Method and apparatus for thoracoscopic intracardiac procedures
First Claim
1. A method for closing a cardiac septal defect in a patient'"'"'s heart by passing at least one instrument through a first penetration in the patient'"'"'s chest and through a second penetration in the wall of the patient'"'"'s heart, said method comprising:
- forming a first penetration in the patient'"'"'s chest wall which passes into the patient'"'"'s thoracic cavity;
positioning a tubular access device percutaneously through the penetration in the chest wall and through an intercostal space;
forming a second penetration in the wall of the patient'"'"'s heart which passes into a cardiac chamber of the patient'"'"'s heart;
positioning at least a distal end of the tubular access device through the second penetration and into the cardiac chamber of the heart;
passing at least one instrument through an inner lumen of the access device, and out of the distal end of the access device into the cardiac chamber in the heart; and
using the instrument to close the septal defect.
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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.
1072 Citations
45 Claims
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1. A method for closing a cardiac septal defect in a patient'"'"'s heart by passing at least one instrument through a first penetration in the patient'"'"'s chest and through a second penetration in the wall of the patient'"'"'s heart, said method comprising:
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forming a first penetration in the patient'"'"'s chest wall which passes into the patient'"'"'s thoracic cavity; positioning a tubular access device percutaneously through the penetration in the chest wall and through an intercostal space; forming a second penetration in the wall of the patient'"'"'s heart which passes into a cardiac chamber of the patient'"'"'s heart; positioning at least a distal end of the tubular access device through the second penetration and into the cardiac chamber of the heart; passing at least one instrument through an inner lumen of the access device, and out of the distal end of the access device into the cardiac chamber in the heart; and using the instrument to close the septal defect. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28)
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29. A method for closing a cardiac septal defect of the type in which a patch of material is secured over the defect by Passing the patch through a first penetration in the patient'"'"'s chest wall and through a second penetration in the wall of the patient'"'"'s heart, wherein the method comprises:
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forming a first opening in a patient'"'"'s chest, the first opening passing through the chest wall and into the patient'"'"'s thoracic cavity; forming a second opening that passes through the wall of the heart and into an interior chamber of the heart; providing a patch and a cardiac septal defect repair instrument, the instrument supporting the patch; passing the patch and part of the instrument through the first opening in the chest wall and through the second opening in the wall of the heart until the patch is located within the interior chamber of the heart; and repairing the cardiac septal defect in the patient'"'"'s heart by securing the patch over the defect. - View Dependent Claims (30, 31, 32, 33, 34)
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35. A method for closing a cardiac septal defect by suturing the defect using an instrument introduced through a first opening passing through a patient'"'"'s chest and through a second opening passing through a muscular wall of the patient'"'"'s heart, the method comprising:
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forming a first opening in a patient'"'"'s chest, the first opening passing through the chest wall and into the patient'"'"'s thoracic cavity; forming a second opening that passes through the wall of the heart and into an interior chamber of the heart; retracting the wall of the heart to provide access to the septum having a defect to be closed; providing an instrument holding at least one needle carrying suture for suturing the defect closed; passing the instrument and needle carrying suture through the first opening in the chest wall and through the second opening in the wall of the heart to a location adjacent the defect; and manipulating the instrument to pass the needle and suture through the wall of the heart and then tensioning and securing the suture to close the septal defect. - View Dependent Claims (36, 37, 38, 39)
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40. A method for thoracoscopically repairing a cardiac septal defect in a patient'"'"'s heart by passing an instrument through a first penetration in the patient'"'"'s chest wall and through a second penetration in the wall of the patient'"'"'s heart, the method comprising:
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forming a first opening in a patient'"'"'s chest, the first opening passing through the chest wall and into the patient'"'"'s thoracic cavity; providing a cardiac access device having a distal end and a lumen in which is positioned an obturator with a cutting edge extendible out of the cardiac access device for penetrating tissue; positioning the cardiac access device and the obturator through the first opening so that the distal end of the cardiac access device is located in the thoracic cavity; contacting the cutting edge of the obturator with the wall of the heart and forming a second opening that passes through the wall of the heart and into an interior chamber of the heart; placing the distal end of the cardiac access device within the interior chamber of the heart and removing the obturator from the lumen of the cardiac access device; providing a cardiac septal defect repair instrument having a distal portion; positioning the cardiac septal defect repair instrument in the lumen of the cardiac access device and placing the distal end of the instrument into the interior chamber of the heart; and repairing the cardiac septal defect in the patient'"'"'s heart using the cardiac septal defect repair instrument. - View Dependent Claims (41, 42, 43, 44)
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45. A method for closing a cardiac septal defect in a heart, said method comprising:
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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 from a proximal end of the access device, through an inner lumen of the access device, and out of a distal end of the access device into a cardiac chamber in the heart, wherein one or more instruments are used to close the septal defect; and forming a hemostatic seal between the access device and the muscular wall of the heart to inhibit blood loss through the penetration in the muscular wall of the heart.
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Specification