Source: https://patents.google.com/patent/WO2004019825A1/en
Timestamp: 2018-06-18 06:37:00
Document Index: 516613578

Matched Legal Cases: ['art 6', 'arts 6', 'art 6', 'art 6', 'arts 6', 'art 6', 'art 6', 'art 6', 'art 6', 'arts 6', 'arts 6', 'art 6', 'arts 6', 'art 6', 'art 6', 'art 6', 'art 6', 'art 6', 'art 6', 'art 6', 'art 6', 'art 6', 'art 6', 'arts 6']

WO2004019825A1 - Device for the implantation and fixing of heart valve prostheses - Google Patents
WO2004019825A1
WO2004019825A1 PCT/DE2003/002669 DE0302669W WO2004019825A1 WO 2004019825 A1 WO2004019825 A1 WO 2004019825A1 DE 0302669 W DE0302669 W DE 0302669W WO 2004019825 A1 WO2004019825 A1 WO 2004019825A1
PCT/DE2003/002669
A device for implantation and fixation of prosthetic heart valves
The invention relates to a device for implantation and fixation of prosthetic heart valves having a self-expandable anchoring support attached to a heart valve prosthesis, which may be at the heart valve prosthesis to a biological or mechanical heart valve prosthesis.
You can transluminal implanted and are used both for implantation of a prosthetic heart valve as Aortenoder pulmonary valve.
Starting from heart valve prostheses implants in which a surgical opening of the chest of patients was required and must- be connected to a heart-lung machine during the period of surgery, the respective patient te, which was ruled out for a large number of patients at risk and a lengthy postoperative phase of treatment required, searched for solutions such as those implants were done minimally invasively.
To this end, various solutions are known. So 195 46 692 C2 a self-expandable heart valve prosthesis for implantation in the human body is known about a catheter system with a heart valve and a heart valve attached to the collapsible and expandable stent in DE. advertising such a self-expandable prosthetic heart valve can be guided by means of a catheter system through a groin artery up to the implantation site in the heart of the. Upon reaching the implantation site can then such a stent, which is composed in its longitudinal direction of several relative to each other angled self-expanding .Stent segments are deployed successively. After unfolding the heart valve prosthesis can be anchored at least in the heart region close to the respective blood vessel, with the support of anchoring hooks.
The actual heart valve prosthesis is in this case directly in the proximal region of the stent.
In DE 100 10 074 Al a device for fastening and anchoring of cardiac valve prosthesis is described which is formed substantially from drahtfδrmigen interconnected elements. Different brackets are used to achieve a secure fastening and supporting a heart valve prosthesis. The device described therein uses three pairs of respectively identical stirrups, which are arranged in a respective interval of 120 ° of the zueinan-. These brackets are mutually connected by solid joints, whereby the solid articulations fulfill the function of pivot bearings.
In addition, oppositely curved brackets are pre hands which form equally long lever arms as possible in order to achieve a safe system of ironing even at peristaltic schematically movements of the heart and blood vessel, and a reliable seal of an implanted and fixed heart valve prosthesis.
In the known solutions, however, there is a risk of incorrect implantation of heart valves. This relates primarily to the exact positioning and orientation of angula- re Herzklappenpro- to be implanted prostheses. It is with the known solutions, the removal of an incorrectly positioned th implantable prosthetic heart valve, if at all, only very expensive possible, in which case at least one further surgery may be required.
Such faulty implants lead to leaks
(Regurgitation) and accordingly substantial burdens of the ventricle. If, for example, implantation of a heart valve prosthesis too far above the actual heart valve plane, it can for closing the outlets of the coronary arteries (coronary arteries) and thus to a fatal coronary ischemia with myocardial infarction.
Upon implantation techniques in which Herzklappenpro- prostheses have heretofore been guided through a minimally invasive arterial strips to the implantation site in the heart, is carried out by means of the introduction of a guide wire and with the aid of catheters, whereby conventional balloon catheters have been used.
