US 20060069430 A9
Devices, systems and methods retain a native heart valve leaflet to prevent retrograde flow. The devices, systems, and methods employ an implant that, in use, rests adjacent a valve annulus and includes a retaining structure that is sized and shaped to overlay at least a portion of one or more native valve leaflets. The retaining structure retains the leaflet or leaflets it overlays, to resist leaflet eversion and/or prolapse. In this way, the implant prevents or reduces regurgitation. The implant does not interfere significantly with the opening of and blood flow through the leaflets during periods of antegrade flow.
1. An implant that retains a native heart valve leaflet to resist retrograde flow comprising a scaffold sized and configured to rest adjacent all or a portion of a native heart valve annulus, at least a portion of the scaffold defining a pseudo-annulus and including a retaining structure near or within the pseudo-annulus that is sized and shaped to overlay at least a portion of one or more native valve leaflets, the scaffold further including spaced-apart struts sized and configured to contact tissue near or within the heart valve annulus to brace the retaining structure to resist leaflet eversion and/or prolapse.
2. An implant according to
wherein the retaining structure comprises a wire-form structure.
3. An implant according to
wherein at least one of the struts comprises a wire-form structure.
4. An implant according to
wherein the retaining structure and the struts each comprises a wire-form structure.
5. An implant according to
wherein the scaffold is collapsible for placement within a catheter.
6. An implant according to
wherein at least one of the struts carries a structure sized and configured to increase a surface area of contact with tissue at, above, or below the annulus.
7. An implant according to
further including at least one structure appended to the scaffold and being sized and configured to contact tissue at, above, or below the heart valve annulus to stabilize the scaffold.
8. An implant according to
wherein the scaffold includes a material and a shape to provide a spring-like bias to enable compliant contact with tissue near or within the heart valve annulus.
9. An implant according to
wherein the struts reshape the heart valve annulus.
10. An implant according to
wherein the struts apply tension to tissue to reshape the heart valve annulus.
11. An implant according to
wherein the struts displace tissue to reshape the heart valve annulus.
12. An implant according to
further including a second heart valve treatment element appended to the scaffold to affect a heart valve function.
13. An implant according to
wherein the second heart valve treatment element includes means for reshaping the heart valve annulus for leaflet coaptation.
14. An implant according to
wherein the second heart valve treatment element includes means for separating tissue along an axis of the heart valve annulus for leafleted coaptation.
15. A method for retaining a native heart leaflet to resist retrograde flow comprising the steps of
introducing an implant as defined in
resisting leaflet eversion and/or prolapse by locating the scaffold as defined in
16. A method according to
wherein the introducing step comprises using an open heart surgical procedure.
17. A method according to
wherein the introducing step comprises using a surgical procedure in which the implant is carried within a catheter.
18. A method according to
wherein the introducing step comprises using an intravascular surgical procedure.
This application claims the benefit of co-pending U.S. patent application Ser. No. 09/666,617, filed Sep. 20, 2000 and entitled “Heart Valve Annulus Device and Methods of Using Same,” which is incorporated herein by reference. This application also claims the benefit of Patent Cooperation Treaty Application Serial No. PCT/US 02/31376, filed Oct. 1, 2002 and entitled “Systems and Devices for Heart Valve Treatments,” which claimed the benefit of U.S. Provisional Patent Application Serial No. 60/326,590, filed Oct. 1, 2001, which are incorporated herein by reference. This application also claims the benefit of U.S. Provisional Application Serial No. 60/429,444, filed Nov. 26, 2002, and entitled “Heart Valve Remodeling Devices;” U.S. Provisional Patent Application Serial No. 60/429,709, filed Nov. 26, 2002, and entitled “Neo-Leaflet Medical Devices;” and U.S. Provisional Patent Application Serial No. 60/429,462, filed Nov. 26, 2002, and entitled “Heart Valve Leaflet Retaining Devices,” which are each incorporated herein by reference.
The invention is directed to devices, systems, and methods for improving the function of a heart valve, e.g., in the treatment of mitral valve regurgitation.
I. The Anatomy of a Healthy Heart
The heart (see
The heart has four chambers, two on each side—the right and left atria, and the right and left ventricles. The atria are the blood-receiving chambers, which pump blood into the ventricles. A wall composed of membranous and muscular parts, called the interatrial septum, separates the right and left atria. The ventricles are the blood-discharging chambers. A wall composed of membranous and muscular parts, called the interventricular septum, separates the right and left ventricles.
The synchronous pumping actions of the left and right sides of the heart constitute the cardiac cycle. The cycle begins with a period of ventricular relaxation, called ventricular diastole. The cycle ends with a period of ventricular contraction, called ventricular systole.
