Retrograde delivery catheter and method for inducing cardioplegic arrest
First Claim
1. A retrograde delivery catheter adapted to be introduced into a peripheral vein and advanced into a coronary sinus of a patient'"'"'s heart for retrograde delivery of a fluid into a coronary vasculature, the retrograde delivery catheter comprising:
- a flexible, elongated shaft having a proximal end and a distal end, the shaft having sufficient length and flexibility so that the proximal end may extend intraluminally through a patient'"'"'s peripheral vein when the distal end is positioned in the coronary sinus;
an expandable member near the distal end configured to occlude the patient'"'"'s coronary sinus; and
a delivery lumen having an inlet port at the proximal end and an outlet port distal to the expandable member, the delivery lumen being configured to deliver a fluid having a viscosity of at least about 3.0 centipoise at a flow rate of at least 200 ml/min. and at a pump pressure of less than 300 mm Hg;
the distal end of the shaft having a shape configured to position the expandable member in the patient'"'"'s coronary sinus when the proximal end of the shaft extends through the patient'"'"'s peripheral vein.
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Accused Products
Abstract
A retrograde delivery catheter includes at its distal end a balloon configured to occlude the coronary sinus of a patient'"'"'s heart, and has a length and flexibility which allow the distal end to be positioned in the coronary sinus with the proximal end extending transluminally to a peripheral vein such as an internal jugular vein and out of the body through a puncture therein. The delivery catheter has a delivery lumen extending between its proximal and distal ends which is configured to allow a cardioplegic fluid to be delivered at a flow rate of at least 200 ml/min with a pump pressure less than 300 mm Hg, thereby allowing cardioplegic arrest to be maintained using a blood cardioplegic fluid without causing excessive hemolysis. In a method of inducing cardioplegic arrest according to the invention, the patient is placed on cardiopulmonary bypass, the coronary arteries are isolated from remainder of the arterial system, and the delivery catheter is positioned transluminally in the coronary sinus from a peripheral vein. A cardioplegic fluid is then delivered to the coronary sinus through the delivery catheter at a flow rate of at least 200 ml/min and a pump pressure less than 300 mm Hg. The heart may be vented by withdrawing blood from the pulmonary artery through a catheter introduced through a peripheral vein, or withdrawing blood from the aortic root through an aortic catheter introduced through a peripheral artery.
433 Citations
29 Claims
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1. A retrograde delivery catheter adapted to be introduced into a peripheral vein and advanced into a coronary sinus of a patient'"'"'s heart for retrograde delivery of a fluid into a coronary vasculature, the retrograde delivery catheter comprising:
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a flexible, elongated shaft having a proximal end and a distal end, the shaft having sufficient length and flexibility so that the proximal end may extend intraluminally through a patient'"'"'s peripheral vein when the distal end is positioned in the coronary sinus; an expandable member near the distal end configured to occlude the patient'"'"'s coronary sinus; and a delivery lumen having an inlet port at the proximal end and an outlet port distal to the expandable member, the delivery lumen being configured to deliver a fluid having a viscosity of at least about 3.0 centipoise at a flow rate of at least 200 ml/min. and at a pump pressure of less than 300 mm Hg; the distal end of the shaft having a shape configured to position the expandable member in the patient'"'"'s coronary sinus when the proximal end of the shaft extends through the patient'"'"'s peripheral vein. - View Dependent Claims (2, 4, 12, 13)
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3. A retrograde delivery catheter adapted to be introduced into a peripheral vein and advanced into a coronary sinus of a patient'"'"'s heart for retrograde delivery of a fluid into a coronary vasculature, the retrograde delivery catheter comprising:
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a flexible, elongated shaft having a proximal end and a distal end, the shaft having sufficient length and flexibility so that the proximal end may extend intraluminally through a patient'"'"'s peripheral vein when the distal end is positioned in the coronary sinus; an expandable member positioned near the distal end and configured to occlude the patient'"'"'s coronary sinus; and a delivery lumen having an inlet port at the proximal end to and an outlet port distal to the expandable member; wherein a distal portion of the shaft has an outer diameter of less than about 4.6 mm, the distal portion having a length of at least 50 cm proximal to the distal end.
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5. A retrograde delivery catheter adapted to be introduced into a peripheral vein and advanced into a coronary sinus of a patient'"'"'s heart for retrograde delivery of a fluid into a coronary vasculature, the retrograde delivery catheter comprising:
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a flexible, elongated shaft having a proximal end and a distal end, the shaft having sufficient length and flexibility so that the proximal end may extend intraluminally to the peripheral vein when the distal end is positioned in the coronary sinus; an expandable member near the distal end configured to occlude the coronary sinus; and a delivery lumen having an inlet port at the proximal end and an outlet port distal to the expandable member, the delivery lumen being configured to deliver a fluid having a viscosity of at least about 3.0 centipoise at a flow rate of at least 200 ml/min. and at a pump pressure of less than 300 mm. the shaft having at least a first bend near the distal end of the shaft to facilitate positioning the distal end in the coronary sinus, the first bend being in a range of about 20°
to 70°
from a longitudinal axis of a proximal portion of the retrograde delivery catheter proximal to the first bend. - View Dependent Claims (10, 11)
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6. A retrograde delivery catheter adapted to be introduced into a peripheral vein and advanced into a coronary sinus of a patient'"'"'s heart for retrograde delivery of a fluid into a coronary vasculature, the retrograde delivery catheter comprising;
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a flexible, elongated shaft having a proximal end and a distal end, the shaft having sufficient length and flexibility so that the proximal end may extend intraluminally through a patient'"'"'s peripheral vein when the distal end is positioned in the coronary sinus; an expandable member near the distal end configured to occlude the coronary sinus; and a delivery lumen having an inlet port at the proximal end and an outlet port distal to the expandable member; the shaft having at least a first bend near the distal end of the shaft to facilitate positioning the distal end in the coronary sinus, the first bend being between 20 mm and 40 mm from the distal end.