In such a procedure, the insertion through fluoroscopy (cath lab = HKL) and ultrasound (Transesophageal Echocardiogram = TEE) was.
Despite these tools, however, can not be assured that with the conventional solutions, the necessary lateral positioning accuracy and especially the angular position of heart valve prostheses with a correspondingly attached thereto fasteners could be achieved, in particular, a corresponding angular displacement of a risk for the patient because of a possible occlusion of can display coronary arteries.
advertising in particular act at a Aortenherzklappenprothe- se considerable forces during the filling phase of the cardiac cycle (diastole), so that a secure anchoring is required and detachment of the prosthetic heart valve and anchor elements prevents the need.
It is therefore Proceeding from this, the object of the invention to provide ways to be able to implant prosthetic heart valves minimally invasive with increased positioning accuracy of a ventricle of a patient.
According to the invention this object is achieved with a device having the features of claim 1, Ge dissolves. Advantageous embodiments and developments of the invention can be achieved with the designated in the subordinate claims.
The inventive device for implantation and
Fixing of heart valve prostheses fixed with a self-expandable to an anchoring support (stent) prosthetic heart valve is adapted here that the anchoring support is received in a catheter connectable to a cartridge in the folded form. The anchoring support should thereby be compressed so that all parts have a certain degree of a radially outwardly acting bias effect the self-expansion after release by a cartridge.
Anchoring support with heart valve prosthesis can then be implanted together with the cartridge by means of a catheter through a groin aorta conventional GR ge. support of the invention be used according to the anchoring support bracket are formed on the proximal side. These support bars are then inserted into the pockets of heart valves of the individual patient during the actual implantation procedure, while the pockets of the heart valve of a patient to form an abutment in that the proximal insertion counteracts, so that the Verankerungsstü ze is laterally positioned exactly with heart valve prosthesis. At the same time it is ensured that anchoring support and
Heart valve prosthesis can take an exact angular position, as this quasi represent the bags during insertion of a guide for the support bracket.
The characteristic effects can be achieved, are achieved by a predefinable first motion of the cartridge only the support bracket of the anchoring support given free and straighten radially outwards and the other elements of the anchoring support within the cartridge be kept pressed together in the folded form.
Only after the support brackets have been introduced into the pockets of the heart valve of the patient and the final position has been reached for the implantation to be by a second movement of the cartridge and / or the catheter used and the other elements of the anchoring support with heart valve prosthesis to its fully released expansion and anchoring of the anchoring support and is reached exactly the cheapest and best place secure attachment of the heart valve prosthesis.
Faulty implants as they were possible in the known solutions, can thus be excluded. Furthermore, there is compared to the known solutions, but also the opportunity to cancel a non-leading to the success of implantation of heart valve prostheses and to remove the device by retracting the catheter again, whereby this already folded unfolded support bracket again and returned to a cartridge or a portion of a cartridge can be.
However, the device according to the invention can also be formed by Kommissurenbügel are additionally provided on the anchoring support.
In this case include the Kommissurenbügel to elements of the anchoring support to be released only at a second subsequent movement of the cartridge and / or the catheter to its expansion, when the support bracket has been correctly inserted position in the pockets of a heart valve.
Upon deployment of the Kommissurenbügel parts of the old heart valve of the patient in each case between a support and a Kommissurenbügel then pass, so that the respective portions of the old heart valve between the two ironing after the unfolding of the anchoring support to be clampingly held, similar to having a paper between is the brackets of a paper clip of the case.
In particular for the subsequent cartridge and catheter means and actuators to be performed movements which result in the sequential release of the individual elements of the anchoring support, it is advantageous zen einzuset- a multi-part cartridge, whereby at least two individual parts can each be moved relative to each other.
Thus, the movements to be performed for the self-expansion of a cartridge or individual parts of a cartridge may for example be a proximal and / or distal displacement, which can be carried out in several sequentially carried out step, wherein each different paths to be covered to the corresponding parts at the time of implantation one after the other free for their expansion.
