JP2019520917A - 弁クリップ切除のための方法および装置 - Google Patents
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/10—Surgical instruments, devices or methods, e.g. tourniquets for applying or removing wound clamps, e.g. containing only one clamp or staple; Wound clamp magazines
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/128—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips
- A61B17/1285—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips for minimally invasive surgery
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
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- A61B17/32—Surgical cutting instruments
- A61B17/3205—Excision instruments
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- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
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- A61B18/1492—Probes or electrodes therefor having a flexible, catheter-like structure, e.g. for heart ablation
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- A—HUMAN NECESSITIES
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/08—Wound clamps or clips, i.e. not or only partly penetrating the tissue ; Devices for bringing together the edges of a wound
- A61B17/083—Clips, e.g. resilient
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00238—Type of minimally invasive operation
- A61B2017/00243—Type of minimally invasive operation cardiac
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00358—Snares for grasping
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- A—HUMAN NECESSITIES
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00743—Type of operation; Specification of treatment sites
- A61B2017/00778—Operations on blood vessels
- A61B2017/00783—Valvuloplasty
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- A61B2017/00831—Material properties
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- 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
- A61B17/22031—Gripping instruments, e.g. forceps, for removing or smashing calculi
- A61B2017/22035—Gripping instruments, e.g. forceps, for removing or smashing calculi for retrieving or repositioning foreign objects
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B2017/32006—Surgical cutting instruments with a cutting strip, band or chain, e.g. like a chainsaw
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
- A61B2018/00345—Vascular system
- A61B2018/00351—Heart
- A61B2018/00369—Heart valves
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
- A61B2018/00601—Cutting
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B2018/1405—Electrodes having a specific shape
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- A—HUMAN NECESSITIES
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B2018/1405—Electrodes having a specific shape
- A61B2018/144—Wire
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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
- A61F2/2442—Annuloplasty rings or inserts for correcting the valve shape; Implants for improving the function of a native heart valve
- A61F2/246—Devices for obstructing a leak through a native valve in a closed condition
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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
- A61F2/2442—Annuloplasty rings or inserts for correcting the valve shape; Implants for improving the function of a native heart valve
- A61F2/2466—Delivery devices therefor
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Abstract
Description
Claims (30)
- 心臓弁の対向する1対の弁尖に接近するクリップを切除するための方法であって、前記方法は、
クリップの片側の弁尖に隣接する心腔内に捕捉カテーテルを導入するステップと、
クリップの反対側の弁尖に隣接する心腔内に移送カテーテルを導入するステップと、
弁尖のうちの少なくとも1つの組織に対して切断要素を配置するために、移送カテーテルから捕捉カテーテルまで切断要素を配備するステップと、
弁尖組織に対して切断部材を係合させるステップと、
切断部材を使用して少なくとも1つの弁尖からクリップを切除するステップと、
を備える方法。 - 心腔が左心房であり、心臓弁が僧帽弁である、請求項1に記載の方法。
- 心腔が左心室であり、心臓弁が僧帽弁である、請求項1に記載の方法。
- 心腔が右心房であり、心臓弁が三尖弁である、請求項1に記載の方法。
- 心腔が右心室であり、心臓弁が三尖弁である、請求項1に記載の方法。
- 切断要素を配備するステップが、両方のカテーテルの先端を近傍に持って行くために、捕捉カテーテルおよび移送カテーテルのうちの少なくとも1つの先端を操縦するステップを備える、請求項1に記載の方法。
- 切断部材を配備するステップが、切断部材上の磁気要素に対して捕捉カテーテル上の磁気要素を係合させるステップと、弁を通過して切断部材を引っ張るステップと、をさらに備える、請求項6に記載の方法。
- 切断要素を配備するステップが、切断部材の自由端の上に捕捉カテーテルのループを係合させるステップと、弁を通過して切断部材を引っ張る、ステップと、をさらに備える、請求項6に記載の方法。
- 切断要素を配備するステップが、弁を通過する経路を形成するために捕捉カテーテルおよび移送カテーテルの先端をまとめるステップと、経路上で切断部材を前進させるステップと、をさらに備える、請求項6に記載の方法。
