Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/02—Prostheses implantable into the body
  • A61F2/24—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body
  • A61F2/2442—Annuloplasty rings or inserts for correcting the valve shape; Implants for improving the function of a native heart valve
  • A61F2/2445—Annuloplasty rings in direct contact with the valve annulus
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
  • A61B17/0487—Suture clamps, clips or locks, e.g. for replacing suture knots; Instruments for applying or removing suture clamps, clips or locks
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/02—Prostheses implantable into the body
  • A61F2/24—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body
  • A61F2/2412—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body with soft flexible valve members, e.g. tissue valves shaped like natural valves
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/02—Prostheses implantable into the body
  • A61F2/24—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body
  • A61F2/2442—Annuloplasty rings or inserts for correcting the valve shape; Implants for improving the function of a native heart valve
  • A61F2/2466—Delivery devices therefor
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
  • A61B17/0487—Suture clamps, clips or locks, e.g. for replacing suture knots; Instruments for applying or removing suture clamps, clips or locks
  • A61B2017/0488—Instruments for applying suture clamps, clips or locks
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
  • A61B2017/0496—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials for tensioning sutures
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
  • A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
  • A61F2220/0033—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementary-shaped recess, e.g. held by friction fit
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
  • A61F2250/0004—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof adjustable
  • A61F2250/0007—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof adjustable for adjusting length
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
  • A61F2250/0004—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof adjustable
  • A61F2250/001—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof adjustable for adjusting a diameter
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
  • A61F2250/0058—Additional features; Implant or prostheses properties not otherwise provided for
  • A61F2250/006—Additional features; Implant or prostheses properties not otherwise provided for modular
  • A61F2250/0064—Sets comprising a plurality of prosthetic parts of different sizes
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
  • A61F2250/0058—Additional features; Implant or prostheses properties not otherwise provided for
  • A61F2250/0096—Markers and sensors for detecting a position or changes of a position of an implant, e.g. RF sensors, ultrasound markers
  • A61F2250/0098—Markers and sensors for detecting a position or changes of a position of an implant, e.g. RF sensors, ultrasound markers radio-opaque, e.g. radio-opaque markers

Definitions

• the present invention relates to a device for treating a valve comprising a body having two elongate sections, each elongate section having:
• the pulling end comprising a hooking element of a traction system.
• This device is particularly applicable to the treatment of heart valves and in particular to the treatment of tricuspid valves.
• the heart has valves that are present at the entrance and exit of the right ventricle (tricuspid and pulmonary valve) and the left ventricle (mitral and aortic valve).
• valves provide unambiguous flow of blood, avoiding blood reflux after ventricular contraction.
• a native valve treatment involves replacing the native valve with a prosthesis.
• the valve ring has varying sizes from one patient to another, the range of necessary prostheses is wide;
• An object of the invention is to obtain a treatment device for implanting a prosthesis of predefined size minimally invasive and slightly disturbing the operation of the valve when the device is put in place.
• the subject of the invention is a device of the aforementioned type, characterized in that each traction end comprises a locking element.
• the device according to the invention may comprise one or more of the following characteristics, taken separately or in any technically possible combination:
• the device comprises at least one closure ring, the closure ring being movable relative to the traction ends between an unlocking position and a locking position, wherein the ring links the traction ends between them;
• Each elongated section has a central region between the connecting end and the pulling end, the central region of a section is a flexible band;
• each pulling end comprises a locking element, each locking element being fixed to the ring when the ring is in the locking position;
• the ring comprises at least one eyelet, the pulling end of each elongated section being inserted into the eyelet in the locking position, the locking element being adapted to be fixed in the eyelet;
• the locking member comprises a movable abutment relative to the elongated section, between an insertion position and a locking position;
• the ring comprises a diaphragm, the diaphragm being able to fix the two traction ends;
• connection ends are permanently linked, the body having a loop shape.
