DEVICES, SYSTEMS, AND METHODS FOR CLOSING THE LEFT ATRIAL APPENDAGE

• US 20090143791A1
• Filed: 01/30/2009
• Published: 06/04/2009
• Est. Priority Date: 03/30/2007
• Status: Active Grant

• Current Assignee: SentreHeart, LLC (Atricure, Inc.)
• Original Assignee: SentreHEART Incorporated (Atricure, Inc.)
• Inventors: SEIBER, Russell A., FUNG, Gregory W., MILLER, Gary H.
• Granted Patent: US 8,986,325 B2
• Time in Patent Office: Days
• US Class Current: 606/148
• CPC Class Codes: A61B 17/0467 Instruments for cutting sutures surgical cutting instruments A61B17/32
• CPC Class Codes: A61B 17/0469 Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 17/12009 Implements for ligaturing other than by clamps or clips, e.g. using a loop with a slip knot
• CPC Class Codes: A61B 17/12013 for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 2017/00243 cardiac
• CPC Class Codes: A61B 2017/00575 for closure at remote site, e.g. closing atrial septum defects
• CPC Class Codes: A61B 2017/00623 Introducing or retrieving devices therefor
• CPC Class Codes: A61B 2017/00867 shape memory effect for prostheses A61F2210/0014
• CPC Class Codes: A61B 2017/00876 magnetic
• CPC Class Codes: A61B 2017/0475 using sutures having a slip knot
• CPC Class Codes: A61B 2017/0477 with pre-tied sutures
• CPC Class Codes: A61B 2090/3966 Radiopaque markers visible in an X-ray image
• CPC Class Codes: A61M 25/10 Balloon catheters A61M25/0125 takes precedence; embolectomy A61B17/22032; retractors A61B17/02; inflatable balloons for placing stents or stent-grafts A61F2/958 ; stomach balloons for treatment of obesity A61F5/0003; oesophagal tubes A61J15/00

Abstract

Described here are devices, systems and methods for closing the left atrial appendage. Some of the methods described here utilize one or more guide members having alignment members to aid in positioning of a closure device. In general, these methods include advancing a first guide having a first alignment member into the left atrial appendage, advancing a second guide, having a second alignment member, into the pericardial space, aligning the first and second alignment members, advancing a left atrial appendage closure device into the pericardial space and adjacent to the left atrial appendage, and closing the left atrial appendage with the closure device. In these variations, the closure device typically has an elongate body having a proximal end and a distal end, and a closure element at least partially housed within the elongate body. The closure element comprises a loop defining a continuous aperture therethrough.

Claims

1. A method for closing a left atrial appendage comprising:

advancing a first guide through the vasculature, into the left atrial appendage, and out of the left atrial appendage;

advancing an expandable member into the left atrial appendage;

expanding the expandable member;

advancing a left atrial appendage closure device adjacent to the left atrial appendage from outside the heart, wherein the closure device comprises an elongate body and a closure element comprising a loop; and

closing the neck of the left atrial appendage with the closure element.

2. The method of claim 1, wherein the expandable member comprises a balloon.

3. The method of claim 2, wherein the balloon is echogenic.

4. The method of claim 1, wherein at least a portion of the expandable member has one or more apertures therein.

5. The method of claim 1, further comprising confirming satisfactory closure of the left atrial appendage.

6. The method of claim 1, wherein the first guide, expandable member, closure device, or combination thereof, is advanced under visualization.

7. The method of claim 1, wherein the first guide, expandable member, closure device, or combination thereof, is advanced over a guidewire.

8. The method of claim 1, wherein the closure device comprises a suture releasably coupled to the closure element.

9. The method of claim 8, wherein the suture comprises a slip knot.

10. The method of claim 9, further comprising tensioning the suture.

11. The method of claim 10, further comprising releasing the suture from the closure element.

12. The method of claim 11, further comprising severing the suture.

25. The method of claim 9, wherein the slip knot is a one-way slip knot.

13. A method for closing a left atrial appendage comprising:

advancing a first guide into the pericardial space and through the left atrial appendage;

advancing an expandable member into the left atrial appendage;

expanding the expandable member;

advancing a left atrial appendage closure device adjacent to the left atrial appendage, wherein the closure device comprises an elongate body and a closure element comprising a loop; and

closing the neck of the left atrial appendage with the closure element.

14. The method of claim 13, wherein the expandable member is a balloon.

15. The method of claim 14, wherein the balloon is echogenic.

16. The method of claim 15, wherein the balloon has one or more apertures therein.

17. The method of claim 13, further comprising confirming satisfactory closure of the left atrial appendage.

18. The method of claim 13, wherein the first guide, expandable member, closure device, or combination thereof, is advanced under visualization.

19. The method of claim 13, wherein the first guide, expandable member, closure device, or combination thereof, is advanced over a guidewire.

20. The method of claim 13, wherein the closure device comprises a suture releasably coupled to the closure element.

21. The method of claim 20, wherein the suture comprises a slip knot.

22. The method of claim 21, further comprising tensioning the suture.

23. The method of claim 22, further comprising releasing the suture from the closure element.

24. The method of claim 23, further comprising severing the suture.