to the longitudinal axis; and

at least one cutting element, for cutting the diseased heart valve, disposed on the apparatus, wherein the at least one cutting element is moved from the first position to the second position by the selectively expandable portion.

2. Apparatus according to claim 1 wherein the at least one cutting element is disposed on the selectively expandable portion of the apparatus.

3. Apparatus according to claim 2 wherein when the selectively expandable portion is in the second position, the at least one cutting element cuts as the selectively expandable portion is rotated with respect to the longitudinal axis of the selectively expandable portion.

4. Apparatus according to claim 2 wherein the at least one cutting element extends longitudinally along the longitudinal axis of the selectively expandable portion such that when the at least one cutting element is in the second position, the at least one cutting element cuts as the selectively expandable portion is rotated with respect to the longitudinal axis of the selectively expandable portion.

5. Apparatus according to claim 1 wherein the at least one cutting element is disposed on the elongate member.

6. Apparatus according to claim 5 wherein the at least one cutting element extends longitudinally along the elongate member and when the selectively expandable portion is in the second position, the at least one cutting element cuts as the selectively expandable portion is rotated with respect to the longitudinal axis of the selectively expandable portion.

7. Apparatus according to claim 5 wherein the selectively expandable portion has a first opening extending into the proximal end, the first opening able to receive a portion of the elongate member, and having a given width from the first opening to an outer surface in a direction perpendicular to the longitudinal axis, the given width preventing a wall of a cardiovascular structure from being cut by the cutting element disposed on the elongate member that is within the first opening and to permit the apparatus to be placed within the diseased valve.

8. Apparatus according to claim 1 wherein the selectively expandable portion comprises a set of at least three expandable arms, the at least one cutting element is disposed on at least one of the three expandable arms, and further comprising a first restraining element at the proximal end of the set of expandable arms and a second restraining element at the distal end of the set of expandable arms, wherein the first and second restraining elements selectively position the set of expandable arms between the first and second positions.

9. Apparatus according to claim 8 wherein at least one of the at least three expandable arms having the cutting device disposed thereon defines a window recess therein having a given depth from an outer surface, and further wherein the cutting device is disposed in the window recess.

10. Apparatus according to claim 1 wherein the elongate member comprises a catheter and the first position is with the selectively expandable portion being inside the distal end of the catheter and the second position is with the selectively expandable portion being outside the distal end of the catheter.

11. Apparatus according to claim 2 wherein the at least one cutting element comprises a plurality of blades that move together and in a similar manner from the first position to the second position.

12. Apparatus according to claim 11 wherein the selectively expandable portion further comprises a hinge mechanism holding the blades together, the apparatus further comprises a control rod extending from the proximal end of the selectively expandable portion, and the control rod is able to position the blades from the first position to the second position

13. Apparatus according to claim 1 further comprising at least one barb that extends longitudinally from the elongate member such that the at least one barb is able to retain at least a portion of heart valve tissue.

14. Apparatus according to claim 13 wherein while the selectively expandable portion is in the first position, the barb is at least partially enclosed by the selectively expandable portion.

15. Apparatus according to claim 1 further comprising at least one barb that extends longitudinally from the selectively expandable portion such that the at least one barb is able to retain at least a portion of heart valve tissue.

16. Apparatus according to claim 15 wherein while the selectively expandable portion is in the first position, the barb is at least partially enclosed by the selectively expandable portion.

17. Apparatus of claim 1 wherein the cutting element comprises a wire.

18. Apparatus of claim 17 wherein the wire comprises an electrocautery element.

19. Apparatus of claim 17 wherein the wire is rotary driven.

20. Apparatus of claim 17 wherein the wire is reciprocally driven.

21. Apparatus of claim 17 wherein the wire comprises a rough surface.

22. Apparatus of claim 1 wherein at least one cutting element comprises a power shaver.

23. Apparatus of claim 1 further comprising an inflatable balloon that is used to expand the selectively expandable portion from the first position to the second position.

24. A method for resecting a diseased heart valve, the method comprising:

providing an apparatus for resecting the diseased heart valve, the apparatus comprising;

an elongate member to allow the apparatus to be positioned in the heart, the elongate member having a longitudinal axis and a distal end;

a selectively expandable portion having a proximal end and a distal end, wherein the selectively expandable portion is positioned at the distal end of the elongate member, the selectively expandable portion defines a longitudinal axis from the proximal end to the distal end and is selectively expandable from a first position having a given width in a perpendicular direction to the longitudinal axis to a second position having a larger width in the perpendicular direction to the longitudinal axis; and

at least one cutting element, for cutting a diseased heart valve, disposed on the apparatus, wherein the at least one cutting element is moved from the first position to the second position by the selectively expandable portion;

positioning the apparatus adjacent the diseased heart valve;

expanding the selectively expandable position to the second position;

cutting the diseased heart valve with the at least one cutting element; and

removing the cut diseased heart valve.

25. The method of claim 24, wherein the cutting step comprises rotating the selectively expandable portion in order to cut the diseased heart valve with the at least one cutting element.

26. The method of claim 24, wherein the at least one cutting element of the apparatus extends longitudinally along the apparatus such that when the at least one cutting element is in the second position, the at least one cutting element cuts as the selectively expandable portion is rotated.

27. The method of claim 24, wherein the expanding step comprises moving a plurality of cutting elements at the same time and in the same manner with respect to one another to the second position.

28. The method of claim 24, wherein the elongate member comprises a catheter and the first position is with the selectively expandable portion being inside the distal end of the catheter and the second position is with the selectively expandable portion being outside the distal end of the catheter.

29. The method of claim 24, wherein the apparatus further comprises at least one barb that is able to retain at least a portion of heart valve tissue, and further comprising, after the cutting step, the step of retaining cut heart valve tissue on the at least one barb.

30. The method of claim 29, wherein the removing step comprises retaining cut heart valve tissue on the at least one barb and removing the tissue by removing the apparatus.

31. The method of claim 24, wherein the apparatus further comprises at least one barb that is able to retain at least a portion of heart valve tissue, and further comprising, before the cutting step, the step of retaining the diseased heart valve tissue on the at least one barb to hold the tissue in place for cutting.