For example, the first movement may be a dista- les retraction of the cartridge or a portion of a cartridge.
In this case, then, should this be necessary in order to avoid incorrect implantation proximal movement of the cartridge or a
Part of a cartridge be used in order that the removal of the device from the patient is already deployed radially collapse again and receive in the interior of the cartridge outward-acting with a biasing force supporting yoke, so possible.
see as actuating elements for a manipulation and accordingly, a displacement movement of the Kartu- or individual parts of the cartridge can Bowman denzüge or flexible pusher tubes are used, which are guided through the interior of the catheter to the cartridge or a portion of the cartridge may be employed.
Such actuators may actuating elements also mounting flange, or, for example, eyelets, which are provided on the anchoring support, attack.
Such fasteners can also be used alone or in addition used for fixing the anchor post at the respective blood vessel.
In order to allow a delayed deployment of support brackets, may be on the cartridge slots is excluded, an unfolding of the support bracket is made possible by the initialization according to the first movement of the cartridge.
Such slots may Told in unterschiedlichster GES, starting from an end face on the cartridge in a straight form, be formed in obliquely inclined angles or in a curve shape (waveform).
The release of the support bracket for their deployment can be effected by proximally open slots of a cartridge or a portion of a cartridge when the cartridge or a corresponding part of a cartridge moves in a distal direction, is so withdrawn or for example a rotary movement about the longitudinal axis the cartridge can be carried out, so that the respective slots are aligned with respect to the support brackets so that the support bracket can develop by the free slots.
but such slits can also be held temporarily covered by another part of a cartridge to by a corresponding relative movement of the individual parts cartridge in a proximal or distal direction, or a rotation about the longitudinal axis of the slits are released and the support bracket can be deployed.
In this case, can at the portion of a cartridge, in which no slots are formed, these slots may be formed exceeds wide webs that prevent release of the support bracket to be inserted into the pockets in the heart valve of a patient and the release of the support bracket to its deployment only can be carried out a cartridge according to a corresponding relative movement of the respective parts.
Present on an anchoring support support bracket and the Kommissurenbügel should be curved convex and curved in a proximal direction and by such a rounded shape of the blood vessel injuries can be avoided at the heart and facilitate the deployment in the self-expansion. the support bracket can be easily implemented with such a design according to the pockets of the old heart valve also without corresponding injury to the tissue in or all blood vessels can be reported.
An anchoring supports as well as additional stabilizing bracket may be present, with which an increase in strength after the self-expansion of the anchored anchoring support is achievable.
Such stabilizing brackets can be advantageous because of the utilization of the necessary self-expansion effect on an anchoring support for a secure fixation of the anchoring support with heart valve prosthesis, taking into account the fact that during the phase of inserting a folded within a cartridge anchoring support smallest possible volumes are achieved müs- sen, small cross-sections must be met for each bracket.
All Ironing an anchoring support should be DA located, designed and dimensioned in such a way that iron the sequential release of supporting and reaches the other ironing with optionally further provided on an anchoring support elements and the heart valve prosthesis with the appropriate manipulation of cartridge and / or catheter can be. In this case, the design of the cartridge or at least a portion of a cartridge should of course be taken into account, these slots can apply overlapping webs, for example, to the already-mentioned slots and.
According to the anatomy arranged on the anchoring support three mutually at equal angular intervals support bracket should be available.
Accordingly, three Kommissurenbügel may be present, with the minimum number of existing on an anchoring support Kommissurenbügeln JE but should be two.
The support and the Kommissurenbügel can be arranged would be because of an anchoring support in each case the same angle, so that in each case a support bracket inserted into a respective pocket of the old heart valve, and the corresponding Kommissurenbügel then the portion of the heart valve in connection with the support bracket clampingly from Kommissurenbügel is maintained.
There is also the possibility that the existing on an anchoring support supporting and Commission are acids temple each arranged in an angular offset to each other.
