Abstract:
An apparatus and method for treatment of a failing heart. In one embodiment, the apparatus and method includes a deploying a tension member for drawing at least two portions of the heart toward each other across a heart chamber.

Description:
RELATED APPLICATIONS 
       [0001]    This application is a continuation of U.S. application Ser. No. 12/314,004, entitled Heart Wall Tension Reduction Apparatus and Method, filed Dec. 2, 2008, which is a continuation of U.S. application Ser. No. 10/073,968, entitled Heart Wall Tension Reduction Apparatus and Method, filed Feb. 14, 2002, which is a continuation of U.S. application Ser. No. 09/985,361, entitled Heart Wall Tension Reduction Apparatus and Method, filed Nov. 2, 2001, now U.S. Pat. No. 6,589,160, which is a continuation of U.S. application Ser. No. 09/697,597, filed Oct. 27, 2000, now U.S. Pat. No, 6,332,864, which is a continuation of application Set No. 09/492,777, filed Jan. 28, 2000, now U.S. Pat. No. 6,162,168, which is a continuation of application Ser. No. 08/778,277, filed Jan. 2, 1997, now U.S. Pat. No. 6,050,936. The entirety of each of the above applications is incorporated herein by reference. 
     
    
     FIELD OF THE INVENTION 
       [0002]    The present invention pertains to the field of apparatus for treatment of a failing heart. In particular, the apparatus of the present invention is directed toward reducing the wall stress in the failing heart. 
       BACKGROUND OF THE INVENTION 
       [0003]    The syndrome of heart failure is a common course for the progression of many forms of heart disease. Heart failure may be considered to be the condition in which an abnormality of cardiac function is responsible for the inability of the heart to pump blood at a rate commensurate with the requirements of the metabolizing tissues, or can do so only at an abnormally elevated filling pressure. There are many specific disease processes that can lead to heart failure with a resulting difference in pathophysiology of the failing heart, such as the dilatation of the left ventricular chamber. Etiologies that can lead to this form of failure include idiopathic cardiomyopathy, viral cardiomyopathy, and ischemic cardiomyopathy. 
         [0004]    The process of ventricular dilatation is generally the result of chronic volume, overload or specific damage to the myocardium. In a normal heart that is exposed to long term increased cardiac output requirements, for example, that of an athlete, there is an adaptive process of slight ventricular dilation and muscle myocyte hypertrophy. In this way, the heart fully compensates for the increased cardiac output requirements. With damage to the myocardium or chronic volume overload, however, there are increased requirements put on the contracting myocardium to such a level that this compensated state is never achieved and the heart continues to dilate. 
         [0005]    The basic problem with a large dilated left ventricle is that there is a significant increase in wall tension and/or stress both during diastolic filling and during systolic contraction. In a normal heart, the adaptation of muscle hypertrophy (thickening) and ventricular dilatation maintain a fairly constant wall tension for systolic contraction. However, in a failing heart, the ongoing dilatation is greater than the hypertrophy and the result is a rising wall tension requirement for systolic contraction. This is felt to be an ongoing insult to the muscle myocyte resulting in further muscle damage. The increase in wall stress is also true for diastolic filling. Additionally, because of the lack of cardiac output, there is generally a rise in ventricular filling pressure from several physiologic mechanisms. Moreover, in diastole there is both a diameter increase and a pressure increase over normal, both contributing to higher wall stress levels. The increase in diastolic wall stress is felt to be the primary contributor to ongoing dilatation of the chamber. 
         [0006]    Prior art treatments for heart failure fall into three generally categories. The first being pharmacological, for example, diuretics. The second being assist systems, for example, pumps. Finally, surgical treatments have been experimented with, which are described in more detail below. 
         [0007]    With respect to pharmacological treatments, diuretics have been used to reduce the workload of the heart by reducing blood volume and preload. Clinically, preload is defined in several ways including left ventricular end diastolic pressure (LVEDP), or left ventricular end diastolic volume (LVEDV). Physiologically, the preferred definition is the length of stretch of the sarcomere at end diastole. Diuretics reduce extra cellular fluid which builds in congestive heart failure patients increasing preload conditions. Nitrates, arteriolar vasodilators, angiotensin converting enzyme inhibitors have been used to treat heart failure through the reduction of cardiac workload through the reduction of afterload. Afterload may be defined as the tension or stress required in the wall of the ventricle during ejection. Inotropes like digoxin are cardiac glycosides and function to increase cardiac output by increasing the force and speed of cardiac muscle contraction. These drug therapies offer some beneficial effects but do not stop the progression of the disease. 
