|Publication number||US20050119735 A1|
|Application number||US 10/949,412|
|Publication date||Jun 2, 2005|
|Filing date||Sep 24, 2004|
|Priority date||Oct 21, 2002|
|Publication number||10949412, 949412, US 2005/0119735 A1, US 2005/119735 A1, US 20050119735 A1, US 20050119735A1, US 2005119735 A1, US 2005119735A1, US-A1-20050119735, US-A1-2005119735, US2005/0119735A1, US2005/119735A1, US20050119735 A1, US20050119735A1, US2005119735 A1, US2005119735A1|
|Inventors||Paul Spence, Brian Gore, Ed McNamara|
|Original Assignee||Spence Paul A., Brian Gore, Mcnamara Ed|
|Export Citation||BiBTeX, EndNote, RefMan|
|Patent Citations (99), Referenced by (73), Classifications (21), Legal Events (1)|
|External Links: USPTO, USPTO Assignment, Espacenet|
The present application claims the priority of U.S. Provisional Application No. 60/531,855 filed on Dec. 23, 2003 (pending) and U.S. Provisional Application No. 60/554,314 filed Mar. 18, 2004 (pending), the disclosures of which are hereby incorporated herein by reference.
The present application is also a Continuation-In-Part of U.S. Ser. No. 10/689,872, filed Oct. 21, 2003 (pending) which claims the priority of U.S. Provisional Application Ser. No. 60/420,095, filed Oct. 21, 2002 (abandoned). The disclosures of these applications are hereby fully incorporated by reference herein.
The present invention relates generally to techniques for treating mitral valve insufficiencies such as mitral valve leakage due to prolapse, papillary muscle dysfunction, or annular dilation. More particularly, the present invention relates to systems and methods for treating a leaking mitral valve in a minimally invasive manner. Various aspects of the invention further pertain more generally to magnetic guidance and/or fastener delivery systems used for approximating or otherwise operating on tissue.
Congestive heart failure (CHF), which is often associated with an enlargement of the heart, is a leading cause of death. As a result, the market for the treatment of CHF is becoming increasingly prevalent. For instance, the treatment of CHF is a leading expenditure of Medicare and Medicaid dollars in the United States. Typically, the treatment of CHF enables many who suffer from CHF to enjoy an improved quality of life.
Referring initially to Fig. A, the anatomy of a heart 10, specifically the left side of the heart 10, includes a left atrium (LA) 12 and a left ventricle (LV) 14. An aorta 16 receives blood from left ventricle 14 through an aortic valve 18, which serves to prevent regurgitation of blood back into left ventricle 14. A mitral valve 20 is positioned between left atrium 12 and left ventricle 14, and allows one-way flow of blood from the left atrium 12 to the left ventricle 14.
Mitral valve 20, which will be described below in more detail, includes an anterior leaflet 22 and a posterior leaflet 24 that are coupled to cordae tendonae 26 which serve as “tension members” that prevent the leaflets 22, 24 of mitral valve 20 from going past their closing point and prolapsing back into the left atrium. When left ventricle 14 contracts during systole, cordae tendonae 26 limit the upward (toward the left atrium) motion of the anterior and posterior leaflets past the point at which the anterior and posterior leaflets 22, 24 meet and seal to prevent backflow from the left ventricle to the left atrium (“mitral regurgitation” or “mitral insufficiency”). Cordae tendonae 26 arise from a columnae carnae or, more specifically, a musculi papillares (papillary muscles) 28 of the columnae carnae. In various figures herein, some anatomical features have been deleted solely for clarity.
Fig. B is a cut-away top-view representation of mitral valve 20 and aortic valve 18. Anterior leaflet 22 and posterior leaflet 24 of the mitral valve 20 are generally thin, flexible membranes. When mitral valve 20 is closed (as shown in Fig. B), anterior leaflet 22 and posterior leaflet 24 are generally aligned and contact one another along a “line of coaptation” several millimeters back from their free edges, to create a seal that prevents mitral regurgitation. Alternatively, when mitral valve 20 is opened, blood flows downwardly through an opening created between anterior leaflet 22 and posterior leaflet 24 into left ventricle 14.
Many problems relating to mitral valve 20 may occur and may cause many types of ailments. Such problems include, but are not limited to, mitral regurgitation. Mitral regurgitation, or leakage, is the backflow of blood from left ventricle 14 into the left atrium 12 due to an imperfect closure or prolapse of mitral valve 20. That is, leakage often occurs when the anterior and posterior leaflets to not seal against each other, resulting in a gap 32 between anterior leaflet 22 and posterior leaflet 24.
In general, a relatively significant gap 32 may exist between anterior leaflet 22 and posterior leaflet 24 (as shown in Fig. C) for a variety of different reasons. For example, a gap 32 may exist due to congenital malformations, because of ischemic disease, or because the heart 10 has been damaged by a previous heart attack. A gap 32 may also be created when congestive heart failure, e.g., cardiomyopathy, or some other type of distress which causes a heart to be enlarged. Enlargement of the heart can result in dilation (stretching) of the mitral annulus. This enlargement is usually limited to the posterior valve annulus and is associated with the posterior leaflet, because the anterior annulus is a relataively rigid fibrous structure. When the posterior annulus enlarges, it causes the posterior leaflet to move away from the anterior leaflet, causing a gap because the two leaflets no longer form proper coaptation, and this results in leakage of blood through the valve, or regurgitation.
Leakage through mitral valve 20 generally causes a heart 10 to operate less efficiently, as the heart 10 must pump blood both out to the body via the aorta, and also back (in the form of mitral regurgitation) back into the left atrium. Leakage through mitral valve 20, or general mitral insufficiency, is thus often considered to be a precursor to CHF or a cause of progressive worsening of heart failure. There are generally different levels of symptoms associated with heart failure. Such levels are classified by the New York Heart Association (NYHA) functional classification system. The levels range from a Class 1 level which is associated with an asymptomatic patient who has substantially no physical limitations to a Class 4 level which is associated with a patient who is unable to carry out any physical activity without discomfort, and has symptoms of cardiac insufficiency even at rest. In general, correcting or reducing the degree of mitral valve leakage may be successful in allowing the NYHA classification grade of a patient to be reduced. For instance, a patient with a Class 4 classification may have his classification reduced to Class 3 or Class 2 and, hence, be relatively comfortable at rest or even on mild physical exertion. By eliminating the flow of blood backwards into the left atrium, therapies that reduce mitral insufficiency reduce the work load of the heart and may prevent or slow the worsening of heart function and congestive heart failure symptoms that is common when a significant degree of mitral insufficiency remains uncorrected.
Treatments used to correct for mitral valve leakage or, more generally, CHF, are typically highly invasive, open-heart surgical procedures as described below. In extreme cases, this may include implantation of a ventricular assist device such as an artificial heart in a patient whose own heart is failing. The implantation of a ventricular assist device is often expensive, and a patient with a ventricular assist device must be placed on extended anti-coagulant therapy. As will be appreciated by those skilled in the art, anti-coagulant therapy reduces the risk of blood clots being formed, as for example, within the ventricular assist device. While reducing the risks of blood clots associated with the ventricular assist device is desirable, anti-coagulant therapies may increase the risk of uncontrollable bleeding in a patient, e.g., as a result of a fall, which is not desirable.
