Methods and Devices for Endoscopic Access to the Heart

• US 20100160725A1
• Filed: 12/18/2009
• Published: 06/24/2010
• Est. Priority Date: 12/19/2008
• Status: Abandoned Application

• Current Assignee: Aegis Surgical Limited
• Original Assignee: Aegis Surgical Limited
• Inventors: Kiser, Andy Christopher, Landers, Mark Douglas
• Application Number:
  US12/642,137
• Publication Number:
  US 20100160725A1
• Time in Patent Office: Days
• US Class Current: 600/104
• CPC Class Codes: A61B 1/04 combined with photographic or television appliances
• CPC Class Codes: A61B 1/3132 for laparoscopy
• CPC Class Codes: A61B 1/3137 for examination of the interior of blood vessels
• CPC Class Codes: A61B 17/0057 Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect sutures A61B17/04; closing rectum or urethra near body surface A61F2/0009
• 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 17/0485 Devices or means, e.g. loops, for capturing the suture thread and threading it through an opening of a suturing instrument or needle eyelet
• CPC Class Codes: A61B 17/0487 Suture clamps, clips or locks, e.g. for replacing suture knots; Instruments for applying or removing suture clamps, clips or locks suture anchors A61B17/0401; wound clamps or clips A61B17/08; ligaturing clamps or clips A61B17/122
• CPC Class Codes: A61B 17/3421 Cannulas
• CPC Class Codes: A61B 18/1477 Needle-like probes
• CPC Class Codes: A61B 18/1492 having a flexible, catheter-like structure, e.g. for heart ablation A61B18/1477 takes precedence
• CPC Class Codes: A61B 2017/00243 cardiac
• CPC Class Codes: A61B 2017/00637 for sealing trocar wounds through abdominal wall
• CPC Class Codes: A61B 2017/00663 the implement being a suture
• CPC Class Codes: A61B 2017/0404 Buttons
• CPC Class Codes: A61B 2017/0409 Instruments for applying suture anchors for applying suture clamps, clips or locks A61B2017/0488
• CPC Class Codes: A61B 2017/0412 having anchoring barbs or pins extending outwardly from suture anchor body
• CPC Class Codes: A61B 2017/0427 having anchoring barbs or pins extending outwardly from the anchor body
• CPC Class Codes: A61B 2017/0437 the barbs being resilient or spring-like
• CPC Class Codes: A61B 2017/0464 for soft tissue
• CPC Class Codes: A61B 2017/0496 for tensioning sutures
• CPC Class Codes: A61B 2017/06052 : Needle-suture combinations in which a suture is extending inside a hollow tubular needle, e.g. over the entire length of the needle hollow suture needles A61B2017/061
• CPC Class Codes: A61B 2017/3425 : for internal organs, e.g. heart ports
• CPC Class Codes: A61B 2017/3445 : used as instrument channel for multiple instruments catheters A61B2017/22072
• CPC Class Codes: A61B 2018/1425 : Needle
• CPC Class Codes: A61F 2/2433 : using balloon catheter

Abstract

Disclosed are devices for cardioscopic and pericardioscopic access to the heart, including direct access to the left atrium. In certain embodiments, the device may comprise an atrial portal having a configuration such that the distal end of the atrial portal can access the atrium while the proximal end of the portal can extend to outside of the subject. The devices and methods may also include a pericardioscopic portal for emplacement of the atrial portal. Also, methods for using such atrial portals and pericardial portals to perform surgery on the heart, and in some cases to directly access the left atrium, and systems (e.g., kits) comprising these portals in combination with other therapeutic devices are disclosed.

Claims

1. A device for accessing an atrium of a heart in a subject so as to perform a surgical procedure upon the atrium, the device comprising an atrial portal having a configuration such that the distal end of the atrial portal can provide cardioscopic access the atrium while the proximal end of the atrial portal can extend to outside of the subject.

2. The device of claim 1, wherein the cardioscopic access is via an incision in the diaphragm and via the pericardial space.

3. The device of claim 1, wherein the atrium is the left atrium.

4. The device of claim 1, further comprising a pericardial portal into which the atrial portal is inserted, the pericardial portal having a configuration such that the distal end of the atrial portal can access the atrium while the proximal end of the atrial portal can extend to outside of the subject.

5. The device of claim 1, further comprising an imaging device to provide an image of body structures present near the distal end of the atrial portal.

6. The device of claim 1, further comprising a tool configured for emplacing sutures in the atrial wall to secure the atrial portal in the atrium wall.

7. The device of claim 6, wherein the sutures are of a configuration so as to surround the atrial portal upon insertion of the atrial portal in the atrium such that tightening the sutures around the atrial portal secures the atrial portal in the atrium.

