Source: http://www.google.es/patents/US9724105
Timestamp: 2017-11-21 15:42:07
Document Index: 582041342

Matched Legal Cases: ['Application No. 10', 'Application No. 12', 'Application No. 14', 'art 2', 'Application No. 2006', 'Application No. 2002', 'Application No. 2006', 'art 91', 'art 78', 'art 2', 'art 91', 'art 94', 'Application No. 00957904', 'Application No. 04', 'art 86', 'art 92']

Patente US9724105 - Methods and apparatus for transpericardial left atrial appendage closure - Google Patentes
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...http://www.google.es/patents/US9724105?utm_source=gb-gplus-sharePatente US9724105 - Methods and apparatus for transpericardial left atrial appendage closure
Número de publicación US9724105 B2
Número de solicitud US 14/604,632
También publicado como US6488689, US7226458, US7318829, US8974473, US20020049457, US20020099390, US20020103492, US20020111637, US20080125795, US20150157330
Número de publicación 14604632, 604632, US 9724105 B2, US 9724105B2, US-B2-9724105, US9724105 B2, US9724105B2
Citas de patentes (555), Otras citas (330), Clasificaciones (13), Eventos legales (1)
US 9724105 B2
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.
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.
The present application is a continuation of U.S. patent application Ser. No. 11/944,522, filed Nov. 23, 2007, which is a continuation of U.S. patent application Ser. No. 10/105,978, filed Mar. 25, 2002, which issued as U.S. Pat. No. 7,318,829 on Jan. 15, 2008, which is a divisional of U.S. patent application Ser. No. 10/007,364, filed Nov. 5, 2001, which issued as U.S. Pat. No. 7,226,458 on Jun. 5, 2007, which is a divisional of U.S. patent application Ser. No. 09/315,601, filed May 20, 1999, which issued as U.S. Pat. No. 6,488,689 on Dec. 3, 2002.
For that reason, alternative procedures which do not require opening of the patient's chest, i.e., a large median stemotomy, have been proposed. U.S. patent No. 3,306,234 to Johnson describes a thoracoscopic procedure where access to the pericardial space over the heart is achieved using a pair of intercostal penetrations (i.e., penetrations between the patient's ribs) to establish both visual and surgical access. While such procedures may be performed while the heart remains beating, they still require deflation of the patient's lung and that the patient be placed under full anesthesia. Furthermore, placement of a chest tube is typically required to reinflate the lung, often requiring a hospitalization for a couple of days.
U.S. Pat. No. 5,865,791, to Whayne et al. describes a transvascular approach for closing the left atrial appendage. Access is gained via the venous system, typically through a femoral vein, a right internal jugular vain, or a subclavian vein, where a catheter is advanced in an antegrade direction to the right atrium. The intra-atrial septum is then penetrated, and the catheter passed into the left atrium. The catheter is then positioned in the vicinity of the left atrial appendage which is then fused closed, e.g., using radiofrequency energy, ether electrical energy, thermal energy, surgical adhesives, or the like. Whayne et al. further describes a thoracoscopic procedure where the pericardium is penetrated through the rib cage and a lasso placed to tie off the neck of the left atrial appendage. Other fixation means described include sutures, staples, shape memory wires, biocompatible adhesives, tissue ablation, and the like. The transvascular approach, suggested by Whayne et al. is advantageous in that it avoids the need to penetrate the patient's chest but suffers from the need to penetrate the intra-atrial septum, may not provide definitive closure, requires entry into the left atrial appendage which may dislodge clot and requires injury to the endocardial surface which may promote thrombus formation. A thoracoscopic approach which is also suggested by Whayne et al. suffers from the same problems as the thoracoscopic approach suggested by Johnson.
FIG. 10 illustrates an exemplary kit including a closure device and optional components acconding to the present invention.
FIG. 1 is an anterior view of a heart illustrating the right ventricle RV, the left ventricle LV, and the left atrial appendage LAA. The methods and apparatus of the present invention are intended to place a closure structure over or otherwise close of the base region BR of the left atrial appendage. By closing off the base region BR, the exchange of materials between the left atrial appendage LAA and the left atrium LA will be stopped. Thus, the release of emboli from the left atrial appendage into the left atrium will be stopped.
While the closure tool may have any of a wide variety of designs, the presently preferred tool, is shown in FIG. 3A. The tool comprises a grasper 30 and a capture loop 32. Capture loop 32 is attached to a manipulation wire 34 which permits the loop 32 to be advanced over the forward end of the grasper to encircle and close the left atrial appendage, as will be described in more detail below. The grasping tool 30 may be manipulated using a thumb guide 40, while the capture loop 32 may be manipulated using a second thumb guide 42, both of which are located on the handle 18.
Referring now to FIGS. 7A-7C, an exemplary clip 300 for use in the methods of the present invention will be described. The clip 300 has a generally U-shaped profile, as best seen in FIG. 7A, optionally having a serpentine or zig-zag profile on at least one of the legs of the clip. As illustrated, a series of peaks and valleys 302 is provided on an “upper” leg of the clip. The clip 300 further includes a hinge region 304 which has a narrowed width to facilitate introduction through a introducer catheter 400, as shown in FIG. 8. Introducer catheter 400 has a I-shaped lumen 402 which receives the clip 300 so that the upper leg and lower leg of the clip are held in an open configuration in upper and lower tracks of the lumen, as described below in connection with FIGS. 9A-9C. Optionally, the catheter 400 may include a radiopaque marker 404 to permit orientation under fluoroscopic imaging (so the position can confirm that the clip is in the proper vertical orientation when being placed). A pusher 408 is provided having a I-shaped distal end 410 which is received in the I-shaped lumen 402 in order to advance and eject the dip from the catheter.
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