Source: http://www.google.com/patents/US6955175?ie=ISO-8859-1&dq=6,406,777
Timestamp: 2016-02-11 19:44:03
Document Index: 159946029

Matched Legal Cases: ['art. 4', 'art. 13', 'art 100', 'art 100', 'art 1', 'art 2']

Patent US6955175 - Method and apparatus for thoracoscopic intracardiac procedures - Google PatentsSearch Images Maps Play YouTube News Gmail Drive More »Sign inPatentsDevices, 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...http://www.google.com/patents/US6955175?utm_source=gb-gplus-sharePatent US6955175 - Method and apparatus for thoracoscopic intracardiac proceduresAdvanced Patent SearchPublication numberUS6955175 B2Publication typeGrantApplication numberUS 10/427,438Publication dateOct 18, 2005Filing dateMay 1, 2003Priority dateFeb 22, 1993Fee statusPaidAlso published asCA2218545A1, CA2218545C, EP0822777A1, EP0822777A4, EP1980200A2, EP1980200A3, US5797960, US5823956, US5829447, US5855614, US5924424, US6079414, US6401720, US6679268, US7100614, US20020096183, US20020100485, US20030225402, US20040019348, WO1996032882A1Publication number10427438, 427438, US 6955175 B2, US 6955175B2, US-B2-6955175, US6955175 B2, US6955175B2InventorsJohn H. Stevens, Bruce A. Reitz, Alex T. Roth, William S. Peters, Hanson S. GiffordOriginal AssigneeStevens John H, Reitz Bruce A, Roth Alex T, Peters William S, Gifford Hanson SExport CitationBiBTeX, EndNote, RefManPatent Citations (104), Non-Patent Citations (99), Referenced by (78), Classifications (92), Legal Events (4) External Links: USPTO, USPTO Assignment, EspacenetMethod and apparatus for thoracoscopic intracardiac procedures
US 6955175 B2Abstract
providing an electrophysiological ablating device comprising at least one ablating element; creating an intercostal opening in a patient's chest, the intercostal opening passing through the chest wall and into the patient's thoracic cavity; passing the ablating element through the intercostal opening; positioning the ablating element adjacent to heart tissue; and ablating the heart tissue with the ablating element to create a lesion in the heart tissue to treat atrial fibrillation. 2. The method of claim 1, comprising the steps of:
creating a second opening in the wall of the patient's heart, the second opening passing through the wall of the heart and into an interior chamber of the heart; positioning the ablating element through the second opening and within an interior chamber of the heart prior to the step of ablating the heart tissue with the ablating element. 3. The method of claim 2, wherein the step of positioning the ablating element within a chamber of the patient's heart comprises the steps of:
introducing a tubular access device into the second opening, the access device having an inner lumen and a distal end; inserting the electrophysiological ablation device through the inner lumen at the tubular access device such that the ablating element extends beyond the distal end of the access device end within an interior chamber of the heart. 4. The method of claim 1, wherein the opening is a small percutaneous incision in the space between the ribs.
5. The method of claim 1, wherein the step of ablating the heart tissue is performed while the heart is beating.
8. The method of claim 1, wherein the step of ablating comprise creating ablation lines in the myocardium to create a directed conduction pathway.
9. The method of claim 8, wherein the directed conduction pathway is between the sinoatrial node and the atrioventricular node.
10. The method of claim 1, wherein the step of ablating comprises creating at least one ablation line of the Cox maze procedure.
11. A method of forming a lesion in heart tissue of a patient, comprising the steps of:
providing an electrophysiological ablating device comprising at least one ablating element; creating an intercostal opening in a patient's chest, the intercostal opening passing through the chest wall and into the patient's thoracic cavity; passing the ablating element trough the intercostal opening; creating a second opening in the wall of the patient's heart, the second opening passing through the wall of the heart and into an interior chamber of the heart; positioning the ablating element through the second opening and within an interior chamber of the heart; positioning the ablating element adjacent to heart tissue; and ablating the heart tissue with the ablating element to create a lesion in the heart tissue. 12. The method of claim 11, wherein the step of positioning the ablating element within a chamber of the patient's heart comprises the steps of:
introducing a tubular access device into the second opening, the access device having an inner lumen and a distal end; inserting the electrophysiological ablation device through the inner lumen of the tubular access device such that the ablating element extends beyond to distal end of the access device and within an interior chamber of the heart. 13. The method of claim 11, wherein the step of ablating comprises creating ablation lines in the myocardium to treat atrial fibrillation.
14. The method of claim 13, wherein the ablation lines are for creating a directed conduction pathway is between the sinoatrial node and the atrioventricular node.
15. The method of claim 11, wherein the step of ablating comprises creating at leant one ablation line of the Cox maze procedure.
16. A method of forming a lesion in heart tissue of a patient, comprising the steps of:
creating an intercostal opening in a patient's chest, the intercostal opening passing through the chest wall and into the patient's thoracic cavity; providing an electrophysiological ablating device comprising a rigid shaft having a distal end and a proximal end, a flexible tip attached to the distal end of the shaft, and at least one ablating element carried on the flexible tip; passing at least a portion of the flexible tip of the ablating device through the intercostal opening; positioning the at least one ablating element adjacent to heart tissue; and ablating the heart tissue with the ablating element to create a lesion in the heart tissue. 17. The method of claim 16, wherein the rigid shaft is approximately 20 to 30 cm in length.
18. The method of claim 16, wherein the flexible tip is deflectable, and the positioning step comprises deflecting the flexible tip to locate the ablating element adjacent to heart tissue.
19. The method of claim 16, wherein the step of ablating comprises creating ablation lines in the myocardium to create a directed conduction pathway.
20. The method of claim 16, wherein the step of ablating comprises creating at least one ablation line of the Cox maze procedure.
This application is a continuation of application Ser. No. 10/099,690, filed Mar. 15, 2002, which is a continuation of application Ser. No. 09/411,095, filed Oct. 4, 1999, now issued as U.S. Pat. No. 6,401,720, which is a continuation of application Ser. No. 08/643,898, filed May 7, 1996, now issued as U.S. Pat. No. 6,079,414, which is a divisional of application Ser. No. 08/425,179, filed Apr. 20, 1995, now issued as U.S. Pat. No. 5,797,960, which is a continuation-in-part of application Ser. No. 08/163,241, filed Dec. 6, 1993, now issued as U.S. Pat. No. 5,571,215, which is a continuation-in-part of application Ser. No. 08/023,778, filed Feb. 22, 1993, now issued as U.S. Pat. No. 5,452,733. The complete disclosures of these applications are hereby incorporated herein by reference for all purposes.
Ordinarily, such surgery is performed using open-chest techniques while the heart is under cardioplegic arrest and circulation is maintained by cardiopulmonary bypass. Using such techniques, a gross thoracotomy is created in order to gain access to the heart and great vessels, facilitating clamping and cannulation of the aorta for inducing cardioplegic arrest, and allowing instruments to be introduced into the chest cavity and into the heart to perform the surgical repair. The necessity of stopping the heart significantly heightens the risks attendant such procedures, particularly the risks of causing ischemic damage to the heart muscle, and of causing stroke or other injury due to circulatory emboli produced by aortic clamping and vascular cannulation. In addition, the creation of a gross thoracotomy produces significant morbidity and mortality, lengthens hospital stay and subsequent recovery, increases costs, and worsens the pain and trauma suffered by the patient. Moreover, many congenital defects are repaired in children under the age often years for whom the morbidity and mortality of open-chest surgery and cardioplegic arrest can be even greater than for older patients.
In an effort to avoid the necessity of grossly opening the chest and stopping the heart, a number of intravascular devices have been developed for repair of ASD's, VSD's, and PDA. For example, U.S. Pat. No. 3,874,388 to King et al discloses an intravascular delivery catheter introduced intraluminally from a peripheral vein into the right side of the heart which can be used to position an artificial umbrella-like patch across a septal defect and to anchor the patch to the cardiac septum. Other intravascular delivery devices and artificial patches for the repair of septal defects can be seen in U.S. Pat. No. 5,334,217, U.S. Pat. No. 5,284,488, U.S. Pat. No. 4,917,089, U.S. Pat. No. 4,007,743, and PCT Application No. PCT/US92/10141.
