Treatments for a patient with congestive heart failure

• US 7,871,433 B2
• Filed: 02/20/2008
• Issued: 01/18/2011
• Est. Priority Date: 12/08/2001
• Status: Active Grant

• Current Assignee: Omar M. Lattouf
• Original Assignee: Omar M. Lattouf
• Inventors: Lattouf, Omar M.
• Primary Examiner(s): GHERBI, SUZETTE JAIME J
• Application Number:
  US12/070,680
• Publication Number:
  US 20080147184A1
• Time in Patent Office: 1,063 Days
• Field of Search: 623 21- 212, 623/904, 128/898
• US Class Current: 623/2.11
• 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 17/0401 Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors A61B17/0642 takes precedence; fixation devices for tendons or ligaments A61F2/0811
• CPC Class Codes: A61B 17/064 Surgical staples, i.e. penetrating the tissue
• CPC Class Codes: A61B 17/0644 penetrating the tissue, deformable to closed position
• CPC Class Codes: A61B 17/068 Surgical staplers , e.g. containing multiple staples or clampsstaplers containing only one staple A61B17/10; magazines or containers for staples A61B17/105; for performing anastomosis A61B17/115; staplers in general B25C5/00
• CPC Class Codes: A61B 17/0682 for applying U-shaped staples or clamps, e.g. without a forming anvil
• CPC Class Codes: A61B 17/08 Wound clamps or clips, i.e. not or only partly penetrating the tissue suture bridges A61B17/0466; Devices for bringing together the edges of a wound
• CPC Class Codes: A61B 17/10 for applying or removing wound clamps, e.g. containing only one clamp or staple A61B17/076 takes precedence; containing multiple wound clamps A61B17/068; Wound clamp magazines containers, packaging elements or packages specially adapted for particular articles or with special means for dispensing contents B65D83/00, B65D85/00
• 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 17/1285 for minimally invasive surgery
• CPC Class Codes: A61B 17/29 Forceps for use in minimally invasive surgery
• CPC Class Codes: A61B 17/3421 Cannulas
• CPC Class Codes: A61B 17/3423 Access ports, e.g. toroid shape introducers for instruments or hands access sites for liquids A61M39/0247
• 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 2017/00398 using powered actuators, e.g. stepper motors, solenoids
• CPC Class Codes: A61B 2017/00539 hydraulically
• CPC Class Codes: A61B 2017/00557 inflatable A61B2017/22051 takes precedence
• CPC Class Codes: A61B 2017/0647 having one single leg, e.g. tacks
• CPC Class Codes: A61B 2017/0649 Coils or spirals
• CPC Class Codes: A61B 2017/22068 : Centering
• CPC Class Codes: A61B 2017/22069 : Immobilising; Stabilising
• CPC Class Codes: A61B 2017/306 : holding by means of suction
• CPC Class Codes: A61B 2017/320064 : with tissue or sample retaining means
• CPC Class Codes: A61B 2017/3425 : for internal organs, e.g. heart ports
• CPC Class Codes: A61B 2017/3488 : Fixation to inner organ or inner body tissue
• CPC Class Codes: A61B 2018/00392 : Transmyocardial revascularisation
• CPC Class Codes: A61F 2/06 : Blood vessels
• CPC Class Codes: A61F 2/24 : Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body
• CPC Class Codes: A61N 1/056 : Transvascular endocardial electrode systems
• CPC Class Codes: A61N 1/0573 : chacterised by means penetrating the heart tissue, e.g. helix needle or hook
• CPC Class Codes: A61N 1/0587 : Epicardial electrode systems; Endocardial electrodes piercing the pericardium
• CPC Class Codes: A61N 2001/0578 : having means for removal or extraction
• CPC Class Codes: A61N 2001/058 : Fixing tools
• CPC Class Codes: Y10S 623/904 : Heart

Abstract

The invention is directed to two minimally invasive therapeutic procedures, particularly for patients with congestive heart failure, and devices and systems for such procedures. One procedure involves providing a valved passageway through the patient'"'"'s left ventricular wall at the apex of the patient'"'"'s heart and advancing instruments through the valved passageway to connect the valve leaflets of the patient'"'"'s heart valve, e.g. the mitral valve, in a “Bow-Tie” configuration to prevent or minimize regurgitation through the valve. The second procedure involves advancing a pacing lead and a pacing lead implanting device through a trocar in the patient'"'"'s chest and implanting the pacing lead on an exposed epicardial region of the patient'"'"'s heart wall. The pacing lead has a penetrating electrode which is secured within the heart wall. One or both procedures may be performed on a patient with CHF.

Improved devices for these procedures include a minimally invasive grasping device having an inner lumen for advancing connecting members and other instruments through the device to the distal end thereof. Other improved devices include a pacing lead implant instrument which is releasably secured by its distal end to the exposed heart wall to facilitate penetration of the pacing lead electrode into the heart wall. Other improved instruments include a leaflet connector with an artificial cordae tendenae strand secured to an end of the leaflet connector.

