Delivering a conduit into a heart wall to place a coronary vessel in communication with a heart chamber and removing tissue from the vessel or heart wall to facilitate such communication

• US 20070233225A1
• Filed: 09/29/2006
• Published: 10/04/2007
• Est. Priority Date: 02/13/1998
• Status: Active Grant

• Current Assignee: Alan Rapacki, Darin Gittings, Gilbert Laroya, Mark Foley
• Original Assignee: Alan Rapacki, Darin Gittings, Gilbert Laroya, Mark Foley
• Inventors: Gittings, Darin, Rapacki, Alan, Foley, Mark, Laroya, Gilbert
• Granted Patent: US 7,993,356 B2
• Time in Patent Office: Days
• US Class Current: 623/1.120
• CPC Class Codes: A61B 17/3468 for implanting or removing devices, e.g. prostheses, implants, seeds, wires devices for implanting seeds A61M37/0069
• CPC Class Codes: A61B 2017/00247 Making holes in the wall of the heart, e.g. laser Myocardial revascularization
• CPC Class Codes: A61B 2017/00252 for by-pass connections, i.e. connections from heart chamber to blood vessel or from blood vessel to blood vessel
• CPC Class Codes: A61B 2018/00392 Transmyocardial revascularisation
• CPC Class Codes: A61B 2090/062 penetration depth
• CPC Class Codes: A61F 2/064 with special features to facilitate anastomotic coupling anastomosis of natural blood vessels A61B17/11
• CPC Class Codes: A61F 2/2493 Transmyocardial revascularisation [TMR] devices
• CPC Class Codes: A61F 2/90 characterised by a net-like or mesh-like structure
• CPC Class Codes: A61F 2/94 Stents retaining their form, i.e. not being deformable, after placement in the predetermined place
• CPC Class Codes: A61F 2/9517 handle assemblies therefor
• CPC Class Codes: A61F 2/966 with relative longitudinal movement between outer sleeve and prosthesis, e.g. using a push rod
• CPC Class Codes: A61F 2002/30079 magnetic
• CPC Class Codes: A61F 2002/30617 Visible markings for adjusting, locating or measuring
• CPC Class Codes: A61F 2210/009 magnetic
• CPC Class Codes: A61F 2250/0097 Visible markings, e.g. indicia

Abstract

Devices and methods for delivering conduits into the wall of a patient'"'"'s heart to communicate a coronary vessel with a heart chamber. The devices are passed through the coronary vessel and the heart wall to place the conduit and establish a blood flow path between the vessel and the heart chamber. Additional devices and methods are provided for removing tissue from a coronary vessel or the heart wall to establish a flow path between the coronary vessel in communication with the heart chamber.

Claims

1. A device for delivering a conduit into the wall of a patient'"'"'s heart to place the conduit to place the conduit in communication with a heart chamber, the device comprising:

a support member having a length, a proximal end and a distal end;

a conduit supported by the support member;

a sheath overlying at least a portion of the conduit, the sheath being movable to selectively expose the portion of the conduit covered by the sheath; and

wherein the sheath is moved to expose said portion of the conduit upon positioning the support member and conduit at a desired location within the wall of the heart.

2. The device of claim 1, wherein the support member is substantially straight and rigid over the length and has a sharpened tip for forming an opening in the heart wall.

3. The device of claim 2, wherein the support member has a tapered portion for dilating the opening formed by the distal end of the shaft.

4. The device of claim 2, wherein the support member comprises a hollow member that removably receives a dilator having the sharpened tip for forming an opening in the heart wall.

5. The device of claim 1, wherein the conduit comprises a rigid and non-expandable tubular member, and the sheath comprises a sleeve overlying the conduit.

6. The device of claim 5, wherein the conduit has two open ends and a plurality of openings disposed between the two ends.

7. The device of claim 1, further comprising a positioning member that provides a visual indication of the position of the conduit with respect to the heart wall.