In this case, the support bars are then inserted with their proximal portions in the pockets of an old heart valve in the implanted state and the old heart valve can then be so held clamped with support brackets that a Kommissurenbügel with two adjacent support brackets holding two parts of the old heart valve clampingly ,
The stability of an implanted and fixed anchoring support can be increased by at least one ring support, which can be an element on an anchoring support.
Thus, there is a possibility the support at a mooring different existing bow, preferably to connect at their base support points with such a ring carrier. It is not absolutely necessary to provide a connection between the ring support and all shackles of an anchoring support.
However, an anchor post with an additional ring carrier can also be formed so that a ring carrier at a distance to the plane in which the heart valve prosthesis is fixed to the anchoring support, for example is arranged with longitudinal ridges. Such a ring carrier should then have a support structure that is z-shaped, wavy or meander-shaped.
The erf indungsgemäße device can also eingeset together with a balloon catheter zt. With the balloon catheter, the old heart valve may prior to
Self-expansion of the anchoring support to be pushed away.
1 shows in schematic form an example of an implanted anchoring support;
2 shows in schematic form an implantation of an anchoring support with heart valve prosthesis;
Figures 3a to 3d four temporally subsequent phases upon implantation of a heart valve prosthesis;
Figure 4 in perspective view a playing examples for anchoring support;
5 shows another example of an anchoring support;
6 shows a further example of an anchoring support;
7 shows a further example of an anchoring support;
8 shows a further example of an anchoring support;
Figure 9 approximately support another example of an anchoring; Figure 10 is a representation of a teilentfalteten anchoring support within a cartridge;
11 shows a further teilentfaltete anchoring support in a cartridge according to Figure 10;
Figure 12 is a fully self-expands deployed anchoring support outside a cartridge according to Figures 10 and 11;
13 shows an example of a multi-part cartridge;
Figure 14 is a teilentfaltete anchoring support in a cartridge according to Figure 13;
Figure 15 is a vollentfaltete anchoring support outside a cartridge according to the figures 13 and 14;
16 shows another example of a cartridge;
17 shows a cartridge according to Figure 16 with teilentfalteter anchoring support;
18 shows a cartridge according to the figures 16 and 17 with further deployed anchoring support;
Figure 19 is a vollentfaltete anchoring support outside a cartridge according to the examples of figures 16 to 18 and
20 shows another example of a multi-part cartridge.
Figure 1 shows an example of an implanted anchor post 1 with a plane spanned thereon heart valve prosthesis 4 in a schematic representation.
In this case, provided on the anchoring support 1 shown here, the support bracket 2, which engage after insertion into the pockets of the old heart valve of the patient.
In addition, three Kommissurenbügel 3 are provided on the anchoring support 1 here present, the exercise also after expansion radially outwardly acting forces and at the same time in addition to a certain anchoring effect of the anchoring support 1 parts of the old heart valve of the patient, the missurenbügeln between the com- 3 and the support brackets 2 are arranged to hold a clamping manner.
In the example shown here, an anchoring support 1, the latter has a distal ring carrier 5, which is designed as z-shaped support structure on. These support structure has self-expanding properties.
With Figure 2 will be illustrated in schematic form how an anchoring support with heart valve 1 penprothese can be implanted through the strips 4 transvascularly aorta.
With the two additional openings, as shown in Figure 2, to be again illustrates how the support bracket 2 an anchoring support 1 may be introduced into the pockets of an old heart valve of a patient and subsequently, after complete expansion / unfolding of the anchoring support 1, a chucking the heart valve prosthesis 4 is achievable. In the figures 3a to 3d, a plurality of temporally subsequent phases in the transvascular implantation of a prosthetic heart valve are shown.
Figure 3a shows the transvascular introducing an anchoring support 1 along a guide wire 15 which is folded in a cartridge 6 on a relatively small volume, said cartridge 6, and a not explicitly shown here catheter has outer dimensions smaller than the inner diameter of the transvascular for is used implant blood vessel.