Rather than implanting a ventricular assist device, bi-ventricular pacing devices similar to pace makers may be implanted in some cases, e.g., cases in which a heart beats inefficiently in a particular asynchronous manner. While the implantation of a bi-ventricular pacing device may be effective, not all heart patients are suitable for receiving a bi-ventricular pacing device. Further, the implantation of a bi-ventricular pacing device is expensive, and is generally not effective in significantly reducing or eliminating the degree of mitral regurgitation.
Open-heart surgical procedures which are intended to correct for mitral valve leakage, specifically, can involve the implantation of a replacement valve. Valves from animals, e.g., pigs, may be used to replace a mitral valve 20 in a human. While the use of a pig valve may relatively successfully replace a mitral valve, such valves generally wear out, thereby requiring additional open surgery at a later date. Mechanical valves, which are less likely to wear out, may also be used to replace a leaking mitral valve. However, when a mechanical valve is implanted, there is an increased risk of thromboembolism, and a patient is generally required to undergo extended anti-coagulant therapies.
A less invasive surgical procedure involves heart bypass surgery associated with a port access procedure. For a port access procedure, the heart may be accessed by cutting between ribs or sometimes removing parts of one or more ribs, as opposed to dividing the sternum to open the entire chest of a patient. In other words, the opening occurs between the ribs in a port access procedure, rather than opening a patient's sternum.
One open-heart surgical procedure that is particularly successful in correcting for mitral valve leakage and, in addition, mitral regurgitation, is an annuloplasty procedure. During an annuloplasty procedure, a medical device—an annuloplasty ring—may be implanted surgically on the left atrial side of mitral annulus (the attachment of the base of the mitral valve to the heart) to cause the size of a dilated mitral valve annulus to be reduced to a relatively normal size, and specifically to move the posterior leaflet closer to the anterior leaflet to aid anterior—posterior leaflet coaptation and thus improve the quality of mitral valve closure and significantly reduce the amount of mitral insufficiency. Fig. D is a schematic representation of an annuloplasty ring 34. An annuloplasty ring 34 is shaped approximately like the contour of a normal mitral valve 20. That is, annuloplasty ring 34 is shaped substantially like the letter “D.” Typically, annuloplasty ring 34 may be formed from a rod or tube of biocompatible material, e.g., plastic, that has a DACRON mesh covering.
In order for annuloplasty ring 34 to be implanted, a surgeon surgically attaches annuloplasty ring 34 to the mitral valve on the atrial side of the mitral valve 20. Conventional methods for installing ring 34 require open-heart surgery which involve opening a patient's sternum and placing the patient on a heart bypass machine. As shown in Fig. E, annuloplasty ring 34 is sewn to a posterior leaflet 24 and an anterior leaflet 22 of a top portion of mitral valve 20. In sewing annuloplasty ring 34 onto mitral valve 20, a surgeon generally sews the straight side of the “D” to the fibrous tissue located at the junction between the posterior wall of the aorta and the base of the anterior mitral valve leaflet. As the curved part of the ring is sewn to the posterior aspect of the annulus, the surgeon alternately acquires a relatively larger amount of tissue from the mitral annulus, e.g., a one-eighth inch bite of tissue, using a needle and thread, compared to a relatively smaller bite taken of the fabric covering of annuloplasty ring 34. Once a thread has loosely coupled annuloplasty ring 34 to mitral valve tissue, annuloplasty ring 34 is slid into contact with the mitral annulus 40 such that the tissue of the posterior mitral annulus that was previously stretched out, e.g., due to an enlarged heart, is effectively reduced in circumference and pulled forwards towards the anterior mitral leaflet by the tension applied by annuloplasty ring 34 by the thread that binds the annuloplasty ring 34 to the mitral annulus tissue. As a result, a gap, such as gap 32 of Fig. C, between anterior leaflet 22 and posterior leaflet 24 during ventricular contraction (systole) may be reduced and even substantially closed off in many cases thereby significantly reducing or even eliminating mitral insufficiency. After the mitral valve 20 is shaped by ring 34, the anterior and posterior leaflets 22, 24 will reform typically by pulling the posterior leaflet forward to properly meet the anterior leaflet and create a new contact line that will enable mitral valve 20 to appear and to function properly.
Once implanted, tissue generally grows over annuloplasty ring 34, and a line of contact between annuloplasty ring 34 and mitral valve 20 will essentially enable mitral valve 20 to appear and function normally. Although a patient who receives annuloplasty ring 34 may be subjected to anti-coagulant therapies, the therapies are not extensive, as a patient is only subjected to the therapies for a matter of weeks, e.g., until tissue grows over annuloplasty ring 34.
A second surgical procedure which is generally effective in reducing mitral valve leakage associated with prolapse of the valve leaflets involves placing a single edge-to-edge suture in the mitral valve 20 that apposes the mid-portions of anterior and posterior leaflets. With reference to Fig. F, such a surgical procedure, e.g., an Alfieri stitch procedure or a bow-tie repair procedure, will be described. An edge-to-edge stitch 36 is used to stitch together an area at approximately the center of the gap 32 defined between an anterior leaflet 22 and a posterior leaflet 24 of a mitral valve 20. Once stitch 36 is in place, stitch 36 is pulled in to form a suture which holds anterior leaflet 22 against posterior leaflet 24, as shown. By reducing the size of gap 32, the amount of leakage through mitral valve 20 may be substantially reduced.
Although the placement of edge-to-edge stitch 36 is generally successful in reducing the amount of mitral valve leakage through gap 32, edge-to-edge stitch 36 is conventionally made through open-heart surgery. In addition, the use of edge-to-edge stitch 36 is generally not suitable for a patient with an enlarged, dilated heart, as blood pressure causes the heart to dilate outward, and may put a relatively large amount of stress on edge-to-edge stitch 36. For instance, blood pressure of approximately 120/80 or higher is typically sufficient to cause the heart 10 to dilate outward to the extent that edge-to-edge stitch 36 may become undone, or tear mitral valve tissue.
Another surgical procedure which reduces mitral valve leakage involves placing sutures along a mitral valve annulus around the posterior leaflet. A surgical procedure which places sutures along a mitral valve 20 will be described with respect to Fig. G. Sutures 38 are formed along the annulus 40 of a mitral valve 20 that surrounds the posterior leaflet 24 of mitral valve 20. These sutures may be formed as a double track, e.g., in two “rows” from a single strand of suture material 42. Sutures 38 are tied off at approximately a central point (P2) of posterior leaflet 24. Pledgets 44 are often positioned under selected sutures, e.g., at the two ends of the sutured length of annulus or at the central point P2, to prevent sutures 38 from tearing through annulus 40. When sutures 38 are tightened and tied off, the circumference of the annulus 40 may effectively be reduced to a desired size such that the size of a gap 32 between posterior leaflet 24 and an anterior leaflet 22 may be reduced.
The placement of sutures 38 along annulus 40, in addition to the tightening of sutures 38, is generally successful in reducing mitral valve leakage. However, the placement of sutures 38 is conventionally accomplished through open-heart surgical procedures. That is, like other conventional procedures, a suture-based annuloplasty procedure is invasive.