• the subject of the invention is also a treatment kit comprising
• the treatment kit according to the invention may comprise one or more of the following characteristics, taken separately or in any technically possible combination: the kit comprises at least two guidewires, each guidewire being able to separately guide each elongate section when the traction end is pulled by the traction system; and
• the kit comprises a ring guard having at least one axial retaining member of the ring adapted to allow relative movement between the traction ends and the ring during the transport of the traction system.
• FIG. 1 is a sectional view of a first treatment kit according to the invention before a pulling step
• FIG. 2 is a view similar to FIG. 1 of the first treatment kit according to the invention following the traction step;
• FIG. 3 is a view similar to FIG. 1 of the first treatment kit according to the invention following locking of the ring;
• FIG. 4 is a view of the body of the treatment device of the first treatment kit
• FIG. 5 is a view of the locking ring of the treatment device of the first treatment kit
• FIG. 6 is a view similar to FIG. 1 of the first treatment kit according to the invention following the deployment of the prosthesis;
• FIG. 7 is a view similar to FIG. 4 of the body of the treatment device of a second treatment kit according to the invention.
• FIG. 8 is a side view of a fifth treatment kit according to the invention before a traction step, during the treatment of a mitral valve;
• FIG. 9 is a view from above of the treatment device of FIG. 8, placed in a mitral valve,
• FIG. 10 is a view similar to FIG. 9 of a device for treating a sixth treatment kit according to the invention placed in a mitral valve.
• FIGS. 1 to 6 A first treatment kit 1 according to the invention is illustrated in FIGS. 1 to 6.
• the first treatment kit 1 is intended for treating a valve, in particular for treating a heart valve and in particular a tricuspid valve of a patient.
• a tricuspid valve 4 is shown in FIG.
• the tricuspid valve 4 is formed by an anterior leaflet 6, a septal leaflet 8 and a posterior leaflet 10.
• the leaflets 6, 8, 10 are attached to a native fibrous valve ring 12.
• the sheets 6, 8, 10 are separated by commissures 13.
• the tricuspid valve 4 is accessible through a top approach 14 of the heart and a lower approach of the heart.
• the top approach 14 of the heart is an access to the superior vena cava approached by the patient's jugular.
• the lower approach of the heart is an access to the inferior vena cava approached by the femoral vein into the thigh of the patient
• the first treatment kit 1 according to the invention is intended for treating a tricuspid valve by placing a prosthesis.
• the first treatment kit 1 comprises a treatment device 16 comprising a body 18 and a closure ring 20 of the body.
• the first treatment kit 1 further comprises a traction system 22 adapted to set up the body 18 of the treatment device 16 in the tricuspid valve 4.
• the first treatment kit 1 further comprises at least two guidewires 24 and a ring protector 26 facilitating the installation of the device 16.
• the first treatment kit 1 further comprises at least one prosthesis 72.
• the first treatment kit 1 comprises means for placing the prosthesis 72.
• the first treatment kit 1 comprises a plurality of prostheses 72 of different diameters.
• the prosthesis 72 is for example a prosthetic valve intended to functionally replace the native valve.
• the prosthesis 72 is intended to be placed in the valve ring 12.
• the prosthesis 72 is advantageously tubular.
• the outer diameter of the prosthesis 72 is for example between 20 mm and 40 mm, advantageously between 25 mm and 33 mm.
• the diameter of the prosthesis is 27 mm or 29 mm.
• the processing device 16 is intended to form a closed loop after it has been put in place.
• the loop forms a new prosthetic ring around the native valve leaflets 6, 8, 10 and close to the fibrous valve ring 12.
• the treatment device 16 is intended to prepare a drop site for a prosthesis 72 implanted secondarily. This site is detectable by fluoroscopy (and ultrasound) and is calibrated, allowing the implantation of a prosthesis 72 reliably determined size. Finally the device helps prevent periprosthetic leakage by plating the native leaflets 6, 8, 10 on the outer surface of the prosthesis 72 to be implanted.