8. The device of claim 1, wherein the positioning member is configured to engage a tissue surface and is supported adjacent the distal end of the shaft, the positioning member being movable between collapsed and expanded orientations.

9. The device of claim 1, wherein the positioning member is configured to engage a surface of the heart wall and is supported by the sheath.

10. The device of claim 9, wherein the sheath has a large diameter section that comprises the positioning member.

11. The device of claim 1, wherein the conduit comprises an expandable tubular element and the sheath comprises a retractable sleeve that overlies the tubular element.

12. The device of claim 11, wherein the expandable tubular element comprises a stent and the support member comprises a shaft on which the stent is mounted, and the shaft includes an expansion mechanism for expanding the stent.

13. A device for delivering a conduit to a selected location in the wall of a patient'"'"'s heart to place the conduit in communication with a heart chamber, the device comprising:

a support member having a length, a proximal end and a distal end;

a conduit disposed on the support member; and

a positioning member provided on the support member, the positioning member configured to indicate placement of the conduit in a selected position within the heart wall;

wherein the positioning member is disposed a predetermined distance from the conduit and the position of the conduit relative to the heart wall is determined by the position of the positioning member relative to the heart wall.

14. A device for delivering a conduit though the wall of a patient'"'"'s heart and the wall of a coronary vessel to communicate a heart chamber with the coronary vessel, the device comprising:

a support member configured for placement through the wall of a hear so that a portion of the support member extends into a heart chamber;

an expandable conduit sized and configured for placement in the heart wall so as to communicate the heart chamber with a coronary vessel, wherein the conduit is supported on the support member in a collapsed orientation and is expanded to an expanded orientation for placement in the heart wall; and

wherein the support member has an expansion mechanism that engages the conduit and is actuated to move the conduit from the collapsed orientation to the expanded orientation to securely position the conduit in the heart wall.

15. The device of claim 14, wherein the distal end of the support member is sharpened for forming an opening in the wall of the heart, and the support member has a section that is tapered for dilating the opening formed by the distal end.

16. The device of claim 14, wherein the support member comprises a hollow member that removably receives a dilator having a sharpened tip for forming an opening in the heart wall.

17. The device of claim 14, further comprising a positioning member for engaging tissue to control the position of the conduit with respect to the heart wall.

18. The device of claim 17, further comprising a sheath disposed over the conduit so as to substantially cover the exterior of the conduit.

19. The device of claim 18, wherein the sheath is a retractable sleeve and the positioning member is supported by the sheath.

20-29. -29. (canceled)

30. A method for placing and expanding a conduit in the wall of a patient'"'"'s heart, the method comprising steps of:

(a) providing a support member and a conduit, the conduit being supported in a collapsed orientation and movable to an expanded orientation;

(b) placing the support member .and the conduit in a wall of a patient'"'"'s heart;

(c) positioning the conduit within the wall of the heart;

(d) expanding the conduit to the expanded orientation; and

(e) removing the support member and leaving the conduit in the wall of the heart.

31. The method of claim 30, wherein the conduit is passed through a wall of a coronary vessel and through the wall of the heart into a heart chamber containing oxygenated blood, the conduit placing the heart chamber in communication with the interior of the coronary vessel.

32. The method of claim 31, wherein the coronary vessel is a coronary artery and the heart chamber is the left ventricle.

33. The method of claim 31, wherein the conduit is positioned in the wall of the heart so that one end of the conduit extends partially into the heart chamber.

34. The method of claim 30, further comprising a positioning member for engaging the heart wall to control the position of the conduit with respect to the heart wall.

35-58. -58. (canceled)

59. A method for introducing a medical device through a coronary vessel and the wall of a patient'"'"'s heart to perform a medical procedure, the method comprising steps of:

positioning a guide member through a coronary vessel and the wall of a patient'"'"'s heart into a heart chamber;

providing a medical device configured to carry out a medical procedure on the heart; and

using the guide member to introduce the medical device into the heart wall.