ATRIAL APPENDAGE LIGATION

• US 20160249932A1
• Filed: 10/27/2014
• Published: 09/01/2016
• Est. Priority Date: 10/26/2013
• Status: Active Grant

• Current Assignee: United States Department Of Health And Human Services
• Original Assignee: United States Department Of Health And Human Services
• Inventors: Ratnayaka, Kaniska, Rogers, Toby, Kocaturk, Ozgur, Lederman, Robert J.
• Granted Patent: US 10,575,851 B2
• Time in Patent Office: Days
• US Class Current: 1/1
• CPC Class Codes: A61B 17/0469 Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 17/12013 for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 2017/00243 cardiac
• CPC Class Codes: A61B 2017/00867 shape memory effect for prostheses A61F2210/0014
• CPC Class Codes: A61B 2017/308 with suction cups

Abstract

This disclosure relates to devices and methods for manipulating, such as with a suction based traction device, a target anatomic structure inside the body and delivering an ligation device around the anatomic structure. In particular examples, the target structure can be an atrial appendage, and the devices and methods are for atrial appendage ligation.

Claims

1. A device for ligating the left atrial appendage, comprising:

a delivery catheter configured to be directed into the pericardial space adjacent the left atrial appendage;

a traction device extending through the delivery catheter that non-traumatically grasps an outer surface the left atrial appendage using suction and applies traction to the left atrial appendage, the traction device comprising two or more independent suckers that attach to surfaces of the left atrial appendage using suction; and

a delivery device that delivers a ligation device to the left atrial appendage while the traction is applied by the traction device.

2. The device of claim 1, wherein the delivery catheter is adapted to be delivered through the right atrial appendage into the pericardial space to adjacent the left atrial appendage.

3. The device of claim 1, wherein the traction device includes a resiliently deformable pad positioned around each of the suckers, the pads providing increased surface area for non-traumatically contacting surfaces of the left atrial appendage.

4. The device of claim 1, wherein each sucker is independently coupled to a vacuum source via discrete vacuum tubes that extend through the delivery catheter.

5. The device of claim 1, wherein each sucker is positioned at a distal end of an independent vacuum conduit extending through the delivery catheter, and the vacuum conduits comprise a shape memory material that resiliently regains a predetermined shape when released from a distal end of the delivery catheter.

6. The device of claim 1, wherein the traction device includes two articulating wings, each including at least one of the suckers.

7. The device of claim 6, wherein the traction device include at least one sucker at a junction between the two articulating wings.

8. The device of claim 6, wherein an articulation angle between the two wings is adjustable by relative axial motion between the delivery catheter and the two wings.

9. The device of claim 6, wherein the articulation angle between the two wings is adjustable by relative motion between the delivery catheter and a rod or vacuum tube positioned within the delivery catheter and coupled to a junction between the two wings.

10. The device of claim 6, wherein each of the two wings comprises a broad, deformable surface positioned around the suckers located in the wings, the deformable surfaces providing increased surface area for non-traumatically contacting surfaces of the left atrial appendage.

12. The device of claim 1, wherein the delivery device comprises a pre-shaped, articulated interrupted shape-memory loop that carries a suture.

14. The device of claim 1, wherein the delivery device comprises a hollow loop with the suture inside, or a solid loop inside a hollow suture, and the delivery device comprises separable segments that are withdrawn to leave only the suture in place around the left atrial appendage.

11. (canceled)

13. (canceled)

15. A method of left atrial appendage ligation comprising:

advancing a delivery catheter into a pericardial space;

advancing a traction device from a distal end of the delivery catheter into the pericardial space such that a distal portion of the traction device including two or more suckers resiliently enlarges to an operative configuration;

securing the suckers to a left atrial appendage using suction applied from a proximal control end of the delivery catheter via respective tubes, and then manipulating the left atrial appendage via the traction device to facilitate placement of a ligation device on the left atrial appendage, or a neck or base thereof; and

advancing a delivery device for the ligation device from the distal end of the delivery catheter and positioning the ligation device on the left atrial appendage, or a neck or base thereof.

16. The method of claim 15, further comprising;

detaching the traction device from the left atrial appendage and withdrawing the traction device proximally into the delivery catheter, and withdrawing the delivery device proximally into the delivery catheter while leaving the ligation device on the left atrial appendage, or neck or base thereof.

17. The method of claim 15, wherein the method comprises adjusting a distance between two of the suckers based on an anatomical size of the left atrial appendage prior to securing the suckers to the left atrial appendage

18. The method of claim 15, wherein the suckers are secured to the left atrial appendage in a series.

19. The method of claim 15, wherein the traction device includes two flexible wings and the method includes adjusting the spacing between the wings by pulling or pushing a tube or rod attached to a junction between the two wings.

20. The method of claim 15, wherein the method comprises advancing the delivery catheter into the pericardial space from within the right atrial appendage.

21. The method of claim 15, wherein the method comprises advancing the delivery catheter into the pericardial space through the pericardium.

22. The method of claim 15, wherein the method comprises delivering the delivery catheter into the pericardial space from a subxiphoid transpericardial approach.