Thorascopic Heart Valve Repair Method and Apparatus

• US 20080188873A1
• Filed: 01/19/2006
• Published: 08/07/2008
• Est. Priority Date: 01/21/2005
• Status: Active Grant

• Current Assignee: Mayo Foundation For Medical Education And Research (Mayo Clinic)
• Original Assignee: Mayo Foundation For Medical Education And Research (Mayo Clinic)
• Inventors: Speziali, Giovanni
• Granted Patent: US 8,465,500 B2
• Time in Patent Office: Days
• US Class Current: 606/144
• CPC Class Codes: A61B 1/00167 Details of optical fibre bundles, e.g. shape or fibre distribution
• CPC Class Codes: A61B 1/07 using light-conductive means, e.g. optical fibres
• CPC Class Codes: A61B 17/0469 Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 17/0482 Needle or suture guides guides for drills, pins or wire A61B17/17; for puncturing needles A61B17/3403
• CPC Class Codes: A61B 17/0483 Hand-held instruments for holding sutures A61B17/0469 takes precedence; other holders for needles or sutures A61B17/06061; surgical forceps A61B17/28; surgical pincettes A61B17/30
• CPC Class Codes: A61B 17/0491 Sewing machines for surgery
• CPC Class Codes: A61B 17/06 Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials puncturing needles A61B17/34; hypodermic needles A61M5/32 ; sewing needles D05B85/00
• CPC Class Codes: A61B 17/0625 the needle being specially adapted to interact with the manipulator, e.g. being ridged to snap fit in a hole of the manipulator A61B17/06109 takes precedence
• CPC Class Codes: A61B 17/29 Forceps for use in minimally invasive surgery
• CPC Class Codes: A61B 17/295 combined with cutting implements
• CPC Class Codes: A61B 2017/00057 Light
• CPC Class Codes: A61B 2017/00243 cardiac
• CPC Class Codes: A61B 2017/00783 Valvuloplasty
• CPC Class Codes: A61B 2017/0608 J-shaped
• CPC Class Codes: A61B 2090/0807 Indication means
• CPC Class Codes: A61B 2090/306 using optical fibres
• CPC Class Codes: A61B 5/0036 including treatment, e.g., using an implantable medical device, ablating, ventilating
• CPC Class Codes: A61B 5/0084 for introduction into the body, e.g. by catheters A61B5/1459 takes precedence
• CPC Class Codes: A61B 5/02028 Determining haemodynamic parameters not otherwise provided for, e.g. cardiac contractility or left ventricular ejection fraction
• CPC Class Codes: A61B 5/4836 Diagnosis combined with treatment in closed-loop systems or methods A61B5/0036 takes precedence
• CPC Class Codes: G02B 23/2469 : using optical fibres

Abstract

An instrument for performing thorascopic repair of heart valves includes a shaft for extending through the chest cavity and into a heart chamber providing access to a valve needing repair. A movable tip on the shaft is operable to capture a valve leaflet and a needle is operable to penetrate a capture valve leaflet and draw the suture therethrough. The suture is thus fastened to the valve leaflet and the instrument is withdrawn from the heart chamber transporting the suture outside the heart chamber. The suture is anchored to the heart wall with proper tension as determined by observing valve operation with an ultrasonic imaging system.

Claims

1. A method for repairing a heart valve, the steps comprising:

a) inserting an instrument through the subject'"'"'s chest wall and into the chest cavity;

b) inserting the distal end of the instrument through a heart wall and entering a heart chamber;

c) grasping a leaflet on the heart valve with a movable device on the distal end of the instrument;

d) puncturing the leaflet with a needle disposed on the distal end of the instrument and drawing a suture through the puncture to connect the suture thereto;

e) anchoring the suture to another structure in the heart;

f) withdrawing the instrument from the heart chamber; and

g) withdrawing the instrument from the chest cavity.

2. The method as recited in claim 1 in which step e) includes withdrawing the suture with the instrument from the heart chamber as recited in step f) and anchoring the suture to the outer surface of the heart wall.

3. The method as recited in claim 2 in which the tension on the suture is adjusted before anchoring by observing the operation of the heart valve using a medical imaging system.

4. The method as recited in claim 1 which includes placing a purse-string suture in the heart wall around the location of the instrument insertion.

5. The method as recited in claim 1 in which the distal end of the instrument is inserted in step b) through the apex of the heart.

6. The method as recited in claim 5 in which step e) includes withdrawing the suture with the instrument from the heart chamber as recited in step f) and anchoring the suture to the outer surface of the heart wall near the apex of the heart.

7. An instrument for repairing a heart valve the combination comprising:

a shaft for insertion through a chest wall and into a heart chamber;

a movable element mounted on the distal end of the shaft and being operable from the extrathoracic end of the shaft to capture and hold a valve leaflet against the distal end of the shaft;

a suture disposed in the distal end of the instrument; and

a needle mechanism mounted on the distal end of the shaft and being operable from the extrathoracic end of the shaft to penetrate through a captured valve leaflet and draw a suture back through the penetration.

8. The instrument as recited in claim 7 which includes:

an illumination fiberoptic that extends through the shaft and terminates at the distal end of the shaft; and

a sensor fiberoptic that extends through the shaft and terminates at the distal end of the shaft;

wherein the distal ends of the fiberoptics are positioned such that light is conveyed to the valve leaflet when the valve leaflet is captured and reflected back through the sensor fiberoptic.

9. The instrument as recited in claim 8 in which there are a plurality of illumination and sensor fiberoptics with their distal ends disposed around the needle mechanism.

10. The instrument as recited in claim 7 in which the movable element is a tip which is slidably mounted to the distal end of the shaft and slidable from an open position in which a space is created between the tip and the distal end of the shaft and a closed position in which the space is substantially reduced to grasp a valve leaflet therebetween.

11. The instrument as recited in claim 10 in which the needle mechanism is operable to extend outward from the distal and of the shaft, through a captured valve leaflet and into the tip.

12. The instrument as recited in claim 11 in which the suture is disposed in the tip and the needle mechanism includes means for attaching to the suture when extended into the tip.

13. The instrument as recited in claim 12 in which the means for attaching is a notch formed along one side of a needle that penetrates through the valve leaflet, the notch being positioned when the needle mechanism is extended into the tip to hook the suture.

14. The instrument as recited in claim 11 in which the suture is disposed in the shaft with a loop formed at its midpoint extending into the tip.

15. The instrument as recited in claim 14 in which the means for attaching is a notch formed along one side of a needle that penetrates through the valve leaflet, the notch being positioned when the needle mechanism is extended into the tip to hook the loop formed in the suture.

16. The instrument as recited in claim 11 in which the suture is a loop and the needle mechanism includes a notch formed along one side of the needle that penetrates through the valve leaflet, the notch being positioned when the needle mechanism is extended into the tip to hook one end of the suture loop disposed therein.

17. The instrument as recited in claim 16 in which another end of the suture loop wraps around the needle mechanism at a point proximal the valve leaflet.