Devices and methods for intracardiac procedures
First Claim
1. A method of closed-chest replacement of a heart valve in a valve position in a patient'"'"'s heart, the method comprising:
- establishing cardiopulmonary bypass by withdrawing blood from a major vein in the patient, oxygenating the blood, and returning the blood after oxygenation to a major artery in the patient;
arresting the patient'"'"'s heart;
forming a plurality of percutaneous intercostal penetrations in the patient'"'"'s chest, each of the percutaneous intercostal penetrations being within an intercostal space between two adjacent ribs;
viewing the patient'"'"'s heart through a scope extending through a first of said percutaneous intercostal penetrations in the patient'"'"'s chest;
forming an internal penetration through a wall of the patient'"'"'s heart using a cutting tool introduced through one of said percutaneous intercostal penetrations in the patient'"'"'s chest;
locating a valve position in the heart;
positioning a replacement valve through one of said plurality of percutaneous intercostal penetrations in the patient'"'"'s chest;
using an elongated instrument positioned in one of said percutaneous intercostal penetrations to position the replacement valve through the internal penetration into a chamber of the heart, the elongated instrument having a length sufficient to reach the valve position from outside of the patient'"'"'s chest; and
securing the replacement valve in the valve position in the heart;
wherein all surgical manipulations are performed from outside of the patient'"'"'s chest.
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0 Petitions
Accused Products
Abstract
The invention provides devices and methods for performing less-invasive surgical procedures within an organ or vessel. In an exemplary embodiment, the invention provides a method of closed-chest surgical intervention within an internal cavity of a patient'"'"'s heart or great vessel. According to the method, the patient'"'"'s heart is arrested and cardiopulmonary bypass is established. A scope extending through a percutaneous intercostal penetration in the patient'"'"'s chest is used to view an internal portion of the patient'"'"'s chest. An internal penetration is formed in a wall of the heart or great vessel using cutting means introduced through a percutaneous penetration in an intercostal space in the patient'"'"'s chest. An interventional tool is then introduced, usually through a cannula positioned in a percutaneous intercostal penetration. The interventional tool is inserted through the internal penetration in the heart or great vessel to perform a surgical procedure within the internal cavity under visualization by means of the scope. In a preferred embodiment, a cutting tool is introduced into the patient'"'"'s left atrium from a right portion of the patient'"'"'s chest to remove the patient'"'"'s mitral valve. A replacement valve is then introduced through an intercostal space in the right portion of the chest and through the internal penetration in the heart, and the replacement valve is attached in the mitral valve position.
1083 Citations
51 Claims
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1. A method of closed-chest replacement of a heart valve in a valve position in a patient'"'"'s heart, the method comprising:
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establishing cardiopulmonary bypass by withdrawing blood from a major vein in the patient, oxygenating the blood, and returning the blood after oxygenation to a major artery in the patient; arresting the patient'"'"'s heart; forming a plurality of percutaneous intercostal penetrations in the patient'"'"'s chest, each of the percutaneous intercostal penetrations being within an intercostal space between two adjacent ribs; viewing the patient'"'"'s heart through a scope extending through a first of said percutaneous intercostal penetrations in the patient'"'"'s chest; forming an internal penetration through a wall of the patient'"'"'s heart using a cutting tool introduced through one of said percutaneous intercostal penetrations in the patient'"'"'s chest; locating a valve position in the heart; positioning a replacement valve through one of said plurality of percutaneous intercostal penetrations in the patient'"'"'s chest; using an elongated instrument positioned in one of said percutaneous intercostal penetrations to position the replacement valve through the internal penetration into a chamber of the heart, the elongated instrument having a length sufficient to reach the valve position from outside of the patient'"'"'s chest; and securing the replacement valve in the valve position in the heart; wherein all surgical manipulations are performed from outside of the patient'"'"'s chest. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21)
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22. A method of closed-chest replacement of a heart valve in a valve position in a patient'"'"'s heart, the method comprising:
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establishing cardiopulmonary bypass by withdrawing blood from a major vein in the patient, oxygenating the blood, and returning the blood after oxygenation to a major artery in the patient; arresting the patient'"'"'s heart; forming a plurality of percutaneous penetrations in the patient'"'"'s chest, each of the percutaneous penetrations being within an intercostal space between two adjacent ribs; placing a cannula in one of said percutaneous penetrations, the cannula having a proximal end disposed outside of the patient'"'"'s chest, a distal end disposed within the chest, and a lumen therebetween; viewing the patient'"'"'s heart through a scope extending through one of said percutaneous penetrations; forming an internal penetration in a structure selected from the heart or a great vessel connected to the heart using a cutting tool introduced through one of said percutaneous penetrations; locating a valve position in the heart; positioning a replacement valve through the lumen in said cannula and through the internal penetration into the valve position in the heart; and securing the replacement valve in the valve position in the heart. - View Dependent Claims (23, 24, 25, 26, 27, 28, 29)
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30. A method of closed-chest replacement of a heart valve in a valve position in a patient'"'"'s heart, the method comprising:
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establishing cardiopulmonary bypass by withdrawing blood from a major vein in the patient, oxygenating the blood, and returning the blood after oxygenation to a major artery in the patient; arresting the patient'"'"'s heart; forming a plurality of percutaneous penetrations in the patient'"'"'s chest, each of the percutaneous intercostal penetrations being within an intercostal space between two adjacent ribs; viewing the patient'"'"'s heart through one of said percutaneous penetrations; locating a valve position in the heart; forming an internal penetration in a structure selected from the heart or a great vessel connected to the heart using a cutting tool introduced through one of said percutaneous penetrations; positioning a replacement valve through one of said percutaneous penetrations; using a first elongated instrument to position the replacement valve through the internal penetration into the valve position in the heart; and securing the replacement valve in the valve position in the heart using a second elongated instrument positioned through one of the percutaneous penetrations; wherein the first and second elongated instruments are manipulated only from outside of the patient'"'"'s chest. - View Dependent Claims (31, 32, 33, 34, 35, 36)
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37. A method of closed-chest replacement of a heart valve in a valve position in a patient'"'"'s heart, the heart being disposed within a chest cavity defined by a plurality of ribs, each rib being separated from an adjacent rib by an intercostal space having an intercostal width when the ribs are intact and substantially unretracted, the method comprising the steps of:
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establishing cardiopulmonary bypass by withdrawing blood from a major vein in the patient, oxygenating the blood, and returning the blood after oxygenation to a major artery in the patient; arresting the patient'"'"'s heart; forming a plurality of percutaneous intercostal penetrations within intercostal spaces in the patient'"'"'s chest, each of the percutaneous intercostal penetrations having a width smaller than the intercostal width; viewing the patient'"'"'s heart through a first of the percutaneous intercostal penetrations; locating a valve position in the heart; forming an internal penetration through a wall of the patient'"'"'s heart using a cutting tool introduced through one of the percutaneous intercostal penetrations while viewing the heart through the first percutaneous intercostal penetration; positioning a replacement valve through one of the percutaneous intercostal penetrations; positioning the replacement valve through the internal penetration into a chamber of the heart; and securing the replacement valve in the valve position in the heart while viewing the interior of the heart through the first percutaneous intercostal penetration; wherein during each of said steps, the plurality of ribs is maintained intact and substantially unretracted.