While invasive surgical procedures have proven to be effective in the treatment of mitral valve leakage, invasive surgical procedures often have significant drawbacks. Any time a patient undergoes open-heart surgery, there is a risk of infection. Opening the sternum and using a cardiopulmonary bypass machine has also been shown to result in a significant incidence of both short and long term neurological deficits. Further, given the complexity of open-heart surgery, and the significant associated recovery time, people who are not greatly inconvenienced by CHF symptoms, e.g., people at a Class 1 classification, may choose not to have corrective surgery. In addition, people who most need open heart surgery, e.g., people at a Class 4 classification, may either be too frail or too weak to undergo the surgery. Hence, many people who may benefit from a surgically repaired mitral valve may not undergo surgery.
Fig. H illustrates the cardiac anatomy, highlighting the relative position of the coronary sinus (CS) 46 running behind the posterior leaflet 24 of the mitral valve 20. FIG. I is an illustration of the same anatomy but schematically shows a cinching device 48 which is placed within the CS 46 using a catheter system 50, with distal, mid, and proximal anchors 52 a, 52 b, 52 c within the lumen of the CS 46 to allow plication of the annulus 40 via the CS 46. In practice, these anchors 52 a-c are cinched together, i.e., the distance between them is shortened by pulling a flexible tensile member 54 such as a cable or suture with the intent being to shorten the valve annulus 40 and pull the posterior leaflet 24 closer to the anterior leaflet 22 in a manner similar to an annuloplasty procedure. Unfortunately, since the tissue which forms the CS 46 is relatively delicate, the anchors 52 a-c are prone to tear the tissue during the cinching procedure, and the effect on the mitral annulus may be reduced by the position of the coronary sinus up more towards the left atrium rather than directly over the mitral annulus itself. Other minimally invasive techniques have been proposed and/or developed but have various drawbacks related to such factors as effectiveness and/or cases and accuracy of catheter-based implementation.
Therefore, there remains a need for improved minimally invasive treatments for mitral valve leakage. Specifically, what is desired is a method for decreasing the circumference of the posterior mitral annulus, moving the posterior leaflet forwards towards the anterior leaflet and thereby reducing leakage between an anterior leaflet and a posterior leaflet of a mitral valve, in a manner that does not require conventional surgical intervention.
The invention provides a method of modifying an annulus of a heart valve in a first general aspect. The annulus lies generally below the coronary sinus at least at one location. The method comprises fastening the coronary sinus to the annulus to bring the annulus closer to the coronary sinus at least at the one location, and then reducing regurgitation by modifying the annulus. For example, the annulus may be modified by shortening the circumferential length (i.e., the arc length) of the annulus or changing the shape or other physical characteristic of the annulus. Fastening the coronary sinus can further comprise inserting a first guide element into the coronary sinus, directing a second guide element into the left ventricle so it lies under and/or adjacent to the annulus, securing the first and second guide elements together, and applying a fastener between the annulus and the coronary sinus.
The guide elements may be removed after applying the fastener, and therefore act as a temporary anchor for the fastener delivery device and/or the tissue to be secured. Alternatively, the guide elements, or portions thereof, may be left in place. The guide elements may comprise mechanical fasteners or other types of fasteners such as magnets (i.e., magnetic elements), or combinations thereof. One guide element of the invention comprises first and second spaced apart magnets on the distal support portion of a catheter. Repelling poles of the magnets face each other to create a circumferential virtual pole emanating around the gap formed between the spaced apart magnets. Securing the first and second guide elements together can further comprise magnetically attracting the first and second guide elements together. The same catheter device may be used to direct the second guide element and apply the fastener. In addition, the method can include applying a second fastener to the annulus, coupling the first and second fasteners together, and reducing the distance between the first and second fasteners to reduce the circumference of the annulus. In this case applying the first and second fasteners can occur through the same catheter device. More particularly, the method can involve serially applying the first and second fasteners through one lumen in a catheter device or, as another example, applying the first and second fasteners through different lumens of the same catheter device. In another aspect of the invention, at least one flexible tensile member is used to couple the first and second fasteners together and the flexible tensile member is tensioned to reduce the distance between the first and second fasteners. Shortening the circumferential length of the annulus can further comprise fastening a flexible fabric to the annulus and shortening the circumferential length of the flexible fabric.
In another general aspect, a method of modifying an annulus of a heart valve comprises applying first and second fasteners on opposite sides of the annulus through at least one catheter thereby holding heart tissue between the first and second fasteners, applying third and fourth fasteners on opposite sides of the annulus through at least one catheter thereby holding heart tissue between the third and fourth fasteners. As with the fasteners applied in the various aspects of this invention, different chateters or different catheter portions may be used to apply the different fasteners or the same catheter may be used. The first and second fasteners are coupled and the third and fourth fasteners are coupled using at least one flexible tensile member. The distance between adjacent ones of at least two of the first, second, third and fourth fasteners is reduced by applying tension to the flexible tensile member thereby modifying the annulus.
The first, second, third, and fourth fasteners can include at least one magnet and/or at least one mechanical fastening element, such as a mechanical element configured to penetrate and engage with tissue. In addition, the method can include using at least one magnet delivered through a catheter to guide at least one of the fasteners into position. As one option, the guiding magnet may be removed after guiding the fastener or fasteners into position. The fastener or fasteners may be delivered through the guiding magnet.
In another general aspect of the invention, a heart valve annulus is modified by delivering a first fastener through a catheter into the coronary sinus, and delivering a second fastener through a catheter to at least one of two locations, the two locations being 1) generally above the annulus in the left atrium, and 2) generally below the annulus in the left ventricle. The fasteners are secured to the annulus and the distance between the first and second fasteners is reduced to thereby modify the annulus with the respectively delivered fasteners. In another aspect, a flexible tensile member is connected between the fasteners, and the distance between the fasteners is reduced by tensioning the flexible tensile member to modify the annulus. The flexible tensile member may be locked into position with respect to the fasteners by applying a crimp member or other locking element, which may or may not be part of a fastener, to the flexible tensile member. In another embodiment, the fasteners are held in spaced apart positions while securing the fasteners to heart tissue at the two locations. The fasteners are biased toward each other to reduce the distance between adjacent fasteners and modify the annulus with the respectively delivered fasteners. Biasing the fasteners can further comprise magnetically attracting adjacent fasteners toward one another or, as another example, spring biasing adjacent fasteners toward one another. As one option, pressurized air may be used to hold the fasteners in the spaced apart positions prior to biasing the fasteners together. In another aspect, radio frequency energy or any other suitable method is used to form an aperture in the heart tissue in order to apply the fastener(s) through the tissue.
The invention further provides a system for modifying an annulus of a heart valve comprising a first catheter, a first magnet coupled with the first catheter in such a manner that the first catheter is operative to deliver the first magnet adjacent to the annulus. The system further includes a second catheter and a second magnet coupled with the second catheter in such a manner that the second catheter is operative to deliver the second magnet adjacent to the annulus. A fastener delivery portion may be operatively associated with the first catheter. The fastener delivery portion may be coupled at predetermined angle relative to an axis of magnetic attraction between the first and second magnets.
