Method and device for percutaneous left ventricular reconstruction
Inventors
Chin, Sing-Fatt • Bertolero, Arthur • Annest, Lon S.
Assignees
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Publication Number
US-11273040-B2
Publication Date
2022-03-15
Expiration Date
Abstract
A method for reducing left ventricular volume, which comprises identifying infarcted tissue during open chest surgery; reducing left ventricle volume while preserving the ventricular apex; and realigning the ventricular apex, such that the realigning step comprises closing the lower or apical portion of said ventricle to achieve appropriate functional contractile geometry of said ventricle in a dyskinetic ventricle of a heart.
Core Innovation
The invention concerns reducing a volume in a heart by closing off a lower or apical portion of a heart chamber. A delivery catheter is insertable endovascularly into the heart, and simultaneously delivers a plurality of guidewires across a wall of a chamber such that distal ends extend beyond the wall and the guidewires are laterally offset from adjacent guidewires. At least one fixation member is positionable on a surface of the wall and is coupled with the guidewires to apply tension that pulls the wall toward an opposing wall of the chamber.
In the disclosed cardiac reconstruction context, the system is used to target infarcted tissue and achieve left ventricular reconstruction. Detection identifies infarcted myocardium including the septum and a left ventricular wall, and a perforating member is advanced across the septum to reach and identify the infarcted left ventricular wall. Fixation and retention elements are deployed and then retracted or pulled to appose a lower or apical portion, thereby reducing left ventricular volume while preserving and/or realigning the ventricular apex and improving contractile geometry.
The invention further includes optional sensing and visualization to support the reconstruction. A tissue sensing element is configured to sense infarcted tissue, including approaches based on monophasic action potential, pacing, angiography, echocardiography, and tissue Doppler, and a MAP-based device. Visualization can be provided by an endoscopy/camera/video device/thoracoscope, and an off-pump thoracoscopic variant is described using suction/clamp/patch and suturing, together with the disclosed fixation element concepts.
Claims Coverage
The independent claims are directed to a system and a method for heart volume reduction using an endovascular delivery catheter that simultaneously deploys laterally offset guidewires across a chamber wall, and fixation members that couple to the guidewires to apply tension for closing off a lower or apical portion. The inventive features include multi-guidewire delivery with lateral offset, tension-applied wall apposition via fixation members, and chamber-specific reconstruction with optional sensing and visualization.
Endovascular delivery of laterally offset guidewires across a chamber wall
A delivery catheter insertable endovascularly into the heart simultaneously delivers a plurality of guidewires, each guidewire being deliverable across a wall of a chamber of the heart so that a distal end of each guidewire extends beyond the wall and so that each guidewire is laterally offset from an adjacent guidewire.
Fixation member coupled to guidewires to apply tension and close an apical/lower portion
At least one fixation member positionable on a surface of the wall is coupleable with at least one guidewire so that tension is applicable to the at least one guidewire to cause the fixation member to pull the wall toward an opposing wall of the chamber to close off a lower or apical portion of the chamber.
Simultaneous guidewire deployment with tension-applied fixation to reduce chamber volume
A method for reducing a volume in a heart inserts a delivery catheter endovascularly, simultaneously delivers a plurality of guidewires across a wall of a chamber so that distal ends extend beyond the wall and the guidewires are laterally offset, couples at least one fixation member positionable on a surface of the wall with at least one guidewire, and applies tension to the guidewire to pull the wall toward an opposing wall to close off a lower or apical portion.
Left ventricular reconstruction with septum and left ventricular wall perforation while catheter is positioned in a right ventricle
The method includes that the chamber wall is the left ventricular wall and the opposing wall is the septum, and that perforating elements perforate the septum and the left ventricular wall while the delivery catheter is positioned within a right ventricle of the heart.
Across the independent claims, the central coverage is multi-guidewire, laterally offset delivery across a chamber wall, followed by fixation-member coupling that applies tension to pull the wall toward an opposing wall to close off a lower or apical portion to reduce chamber volume. Dependent refinements identified in the provided claim set further ground the invention in left ventricular reconstruction, and add sensing/visualization options and specific fixation-member forms.
Stated Advantages
Reduces left ventricular volume while closing off a lower or apical portion of the chamber.
Preserves and/or realigns the ventricular apex and improves contractile geometry.
Documented Applications
Minimally invasive/percutaneous left ventricular reconstruction (LVR) to reduce left ventricular volume by apposing a lower/apical portion while preserving/realigning the ventricular apex.
Congestive heart failure (CHF) context is described in connection with the left ventricular reconstruction workflow.
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