• FIG. 1 and FIG. 2 illustrate the treatment device 16 before it is put in place.
• Figure 3 shows the processing device 16 at the end of its implementation.
• the body 18 is intended to form the inside of the loop, the loop being locked by the closure ring 20 in the first treatment kit 1.
• the body 18 has two elongate sections 30.
• the length is adapted to the implantation of a cylindrical prosthesis 72 with a diameter of between 20 mm and 40 mm and advantageously between 25 mm and 33 mm.
• Each elongate section 30 has substantially the same length. Each elongated section 30 is intended to be placed on a part of the perimeter of the fibrous valve ring 12, on either side of the native valve.
• Each elongated section 30 has a connecting end 32 intended to link the two elongate sections 30 to each other, a traction end 34 intended to cooperate with the traction system 22 and a central region 36 situated between the connecting end 32 and the pulling end 34.
• the link ends 32 are permanently linked, the body 18 having a loop shape.
• the two sections 30 are linked permanently by their connecting ends 32.
• the central region 36 of an elongated section 30 consists of a flexible band 40.
• the width of the band 40 is able to obtain a stabilized orientation of the body 18 with respect to the valve ring 12 and with respect to the sheets 6, 8 10.
• the width of the band 40 makes it possible to obtain a stabilized orientation of the prosthesis 72 with respect to the body 18 when the prosthesis 72 is put in place.
• the width of the band 40 is advantageously between 1 mm and 8 mm, for example equal to 4 mm.
• the band is for example made of metal material advantageously nitinol, a fabric for example polyester or son for example Goretex®, made radiopaque.
• the central region 36 of the body 18 is advantageously radiopaque.
• Each pulling end 34 comprises a hooking element 42 of a traction system 22.
• the hook member 42 is constituted by a hole for taking a hook.
• Each pulling end 34 further comprises a locking element 44.
• each locking element 44 is able to cooperate with the closure ring 20 as will be described later.
• the locking element 44 comprises a stop 46 movable, relative to the elongated section 30, between an insertion position and a locking position.
• the abutment 46 is of elongate shape along a main axis X.
• the abutment 46 is rotatable about the traction end of the elongated section 30.
• the stop 46 is shown in Figures 1, 2 and 4 in the insertion position and in Figure 3 in the locking position.
• the main axis X of the abutment 46 is situated in the extension of the axis of the elongated section 30.
• the main axis of the abutment 46 is perpendicular to the extension of the axis of the elongated section 30.
• the closure ring 20 is movable relative to the pulling ends 34 between an unlocking position and a locking position. In the locking position, the ring 20 permanently and irreversibly links the traction ends 34 between them.
• the closure ring 20 comprises at least one eyelet 50, the pulling end 34 of each elongate section being inserted into the eyelet 50 in the locking position, the locking element being adapted to be fixed in the eyelet 50 .
• first necessary ring 20 shown in detail in Figure 5 comprises two eyelets 50, each being intended to cooperate with a pull end of one of the sections 30.
• the eyelets 50 are adapted to cooperate with the abutments 46.
• the eyelets 50 are thus complementary in shape to the abutments 46. When the abutments 46 are in the insertion position, they are able to be inserted into the eyelets 50. 46 are in the locking position, they can not pass into the eyelets 50.
• the ring 20 further comprises a fixing means 51 of the ring protector 26.
• the fixing between the ring protector 26 and the ring 20 is reversible.
• the ring guard 26 has a threaded end and the ring 51 has a hole with a complementary thread.
• the traction system 22 is intended to transport the body 18 from the low level of a patient to the tricuspid valve 4 as will be described later.
• the traction system 22 is adapted to pull the traction ends 34 by reversibly locking in respective hook members 42.
• the traction system 22 comprises for example two cables 52, having a hooked end 54 and a gripping end, each cable 52 being received in a sheath 60.