The insertion of the cartridge 6 with anchoring support 1 may in this case be controlled in the usual form by means of X-ray and ultrasound technology.
Achieves the cartridge 6 in about the position for the actual implantation will see at the Kartu- 6 or by means of a catheter performed a defined predeterminable movement which, as is illustrated in Figure 3b, results in the release and deployment of the support bracket 2, and this thereby unfold radially outward. Thereafter, the entire device is displaced by the respective blood vessel, usually the aorta strips or the pulmonary artery in a proximal direction, so that the support bracket 2 engage behind the old heart valve of the patient and introduced into the pockets of the heart valve. Touch the support bracket 2 with its proximal end sides of the base points of the pockets of the old heart valve there has been a noticeable resistance.
Subsequently at least a further movement may be carried out with the cartridge 6, or a catheter which releases further elements of the anchoring support 1 and leads to their radially outward deployment.
Thus, as this is illustrated by Figure 3c, radial delayed only released by appropriate relative movement of the cartridge 6 and anchoring support 1 Kommissurenbügel 3 for the deployment of the cartridge 6 to the outside when the Stützbü- gel 2 of the pockets of the old heart valve each patient have been introduced. As a result, the entire anchoring support 1 with all its elements in both the lateral direction as precisely positioned in its angular position and is represented by the fully continuous deployment of the anchoring support 1, after complete deployment as 3d in figure, can secure attachment the anchoring support with heart valve prosthesis 1 4 can be achieved, and subsequently the catheter to the cartridge 6 by pulling to be removed again.
With the figures 4 to 9 are to some modified examples of anchoring supports 1 that can be used in the inven- tion, be explained further. The same elements have been denoted by the respective same reference numerals.
are formed the anchor post 1 as in Figure 4 represents ones shown, is essential to the invention comprises, besides the three support brackets 2, extended in the proximal direction Kommissurenbügel 3 and corresponding stabilizing strap 7 which sämtlichst proximally convexly curved. The base points of supporting, Kommissuren- and stabilizing bar 2, 3 and 7, in this and the following still arranged examples to be described substantially in the plane in which the prosthetic heart valve 4 is arranged.
In contrast to the embodiment according to FIG 4, in which the stabilization bracket 7 in the proximal direction longer than the Kommissurenbügel 2 and which in turn are formed slightly longer than the supporting bracket 2, in the example of Figure 5 a prolonged training fertil of support brackets 2 with respect to the length of been selected by stabilization brackets 7 and Kommissurenbügeln 3, the length of which in turn is only slightly different from each other.
The example shown in Figure 6 essentially corresponds to the embodiment according to FIG 5. However, it was dispensed stabilizing bracket. 7
In the example of Figure 7 were again relative to the supporting brackets 2 in the proximal direction prolonged
3 Kommissurenbügel used.
In the examples shown in Figures 4 to 7 Examples of anchoring supports additional 1 each have the same elements have been used on an anchoring support. 1
Thus, ring carrier 5 are about aligned in the longitudinal direction of the anchoring support 1 ridges 8 are respectively connected to base points of the respective frames 2, 3 and 7, respectively.
Such a ring carrier 5 is advantageously in the form of a self-expandable support structure, here in the example shown a z-shaped support structure is formed, which advantageously effected by radially outwardly acting contact pressures and their design, a further improved fixing of the anchoring support 1 at the implant site, so that a displacement o- the rotation of the anchoring support with heart valve prosthesis 1 4 can also be prevented.
Further, distal-side fixing members 9 on the anchoring support 1, here in the form of eyelets. At these fastening elements 9 manipulation members may deteriorate, so that shifting or twisting of the anchor post 1 can be facilitated.
