Thorascopic heart valve repair method and apparatus

• US 8,968,338 B2
• Filed: 02/19/2010
• Issued: 03/03/2015
• Est. Priority Date: 01/21/2005
• Status: Active Grant

• Current Assignee: Mayo Foundation For Medical Education And Research (Mayo Clinic)
• Original Assignee: Mayo Foundation For Medical Education And Research (Mayo Clinic)
• Inventors: Speziali, Giovanni
• Primary Examiner(s): Anderson, Gregory
• Assistant Examiner(s): Templeton, Christopher L
• Application Number:
  US12/709,220
• Publication Number:
  US 20100174297A1
• Time in Patent Office: 1,838 Days
• Field of Search: 606/139, 606/144, 606/145, 600/109, 600110-112, 600160-182
• US Class Current: 606/144
• CPC Class Codes: A61B 1/00167 Details of optical fibre bundles, e.g. shape or fibre distribution
• CPC Class Codes: A61B 1/07 using light-conductive means, e.g. optical fibres
• 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 17/0483 Hand-held instruments for holding sutures A61B17/0469 takes precedence; other holders for needles or sutures A61B17/06061; surgical forceps A61B17/28; surgical pincettes A61B17/30
• CPC Class Codes: A61B 17/0491 Sewing machines for surgery
• CPC Class Codes: A61B 17/06 Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials puncturing needles A61B17/34; hypodermic needles A61M5/32 ; sewing needles D05B85/00
• CPC Class Codes: A61B 17/0625 the needle being specially adapted to interact with the manipulator, e.g. being ridged to snap fit in a hole of the manipulator A61B17/06109 takes precedence
• CPC Class Codes: A61B 17/29 Forceps for use in minimally invasive surgery
• CPC Class Codes: A61B 17/295 combined with cutting implements
• CPC Class Codes: A61B 2017/00057 Light
• CPC Class Codes: A61B 2017/00243 cardiac
• CPC Class Codes: A61B 2017/00783 Valvuloplasty
• CPC Class Codes: A61B 2017/0608 J-shaped
• CPC Class Codes: A61B 2090/0807 Indication means
• CPC Class Codes: A61B 2090/306 using optical fibres
• CPC Class Codes: A61B 5/0036 including treatment, e.g., using an implantable medical device, ablating, ventilating
• CPC Class Codes: A61B 5/0084 for introduction into the body, e.g. by catheters A61B5/1459 takes precedence
• CPC Class Codes: A61B 5/02028 Determining haemodynamic parameters not otherwise provided for, e.g. cardiac contractility or left ventricular ejection fraction
• CPC Class Codes: A61B 5/4836 Diagnosis combined with treatment in closed-loop systems or methods A61B5/0036 takes precedence
• CPC Class Codes: G02B 23/2469 : using optical fibres

Abstract

An instrument for performing thorascopic repair of heart valves includes a shaft for extending through the chest cavity and into a heart chamber providing access to a valve needing repair. A movable tip on the shaft is operable to capture a valve leaflet and a needle is operable to penetrate a captured valve leaflet and draw the suture through the leaflet. Proper leaflet capture can be confirmed with a fiber optic imaging system.

Claims

1. An instrument for repairing a heart valve comprising:

a shaft for insertion through a chest wall and into a heart chamber;

a movable element mounted on a distal end of the shaft and being operable from an extrathoracic end of the shaft to capture and hold a valve leaflet against the distal end of the shaft;

a suture disposed in the distal end of the shaft;

a needle mechanism mounted on the distal end of the shaft and being operable from the extrathoracic end of the shaft to penetrate through a captured valve leaflet and draw the suture back through the valve leaflet;

a plurality of fiber optic channels extending longitudinally through the shaft and terminating generally parallel with each other at the distal end of the shaft, each fiber optic channel containing;

an illumination fiber optic that extends through the channel and has a distal end that terminates adjacent the distal end of the shaft; and

a sensor fiber optic that extends through the channel and has a distal end that terminates adjacent the distal end of the shaft,

wherein the distal ends of the fiber optics are positioned such that light is conveyed to the valve leaflet through the illumination fiber optic and reflected back through the sensor fiber optic of each channel to provide a plurality of distinct and independent indications presented for simultaneous observation of whether the valve leaflet is captured against the distal end of the shaft with the movable element, wherein the plurality of distinct and independent indications each comprise a colored dot, and wherein each channel corresponds to one of the colored dots.

2. The instrument as recited in claim 1 in which the fiber optic channels are geometrically disposed around the needle mechanism.

3. The instrument as recited in claim 1 in which the movable element is a tip which is slidably mounted with respect to the distal end of the shaft and slidable from an open position in which a space is created between the tip and the distal end of the shaft and a closed position in which the space is substantially reduced to grasp a valve leaflet therebetween.

4. The instrument as recited in claim 3 in which the needle mechanism is operable to extend outward from the distal end of the shaft, through a captured valve leaflet and into the tip.

5. The instrument as recited in claim 4 in which the suture is disposed in the tip and the needle mechanism includes means for attaching to the suture when extended into the tip.

6. The instrument as recited in claim 5 in which the means for attaching is a notch formed along one side of the needle mechanism that penetrates through the valve leaflet, the notch being positioned when the needle mechanism is extended into the tip to hook the suture.

7. The instrument as recited in claim 4 in which the suture is a loop and the needle mechanism includes a notch formed along one side of the needle mechanism that is capable of penetrating through the valve leaflet, the notch being positioned when the needle mechanism is extended into the tip to hook one end of the suture loop disposed therein.

8. The instrument as recited in claim 7 in which another end of the suture loop wraps around the needle mechanism at a point proximal the valve leaflet.

9. An instrument for repairing a heart valve comprising:

a shaft for insertion through a chest wall and into a heart chamber;

a movable element mounted on a distal end of the shaft and being operable from an extrathoracic end of the shaft to capture and hold a valve leaflet against the distal end of the shaft, the movable element comprising a tip slidably mounted with respect to the distal end of the shaft;

a suture disposed in the distal end of the shaft and configured as a loop;

a needle mechanism including a notch formed along one side of the needle mechanism, the needle mechanism mounted on the distal end of the shaft and being operable from the extrathoracic end of the shaft to extend outward from the distal end of the shaft into the tip to penetrate through a captured valve leaflet and hook one end of the suture loop with the notch to draw the suture back through the valve leaflet, and wherein another end of the suture loop wraps around the needle mechanism at a point proximal the valve leaflet;

a plurality of fiber optic channels extending longitudinally through the shaft and terminating generally parallel with each other at the distal end of the shaft, each fiber optic channel containing;

an illumination fiber optic that extends through the channel and has a distal end that terminates adjacent the distal end of the shaft; and

a sensor fiber optic that extends through the channel and has a distal end that terminates adjacent the distal end of the shaft,

wherein the distal ends of the fiber optics are positioned such that light is conveyed to the valve leaflet through the illumination fiber optic and reflected back through the sensor fiber optic of each channel to provide a plurality of distinctly presented indications of whether the valve leaflet is captured against the distal end of the shaft with the movable element.

10. The instrument as recited in claim 9 in which the fiber optic channels are geometrically disposed around the needle mechanism.

11. The instrument of claim 9, wherein the plurality of distinctly presented indications each comprise a colored dot.