• the cables 52 of the traction system 22 have a length sufficient to be pulled from the top 14, from the outside of the patient, during the transportation of the device 16 from the low approach 15 to the tricuspid valve 4.
• the length of the cables 52 of the traction system 22 is between 50 cm and 2 m.
• Each hooked end 54 is adapted to cooperate with the hooking element 42 of the pulling end 34 of a section 30.
• the hanging end comprises a hook capable of gripping the hook. hooked end 42 through the hole.
• Each guide wire 24 is able to separately guide each elongated section 30 when the traction end 34 is pulled by the traction system 22.
• a first guide wire 24 is intended to pass from one side of the native valve, and a second guide wire 24 is intended to pass from an opposite side of the native valve.
• Each sheath 60 has a diameter sufficient to receive the guide wire
• the internal diameter of the sheaths is between 1 mm and 3 mm.
• the length of the guidewires 24 is advantageously greater than the length of the cables 52 of the traction system 22.
• the length of the guided son is between 2 m and 3 m, preferably equal to 2 m 60.
• each sheath 60 receiving the cable 52 and the guide wire 24 is slidable in a grommet 50.
• the ring protector 26 is a tool for setting up the ring.
• the ring protector 26 is adapted to cooperate with the fixing means 51 of the ring 20.
• the ring protector 26 is housed in an outer insertion sheath 61.
• the ring protector 26 comprises at least one axial retaining member of the ring 20 adapted to allow relative movement between the traction ends 34 and the ring 20 during the transport of the traction system 22.
• the first treatment kit 1 is provided. A top 14 of the heart is prepared. A low baseline is prepared.
• a first guide wire 24 is introduced through the top 14 into the commissure 13 between the anterior leaflet 6 and the septal leaflet 8 of the tricuspid valve 4.
• the first guidewire 24 is placed under the septal leaflet 8 so that it runs along the inside of the ring valve 12 and out through the commissure 13 between the septal leaflet 8 and the posterior leaflet 10.
• the second guide wire 24 is introduced through the top 14 into the commissure 13 between the anterior leaflet 6 and the septal leaflet 8 of the tricuspid valve 4.
• the second guidewire 24 is placed under the anterior leaflet 6 and the leaflet posterior 10 so that it runs along the inside of the valve ring 12 and out through the commissure 13 between the septal leaflet 8 and the posterior leaflet 10.
• the two guide wires 24 thus encircle the leaflets 6, 8, 10 inside the valve ring 12.
• a first end of each guide wire 24 is recovered in the lowermost 15 while the second end of each guide wire 24 remains disposed in the top 14.
• the two guide wires 24 once in place thus constitute two separate guide paths around the native ring.
• the traction system 22 is introduced through the top 14 with its hooked ends 54 directed downwards.
• Each sheath 60 is threaded around a guide wire 24 and is slid from the top 14 to the low 15.
• Each cable 52 of the traction system 22 is deployed in a sheath 60 following one of the guide tracks formed by one of the guide wires 54, until the hooked ends 54 of the traction system emerge by the first 15. For this, each cable 52 is deployed by sliding in the sheath 60.
• the hooked ends 54 then project out of the sheaths 60 as illustrated in FIG. 1.
• the gripping ends of the traction system 22 protrude into the top approach 14.
• the two cables 52 of the traction system 22 thus encircle the sheets 6, 8, 10 inside the valve ring 12.
• the tensile ends 34 of the elongated sections 30 of the device 16 are then attached to the respective hooked ends 54 of the traction system 22 in the low point 15 as illustrated in FIG.
• each hook located at the hooked end 54 is inserted into a hole forming a hooking element 42 in a pulling end 34.
• the gripping ends of the traction system 22 are grasped in the high approach 14 and then pulled by the operator.
• Each cable 52 of the traction system then slides in the sheath 60.
• Each cable 52 drives one of the elongated sections 30 due to the hooking of a hooked end 54 of the traction system 22 to an element Hooked 42 of the body 18.