The fastener delivery portion can be movable relative to the first and second magnets so as to enable delivery of a fastener to a desired position. The system can further comprise a plurality of fastener delivery portions configured to deliver respective fasteners at spaced apart locations along the annulus. The plurality of fasteners may be coupled together with at least one flexible tensile member such that the flexible tensile member is capable of drawing the fasteners together and thereby modifying the annulus.
In another embodiment, a catheter system for modifying an annulus of a heart valve comprises a catheter having at least one lumen and first and second fasteners coupled together by an elongate flexible member such that the first fastener is movable along the elongate flexible member to a position closer to the second fastener. An actuation device is coupled in a releasable manner to the elongate flexible member and adapted to pull the elongate flexible member to thereby reduce the distance between the first and second fasteners. A coupling secures the elongate flexible member in a locked position relative to the first and second fasteners. The first and second fasteners can further comprise magnets and/or mechanical fasteners, such as fasteners having projections configured to penetrate heart tissue. The coupling further can further comprise a crimpable or other type of locking member. The first and second fasteners may be further coupled together by a length adjustable member configured to allow the distance between the first and second fasteners to be shortened as the actuation mechanism pulls the flexible tensile member. The length adjustable member can include first and second telescoping portions coupled together or, as another example, a generally accordion-shaped section.
In another embodiment, a catheter system for modifying an annulus of a heart valve comprises a catheter having at least one lumen and first and second fasteners coupled together by a flexible tensile member such that the first fastener is movable along the flexible tensile member relative to the second fastener. A first fastener delivery portion is coupled with the catheter and delivers the first fastener into a first position proximate the annulus. A second fastener delivery portion is coupled with the catheter and moves with respect to the first fastener delivery portion. The second fastener delivery portion delivers the second fastener into a second position proximate the annulus and spaced from the first position. This system can further include a third fastener coupled to the flexible tensile member, and a third fastener delivery portion coupled with the catheter and capable of delivering the third fastener into a third position-proximate the annulus and spaced from the first and second positions. The system can also include first and second fastener drive members coupled respectively with the first and second fastener delivery portions, and being selectively movable to drive the first and second fasteners into the tissue proximate the annulus.
The systems of this invention can include fastener delivery portions comprising at least one spring and drive member each located, for example, at the distal end of a catheter device. Such fastener delivery portions can force the fastener(s) into tissue proximate the annulus. Catheters used in the invention can include a magnet at the distal end for coupling with another magnet located proximate the annulus thereby stabilizing the catheter during delivery of the fastener(s). A lock member may be secured to the flexible tensile member and used to selectively prevent relative movement between the delivered fasteners.
In another embodiment, a catheter system for modifying an annulus of a heart valve includes a catheter having at least one lumen and first and second fasteners coupled together by a flexible tensile member and adapted to be secured to heart tissue proximate the annulus. A rod is movable between a compact state within the lumen and an expanded state outside of the lumen. The first and second fasteners are further coupled to the rod such that the first fastener is movable along the rod relative to the second fastener by applying tension to the flexible tensile member. The rod may be generally C-shaped in the expanded state so as to follow the annulus. A third fastener may be coupled for movement along the rod and adapted to be secured to heart tissue proximate the annulus. A second flexible tensile member can be secured to the third fastener. The third fastener may then be moved along the rod relative to the second fastener by applying tension to the second flexible tensile member. A magnet can be connected to the rod and adapted to magnetically couple with a magnet in the coronary sinus for stabilizing the position of the rod as the fasteners are secured to the heart tissue.
Another catheter system for modifying an annulus of a heart valve generally comprises a catheter having at least one lumen and first and second fasteners adapted to be secured to heart tissue proximate the annulus. At least one flexible tensile member couples the first and second fasteners together. A locking device activated by way of a catheter to fix the fastener positions is provided. For example, a locking element delivery device is deployable through a catheter, which may be the same catheter as a fastener delivery catheter, or a different catheter. For example, the locking element can be a crimp and a compression applying mechanism deployed from the catheter can be configured to compress the crimp onto the flexible tensile member after the fasteners are pulled toward one another with the flexible tensile member to modify the annulus. Other types of locking elements may, for example, include spring elements or other biased elements which are held in an open position and then released into a closed or locked position onto one or more flexible tensile members. Any locking element which is selectively lockable onto a flexible tensile member may be used as appropriate for the application. A flexible tensile member releasing device is provided which releases the flexible tensile member from the catheter system is also provided. This may involve a mechanical disconnection mechanism, such as threads or other connectors, or a cutting mechanism associated which cuts the flexible tensile member after locking takes place, such as mentioned above. A third fastener is adapted to be secured to the heart tissue, and separate flexible tensile members may be connected with each of the fasteners and threaded through the locking element, such as a crimp. It will be appreciated that the term “flexible tensile members”, as used herein, will apply to separate portions of a single element, such as a suture strand, wire, cable or other solid or hollow elongate structure which may be looped back on itself and locked in place, and it will also apply to separate elements altogether.
Another catheter system for modifying an annulus of a heart valve comprises first, second and third fasteners adapted to be secured to heart tissue proximate the annulus. First, second and third flexible tensile members are respectively connectable to the first, second and third fasteners. A generally V-shaped valve support member is provided having a pair of legs movable between a compact state suitable for carrying the valve support member within a catheter and an expanded state in which the legs are more separated. A free end of each leg includes respective first and second eyelets receiving the first and second flexible tensile members and an apex between the pair of legs including a third eyelet receiving the third flexible tensile member. First, second and third crimp members may be provided for respectively securing the first, second and third flexible tensile members with respect to the first, second and third eyelets after at least one of the flexible tensile members is pulled tight to modify the shape of the annulus.
Various additional features, advantages, and aspects of the invention will become more readily apparent to those of ordinary skill in the art upon review of the following detailed description of the illustrative embodiments taken in conjunction with the accompanying drawings.
Fig. A is a cutaway of the left side of the heart showing the internal muscular and valve structure.
Fig. B is a top view showing the normal positions of a mitral valve and adjacent aortic valve.
Fig. C is a top view similar to Fig. B but illustrating the mitral valve in a prolapsed condition in which the posterior leaflet is separated from the anterior leaflet.
Fig. D is an elevational view illustrating a conventional annuloplasty ring.
Fig. E is a top view similar to Fig. B, but illustrating the attachment of the annuloplasty ring to the mitral valve annulus.
Fig. F is a top view of the mitral valve illustrating an Alfieri stitch technique for reducing the gap between the posterior and anterior leaflets.
Fig. G is a top view of the mitral valve illustrating another suturing technique which has been used to close the gap between the posterior and anterior leaflets.
Fig. H is a cross sectional view of the heart anatomy illustrating the coronary sinus (CS) running behind the posterior leaflet of the mitral valve.
FIGS. 6A-6E-1 illustrate a cross section of the heart anatomy through the CS and illustrating a pair of catheter devices being used to successively apply fasteners in a daisy chained fashion and both cinch and lock the fasteners in place.
FIGS. 6F and 6F-1 illustrate the final locked positions of the fasteners, flexible tensile member and locking member placed via catheters.
