Surgical system and procedure for treatment of medically refractory atrial fibrillation

• US 7,387,126 B2
• Filed: 06/12/2002
• Issued: 06/17/2008
• Est. Priority Date: 10/22/1996
• Status: Expired due to Fees

• Current Assignee: St. Jude Medical (Abbott Laboratories Incorporated)
• Original Assignee: St. Jude Medical (Abbott Laboratories Incorporated)
• Inventors: Merrick, Daniel D., Gifford, Hanson S. III, Vaska, Matthias, Cox, James L., Boyd, Stephen W.
• Primary Examiner(s): Isabella; David J
• Application Number:
  US10/171,411
• Publication Number:
  US 20040106918A1
• Time in Patent Office: 2,197 Days
• Field of Search: 128/898, 606/38, 606/219, 606/32, 606/34, 606/35, 606 39- 42, 606 46- 52, 606/80, 601/41, 601/46, 601/47, 607/122, 607/100, 607/101, 607/119, 607/96, 607/115, 607/116, 607/129, 607/130, 600373-377
• US Class Current: 128/898
• CPC Class Codes: A61B 1/042 characterised by a proximal camera, e.g. a CCD camera
• 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 17/0467 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 17/2909 Handles
• CPC Class Codes: A61B 17/320016 Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes A61B10/0233, A61B17/29, A61B17/3207 take precedence
• CPC Class Codes: A61B 17/3211 Surgical scalpels, knives; Accessories therefor
• CPC Class Codes: A61B 17/3468 for implanting or removing devices, e.g. prostheses, implants, seeds, wires devices for implanting seeds A61M37/0069
• CPC Class Codes: A61B 18/00 Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body eye surgery A61F9/007; ear surgery A61F11/00
• CPC Class Codes: A61B 18/02 by cooling, e.g. cryogenic techniques devices for cooling specific reflex points of the body within cell-life limits A61H39/06
• CPC Class Codes: A61B 18/1447 wherein sliding surfaces cause opening/closing of the end effectors
• CPC Class Codes: A61B 18/1482 having a long rigid shaft for accessing the inner body transcutaneously in minimal invasive surgery, e.g. laparoscopy
• 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 18/18 by applying electromagnetic radiation, e.g. microwaves radiation therapy A61N5/00
• CPC Class Codes: A61B 18/20 using laser
• 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 2017/00946 : malleable
• CPC Class Codes: A61B 2017/0243 : for immobilizing local areas of the heart, e.g. while it beats trocars attached to inner organs or inner body tissue A61B2017/3488
• 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 J-shaped suture needles A61B2017/0608
• 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 2017/2931 : with releasable head
• CPC Class Codes: A61B 2017/2943 : Toothed members, e.g. rack and pinion
• CPC Class Codes: A61B 2017/2945 : Curved jaws
• CPC Class Codes: A61B 2017/306 : holding by means of suction
• CPC Class Codes: A61B 2017/3405 : using mechanical guide means
• CPC Class Codes: A61B 2017/3419 : Sealing means between cannula and body
• CPC Class Codes: A61B 2017/3486 : Balloon
• 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 2018/0212 : using an instrument inserted into a body lumen, e.g. catheter
• CPC Class Codes: A61B 2018/0225 : using an instrument for clamping tissue, e.g. forceps
• CPC Class Codes: A61B 2018/0262 : using a circulating cryogenic fluid
• CPC Class Codes: A61B 2018/1432 : curved
• CPC Class Codes: A61B 2018/145 : wherein the effectors remain parallel during closing and opening
• CPC Class Codes: A61B 2018/1465 : Deformable electrodes
• CPC Class Codes: A61B 8/12 : in body cavities or body tracts, e.g. by using catheters catheters per se A61M25/00
• CPC Class Codes: A61B 90/37 : Surgical systems with images on a monitor during operation
• CPC Class Codes: A61B 90/50 : Supports for surgical instruments, e.g. articulated arms
• CPC Class Codes: A61F 2/2427 : Devices for manipulating or deploying heart valves during implantation
• CPC Class Codes: A61M 2025/028 : having a mainly rigid support structure
• CPC Class Codes: A61M 2039/0252 : for access to the lungs
• CPC Class Codes: A61M 2039/0276 : for introducing or removing fluids into or out of the body
• CPC Class Codes: A61M 2039/0279 : for introducing medical instruments into the body, e.g. endoscope, surgical tools
• 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
• CPC Class Codes: A61N 7/02 : Localised ultrasound hyperthermia hyperthermia in general A61F7/00