• the elongate sections 30 are thus reassembled each along a respective guide wire 24.
• a first section 30 is placed under the septal leaflet 8 so that it runs along the inside of the valve ring 12 and out through the commissure 13 between the septal leaflet 8 and the posterior leaflet 10.
• a second section 30 is placed under the anterior leaflet 6 and the posterior leaflet 10 so that it runs along the inside of the valve ring 12 and out through the commissure 13 between the septal leaflet 8 and the posterior leaflet 10. The ends of the Tractions 34 protrude out of the valve 4.
• the ring 20 is put in place in the top 14 by sliding the cables
• the operator positions the ring 20 in the vicinity of the traction ends 34 by the top 14 by means of the guard 26.
• the operator holds the traction ends 34 in place with the help of cables 52.
• the locking elements 44 are inserted into the eyelets 50 of the ring 20.
• the stop 46 is pulled into its insertion position so as to protrude out of the eyelets 50 of the ring 20 after the introduction.
• the stop 46 is moved to its blocking position.
• the ring 20 is placed in the locking position so as to secure the two traction ends 34.
• a step of placing the prosthesis 72 is shown in Figure 6.
• the establishment of the prosthesis 72 is performed before the stall of the system. pulling and removing the guide wires. Locking by the ring 20 shown in FIG. 3 is advantageously carried out before the prosthesis 72 is put in place.
• the treatment device 16 shown in FIG. 3 according to the invention makes it possible to prepare the placement of the prosthesis 72 shown in FIG. 6 and limits the risks of leakage during the placement of the prosthesis 72.
• the first treatment kit 1 comprises a plurality of prostheses 72 of different diameters.
• the operator selects the most appropriate prosthesis 72.
• a step of viewing the zone encircled by the body 18 according to the invention makes it possible to determine the size of the prosthesis 72 to be placed and thus to choose the prosthesis 72 having the best characteristics among the plurality of prostheses 72.
• the prosthesis 72 is introduced into the valve ring 12 by the low approach by not shown delivery means.
• the prosthesis 72 is deployed.
• the prosthesis 72 is held in position by the body 18 which encircles it inside the native valve ring 12.
• the operator picks up the hooked ends 54 of the traction system 22 from the traction ends 34.
• the operator removes the guidewires 24 by the top 14.
• the operator removes the ring guard 26 from the top 14.
• only the device 16 remains positioned in the heart.
• the various steps are performed under ultrasound and radioscopic control.
• the treatment kit according to the invention thus allows a strapping of the valve 4 by the inside of the valve 4.
• the ring 20 which holds the body 18 closed is outside the valve 4, it thus remains accessible.
• a second processing kit 80 is illustrated in FIG. 7.
• the second processing kit 80 differs from the first treatment kit 1 in that the locking elements 44 consist of a detent module 82 and the ring is adapted to cooperate with the latching module 82.
• the detent module 82 comprises notches 84 intended to receive the ring.
• a third treatment kit according to the invention differs from the treatment kits previously described, the two elongate sections 30 are separable.
• each connecting end 32 has a hooking element at the other connecting end 32.
• the elongate sections 30 have for example different lengths depending on the position they are intended to have in the valve 4. For example, the elongated section 30 intended to be positioned under the septal leaflet 8 is shorter than the elongate section 30 intended to be positioned under the anterior leaflet 6 and under the posterior leaflet 10.
• connection ends 32 are fixed to each other at the level of the low level
• a fourth treatment kit according to the invention differs from the treatment kits previously described in that a connecting end 32 comprises a hook member.
• the hook member is adapted to allow the traction of the body 18 of the device
• the operation of the fourth necessary according to the invention differs from the operation of the previously described kits in that the body 18 is towed by the traction system 22 to the top 14 and by means of the hook member to the lower approach 15 to have a precise placement of the body in the valve ring 12.
• the hook member comprises a pulling wire and, for example two eyelets secured to the body 18.