         [0008]    Assist devices include mechanical pumps and electrical stimulators. Mechanical pumps reduce the load on the heart by performing all or part of the pumping function normally done by the heart. Currently, mechanical pumps are used to sustain the patient while a donor heart for transplantation becomes available for the patient. Electrical stimulation such as bi-ventricular pacing have been investigated for the treatment of patients with dilated cardiomyopathy. 
         [0009]    There are at least three surgical procedures for treatment of heart failure: 1) heart transplant; 2) dynamic cardiomyoplasty; and 3) the Batista partial left ventriculectomy. Heart transplantation has serious limitations including restricted availability of organs and adverse effects of immunosuppressive therapies required following heart transplantation. Cardiomyoplasty includes wrapping the heart with skeletal muscle and electrically stimulating the muscle to contract synchronously with the heart in order to help the pumping function of the heart. The Batista partial left ventriculectomy includes surgically remodeling the left ventricle by removing a segment of the muscular wall. This procedure reduces the diameter of the dilated heart, which in turn reduces the loading of the heart. However, this extremely invasive procedure reduces muscle mass of the heart. 
       SUMMARY OF THE INVENTION 
       [0010]    The present invention pertains to a non-pharmacological, passive apparatus for the treatment of a failing heart. The device is configured to reduce the tension in the heart wall. It is believed to reverse, stop or slow the disease process of a failing heart as it reduces the energy consumption of the failing heart, decrease in isovolumetric contraction, increases sarcomere shortening during contraction and an increase in isotonic shortening in turn increases stroke volume. The device reduces wall tension during diastole (preload) and systole. 
         [0011]    In one embodiment, the apparatus includes a tension member for drawing at least two walls of the heart chamber toward each other to reduce the radius or area of the heart chamber in at least one cross sectional plane. The tension member has anchoring member disposed at opposite ends for engagement with the heart or chamber wall. 
         [0012]    In another embodiment, the apparatus includes a compression member for drawing at least two walls of a heart chamber toward each other. In one embodiment, the compression member includes a balloon. In another embodiment of the apparatus, a frame is provided for supporting the compression member. 
         [0013]    Yet another embodiment of the invention includes a clamp having two ends biased toward one another for drawing at least two walls of a heart chamber toward each other. The clamp includes at least two ends having atraumatic anchoring member disposed thereon for engagement with the heart or chamber wall. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0014]      FIG. 1  is a transverse cross-section of the left and right ventricles of a human heart showing the placement of a splint in accordance with the present invention; 
           [0015]      FIG. 2  is a transverse cross-section of the left and right ventricles of a human heart showing the placement of a balloon device in accordance with the present invention; 
           [0016]      FIG. 3  is a transverse cross-section of the left and right ventricles of a human heart showing the placement of an external compression frame structure in accordance with the present invention; 
           [0017]      FIG. 4  is a transverse cross-section of the left and right ventricles of a human heart showing a clamp in accordance with the present invention; 
           [0018]      FIG. 5  is a transverse cross-section of the left and right ventricles of a human heart showing a three tension member version of the splint of  FIG. 1 ; 
           [0019]      FIG. 6  is a transverse cross-section of the left and right ventricles of a human heart showing a four tension member version of the splint shown in  FIG. 1 ; 
           [0020]      FIG. 7  is a vertical cross-section of the left ventricle and atrium, the left ventricle having scar tissue; 
           [0021]      FIG. 8  is a vertical cross-section of the heart of  FIG. 7  showing the splint of  FIG. 1  drawing the scar tissue toward the opposite wall of the left ventricle; 
           [0022]      FIG. 9  is a vertical cross-section of the left ventricle and atrium of a human heart showing a version of the splint of  FIG. 1  having an elongate anchor bar; 
           [0023]      FIG. 10  is a side view of an undeployed hinged anchor member; 
           [0024]      FIG. 11  is a side view of a deployed hinged anchor member of  FIG. 10 ; 
           [0025]      FIG. 12  is a cross-sectional view of an captured ball anchor member; 
           [0026]      FIG. 13  is a perspective view of a cross bar anchor member; 
           [0027]      FIG. 14  is a idealized cylindrical model of a left ventricle of a human heart; 
           [0028]      FIG. 15  is a splinted model of the left ventricle of  FIG. 14 ; 
           [0029]      FIG. 16  is a transverse cross-sectional view of  FIG. 15  showing various modeling parameters; 
           [0030]      FIG. 17  is a transverse cross-section of the splinted left ventricle of  FIG. 15  showing a hypothetical force distribution; and 
           [0031]      FIG. 18  is a second transverse cross-sectional view of the model left ventricle of  FIG. 15  showing a hypothetical force distribution. 
       
