Tool for actuating an adjusting mechanism

• US 9,622,861 B2
• Filed: 04/07/2014
• Issued: 04/18/2017
• Est. Priority Date: 12/02/2009
• Status: Active Grant

• Current Assignee: Valtech Cardio Ltd (Edwards Lifesciences Corporation)
• Original Assignee: Valtech Cardio Ltd (Edwards Lifesciences Corporation)
• Inventors: Miller, Eran, Pomerantz, Uriel Aba, Cabiri, Oz, Herman, Yaron, Weitzman, Yoseph, Gross, Yossi
• Primary Examiner(s): ORKIN, ALEXANDER J
• Application Number:
  US14/246,417
• Publication Number:
  US 20140222137A1
• Time in Patent Office: 1,107 Days
• 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 17/0469 Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 2017/00243 cardiac
• CPC Class Codes: A61B 2017/0409 Instruments for applying suture anchors
• CPC Class Codes: A61B 2017/0414 having a suture-receiving opening, e.g. lateral opening
• CPC Class Codes: A61B 2017/044 with a threaded shaft, e.g. screws
• CPC Class Codes: A61B 2017/0441 the shaft being a rigid coil or spiral
• CPC Class Codes: A61B 2017/0464 for soft tissue
• CPC Class Codes: A61B 2017/048 for reducing heart wall tension, e.g. sutures with a pad on each extremity
• CPC Class Codes: A61F 2/2427 Devices for manipulating or deploying heart valves during implantation
• CPC Class Codes: A61F 2/2457 Chordae tendineae prostheses
• CPC Class Codes: A61F 2/2466 Delivery devices therefor

Abstract

Apparatus is provided, including a tissue-adjusting member selected from the group consisting of: one or more artificial chordae tendineae and at least a portion of an annuloplasty ring structure. The tissue-adjusting member includes an adjusting mechanism that is configured to adjust a tension of the tissue-adjusting member. The adjusting mechanism includes a locking mechanism configured to restrict adjusting of the tissue-adjusting member by the adjusting mechanism. An elongate member is configured to maintain the locking mechanism in an unlocked state during adjusting of the tension of the tissue-adjusting member by the adjusting mechanism, and facilitate locking of the adjusting mechanism by the locking mechanism. A tool is configured to facilitate actuation of the adjusting mechanism to adjust the tension of the tissue-adjusting mechanism. The elongate member and the tool are slidably coupled with respect to each other. Other applications are also described.

Claims

1. Apparatus, comprising:

an implant comprising a tissue-adjusting member selected from the group consisting of;

one or more artificial chordae tendineae and at least a portion of an annuloplasty ring structure, the implant further comprising an adjusting mechanism that is configured, upon actuation thereof, to adjust a tension of the tissue-adjusting member, the adjusting mechanism;

(1) comprising a locking mechanism configured to restrict adjusting of the tissue-adjusting member by the adjusting mechanism, and (2) being shaped so as to define an interface;

an elongate member configured to;

directly contact a portion of the locking mechanism and by the contact apply an unlocking force to the portion of the locking mechanism to maintain the locking mechanism in an unlocked state during adjusting of the tension of the tissue-adjusting member by the adjusting mechanism, and

facilitate locking of the adjusting mechanism by the locking mechanism; and

a tool configured to actuate the adjusting mechanism via direct contact of the tool with the interface and application of an actuation force by the tool to the interface, while the elongate member applies the unlocking force to the portion of the locking mechanism, wherein the elongate member and the tool are longitudinally slidably coupled with respect to each other.

2. The apparatus according to claim 1, wherein the tool is shaped so as to define a tool lumen for slidable passage therethrough of the elongate member.

3. The apparatus according to claim 1, wherein the interface of the adjusting mechanism is shaped so as to define a driving interface shaped so as to define a threaded portion.

4. The apparatus according to claim 1, further comprising a housing, wherein the housing surrounds the adjusting mechanism.

5. The apparatus according to claim 1, wherein the tool comprises a holder at a distal end thereof, the holder comprising one or more graspers which grasp a portion of the adjusting mechanism, wherein the one or more graspers maintain coupling of the tool to the adjusting mechanism during restricting of the adjusting of the tissue-adjusting member by the locking mechanism.

6. The apparatus according to claim 1, wherein the selected tissue-adjusting member comprises the one or more artificial chordae tendineae coupled at least in part to the adjusting mechanism, and wherein the adjusting mechanism adjusts a tension of the one or more artificial chordae tendineae.

7. The apparatus according to claim 1, wherein the tool and the adjusting mechanism are configured to maintain coupling of the tool to the adjusting mechanism during restricting of the adjusting of the tissue-adjusting member by the locking mechanism.