The patch includes a means for securing the patch to the cardiac septum. The securing means may comprise a second patch coupled to a central portion of the first patch mid parallel thereto such that one patch may be positioned through the septal defect on the left side of the cardiac septum and the second patch positioned on the right side of the cardiac septum, with the outer edges of the two patches compressively engaging the cardiac septum between them. For example, in the hub and spoke embodiment describe above, two sets of spokes may be mounted to the hub and a patch mounted to each set of spokes so that the two patches are generally parallel to each other and spaced slightly apart. Alternatively, the securing means may comprise a plurality of flexible wire struts coupled to a central part of the frame such that the outer ends of the struts will compressively engage the cardiac septum on the side opposite that on which the patch is positioned. Like the patch, the securing means is collapsible to allow introduction through the inner lumen of the access device. To facilitate secure fixation to the septum, the frame or the securing means may include pins or spikes pointing generally perpendicular to the patch to partially penetrate the cardiac septum when the patch has been positioned across the defect, preventing migration of the patch.
In an alternative embodiment, the septal defect closure means comprises a suturing device for applying at least one suture across the septal defect. The suturing device includes a rigid delivery shaft suitable for introduction through the inner lumen of the access device, and a plurality of needle holders mounted to the delivery shaft for releasably holding at least two needles connected by a suture thread. The needle holders are movable between a contracted position suitable for introducing the needles through the septal defect into the cardiac chamber on the opposite side of the septum, and an expanded position in which the tips of the needles are aimed proximally toward the cardiac septum on opposing sides of the septal defect in one embodiment, the needle holders are mounted on opposing sides of a balloon which may be deflated during introduction through a septal defect and then inflated to move the needles into the expanded position. The needle holders are then pulled proximally so that the needles penetrate the cardiac septum. A means is mounted to the delivery shaft for capturing the distal tips of the needles after penetrating the septum. For example, the needles may have barbed tips which engage a porous fabric disk slidably mounted to the delivery shaft. The needle capture means is retracted to draw the needles through the septum and out of the heart through the inner lumen of the access device. In this way, a plurality of sutures may be applied to the cardiac septum simultaneously. Knots may then be tied in the sutures extracorporeally, and, using a long-handled endoscopic knot-pusher, pushed through the access device into the heart so as to tighten the sutures and draw the opposing sides of the septal defect together.
An electrophysiological device according to the invention comprises a rigid shaft suitable for introduction through the inner lumen of the access device. A deflectable tip is attached to the distal end of the shaft. The deflectable tip has at least one and usually a plurality of electrodes mounted to it. A steering means is provided in the shaft for deflecting the tip into the desired orientation. The electrodes are electrically coupled to a connector at the proximal end of the shaft, which may be connected to a sensitive electrocardiogram (ECG) monitoring apparatus. The deflectable tip may be introduced into a chamber of the heart through the access device, and the electrodes positioned against a site on an interior wall of the heart to perform an electrophysiological procedure. For example, a plurality of electrode bands may be mounted in a spaced-apart relationship on the deflectable tip, and the voltage difference can be measured across selected electrodes to identify aberrant conduction pathways in the heart wall, a process known as cardiac mapping. In addition, radiofrequency current may be delivered through one or more electrodes to ablate tissue at selected sites on the heart wall.
A first representative embodiment of an intracardiac access system according to the invention is illustrated in Figure I. The intracardiac access system 20 includes a tubular access device 22 comprising a rigid shaft 24 having a distal end 26, a proximal end 28, and an inner lumen 30 extending therebetween. Access device 22 includes a means near distal end 26 for hemostatically sealing a cardiac penetration through which shaft 24 is introduced, which may comprise a toroidal balloon 32. An inflation lumen 34 extends through shaft 24 and has an opening 36 in communication with the interior of balloon 32. An inflation fluid port 38 is mounted to shaft 24 at proximal end 28 in communication with inflation lumen 34 and is configured for connection to an inflation fluid delivery source such as a syringe or other balloon inflation device.
The patient is prepared for cardiac surgery in the conventional manner, and general anesthesia is induced. The patient is positioned on the patient's left side so that the right lateral side of the chest is disposed upward. Two to three small incisions 2-3 cm in length are made between the ribs, usually in the third, fourth, or fifth intercostal spaces. Thoracoscopic access ports 90 (e.g. trocar sleeves or other tubular cannulae), are positioned in each incision to retract away adjacent tissue and protect it from trauma as instruments are introduced into the chest cavity. Access ports 90 have an outer diameter which does not require retraction, cutting or removal of ribs, preferably less than 14 mm, and an axial passage with a diameter less than about 12 mm. Access ports 90 may also be non-circular in cross-section, or may be made of a flexible material to deform into a noncircular shape when introduced between two ribs. The right lung is deflated using conventional techniques, usually by introducing a tube through the patient's trachea into the right lung and applying a vacuum through the tube to deflate the lung. An endoscopic visualization device such as a thoracoscope 92 connected to a video monitor (not shown) by a cable 93 is introduced through one of access ports 90 to visualize the interior of the chest cavity. A traumatic retraction instruments may be introduced through access ports 90 to assist in deflating and retracting the lung, thereby providing a working space within the chest cavity.
Referring to FIG. 4, in order to gain access to the heart, an opening is made in the pericardium 94 using thoracoscopic instruments introduced through access ports 90, including thoracoscopic scissors 96 and thoracoscopic forceps 98. Instruments suitable for use in this procedure are described in application Ser. No. 08/194,946, filed Feb. 11, 1994, which is incorporated herein by reference. An opening approximately 2 cm-8 cm square is formed in the pericardium, exposing the exterior of the heart 100.
As shown in FIG. 5, a purse string suture 102 is then placed in the wall 104 of heart 100 around the site at which it is desired to introduce access device 22. This is accomplished by using thoracoscopic needle drivers 106 to introduce into the chest cavity a curved suture needle 108 attached to one end of a suture thread 110, and to drive the needle through the heart wall to form a running stitch in a circular pattern approximately 12-14 mm in diameter. A double-armed suture may also be used, wherein the suture thread 110 has needles at both ends, allowing each needle to be used to form one semicircular portion of the purse-string. Suture thread 110 may be long enough to allow both ends of the suture to be drawn outside of the chest cavity once purse-string suture 102 has been placed, or it may be shorter and manipulated within the chest cavity using thoracoscopic instruments. Suture needle 108 is then cut from thread 110 using thoracoscopic scissors.
As shown in FIGS. 11A-11B, struts 148 may be hingedly coupled to hub 146 by means of a hinge ring 156 which extends through an eyelet 158 at the end of each strut.
Hinge ring 156 and struts 148 are retained on hub 146 by keeper 152. Alternatively, struts 148 may be a resilient, flexible material and rigidly coupled to hub 146 so as to naturally assume a radially expanded configuration when unrestrained. A plurality of axial grooves 159 are provided on hub 146 to receive struts 148 when collapsed inward. Hub 146 further includes a threaded hole 160 on its proximal end into which the threaded distal end of inner control rod 140 maybe threaded. A circumferential flange 162 is disposed about the proximal end of hub 146 for attachment to the proximal patch of the defect repair device, as described below.
Delivery shaft 134, along with inner control rod 140 and outer control rod 138, are then removed from the chest cavity through access device 22. If desired, the defect repair may be inspected by placing an endoscope with a transparent bulb or balloon over its distal end through access device 22 into right atrium RA. The bulb or balloon is positioned against septum S and/or proximal patch 164 to inspect the position of the patch and to determine whether the septal defect has been completely occluded. Shunting of blood may also be detected using TEE or other ultrasonic technique. If patch position is satisfactory, access device 22 may be removed from the patient Balloon 32 (if used) is deflated, and access device 22 is withdrawn from the penetration in heart wall 104. As shown in FIG. 19, sutures 110 are pulled tight as access device 22 is withdrawn to close the penetration without significant loss of blood from the heart. Knots are tied in sutures 110, usually extracorporeally, and slid into the chest cavity and against heart wall 104 using an endoscopic knot pusher 196 introduced through access port 90. This may be done under visualization with an endoscope introduced through a separate access port 90 (not shown in FIG. 19). Sutures 110 are then trimmed off with a pair of endoscopic scissors.
