Method and apparatus for thoracoscopic intracardiac procedures
First Claim
1. A system for closing a cardiac septal defect in a chamber of a patient'"'"'s heart having a muscular outer wall by passing an instrument through a percutaneous penetration in the patient'"'"'s chest wall and into a cardiac penetration in the muscular outer wall of the heart, said system comprising:
- a patch for securing across the cardiac septal defect to occlude blood flow therethrough;
an introducing instrument comprising an elongate shaft having a proximal end and a distal end, the distal end of the introducing instrument being configured for releasably holding the patch; and
an access device having a distal end positionable through a cardiac penetration in the outer wall of the heart, a proximal extremity configured to extend outside the chest through the percutaneous penetration in the chest wall with the distal end positioned in the cardiac penetration, and a passage therebetween adapted for introduction of the patch therethrough into the chamber using the introducing instrument, the proximal extremity being generally rigid to facilitate manipulation of the access device from outside the chest.
1 Assignment
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Accused Products
Abstract
Devices, systems, and methods are provided for accessing the interior of the heart and performing procedures therein while the heart is beating. In one embodiment, a tubular access device having an inner lumen is provided for positioning through a penetration in a muscular wall of the heart, the access device having a means for sealing within the penetration to inhibit leakage of blood through the penetration. The sealing means may comprise a balloon or flange on the access device, or a suture placed in the heart wall to gather the heart tissue against the access device. An obturator is removably positionable in the inner lumen of the access device, the obturator having a cutting means at its distal end for penetrating the muscular wall of the heart. The access device is preferably positioned through an intercostal space and through the muscular wall of the heart. Elongated instruments may be introduced through the tubular access device into an interior chamber of the heart to perform procedures such as septal defect repair and electrophysiological mapping and ablation. A method of septal defect repair includes positioning a tubular access device percutaneously through an intercostal space and through a penetration in a muscular wall of the heart, passing one or more instruments through an inner lumen of the tubular access device into an interior chamber of the heart, and using the instruments to close the septal defect. Devices and methods for closing the septal defect with either sutures or with patch-type devices are disclosed.
1278 Citations
26 Claims
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1. A system for closing a cardiac septal defect in a chamber of a patient'"'"'s heart having a muscular outer wall by passing an instrument through a percutaneous penetration in the patient'"'"'s chest wall and into a cardiac penetration in the muscular outer wall of the heart, said system comprising:
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a patch for securing across the cardiac septal defect to occlude blood flow therethrough; an introducing instrument comprising an elongate shaft having a proximal end and a distal end, the distal end of the introducing instrument being configured for releasably holding the patch; and an access device having a distal end positionable through a cardiac penetration in the outer wall of the heart, a proximal extremity configured to extend outside the chest through the percutaneous penetration in the chest wall with the distal end positioned in the cardiac penetration, and a passage therebetween adapted for introduction of the patch therethrough into the chamber using the introducing instrument, the proximal extremity being generally rigid to facilitate manipulation of the access device from outside the chest. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20)
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21. A system for closing an opening in tissue within a heart in a patient'"'"'s chest, the heart having a muscular outer wall, by passing an instrument through a percutaneous penetration in the patient'"'"'s chest, the system comprising:
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a patch for securing across the opening to inhibit blood flow therethrough; an introducing instrument comprising an elongate shaft having a proximal end and a distal end, the distal end being configured for releasably holding the patch; an access device having a distal end positionable through a cardiac penetration in the outer wall of the heart, a proximal extremity configured to extend outside the chest through a percutaneous penetration with the distal end positioned through the cardiac penetration, and an inner lumen therebetween, the patch being positionable through the inner lumen using the introducing instrument; and a sealing device cooperative with the distal end of the access device for inhibiting blood flow through the penetration in the muscular outer wall of the heart around the access device.
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22. A system for closing an opening in tissue within a heart in a patient'"'"'s chest by passing an instrument through a cardiac penetration formed in a muscular outer wall of the heart, the system comprising:
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a patch for securing across the opening to inhibit blood flow therethrough; an introducing instrument comprising a substantially rigid elongate shaft having a proximal end and a distal end, the distal end being configured for releasably holding the patch; and an access device having a distal end positionable through the cardiac penetration in the outer wall of the heart, a proximal extremity configured to extend outside the chest through a percutaneous penetration in the chest wall with the distal end positioned in the cardiac penetration, and an inner lumen therebetween, the patch being positionable through the inner lumen using the introducing instrument, wherein the distal end of the access device is provided with means for forming a seal against the outer wall of the heart to inhibit blood flow through the cardiac penetration in the outer wall of the heart.
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23. A system for closing an opening in tissue within a heart in a patient'"'"'s chest, the heart having a muscular outer wall, the system comprising:
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a patch for securing across the opening to inhibit blood flow therethrough; an introducing instrument comprising an elongate shaft having a proximal end and a distal end, the distal end being configured for releasably holding the patch; and an access device having a distal end positionable through a cardiac penetration in the outer wall of the heart, a proximal extremity configured to extend outside the chest through a percutaneous penetration in the chest wall with the distal end positioned in the cardiac penetration, a distal opening in the distal end, a proximal opening in the proximal extremity, and an inner lumen therebetween, the patch being positionable through the inner lumen using the introducing instrument, wherein the access device has a length of about 10-30 cm between the proximal and distal openings.
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24. A system for closing an opening in tissue within a heart in a patient'"'"'s chest, the heart having a muscular outer wall, the system comprising:
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a patch for securing across the opening to inhibit blood flow therethrough; an introducing instrument comprising an elongate shaft having a proximal end and a distal end, the distal end being configured for releasably holding the patch; a delivery sleeve having an interior lumen, the patch being removably positionable in the interior lumen when held by the introducing instrument, wherein the delivery sleeve is formed of a rigid, substantially inflexible material; and an access device having a distal end positionable through a cardiac penetration in the outer wall of the heart, a proximal extremity configured to extend outside the chest through a percutaneous penetration in the chest wall with the distal end positioned in the cardiac penetration, and an inner lumen between the distal end and the proximal extremity, the delivery sleeve being positionable through the inner lumen.
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25. A system for closing an opening in tissue within a heart in a patient'"'"'s chest, the heart having a muscular outer wall, the system comprising:
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a patch for securing across the opening to inhibit blood flow therethrough; an introducing instrument comprising an elongate shaft having a proximal end and a distal end, the distal end being configured for releasably holding the patch; an access device having a distal end positionable through a penetration in the outer wall of the heart, a proximal extremity configured to extend outside the chest through a percutaneous penetration in the chest wall with the distal end positioned in the cardiac penetration, and an inner lumen therebetween; and an obturator positionable in the inner lumen of the access device, the obturator having a distal end extendable from the distal end of the access device, the distal end of the obturator being configured to penetrate the outer wall of the heart.
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26. A system for closing an opening in tissue within a heart in a patient'"'"'s chest, the heart having a muscular outer wall, by passing an instrument through the chest wall and an intercostal space defined between adjacent ribs, the system comprising:
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a patch for securing across the opening to inhibit blood flow therethrough; an introducing instrument comprising an elongate shaft having a proximal end and a distal end, the distal end being configured for releasably holding the patch; and an access device having a distal end positionable through a cardiac penetration in the outer wall of the heart, a proximal extremity configured to extend outside the chest through the chest wall and the intercostal space with the distal end positioned in the cardiac penetration, and an inner lumen therebetween, the patch being positionable through the inner lumen using the introducing instrument, wherein the access device is formed at least in part of substantially rigid material selected from the group consisting of stainless steel, titanium, and a substantially inflexible polymer.
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Specification