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
       [0032]    Referring now to the drawings wherein like reference numerals refer to like elements throughout the several views,  FIG. 1  shows a transverse cross-section of a left ventricle  10  and a right ventricle  12  of a human heart  14 . Extending through the left ventricle is a splint  16  including a tension member  18  and oppositely disposed anchors  20 . Splint  16  as shown in  FIG. 1  has been positioned to draw opposite walls of left ventricle  10  toward each other to reduce the “radius” of the left ventricular cross-section or the cross-sectional area thereof to reduce left ventricular wall stresses. It should be understood that although the splint  16  and the alternative devices disclosed herein are described in relation to the left ventricle of a human heart, these devices could also be used to reduce the radius or cross-sectional area of the other chambers of a human heart in transverse or vertical directions, or at an angle between the transverse and vertical. 
         [0033]      FIG. 2  discloses an alternate embodiment of the present invention, wherein a balloon  200  is deployed adjacent the left ventricle. The size and degree of inflation of the balloon can be varied to reduce the radius or cross-sectional area of left ventricle  10  of heart  14 . 
         [0034]      FIG. 3  shows yet another alternative embodiment of the present invention deployed with respect to left ventricle  10  of human heart  14 . Here a compression frame structure  300  is engaged with heart  14  at atraumatic anchor pads  310 . A compression member  312  having an atraumatic surface  314  presses against a wall of left ventricle  10  to reduce the radius or cross-sectional area thereof. 
         [0035]      FIG. 4  is a transverse cross-sectional view of human heart  14  showing yet another embodiment of the present invention. In this case a clamp  400  having atraumatic anchor pads  410  biased toward each other is shown disposed on a wall of left ventricle  10 . Here the radius or cross-sectional area of left ventricle  10  is reduced by clamping off the portion of the wall between pads  410 . Pads  410  can be biased toward each other and/or can be held together by a locking device. 
         [0036]    Each of the various embodiments of the present invention disclosed in  FIGS. 1-4  can be made from materials which can remain implanted in the human body indefinitely. Such biocompatible materials are well-known to those skilled in the art of clinical medical devices. 
         [0037]      FIG. 5  shows an alternate embodiment of the splint of  FIG. 1  referred to in  FIG. 5  by the numeral  116 . The embodiment  116  shown in  FIG. 5  includes three tension members  118  as opposed to a single tension member  18  as shown in  FIG. 1 .  FIG. 6  shows yet another embodiment of the splint  216  having four tension members  218 . It is anticipated that in some patients, the disease process of the failing heart may be so advanced that three, four or more tension members may be desirable to reduce the heart wall stresses more substantially than possible with a single tension member as shown in  FIG. 1 . 
         [0038]      FIG. 7  is a partial vertical cross-section of human heart  14  showing left ventricle  10  and left atrium  22 . As shown in  FIG. 7 , heart  14  includes a region of scar tissue  24  associated with an aneurysm or ischemia. As shown in  FIG. 7 , the scar tissue  24  increases the radius or cross-sectional area of left ventricle  10  in the region affected by the scar tissue. Such an increase in the radius or cross-sectional area of the left ventricle will result in greater wall stresses on the walls of the left ventricle. 
         [0039]      FIG. 8  is a vertical cross-sectional view of the heart  14  as shown in  FIG. 7 , wherein a splint  16  has been placed to draw the scar tissue  24  toward an opposite wall of left ventricle  10 . As a consequence of placing splint  16 , the radius or cross-sectional area of the left ventricle affected by the scar tissue  24  is reduced. The reduction of this radius or cross-sectional area results in reduction in the wall stress in the left ventricular wall and thus improves heart pumping efficiency. 
         [0040]      FIG. 9  is a vertical cross-sectional view of left ventricle  10  and left atrium  22  of heart  14  in which a splint  16  has been placed. As shown in  FIG. 9 , splint  16  includes an alternative anchor  26 . The anchor  26  is preferably an elongate member having a length as shown in  FIG. 9  substantially greater than its width (not shown). Anchor bar  26  might be used to reduce the radius or cross-sectional area of the left ventricle in an instance where there is generalized enlargement of left ventricle  10  such as in idiopathic dilated cardiomyopathy. In such an instance, bar anchor  26  can distribute forces more widely than anchor  20 . 
         [0041]      FIGS. 10 and 11  are side views of a hinged anchor  28  which could be substituted for anchors  20  in undeployed and deployed positions respectively. Anchor  28  as shown in  FIG. 10  includes two legs similar to bar anchor  26 . Hinged anchor  28  could include additional legs and the length of those legs could be varied to distribute the force over the surface of the heart wall. In addition there could be webbing between each of the legs to give anchor  28  an umbrella-like appearance. Preferably the webbing would be disposed on the surface of the legs which would be in contact with the heart wall. 
         [0042]      FIG. 12  is a cross-sectional view of a capture ball anchor  30 . Capture ball anchor  30  can be used in place of anchor  20 . Capture ball anchor  30  includes a disk portion  32  to distribute the force of the anchor on the heart wall, and a recess  34  for receiving a ball  36  affixed to an end of tension member  18 . Disk  32  and recess  34  include a side groove which allows tension member  38  to be passed from an outside edge of disk  32  into recess  34 . Ball  36  can then be advanced into recess  34  by drawing tension member  18  through an opening  38  in recess  34  opposite disk  32 . 
         [0043]      FIG. 13  is a perspective view of a cross bar anchor  40 . The cross bar anchor  40  can be used in place of anchors  20 . The anchor  40  preferably includes a disk or pad portion  42  having a cross bar  44  extending over an opening  46  in pad  42 . Tension member  18  can be extended through opening  46  and tied to cross bar  42  as shown. 
         [0044]    In use, the various embodiments of the present invention are placed in or adjacent the human heart to reduce the radius or cross-section area of at least one chamber of the heart. This is done to reduce wall stress or tension in the heart or chamber wall to slow, stop or reverse failure of the heart. In the case of the splint  16  shown in  FIG. 1 , a canula can be used to pierce both walls of the heart and one end of the splint can be advanced through the canula from one side of the heart to the opposite side where an anchor can be affixed or deployed. Likewise, an anchor is affixed or deployed at the opposite end of splint  16 . 
         [0045]      FIG. 14  is a view of a cylinder or idealized heart chamber  48  which is used to illustrate the reduction of wall stress in a heart chamber as a result of deployment of the splint in accordance with the present invention. The model used herein and the calculations related to this model are intended merely to illustrate the mechanism by which wall stress is reduced in the heart chamber. No effort is made herein to quantify the actual reduction which would be realized in any particular in vivo application. 
         [0046]      FIG. 15  is a view of the idealized heart chamber  48  of  FIG. 14  wherein the chamber has been splinted along its length L such that a “figure eight” cross-section has been formed along the length thereof. It should be noted that the perimeter of the circular transverse cross-section of the chamber in  FIG. 14  is equal to the perimeter of the figure eight transverse cross-section of  FIG. 15 . For purposes of this model, opposite lobes of the figure in cross-section are assumed to be mirror images. 
         [0047]      FIG. 16  shows various parameters of the  FIG. 8  cross-section of the splinted idealized heart chamber of  FIG. 15 . Where λ is the length of the splint between opposite walls of the chamber, R 2  is the radius of each lobe, ⊖ is the angle between the two radii of one lobe which extends to opposite ends of the portion of the splint within chamber  48  and h is the height of the triangle formed by the two radii and the portion of the splint within the chamber  48  (R 1  is the radius of the cylinder of  FIG. 14 ). These various parameters are related as follows: 
         [0000]        h=R   2  COS (⊖/2)
 