FIGS. 24A-24B illustrate still another embodiment of defect repair device 130. In this embodiment, defect repair device 130D has a distal patch 244 of a flexible, biocompatible material attached to a wire frame 246, much like distal patches 206, 208, 210 of FIGS. 21-23. Wire frame 246 may be continuous wire of stainless steel, Nitinol™, or other biocompatible, resilient metal or polymer, and may include a plurality of loops 248 like those shown in FIGS. 21-23. Rather than being attached to a proximal patch like the above-described embodiments, however, distal patch 244 of FIG. 24 is attached to a central hub 250, to which are coupled a plurality of radially-extending struts 252 on the proximal side of patch 244 and parallel thereto. While defect repair device 130D is pictured with four such struts in FIGS. 24A-24B, struts 252 may be between three and twelve in number. Struts 252 are Nitinol, stainless steel, or other flexible, resilient biocompatible metal or polymer, and are coupled to hub 250 in such a way that the outer ends 254 of struts 252 are biased toward patch 244 and deflectable away from patch 244 about an axis perpendicular to the central axis of hub 250. An additional patch (not shown) may be attached to struts 252 to provide patches on both sides of septum S, although in most cases, a single patch on the higher pressure side of the septum (the left side of the heart) is sufficient to prevent interatrial or interventricular blood flow through a-septal defect.
Defect repair device 130D of FIG. 24A is shown in FIG. 25A in a collapsed configuration within delivery shaft 134 for introduction into the heart through access device 22. Hub 250 is threadably mounted to a rod 273 attached to the end of an elongated tubular 31 introducer shaft 268 to facilitate deployment of repair device 130D within the heart. Patch 244 and distal struts 260 are collapsed together distally of hub 250, while struts 252 are collapsed together proximally of hub 250. Spring loops at the inner ends 256, 262 of struts 252, 260 bias the struts outwardly against the inner wall of delivery shaft 134. A retraction wire 270, which may be a length of suture or wire, is attached to the outer end 254 of each strut 252 and extend through the interior of introducer shaft 268. After deployment of repair device 130D, retraction wires 270 may by used to retract the device back into delivery shaft 134 to reposition or remove the device. By tensioning retraction wires 270 from outside of the patient's body, struts 252 are re-collapsed and repair device 130 may be pulled back into delivery shaft 134. Preferably, retraction wires 270 are looped through outer ends 254 of the struts so that both ends of the retraction wires extend out of the body through delivery shaft 134. In this way, once repair device 130D is deployed satisfactorily, retraction wires 270 may be removed by simply pulling one end. Short lengths of suture or wire (not shown) may also be connected between outer ends 254 of adjacent pairs of struts 252, and a retraction wire 270 then looped through each short length. This configuration helps to maintain spacing between struts 252 and prevent tangling. Alternatively, a single retraction wire may extend through all of the loops at the outer ends of struts 252, with both ends of the single retraction wire extending out of the patient's body through delivery shaft 134.
Introducer shaft 278 is preferably a rigid material such as stainless steel for optimum control in manipulating and positioning needles 274 from outside of the chest cavity. Alternatively, all or a distal portion of introducer shaft 278 may be a flexible material and may include means for deflecting or steering distal end 276, such as pull wires anchored internally to distal end 276 and extending through the introducer shaft to an actuator at the proximal end for selectively tensioning the pull wires. Introducer shaft 278 may be used to introduce needles 274 through access device 22 into the right atrium RA, and through septal defect D into left atrium LA, as illustrated in FIG. 27. Needles 274 have sharp distal tips 280 oriented so as to point in a proximal direction toward septum S from left atrium LA, and are held removably at their proximal ends 282 in needle holders 284 extending distally from the distal end of introducer shaft 278. Needle holders 284 comprise flexible rods of stainless steel, titanium, Nitinol™ (Raychem Corp.), or a biocompatible polymer, having a needle holding cup 285 (seen more clearly in FIGS. 28-29) at their distal ends in which needles 274 are inserted.
As a further alternative technique for capturing needles 274 after they have penetrated septum S, needles 274 are removed from cups 285 by pushing distally on needle holders 284. Expandable-member 286 is then deflated and withdrawn through defect D along with needle holders 284. Introducer shaft 278, inflation tube 288 and needle holders 284 are then withdrawn from the heart through access device 22, leaving needles 274 extending through septum S. An elongated endoscopic needle driver (not shown) may then be introduced through access device 22 into the heart, and, under visualization with ultrasound, a endoscope, or fluoroscope, the needle driver is used to grasp each needle 274 and pull it through septum S and out of the heart through access device 22.
When needles 274 have been withdrawn from the heart, at least one, an usually two to six loops of suture (depending upon the number of needle pairs used), will have been formed across defect D, as illustrated in FIG. 31A-31B. Suture threads 275 are long enough, usually at least about 30 cm in length, to extend across defect D and through septum S, with both ends extending out of the heart and chest cavity through access device 22. In this way, sutures 275 may be tensioned to draw defect D closed, and knots formed extracorporeally and pushed into the heart through access device 22 using an elongated endoscopic knot pusher. As shown in FIG. 31C, a plurality of knots 304 are formed in each suture 275 and pushed against septum S to ensure tight closure of defect D. Sutures 275 are then trimmed using elongated endoscopic scissors introduced through access device 22. Complete closure and absence of shunting is verified using transesophageal echocardiography or one of the other visualization techniques outlined above.
The embodiment of the defect repair device of FIGS. 32A-32D is otherwise similar to the embodiments of FIGS. 27-31 described above. As shown in FIGS. 32C-32D, after needles 274 have been drawn through septum S around defect D, the needles are captured by means of a capture disk 298 with a porous outer layer 300, or by another means such as endoscopic needle drivers introduced through access device 22, as described above. After capture of needles 274, restraining sleeve 306 is advanced distally to collapse needle holders 284 inward, and needle holders 284, restraining sleeve 306, capture disk 298, and needles 274 are withdrawn from the heart through access device 22. This leaves sutures 275 extending across defect D as shown in FIGS. 31A-31B; sutures 275 are then tensioned, knots are formed in sutures 275 extracorporeally, and the knots are pushed into the heart and against septum S using an endoscopic knot pusher, closing defect D as illustrated in FIG. 31C. A suitable knot pusher is disclosed in application Ser. No. 08/288,674, entitled “Surgical Knot Pusher and Method of Use,” filed Aug. 10, 1994, the disclosure of which is hereby incorporated herein by reference.
In addition to the embodiment illustrated, various types of structures may be used for electrode, array 332, including those disclosed in U.S. Pat. Nos. 4,699,147, 4,660,571, 4,628,937, 4,522,212, 5,313,943, and 5,327,889, which are incorporated herein by reference. Although these patents describe endovascular electrophysiological catheters, it will be understood to those of ordinary skill in the art that the electrode array configurations, structures and deployment mechanisms disclosed may be easily adapted to the larger diameter, shorter and more rigid thoracoscopic electrophysiology device of the present invention.
