JP2009515658A - 経心尖部心臓弁送達システムおよび方法 - Google Patents
経心尖部心臓弁送達システムおよび方法 Download PDFInfo
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- 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
- A61F2/2427—Devices for manipulating or deploying heart valves during implantation
-
- 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
- A61F2/2427—Devices for manipulating or deploying heart valves during implantation
- A61F2/243—Deployment by mechanical expansion
- A61F2/2433—Deployment by mechanical expansion using balloon catheter
-
- 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
- A61F2/2427—Devices for manipulating or deploying heart valves during implantation
- A61F2/2436—Deployment by retracting a sheath
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
- A61B2017/22098—Decalcification of 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
- A61F2/2412—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
- A61F2/95—Instruments specially adapted for placement or removal of stents or stent-grafts
- A61F2/958—Inflatable balloons for placing stents or stent-grafts
- A61F2002/9583—Means for holding the stent on the balloon, e.g. using protrusions, adhesives or an outer sleeve
-
- 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
- A61F2220/0008—Fixation appliances for connecting prostheses to the body
- A61F2220/0016—Fixation appliances for connecting prostheses to the body with sharp anchoring protrusions, e.g. barbs, pins, spikes
Abstract
Description
Claims (21)
- 患者の大動脈弁輪に人工心臓弁を移植するオフポンプ低侵襲手術方法であって、該患者の心臓が鼓動している間に、
その遠位端のバルーンと該バルーンの近位端を係合する遠位スリーブを有する可動プッシャとを含むバルーンカテーテルを提供することと、
該バルーンカテーテルの該遠位端のバルーンの上に装着されたバルーン拡張可能人工心臓弁を提供することと、
該患者の左心室の心尖部またはその近傍の心室壁を通って穿刺を生成することと、
該穿刺を通ってイントロデューサーシースを挿入することと、
該イントロデューサーシースを通って該左心室に該バルーンカテーテルを通過させることと、
該人工心臓弁を該大動脈弁輪内に配置できるように、該バルーンおよびその上に装着された該人工心臓弁を前進させるために、該プッシャおよびスリーブを使用することと、
該バルーンに対して該プッシャおよびスリーブを近位に移動させることと、
該大動脈弁輪における該人工心臓弁を拡張させるために該バルーンを膨張させることと
を含む、方法。 - 前記患者の前記左心室の心尖部または近傍の周囲を画定する一方向の第1の円に巾着縫合の第1の糸を概して配置し、その後、該第1の円と同心の円であるが反対方向に巾着縫合の第2の糸を概して配置することと、
該周囲の範囲内に穿刺を生成することと、
該穿刺を通って前記イントロデューサーシースを挿入後、その周囲に密封を生成するために該巾着縫合を締着することと
をさらに含む、請求項1に記載の方法。 - 前記バルーンカテーテルはその中に操縦機構を含み、
前記大動脈弁輪内に前記人工心臓弁を配置することを容易にするように、前記左心室内の該操縦機構を用いて該バルーンカテーテルを操縦することをさらに含む、請求項1に記載の方法。 - 前記バルーンカテーテルは、前記バルーンの直近位に位置する偏向セグメントを含み、前記操縦することは、