Abstract

The invention provides surgical systems and methods for ablating heart tissue within the interior and/or exterior of the heart. A plurality of probes is provided with each probe configured for introduction into the chest for engaging the heart. Each probe includes an elongated shaft having an elongated ablating surface of a predetermined shape. The elongated shaft and the elongated ablating surface of each probe are configured to ablate a portion of the heart. A sealing device affixed to the heart tissue forms a hemostatic seal between the probe and the penetration in the heart to inhibit blood loss therethrough.

Claims

1. A method of forming an elongate ablation around the pulmonary veins to electrically isolate the pulmonary veins to treat cardiac arrhythmia, comprising the steps of:

providing an ablation device having a first jaw, a second jaw and at least one ablating portion on the first jaw, the first jaw being movable relative to the second jaw to clamp cardiac tissue therebetween;

forming an opening in a patient'"'"'s body;

forming an opening in the pericardium;

moving the ablation device through the openings in the patient'"'"'s body and pericardium;

clamping a portion of the patient'"'"'s heart between the first and second jaws, the at least one ablating portion being positioned to form a first elongate lesion in the patient'"'"'s heart to electrically isolate tissue;

ablating tissue with the at least one ablating portion to form the first elongate lesion; and

changing the position of the ablating device and performing the clamping and ablating steps a number of times to create a plurality of lesions in cardiac tissue which electrically isolates the pulmonary veins.

4. The method of claim 1, wherein:

the providing step Is carried out with the first jaw pivoting relative to the second jaw.

5. The method of claim 1, wherein:

the providing step is carried out with the ablating portion extending along a length of the first jaw.

6. The method of claim 1, wherein the ablating step is carried out while the patient'"'"'s heart is beating.

2. A method of forming an elongate ablation to treat cardiac arrhythmia, comprising the steps of:

providing an ablation device having a first jaw, a second jaw and at least one ablating portion on the first jaw, the first jaw being movable relative to the second jaw to clamp cardiac tissue therebetween;

forming an opening in a patient'"'"'s body;

forming an opening in the pericardium;

moving the ablation device through the openings in the patient'"'"'s body and pericardium;

clamping a portion of the patient'"'"'s heart between the first and second jaws, the at least one ablating portion being positioned to form an elongate lesion in the patient'"'"'s heart to electrically isolate tissue;

ablating tissue with the at least one ablating portion to form the first elongate lesion;

the clamping step being carried out by inserting at least one of the first and second jaws into the patient'"'"'s heart while the other jaw remains outside the heart so that the ablation device clamps the portion of the patient'"'"'s heart between an endocardial surface and an epicardial surface.

3. The method of claim 2, wherein:

the clamping step is carried out by using a purse-string suture to maintain hemostasis around the jaw which is inserted into the patient'"'"'s heart.

7. The method of claim 2, wherein the first jaw of the provided ablation device slides relative to the second jaw.

8. The method of claim 2, wherein the ablating portion extends along a length of the first jaw of the provided ablation device.

9. The method of claim 2, wherein the ablating step is carried out while the patient'"'"'s heart is beating.

10. The method of claim 2, wherein the ablating step comprises cryogenically freezing cardiac tissue.

11. The method of claim 2, wherein the ablating step comprises delivery of ablating energy to cardiac tissue, the ablating energy being selected from the group consisting of:

RF energy, laser energy, microwave energy, thermal energy, ultrasound energy, and any combinations thereof.

12. The method of claim 2, wherein the ablating step comprises delivery of an ablating agent to cardiac tissue.

13. The method of claim 2, wherein the clamping step is carried out with the first jaw inserted into the patient'"'"'s heart such that the at least one ablating portion thereon is in contact with an endocardial surface of the patient'"'"'s heart.

14. The method of claim 2, wherein only the first jaw includes an ablating portion thereon.

15. The method of claim 2, wherein the first jaw of the provided ablation device is releasably movably coupled to the second jaw.

16. The method of claim 2, wherein a transverse cross-sectional dimension of the ablating portion is teardrop-shaped.