Patent CitationsCited PatentFiling datePublication dateApplicantTitleUS1127325Feb 2, 1915Baldwin Locomotive WorksJoint.US3124136Jan 3, 1961Mar 10, 1964 Method of repairing body tissueUS3874388Feb 12, 1973Apr 1, 1975Ochsner Med Found AltonShunt defect closure systemUS3890969Jan 21, 1974Jun 24, 1975Baxter Laboratories IncCardiopulmonary bypass systemUS4007743Oct 20, 1975Feb 15, 1977American Hospital Supply CorporationOpening mechanism for umbrella-like intravascular shunt defect closure deviceUS4061135Sep 27, 1976Dec 6, 1977Jerrold WidranBinocular endoscopeUS4345600Aug 4, 1980Aug 24, 1982Senco Products, Inc.Purse-stringerUS4423730Mar 1, 1982Jan 3, 1984Shelhigh Inc.Atriotomy button and implantation deviceUS4529397Jul 24, 1983Jul 16, 1985Sartorius GmbhCardioplegic controlling and regulating systemUS4573473Apr 13, 1984Mar 4, 1986Cordis CorporationCardiac mapping probeUS4598698Jan 17, 1985Jul 8, 1986Warner-Lambert Technologies, Inc.Diagnostic deviceUS4605002Mar 5, 1984Aug 12, 1986Carlo RebuffatPurse-string instrumentUS4621638Jul 15, 1985Nov 11, 1986Pfizer Hospital Products Group, Inc.Hard elastic suturesUS4628937Aug 2, 1984Dec 16, 1986Cordis CorporationMapping electrode assemblyUS4665906May 21, 1986May 19, 1987Raychem CorporationMedical devices incorporating sim alloy elementsUS4702250Jan 23, 1986Oct 27, 1987Galil Advanced Technologies Ltd.Surgical implement particularly useful for suturing prosthetic valvesUS4779611Feb 24, 1987Oct 25, 1988Grooters Ronald KDisposable surgical scope guideUS4786155Dec 16, 1986Nov 22, 1988Fantone Stephen DOperating microscope providing an image of an obscured objectUS4822345Mar 16, 1988Apr 18, 1989Danforth John WControllable flexibility catheterUS4836204Jul 6, 1987Jun 6, 1989Landymore Roderick WMethod for effecting closure of a perforation in the septum of the heartUS4901721Aug 2, 1988Feb 20, 1990Hakki Samir ISuturing deviceUS4915107Feb 27, 1989Apr 10, 1990Harley International Medical Ltd.Automatic instrument for purse-string sutures for surgical useUS4917089Aug 29, 1988Apr 17, 1990Sideris Eleftherios BButtoned device for the transvenous occlusion of intracardiac defectsUS4943277Mar 24, 1989Jul 24, 1990Bolling Steven FRetrograde coronary sinus cardioplegia cannula and method for using same in heart surgeryUS4960424Jun 30, 1988Oct 2, 1990Grooters Ronald KMethod of replacing a defective atrio-ventricular valve with a total atrio-ventricular valve bioprosthesisUS4972827Jan 25, 1990Nov 27, 1990Fuji Photo Optical Co., Ltd.Guide device for percutaneous insertion of endoscopeUS5029574Apr 14, 1988Jul 9, 1991Okamoto Industries, Inc.Endoscopic balloon with a protective film thereonUS5053046Sep 6, 1990Oct 1, 1991Woodrow W. JaneseDural sealing needle and method of useUS5067957Sep 27, 1988Nov 26, 1991Raychem CorporationMethod of inserting medical devices incorporating SIM alloy elementsUS5108420Feb 1, 1991Apr 28, 1992Temple UniversityAperture occlusion deviceUS5147374Dec 5, 1991Sep 15, 1992Alfredo FernandezProsthetic mesh patch for hernia repairUS5156151 *Feb 15, 1991Oct 20, 1992Cardiac Pathways CorporationEndocardial mapping and ablation system and catheter probeUS5178133Mar 26, 1991Jan 12, 1993Pena Louis TLaparoscopic retractor and sheathUS5183464May 17, 1991Feb 2, 1993Interventional Thermodynamics, Inc.Radially expandable dilatorUS5188636May 7, 1992Feb 23, 1993Ethicon, Inc.Purse string suture instrumentUS5192301Sep 3, 1991Mar 9, 1993Nippon Zeon Co., Ltd.Closing plug of a defect for medical use and a closing plug device utilizing itUS5209747Jun 5, 1992May 11, 1993Knoepfler Dennis JAdjustable angle medical forcepsUS5242457May 8, 1992Sep 7, 1993Ethicon, Inc.Surgical instrument and staples for applying purse string suturesUS5275166Nov 16, 1992Jan 4, 1994Ethicon, Inc.Method and apparatus for performing ultrasonic assisted surgical proceduresUS5284488Dec 23, 1992Feb 8, 1994Sideris Eleftherios BAdjustable devices for the occlusion of cardiac defectsUS5293869 *Sep 25, 1992Mar 15, 1994Ep Technologies, Inc.Cardiac probe with dynamic support for maintaining constant surface contact during heart systole and diastoleUS5295484May 19, 1992Mar 22, 1994Arizona Board Of Regents For And On Behalf Of The University Of ArizonaApparatus and method for intra-cardiac ablation of arrhythmiasUS5306234Mar 23, 1993Apr 26, 1994Johnson W DudleyMethod for closing an atrial appendageUS5309896 *Nov 19, 1991May 10, 1994Origin Medsystems, Inc.Retraction methods using endoscopic inflatable retraction devicesUS5309910 *Sep 25, 1992May 10, 1994Ep Technologies, Inc.Cardiac mapping and ablation systemsUS5312341Aug 14, 1992May 17, 1994Wayne State UniversityRetaining apparatus and procedure for transseptal catheterizationUS5313943Sep 25, 1992May 24, 1994Ep Technologies, Inc.Catheters and methods for performing cardiac diagnosis and treatmentUS5314466Apr 13, 1992May 24, 1994Ep Technologies, Inc.Articulated unidirectional microwave antenna systems for cardiac ablationUS5318525Apr 10, 1992Jun 7, 1994Medtronic CardiorhythmSteerable electrode catheterUS5328467Nov 8, 1991Jul 12, 1994Ep Technologies, Inc.Catheter having a torque transmitting sleeveUS5329927Feb 25, 1993Jul 19, 1994Echo Cath, Inc.Apparatus and method for locating an interventional medical device with a ultrasound color imaging systemUS5330492Oct 21, 1992Jul 19, 1994Dlh Concepts, Inc.Safety scalpelUS5334210Apr 9, 1993Aug 2, 1994Cook IncorporatedVascular occlusion assemblyUS5334217May 14, 1993Aug 2, 1994Regents Of The University Of MinnesotaSeptal defect closure deviceUS5336182Jul 30, 1993Aug 9, 1994Ep Technologies, Inc.Catheter steering mechanismUS5338317May 3, 1991Aug 16, 1994Vance Products IncorporatedRotational surgical instrument handleUS5345937Jul 28, 1993Sep 13, 1994Raychem CorporationSteerable cannulaUS5346459Apr 14, 1993Sep 13, 1994Minnesota Mining And Manufacturing CompanyTrocarUS5353783Jun 7, 1993Oct 11, 1994Nakao Naomi LEndoscopic method using sheathUS5358478May 6, 1993Oct 25, 1994Ep Technologies, Inc.Catheter steering assembly providing asymmetric left and right curve configurationsUS5358488Nov 16, 1993Oct 25, 1994Chinda SuriyapaDevice to control gastrostomy leakageUS5361752May 4, 1992Nov 8, 1994Origin Medsystems, Inc.Retraction apparatus and methods for endoscopic surgeryUS5363861Nov 8, 1991Nov 15, 1994Ep Technologies, Inc.Electrode tip assembly with variable resistance to bendingUS5364351Nov 13, 1992Nov 15, 1994Ep Technologies, Inc.Catheter steering mechanismUS5368592Sep 23, 1993Nov 29, 1994Ep Technologies, Inc.Articulated systems for cardiac ablationUS5380291Nov 17, 1993Jan 10, 1995Kaali; Steven G.Visually directed trocar for laparoscopic surgical procedures and method of using sameUS5381794Jan 21, 1993Jan 17, 1995Aloka Co., Ltd.Ultrasonic probe apparatusUS5381795Nov 19, 1993Jan 17, 1995Advanced Technology Laboratories, Inc.Intraoperative ultrasound probeUS5383466May 14, 1993Jan 24, 1995Becton, Dickinson And CompanyInstrument having enhanced ultrasound visibilityUS5383888Feb 12, 1992Jan 24, 1995United States Surgical CorporationArticulating endoscopic surgical apparatusUS5386817Apr 5, 1993Feb 7, 1995Endomedical Technologies, Inc.Endoscope sheath and valve systemUS5391156Jan 6, 1994Feb 21, 1995Ethicon, Inc.Flexible encoscopic surgical portUS5397331Nov 25, 1992Mar 14, 1995Cook IncorporatedSupporting device and apparatus for inserting the deviceUS5400770Feb 28, 1994Mar 28, 1995Nakao; Naomi L.Device