Corning device for myocardial revascularization

• US 6,162,214 A
• Filed: 10/30/1998
• Issued: 12/19/2000
• Est. Priority Date: 10/30/1997
• Status: Expired due to Fees

• Current Assignee: Eclipse Surgical Technologies, Inc. (Cryolife Incorporated)
• Original Assignee: Eclipse Surgical Technologies, Inc. (Cryolife Incorporated)
• Inventors: Khairkhahan, Alexander, Mueller, Richard L.
• Primary Examiner(s): Leubecker, John P.
• Assistant Examiner(s): FARAH, AHMED M
• Application Number:
  US09/183,757
• Time in Patent Office: 781 Days
• Field of Search: 606/170, 606/2, 606/5, 606/7-15, 606/89, 606/45, 606/28, 606/180, 600/564-568
• US Class Current: 606/15
• CPC Class Codes: A61B 18/22 the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor
• CPC Class Codes: A61B 18/24 with a catheter A61B18/26, A61B18/28 take precedence
• CPC Class Codes: A61B 2017/00247 Making holes in the wall of the heart, e.g. laser Myocardial revascularization
• CPC Class Codes: A61B 2018/00392 Transmyocardial revascularisation
• CPC Class Codes: A61B 2018/00625 Vaporization
• CPC Class Codes: A61B 2218/008 for smoke evacuation

Abstract

Apparatus and method for creating pathways in tissue and destroying the cored tissue to avoid release of the cored tissue within the body. The apparatus has a coring mechanism and a tissue vaporization mechanism. The apparatus is useful in creating revascularization pathways in the myocardium. The apparatus and methods are adaptable for either surgical or percutaneous procedures.

Claims

1. An apparatus for cutting a pathway in tissue comprising:

a housing, a catheter coupled to the housing, the catheter including a lumen and proximal and distal portions, an end effector at the distal portion of the catheter for cutting a pathway in the tissue, a tissue vaporization device in combination with the distal portion of the catheter so that the tissue severed by the end effector and held within the distal end of the catheter is vaporized by the tissue vaporization device in the distal end of the catheter in the body.

2. The apparatus of claim 1 further including a therapeutic agent delivery device in combination with the tissue vaporization device for delivering one or more therapeutic agents to the pathway.

3. The apparatus of claim 1 further including a therapeutic agent delivery device within the lumen of the catheter for delivering one or more therapeutic agents to the pathway.

4. The apparatus of claim 1 further including a shaft having a lumen and proximal and distal portions, the shaft housing the catheter, the catheter translatable in the shaft and extendable out the distal portion of the shaft.

5. The apparatus of claim 4 further including at the distal portion of the shaft a device for stabilizing the end effector in contact with the tissue.

6. The apparatus of claim 4 further including a sensing device at the distal portion of the shaft for determining the depth of the tissue.

7. The apparatus of claim 1 further including a rotation mechanism coupled to the housing and causing rotation of the catheter.

8. The apparatus of claim 1 wherein the effector end is removably mounted to the housing.

9. The apparatus of claim 1 further including a depth stop mechanism coupled to the housing for controlling advancement of the effector end.

10. The apparatus of claim 1 further including an element for heating the effector end coupled to the distal portion of the catheter and to an energy source.

11. The apparatus of claim 1 wherein the tissue vaporization device comprises a laser energy delivery device translatable within the lumen of the catheter.

12. The apparatus of claim 1 wherein the tissue vaporization device comprises a laser energy delivery device mounted within the lumen of the catheter and coupled to a laser energy source.

13. The apparatus of claim 1 further including a gas removal mechanism in communication with the lumen of the catheter for withdrawing generated gases created during vaporization.

56. The apparatus of claim 1 wherein the tissue vaporization device comprises a radio frequency ablation device.

14. A tissue removal apparatus for use in a body comprising:

a coring mechanism having a lumen for excised tissue, and

a tissue vaporization mechanism housed within the lumen of the coring mechanism for destroying excised tissue within the coring mechanism in the body.

15. The apparatus of claim 14 wherein the tissue vaporization mechanism is translatable within the lumen of the coring mechanism.

16. The apparatus of claim 14 wherein the coring mechanism comprises a catheter having proximal and distal ends, the distal end of the catheter comprising a cutting portion.

17. The apparatus of claim 14 wherein the coring mechanism comprises a hypotube having proximal and distal ends, the distal end of the hypotube comprising a cutting portion.

