Reconfiguring Heart Features

• US 20080167713A1
• Filed: 01/08/2007
• Published: 07/10/2008
• Est. Priority Date: 01/08/2007
• Status: Active Grant

• Current Assignee: Boston Scientific Scimed (Boston Scientific Corporation)
• Original Assignee: Millipede, Inc. (Boston Scientific Corporation)
• Inventors: Bolling, Steven F.
• Granted Patent: US 9,192,471 B2
• Time in Patent Office: Days
• US Class Current: 623/2.11
• 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 17/0401 Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors A61B17/0642 takes precedence; fixation devices for tendons or ligaments A61F2/0811
• CPC Class Codes: A61B 17/0644 penetrating the tissue, deformable to closed position
• CPC Class Codes: A61B 17/068 Surgical staplers , e.g. containing multiple staples or clampsstaplers containing only one staple A61B17/10; magazines or containers for staples A61B17/105; for performing anastomosis A61B17/115; staplers in general B25C5/00
• CPC Class Codes: A61B 2017/00243 cardiac
• CPC Class Codes: A61B 2017/00783 Valvuloplasty
• CPC Class Codes: A61B 2017/00862 elastic or resilient for sutures A61B2017/0618
• CPC Class Codes: A61B 2017/00867 shape memory effect for prostheses A61F2210/0014
• CPC Class Codes: A61B 2017/0409 Instruments for applying suture anchors for applying suture clamps, clips or locks A61B2017/0488
• CPC Class Codes: A61B 2017/0414 having a suture-receiving opening, e.g. lateral opening lateral eyelet for attaching suture to needle A61B2017/06019
• CPC Class Codes: A61B 2017/0647 having one single leg, e.g. tacks
• CPC Class Codes: A61B 2017/12018 Elastic band ligators
• CPC Class Codes: A61F 2/243 Deployment by mechanical expansion
• CPC Class Codes: A61F 2/2445 Annuloplasty rings in direct contact with the valve annulus
• CPC Class Codes: A61F 2/2466 Delivery devices therefor

Abstract

In general, in an aspect, an annulus of a heart valve is caused to dilate to a predetermined configuration. While the annulus is dilated, a valve support is attached to tissue at locations along the annulus. After attachment, the support is caused to contract.

Claims

1. A method comprising:

applying a force on a tool toward an annulus of a heart valve to cause the annulus to dilate,

while the annulus is dilated, attaching a valve support to tissue at locations along the annulus, and

after attachment, causing the support to contract.

2. The method of claim 1 in which the valve support is attached to the tool before the annulus is dilated.

3. The method of claim 1 in which the valve support is caused to conform to a delivery configuration for attachment.

4. The method of claim 2 in which the valve support is expanded before being attached to the tool.

5. The method of claim 1 in which the valve support is attached to the tissue by applying a force to the tool in the direction axial to the annulus.

6. The method of claim 1 also including attaching the valve support to the tool before attaching the valve support to the tissue.

7. The method of claim 6 in which the valve support is attached to the tool by one or more breakable connections.

8. The method of claim 7 in which the breakable connections comprise sutures.

9. The method of claim 7 in which the breakable connections comprise fingers.

10. The method of claim 6 in which attaching the valve support to the tool comprises forcing the valve support to engage retaining elements on the tool.

11. The method of claim 1 in which attaching the valve support comprises anchoring the valve support using one of more hooks.

12. The method of claim 1 in which applying the force causes a tapered surface of the tool to engage the annulus.

13. The method claim 11 in which causing the support to contract comprises retracting the tapered head from the annulus.

14. The method of claim 1 in which causing the support to contract comprises permitting the support to contract itself.

15. A method comprising:

causing an annulus of a heart valve to dilate to a predetermined configuration; and

while the annulus is dilated, attaching a valve support to tissue at locations along the annulus; and

after attachment, causing the support to contract.

16. The method of claim 15 also including expanding the valve support to a delivery configuration before attaching the valve support to the tissue.

17. The method of claim 16 in which expanding the valve support comprises displacing the valve support axially along a tapered head of a delivery tool.

18. The method of claim 15 also including positioning the valve support on a tapered head of a delivery tool.

19. The method of claim 18 also including releasably attaching the valve support to the tapered head.

20. The method of claim 15 in which causing the annulus of the heart valve to dilate comprises forcing the tapered head of the delivery tool into the heart valve in a direction axial to the annulus.