In the example of Figure 8 supporting bracket 2 and communication have been used missurenbügel 3 each having the same length in the proximal direction. However, the support bracket 2 are arranged in an angular offset to the Kommissu- renbügeln. 3
but the angular displacement and the design with dimensions of Kommissurenbügel 3 should be such that parts of the old heart valve of a patient can be clamped together with imported into the pockets of the old heart valve support brackets. 2 It may happen, for example, that a holding Kommissurenbügel 3 parts of two old heart valve of a patient clamping parts, each arranged adjacent to this Kommissurenbügel 3 parts of support brackets. 2
In the example shown in Figure 9 example, a dialed with a certain predetermined angular offset arrangement of supporting brackets 2 and Kommissuren- was re iron 3 is selected. but doing the supporting bracket 2 in the proximal direction are significantly shorter than the Kommissurenbügel 3 and an additional stabilization bar 7, the renbügeln in the same angular position with the Kommissu- 3 are arranged, are provided. Here, the Kommissurenbügel 3 and the stabilization bracket 7 differ only slightly in their length in the proximal direction.
are in the positions shown in Figures 8 and 9 Examples additional ring support 5 'exists, to which the foot points of all the brackets 2, 3 and 7 are arranged and can attack. The heart valve prosthesis 4 can then be arranged in a plane in the region of the annular carrier 5 '.
play in the processes shown in Figures 8 and 9 examples a further annular carrier 5 is connected via webs 8 with the anchoring support. 1
Below are intended to be exemplary to 20 design options and functions of cartridges 6, which can be used in devices of the invention, illustrated by means of figures 10th
It is generally to multi-piece cartridge 6. The individual parts of the cartridges can then be moved relative to one another to permit a sequential release and deployment of elements of anchoring supports. 1
10 shows a cartridge 6 is shown at a proximal end portion during the insertion of the anchoring support 1 can absorb the greater part of yokes 2, 3 and 7 6.2 at least and further elements of the anchoring support 1 in a folded form in a central part 6.1 of the cartridge 6 listed are accepted. 10 shows a phase of an implantation of an anchoring support 1 has already been shown in which a release of support brackets 2 to the radial-outwardly directed deployment is effected by a relative movement of the parts 6.1 and 6.2, and the support bar 2 already in pockets of an old heart valve have been introduced. The Aortenwandung is indicated schematically here.
The remaining brackets are accommodated in a folded shape or compressed within the proximal part 6.2 of the cartridge and with their foot points in the central part 6.1.
In a second movement step, which represents a further relative movement between the parts 6.1 and 6.2 of the cartridge 6, the stabilization bracket 7 and Kommissurenbügel 3 an anchoring support 1 were released and allowed to develop in radi- aler outward direction, as this implantation phase stage with Figure 11 will be illustrated.
In this case, there are parts of the old heart valve of the patient at least between support brackets 2 and Kommissurenbügeln 3 and by the radially outwardly acting forces of Kommissurenbügel 3 and the supporting effect of the aortic wall, the old parts of the heart valve of a patient, at least between the supporting brackets 2 and Kommissurenbügeln 3 pinched. The
Stabilization bracket 7 can optionally support the clamping action.
In Figure 12 a is again shown to figure 11 of the subsequent stage at an implantation of a heart valve prosthesis. 4 By retracting the distally disposed parts of the cartridge 6, and especially at least the central part 6.1, the entire anchoring support 1 is released and can self-expanding unfold, wherein tig the respective heart valve prosthesis 4 simultaneous irrespective of whether it is an artificial or biological implant is, is deployed.
Below all parts of the cartridge can be removed and corresponds prosthetic heart valve 4 resume their function immediately.
13 shows a cartridge 6 having a plurality of individual parts is again shown 6.1 to 6.6, which accommodates a folded anchoring support. 1
Here, too, there is a proximal part 6.2, which must essentially take up the front portions of support brackets. 2
At the proximal part 6.2 grab actuation elements 10, in this example, Bowden cables for its manipulation and for initiating the necessary for the release of brackets relative movement.
The middle section 6.1 receives the further elements of an anchoring support 1 substantially.