In this description of illustrative examples, like reference numerals refer to like element throughout the drawings. Like reference numerals with prime (′) marks or double prime (″) marks refer to like structure except for minor differences which will be apparent.
As shown in
Now referring to FIGS. 11A, 11A-1, 11B and 11B-1, a CS catheter 116 may be configured with multiple discrete magnets 118 along its length, wherein the poles of the magnets 118 are arranged such that they are magnetically attracted to each other, yet kept apart by a restraining force, such as pressurized air directed to a bladder-like structure 120 between the magnets 118. In this case, the magnets 118 are being used as fasteners to fasten or trap tissue therebetween. A similar catheter 122 delivers magnets 124 on an opposite side of the tissue, such as within the LV 14. When the restraining force is removed, such as by reducing the air pressure as shown in FIGS. 11B and 11B-1, the magnets 118 are attracted to each other and thereby modify the valve annulus 40 such that the posterior leaflet 24 is pulled toward the anterior leaflet 22. As shown best in
Referring more specifically to
As shown in
As further illustrated in
As shown in
FIGS. 40 illustrates the use of an additional magnet 480 in the left atrium 12 for supplying additional magnetic force at the junction of the annulus 40 and CS 46. An arrangement of magnets 480, 482, 484 may be used for temporarily locking up the catheter system at the location that it is desired to deliver a fastener or anchor (not shown), such as in those manners previously described.
While the present invention has been illustrated by a description of various preferred embodiments and while these embodiments has been described in some detail, it is not the intention of the Applicant to restrict or in any way limit the scope of the appended claims to such detail. Additional advantages and modifications will readily appear to those skilled in the art. The various features of the invention may be used alone or in any combination depending on the needs and preferences of the user. This has been a description of the present invention, along with the preferred methods of practicing the present invention as currently known.
|Cited Patent||Filing date||Publication date||Applicant||Title|
|US3674014 *||Oct 21, 1970||Jul 4, 1972||Astra Meditec Ab||Magnetically guidable catheter-tip and method|
|US3794041 *||Nov 30, 1971||Feb 26, 1974||Yeda Res & Dev||Gastrointestinal catheter|
|US3986493 *||Jul 28, 1975||Oct 19, 1976||Hendren Iii William Hardy||Electromagnetic bougienage method|
|US4042979 *||Jul 12, 1976||Aug 23, 1977||Angell William W||Valvuloplasty ring and prosthetic method|
|US4055861 *||Apr 9, 1976||Nov 1, 1977||Rhone-Poulenc Industries||Support for a natural human heart valve|
|US4489446 *||Jul 14, 1982||Dec 25, 1984||Reed Charles C||Heart valve prosthesis|
|US4809713 *||Oct 28, 1987||Mar 7, 1989||Joseph Grayzel||Catheter with magnetic fixation|
|US4917689 *||Dec 2, 1988||Apr 17, 1990||Smiths Industries Public Limited Company||Ostomy bag with support ring|
|US4945912 *||Nov 25, 1988||Aug 7, 1990||Sensor Electronics, Inc.||Catheter with radiofrequency heating applicator|
|US5041129 *||Jul 2, 1990||Aug 20, 1991||Acufex Microsurgical, Inc.||Slotted suture anchor and method of anchoring a suture|
|US5041130 *||Nov 30, 1989||Aug 20, 1991||Baxter International Inc.||Flexible annuloplasty ring and holder|
|US5061277 *||Sep 2, 1988||Oct 29, 1991||Baxter International Inc.||Flexible cardiac valvular support prosthesis|
|US5104407 *||Sep 20, 1990||Apr 14, 1992||Baxter International Inc.||Selectively flexible annuloplasty ring|
|US5201880 *||Jan 27, 1992||Apr 13, 1993||Pioneering Technologies, Inc.||Mitral and tricuspid annuloplasty rings|
|US5306234 *||Mar 23, 1993||Apr 26, 1994||Johnson W Dudley||Method for closing an atrial appendage|
|US5306296 *||Aug 21, 1992||Apr 26, 1994||Medtronic, Inc.||Annuloplasty and suture rings|
|US5360444 *||Dec 9, 1993||Nov 1, 1994||Kenji Kusuhara||Occluder supporter and a method of attachment thereof|
|US5429131 *||Feb 25, 1994||Jul 4, 1995||The Regents Of The University Of California||Magnetized electrode tip catheter|
|US5450860 *||Aug 31, 1993||Sep 19, 1995||W. L. Gore & Associates, Inc.||Device for tissue repair and method for employing same|
|US5464023 *||Jan 31, 1994||Nov 7, 1995||Cordis Corporation||Magnetic exchange device for catheters|
|US5480388 *||Dec 3, 1993||Jan 2, 1996||Zadini; Filiberto P.||Semi-automatic cannulation device|
|US5571215 *||Dec 6, 1993||Nov 5, 1996||Heartport, Inc.||Devices and methods for intracardiac procedures|
|US5593424 *||Aug 10, 1994||Jan 14, 1997||Segmed, Inc.||Apparatus and method for reducing and stabilizing the circumference of a vascular structure|
|US5607471 *||Aug 21, 1995||Mar 4, 1997||Jacques Seguin||Prosthetic ring for heart surgery|
|US5623943 *||Aug 12, 1992||Apr 29, 1997||Scimed Life Systems, Inc.||Magnetic medical shaft movement control device and method|
|US5640955 *||Feb 14, 1995||Jun 24, 1997||Daig Corporation||Guiding introducers for use in the treatment of accessory pathways around the mitral valve using a retrograde approach|
|US5669919 *||Aug 16, 1996||Sep 23, 1997||Medtronic, Inc.||Annuloplasty system|
|US5674279 *||Jun 29, 1995||Oct 7, 1997||Medtronic, Inc.||Annuloplasty and suture rings|
|US5682906 *||Jun 5, 1995||Nov 4, 1997||Heartport, Inc.||Methods of performing intracardiac procedures on an arrested heart|
|US5690656 *||Jun 27, 1995||Nov 25, 1997||Cook Incorporated||Method and apparatus for creating abdominal visceral anastomoses|
|US5706827 *||Aug 14, 1996||Jan 13, 1998||Scimed Life Systems, Inc.||Magnetic lumen catheter|
|US5716367 *||Oct 18, 1996||Feb 10, 1998||Nissho Corporation||Catheter assembly for intracardiac suture|
|US5716397 *||Dec 6, 1996||Feb 10, 1998||Medtronic, Inc.||Annuloplasty device with removable stiffening element|
|US5716399 *||Oct 6, 1995||Feb 10, 1998||Cardiomend Llc||Methods of heart valve repair|
