Minimally-invasive devices and methods for treatment of congestive heart failure

• US 6,802,319 B2
• Filed: 03/24/2000
• Issued: 10/12/2004
• Est. Priority Date: 02/22/1993
• Status: Expired due to Fees

• Current Assignee: Brian S. Donlon, Daniel C. Rosenman, Hanson S. Gifford III, John H. Stevens, Lee R. Bolduc, Philip R. Houle, Stephen W. Boyd
• Original Assignee: Brian S. Donlon, Daniel C. Rosenman, Hanson S. Gifford III, John H. Stevens, Lee R. Bolduc, Philip R. Houle, Stephen W. Boyd
• Inventors: Stevens, John H., Houle, Philip R., Boyd, Stephen W., Rosenman, Daniel C., Donlon, Brian S., Gifford, Hanson S. III, Bolduc, Lee R.
• Primary Examiner(s): Isabella, David J.
• Application Number:
  US09/535,141
• Publication Number:
  US 20030102000A1
• Time in Patent Office: 1,663 Days
• Field of Search: 128/898, 623/1.11, 623/2.11, 623/11, 604/4, 604/5, 604/6, 600/16, 600/17, 600/18
• US Class Current: 128/898
• CPC Class Codes: A61B 17/00234 for minimally invasive surgery A61B17/0218, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/0057 Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect sutures A61B17/04; closing rectum or urethra near body surface A61F2/0009
• CPC Class Codes: A61B 17/0218 for minimally invasive surgery A61B17/0281, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/0293 with ring member to support retractor elements
• CPC Class Codes: A61B 17/0467 Instruments for cutting sutures surgical cutting instruments A61B17/32
• CPC Class Codes: A61B 17/0469 Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 17/06061 Holders for needles or sutures, e.g. racks, stands hand-held holding instruments A61B17/0483; holders for articles A61B50/20; racks for syringes or for hypodermic or infusion needles A61M5/008
• CPC Class Codes: A61B 17/122 Clamps or clips , e.g. for the umbilical cord for the vas deferens A61F6/206
• CPC Class Codes: A61B 17/29 Forceps for use in minimally invasive surgery
• CPC Class Codes: A61B 17/2909 Handles
• CPC Class Codes: A61B 17/3421 Cannulas
• CPC Class Codes: A61B 18/1492 having a flexible, catheter-like structure, e.g. for heart ablation A61B18/1477 takes precedence
• CPC Class Codes: A61B 2017/00053 Mapping
• CPC Class Codes: A61B 2017/00243 cardiac
• CPC Class Codes: A61B 2017/00247 Making holes in the wall of the heart, e.g. laser Myocardial revascularization
• CPC Class Codes: A61B 2017/00575 for closure at remote site, e.g. closing atrial septum defects
• CPC Class Codes: A61B 2017/00867 shape memory effect
• CPC Class Codes: A61B 2017/00907 for light
• CPC Class Codes: A61B 2017/00946 malleable
• CPC Class Codes: A61B 2017/0237 for heart surgery
• CPC Class Codes: A61B 2017/0243 : for immobilizing local areas of the heart, e.g. while it beats
• CPC Class Codes: A61B 2017/047 : having at least one proximally pointing needle located at the distal end of the instrument, e.g. for suturing trocar puncture wounds starting from inside the body
• CPC Class Codes: A61B 2017/0472 : Multiple-needled, e.g. double-needled, instruments
• CPC Class Codes: A61B 2017/0474 : Knot pushers
• CPC Class Codes: A61B 2017/0475 : using sutures having a slip knot
• CPC Class Codes: A61B 2017/0496 : for tensioning sutures
• CPC Class Codes: A61B 2017/2912 : transmission of forces to actuating rod or piston
• CPC Class Codes: A61B 2017/2926 : Details of heads or jaws
• CPC Class Codes: A61B 2017/2927 : the angular position of the head being adjustable with respect to the shaft
• CPC Class Codes: A61B 2017/2932 : Transmission of forces to jaw members
• CPC Class Codes: A61B 2017/2943 : Toothed members, e.g. rack and pinion
• CPC Class Codes: A61B 2017/306 : holding by means of suction
• CPC Class Codes: A61B 2017/308 : with suction cups
• CPC Class Codes: A61B 2017/3405 : using mechanical guide means
• CPC Class Codes: A61B 2017/3492 : against the outside of the body
• CPC Class Codes: A61B 2018/00214 : Expandable means emitting energy, e.g. by elements carried thereon
• CPC Class Codes: A61B 2018/00232 : having an irregular shape
• CPC Class Codes: A61B 2018/00261 : arranged in a line
• CPC Class Codes: A61B 2018/00291 : using suction
• CPC Class Codes: A61B 2018/00363 : Epicardium
• CPC Class Codes: A61B 2018/00392 : Transmyocardial revascularisation
• CPC Class Codes: A61B 2018/00577 : Ablation
• CPC Class Codes: A61B 2018/00982 : combined with or comprising means for visual or photographic inspections inside the body, e.g. endoscopes
• CPC Class Codes: A61B 2090/061 : for measuring dimensions, e.g. length
• CPC Class Codes: A61B 2090/306 : using optical fibres
• CPC Class Codes: A61B 90/36 : Image-producing devices or illumination devices not otherwise provided for
• CPC Class Codes: A61B 90/50 : Supports for surgical instruments, e.g. articulated arms
• CPC Class Codes: A61F 2/2442 : Annuloplasty rings or inserts for correcting the valve shape; Implants for improving the function of a native heart valve
• CPC Class Codes: A61F 2/2445 : Annuloplasty rings in direct contact with the valve annulus
• CPC Class Codes: A61F 2007/0001 : Body part
• CPC Class Codes: A61F 2007/0054 : with a closed fluid circuit, e.g. hot water
• CPC Class Codes: A61F 2007/101 : for cooling organs in the body before or during surgery
• CPC Class Codes: A61F 7/10 : Cooling bags, e.g. ice-bags
• CPC Class Codes: A61M 1/3621 : Extra-corporeal blood circuits single-needle circuits A61M1/30
• CPC Class Codes: A61M 2025/028 : having a mainly rigid support structure
• CPC Class Codes: A61M 2039/027 : having a particular valve, seal or septum
• CPC Class Codes: A61M 2039/0279 : for introducing medical instruments into the body, e.g. endoscope, surgical tools
• CPC Class Codes: A61M 2202/047 : cardioplegic
• CPC Class Codes: A61M 2205/3344 : Measuring or controlling pressure at the body treatment site
• CPC Class Codes: A61M 2205/3355 : Controlling downstream pump pressure
• CPC Class Codes: A61M 2205/366 : by liquid heat exchangers
• CPC Class Codes: A61M 25/1011 : Multiple balloon catheters
• CPC Class Codes: A61M 39/0247 : Semi-permanent or permanent transcutaneous or percutaneous access sites to the inside of the body peritoneal dialysis catheters A61M1/285; tracheostomy devices A61M16/0465; measuring pressure within the body A61B5/03; colostomy devices A61F5/445; gastrotomy feeding tubes A61J15/0015; means for fixing a feeding tube outside of the body A61J15/0053