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- 7. A retrograde delivery catheter adapted to be introduced into a peripheral vein and advanced into a coronary sinus of a patient'"'"'s heart for retrograde delivery of a fluid into a coronary vasculature, the retrograde delivery catheter comprising a flexible, elongated shaft having a proximal end and a distal end, the shaft having sufficient length and flexibility so that the proximal end may extend intraluminally to the peripheral vein when the distal end is positioned in the coronary sinus, an expandable member near the distal end configured to occlude the coronary sinus, and a delivery lumen having an inlet port at the proximal end and an outlet port distal to the expandable member, the shaft having at least a first bend near the distal end of the shaft to facilitate positioning the distal end in the coronary sinus, the first bend being between 20 mm and 40 mm from the distal end, the shaft having a second bend distal to the first bend.
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14. A retrograde delivery catheter adapted to be introduced into a peripheral vein and advanced into a coronary sinus of a patient'"'"'s heart for retrograde delivery of a fluid into a coronary vasculature, the retrograde delivery catheter comprising a flexible, elongated shaft having a proximal end and a distal end, the shaft having sufficient length and flexibility so that the proximal end may extend intraluminally to the peripheral vein when the distal end is positioned in the coronary sinus, an expandable member near the distal end configured to occlude the coronary sinus, a delivery lumen having an inlet port at the proximal end and an outlet port distal to the expandable member, the delivery lumen being configured to deliver a fluid having a viscosity of at least about 3.0 centipoise at a flow rate of at least 200 ml/min. and at a pump pressure of less than 300 mm, an inflation lumen extending through the shaft, the expandable member including an inflatable balloon having an interior in communication with the inflation lumen, the balloon being configured to be inflatable to a size larger than the coronary sinus, the retrograde delivery catheter further including pressure limiting means to maintain inflation pressure of the balloon below a predetermined value selected to avoid injury to coronary sinus tissue.
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15. A system for inducing cardioplegic arrest of a patient'"'"'s heart, the heart having an aorta leading away from the heart to a peripheral artery, coronary arteries in communication with the aorta, and a brachiocephalic artery in communication with the aorta downstream of the coronary arteries, the system comprising:
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a retrograde delivery catheter having a distal end, a proximal end, a delivery lumen having an inlet port at the proximal end and an outlet port at the distal end, and an expandable member near the distal end configured to occlude the coronary sinus of a patient when expanded, the retrograde delivery catheter having sufficient length and flexibility so that the distal end may be positioned in the patient'"'"'s coronary sinus with the proximal end extending intraluminally to a peripheral vein, and the delivery lumen being configured to deliver a fluid having a viscosity of at least about 3.0 centipoise at a flow rate of at least 200 ml/min. and at a pump pressure of less than 300 mm Hg; a venous cannula configured for introduction into a peripheral vein of the patient for withdrawing blood therefrom; means for oxygenating the blood withdrawn from the peripheral vein, the oxygenating means being fluidly coupled to the venous cannula; an arterial cannula configured for introduction into a peripheral artery for returning the blood from the oxygenating means to the peripheral artery, the arterial cannula being fluidly coupled to the oxygenating means, the peripheral artery being in communication with the aorta; venting means for withdrawing fluid from the heart of the patient; and occlusion means for preventing blood flow from the arterial cannula into the coronary arteries of the patient while allowing blood flow from the arterial cannula into the brachiocephalic artery of the patient. - View Dependent Claims (16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28)
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29. A retrograde delivery catheter adapted to be introduced into a peripheral vein and advanced into a coronary sinus of a patient'"'"'s heart for retrograde delivery of a fluid into a coronary vasculature, the retrograde delivery catheter comprising:
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a flexible, elongated shaft having a proximal end and a distal end, the shaft having sufficient length and flexibility so that the proximal end may extend intraluminally through a patient'"'"'s peripheral vein when the distal end is positioned in the coronary sinus; an expandable member positioned near the distal end and configured to occlude the patient'"'"'s coronary sinus; a delivery lumen having an inlet port at the proximal end to and an outlet port distal to the expandable member; and a pressure limiting device coupled to the delivery lumen, the pressure limiting device limiting an inflation pressure of the balloon below a predetermined value selected to avoid injury to the coronary sinus.
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Specification