Methods and apparatus for transpericardial left atrial appendage closure

• US 9,724,105 B2
• Filed: 01/23/2015
• Issued: 08/08/2017
• Est. Priority Date: 05/20/1999
• Status: Expired due to Fees

• Current Assignee: SentreHeart, LLC (Atricure, Inc.)
• Original Assignee: SentreHEART Incorporated (Atricure, Inc.)
• Inventors: Bajor, Jordan T., Kaplan, Aaron V.
• Primary Examiner(s): Woo, Julian W
• Application Number:
  US14/604,632
• Publication Number:
  US 20150157330A1
• Time in Patent Office: 928 Days
• 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 17/12 for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord specially adapted for vas deferens or fallopian tubes A61F6/20; materials for ligaturing blood vessels A61L17/00
• CPC Class Codes: A61B 17/12013 for use in minimally invasive surgery, e.g. endoscopic surgery
• 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 2017/00243 cardiac
• CPC Class Codes: A61B 2017/320048 Balloon dissectors

Abstract

Methods for closing a left atrial appendage rely on introducing a closure tool from a location beneath the rib cage, over an epicardial surface, and to the exterior of the left atrial appendage. The closure device may then be used to close the left atrial appendage, preferably at its base, by any one of a variety of techniques. One specific technique uses graspers and a closing loop. Methods may include advancing a closure tool adjacent to the left atrial appendage using a sub-xiphoid approach and closing the left atrial appendage using the closure tool. Methods may also include advancing a loop adjacent to the left atrial appendage using a sub-xiphoid approach and closing the left atrial appendage using the loop.

Claims

1. A method for closing a left atrial appendage of a patient'"'"'s heart, said method comprising:

advancing a closure tool adjacent to the left atrial appendage using a sub-xiphoid approach; and

closing the left atrial appendage using the closure tool.

2. The method of claim 1, wherein closing comprises looping, suturing, stapling, clipping, riveting, clamping, or fusing the left atrial appendage at a neck region thereof.

3. The method of claim 2, wherein closing further comprises engaging the left atrial appendage prior to closing the neck region thereof.

4. The method of claim 1, wherein the method is performed while the patient'"'"'s heart is beating.

5. The method of claim 4, wherein the method is performed while both lungs of the patient remain inflated.

6. The method of claim 5, wherein the method is performed while the patient is under a local anesthetic.

7. The method of claim 1, further comprising separating the parietal pericardium from the visceral pericardium near the left atrial appendage prior to closing the left atrial appendage to create a space over the left atrial appendage.

8. The method of claim 7, further comprising viewing the left atrial appendage through the space.

9. The method of claim 1, wherein advancing further comprises advancing a distal end of the closure tool through a sheath, into the pericardial space, and over an epicardial surface.

10. The method of claim 1, wherein the closure tool comprises a shaft and a closure loop, and wherein closing the left atrial appendage comprises advancing the closure loop over the left atrial appendage and cinching the loop.

11. The method of claim 1, wherein the closure tool comprises a shaft and a clip, and wherein closing the left atrial appendage comprises advancing the clip over a distal end of the left atrial appendage and closing the clip.

12. A method for closing a left atrial appendage of a patient'"'"'s heart, said method comprising:

advancing a loop adjacent to the left atrial appendage using a sub-xiphoid approach; and

closing the left atrial appendage using the loop.

13. The method of claim 12, wherein closing comprises suturing the left atrial appendage at a neck region thereof.

14. The method of claim 13, wherein closing further comprises engaging the left atrial appendage prior to closing the neck region thereof.

15. The method of claim 12, wherein the method is performed while the patient'"'"'s heart is beating.

16. The method of claim 15, wherein the method is performed while both lungs of the patient remain inflated.

17. The method of claim 16, wherein the method is performed while the patient is under a local anesthetic.

18. The method of claim 12, further comprising separating the parietal pericardium from the visceral pericardium near the left atrial appendage prior to closing the left atrial appendage to create a space over the left atrial appendage.

19. The method of claim 18, further comprising viewing the left atrial appendage through the space.

20. The method of claim 12, wherein advancing further comprises advancing the loop through a sheath, into the pericardial space, and over an epicardial surface.