Apparatus for reducing the circumference of a vascular structure

• US 5,709,695 A
• Filed: 08/29/1996
• Issued: 01/20/1998
• Est. Priority Date: 08/10/1994
• Status: Expired due to Term

• Current Assignee: Peters Surgical
• Original Assignee: Segmed, Inc.
• Inventors: Northrup, William F. III
• Primary Examiner(s): SCHMIDT, JEFFREY
• Application Number:
  US08/705,179
• Time in Patent Office: 509 Days
• Field of Search: 606/232, 606/233, 606/148, 606/1, 623/2, 128/898
• US Class Current: 606/148
• 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 2017/00243 cardiac
• CPC Class Codes: A61B 2017/00783 Valvuloplasty
• CPC Class Codes: A61B 2017/0406 Pledgets
• CPC Class Codes: A61F 2/2445 Annuloplasty rings in direct contact with the valve annulus

Abstract

An apparatus and method for reducing the circumference of a vascular structure comprising the steps of providing a plurality of sutures and a plurality of discrete suture support segments of a biocompatible, inert material, each suture support segment having at least two suture holes spaced a predetermined distance (D) apart; individually suturing each discrete suture support segment to the vascular structure with one of the plurality of sutures by effecting a horizontal mattress (U-shaped) suture along the vascular structure through a length of tissue of the vascular structure such that the length (D'"'"') of tissue sutured is greater than distance (D); and tightening and tying off the suture, whereby each sutured suture support segment creates an imbrication in the vascular structure, thereby reducing the circumference thereof. A biocompatible, inert stabilizing material may optionally be affixed over the suture support segments and the vascular structure after prior to tying off the suture to stabilize the interval between the suture support segments and eliminate direct exposure of the segmented apparatus to blood.

Claims

1. An anatomical structure circumference reduction apparatus for precisely reducing the circumference of an anatomical structure, the apparatus comprising:

a plurality of substantially rigid discrete support segments for disposition at least partially circumferentially about the anatomical structure to form a line of discrete support segments;

each segment consisting of opposite sides, a proximal end, a distal end, and structure defining only two suture apertures, the two suture apertures being constructed to receive and support suture material for attaching each segment with respect to the anatomical structure at a precise location, the suture apertures extending from a top surface of each segment to a bottom surface of each segment, the top surface and the bottom surface of each segment each being substantially planar, the line of segments being disposed and the suture apertures being spaced such that suture material passing through the suture apertures reduces the circumference of the anatomical structure by a precise amount along the line of segments.

2. The anatomical structure circumference reduction apparatus of claim 1, wherein the line of segments substantially prevents circumferential lengthening of the anatomical structure along the line of segments.

3. The anatomical structure circumference reduction apparatus of claim 1, wherein the line of segments is disposed for creating anatomical structure plication regions alternating with anatomical structure non-plication regions.

4. The anatomical structure circumference reduction apparatus of claim 1, further comprising stabilizing material for covering the line of segments to stabilize the line of segments and to substantially prevent contact of the line of segments with blood.

5. The anatomical structure circumference reduction apparatus of claim 1, wherein at least one segment includes a surface for supporting a layer of tissue to cover and stabilize the line of segments.

6. The anatomical structure circumference reduction apparatus of claim 1, wherein the line of segments is substantially curved.

7. The anatomical structure circumference reduction apparatus of claim 6, wherein the line of segments forms a partial ring shape.

8. The anatomical structure circumference reduction apparatus of claim 6, wherein the line of segments forms a substantially complete ring shape.

9. The anatomical structure circumference reduction apparatus of claim 1, wherein the line of segments is constructed such that sutures passing through the segments into a vascular structure plicate the vascular structure.

10. The anatomical structure circumference reduction apparatus of claim 9, wherein the line of segments is constructed to plicate the circumference of a valve annulus.

11. The apparatus of claim 1, wherein the top and bottom surfaces of each of the segments are free for direct exposure to material for covering the line of segments.

12. A vascular structure circumference reduction apparatus for precisely reducing the circumference of a vascular structure, the apparatus comprising:

circumference reduction means for creating a series of plication regions in the vascular structure, the circumference reduction means comprising a plurality of substantially rigid discrete support segments for disposition at least partially circumferentially about the vascular structure to form a line of discrete support segments, each plication region in the series of plication regions being disposed beneath each segment, and to reduce the circumference of the vascular structure along the circumference reduction means by a precise amount;

each segment of the circumference reduction means consisting of structure including opposite sides, a proximal end, a distal end, and only two aperture means for receiving and supporting suture means for attaching each segment to the vascular structure at a precise location, the structure having substantially flat opposite surfaces through which the aperture means passes; and

the circumference reduction means providing flexibility to follow the vascular structure while substantially preventing circumferential lengthening of the vascular structure.