• the pull wire is removable that is to say it is movable between an attachment position in which it is secured to the body 18 and a release position in which it is removed from the body 18.
• the pull wire passes through the two eyelets, the surgeon can pull on both ends of the pull wire both to act on the position of the connecting end 32 and thus on the position of the body 18.
• the surgeon wants to remove the wire it pulls on one of the two ends of the pull wire, the wire then slides through carnations and is released from the body 18.
• the central region 34 is a thick wire. Many other locking systems are also contemplated.
• the closure ring 20 comprises a safety pin able to hook with a ring of the locking element 44.
• the ring 20 is a key-holder sheath consisting of two arches able to grip the locking elements 44.
• the locking system is activated by means of the ring stent 26.
• the ring 20 comprises a diaphragm, the diaphragm being able to fix the two traction ends 34.
• the diaphragm has an adjustable internal diameter by means of the ring retainer 26 between a first diameter allowing the insertion of the pulling ends 34 and a second diameter allowing locking of the locking elements 44 in the ring 20.
• the ring 20 is a flat strip, especially of fabric. Its thickness is much smaller than its other dimensions and is for example less than 3 mm.
• the hung elements have rounded ends so as not to be sharp.
• the hooked elements have sharp ends but remain covered by a sheath as long as they are not in the desired position.
• a fifth treatment kit 90 is shown in FIGS. 8 and 9.
• the fifth treatment kit 90 differs from the treatment kits 1, 80 previously described in that each locking element 44 is able to anchor a section 30 to a fabric An attachment point 94.
• the locking member 44 is adapted to attach to a native valve ring or native valve tissue.
• the anchoring of each section 30 to the fabric is made by transfixing between a first face of the fabric and a second face of the fabric at the point of attachment 94. That is to say at the point of attachment 94, a portion of the section 30 is on one side of the fabric and another portion of the section 30 is on the other side of the fabric on the side of the second side.
• the attachment point 94 of a first traction end 34 is, for example, away from the attachment point 94 of the other traction end 34 so that once the treatment device 16 has been put in place, the traction ends 34 are at a distance from each other.
• the processing device 16 thus forms an open loop after it has been put in place.
• the locking element 44 has a stop 46 as previously described.
• the stops 46 are in the insertion position, they are able to pass through the fabric.
• the stops 46 are in the locking position, they can not pass through the fabric.
• the stops 46 are needles.
• the fifth treatment kit 90 is for the treatment of a mitral valve 96 of a patient.
• a mitral valve 96 is shown in Figure 8 and Figure 9.
• the mitral valve 96 includes an anterior leaflet 98 and a posterior leaflet 100, attached to a native valve ring 102 and separated by a commissure 104.
• the treatment device 16 is intended to be put in place under the valve leaflets 98, 100 as close as possible to the ring 102.
• the treatment device 16 is intended to be fixed to the ring 102 by means of the locking elements 44. at the attachment points 94 by transfixation.
• the loop formed by the device 16 surrounds the valvular leaflets 98, 100 as close as possible to the native valve ring 102 of the mitral valve 94.
• the locking elements 44 of the traction ends 34 are intended to be fixed in the tissue, on either side of the central festoon 1 10 of the posterior leaflet 100 of the mitral valve 96.
• the body 18 to the tissue by two attachment points 94 by means of the locking elements 44 reinforces the maintenance of the body 18 as close as possible to the native valve ring 102.
• the The loop formed by the treatment device 16 forms a new prosthetic ring around the valvular leaflets 98, 100 of the mitral valve 96 as close as possible to the valve ring 102 in the left ventricular flush chamber.
• the operation of the fifth treatment kit 90 according to the invention, during the treatment of a mitral valve 94 will now be described with reference to FIGS. 8 and 9.
• the operation differs from the operation described above for the treatment of a tricuspid valve 4 at least in that the path defined by the guide wires 24 and then by the sheaths 60 is different.