その上に装着された該バルーンおよび人工心臓弁に角度を付けるために、該偏向セグメントを屈曲させることを含む、請求項3に記載の方法。 - 前記プッシャスリーブは前記偏向セグメントの上に載っており、
前記バルーンを膨張させることに先立って、該偏向セグメントに対して前記プッシャおよびスリーブを近位に移動させることをさらに含む、請求項4に記載の方法。 - 前記偏向セグメントを屈曲させることに先立って、該偏向セグメントに対して前記プッシャおよびスリーブを近位に移動させることをさらに含む、請求項5に記載の方法。
- 自然大動脈弁尖をしかるべき位置に置いた状態にすることにより、前記バルーンを膨張させることにより前記人工心臓弁がそれと接触できるようにすることをさらに含む、請求項1に記載の方法。
- 前記人工心臓弁を、前記大動脈弁輪に以前に移植された人工心臓弁と接触するように拡張させることをさらに含む、請求項1に記載の方法。
- 人工心臓弁を患者の大動脈弁輪に送達するオフポンプ低侵襲手術方法であって、該患者の心臓が鼓動している間に、
拡張可能な人工心臓弁を拡張状態で提供することと、
遠位端を有する送達カテーテルを提供することと、
該拡張可能な人工心臓弁を、該送達カテーテル遠位端の上で収縮状態まで圧着することと、
肋間のアクセス開口部を作成および該患者の左心室の心尖部を露呈させることと、
該左心室の心尖部または近傍で穿刺を生成することと、
該穿刺を通ってイントロデューサーシースを挿入することと、
該イントロデューサーシースを通って該左心室に該送達カテーテルを通過させることと、
該人工心臓弁が該大動脈弁輪内に適切に配置および配向されるように、該送達カテーテルの遠位端を前進および操縦することと、
該大動脈弁輪における該人工心臓弁をそれと接触するように拡張させることと
を含む、方法。 - 前記送達カテーテルはその遠位端にバルーンを含み、前記人工心臓弁はバルーン拡張可能ステントを含み、前記拡張させることは、前記大動脈弁輪と接触するように人工心臓弁を外側へ拡張させるために、該バルーン内に液体を注入することを含む、請求項9に記載の方法。
- 自然大動脈弁尖をしかるべき位置に置いた状態にすることにより、前記バルーンを膨張させることによって前記人工心臓弁がそれと接触できるようにすることをさらに含む、請求項9に記載の方法。
- 前記送達カテーテルは、その遠位端の直近位に位置する偏向セグメントを含み、前記操縦することは、
偏向セグメントを屈曲させることにより、その上の遠位端に装着された前記人工心臓弁の角度を付けることを含む、請求項9に記載の方法。 - 前記送達カテーテルは、前記偏向セグメントの上に装着された遠位スリーブを有するプッシャをさらに含み、
該送達カテーテルの遠位端およびその上に装着された人工心臓弁を前進させるために、該プッシャおよびスリーブを使用することと、
該偏向セグメントを屈曲させることに先立って、該偏向セグメントに対して該プッシャおよびスリーブを近位に移動させることをさらに含む、請求項12に記載の方法。 - 24フレンチ以下の自身を通過する管腔を有するイントロデューサーシースと、
遠位端の上にバルーンを有するバルーンカテーテルであって、該遠位端を偏向させるための操縦機構をさらに含む、バルーンカテーテルと、
該バルーンの上に圧着されたバルーン拡張可能な人工心臓弁と
を含み、
自身の上に該人工心臓弁を有する該バルーンカテーテルの外側寸法は、該イントロデューサーシース管腔を通過するのに十分に小さい、低侵襲人工心臓弁送達システム。 - 前記操縦機構は、前記バルーンの直近位に位置する前記バルーンカテーテルの上の偏向セグメントを含む、請求項14に記載のシステム。
- 前記偏向セグメントの遠位端に接続され、前記バルーンカテーテルを通って近位の偏向ハンドルまで延在する偏向ワイヤをさらに含む、請求項15に記載のシステム。
- 前記偏向セグメントおよび前記バルーンの近位端を包囲するような大きさにされた遠位スリーブを有するプッシャであって、該プッシャは該偏向セグメントに対して縦方向に移動可能である、プッシャをさらに含む、請求項15に記載のシステム。
- 前記バルーンカテーテルは、
前記バルーンの反対端に接続され、該バルーンを同心円状で交互に伸張および短縮させるように互いに摺動可能に配置される内側および外側バルーン膨張管と、
該内側バルーン膨張管を移動させるための内側管ハンドルと、
該内側バルーン膨張管が通過し、該外側バルーン膨張管が接続するバルーン膨張コネクタと、
該バルーン膨張コネクタ内で画定される空間への側面ポート開口部であって、該側面ポートは、前記空間へ、および該バルーンを膨張させるための該内側および外側バルーン膨張管の間の管状空間へ膨張流体を導入するために適合される、側面ポート開口部と
をさらに含む、請求項14に記載のシステム。 - 前記バルーン膨張コネクタの直遠位に接続され、前記外側バルーン膨張管が通過する偏向ハンドルであって、該外側バルーン膨張管は、前記内側バルーン膨張管の通路のための第1の管腔と第2の管腔とを含む、偏向ハンドルと、
偏向ハンドルの上のアクチュエータに接続され、該外側バルーン膨張管の該第2の管腔を通って前記バルーンカテーテルの遠位端に入る偏向ワイヤと、
