Thorascopic heart valve repair method

• US 9,364,213 B2
• Filed: 05/21/2013
• Issued: 06/14/2016
• 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): Templeton, Christopher L
• Application Number:
  US13/898,709
• Publication Number:
  US 20140039324A1
• Time in Patent Office: 1,120 Days
• Field of Search: 600/166, 600/111, 359/462, 359/475, 359/472, 359/466
• US Class Current: 1/1
• 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

A method for confirming capture of a moving heart valve leaflet of a beating heart of a patient includes inserting an instrument through the chest cavity and into a heart chamber providing access to a valve needing repair. A movable tip on the distal end of the instrument is operable to capture a moving valve leaflet. Proper capture of the valve leaflet is confirmed at a proximal end of the instrument with a fiber optic capture confirmation system.

Claims

1. A method of capturing a moving heart valve leaflet in a beating heart of a patient, comprising:

inserting an instrument through a chest wall of the patient and into a chest cavity of the patient through a minimally invasive opening;

inserting a distal end of the instrument through a heart wall and into the beating heart of the patient;

grasping the moving valve leaflet of a heart valve in the beating heart with the distal end of the instrument;

confirming, at a proximal end of the instrument external to the patient, capture and proper positioning of the moving valve leaflet relative to the instrument with a fiber optic capture confirmation system having a plurality of illumination fiber optics and a plurality of detection fiber optics, the detection fiber optics configured to detect light from the illumination fiber optics reflected off of the leaflet when the leaflet is properly positioned relative to the instrument, the capture confirmation system providing a plurality of independent indications of the positioning of the leaflet relative to the instrument,

wherein the step of confirming capture and proper positioning includes confirming that the moving valve leaflet is captured directly against and in contact with a capture surface at the distal end of the instrument, the capture surface defining a plurality of apertures that are covered by the valve leaflet when the valve leaflet is properly captured and positioned, each aperture connecting to a respective longitudinal channel extending through the instrument, each longitudinal channel containing at least one of the illumination fiber optics and at least one of the detection fiber optics.

2. The method of claim 1, wherein the instrument includes a shaft having a distal end, wherein the shaft includes the capture surface at the distal end of the shaft, wherein the instrument includes a movable element longitudinally displaceable relative to the shaft, and wherein the step of grasping the moving valve leaflet with the instrument includes capturing the leaflet between the movable element and the capture surface.

3. The method of claim 1, wherein the plurality of illumination fiber optics and the plurality of detection fiber optics are divided into a plurality of groups of fiber optics each having at least one illumination fiber optic of the plurality of illumination fiber optics and at least one detection fiber optic of the plurality of detection fiber optics, and wherein each of the groups provides a respective one of the plurality of independent indications.

4. The method of claim 3, wherein each group of fiber optics extends through a different longitudinal channel of the longitudinal channels extending through the instrument.

5. The method of claim 1, further comprising:

puncturing the leaflet with a needle to create an opening; and

drawing a suture through the opening.

6. The method of claim 5, further comprising:

anchoring the suture to a structure of the heart.

7. The method of claim 1, wherein when the valve leaflet is covering the plurality of apertures in the capture surface the valve leaflet is in direct contact with the plurality of illumination fiber optics and the plurality of detection fiber optics.

8. A method of confirming capture and proper positioning of a moving valve leaflet in a beating heart of a patient, comprising:

inserting an instrument into the beating heart of the patient, the instrument including a fiber optic capture confirmation system having a plurality of illumination fiber optics and a plurality of detection fiber optics;

grasping the moving valve leaflet in the beating heart with a distal end of the instrument; and

presenting, external to the patient for visual observation by an operator of the instrument a plurality of independent indications of a capture status of the leaflet generated by the fiber optic capture confirmation system, the indications each being a distinct colored dot generated by light from an illumination fiber optic of the plurality of illumination fiber optics being reflected and detected by a detection fiber optic of the plurality of detection fiber optics,

confirming the leaflet is captured directly against and in contact with a capture surface of the distal end at the instrument, wherein the capture surface defines a plurality of apertures, wherein the apertures are covered by the valve leaflet when the valve leaflet is properly captured and positioned, each aperture connecting to a respective channel, each channel containing at least one of the illumination fiber optics and at least one of the detection fiber optics.

9. The method of claim 8, wherein the instrument includes a shaft having a distal end, wherein the shaft includes the capture surface at the distal end of the shaft, wherein the instrument includes a movable element longitudinally displaceable relative to the shaft, and wherein grasping the moving valve leaflet with the instrument includes capturing the leaflet between the movable element and the capture surface.

10. The method of claim 8, wherein the capture status of the leaflet is indicated by a specific color.

11. The method of claim 10, wherein a generally white color indicates a positive capture status and a generally red color indicates a negative capture status.

12. The method of claim 8, wherein when the valve leaflet is covering the plurality of apertures in the capture surface the valve leaflet is in direct contact with the illumination fiber optic and the detection fiber optic corresponding to each indication.