Source: https://patents.google.com/patent/US9889008B2/en
Timestamp: 2019-05-25 19:15:31
Document Index: 288930308

Matched Legal Cases: ['Application No. 60', 'Application No. 61', 'art.\n6', 'art.\n8', 'art.\n17', 'art.\n19']

US9889008B2 - Treating dysfunctional cardiac tissue - Google Patents
US9889008B2
US9889008B2 US15/341,945 US201615341945A US9889008B2 US 9889008 B2 US9889008 B2 US 9889008B2 US 201615341945 A US201615341945 A US 201615341945A US 9889008 B2 US9889008 B2 US 9889008B2
US15/341,945
US20170156865A1 (en
2016-11-02 Assigned to BIOVENTRIX, INC. reassignment BIOVENTRIX, INC. ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: ANNEST, LON S., BUTLER, WILLIAM, ARGENTO, CLAUDIO, HEFLIN, ERNEST
2016-11-02 Priority to US15/341,945 priority patent/US9889008B2/en
2016-11-02 Application filed by BioVentrix Inc filed Critical BioVentrix Inc
2016-11-04 Assigned to BIOVENTRIX, INC. reassignment BIOVENTRIX, INC. MERGER (SEE DOCUMENT FOR DETAILS). Assignors: CHF TECHNOLOGIES, INC.
2017-06-08 Publication of US20170156865A1 publication Critical patent/US20170156865A1/en
2018-02-13 Publication of US9889008B2 publication Critical patent/US9889008B2/en
This application is a continuation of U.S. patent application Ser. No. 14/636,068 entitled “Treating Dysfunctional Cardiac Tissue,” filed Mar. 2, 2015, which is a continuation of U.S. patent application Ser. No. 13/949,025 entitled “Treating Dysfunctional Cardiac Tissue,” filed Jul. 23, 2013, now U.S. Pat. No. 8,968,175, which is a continuation of U.S. patent application Ser. No. 12/245,040 entitled “Treating Dysfunctional Cardiac Tissue,” filed on Oct. 3, 2008, now U.S. Pat. No. 8,491,455, which claims the benefit of U.S. Provisional Patent Application No. 60/977,286 entitled “Method and Device for Treating Dysfunctional Cardiac Tissue,” filed on Oct. 3, 2007; and to U.S. Provisional Patent Application No. 61/082,438, entitled “Cardiac Anchor Structures, Methods, and Systems for Treatment of Congestive Heart Failure and Other Conditions,” filed on Jul. 21, 2008, the disclosures of which are hereby incorporated herein by reference.
FIGS. 13-14 show aspects of a method of reducing the distance between two points in tissue wall according to embodiments of the invention;
FIG. 14A shows an additional aspect of the method of reducing the distance between two points in tissue wall according to embodiments of the invention;
FIGS. 15-24 show additional aspects of the method of reducing the distance between two points in tissue wall according to embodiments of the invention;
FIGS. 45A-45G show exemplary embodiments of external anchors according to embodiments of the invention;
FIG. 45Gi shows an exemplary embodiment of an external anchor according to an embodiment of the invention;
FIGS. 45H-45O show exemplary embodiments of external anchors according to embodiments of the invention;
FIGS. 46A-46B show the distal end of an anchor device according to an embodiment of the invention;
FIGS. 47A-47B show the distal end of an anchor device according to an embodiment of the invention;
FIGS. 48A-48B show the distal end of an anchor device according to an embodiment of the invention;
FIGS. 49A-49B show the distal end of an anchor device according to an embodiment of the invention;
FIGS. 50A-50B show the distal end of an anchor device according to an embodiment of the invention;
FIGS. 51A-51B show the distal end of an anchor device according to an embodiment of the invention;
FIG. 52 shows the distal end of an anchor device according to an embodiment of the invention;
FIGS. 52A-52B show the distal end of an anchor device according to an embodiment of the invention;
FIG. 111 shows the leading end of an anchor device according to an embodiment of the invention;
FIGS. 112A-112B show the leading end of the anchor device of FIG. 111;
FIGS. 113A-113B show the leading end of an anchor device according to an embodiment of the invention;
FIGS. 114A-114C show the leading end of an anchor device according to an embodiment of the invention;
FIGS. 115A-115B show the leading end of an anchor device according to an embodiment of the invention;
FIGS. 116A-116B show the leading end of an anchor device according to an embodiment of the invention;
FIGS. 117A-117C show the leading end of an anchor device according to an embodiment of the invention;
FIGS. 118A-118D show the leading end of an anchor device according to an embodiment of the invention;
FIGS. 119A-119C show the leading end of an anchor device according to an embodiment of the invention;
FIGS. 120A-120B show an exemplary tether cutting mechanism according to an embodiment of the invention;
FIGS. 121A-121B show an exemplary tether cutting mechanism according to an embodiment of the invention;
FIGS. 122A-122C show an exemplary tether cutting mechanism according to an embodiment of the invention;