|US5776080 *||May 2, 1997||Jul 7, 1998||Scimed Life Systems, Inc.||Shaft movement control apparatus|
|US5776189 *||Mar 5, 1997||Jul 7, 1998||Khalid; Naqeeb||Cardiac valvular support prosthesis|
|US5813996 *||Dec 21, 1995||Sep 29, 1998||Scimed Life Systems, Inc.||Guide wire extension system with magnetic coupling|
|US5824066 *||May 21, 1997||Oct 20, 1998||Medtronic, Inc.||Annuloplasty prosthesis|
|US5829447 *||May 7, 1996||Nov 3, 1998||Heartport, Inc.||Method and apparatus for thoracoscopic intracardiac procedures|
|US5830224 *||Mar 15, 1996||Nov 3, 1998||Beth Israel Deaconess Medical Center||Catheter apparatus and methodology for generating a fistula on-demand between closely associated blood vessels at a pre-chosen anatomic site in-vivo|
|US5851185 *||Jul 2, 1997||Dec 22, 1998||Cabot Technology Corporation||Apparatus for alignment of tubular organs|
|US5860920 *||Sep 16, 1997||Jan 19, 1999||Ep Technologies, Inc.||Systems for locating and ablating accessory pathways in the heart|
|US5868733 *||Apr 14, 1995||Feb 9, 1999||Daig Corporation||Guiding introducer system for use in the treatment of accessory pathways around the mitral valve using a retrograde approach|
|US5888240 *||Dec 3, 1996||Mar 30, 1999||Baxter International Inc.||Distensible annuloplasty ring for surgical remodelling of an atrioventricular valve and nonsurgical method for post-implantation distension thereof to accomodate patient growth|
|US5906579 *||Aug 14, 1997||May 25, 1999||Smith & Nephew Endoscopy, Inc.||Through-wall catheter steering and positioning|
|US5928224 *||Jan 24, 1997||Jul 27, 1999||Hearten Medical, Inc.||Device for the treatment of damaged heart valve leaflets and methods of using the device|
|US5931816 *||Mar 24, 1998||Aug 3, 1999||Novinkov; Oleg L.||Syringe and method of using same|
|US6015414 *||Aug 29, 1997||Jan 18, 2000||Stereotaxis, Inc.||Method and apparatus for magnetically controlling motion direction of a mechanically pushed catheter|
|US6068637 *||Aug 29, 1996||May 30, 2000||Cedar Sinai Medical Center||Method and devices for performing vascular anastomosis|
|US6099460 *||Apr 28, 1998||Aug 8, 2000||Denker; Stephen||Electromagnetic heart assist technique and apparatus|
|US6102945 *||Oct 16, 1998||Aug 15, 2000||Sulzer Carbomedics, Inc.||Separable annuloplasty ring|
|US6126647 *||May 17, 1999||Oct 3, 2000||Hermetic Switch, Inc.||Magnetically guided catheter with sensor|
|US6165183 *||Jul 15, 1998||Dec 26, 2000||St. Jude Medical, Inc.||Mitral and tricuspid valve repair|
|US6173199 *||May 5, 1998||Jan 9, 2001||Syncro Medical Innovations, Inc.||Method and apparatus for intubation of a patient|
|US6190353 *||Oct 11, 1996||Feb 20, 2001||Transvascular, Inc.||Methods and apparatus for bypassing arterial obstructions and/or performing other transvascular procedures|
|US6210432 *||Jun 30, 1999||Apr 3, 2001||Jan Otto Solem||Device and method for treatment of mitral insufficiency|
|US6231587 *||Mar 11, 1999||May 15, 2001||Transvascular, Inc.||Devices for connecting anatomical conduits such as vascular structures|
|US6267781 *||Oct 9, 1999||Jul 31, 2001||Quantum Therapeutics Corp.||Medical device and methods for treating valvular annulus|
|US6269819 *||Jun 25, 1998||Aug 7, 2001||The Trustees Of Columbia University In The City Of New York||Method and apparatus for circulatory valve repair|
|US6287317 *||Apr 5, 2000||Sep 11, 2001||Transvascular, Inc.||Transluminal methods and devices for closing, forming attachments to, and/or forming anastomotic junctions in, luminal anatomical structures|
|US6298257 *||Sep 22, 1999||Oct 2, 2001||Sterotaxis, Inc.||Cardiac methods and system|
|US6306133 *||Oct 2, 1999||Oct 23, 2001||Quantum Cor Incorporated||Ablation catheter system and methods for repairing a valvular annulus|
|US6312447 *||Oct 13, 1999||Nov 6, 2001||The General Hospital Corporation||Devices and methods for percutaneous mitral valve repair|
|US6352543 *||Apr 29, 2000||Mar 5, 2002||Ventrica, Inc.||Methods for forming anastomoses using magnetic force|
|US6385472 *||Sep 10, 1999||May 7, 2002||Stereotaxis, Inc.||Magnetically navigable telescoping catheter and method of navigating telescoping catheter|
|US6402781 *||Jan 31, 2000||Jun 11, 2002||Mitralife||Percutaneous mitral annuloplasty and cardiac reinforcement|
|US6447522 *||Jun 18, 2001||Sep 10, 2002||C. R. Bard, Inc.||Implant delivery system|
|US6461366 *||Mar 10, 2000||Oct 8, 2002||Evalve, Inc.||Surgical device for connecting soft tissue|
|US6524303 *||Sep 8, 2000||Feb 25, 2003||Stereotaxis, Inc.||Variable stiffness magnetic catheter|
|US6530952 *||Dec 21, 2000||Mar 11, 2003||The Cleveland Clinic Foundation||Bioprosthetic cardiovascular valve system|
|US6537314 *||Jan 30, 2001||Mar 25, 2003||Ev3 Santa Rosa, Inc.||Percutaneous mitral annuloplasty and cardiac reinforcement|
|US6542766 *||Jul 19, 2001||Apr 1, 2003||Andrew F. Hall||Medical devices adapted for magnetic navigation with magnetic fields and gradients|
|US6544230 *||Mar 31, 1999||Apr 8, 2003||Transvascular, Inc.||Catheters, systems and methods for percutaneous in situ arterio-venous bypass|
|US6562019 *||Sep 20, 1999||May 13, 2003||Stereotaxis, Inc.||Method of utilizing a magnetically guided myocardial treatment system|
|US6565562 *||Sep 10, 2001||May 20, 2003||Baylis Medical Company Inc.||Method for the radio frequency perforation and the enlargement of a body tissue|
|US6594517 *||May 12, 1999||Jul 15, 2003||Robin Medical, Inc.||Method and apparatus for generating controlled torques on objects particularly objects inside a living body|
|US6619291 *||Apr 24, 2001||Sep 16, 2003||Edwin J. Hlavka||Method and apparatus for catheter-based annuloplasty|
|US6626930 *||May 1, 2000||Sep 30, 2003||Edwards Lifesciences Corporation||Minimally invasive mitral valve repair method and apparatus|
|US6629534 *||Apr 7, 2000||Oct 7, 2003||Evalve, Inc.||Methods and apparatus for cardiac valve repair|
|US6676702 *||May 14, 2001||Jan 13, 2004||Cardiac Dimensions, Inc.||Mitral valve therapy assembly and method|