Claims

1. A method for treating a valve of a patient'"'"'s heart, the valve having a valve leaflet, comprising:

a. providing an artificial chordate tendineae having first and second portions;

b. advancing the artificial chordae tendineae through a passageway in a wall of the patient'"'"'s heart into a heart chamber defined in part by the wall;

c. securing the first portion of the artificial chordae tendineae to a free edge of the valve leaflet from within the patient'"'"'s heart; and

d. securing the second portion of the artificial chordae tendenae to the wall which defines in part the heart chamber.

2. The method of claim 1 wherein the free edge of the valve leaflet is guided to a grasping location.

3. The method of claim 2 wherein a grasping device is advanced through the passageway in the wall into the heart chamber and grasps the free edge of the valve leaflet in the grasping location.

4. The method of claim 3 wherein the first portion of the artificial chordae tendenae is secured to the free edge of the valve leaflet when the free edge thereof is grasped by the grasping devices.

5. The method of claim 4 including withdrawing the grasping device from the patient'"'"'s heart and securing the second portion of the artificial chordae tendineae to the wall of the patient'"'"'s heart.

6. The method of claim 1 wherein the second portion of the artificial chordae tendineae is secured to an exterior surface of the wall of the patient'"'"'s heart.

7. The method of claim 1 including seating a valve into the passageway in the wall of the patient'"'"'s heart.

8. The method of claim 2 wherein the valve leaflet is guided to the grasping location by a stabilizer member.

9. The method of claim 8 wherein the stabilizer member is advanced through the passageway through the wall of the patient'"'"'s heart and which extends beyond the valve leaflet to an up-stream side of the valve leaflet.

10. The method of claim 1 wherein the first portion of the artificial chordae tendineae is secured to the free edge of the valve leaflet with a connecting member.

11. The method of claim 1 wherein the first portion of the artificial chordae tendineae is also secured to a free edge of an adjacent second valve leaflet.

12. The method of claim 11 wherein the free edge of the valve leaflet and the free edge of the adjacent valve leaflet are secured together in a bow-tie configuration.

26. The method of claim 1 wherein the first and second portions of the artificial chordae tendineae are ends.

28. The method of claim 1 wherein the first portion of the artificial chordate tendineae is passed through a passageway in an apical region of the patient'"'"'s heart.

13. A method for treating a patient'"'"'s heart with a mitral valve having a valve leaflet with a torn or damaged chordae tendineae, the method comprising:

a. providing an artificial chordate tendineae having first and second portions;

advancing the first portion of the artificial chordae tendineae through a passageway in a ventricular wall of the patient'"'"'s heart and into a chamber defined in part by the ventricular wall;

c. securing the first portion of the artificial chordae tendineae to a free edge of the valve leaflet from within the patient'"'"'s heart; and

d. securing the second portion of the artificial chordae tendenae within the heart chamber oriented with respect to a papillary muscle within the heart chamber.

14. The method of claim 13 wherein the free edge of the valve leaflet is guided to a grasping location.

15. The method of claim 14 wherein a grasping device is advanced through the passageway in the ventricular wall into the left ventricle and grasps the free edge of the valve leaflet in the grasping location.

16. The method of claim 15 wherein the first portion of the artificial chordae tendenae is secured to the free edge of the valve leaflet when the free edge thereof is grasped by the grasping devices.

17. The method of claim 16 including withdrawing the grasping device from the patient'"'"'s heart and securing second portion of the artificial chordae tendineae to the ventricular wall.

18. The method of claim 16 wherein the second portion of the artificial chordae tendineae extends through a passageway in the patient'"'"'s ventricular wall and is secured to an exterior surface thereof.

19. The method of claim 18 including seating a valve into the passageway in the ventricular wall.

20. The method of claim 14 wherein the valve leaflet is guided to the grasping location by a stabilizer member.

21. The method of claim 20 wherein the stabilizer member is advanced through the valve leaflets to a location on an up-stream side of the valve leaflets.

22. The method of claim 14 wherein the first portion of the artificial chordae tendineae is secured to the free edge of the valve leaflet with a connecting member.

23. The method of claim 14 wherein the first portion of the artificial chordae tendineae is also secured to a free edge of an adjacent valve leaflet.

24. The method of claim 23 wherein the free edge of the valve leaflet and the free edge of the adjacent valve leaflet are secured together in a bow-tie configuration.

25. The method of claim 14 wherein the valve leaflet has a torn or damaged chordae tendineae.

27. The method of claim 13 wherein the first and second portions of the artificial chordae tendineae are ends.

29. The method of claim 13 wherein the first portion of the artificial chordate tendineae is passed through a passageway in an apical region of the patient'"'"'s heart.