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38. A method of closed-chest replacement of a heart valve in a valve position in a patient'"'"'s heart, the heart being disposed within a chest cavity defined by a plurality of ribs, each rib being separated from an adjacent rib by an intercostal space, the method comprising the steps of:
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establishing cardiopulmonary bypass by withdrawing blood from a major vein in the patient, oxygenating the blood, and returning the blood after oxygenation to a major artery in the patient; arresting the patient'"'"'s heart by means of an aortic catheter having a distal end positioned in an ascending region of an aorta leading from the heart to a peripheral artery, and a proximal extremity extending through the aorta to the peripheral artery and out of the patient through a puncture therein; forming a plurality of percutaneous intercostal penetrations within intercostal spaces in the patient'"'"'s chest; viewing the patient'"'"'s heart through a first of the percutaneous intercostal penetrations; locating a valve position in the heart; forming an internal penetration through a wall of the patient'"'"'s heart using a cutting tool introduced through one of the percutaneous intercostal penetrations while viewing the heart through the first percutaneous intercostal penetration; positioning a replacement valve through one of the percutaneous intercostal penetrations; positioning the replacement valve through the internal penetration into a chamber of the heart; and securing the replacement valve in the valve position in the heart while viewing the interior of the heart through the first percutaneous intercostal penetration. - View Dependent Claims (39, 40, 41, 42, 43, 44, 45)
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46. A method of closed-chest replacement of a heart valve in a valve position in a patient'"'"'s heart, the heart being disposed within a chest cavity defined by a plurality of ribs, each rib being separated from an adjacent rib by an intercostal space, the method comprising the steps of:
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establishing cardiopulmonary bypass by withdrawing blood from a major vein in the patient, oxygenating the blood, and returning the blood after oxygenation to a major artery in the patient; arresting the patient'"'"'s heart; forming a plurality of percutaneous intercostal penetrations within the intercostal spaces in the patient'"'"'s chest; viewing the patient'"'"'s heart through a first of the percutaneous intercostal penetrations; locating a valve position in the heart; forming an internal penetration through a wall of the patient'"'"'s heart using a cutting tool introduced through one of the percutaneous intercostal penetrations while viewing the heart through the first percutaneous intercostal penetration; positioning a mechanical valve prosthesis through one of the percutaneous intercostal penetrations, the mechanical valve prosthesis having a rigid annular frame and a movable leaflet coupled to the annular frame; using a first elongated instrument to position the mechanical valve prosthesis through the internal penetration into a chamber of the heart; and securing the annular frame of the mechanical valve prosthesis to a valve annulus in the valve position in the heart using a second elongated instrument positioned through one of the percutaneous intercostal penetrations while viewing the interior of the heart through one of the percutaneous intercostal penetrations. - View Dependent Claims (47)
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48. A method of closed-chest replacement of a heart valve in a valve position in a patient'"'"'s heart, the heart being disposed within a chest cavity defined by a plurality of ribs, each rib being separated from an adjacent rib by an intercostal space having an intercostal width when the ribs are intact and substantially unretracted, the method comprising the steps of:
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establishing cardiopulmonary bypass by withdrawing blood from a major vein in the patient, oxygenating the blood, and returning the blood after oxygenation to a major artery in the patient; arresting the patient'"'"'s heart; forming a plurality of percutaneous intercostal penetrations within intercostal spaces in the patient'"'"'s chest, each of the percutaneous intercostal penetrations having a width smaller than the intercostal width; viewing the patient'"'"'s heart through a first of the percutaneous intercostal penetrations; locating a valve position in the heart; forming an internal penetration through a wall of the patient'"'"'s heart using a cutting tool introduced through one of the percutaneous intercostal penetrations while viewing the heart through the first percutaneous intercostal penetration; positioning a replacement valve through one of the percutaneous intercostal penetrations with the replacement valve in a first orientation; reorienting the replacement valve into a second orientation within the patient'"'"'s chest; positioning the replacement valve through the internal penetration into a chamber of the heart; and securing the replacement valve in the valve position in the heart while viewing the interior of the heart through the first percutaneous intercostal penetration. - View Dependent Claims (49, 50, 51)
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Specification