- クリップが1つの弁尖のみから切除される、請求項1に記載の方法。
- クリップが対向する対の両方の弁尖から切除される、請求項1に記載の方法。
- 少なくとも1つの弁尖からクリップを切除するステップが、切断部材を通じて高周波電流を供給するステップを備える、請求項1に記載の方法。
- 少なくとも1つの弁尖からクリップを切除するステップが、切断部材を用いて弁組織を機械的に切断または摩耗するステップを備える、請求項1に記載の方法。
- 心腔内にクリップ除去カテーテルを導入するステップと、切断部材を使用して少なくとも1つの弁尖からクリップを切除する間にクリップに対してクリップ除去カテーテルの遠位端を係合させるステップと、をさらに備える、請求項1に記載の方法。
- 両方の対向する弁尖からクリップを切除するステップと、クリップ除去カテーテルを用いてクリップを除去するステップと、をさらに備える、請求項1に記載の方法。
- 捕捉カテーテルおよび移送カテーテルが経中隔的に導入される、請求項1に記載の方法。
- 捕捉カテーテルおよび移送カテーテルが経心尖的に導入される、請求項1に記載の方法。
- 心臓弁の対向する弁尖に接近する移植されたクリップを切除するためのシステムであって、前記システムは、
クリップの片側の弁尖に隣接する心腔内に導入されるように構成された、捕捉カテーテルと、
クリップの反対側の弁尖に隣接する心腔内に導入されるように構成された、移送カテーテルと、
クリップを切除するために弁尖のうちの少なくとも1つの組織に対して切断要素を配置するために、移送カテーテルから捕捉カテーテルまで配備されるように構成された、切断部材と、
を備えるシステム。 - 捕捉カテーテルおよび移送カテーテルのうちの少なくとも1つが操縦可能な遠位先端を有する、請求項18に記載のシステム。
- 捕捉カテーテルおよび移送カテーテルの各々が操縦可能な遠位先端を有する、請求項18に記載のシステム。
- 捕捉カテーテルが磁気遠位先端を有する、請求項18に記載のシステム。
- 切断部材が、移送カテーテルによって担持されており、心腔内のカテーテル位置の操作によって捕捉カテーテルが切断部材を捕捉できるように、移送カテーテルの遠位端に露出した磁気要素を有する、請求項21に記載のシステム。
- クリップと係合して捕捉するように構成された遠位端を有するクリップ除去カテーテルをさらに備える、請求項18に記載のシステム。
- 切断部材が、弁組織の通電切断のための高周波電極を備える、請求項18に記載のシステム。
- 切断部材が、弁組織を機械的に切断するための機械的に摩耗するまたは鋭利な刃を備える、請求項18に記載のシステム。
- 切断部材が、放射線不透過性マーカによって画定された切断ゾーンを備える、請求項18に記載のシステム。
- 捕捉カテーテルおよび移送カテーテルを心腔内に導入するように構成された送達シースをさらに備える、請求項18に記載のシステム。
- 送達シースが、捕捉カテーテルおよび移送カテーテルの両方を同時に収容するようにサイズ決めされている内腔を備える、請求項18に記載のシステム。
- 送達シースが経中隔シースを備える、請求項18に記載のシステム。
- 送達シースが経心尖シースを備える、請求項18に記載のシステム。
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JP2022052956A JP7346645B2 (ja) | 2016-07-06 | 2022-03-29 | 弁クリップ切除のための方法および装置 |
JP2023143431A JP2023166503A (ja) | 2016-07-06 | 2023-09-05 | 弁クリップ切除のための方法および装置 |
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US201662359121P | 2016-07-06 | 2016-07-06 | |
US62/359,121 | 2016-07-06 | ||
US201662418571P | 2016-11-07 | 2016-11-07 | |
US62/418,571 | 2016-11-07 | ||
US15/642,245 | 2017-07-05 | ||
US15/642,245 US10736632B2 (en) | 2016-07-06 | 2017-07-05 | Methods and devices for valve clip excision |
PCT/US2017/040977 WO2018009718A1 (en) | 2016-07-06 | 2017-07-06 | Methods and devices for valve clip excision |
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JP2022052956A Active JP7346645B2 (ja) | 2016-07-06 | 2022-03-29 | 弁クリップ切除のための方法および装置 |
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US (2) | US10736632B2 (ja) |
EP (2) | EP3791795B1 (ja) |
JP (3) | JP2019520917A (ja) |
CN (2) | CN109561891B (ja) |
CR (1) | CR20190042A (ja) |
SG (1) | SG11201811457QA (ja) |
WO (1) | WO2018009718A1 (ja) |
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US9011468B2 (en) | 2011-09-13 | 2015-04-21 | Abbott Cardiovascular Systems Inc. | Independent gripper |
US9345573B2 (en) | 2012-05-30 | 2016-05-24 | Neovasc Tiara Inc. | Methods and apparatus for loading a prosthesis onto a delivery system |
US9572665B2 (en) | 2013-04-04 | 2017-02-21 | Neovasc Tiara Inc. | Methods and apparatus for delivering a prosthetic valve to a beating heart |
US10390943B2 (en) | 2014-03-17 | 2019-08-27 | Evalve, Inc. | Double orifice device for transcatheter mitral valve replacement |
US9572666B2 (en) | 2014-03-17 | 2017-02-21 | Evalve, Inc. | Mitral valve fixation device removal devices and methods |
CN108882981B (zh) | 2016-01-29 | 2021-08-10 | 内奥瓦斯克迪亚拉公司 | 用于防止流出阻塞的假体瓣膜 |
EP3471628B8 (en) | 2016-06-20 | 2021-04-21 | Evalve, Inc. | Transapical removal device |
US11071564B2 (en) | 2016-10-05 | 2021-07-27 | Evalve, Inc. | Cardiac valve cutting device |
US10363138B2 (en) | 2016-11-09 | 2019-07-30 | Evalve, Inc. | Devices for adjusting the curvature of cardiac valve structures |
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CN113842188A (zh) | 2021-12-28 |
CN113842188B (zh) | 2023-12-05 |
EP3791795B1 (en) | 2022-03-02 |
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EP3481303B1 (en) | 2020-12-23 |
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SG11201811457QA (en) | 2019-01-30 |
CR20190042A (es) | 2019-07-08 |
JP2023166503A (ja) | 2023-11-21 |
JP7346645B2 (ja) | 2023-09-19 |
US20180008268A1 (en) | 2018-01-11 |
CN109561891B (zh) | 2021-09-28 |
WO2018009718A1 (en) | 2018-01-11 |
EP3791795A1 (en) | 2021-03-17 |
US20200323528A1 (en) | 2020-10-15 |
JP2022088522A (ja) | 2022-06-14 |
EP3481303A4 (en) | 2019-12-18 |
EP3481303A1 (en) | 2019-05-15 |
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