utilizable with endoscope and related methodUS5402772Aug 13, 1993Apr 4, 1995Origin Medsystems, Inc.Endoscopic expandable retraction deviceUS5403328Feb 3, 1993Apr 4, 1995United States Surgical CorporationSurgical apparatus and method for suturing body tissueUS5403329Mar 21, 1994Apr 4, 1995United States Surgical CorporationInstrument for closing trocar puncture woundsUS5405360Jul 22, 1993Apr 11, 1995United States Surgical CorporationResilient arm mesh deployerUS5409483May 14, 1993Apr 25, 1995Jeffrey H. ReeseDirect visualization surgical probeUS5411481Oct 27, 1992May 2, 1995American Cyanamid Co.Surgical purse string suturing instrument and methodUS5421323Nov 24, 1993Jun 6, 1995Richard Wolf GmbhEndoscope with additional viewing apertureUS5425357Oct 8, 1993Jun 20, 1995Origin Medsystems, Inc.Inflatable retraction devices for use in laparoscopic surgeryUS5425737Jul 9, 1993Jun 20, 1995American Cyanamid Co.Surgical purse string suturing instrument and methodUS5425744Apr 18, 1994Jun 20, 1995C. R. Bard, Inc.Occluder for repair of cardiac and vascular defectsUS5425747Oct 12, 1993Jun 20, 1995Brotz; Gregory R.SutureUS5433727Aug 16, 1994Jul 18, 1995Sideris; Eleftherios B.Centering buttoned device for the occlusion of large defects for occludingUS5450843Mar 14, 1994Sep 19, 1995Origin Medsystems, Inc.Retraction apparatus and methods for endoscopic surgeryUS5451235Apr 14, 1994Sep 19, 1995C.R. Bard, Inc.Occluder and method for repair of cardiac and vascular defectsUS5486193May 1, 1995Jan 23, 1996C. R. Bard, Inc.System for the percutaneous transluminal front-end loading delivery of a prosthetic occluderUS5507811Nov 15, 1994Apr 16, 1996Nissho CorporationProsthetic device for atrial septal defect repairUS5613947Nov 15, 1995Mar 25, 1997Origin Medsystems, Inc.Everting cannula apparatus and methodUS5809447 *Apr 4, 1996Sep 15, 1998Aisin Aw Co., Ltd.Voice navigation by sequential phrase readoutUS5829447May 7, 1996Nov 3, 1998Heartport, Inc.Method and apparatus for thoracoscopic intracardiac proceduresUS5924424Oct 14, 1997Jul 20, 1999Heartport, Inc.Method and apparatus for thoracoscopic intracardiac proceduresUS5964754May 23, 1997Oct 12, 1999Sulzer Osypka GmbhDevice for perforating the heart wallUS6156018Sep 25, 1998Dec 5, 2000Daig CorporationGuiding introducer system for use in medical procedures in the left ventricleUS6156031Jun 29, 1998Dec 5, 2000Eclipse Surgical TechnologiesTransmyocardial revascularization using radiofrequency energyUS6401720Oct 4, 1999Jun 11, 2002John H. StevensMethod and apparatus for thoracoscopic intracardiac proceduresEP0573273A2Jun 2, 1993Dec 8, 1993GENERAL SURGICAL INNOVATION, Inc.Apparatus and method for developing an anatomic space for laparoscopic hernia repair and patch for use therewithJPH03198829A Title not availableJPS50103199A Title not availableJPS58146339A Title not availableWO1992021293A1May 26, 1992Dec 10, 1992Origin Medsystems IncEndoscopic inflatable retraction device, method of using, and method of makingWO1993010714A1Nov 25, 1992Jun 10, 1993Dusan PavcnikClosure prosthesis for transcatheter placement* Cited by examinerNon-Patent CitationsReference1Aliot et al., "Mahaim tachycardias", European Society of Cardiology, 1998, No. 19. pp. E-25-E31.2Archives of Surgery 9(3)[part II]:689-1066 (1992).3Benussi et al., "A Simple Way to Treat Chronic Atrial Fibrillation During Mitral Valve Surgery: the Epicardial Radiofrequency Approach", Euro J of Cardiothoriacic Surgery 17 (2000) 524-529.4Bredikis et al, "Laser Surgery of Heart Pathways", Kardiologiya, No 5/1985, 98-99.5Bredikis et al., "Cryogenic and laser techniques in closed heart surgery of ectopic atrial tachycardia" (Abstract), J. Cardiovasc Surg., 29, 1988, p. 54.6Chevalier et al., "Thoracoscopic Epicardial Radiofrequency Ablation for Vagal Atrial Fibrillation in Dogs" PACE, vol. 22, Jun. 1999, Part I, pp. 880-886.7Cox et al., "Five-year experience with the Maze procedure for atrial fibrillation", Ann Thorac Surg, 56:814-824 (1993).8Cox et al., "The surgical treatment of atrial fibrillation I. Summary of the Current concepts of the mechanisms of atrial flutter and atrial fibrillation", J. Thorac Cardivasc Surg 101(2):402-405 (1991).9Cox et al., "The surgical treatment of atrial fibrillation II. Intraoperative electrophysiologic mapping and description of the electrophysiologic basis of atrial flutter and atrial fibrillation", J. Thorac Cardiovasc Surg 101(3):406-426 (1991).10Cox et al., "The surgical treatment of atrial fibrillation III. Development of a definitive surgical procedure", J. Thorac Cardiovasc Surg 103(4):569-583 (1991).11Cox et al., "The surgical treatment of atrial fibrillation IV. Surgical technique", J. Thorac Cardiovasc Surg 101(4):584-592 (1991).12Cox, James L., "Evolving Applications of the Maze Procedure for Atrial Fibrillation", Ann Thorac Surg 1993:55:578-80.13Das et al., "Experimental atrial septal closure with a new, transcatheter, self-centering device", Circulation 88 [part 1]:1754-1765 (1993).14Elvan et al., "Radiofrquency Catheter Ablation of the Atria Reduces Inducibility and Duration of Atrial Fibrillation in Dogs", Circulation, vol. 91, No. 8, Apr. 15, 1995, pp. 2235-2244.15Elvan, et al. "Radiofrequency Catheter Ablation of the Atria Eliminates Pacing-Induced Sustained Atrial Fibrillation and Reduces Connexin 43 in Dogs", Circulation, vol. 96, No. 5, Sep. 2, 1997 pp. 1675-1685.16Ferguson et al., "Surgical Treatment of Arrhythmias" Heart Disease & Stroke, Jan./Feb., 1993, pp. 37-43.17Fishberger et al., "Intraoperative Device Closure of Ventricular Septal Defects", Circulation 88 [part 2]:205-209 (1993).18Frank et al., "Surgical Treatment of Focal Atrial Tachycardia" (Abstract); Kardiologie, 776:118-123 (1987).19Frank et al., "Surgical Treatment of Wolf Parkinson-White Syndrome; Results from Surgeries on 120 Patients", (Abstract), Zeitschrift fur Herz, Thorax & Gefaesschirurgie, 1992, No. 6, pp. 257-263.20Frank, D/" Surgical Treatment of Wolff-Parkinson-White Syndrome-Results From Surgeries on 120 Patients"/ Zeitschrift fur Herz, Thorax und Gefaesschirurgie/No. 6/1992.21Frank, D/" Surgical Treatment of Wolf-Parkinson-White Syndrome-Results From Surgeries on 120 Patients"/ Zeitschrift fur Herz, Thorax und Gefaesschirurgie/No. 6/1992.22Friedman et al., "Successful Closure of a previously unsuspected atrial septal defect by an implantable Clamshell(TM) Device, and subsequent transvenous pacemaker implantation", Texas Heart J, 21:161-6 (1994).23Galal et al., "Peri-operative complications following surgical closure of atrial septal defect type II in 232 patients-a baseline study", European Heart J, 15:1381-1384 (1994).24Ganz et al., "Supraventricular Tachycardia", New England J of Med, 332(3):162-173 (1995).25Gray et al., "Clinical outcomes and costs of transcatheter as compared with surgical closure of patent ductus arteriosus", 329(21):1517-1523.26Gray et al., "Examination of the early 'learning curve' for transcatheter closure of patent ductus arteriosus using the Rashkidn occluder", Circulation, 90:II-36-II-42 (Nov. 1994).27Grifka et al., "New Gianturco-Grifka Vascular Occlusion Device", Circulation, Mar. 15, 91:1840-1846, 1995.28Guffi et al., "Surgical closure of the patent ductus arteriosus with an intravascular prosthesis: Clinical experience", J. Card Surg, 9:343-347 (1994).29Guiraudon et al., "Closed Heart Surgery for Wolff-Parkinson-White