8. The device of claim 6, further comprising a tourniquet configured to tighten the sutures around the atrial portal.

9. The device of claim 1, wherein the atrial portal further comprises a needle within the lumen of the atrial portal, wherein the needle is configured to puncture the atrium so as to provide an opening for insertion of the portal into the atrium.

10. The device of claim 1, wherein the atrial portal further comprises a guide wire, wherein the guide wire is configured to provide a path for insertion of the atrial portal into the atrium by threading the atrial portal over the guide wire and into the atrium.

11. The device of claim 1, wherein the distal end of the atrial portal comprises a dilating introducer, wherein the dilating introducer is configured so as to be inserted in an opening in the atrial wall so as to enlarge the opening of the atrial wall for insertion of the atrial portal into the atrium.

12. The device of claim 1, wherein the distal end of the atrial portal comprises a cap configured to secure the distal end of the atrial portal in the atrial wall.

13. The device of claim 12, wherein at least a portion of the cap can be expanded laterally away from the central longitudinal axis of the atrial portal.

14. The device of claim 1, further comprising at least one tool for performing procedures on the atrium or a region of the heart accessible via the atrium.

15. The device of claim 14, wherein the tool is configured to be threaded over a guide wire that extends from the proximal end of the atrial portal to the distal end of the atrial portal.

16. The device of claim 14, wherein the tool comprises at least one of an ablation element, an electrode, a stent, a valve, an expandable member, a debris capture device, or a barbed needle.

17. A method to access the atrium of a heart in a subject so as to perform surgical procedures upon the atrium, the method comprising:

(a) inserting the distal end of an atrial portal into the pericardium of the subject;

(b) manipulating the proximal end of the atrial portal to position the distal end of the atrial portal at the surface of the atrium;

(c) determining an entry location for the atrial portal to be inserted into the atrium;

(d) inserting the atrial portal into the atrium; and

(e) securing the position of the atrial portal in the atrium.

18. The method of claim 17, further comprising inserting the atrial portal into a pericardial portal and positioning the distal end of the pericardial portal at the surface of the atrium.

19. The method of claim 17, wherein the atrium is the left atrium.

20. The method of claim 17, further comprising using an imaging device positioned at the distal end of the atrial portal to provides an image of body structures present near the distal end of the atrial portal.

21. The method of claim 17, further comprising providing sutures in the surface of the atrium that surround the entry location for the atrial portal and tightening the sutures around the atrial portal upon insertion of the atrial portal in the atrium to secure the atrial portal in the atrium.

22. The method of claim 17, wherein the step of inserting the atrial portal into the atrium comprises using a needle contained within the atrial portal to puncture the atrium wall.

23. The method of claim 17, wherein the step of inserting the atrial portal into the atrium comprises inserting a guide wire through the needle, and withdrawing the needle such that the guide wire is inserted into the atrium at the entry location for the atrial portal, and then threading the atrial portal over the guide wire and into the atrium.

24. The method of claim 17, wherein the step of inserting the atrial portal into the atrium comprises inserting a dilating introducer positioned at the distal end of the atrial portal into the entry location and advancing the introducer distally into the atrium wall to enlarge the opening at the entry location.

25. The method of claim 17, further comprising using a flexible cap positioned on the distal end of the atrial portal to secure the distal end of the atrial portal in the atrial wall.

26. The method of claim 17, wherein at least a portion of the cap can be expanded laterally away from the central longitudinal axis of the atrial portal.

27. The method of claim 17, further comprising inserting a tool in the atrium using the atrial portal.

28. The method of claim 27, wherein the tool comprises at least one of an ablation element, an electrode, a stent, a valve, an expandable, a debris capture device or a barbed needle.

29. The method of claim 27, wherein the cardioscopic access is via an incision in the diaphragm and via the pericardial space

30. A system for accessing an atrium of a heart in a subject so as to perform a surgical procedure upon the atrium, the system comprising an atrial portal having a configuration such that the distal end of the atrial portal can provide cardioscopic access the atrium while the proximal end of the atrial portal can extend to outside of the subject.

31. The system of claim 30, further comprising a pericardial portal into which the atrial portal is inserted, the pericardial portal having a configuration such that the distal end of the atrial portal can access the atrium while the proximal end of the atrial portal can extend to outside of the subject.

32. The system of claim 30, further comprising at least one tool for performing procedures on the atrium or a region of the heart accessible via the atrium.

33. The system of claim 32, wherein the tool comprises at least one of an ablation element, an electrode, a stent, a valve, an expandable member, a debris capture device, or a barbed needle.