をさらに含む、請求項18に記載のシステム。 - 前記バルーンカテーテルは、約24インチ以下(61cm)の前記イントロデューサにはめ込むような大きさにされた作業長さを有する、請求項14に記載のシステム。
- 前記イントロデューサは、約13インチ(33cm)以下の全長を有する、請求項20に記載のシステム。
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US11/280,063 | 2005-11-16 | ||
US11/280,063 US8764820B2 (en) | 2005-11-16 | 2005-11-16 | Transapical heart valve delivery system and method |
PCT/US2006/044422 WO2007059252A1 (en) | 2005-11-16 | 2006-11-15 | Transapical heart valve delivery system and method |
Publications (3)
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JP2009515658A true JP2009515658A (ja) | 2009-04-16 |
JP2009515658A5 JP2009515658A5 (ja) | 2010-12-09 |
JP5095625B2 JP5095625B2 (ja) | 2012-12-12 |
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JP2008541327A Active JP5095625B2 (ja) | 2005-11-16 | 2006-11-15 | 経心尖部心臓弁送達システム |
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Country | Link |
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US (5) | US8764820B2 (ja) |
EP (1) | EP1951166B8 (ja) |
JP (1) | JP5095625B2 (ja) |
CN (1) | CN101309654B (ja) |
CA (1) | CA2632317C (ja) |
HK (1) | HK1117026A1 (ja) |
WO (1) | WO2007059252A1 (ja) |
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JP2011172620A (ja) * | 2010-02-23 | 2011-09-08 | Miracor Medical Systems Gmbh | 血管を間欠的に閉塞するための埋込み可能な装置 |
JP2013534444A (ja) * | 2010-07-09 | 2013-09-05 | ハイライフ エスエーエス | 経カテーテル式房室弁人工器官 |
JP2014079441A (ja) * | 2012-10-17 | 2014-05-08 | Toshiba Corp | X線撮影条件設定システム、画像診断装置及びx線撮影条件設定プログラム |
JP2016501655A (ja) * | 2012-12-31 | 2016-01-21 | クリアストリーム・テクノロジーズ・リミテッド | 位置合わせを容易にするためのマーキングを有するカテーテル |
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JP5095625B2 (ja) | 2012-12-12 |
US8764820B2 (en) | 2014-07-01 |
US20220183835A1 (en) | 2022-06-16 |
EP1951166B1 (en) | 2013-05-01 |
WO2007059252A9 (en) | 2008-08-21 |
US9662207B2 (en) | 2017-05-30 |
US11266500B2 (en) | 2022-03-08 |
US20070112422A1 (en) | 2007-05-17 |
US10314702B2 (en) | 2019-06-11 |
CN101309654A (zh) | 2008-11-19 |
HK1117026A1 (en) | 2009-01-09 |
EP1951166B8 (en) | 2013-07-17 |
US20140309728A1 (en) | 2014-10-16 |
US20190290425A1 (en) | 2019-09-26 |
WO2007059252A1 (en) | 2007-05-24 |
CA2632317A1 (en) | 2007-05-24 |
CN101309654B (zh) | 2012-09-05 |
CA2632317C (en) | 2015-01-13 |
US20170245992A1 (en) | 2017-08-31 |
EP1951166A1 (en) | 2008-08-06 |
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