|US6702825 *||Jul 11, 2001||Mar 9, 2004||Ev3 Sunnyvale, Inc.||Anastomosis catheter|
|US6702826 *||Jun 22, 2001||Mar 9, 2004||Viacor, Inc.||Automated annular plication for mitral valve repair|
|US6718985 *||May 25, 2001||Apr 13, 2004||Edwin J. Hlavka||Method and apparatus for catheter-based annuloplasty using local plications|
|US7037334 *||Jul 18, 2003||May 2, 2006||Mitralign, Inc.||Method and apparatus for catheter-based annuloplasty using local plications|
|US7166127 *||Sep 24, 2004||Jan 23, 2007||Mitralign, Inc.||Tissue fastening systems and methods utilizing magnetic guidance|
|US20020156526 *||Apr 24, 2001||Oct 24, 2002||Hlavka Edwin J.||Method and apparatus for catheter-based annuloplasty|
|US20020173841 *||May 14, 2002||Nov 21, 2002||Paul A. Spence||Annuloplasty devices and related heart valve repair methods|
|US20030014039 *||Jun 29, 2001||Jan 16, 2003||Barzell Winston E.||Medical instrument positioner|
|US20030220685 *||May 25, 2001||Nov 27, 2003||Hlavka Edwin J.||Method and apparatus for catheter-based annuloplasty using local plications|
|US20040019378 *||Jul 18, 2003||Jan 29, 2004||Hlavka Edwin J.||Method and apparatus for performing catheter-based annuloplasty|
|US20040167620 *||Feb 26, 2004||Aug 26, 2004||Medtentia||Annuloplasty devices and related heart valve repair methods|
|US20040172046 *||Oct 21, 2003||Sep 2, 2004||Hlavka Edwin J.||Method and apparatus for performing catheter-based annuloplasty using local plications|
|US20050184122 *||Apr 21, 2005||Aug 25, 2005||Mitralign, Inc.||Method and apparatus for performing catheter-based annuloplasty using local plications|
|US20080228165 *||Mar 13, 2007||Sep 18, 2008||Mitralign, Inc.||Systems and methods for introducing elements into tissue|
|US20080228198 *||Nov 5, 2007||Sep 18, 2008||Mitralign, Inc.||Suture cutter and method of cutting suture|
|US20080228265 *||Mar 13, 2007||Sep 18, 2008||Mitralign, Inc.||Tissue anchors, systems and methods, and devices|
|US20080228266 *||Mar 13, 2007||Sep 18, 2008||Mitralign, Inc.||Plication assistance devices and methods|
|US20080228267 *||Mar 13, 2007||Sep 18, 2008||Mitralign, Inc.||Devices and methods for introducing elements into tissue|
|US20080275503 *||Jul 22, 2008||Nov 6, 2008||Mitralign, Inc.||Method of heart valve repair|
|Citing Patent||Filing date||Publication date||Applicant||Title|
|US7175660||Aug 29, 2003||Feb 13, 2007||Mitralsolutions, Inc.||Apparatus for implanting surgical devices for controlling the internal circumference of an anatomic orifice or lumen|
|US7297150||Aug 29, 2003||Nov 20, 2007||Mitralsolutions, Inc.||Implantable devices for controlling the internal circumference of an anatomic orifice or lumen|
|US7455690||Aug 29, 2003||Nov 25, 2008||Mitralsolutions, Inc.||Methods for controlling the internal circumference of an anatomic orifice or lumen|
|US7670368||Mar 2, 2010||Boston Scientific Scimed, Inc.||Venous valve apparatus, system, and method|
|US7682385||Jul 3, 2006||Mar 23, 2010||Boston Scientific Corporation||Artificial valve|
|US7722666||Apr 15, 2005||May 25, 2010||Boston Scientific Scimed, Inc.||Valve apparatus, system and method|
|US7753924||Jul 27, 2004||Jul 13, 2010||Guided Delivery Systems, Inc.||Delivery devices and methods for heart valve repair|
|US7776053||Dec 12, 2006||Aug 17, 2010||Boston Scientific Scimed, Inc.||Implantable valve system|
|US7780627||Jul 16, 2007||Aug 24, 2010||Boston Scientific Scimed, Inc.||Valve treatment catheter and methods|
|US7780722||Feb 7, 2005||Aug 24, 2010||Boston Scientific Scimed, Inc.||Venous valve apparatus, system, and method|
|US7799038||Jan 20, 2006||Sep 21, 2010||Boston Scientific Scimed, Inc.||Translumenal apparatus, system, and method|
|US7854755||Feb 1, 2005||Dec 21, 2010||Boston Scientific Scimed, Inc.||Vascular catheter, system, and method|
|US7854761||Dec 19, 2003||Dec 21, 2010||Boston Scientific Scimed, Inc.||Methods for venous valve replacement with a catheter|
|US7878966||Feb 4, 2005||Feb 1, 2011||Boston Scientific Scimed, Inc.||Ventricular assist and support device|
|US7883538||Sep 20, 2005||Feb 8, 2011||Guided Delivery Systems Inc.||Methods and devices for termination|
|US7892276||Dec 21, 2007||Feb 22, 2011||Boston Scientific Scimed, Inc.||Valve with delayed leaflet deployment|
|US7951189||Jul 27, 2009||May 31, 2011||Boston Scientific Scimed, Inc.||Venous valve, system, and method with sinus pocket|
|US7967853||Feb 5, 2008||Jun 28, 2011||Boston Scientific Scimed, Inc.||Percutaneous valve, system and method|
|US8002824||Jul 23, 2009||Aug 23, 2011||Boston Scientific Scimed, Inc.||Cardiac valve, system, and method|
|US8012198||Sep 6, 2011||Boston Scientific Scimed, Inc.||Venous valve, system, and method|
|US8066766||Aug 20, 2007||Nov 29, 2011||Guided Delivery Systems Inc.||Methods and devices for termination|
|US8128681||Dec 19, 2003||Mar 6, 2012||Boston Scientific Scimed, Inc.||Venous valve apparatus, system, and method|
|US8133270||Jan 8, 2008||Mar 13, 2012||California Institute Of Technology||In-situ formation of a valve|
|US8137394||Jan 14, 2011||Mar 20, 2012||Boston Scientific Scimed, Inc.||Valve with delayed leaflet deployment|
|US8142493||Jul 22, 2008||Mar 27, 2012||Mitralign, Inc.||Method of heart valve repair|
|US8287557||Aug 20, 2007||Oct 16, 2012||Guided Delivery Systems, Inc.||Methods and devices for termination|
|US8343173||Jan 1, 2013||Guided Delivery Systems Inc.||Delivery devices and methods for heart valve repair|
|US8348999||Feb 13, 2012||Jan 8, 2013||California Institute Of Technology||In-situ formation of a valve|
|US8382829||Mar 9, 2009||Feb 26, 2013||Mitralign, Inc.||Method to reduce mitral regurgitation by cinching the commissure of the mitral valve|
|US8388680||Oct 18, 2006||Mar 5, 2013||Guided Delivery Systems, Inc.||Methods and devices for catheter advancement and delivery of substances therethrough|
|US8414641||Mar 2, 2012||Apr 9, 2013||Boston Scientific Scimed, Inc.||Valve with delayed leaflet deployment|
|US8454656 *||Mar 1, 2011||Jun 4, 2013||Medtronic Ventor Technologies Ltd.||Self-suturing anchors|