Abstract

A method of treatment of congestive heart failure comprises the steps of introducing an aortic occlusion catheter through a patient'"'"'s peripheral artery, the aortic occlusion catheter having an occluding member movable from a collapsed position to an expanded position; positioning the occluding member in the patient'"'"'s ascending aorta; moving the occluding member from the collapsed shape to the expanded shape after the positioning step; introducing cardioplegic fluid into the patient'"'"'s coronary blood vessels to arrest the patient'"'"'s heart; maintaining circulation of oxygenated blood through the patient'"'"'s arterial system; and reshaping an outer wall of the patient'"'"'s heart while the heart is arrested so as to reduce the transverse dimension of the left ventricle. The ascending aorta may be occluded and cardioplegic fluid delivered by means of an occlusion balloon attached to the distal end of an elongated catheter positioned transluminally in the aorta from a femoral, subclavian, or other appropriate peripheral artery.

Claims

1. A method of reshaping a patient'"'"'s heart muscle, comprising the steps of:

introducing a tissue attaching device into the patient'"'"'s chest;

engaging a first location on a wall of the patient'"'"'s left ventricle with the tissue attaching device; and

manipulating the tissue attaching device to attach the first location to a second location on a wall of the heart so as to reduce the transverse dimension of the left ventricle, the user'"'"'s hands remaining outside the patient'"'"'s chest when manipulating the tissue attaching device.

2. The method of claim 1, further comprising the steps of:

introducing a cutter into the patient'"'"'s chest, the cutter having a manually operable actuator;

cutting a portion of a patient'"'"'s left ventricle from the heart with the cutter, the user'"'"'s hands being outside the patient'"'"'s chest when actuating the manually operable actuator; and

removing the portion of the patient'"'"'s heart muscle;

the manipulating step being carried out to close an opening in the patient'"'"'s heart formed by the removing step.

3. The method of claim 2, wherein:

the introducing steps are carried out by passing the cutter and tissue attaching device between adjacent ribs.

4. The method of claim 1, wherein:

the manipulating step is carried out without cutting through the wall of the heart.

5. The method of claim 1, wherein:

the manipulating step comprises folding a section of the heart wall between the first and second locations so as to reduce the size of the left ventricle.

6. The method of claim 1, wherein:

the manipulating step comprises attaching a portion of the left ventricular wall to the interventricular septum.

7. The method of claim 1, further comprising measuring the size of the left ventricle before the step of manipulating using a sizing instrument introduced into the chest while maintaining the hands outside the chest.

8. The method of claim 1, wherein:

the manipulating step is carried out while viewing the heart using a viewing scope.

9. The method of claim 1, wherein:

each of said steps is carried out while maintaining the patient'"'"'s ribs and sternum intact.

10. The method of claim 1, wherein:

the introducing step is carried out with the tissue attaching device extending between adjacent ribs in the patient.