The subsequent thereto in the distal direction part 6.3 essentially serves as a receiving element for actuating elements 10 for the cartridge parts 6.1 and 6.2.
turn the parts 6.4, 6.5 and 6.6 take actuating elements by their inner hollow design and permit by their telescope-like arrangement and design to influence the required for the implantation of the anchoring support 1 with heart valve prosthesis 4 sequentially carried out relative movements.
in turn, Figure 14 shows a subsequent phase at an implantation of a heart valve prosthesis 4 having an anchoring support 1, in which, in turn, by corresponding relative movement of the individual elements of 6.1 to 6.6 of the multi-part here cartridge 6, a sequential release and deployment of the individual support brackets 2, below the Kommissurenbügel 3 and has been realized support bracket 7 for the exact positioning of alignment and clamping of the parts of an old heart valve of a patient.
Figure 15 then again shows a fully deployed anchoring support 1 by corresponding further relative movement of the individual elements of 6.1 to 6.6 of the cartridge 6, wherein the proximal portion has been separated from the remaining 6.2 parts of the cartridge and must be removed separately.
In Figure 16 a multipart Kartu- in turn see 6 shown. In this case, protruding ridges 11 are present in the example shown here, a cartridge 6 on the proximal part 6.2 of the cartridge 6 in the distal direction. The webs 11 are arranged and dimensioned so that by a corresponding re lativbewegung at least the parts 6.1 and 6.2, to be performed at an implantation delayed release of support brackets 2 and 3 at least Kommissuren- ironing can be achieved.
This can be achieved, for example, in a form not shown, by rotating about the longitudinal axis of the cartridge 6 of the proximal part 6.2, so that here slots, also not shown are released on part 6.1 and is enabled by the shared slots deployment of the support bracket. 2 Subsequently, a relative motion of the elements of the cartridge 6 in the lateral direction to further unfolding of Kommissurenbügeln 3 and other elements of the anchoring support can then be carried out. 1
In Figure 17 is shown, however, as a releasing movement allows such sequential development in the proximal, lateral direction of the proximal part 6.2.
Here, at the part 6.1 of the cartridge 6, starting from its proximal end side in the distal direction slots 12 are formed. The slits 12 were covered exceeded advance the webs 11 of the proximal part 6.2, so that the support bracket 2 have been kept folded up inside the cartridge. 6
After deployment and introduction of the support bracket is carried in the pocket of an old heart valve 2, further movement of the cartridge 6 will also release and radially outward acting unfolding of Kommissurenbügeln 3 and support brackets 7. After further corresponding movement of the distal elements of the cartridge 6 are all elements of the anchoring support to their self-expanding
Unfolding released, as indicated by the Figures 18 and 19 in two stages of implantation for a heart valve prosthesis. 4
The example of a cartridge 6 as shown in Figure 20 comprises analogously to the embodiment as has been shown in the figures 16 to 19, again at the proximal part 6.2 webs 11, and it can on part 6.1 again slots be present 12, wherein the slots 12 are not absolutely necessary.
There are indicated in the form of Bowden cables in this example turn actuators 10.
The part 6.3 of the cartridge 6 receives substantially the annular carrier 5 with correspondingly formed
Support structure and the part 6.4 essentially serves to control the part 6.1.
The parts 6.5 and 6.6 can be used as guides for the control and the other elements of a cartridge 6 for the respectively required movements that are required for the sequential release and deployment of an anchoring support elements 1, allow.
1. A device for transluminal implantation and fixation of prosthetic heart valves with a fixed to a self-expandable anchoring support heart valve prosthesis, characterized in that the anchoring support (1) is received in a connectable with a catheter cartridge (6) in folded form;
proximal to the anchoring support (1)
The support bracket (2) are formed, which are inserted into pockets of the heart valve of a patient;
merely the support bracket by a predefinable first motion of the cartridge (6) (2)
Anchoring support (1) for introduction into pockets of heart valves, and
by at least one second subsequent motion of the cartridge (6) and / or of the catheter supply further elements (3, 4, 5, 5 ', 7, 8, 9) of the anchoring support (1) with heart valve prosthesis (4) to its fully expanded and anchoring of the anchoring support (1) can be released.