The heart has four valves (see
At the beginning of ventricular diastole (i.e., ventricular filling)(see
The opening and closing of heart valves occur primarily as a result of pressure differences. For example, the opening and closing of the mitral valve occurs as a result of the pressure differences between the left atrium and the left ventricle. During ventricular diastole, when ventricles are relaxed, the venous return of blood from the pulmonary veins into the left atrium causes the pressure in the atrium to exceed that in the ventricle. As a result, the mitral valve opens, allowing blood to enter the ventricle. As the ventricle contracts during ventricular systole, the intraventricular pressure rises above the pressure in the atrium and pushes the mitral valve shut.
The mitral valve consists of two leaflets, an anterior leaflet 110, and a posterior leaflet 115, attached to chordae tendineae 120 (or chords), which in turn are connected to papillary muscles 130 within the left atrium 140. Typically, the mitral valve has a D-shaped anterior leaflet 110 oriented toward the aortic valve, with a crescent shaped posterior leaflet 115. The leaflets intersect with the atrium 170 at the mitral annulus 190.
In a healthy heart, these muscles and their chords support the mitral and tricuspid valves, allowing the leaflets to resist the high pressure developed during contractions (pumping) of the left and right ventricles. In a healthy heart, the chords become taut, preventing the leaflets from being forced into the left or right atria and everted. Prolapse is a term used to describe the condition wherein the coaptation edges of each leaflet initially may coapt and close, but then the leaflets rise higher and the edges separate and the valve leaks. This is normally prevented by contraction of the papillary muscles and the normal length of the chords. Contraction of the papillary muscles is simultaneous with the contraction of the ventricle and serves to keep healthy valve leaflets tightly shut at peak contraction pressures exerted by the ventricle.
II. Characteristics and Causes of Mitral Valve Dysfunction
Valve malfunction can result from the chords becoming stretched, and in some cases tearing. When a chord tears, the result is a flailed leaflet. Also, a normally structured valve may not function properly because of an enlargement of the valve annulus pulling the leaflets apart. This condition is referred to as a dilation of the annulus and generally results from heart muscle failure. In addition, the valve may be defective at birth or because of an acquired disease, usually infectious or inflammatory.
As a result of regurgitation, “extra” blood back flows into the left atrium. During subsequent ventricular diastole (when the heart relaxes), this “extra” blood returns to the left ventricle, creating a volume overload, i.e., too much blood in the left ventricle. During subsequent ventricular systole (when the heart contracts), there is more blood in the ventricle than expected. This means that: (1) the heart must pump harder to move the extra blood; (2) too little blood may move from the heart to the rest of the body; and (3) over time, the left ventricle may begin to stretch and enlarge to accommodate the larger volume of blood, and the left ventricle may become weaker.
Although mild cases of mitral valve regurgitation result in few problems, more severe and chronic cases eventually weaken the heart and can result in heart failure. Mitral valve regurgitation can be an acute or chronic condition. It is sometimes called mitral insufficiency.
III. Prior Treatment Modalities
In the treatment of mitral valve regurgitation, diuretics and/or vasodilators can be used to help reduce the amount of blood flowing back into the left atrium. An intra-aortic balloon counterpulsation device is used if the condition is not stabilized with medications. For chronic or acute mitral valve regurgitation, surgery to repair or replace the mitral valve is often necessary.
To date, invasive, open heart surgical approaches have been used to repair or replace the mitral valve with either a mechanical valve or biological tissue (bioprosthetic) taken from pigs, cows or horses.
The need remains for simple, cost-effective, and less invasive devices, systems, and methods for treating dysfunction of a heart valve, e.g., in the treatment of mitral valve regurgitation.
The invention provides devices, systems and methods that retain a native heart valve leaflet. The devices, systems, and methods include an implant that, in use, rests adjacent all or a portion of a valve annulus. The implant includes a retaining structure that is shaped to overlay at least a portion of one or more native valve leaflets. The implant further includes spaced-apart struts sized and configured to contact tissue near or within the heart valve annulus. The struts brace the retaining structure to resist leaflet eversion and/or prolapse. In this way, the implant prevents or reduces retrograde flow and regurgitation. The implant does not interfere with the opening of and blood flow through the leaflets during antegrade flow.
Other features and advantages of the invention shall be apparent based upon the accompanying description, drawings, and claims.
FIGS. 12 to 14 are perspective, anatomic views showing the intravascular introduction and deployment of the implant shown in
Although the disclosure hereof is detailed and exact to enable those skilled in the art to practice the invention, the physical embodiments herein disclosed merely exemplify the invention, which may be embodied in other specific structure. While the preferred embodiment has been described, the details may be changed without departing from the invention, which is defined by the claims.
I. Implants for Retaining a Native Heart Valve Implant
A. Planar Wire-Form Implants
In its most basic form, the components of the implant 400 are made—e.g., by bending, shaping, joining, machining, molding, or extrusion—from a biocompatible metallic or polymer material, or a metallic or polymer material that is suitably coated, impregnated, or otherwise treated with a material or combination of materials to impart biocompatibility. The material is also desirably radio-opaque to facilitate fluoroscopic visualization. The implant material may be rigid, semi-rigid, or flexible.
