Methods and apparatus for transpericardial left atrial appendage closure
First Claim
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1. A method for closing a left atrial appendage of a patient'"'"'s heart, said method comprising:
- making an incision between a costal cartilage and a xiphoid of the patient;
placing an access sheath through the incision into a pericardial space;
positioning a closure instrument through the access sheath into the pericardial space beneath the rib cage, over an epicardial surface, and adjacent to the left atrial appendage; and
closing the left atrial appendage using the closure instrument.
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Abstract
Methods and apparatus for closing a left atrial appendage are described. The methods rely on introducing a closure tool from a location beneath the rib cage, over an epicardial surface, and to the exterior of the left atrial appendage. The closure device may then be used to close the left atrial appendage, preferably at its base, by any one of a variety of techniques. A specific technique using graspers and a closing loop is illustrated.
295 Citations
39 Claims
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1. A method for closing a left atrial appendage of a patient'"'"'s heart, said method comprising:
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making an incision between a costal cartilage and a xiphoid of the patient;
placing an access sheath through the incision into a pericardial space;
positioning a closure instrument through the access sheath into the pericardial space beneath the rib cage, over an epicardial surface, and adjacent to the left atrial appendage; and
closing the left atrial appendage using the closure instrument. - View Dependent Claims (2, 3, 4, 5, 6, 7, 9, 10)
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8. An improved method for closing a left atrial appendage of a heart, said method being of the type wherein a closure element is placed over an exterior of the appendage while the patient'"'"'s chest remains closed, wherein the improvement comprises advancing the closure element from beneath the rib cage over an epicardial surface to the exterior of the left atrial appendage prior to placing the closure element over the left atrial appendage.
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11. A method for closing a left atrial appendage of a patient'"'"'s heart, said method comprising:
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positioning a closure instrument through a percutaneous passage into a pericardial space beneath the rib cage, over an epicardial surface, and adjacent to the left atrial appendage, without passing through the pleural space; and
closing the left atrial appendage using the closure instrument. - View Dependent Claims (12, 13, 14, 15, 16, 17, 18, 19, 20)
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21. A method for closing a left atrial appendage of a patient'"'"'s heart, said method comprising:
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positioning a closure instrument through a percutaneous passage into a pericardial space beneath the rib cage, over an epicardial surface, and adjacent to the left atrial appendage, while both lungs of the patient remain inflated; and
closing the left atrial appendage using the closure instrument. - View Dependent Claims (22, 23, 24, 25, 26, 27, 28, 29)
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30. A method for closing a left atrial appendage of a patient'"'"'s heart, said method comprising:
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inserting a closure instrument through a percutaneous passage;
introducing the closure instrument into a pericardial space by passing the closure instrument beneath the rib cage, over an epicardial surface, and adjacent to the left atrial appendage, without passing through the pleural space; and
closing the left atrial appendage using the closure instrument. - View Dependent Claims (31, 32, 33, 34, 35, 36, 37, 38, 39)
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Specification