8. The apparatus according to claim 7, wherein the longitudinally slidable coupling of the elongate member and the tool with respect to each other enables the elongate member to facilitate the locking of the adjusting mechanism while the tool remains coupled to the adjusting mechanism.

9. The apparatus according to claim 1, wherein the adjusting mechanism is shaped so as to define an opening shaped so as to receive a distal portion of the elongate member.

10. The apparatus according to claim 9, wherein the adjusting mechanism is shaped so as to define a threaded portion distal to the opening.

11. The apparatus according to claim 1, wherein the adjusting mechanism comprises a rotatable structure, and wherein the tool comprises a torque-delivering tool.

12. The apparatus according to claim 11, wherein:

the rotatable structure;

comprises a first end shaped to define a first opening,

comprises a second end having a lower surface shaped so as to define a second opening of the rotatable structure,

is shaped so as to define a channel extending from the first opening to the second opening, and

is shaped so as to define a first coupling at the lower surface of the second end of the rotatable structure, and

the locking mechanism further comprises a mechanical element having a surface coupled to the lower surface of the rotatable structure, the mechanical element being shaped to provide;

a second coupling configured to engage the first coupling during a resting state of the mechanical element, in a manner that restricts rotation of the rotatable structure, and

a depressible portion coupled to the second coupling, the depressible portion being disposed in communication with the second opening of the lower surface of the rotatable structure, and configured to disengage the first and second couplings.

13. The apparatus according to claim 12, wherein the elongate member is configured to depress the depressible portion and thereby to facilitate release the rotatable structure by the depressible portion disengaging the second coupling from the first coupling.

14. The apparatus according to claim 11, wherein the tissue-adjusting member is configured to be wound around the rotatable structure, wherein the tool comprises a numerical indicator configured to indicate a number of times the tissue-adjusting member is wound around the rotatable structure.

15. The apparatus according to claim 14, wherein:

prior to the actuation of the adjusting mechanism, at least a portion of the tissue-adjusting member is wound around a portion of the rotatable structure, and

the numerical indicator indicates a number of times the tissue-adjusting member is wound around the rotatable structure prior to the actuation of the adjusting mechanism.

16. The apparatus according to claim 1, wherein the tool is shaped so as to maintain coupling of the tool to the interface when the elongate member facilitates the locking of the adjusting mechanism.

17. A method, comprising:

providing;

an implant including a tissue-adjusting member selected from the group consisting of;

one or more artificial chordae tendineae and at least a portion of an annuloplasty ring structure, the implant further including an adjusting mechanism that is configured, upon actuation thereof, to adjust a tension of the tissue-adjusting member, the adjusting mechanism;

(1) including a locking mechanism configured to restrict adjusting of the tissue-adjusting member by the adjusting mechanism, and (2) being shaped so as to define an interface;

an elongate tool configured to;

directly contact a portion of the locking mechanism and by the contact apply an unlocking force to the portion of the locking mechanism to maintain the locking mechanism in an unlocked state during adjusting of the tension of the tissue-adjusting member by the adjusting mechanism, and

facilitate locking of the adjusting mechanism by the locking mechanism; and

a tool configured to actuate the adjusting mechanism via direct contact of the tool with the interface and application of an actuation force by the tool to the interface, while the elongate member applies the unlocking force to the portion of the locking mechanism, wherein the elongate member and the tool are longitudinally slidably coupled with respect to each other;

reversibly contacting the tool to the adjusting mechanism at the interface;

using the tool, actuating the adjusting mechanism to adjust the tension of the tissue-adjusting member; and

subsequently, using the locking mechanism, restricting the adjusting of the tissue-adjusting member by the adjusting mechanism.

18. The method according to claim 17, further comprising facilitating unlocking the adjusting mechanism using the elongate member.

19. The method according to claim 17, wherein the tool is shaped so as to maintain coupling of the tool to the interface when the elongate member facilitates the locking of the adjusting mechanism.

20. The method according to claim 17, wherein restricting the adjusting of the tissue-adjusting member by the adjusting mechanism comprises restricting the adjusting of the tissue-adjusting member by the adjusting mechanism while maintaining the contacting of the tool to the adjusting mechanism during the restricting.

21. The method according to claim 20, wherein maintaining the coupling of the tool to the adjusting mechanism comprises grasping a portion of the adjusting mechanism using one or more graspers coupled to a distal end of the tool.

22. The method according to claim 21, wherein, subsequently to the restricting, pulling the tool proximally to decouple the graspers from the portion of the adjusting mechanism and to decouple the tool from the adjusting mechanism.