18. The apparatus of claim 16 wherein the cutting portion is substantially rigid.

19. The apparatus of claim 16 wherein the cutting portion is rigid.

20. The apparatus of claim 16 wherein the cutting portion comprises a cutting edge having proximal and distal ends.

21. The apparatus of claim 20 wherein the cutting portion further includes a step edge to retain excised tissue.

22. The apparatus of claim 16 comprising a flexibility imparting device at the distal end of the catheter adjacent the proximal end of the cutting portion.

23. The apparatus of claim 21 wherein the flexibility imparting device is a spring.

24. The apparatus of claim 16 wherein the cutting portion further comprises an external textured surface to create a pathway with a jagged surface.

25. The apparatus of claim 23 wherein the external textured surface is serrated.

26. The apparatus of claim 16 wherein the proximal end of the catheter is flexible.

27. The apparatus of claim 16 wherein the proximal end of the catheter is substantially flexible.

28. The apparatus of claim 16 wherein at least a portion of the catheter is flexible.

29. The apparatus of claim 16 wherein the catheter is torquable.

30. The apparatus of claim 16 wherein the catheter further comprises a torquable insert element in combination with the catheter.

31. The apparatus of claim 30 wherein the torquable insert is embedded in the wall of the catheter.

32. The apparatus of claim 30 wherein the torquable insert comprises a spring.

33. The apparatus of claim 30 wherein the torquable insert comprises wire mesh tubing.

34. The apparatus of claim 14 wherein the tissue vaporization mechanism comprises a laser energy delivery device having proximal and distal ends.

35. The apparatus of claim 34 wherein the laser energy the laser energy delivery device is one or more optical fibers.

36. The apparatus of claim 35 further including a therapeutic agent delivery device at the distal portion of the laser delivery device.

37. The apparatus of claim 16 further including a hand piece coupled to the proximal end of the catheter.

38. The apparatus of claim 16 further including a motor mechanism operatively coupled to the catheter, for motion of the distal end of the catheter.

39. The apparatus of claim 38 further including a depth stop mechanism coupled to the hand piece for controlling advancement of the catheter.

40. The apparatus of claim 16 further including a sensing device at the distal end of the catheter for determining the depth of the tissue.

41. The apparatus of claim 16 further including a shaft with a lumen having distal and proximal ends, the catheter translatable within the lumen of the shaft.

42. The apparatus of claim 41 further including a stabilization device at the distal end of the shaft for stabilizing the coring mechanism in contact with the tissue.

43. The apparatus of claim 42 wherein the stabilization device is one or more suction conduits.

57. The apparatus of claim 14 wherein the tissue vaporization device comprises a radio frequency ablation device.

44. A method for excising tissue in a body comprising:

a) providing an apparatus comprising;

a mechanical tissue excision mechanism housing a tissue vaporization mechanism;

b) placing the distal portion of the apparatus on a tissue surface;

c) creating a pathway in the tissue and capturing excised tissue within the distal portion of the apparatus; and

d) vaporizing the excised tissue within the apparatus.

45. The method of claim 44 wherein step c) further includes delivery of at least one therapeutic agent to the pathway.

46. The method of claim 44 subsequent to step c) delivering at least one therapeutic agent to the pathway.

47. The method of claim 44 subsequent step d) delivering at least one therapeutic agent to the pathway.

48. The method of claim 44 wherein the tissue surface in step b) is the epicardium.

49. The method of claim 44 wherein the tissue surface in step b) is the endocardium.

50. The method of claim 44 wherein step c) further includes causing thermal injury to a remaining tissue.

51. The method of claim 44 wherein step c) includes advancement and rotation of the mechanical tissue excision mechanism in the tissue.

52. The method of claim 44 wherein step d) includes firing the tissue vaporization mechanism within the mechanical tissue excision mechanism.

53. The method of claim 44 the apparatus further including a gas removal mechanism in combination with the tissue vaporization mechanism and step e) comprising removing gases from the tissue vaporization mechanism.

54. A method for enhancing trauma while creating a myocardial pathway comprising

a) providing a mechanical tissue coring device having a textured external distal surface,

b) advancing the tissue coring device into myocardial tissue

c) removing a cored tissue sample while providing an increased trauma surface area within the pathway.

55. A method for creating a revascularization pathway in a body tissue comprising:

a) providing an apparatus comprising;

a mechanical tissue coring mechanism housing a tissue vaporization mechanism;

b) placing the distal portion of the apparatus on a tissue surface;

c) coring a pathway in the tissue; and

d) vaporizing the cored tissue within the apparatus.