Syndrome", IJC 5:387-91 (1984).30Guiraudon et al., "Closed-Heart Technique for Wolff-Parkinson-White Syndrome: Further Experience and Potential Limitations", Ann of Thorac Surg 42:651-57 (1986).31Guiraudon et al., "Supraventricular Tachycardias: The Role of Surgery", PACE, vol. 16, Mar., Part II 1993, pp. 658-670.32Guiraudon et al., "Surgery for Wolf-Parkinson-White syndrome: further experience with an epicardial approach," Circulation 74:525-29 (1986).33Guiraudon et al., "Surgical ablation of posterior septal accessory pathways in the Wolff-Parkinson-White syndrome by a closed heart technique", J Thorac Cardiovasc Surg 92:406-413 (1986).34Guiraudon et al., "Surgical Alternatives for Supraventricular Tachycardias, Am J of Cardiology", vol. 64, No. 20:92J-96J (Dec. 5, 1989).35Guiraudon et al., "Surgical Dissection of Kent Bundle Using Closed Heart Procedure" (Abstract), Archive Des Maladies de Coeur, vol. 77, No. 6, 1984.36Guiraudon et al., "Surgical Epicardial Ablatlon of Left Ventricular Pathway Using Sling Exposure", Ann of Thorac Surg 50:968-71 (1990).37Guiraudon et al., "Surgical Repair of Wolff-Parkinson-White Syndrome: A New Closed-Heart Technique", Annals of Thoracic Surgery, vol. 37, No. 1, Jan. 1984, pp. 67-71.38Guiraudon et al., "Surgical Treatment of Wolff-Parkinson-White Syndrome: A "Retrospecive" View", Ann of Thorac Surg 58:1254-61 (1994).39Guiraudon, Gerard / "Surgical repair of Wolff-Parkinson-White Syndrome: A new closed-heart technique"/ The Annals of Thoracic Surgery/ 37(1):67-71/ Jan 1984.40Guiraudon, Gerard / "Surgical repair of Wolff-Parkinson-White Syndrome: A new closed-heart technique"/ The Annals of Thoracic Surgery/ 37(1):67-71/ Jan. 1984.41Guiraudon, Gerard/ "Closed-heart technique for Wolff-Parkinson-White syndrome: Further experience and potential limitations"/ The Annals of Thoracic Surgery/ 42(6):651-657/ Dec. 1986.42Guiraudon, Gerard/ "Supraventricular tachycardias: The role of surgery"/ PACE/ 16(3pt2):658-670/ Mar. 1993.43Guiraudon, Gerard/ "Surgery for Wolff-Parkinson-White syndrome: Further experience with an epicardial approach"/ Circulation/ 74(3):525-529/ Sep. 1986.44Guiraudon, Gerard/ "SurgicaI ablation of posterior septal accessory pathways in the Wolff-Parkinson-White syndrome by a closed heart technique"/ The Journal of Thoracic and Cardiovascular Surgery/ 92 (3pt1):406-413/ Sep. 1986.45Guiraudon, Gerard/ "Surgical alternatives for supraventricular tachycardias"/ The American Journal of Cardiology/ 64(20):92J-96J/ Dec. 1989.46Guiraudon, Gerard/ "Surgical correction of the Wolff-Parkinson-White syndrome: A new closed-heart technique"/ Journal of the American College of Cardiology/ 1(2):687/ Feb 1983.47Guiraudon, Gerard/ "Surgical correction of the Wolf-Parkinson-White syndrome: A new closed-heart technique"/ Journal of the American College of Cardiology/ 1(2):687/ Feb. 1983.48Guiraudon, Gerard/ "Surgical epicardial ablation of left ventricular pathway using sling exposure"/ The Annals of Thoracic Surgery/ 50(6):968-971/ Dec. 1990.49Guiraudon, Gerard/ "Surgical treatment of supraventricular tachycardia: A five-year experience"/ PACE/ 9(6pt2);1376-1380/ Nov. 1986.50Guiraudon, Gerard/ "Surgical treatment of Wolff-Parkinson-White syndrome: A "retrospectroscopic" view"/ The Annals of Thoracic Surgery/ 58(4):1254-1261/ Oct. 1994.51Guiraudon, Gerard/" Surgical Dissection of Kent Bundle Using Closed Heart Procedure"/ Archive Des Maladies de Coeur/ vol. 77, No. 6/1984.52Guiraudon, Gerard; Klein, George / "Closed heart surgery for Wolff-Parkinson-White syndrome"/ International Journal of Cardiology/ 5(3):387-391 Mar. 1984.53Harrison et al., "Cryosurgical Ablation of the A-V Node-His Bundle; a New Method for Producing A-V Block", Circulation vol. 55, No. 3, Mar. 1977, 463-70.54Hauer et al., "'Para' AV nodal re-entry tachycardias", European Heart J, 1998, 19, (suppl. E), E2-E9.55He et al., "Application of Ultrasound Energy for Intracardiac Ablation of Arrythmias", European Heart J. (1995) 16, pp. 961-966.56He et al., "Preliminary Results Using Ultrasound Energy for Ablation of the Ventricular Myocardium in Dogs", Amer J of Cardiology, vol.73, May 15, 1994, pp. 1029-1031.57Hickey et al., "Transcatheter closure of atrial septal defects: Hemodynamic complications and anesthetic management", Anest Analg, 74:44-50 (1992).58Hoffman et al., "Temperature-controlled Radiofrequency Catheter Ablation of AV conduction: first Clinical Experience", European Heart Journal (1993) 14, 57-64.59Inoue et al., "Video Assisted Thoracoscopic and Cardioscopic Radiofrequency Maze Ablation", ASAIO J. 1997, pp. 334-337.60Iwa et al., "Present Status of Surgical Management of Supraventricular Tachycardias" (Abstract), J. Cardiovasc Surg, 31, 1990, p 13.61Iwa, T/" Surgery for Wolff-Parkinson-White Syndrome"/Grudnaya E Serdechno Sosudistaya Khirurgiya (Thoracic and Cardiovascular Surgery)/No. 4/1990.62Iwa, T/" Surgery for Wolf-Parkinson-White Syndrome"/Grudnaya E Serdechno Sosudistaya Khirurgiya (Thoracic and Cardiovascular Surgery)/No. 4/1990.63Iwa, T/"Subendocardial Resection for Surgical Treatment of Ventricular Arrythmias in Patients Suffering From Ischemic Heart Disease (From Moscow lnternational Symposium "Surgical Treatment of Tachycardial Arrythmias in Adults and Children")"/ Grudnaya E Serdechno-Sosudistaya Khirurgiya (Thoracic and Cardiovascular Surgery)/ No. 4/1990.64Jais et al., "Catheter Ablation for Paroxzysmal Atrial Fibrillation: High Success Rates wioth Ablation in the Left Atrium" (Abstract), Circulation vol. 94, No. 8, Oct. 15, 1996.65Josephson et al., ISubendocardial Resection in Surgical Treatment of Ventricular Arrhythmias in Patients with Ischemic Heart Disease, (Abstract): Grudnaya E. Serdechno-Sosudistaya Khirurgiya, No. 4, 1990.66Khan et al., "Blade atrial septostomy: Experience with first 50 procedures", Catheterization Cardiovasc Diagn, 23:257-262 (1991).67Khan et al., "Experience with 205 procedures of transcatheter closure of ductus arteriosus in 182 patients, with special reference to residual shunts and long-term follow-up", J. Thorac and Cardiovasc Surg., 104(6):1721-1727 (1992).68Klein et al., "Surgical Correction of the Wolff-Parkinson-White Syndrome in the Closed Heart Using Cryosurgery: A simplified Approach", American College of Cardiology, vol. 3, No. 2, Feb. 1984, pp. 405-409.69Klein, George/ "Surgical correction of the Wolff-Parkinson-White syndrome in the closed heart using cryosurgery: A simplified approach"/ Journal of the American College of Cardiology/ 3(2pt1):405-409/ Feb 1984.70Klein, George/ "Surgical correction of the Wolff-Parkinson-White syndrome in the closed heart using cryosurgery: A simplified approach"/ Journal of the American College of Cardiology/ 3(2pt1):405-409/ Feb. 1984.71Latson et al., "Endocarditis Risk of the USCI PDA Umbrella for Transcatheter Closure of Patent Ductus Arteriosus", Circulation, 90:2525-2528, 1993.72Laussen et al., "Transcatheter closure of ventricular septal defects: Hemodynamic instability and anesthetic management", Anesth Analg, 80:1076-82 (1995).73LaVergne et al., "Transcatheter Radiofrequency Ablation of Atrial Tissue Using a Suction Catheter", PACE, vol. 12, Jan. 1989, Part II, pp. 177-186.74Lawrie et al., "Surgical Treatment of Supraventricular Arrhythmias,I Results in 67 Patients", Annals of Surgery, vol. 205, No. 6, Jun. 1987, pp. 700-711.75Lindsay et al., "Inoperative Observations and Epicardial Mapping after Attempted Catheter Ablation of Atrial Fibrillation", (Abstract), Supp. to Circulation, vol. 96, No. 8, Oct. 21, 1997.76Lloyd et al., Atrial septal defect occlusion with buttoned device (a multi-institutional U.S. trial):, Am J Cardiol. 