Method and apparatus for treating ischemic heart disease by providing transvenous myocardial perfusion
First Claim
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1. Apparatus for use in treating ischemic myocardium of a human or animal patient by providing retrograde transvenous myocardial perfusion, the apparatus comprising a kit including:
- a device for forming a passageway, substantially within the patient'"'"'s myocardium between the left ventricle and venous vasculature;
a conduit adapted to be transluminally disposed substantially within the passageway formed between a patient'"'"'s left ventricle and the patient'"'"'s venous vasculature, the conduit having an outlet in the patient'"'"'s venous vasculature, the conduit adapted to channel a volume of blood from the left ventricle to the venous vasculature;
means for achieving a preselected degree of occlusion of the patient'"'"'s venous vasculature proximal of the outlet to direct the volume of blood to the ischemic myocardium; and
, means for limiting the peak pressure attained in the patient'"'"'s venous vasculature to less than 60 mm Hg.
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Abstract
Methods and apparatus are provided for use in intraoperative and percutaneous procedures for supplying long-term retrograde perfusion of the myocardium via one or more conduits disposed between the left ventricle and the coronary venous vasculature. The conduits are of a selected size and number, and portions of the venous vasculature or coronary ostium are partially or completely occluded, to maintain a parameter related to the pressure attained in the venous vasculature to a value less than a predetermined value.
262 Citations
26 Claims
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1. Apparatus for use in treating ischemic myocardium of a human or animal patient by providing retrograde transvenous myocardial perfusion, the apparatus comprising a kit including:
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a device for forming a passageway, substantially within the patient'"'"'s myocardium between the left ventricle and venous vasculature;
a conduit adapted to be transluminally disposed substantially within the passageway formed between a patient'"'"'s left ventricle and the patient'"'"'s venous vasculature, the conduit having an outlet in the patient'"'"'s venous vasculature, the conduit adapted to channel a volume of blood from the left ventricle to the venous vasculature;
means for achieving a preselected degree of occlusion of the patient'"'"'s venous vasculature proximal of the outlet to direct the volume of blood to the ischemic myocardium; and
,means for limiting the peak pressure attained in the patient'"'"'s venous vasculature to less than 60 mm Hg. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14)
a cutting instrument for boring a transmural passageway through the myocardium between the left ventricle and a selected portion of the patient'"'"'s venous vasculature.
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3. The apparatus as defined in claim 2 wherein the cutting instrument is adapted for insertion into the coronary sinus via the coronary ostium, the cutting instrument comprising:
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a catheter having a distal end, and a lumen that accepts a guidewire; and
a sharpened tubular member disposed on the distal end of the catheter.
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4. The apparatus as defined in claim 2 wherein the cutting instrument forms a transmural passageway having a predetermined cross-sectional area.
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5. The apparatus as defined in claim 2 wherein the conduit comprises a lumen defined by tissue surrounding the transmural passageway.
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6. The apparatus as defined in claim 1 wherein the means for achieving a preselected degree of occlusion also limits a parameter related to the pressure attained in the patient'"'"'s venous vasculature.
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7. The apparatus as defined in claim 1 wherein the conduit comprises:
a tubular member having a bore, an exterior surface, and a plurality of engagement means located on the exterior surface.
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8. The apparatus as defined in claim 7 wherein the tubular member further comprises means for regulating flow of blood through the tubular member.
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9. The apparatus as defined in claim 8 wherein the means for regulating comprises a one-way valve that prevents backflow of blood from the coronary sinus to the left ventricle.
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10. The apparatus as defined in claim 8 wherein the means for regulating comprises a constriction in the bore.
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11. The apparatus as defined in claim 1 wherein the means for achieving a preselected degree of occlusion comprises a valve that limits a peak pressure attained within the coronary sinus by venting blood from the coronary sinus into the patient'"'"'s right atrium when the pressure attained within the coronary sinus exceeds a predetermined value.
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12. The apparatus as defined in claim 1 wherein the means for achieving a preselected degree of occlusion comprises:
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a woven mesh having a delivery configuration, wherein the woven mesh is longitudinally stretched to a radially contracted position, and a deployed configuration, wherein the woven mesh is released from longitudinal restraint and radially expands;
a biocompatible coating disposed on the woven mesh; and
means for forming a constriction in a midregion of the woven mesh.
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13. The apparatus as defined in claim 1 wherein the means for achieving a preselected degree of occlusion comprises a plug of open-cell foam having high durometer.
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14. The apparatus as defined in claim 1 wherein the means for achieving a preselected degree of occlusion comprises:
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a deformable tubular member having a delivery diameter for transluminal delivery, and an expanded diameter, wherein the tubular member is deformably expanded by internal application of a radially outwardly directed force; and
a layer of open-cell foam affixed to an exterior surface of the deformable tubular member.
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15. A method of providing retrograde transvenous myocardial perfusion to treat ischemic myocardium, the method comprising:
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forming a conduit between a patient'"'"'s left ventricle and the patient'"'"'s venous vasculature, the conduit having an outlet in the patient'"'"'s venous vasculature, the conduit channeling blood from the left ventricle to the venous vasculature; and
at least partially occluding the patient'"'"'s venous vasculature proximally of the outlet to direct retrograde blood flow to the ischemic myocardium. - View Dependent Claims (16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26)
providing a cutting instrument; and
manipulating the cutting instrument to bore a transmural passageway through the myocardium between the left ventricle and a selected portion of the patient'"'"'s venous vasculature.
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22. The method as defined in claim 21 wherein manipulating the cutting instrument comprises positioning the cutting instrument at a desired location by inserting the cutting instrument through the coronary ostium and into the coronary sinus.
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23. The method as defined in claim 15 wherein forming a conduit forms a transmural passageway having a predetermined cross-sectional area.
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24. The method as defined in claim 15 wherein the conduit comprises a flexible member having a first end, a second end, and a lumen extending therebetween, and forming a conduit comprises:
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engaging the first end of the flexible member in fluid communication with the left ventricle; and
engaging the second end of the flexible member in the coronary ostium.
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25. The method as defined in claim 24 further comprising positioning the conduit within a passageway extending from the right atrial endocardium to the left ventricular septal endocardium.
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26. The method as defined in claim 24 wherein engaging the first end of the flexible member in fluid communication with the left ventricle comprises suturing a sewing ring to the epicardium.
Specification