13. The vascular structure circumference reduction apparatus of claim 12, further comprising stabilizing means for covering the line of segments for stabilizing the line of segments and substantially preventing contact of the line of segments with blood.

14. The vascular structure circumference reduction apparatus of claim 12, wherein the line of segments is substantially curved.

15. The vascular structure circumference reduction apparatus of claim 14, wherein the line of segments forms a ring shape.

16. The vascular structure circumference reduction apparatus of claim 12, wherein the line of segments is discontinuous to create anatomical structure plication regions alternating with anatomical structure non-plication regions.

17. An apparatus for reducing the circumference of a vascular structure, the apparatus comprising in combination a plurality of discrete suture support segments disposed in a line and a plurality of horizontal mattress (U-shaped) sutures, each suture support segment being made of a non-deformable, biocompatible, inert material and comprising a substantially flat upper surface, a substantially flat lower surface, opposite sides, a proximal end, a distal end and only two suture holes extending from the upper surface to the lower surface thereof, the suture holes being spaced a predetermined distance apart, each suture support segment being substantially rigid and substantially non-deformable in a longitudinal dimension defined by said opposite sides, and being constructed and arranged to be individually sutured with one of the plurality of sutures to a length of tissue of the vascular structure whose circumference is to be reduced along the line of segments, the suture holes being spaced such that the length of tissue sutured is greater than the predetermined distance between the holes and such that each sutured suture support segment creates an imbrication in the vascular structure when each suture is tightened and tied off, reducing the circumference of the vascular structure along the line of segments.

18. The apparatus of claim 17, wherein the suture holes of each suture support segment are substantially smooth and of a diameter which accommodates a 2-0 suture and a swedged-on suture needle.

19. The apparatus of claim 17, wherein the distance between centers of the suture holes is about 5±

about 3 mm, further wherein each suture support segment has a width of about 2-4 mm.

20. The apparatus of claim 17, wherein each suture support segment has a thickness of about 1 mm.

21. An anatomical structure circumference reduction apparatus kit for use in precisely reducing the circumference of an anatomical structure, the kit comprising:

a plurality of substantially rigid discrete support segments for disposition at least partially circumferentially about the anatomical structure to form a line of discrete support segments;

each segment including a plurality of suture apertures constructed to receive and support suture material for attaching each segment in fixed relationship with respect to the anatomical structure at a precise location, the suture apertures being spaced such that suture material passing through the suture apertures creates a plication region in the anatomical structure beneath each segment, the line of segments being disposed to create a series of plication regions in the anatomical structure to reduce the circumference of the anatomical structure by a precise amount along the line of segments.

22. An anatomical structure circumference reduction apparatus for precisely reducing the circumference of an anatomical structure, the apparatus comprising:

a plurality of substantially rigid discrete support segments for disposition at least partially circumferentially about the anatomical structure to form a line of discrete support segments;

each segment including a plurality of suture apertures constructed to receive and support suture material for attaching each segment with respect to the anatomical structure at a precise location, the apertures of each segment and the line of segments being constructed and arranged to create a plication region in the anatomical structure beneath each segment and to create a series of plication regions in the anatomical structure to reduce the circumference of the anatomical structure by a precise amount along the line of segments; and

stabilizing material for covering the line of segments to stabilize the line of segments and to substantially prevent contact of the line of segments with blood.

23. A vascular structure circumference reduction apparatus for precisely reducing the circumference of a vascular structure, the apparatus comprising:

circumference reduction means for creating a series of plication regions in the vascular structure, the circumference reduction means comprising a plurality of substantially rigid discrete support segments for disposition at least partially circumferentially about the vascular structure to form a line of discrete support segments, each plication region in the series of plication regions being disposed beneath each segment, and to reduce the circumference of the vascular structure along the circumference reduction means by a precise amount, each segment of the circumference reduction means including aperture means for receiving and supporting suture means for attaching each segment to the vascular structure at a precise location, the circumference reduction means providing flexibility to follow the vascular structure while substantially preventing circumferential lengthening of the vascular structure; and

stabilizing means for covering the line of segments and for stabilizing the line of segments and substantially preventing contact of the line of segments with blood.