21. The method of claim 20 in which enabling the support to contract comprises retracting the tapered head from the heart valve.

22. The method of claim 21 in which retracting comprises releasing the valve support.

23. The method of claim 22 in which releasing the valve support comprises breaking a connection between the valve support and the tapered head of the tool.

24. The method of claim 15 in which attaching the valve support to tissue comprises forcing hooks into the tissue.

25. A method comprising:

pushing a valve support towards an annulus of a heart valve to cause hooks of the support to be driven into tissue at locations along the annulus; and

embedding the hooks more securely in the tissue by pulling on the support.

26. The method of claim 25 in which the valve support comprises an annular body, and in which embedding the hooks more securely include causing the hooks to rotate about the annular body.

27. The method of claim 25 in which pushing on the valve support comprises pushing on a delivery tool that carries the valves support.

28. The method of claim 25 in which pulling on the support comprises pulling on a delivery tool that carries the support.

29. The method of claim 28 also including releasing the valve support after the hooks are more securely embedded.

30. A method comprising:

causing a catheter to traverse a body lumen to place a delivery tool that carries a valve support at an annulus of a heart valve; and

pushing the catheter toward the annulus of the heart valve to cause the delivery tool to dilate the annulus.

31. The method of claim 30 also including pushing the catheter toward the annulus to attach the valve support to the annulus.

32. The method of claim 30 also including pulling on the catheter to release the valve support after it is attached to the annulus.

33. The method of claim 32 in which releasing the valve support permits the valve support to contract.

34. The method of claim 30 also including sheathing the valve support before the catheter is caused to traverse the body lumen and unsheathing the valve support in the vicinity of the heart valve.

35. The method of claim 34 in which the sheathing and unsheathing include moving the catheter and the sheath relative to cause the valve support to be compressed and expanded, respectively.

36. An apparatus comprising:

an annular heart valve support, and

hooks connected to the support to attach the support along an annulus of a heart valve,

each of the hooks having (a) a sharp free end facing a first direction, (b) a connection end where the hooks is attached to the support, and (c) a bend located between the free end and the connection end, the bend defining a sharp feature facing in a second direction generally opposite to the first direction.

37. The apparatus of claim 36 in which the support is expandable and contractable.

38. The apparatus of claim 36 in which the support comprises at least one of stainless steel, gold Nitinol, and a biologically compatible elastomer.

39. The apparatus of claim 36 in which the support comprises a helical torsion spring.

40. The apparatus of claim 36 in which the hooks are rotatable about the support.

41. The apparatus of claim 36 in which the hooks comprise at least one of platinum, gold, palladium, rhenium, tantalum, tungsten, molybdenum, nickel, cobalt, stainless steel, Nitinol, and alloys thereof.

42. An apparatus comprising

a tool bearing a tapered outer surface,

a heart valve support, and

a connection between the tool and the support to translate forces from the tool to the support in each of two opposite directions along an axis of a heart valve and to release when the force along one of the axial directions exceeds a predetermined threshold.

43. The apparatus of claim 42 in which the tool comprises a tapered outer surface.

44. The apparatus of claim 43 in which the tapered outer surface comprises interconnected struts defining apertures.

45. The apparatus of claim 42 in which the connection comprises at least one retaining element on an outer surface of the tool.

46. The apparatus of claim 42 in which the valve support includes hooks each having a sharp free end facing in a first direction, a connection end where the hook is attached to the support, and a bend located between the free end and the connection end, the bend defining a sharp feature facing in a second direction generally opposite the first direction.

47. The apparatus of claim 42 in which the tool includes a tip at a narrow end of the tapered outer surface, and the tapered outer surface is evertable when the tip is pulled toward a broader end of the tapered outer surface.

48. The apparatus of claim 47 also including a movable element connected to the tip and configured to pull the tip to evert the tapered outer surface.

49. The apparatus of claim 42 also including a sheath to cover the tapered outer surface and cause the tapered outer surface to be collapsed when covered.

50. The apparatus of claim 42 in which the tool comprises a self-expanding, semi-rigid net.

51. A method comprising:

applying a force on a tool toward an annular feature of a heart to cause the feature to dilate,

while the feature is dilated, attaching a support to tissue at locations along a periphery of the annular feature, and

after attachment, causing the support to contract to reconfigure the feature.

52. The method of claim 51 in which the feature comprises a left atrial appendage.