• the fifth processing set 90 is provided. A low approach through the femoral vein of the heart and a trans-aortic approach 108 through the femoral artery allowing access to the heart through the aorta 109 are prepared.
• a first guidewire 24 is introduced through the lower approach 15 to the right atrium and then passes the interatrial septum, arrives in the left atrium and passes through the native mitral annulus 102 on the posterior leaflet 100 side. the mitral valve 96.
• the first guidewire 24 is placed under the posterior valve leaflet 100 so that it runs along the inside of the mitral valve native mitral ring 96 96 and out through the approach of the trans-aortic femoral artery 108.
• the second guidewire 24 is introduced through the lower approach to the right atrium and then passes the interatrial septum, arrives in the left atrium and passes through the native mitral annulus 102 on the side of the posterior leaflet 100.
• the mitral valve 96 remotely, for example, a distance of between 1 mm and 15 mm and advantageously between 1 mm and 10 mm, of the first guide wire 24.
• the second guide wire 24 is placed under the posterior valve leaflet 100 and path in the opposite direction to that of the first guidewire 24, so that it runs along the inside of the native mitral annulus 102 of the mitral valve 96 and out through the trans femoral artery approach -aortic 108.
• the two guidewires thus encircle the valvular leaflets 98 and 100 as close as possible to the native mitral mitral valve ring 102.
• each guidewire 24 is retrieved in the trans-aortic approach 108 through the femoral artery while the second end of each guidewire 24 remains disposed in the lowermost approach 15.
• the two guidewires 24 once set up thus constitute two separate guideways.
• each sheath 60 is threaded around a guide wire 24.
• Each cable 52 of the traction system 22 is deployed in a sheath 60 along one of the guide tracks formed by one of the guide wires 24, until that the hooked ends 54 of the traction system 22 emerge through the trans-aortic approach 108 and the femoral artery.
• the tensile ends 34 of the elongate sections 30 of the device 16 are then attached to the respective hooked ends 54 of the traction system 22 in the trans-aortic approach 108, via the femoral artery.
• the grasping ends of the traction system 22 are grasped in the lower approach 15 by the femoral vein and then pulled by the operator.
• the elongate sections 30 are thus raised each along a respective guide wire 24.
• the elongated sections 30 are thus spaced apart from each other.
• a first section 30 passes on one side around the leaflets Valves 98, 100 and reaches the native valve ring 102 or the native valve tissue of the posterior leaflet 100 by an attachment point 94.
• a second section 30 passes on the other side around the valve leaflets 98, 100 and reaches the ring native valve 102 or the native valve tissue of the posterior leaflet 100 by a second attachment point 94 away from the attachment point 94 of the first section 30.
• the second attachment point 94 is, for example, located at a distance of between 1 mm and 15 mm and advantageously between 1 mm and 10 mm from the first point of attachment 94.
• the locking elements 44 are introduced into the ring 102 or the fabric. Stopper 46 is pulled into its insertion position so as to protrude from the other side of ring 102 or tissue after insertion. Then the stop 46 is moved to its blocking position. The fabric secures the two traction ends 34.
• a step of placing the prosthesis 72 is performed.
• the operator picks up the hooked ends 54 of the traction system 22 from the traction ends 34.
• the operator removes the guide wires 24.
• the treatment device 16 of the fifth treatment kit 90 helps prevent periprosthetic leakage by securing the prosthesis 72 to be implanted not only to the valve leaflets 98, 100, but also to the native valve ring 102 by tissue transfixation.
• the arrangement of the treatment device 16 open loop avoids the surgeon to make a complete tour of the structure to implant the prosthesis 72, and facilitates the introduction of the prosthesis 72.
• a locking ring 20 is added to the locking ends 44 after they pass through the tissue at the attachment points 94.
• the locking ring 20 is a band placed over the native valve tissue or the ring
• the locking elements 44 are thus both attached to the fabric and the ring 20.