2. Device according to claim 1, characterized in that on the anchoring support (1) Kommissurenbügel (3) are additionally present, with the support brackets (2) parts of the heart valve of a patient, each (between a support and a Kommissurbügel 2, after deployment of the anchoring support (1) 3) are arranged to hold a clamping manner.
3. A device according to claim 1 or 2, characterized in that the cartridge (6) consists of several parts (6.1 -. 6 6) is formed, which are movable relative to each other.
4. Device according to one of the preceding claims, characterized in that the cartridge (6) or individual parts of a cartridge (6.1, 6.2) is displaceable in the proximal and / or distal direction / are.
5. Device according to one of the preceding claims, characterized in that the cartridge (6) or individual parts of cartridges in stages is displaceable / are.
6. Device according to one of the preceding claims, characterized in that for displacement of the cartridge (6) or individual parts of the cartridge Bowden cables or flexible Schubroh- re (10) through the interior of the catheter to the cartridge (6) or a portion of a cartridge ( 6) are guided.
7. Device according to one of the preceding claims, characterized in that on the cartridge (6), a deconvolution of support brackets
(2) permitting slots (12) are formed.
8. Device according to one of the preceding claims, characterized in that the slots (12) are straight, formed in obliquely inclined angles or in waveform.
9. Device according to one of the preceding claims, characterized in that the cartridge (6) or a part of a cartridge for releasing the support bracket (2) is rotatable about its longitudinal axis.
are arranged 10. Apparatus according to one of the preceding claims, characterized in that on the anchoring support (1) fixing elements (9) forces for the transmission of turning, pushing or pulling and / or the fixing of the anchoring support (1) ,
11. Device according to one of the preceding claims, characterized in that the support bracket (12) and Kommissurenbügel (3) are curved in the direction proxima- 1er convexly arcuate.
12. Device according to one of the preceding claims, characterized in that on the anchoring support (1) additional stabilization bracket (7) are present.
13. Device according to one of the preceding claims, characterized in that the supporting and Kommissurenbügel (2, 3) with an angular offset to each other on the anchoring support (1) are arranged.
14. Device according to one of the preceding claims, characterized in that on the anchoring support (1) at least one annular carrier (5, 5 ') is present.
15. Device according to one of the preceding arrival claims, characterized in that the support bracket
(2) Kommissurenbügel (3) and / or stabilizing bracket (7) with a ring carrier (5 ') are the connectedness.
16. Device according to one of the preceding claims, characterized in that on the anchoring support (1) on longitudinal webs (8) with support brackets (2), Kommissurenbügeln (3) and / or stabilizing brackets (7) connected to the ring carrier (5) with a z is shaped, wavy or maanderformigen support structure available.
17. Device according to one of the preceding claims, characterized in that a plurality of parts of a cartridge (6.1 - 6.6) are arranged in the form of a telescope.
18. Device according to one of the preceding arrival claims, characterized in that in a
Part of a cartridge (6) has slots (12) and movable to a second relative to this part of a cartridge (6) is part of the slots (12) are formed overlying webs (11), the release of the support bracket (2) until insertion into prevent the pockets of a heart valve of a patient.
19. Device according to one of the preceding claims, characterized in that in a part of a cartridge (6.2) distally projecting webs (11) are formed.
PCT/DE2003/002669 2002-08-13 2003-08-05 Device for the implantation and fixing of heart valve prostheses WO2004019825A1 (en)
EP20030790698 EP1469797B1 (en) 2002-08-13 2003-08-05 Device for the implantation and fixing of heart valve prostheses
DE2003501546 DE50301546D1 (en) 2002-08-13 2003-08-05 A device for implantation and fixation of prosthetic heart valves
DE2003193544 DE10393544D2 (en) 2002-08-13 2003-08-05 A device for implantation and fixation of prosthetic heart valves
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