|US8460365||May 27, 2011||Jun 11, 2013||Boston Scientific Scimed, Inc.||Venous valve, system, and method with sinus pocket|
|US8460371||Oct 21, 2003||Jun 11, 2013||Mitralign, Inc.||Method and apparatus for performing catheter-based annuloplasty using local plications|
|US8470023||Jun 22, 2011||Jun 25, 2013||Boston Scientific Scimed, Inc.||Percutaneous valve, system, and method|
|US8512399||Dec 28, 2009||Aug 20, 2013||Boston Scientific Scimed, Inc.||Valve apparatus, system and method|
|US8672997||Apr 24, 2012||Mar 18, 2014||Boston Scientific Scimed, Inc.||Valve with sinus|
|US8673001||Jan 11, 2008||Mar 18, 2014||StJude Medical, Cardiology Division, Inc.||Methods for controlling the internal circumference of an anatomic orifice or lumen|
|US8721717||Jan 27, 2012||May 13, 2014||Boston Scientific Scimed, Inc.||Venous valve apparatus, system, and method|
|US8758372||May 21, 2007||Jun 24, 2014||St. Jude Medical, Cardiology Division, Inc.||Implantable devices for controlling the size and shape of an anatomical structure or lumen|
|US8778021||Sep 3, 2010||Jul 15, 2014||St. Jude Medical, Cardiology Division, Inc.||Post-operative adjustment tool, minimally invasive attachment apparatus, and adjustable tricuspid ring|
|US8795298||Oct 9, 2009||Aug 5, 2014||Guided Delivery Systems Inc.||Tether tensioning devices and related methods|
|US8808371||Jan 22, 2010||Aug 19, 2014||St. Jude Medical, Cardiology Division, Inc.||Post-operative adjustment tool, minimally invasive attachment apparatus, and adjustable tricuspid ring|
|US8828079||Jul 26, 2007||Sep 9, 2014||Boston Scientific Scimed, Inc.||Circulatory valve, system and method|
|US8845723||Mar 13, 2007||Sep 30, 2014||Mitralign, Inc.||Systems and methods for introducing elements into tissue|
|US8864822||Mar 13, 2007||Oct 21, 2014||Mitralign, Inc.||Devices and methods for introducing elements into tissue|
|US8864823||Jun 7, 2006||Oct 21, 2014||StJude Medical, Cardiology Division, Inc.||Methods and apparatus for controlling the internal circumference of an anatomic orifice or lumen|
|US8882830||Jul 26, 2007||Nov 11, 2014||StJude Medical, Cardiology Division, Inc.||Implantable devices for controlling the internal circumference of an anatomic orifice or lumen|
|US8911461||Nov 5, 2007||Dec 16, 2014||Mitralign, Inc.||Suture cutter and method of cutting suture|
|US8932349||Aug 22, 2011||Jan 13, 2015||Boston Scientific Scimed, Inc.||Cardiac valve, system, and method|
|US8945210||Jan 8, 2009||Feb 3, 2015||StJude Medical, Cardiology Division, Inc.||Implantable devices for controlling the internal circumference of an anatomic orifice or lumen|
|US8951285||Jul 5, 2005||Feb 10, 2015||Mitralign, Inc.||Tissue anchor, anchoring system and methods of using the same|
|US8951286||Nov 19, 2008||Feb 10, 2015||Mitralign, Inc.||Tissue anchor and anchoring system|
|US8979923||Sep 24, 2004||Mar 17, 2015||Mitralign, Inc.||Tissue fastening systems and methods utilizing magnetic guidance|
|US8992547||Mar 21, 2012||Mar 31, 2015||Ethicon Endo-Surgery, Inc.||Methods and devices for creating tissue plications|
|US9028542||Sep 6, 2011||May 12, 2015||Boston Scientific Scimed, Inc.||Venous valve, system, and method|
|US9072513||Aug 6, 2008||Jul 7, 2015||Guided Delivery Systems Inc.||Methods and devices for termination|
|US9107750||Jan 3, 2008||Aug 18, 2015||St. Jude Medical, Cardiology Division, Inc.||Implantable devices for controlling the size and shape of an anatomical structure or lumen|
|US9113866||Dec 15, 2011||Aug 25, 2015||Ethicon Endo-Surgery, Inc.||Devices and methods for endoluminal plication|
|US9113867||Dec 15, 2011||Aug 25, 2015||Ethicon Endo-Surgery, Inc.||Devices and methods for endoluminal plication|
|US9113868||Dec 15, 2011||Aug 25, 2015||Ethicon Endo-Surgery, Inc.||Devices and methods for endoluminal plication|
|US9113879||Dec 15, 2011||Aug 25, 2015||Ethicon Endo-Surgery, Inc.||Devices and methods for endoluminal plication|
|US9119615||Dec 15, 2011||Sep 1, 2015||Ethicon Endo-Surgery, Inc.||Devices and methods for endoluminal plication|
|US20040148021 *||Aug 29, 2003||Jul 29, 2004||Cartledge Richard G.||Implantable devices for controlling the internal circumference of an anatomic orifice or lumen|
|US20050125011 *||Jan 31, 2005||Jun 9, 2005||Spence Paul A.||Tissue fastening systems and methods utilizing magnetic guidance|
|US20050149114 *||Aug 29, 2003||Jul 7, 2005||Cartledge Richard G.||Apparatus for implanting surgical devices for controlling the internal circumference of an anatomic orifice or lumen|
|US20060025784 *||Jul 27, 2004||Feb 2, 2006||Guided Delivery Systems, Inc.||Delivery devices and methods for heart valve repair|
|US20060241746 *||Apr 21, 2005||Oct 26, 2006||Emanuel Shaoulian||Magnetic implants and methods for reshaping tissue|
|US20060241748 *||Mar 27, 2006||Oct 26, 2006||Lee Leonard Y||Methods and apparatus for controlling the internal circumference of an anatomic orifice or lumen|
|US20110004297 *||Jan 6, 2011||Boston Scientific Scimed, Inc.||Translumenal apparatus, system, and method|
|US20110011917 *||Jan 20, 2011||Hansen Medical, Inc.||Methods, devices, and kits for treating valve prolapse|
|US20120226294 *||Mar 1, 2011||Sep 6, 2012||Medtronic Ventor Technologies Ltd.||Self-Suturing Anchors|
|WO2012137208A1 *||Apr 4, 2012||Oct 11, 2012||The Medical Research, Infrastructure, And Health Services Fund Of The Tel Aviv Medical Center||Device and method for heart valve repair|
|U.S. Classification||623/2.36, 623/2.11|
|Cooperative Classification||A61F2/2445, A61B17/00234, A61B2017/00867, A61B2017/0417, A61B2017/0496, A61B2017/0462, A61B2017/0649, A61B2017/00243, A61B2017/0472, A61B2017/00349, A61B17/0487, A61B17/0643, A61B2017/0464, A61B17/0644, A61B17/0469|
|European Classification||A61B17/04E, A61B17/064D, A61B17/00E|
|Dec 15, 2004||AS||Assignment|
Owner name: MITRALIGN, INC., NEW HAMPSHIRE
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:SPENCE, PAUL;GORE, BRIAN;MCNAMARA, ED;REEL/FRAME:015455/0569;SIGNING DATES FROM 20041108 TO 20041210