         [0000]      λ=2  R   2  SIN (⊖/2)
 
         [0000]        R   2   =R   1 π/(2π−⊖)
 
         [0048]    From these relationships, the area of the figure eight cross-section can be calculated by: 
         [0000]        A   2 =2π( R   2 ) 2 (1−⊖/2π)+ hλ 
 
         [0049]    Where chamber  48  is unsplinted as shown in  FIG. 14  A , the original cross-sectional area of the cylinder is equal to A 2  where 0=180°, h=0 and λ=2R 2 . Volume equals A 2  times length L and circumferential wall tension equals pressure within the chamber times R 2  times the length L of the chamber. 
         [0050]    Thus, for example, with an original cylindrical radius of four centimeters and a pressure within the chamber of 140 mm of mercury, the wall tension T in the walls of the cylinder is 104.4 newtons. When a 3.84 cm splint is placed as shown in  FIGS. 15 and 16  such that λ=3.84 cm, the wall tension T is 77.33 newtons. 
         [0051]      FIGS. 17 and 18  show a hypothetical distribution of wall tension T and pressure P for the figure eight cross-section. As ⊖ goes from 180° to 0°, tension T s  in the splint goes from 0 to a 2 T load where the chamber walls carry a T load. 
         [0052]    It will be understood that this disclosure, in many respects, is only illustrative. Changes may be made in details, particularly in matters of shape, size, material, and arrangement of parts without exceeding the scope of the invention. Accordingly, the scope of the invention is as defined in the language of the appended claims.