In the embodiment shown in
The retaining element 420 is sized and configured (see
When installed adjacent a mitral valve annulus, during ventricular systole the retaining element 420 exerts a restraining force on the superior surface of the leaflet or leaflets it overlays, resisting deflection of the leaflet or leaflets into the atrium and preventing leaflet eversion and/or prolapse as well as retrograde flow of blood through the valve during ventricular systole from the ventricle into the atrium. The restraining force also serves to keep valve leaflets tightly shut during peak ventricular systolic pressures. The retaining element 420 thus serves as a “backstop” for the leaflet or leaflets it overlays. During ventricular diastole this restraining force goes to zero and the retaining element 420 does not prevent opening of the native valve leaflet or leaflets during antegrade flow. During ventricular diastole, the native valve leaflet or leaflets open normally so that blood flow occurs from the atrium into the ventricle. The implant 400 thereby restores normal one-way function to the valve.
As shown in
2. Fixation of Implants
The spring-like bias of the implant 400 facilitates compliant fixation of the outer periphery of the implant 400 to or near the annulus. The scaffold 410 of the implant 400 dynamically conforms to the shape of the anatomy.
Alternatively or in combination with the supra-annular structures 440, the implant 400 can include infra-annular contact struts 430. The struts 430 are appended to the scaffold 410, extending below the plane of the annulus into the ventricular chamber. The struts 430 are preferably configured to extend through the valve orifice on narrow connecting members, so that they will not interfere with the opening and closing of the valve. The struts 430 fix and stabilize the implant within the annulus.
In this arrangement, the struts 430 are desirably sized and configured to contact tissue near or within the mitral valve annulus to brace the retaining structure 420 to resist leaflet eversion and/or prolapse during ventricular systole. In this arrangement, it is also desirable that the scaffold 410 be “elastic,” i.e., the material of the scaffold 410 is selected to possess a desired spring constant. This means that the scaffold 410 is sized and configured to possess a normal, unloaded, shape or condition, in which the scaffold 410 is not in net compression, and the struts 450 are spaced apart farther than the longest cross-annulus distance between the tissue that the struts 430 are intended to contact. In the illustrated embodiment (
As just described, different forms of heart valve treatment can be provided using a single implant 400.
Implants having one or more of the technical features just described, to thereby function in situ as a backstop or retainer for native leaflets, may be sized and configured in various ways. Various illustrative embodiments will now be described.
As can be seen in the perspective view in
Any number of supra-annular contact structures 440 can also be used, to disperse the loads experienced by the implant throughout the atrium.
Preferably the framework 450 does not interfere with atrial function, but instead is compliant enough to contract with the atrium. As such, the implant 400 may have nonuniform flexibility to improve its function within the heart.
Additionally, the implant 400 of
The implant 400 may be additionally fixed to the annulus in various auxiliary ways. For example, the implant 400 may be secured to the annulus with sutures or other attachment means (i.e. barbs, hooks, staples, etc.). Still, the position and orientation of the implant is desirably braced or fixed by structures appended to or carried by the implant itself, obviating reliance upon such auxiliary fixation measures.
3. Deployment of Wire Form Implants
The implant 400 may be delivered percutaneously, thoracoscopically through the chest, or using open heart surgical techniques. If delivered percutaneously, the implant 400 may be made from a superelastic material (for example superelastic Nitinol alloy) enabling it to be folded and collapsed such that it can be delivered in a catheter, and will subsequently self-expand into the desired shape and tension when released from the catheter. The deployment of an implant in this fashion will now be described.
FIGS. 12 to 14 show a sequence of steps for a catheter-based, percutaneous deployment of an implant 400 having the technical features described. Percutaneous vascular access is achieved by conventional methods into the femoral or jugular vein. Under image guidance (e.g., fluoroscopic, ultrasonic, magnetic resonance, computed tomography, or combinations thereof), a first catheter (not shown) is steered through the vasculature into the right atrium. A needle cannula carried on the distal end of the first catheter is deployed to pierce the septum between the right and left atrium. A guide wire 1710 is advanced trans-septally through the needle catheter into the left atrium. The first catheter is withdrawn, leaving the guide wire 1710 behind.
The implant delivery catheter 1820 carries within it a wire-form implant 400 of a type shown in
B. Wire-Form Mesh Implants
While the new devices and methods have been more specifically described in the context of the treatment of a mitral heart valve, it should be understood that other heart valve types can be treated in the same or equivalent fashion. By way of example, and not by limitation, the present systems and methods could be used to resist or prevent retrograde flow in any heart valve annulus, including the tricuspid valve, the pulmonary valve, or the aortic valve. In addition, other embodiments and uses of the invention will be apparent to those skilled in the art from consideration of the specification and practice of the invention disclosed herein. The specification and examples should be considered exemplary and merely descriptive of key technical features and principles, and are not meant to be limiting. The true scope and spirit of the invention are defined by the following claims. As will be easily understood by those of ordinary skill in the art, variations and modifications of each of the disclosed embodiments can be easily made within the scope of this invention as defined by the following claims.