FIGS. 53a, 53b, 53c, and 53d a show straight hollow bore insertion needle 521, a first curved hollow bore insertion needle 523 a, a second curved hollow bore insertion needle 523 b, and a third curved hollow bore insertion needle 523, respectively. Straight hollow bore insertion needle 521 has a sharp distal tip 522. Curved hollow bore insertion needle 523 a has a sharp distal tip 525 a which is aligned with an axis 524 a of proximal straight portion 526 a. A distal portion of insertion of insertion needle 523 a is curved. The radius of curvature of the curved distal portion may be selected such that when insertion needle 523 a is inserted into the heart at a first specified point, sharp distal tip 525 a perforates the left ventricular wall at a roughly right angle and also perforates the septal wall at a roughly right angle at a second specified point as insertion needle 523 a is further advanced, with the first and second perforation points being separated by a distance in a first desired range. Curved hollow bore insertion needle 523 b has a sharp distal tip 523 b which is aligned with axis 524 b, which is the central axis of proximal straight portion 526 d. A distal portion of insertion of insertion needle 523 b is curved. The radius of curvature of the curved distal portion may be selected such that a different range of separation distances between the perforation points can be provided, such that when insertion needle 523 b is inserted into the heart at a specified point, sharp distal tip 525 b perforates the left ventricular wall at a roughly right angle and later perforates the septal wall at a roughly right angle as insertion needle 523 b is further advanced. Curved hollow bore insertion needle 523 c has a sharp distal tip 523 c which is aligned with axis 524 c, which is the central axis of proximal straight portion 526 c. A distal portion of insertion of insertion needle 523 c is curved so as to accommodate a third range of separation distances. The radius of curvature of the curved distal portion may be selected such that when insertion needle 523 c is inserted into the heart at a specified point, sharp distal tip 525 c perforates the left ventricular wall at a roughly right angle and later perforates the septal wall at a roughly right angle as insertion needle 523 b is further advanced. The first, second, and third ranges allow reshaping (particular radius reduction) along the axis of the ventricle to be varied so as to provide a desired overall ventricle geometry, as can be further understood with reference to application Ser. No. 11/751,573 , the full disclosure of which is incorporated herein by reference. Typical separation differences between perforation points may be pi times the difference in diameter between that of a dysfunctional heart and the same heart after a desired ventricular volume reduction. Exemplary differences in diameter range from about ½ to about 3 cm, resulting in differences in diameter from about 1.5 to about 10 cm, preferably about 4 cm to about 6 cm.
FIGS. 113A to 116B show exemplary embodiments of the distal arm of an anchor having articulated hinges. As shown in FIGS. 113A and 113B, a leading end 11300 comprises an elongate shaft 11310 coupled to a distal arm 11320 through an articulated hinge 11330. FIGS. 114A-114C, show a leading end 11400. Leading end 11400 comprises an elongate shaft 11410 coupled to a distal arm 11420 through an articulated hinge 11430. When constrained, for example, by sheath 1150, a portion of distal arm 11420 may fit into a recessed portion 11450 of elongate shaft 11410. As shown in FIGS. 115A and 115B, leading end 11400 may further comprise a locking mechanism 11460 which can be distally advanced to secure leading end 11400 in a deployed configuration as shown in FIG. 115B. As shown in FIG. 116A and 116B, a leading end 11600 may comprise multiple distal arm segments. A central distal arm segment 11620 is coupled to an elongate shaft 11610 through an articulated hinge 11630. Central distal arm segment 11620 can fit into a recessed portion 11650 of elongate shaft 11610 when leading end 11600 is constrained, for example, by sheath 1150 as shown in FIG. 116A. Central distal arm segment 11620 is coupled to a first side arm segment 11620 a and a second side arm segment 11620 b through articulated hinges 11630. The articulated hinges 11630 may be biased so that central arm segment 11620, first side arm segment 11620 a, and second side arm segment 11620 b are each unfurled perpendicular to elongate shaft 11610 when deployed or no longer constrained, for example, by sheath 1150.
1. A percutaneous ventricular reduction method for treating a heart of a patient comprising:
advancing a distal end of a catheter through a vena cavae and into a right atrium of the heart, the vena cavae being accessed via a femoral vein or an internal jugular vein;
advancing the distal end of the catheter through a tricuspid value and into a right ventricle of the heart;
positioning the distal end of the catheter adjacent a septum so that a distal tip of the catheter is positioned near dysfunctional tissue of the septum;
perforating the septum;
advancing, via the catheter, a guidewire across the septum through said perforation so that a distal end of the guidewire is positioned within a left ventricle of the heart;
advancing the catheter across the septum and across the left ventricle so that the distal end of the catheter is positioned adjacent to dysfunctional tissue on an anterior or lateral wall of the left ventricle;
perforating the dysfunctional tissue of the left ventricle;
advancing the distal end of the guidewire across the anterior or lateral wall of the left ventricle through said perforation so that the distal end of the guidewire is positioned external to the heart;
delivering a first anchor to a position adjacent the anterior or lateral wall of the left ventricle, the first anchor being positioned on an exterior surface of the anterior or lateral wall;
delivering, via the catheter, a second anchor to a position adjacent the septum by advancing the second anchor through the vena cavae, right atrium, and tricuspid valve, the second anchor being positioned within the right ventricle, wherein the first anchor and the second anchor are operably coupled with a tension member; and
tensioning the tension member to draw the first anchor and the second anchor toward one another and thereby draw the septum and anterior or lateral wall into engagement.