73:286-291 (1994).77Lock et al., "Transcatheter closure of atrial septal defects-Experimental studies", Circulation, 79:1091-1099 (1989).78Lock et al., "Transcatheter umbrella closure of congenital heart defects", Circulation 75(3):593-599 (1987).79Louagie et al. "Closed Heart Cryoablation of the His Bundle Using an Anterior Septal Approach", Annals of Thoracic Surgery, vol. 51, No.4, Apr. 1991, pp. 616-619.80Louagie, Yves/ "Closed heart cryoablation of the His bundle using an anterior septal approach"/ The Annals of Thoracic Surgery/ 51(4): 616-619/ Apr. 1991.81Melo, Joao et al., "Surgery for Atrial Fibrillation Using Radiofrequency Catheter Ablation: Assessment of Results at One Year", Euro J of Cariothoriacic Surgery 15 (1999) 851-853.82Minzioni et al., "Surgical Treatment of Atrial Fibrillation in Patients with Atrial Septal Defect" (Abstract), J Cardiovasc Surg., 33, 1992, p. 22.83Nitta et al., "Superior-septal approach for transmittal mapping and cryoablation of ventricular tachycardia", J. of Cardiovascular Surgery, vol. 38, No. 6, 1997, pp. 615-617.84Pfeiffer, et al., "Epicardial Neodymium, YAG Laser Photocoagulation of Vewntricular Tqachycardia without Ventriculotomy in Patients after Myocardial Infarction", Circulation, Vo. 94, No. 12, Dec. 14, 1996; pp. 3221-3225.85Santarelli et al., "Results of Surgical Treatment of Supraventricular Tachycardias", (Abstract), Giornale Italiano di Cardiologia, kVol. 23, Jan. 1993, pp. 9-18.86Santarelli, P/" Results of Surgical Treatment of Supraventricular Tachycardies"/Giornale Italiano di Cardiologia/vol. 23/Jan. 1993.87Scheinman, Melvin, "Supraventricular Tachyarrhythmias: Drug Therapy versus Catheter Ablation", Clin. Cardiol. vol. 17, (Suppl. II0 II-11-II-15 (1994).88Sie et al., " Radiofrequency Ablation of Atrial Fibrillation in Patients Undergoing Valve Surgery" (Abstract), Circulation, vol. 94, No. 12, Oct. 12, 1997.89Smith, Peter et al., "Surgical Treatment of Supraventiruclar Tachyarrhythmias", S. Clinics of No. America, vol., 65, No. 3, Jun., 1985, pp. 553-570.90Sosa, et al., Radiofrequency Catheter Ablation of Ventricular Tachycardia Guided by Nonsurgical Epicardial Mapping in Chronic Chagasic Heart Disease, PACE, vol. 22, Jan. 1999, Part I, pp. 128-130.91Sternik, Leonid/"Comparison of myocardial revascularization without cardiopulmonary bypass to standard open heart technique in patients with left ventricular dysfunction"/European Journal of Cardio-thoracic Surgery/11, 123-128/1997.92Suedo, Taijiro et al., "Efficacy of a Simple Left Atrial Procedure for Chronic Atrial Fibrillation in Mitral Valve Operations", Ann Thorac Surg 1995; 63-1070-1075.93Szabo et al., "Cryosurgical Modification of the Atrioventricular Node: A Closed Heart Approach in the Dog", American College of Cardiology, vol. 10, No. 2, Aug. 1987, pp. 389-398.94Szabo, Tibor/ "Cryosurgical modification of the atrioventricular node: A closed heart approach in the dog"/ Journal of the American College of Cardiology/ 10(2):389-98/ Aug. 1987.95Thomas et al., "An Endocardial Radiofrequency Ablative Technique for Cure of Atrial Fibrillation During Cardiac Surgery" (Abstract), Circulation, Vo. 94, No. 12, Oct. 12, 1997.96Ward et al., "Electrical Ablation of Junctional Tachycardias showing a Long RP Interval", Eur. Heart J., (1989) 10, 718-724.97Watanabe, H./"Histologic findings of long-term cryolesions in a patient with ventricular tachycardia"/Cardiovascular Surgery/Vol4,No. 3, 409-411/1996.98Weber et al., "Laser versus Radiofrequency Catheter Ablation of Ventricular Myocardium in Dogs; a Comparative Test", Cardiology 1997:88:346-352.99Yu, Yu/" Laser Surgery of Heart Pathways"/ Kardiologiya/No. 5/1985.Referenced byCiting PatentFiling datePublication dateApplicantTitleUS7678132Jun 7, 2006Mar 16, 2010Ovalis, Inc.Systems and methods for treating septal defectsUS7686828Jun 7, 2006Mar 30, 2010Ovalis, Inc.Systems and methods for treating septal defectsUS7740640May 28, 2004Jun 22, 2010Ovalis, Inc.Clip apparatus for closing septal defects and methods of useUS7824368 *Jun 19, 2003Nov 2, 2010Ethicon Endo-Surgery, Inc.Method for endoscopic, transgastric access into the abdominal cavityUS7846179Sep 1, 2005Dec 7, 2010Ovalis, Inc.Suture-based systems and methods for treating septal defectsUS7963941 *Mar 22, 2006Jun 21, 2011Wilk Peter JIntra-abdominal medical method and associated deviceUS8070826Dec 11, 2003Dec 6, 2011Ovalis, Inc.Needle apparatus for closing septal defects and methods for using such apparatusUS8257382Mar 30, 2008Sep 4, 2012Boston Scientific LimitedLumen reentry devices and methodsUS8257383Mar 30, 2008Sep 4, 2012Boston Scientific LimitedLumen reentry devices and methodsUS8333686Aug 29, 2007Dec 18, 2012Circulite, Inc.Cannula insertion devices, systems, and methods including a compressible memberUS8343029Oct 23, 2008Jan 1, 2013Circulite, Inc.Transseptal cannula, tip, delivery system, and methodUS8460168Jun 11, 2013Circulite, Inc.Transseptal cannula device, coaxial balloon delivery device, and methods of using the sameUS8465500Jan 19, 2006Jun 18, 2013Mayo Foundation For Medical Education And ResearchThorascopic heart valve repair method and apparatusUS8545380Mar 2, 2009Oct 1, 2013Circulite, Inc.Intravascular blood pump and catheterUS8579936Jun 21, 2010Nov 12, 2013ProMed, Inc.Centering of delivery devices with respect to a septal defectUS8721675Aug 24, 2012May 13, 2014Boston Scientific LimitedLumen reentry devices and methodsUS8747483Nov 16, 2012Jun 10, 2014ProMed, Inc.Needle apparatus for closing septal defects and methods for using such apparatusUS8758393Oct 20, 2008Jun 24, 2014Neochord, Inc.Minimally invasive repair of a valve leaflet in a beating heartUS8758401Sep 30, 2011Jun 24, 2014ProMed, Inc.Systems and methods for treating septal defectsUS8768487Feb 11, 2011Jul 1, 2014Circulite, Inc.Devices, methods and systems for establishing supplemental blood flow in the circulatory systemUS8880185Jun 25, 2013Nov 4, 2014Boston Scientific Scimed, Inc.Renal denervation and stimulation employing wireless vascular energy transfer arrangementUS8915908Mar 19, 2010Dec 23, 2014Atricure, Inc.Cryogenic probeUS8939970Feb 29, 2012Jan 27, 2015Vessix Vascular, Inc.Tuned RF energy and electrical tissue characterization for selective treatment of target tissuesUS8951251Nov 7, 2012Feb 10, 2015Boston Scientific Scimed, Inc.Ostial renal nerve ablationUS8968338Feb 19, 2010Mar 3, 2015Mayo Foundation For Medical Education And ResearchThorascopic heart valve repair method and apparatusUS8974451Oct 25, 2011Mar 10, 2015Boston Scientific Scimed, Inc.Renal nerve ablation using conductive fluid jet and RF energyUS9023034Nov 22, 2011May 5, 2015Boston Scientific Scimed, Inc.Renal ablation electrode with force-activatable conduction apparatusUS9028472Dec 21, 2012May 12, 2015Vessix Vascular, Inc.Methods and apparatuses for remodeling tissue of or adjacent to a body passageUS9028485Sep 23, 2011May 12, 2015Boston Scientific Scimed, Inc.Self-expanding cooling electrode for renal nerve ablationUS9037259Dec 21, 2012May 19, 2015Vessix Vascular, Inc.Methods and apparatuses for remodeling