Methods and devices for performing cardiac valve repair

• US 7,635,386 B1
• Filed: 03/07/2007
• Issued: 12/22/2009
• Est. Priority Date: 03/07/2006
• Status: Active Grant

• Current Assignee: University of Maryland Baltimore County (University of Maryland)
• Original Assignee: University of Maryland Baltimore County (University of Maryland)
• Inventors: Gammie, James S.
• Primary Examiner(s): GHERBI, SUZETTE JAIME J
• Application Number:
  US11/683,282
• Time in Patent Office: 1,021 Days
• Field of Search: 128/898, 607/9, 623 21- 237, 623/904
• US Class Current: 623/2.11
• CPC Class Codes: A61B 17/0469 Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 17/0482 Needle or suture guides guides for drills, pins or wire A61B17/17; for puncturing needles A61B17/3403
• CPC Class Codes: A61B 17/062 Needle manipulators
• CPC Class Codes: A61B 17/29 Forceps for use in minimally invasive surgery
• CPC Class Codes: A61B 2017/00243 cardiac
• CPC Class Codes: A61B 2017/0406 Pledgets
• 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 2017/0475 using sutures having a slip knot
• CPC Class Codes: A61B 2017/3425 for internal organs, e.g. heart ports
• CPC Class Codes: A61F 2/2457 Chordae tendineae prostheses
• CPC Class Codes: Y10S 623/904 Heart

Abstract

The present invention is directed to methods and devices for repairing a cardiac valve. Generally, the methods involve a minimally invasive procedure that includes creating an access in the apex region of the heart through which one or more instruments may be inserted so as to repair a cardiac valve, for instance, a mitral or tricuspid valve. Accordingly, the methods are useful for performing a variety of procedures to effectuate a repair. For instance, in one embodiment, the methods are useful for repairing a cardiac valve by implanting one or more artificial heart valve chordae tendinae into one or more cardiac valve leaflet tissues so as to restore the proper leaflet function and thereby prevent reperfusion. In another embodiment, the methods are useful for repairing a cardiac valve by resecting a portion of one or more cardiac valve leaflets and implanting one or more sutures into the resected valve tissues, which may also include the implantation of an annuloplasty ring. In an additional embodiment, the methods are useful for performing an edge to edge bow-tie repair (e.g., an Alfieri repair) on cardiac valve tissues. Devices for performing the methods of the invention are also provided.

Claims

1. A method for repairing a defective mitral or tricuspid valve, comprising:

creating an access in an apical region of a heart through which a defective cardiac valve is accessed;

introducing a device through said access; and

repairing said cardiac valve by use of said device,

wherein the repairing comprises

replacing one or more chordae tendineae, and

using said device to implant one or more artificial chordae tendineae, and

wherein the one or more artificial chordae comprises a suture with one or more leaflets of the heart.

2. The method of claim 1, wherein the repairing comprises resecting one or more leaflets.

3. The method of claim 1, wherein the device is a suturing or stapling device.

4. The method of claim 1, wherein the repairing comprises annuloplasty.

5. The method of claim 1, wherein the repairing comprises stapling or suturing the annulus to create an annuloplasty “

effect”

.

6. The method of claim 1, wherein the repairing comprises performing a bow-tie Alfieri procedure.

7. The method of claim 1, wherein the repair is performed while the heart is beating.

8. The method of claim 1, wherein the method is a minimally invasive procedure.

9. The method of claim 1, wherein the method comprises the use of endoscopy.

10. The method of claim 1, wherein the introduction of the device is performed in conjunction with sonography or direct transblood visualization.

11. The method of claim 1, wherein said repairing comprises:

anchoring the one or more artificial chordae to a tissue in the apical region of the heart.

12. The method of claim 11, wherein the apical tissue is internal to the heart.

13. The method of claim 11, wherein the apical tissue is a papillary muscle, a papillary connective tissue or an endocardial tissue in the lower ventricle.

14. The method of claim 11, wherein the apical tissue is the epicardium.

15. The method of claim 11, further comprising determining an optimal configuration of the one or more artificial chordae before anchoring the artificial chordae.

16. The method of claim 15, wherein the determining comprises the use of sonic guidance.

17. The method of claim 15, wherein the artificial chordae are anchored to the apical tissue subsequent to said determination.

18. The method of claim 1, wherein the repairing comprises the application of a vacuum.

19. A method for treating a defective mitral or tricuspid valve, comprising:

percutaneously accessing an apical region of a heart with a catheter-based device; and

repairing a cardiac valve by use of said device,

wherein the repairing comprises replacing at least one chordae tendineae, and

wherein the replaced chordae tendineae comprises a suture with one or more leaflets of the heart.

20. The method of claim 19, wherein said accessing is done endovascularly via an antegrade approach.

21. The method of claim 19, wherein said accessing is done endovascularly via a retrograde approach.

22. The method of claim 19, wherein said accessing is done via direct access through a transmyocardial approach.

23. The method of claim 19, wherein the replacing comprises anchoring a neochord to the apical region.