2. The method of claim 1, wherein the catheter is a first catheter and wherein the method further comprises inserting a second catheter through a lumen of the first catheter and positioning a distal tip of the second catheter adjacent the septum, the second catheter being configured to dilate the perforation through the septum to enable advancement of the first catheter and/or second catheter across the septum.
3. The method of claim 2, further comprising advancing the second catheter across the septum.
4. The method of claim 3, further comprising perforation the dysfunctional tissue of the left ventricle via the second catheter and advancing the second catheter across the anterior or lateral wall of the left ventricle.
5. The method of claim 1, wherein the first anchor and the second anchor are delivered through a lumen of the catheter to position said anchors adjacent said anterior or lateral wall and septum of the heart.
6. The method of claim 5, further comprising advancing the first anchor through the septum and the anterior wall to the position adjacent the anterior or lateral wall.
7. The method of claim 1, repeating the method steps to deliver additional anchors to the septum and the anterior or lateral wall of the heart, said additional anchors being positionable along a pre-selected apposition line relative to the heart.
8. The method of claim 1, wherein the first anchor and/or second anchor are advanceable in a low profile configuration and are deployable therefrom.
9. A method for treating a heart of a patient comprising:
advancing a distal end of a catheter percutaneously through a vasculature and an atrium of the heart and into a first chamber of the heart;
positioning the distal end of the catheter adjacent a first wall of the heart so that a distal tip of the catheter is positioned near dysfunctional tissue of the first wall;
advancing the catheter across the first wall so that a distal end of the catheter is positioned within a second chamber of the heart;
advancing the distal end of the catheter across the second chamber so that the distal end of the catheter is positioned adjacent a second wall of the heart;
advancing the distal end of the catheter across the second wall of the heart so that the distal end of the catheter is positioned externally of the heart;
delivering, via the catheter, a first anchor to a position adjacent the second wall of the heart;
delivering, via the catheter, a second anchor to a position adjacent the first wall of the heart, wherein the first anchor and the second anchor are operably coupled with a tension member; and
tensioning the tension member to draw the first anchor and the second anchor toward one another and thereby draw the first wall and the second wall into engagement.
10. The method of claim 9, wherein the first anchor is positioned on an exterior surface of the second wall.
11. The method of claim 10, wherein the second anchor is positioned within the first chamber.
12. The method of claim 9, wherein the distal end of the catheter is advanced percutaneously through the atrium via an access in the femoral vein or the internal jugular vein.
13. The method of claim 9, wherein the catheter comprises a first catheter and a second catheter, the second catheter being insertable through a lumen of the first catheter.
14. The method of claim 13, further comprising advancing a distal end of the second catheter across the first wall of the heart and into the second chamber of the heart while the first catheter remain positioned proximally of the first wall.
15. The method of claim 14, further comprising advancing the distal end of the second catheter across the second wall of the heart so that the distal end of the second catheter is positioned external to the heart while the first catheter remain positioned proximally of the first wall.
16. The method of claim 9, wherein the first anchor and the second anchor are delivered through a lumen of the catheter to position said anchors adjacent said walls of the heart.
17. The method of claim 16, further comprising advancing the first anchor through the first wall and the second wall to the position adjacent the second wall.
18. The method of claim 9, repeating the method steps to deliver additional anchors to the first wall and the second wall of the heart, said additional anchors being positionable along a pre-selected apposition line relative to the heart.
19. The method of claim 9, wherein the first anchor and/or second anchor are advanceable in a low profile configuration and are deployable therefrom.
20. The method of claim 9, further comprising advancing a locking mechanism into the first chamber and against the second anchor, the locking mechanism being configured to secure the second anchor in position about the first wall of the heart.
US15/341,945 2007-10-03 2016-11-02 Treating dysfunctional cardiac tissue Active US9889008B2 (en)
US14/636,068 Continuation US9486206B2 (en) 2007-10-03 2015-03-02 Treating dysfunctional cardiac tissue
US20170156865A1 US20170156865A1 (en) 2017-06-08
US9889008B2 true US9889008B2 (en) 2018-02-13
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:ANNEST, LON S.;ARGENTO, CLAUDIO;BUTLER, WILLIAM;AND OTHERS;SIGNING DATES FROM 20081016 TO 20081111;REEL/FRAME:040202/0241
Free format text: MERGER;ASSIGNOR:CHF TECHNOLOGIES, INC.;REEL/FRAME:040225/0500