• the locking ring 20 maintains the ring 102 sealed between the two points of the valve. fixation 94, for example if the fabric was torn between the two attachment points 94.
• the loop formed by the body 18 is closed opposite the central festoon 1 10 by the locking ring 20.
• a high approach 14 through the jugular vein is prepared, the guidewires 24 are introduced from the top 14 by the jugular vein and the gripping ends of the traction system 22 are grasped in the high approach 14.
• a sixth processing kit 120 is shown in FIG. 10.
• the sixth processing kit 120 differs from the fifth processing kit 90 in that the processing device 16 has both the locking elements 44 and a hook member having an anchoring element 124.
• the hook member is on a connecting end 32.
• the hook member is adapted to allow the traction of the body 18 of the device in a direction opposite to the direction of traction by the traction system 22, using a wire operable from the outside of the patient, from the trans-aortic approach 108 by the femoral artery.
• the anchor element 124 also makes it possible to fix the body 18 of the treatment device 16 to the tissue.
• the anchor element 124 includes a needle that attaches to the native valve tissue or native valve annulus.
• the body 18 placed in place is maintained in the native valve tissue or the native valve ring by three attachment points 94.
• the attachment point 94 of the anchor element 124 is located on the valve substantially diametrically opposite. fixing points 94 of the locking elements 44.
• the anchoring element 124 makes it possible to fix the device at the level of the mitro-aortic continuity, that is to say in the continuity between the ring 102 of the mitral valve and the valve of the aorta 109.
• the anchoring element 124 of this device allows the body 18 not to fall and remain stable at the time of deployment of the prosthesis 72 by traction on the wire. During contractions of the heart, the anchoring element 124 maintains the stable strapping closer to the ring 102 while allowing a good deployment of the prosthesis 72.
• the anchor 124 allows coaxial positioning of the prosthesis 72 relative to the left ventricular flush chamber.
• the anchoring element 124 makes it possible to fix the native valve tissue around the treatment device 16 and the prosthesis 72 making it possible to avoid perivalvular leakage.
• the hook member further comprises a clamping device.
• the clamping device is adapted to adjust the length of the body 18 to tighten the body 18 around the prosthesis 72.
• the invention therefore makes it possible to obtain a treatment device 16 making it possible to prepare a valve in a minimally invasive manner for the implantation of a prosthesis and slightly disturbing the operation of the valve when the device is put in place.
• the treatment device 16 according to the invention is intended for an endovascular treatment, that is to say that it is put in place through the interior of a blood vessel, and does not require open heart surgery.
• Fixing the locking ends 44 in the tissue and / or in the locking ring keeps the treatment device 16 relative to the valve in its position chosen by the surgeon at the time of its introduction.

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• Health & Medical Sciences (AREA)
• Cardiology (AREA)
• Life Sciences & Earth Sciences (AREA)
• Engineering & Computer Science (AREA)
• Biomedical Technology (AREA)
• General Health & Medical Sciences (AREA)
• Heart & Thoracic Surgery (AREA)
• Veterinary Medicine (AREA)
• Public Health (AREA)
• Animal Behavior & Ethology (AREA)
• Vascular Medicine (AREA)
• Oral & Maxillofacial Surgery (AREA)
• Transplantation (AREA)
• Surgery (AREA)
• Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
• Medical Informatics (AREA)
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• Prostheses (AREA)

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• 2014
  • 2014-07-15 FR FR1456778A patent/FR3023704B1/fr active Active
• 2015
  • 2015-07-13 CN CN201580038643.8A patent/CN106687076A/zh active Pending
  • 2015-07-13 US US15/326,278 patent/US20170202668A1/en not_active Abandoned
  • 2015-07-13 WO PCT/EP2015/066003 patent/WO2016008859A1/fr active Application Filing
  • 2015-07-13 EP EP15736833.3A patent/EP3169277A1/de not_active Withdrawn

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