tissue of or adjacent to a body passageUS9044221Dec 29, 2011Jun 2, 2015Neochord, Inc.Exchangeable system for minimally invasive beating heart repair of heart valve leafletsUS9050106Dec 21, 2012Jun 9, 2015Boston Scientific Scimed, Inc.Off-wall electrode device and methods for nerve modulationUS9060761Nov 9, 2011Jun 23, 2015Boston Scientific Scime, Inc.Catheter-focused magnetic field induced renal nerve ablationUS9072902Dec 21, 2012Jul 7, 2015Vessix Vascular, Inc.Methods and apparatuses for remodeling tissue of or adjacent to a body passageUS9078749Aug 21, 2014Jul 14, 2015Georg LutterTruncated cone heart valve stentUS9079000Oct 16, 2012Jul 14, 2015Boston Scientific Scimed, Inc.Integrated crossing balloon catheterUS9084609Jul 18, 2011Jul 21, 2015Boston Scientific Scime, Inc.Spiral balloon catheter for renal nerve ablationUS9089350Nov 9, 2011Jul 28, 2015Boston Scientific Scimed, Inc.Renal denervation catheter with RF electrode and integral contrast dye injection arrangementUS9095433Oct 18, 2011Aug 4, 2015Georg LutterTruncated cone heart valve stentUS9119600Nov 15, 2012Sep 1, 2015Boston Scientific Scimed, Inc.Device and methods for renal nerve modulation monitoringUS9119632Nov 16, 2012Sep 1, 2015Boston Scientific Scimed, Inc.Deflectable renal nerve ablation catheterUS9125666Sep 28, 2007Sep 8, 2015Vessix Vascular, Inc.Selectable eccentric remodeling and/or ablation of atherosclerotic materialUS9125667Oct 18, 2007Sep 8, 2015Vessix Vascular, Inc.System for inducing desirable temperature effects on body tissueUS9132216May 16, 2014Sep 15, 2015Circulite, Inc.Devices, methods and systems for establishing supplemental blood flow in the circulatory systemUS9155589Jul 22, 2011Oct 13, 2015Boston Scientific Scimed, Inc.Sequential activation RF electrode set for renal nerve ablationUS9162046Sep 28, 2012Oct 20, 2015Boston Scientific Scimed, Inc.Deflectable medical devicesUS9173696Sep 17, 2013Nov 3, 2015Boston Scientific Scimed, Inc.Self-positioning electrode system and method for renal nerve modulationUS9174032Jul 12, 2013Nov 3, 2015Boston Scientific Scimed, Inc.Subintimal reentry systemUS9174050Dec 21, 2012Nov 3, 2015Vessix Vascular, Inc.Methods and apparatuses for remodeling tissue of or adjacent to a body passageUS9186209Jul 20, 2012Nov 17, 2015Boston Scientific Scimed, Inc.Nerve modulation system having helical guideUS9186210Oct 10, 2012Nov 17, 2015Boston Scientific Scimed, Inc.Medical devices including ablation electrodesUS9186211Jan 25, 2013Nov 17, 2015Boston Scientific Scimed, Inc.Methods and apparatuses for remodeling tissue of or adjacent to a body passageUS9192374Oct 20, 2008Nov 24, 2015Neochord, Inc.Minimally invasive repair of a valve leaflet in a beating heartUS9192435Nov 22, 2011Nov 24, 2015Boston Scientific Scimed, Inc.Renal denervation catheter with cooled RF electrodeUS9192790Apr 13, 2011Nov 24, 2015Boston Scientific Scimed, Inc.Focused ultrasonic renal denervationUS9216082Mar 10, 2009Dec 22, 2015Symetis SaStent-valves for valve replacement and associated methods and systems for surgeryUS9220558Oct 26, 2011Dec 29, 2015Boston Scientific Scimed, Inc.RF renal denervation catheter with multiple independent electrodesUS9220561Jan 19, 2012Dec 29, 2015Boston Scientific Scimed, Inc.Guide-compatible large-electrode catheter for renal nerve ablation with reduced arterial injuryUS20040260245 *Jun 19, 2003Dec 23, 2004Clem Michael F.Method for endoscopic, transgastric access into the abdominal cavityUS20050137609 *Dec 17, 2003Jun 23, 2005Gerald GuiraudonUniversal cardiac introducerUS20060229653 *Mar 22, 2006Oct 12, 2006Wilk Patent, LlcIntra-abdominal medical method and associated deviceUS20060269444 *Jul 2, 2004Nov 30, 2006Tomislav MihaljevicCardioscopyUS20080076960 *Aug 29, 2007Mar 27, 2008Circulite, Inc.Cannula insertion devices, systems, and methods including a compressible memberUS20090023975 *Jun 24, 2008Jan 22, 2009Circulite, Inc.Cannula for heart chamber implantation and related systems and methodsUS20090112050 *Oct 23, 2008Apr 30, 2009Circulite, Inc.Transseptal cannula, tip, delivery system, and methodUS20090171137 *Mar 2, 2009Jul 2, 2009Circulite, Inc.Intravascular blood pump and catheterUS20090182188 *Feb 25, 2009Jul 16, 2009Circulite, Inc.Devices, methods and systems for establishing supplemental blood flow in the circulatory systemUS20090281567 *Nov 12, 2009Peter Osypka Stiftung Stiftung Des Burgerlichen RechtsOcclusion element for unwanted openings in the heartUS20100185278 *Jan 21, 2010Jul 22, 2010Tendyne MedicalApical Papillary Msucle Attachment for Left Ventricular ReductionUS20100249490 *Mar 9, 2010Sep 30, 2010Circulite, Inc.Transseptal cannula device, coaxial balloon delivery device, and methods of using the sameUS20100249491 *Mar 9, 2010Sep 30, 2010Circulite, Inc.Two-piece transseptal cannula, delivery system, and method of deliveryUS20110004163 *Jul 1, 2009Jan 6, 2011Vaidya Hrushikesh UMethod and apparatus for intraosseous infusionUS20110054487 *Mar 3, 2011Circulite, Inc.Coaxial transseptal guide-wire and needle assemblyUS20110112353 *May 12, 2011Circulite, Inc.Bifurcated outflow cannulaeUS20110137234 *Jun 9, 2011Circulite, Inc.Methods for establishing supplemental blood flow in the circulatory systemUS20110196190 *Aug 11, 2011Circulite, Inc.Devices, methods and systems for establishing supplemental blood flow in the circulatory systemUS20110196191 *Aug 11, 2011Circulite, Inc.Cannula lined with tissue in-growth material and method of using the sameWO2010042812A2 *Oct 9, 2009Apr 15, 2010Epitek, Inc.Method and apparatus for performing minimally invasive transmyocardial revascularization* Cited by examinerClassifications U.S. Classification128/898, 607/122International ClassificationA61B5/0402, A61B17/02, A61B17/04, A61B5/0444, A61B1/00, A61F2/958, A61B18/00, A61B17/34, A61B18/14, A61B17/30, A61B17/06, A61B19/00, A61B17/32, A61B17/00, A61B17/28, A61F2/24, A61M1/00Cooperative ClassificationY10S623/904, A61B17/0469, A61B2017/00243, A61B2017/00053, A61B2017/0475, A61B19/26, A61B2018/00577, A61M2039/0279, A61B2017/00575, A61M2025/028, A61B2018/00363, A61B18/1492, A61B17/0218, A61B2017/00349, A61B2017/3486, A61B2017/00619, A61B17/06061, A61B2018/1465, A61B2017/2946, A61M39/0247, A61B2017/3405, A61B18/1442, A61B2018/00291, A61B2017/00592, A61B2018/00232, A61B17/3417, A61B17/3211, A61B17/2909, A61B17/00234, A61B2017/2943, A61B2017/047, A61B2017/00606, A61B2017/0474, A61B2017/00579, A61B2017/00247, A61M2205/3355, A61B2017/0472, A61B2017/00867, A61B2017/00623, A61M2039/0297, A61B2018/00898, A61M2205/366, A61B2017/306, A61M2205/3344, A61B19/5225, A61B2018/00982, A61B17/3468, A61M25/1011, A61B2018/00214, A61B2017/0243, A61F2/2427, A61B17/0467, A61B2018/00392, A61B17/320016, A61B17/0057, A61B2017/3492, A61B2018/00261, A61B2017/00597, A61B2017/00907, A61B18/1482European ClassificationA61B19/26, A61M25/10D, A61B17/04E, A61B18/14R, A61F2/24H, A61B17/32E, A61B17/34J, A61B17/00P, A61B17/02E, A61B17/06H, A61B18/14V, A61B17/00E, A61M39/02TLegal EventsDateCodeEventDescriptionMar 18, 2009FPAYFee paymentYear of fee payment: 4May 31, 2013REMIMaintenance fee reminder mailedJun 19, 2013SULPSurcharge for late paymentYear of fee payment: 7Jun 19, 2013FPAYFee paymentYear of fee payment: 8RotateOriginal ImageGoogle Home - Sitemap - USPTO Bulk Downloads - Privacy Policy - Terms of Service - About Google Patents - Send FeedbackData provided by IFI CLAIMS Patent Services