JP6602927B2 - 張力を用いた三尖弁の修復 - Google Patents
張力を用いた三尖弁の修復 Download PDFInfo
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- JP6602927B2 JP6602927B2 JP2018158222A JP2018158222A JP6602927B2 JP 6602927 B2 JP6602927 B2 JP 6602927B2 JP 2018158222 A JP2018158222 A JP 2018158222A JP 2018158222 A JP2018158222 A JP 2018158222A JP 6602927 B2 JP6602927 B2 JP 6602927B2
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- tissue
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- longitudinal member
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- A61F2230/0054—V-shaped
Description
本出願は、本出願の譲受人に譲渡された、「Tricuspid valve repair using tension」を発明の名称とする、2010年1月22日に出願された、米国出願第12/692,061号を基に優先権を主張し、かつ、その一部継続出願であり、その出願は参照することにより本書に組み込まれる。
本発明の幾つかの応用例は、概して、弁の修復に関する。特に、本発明の幾つかの応用例は、患者の三尖弁の修復に関する。
三尖弁輪の拡張、弁輪形状、肺高血圧、左心室不全または右心室不全、右心室形状、および、弁尖拘束など、幾つかの病態生理学的な異常に、機能性三尖弁逆流(FTR)は支配される。FTRの治療の選択肢は主に外科手術である。中度から重度の三尖弁逆流の現在の患者数は、米国内で160万人と推定されている。このうち、年間8千人のみが三尖弁手術をうけているが、それらのほとんどは、左の心臓弁の手術を伴うものである。
本発明の幾つかの応用例において、張力を利用して患者の三尖弁を修復するための装置および方法が提供される。典型的には、この三尖弁を修復するための装置および方法は、患者の心臓の、三尖弁の形状を改めること、および/または、右心房の壁の形状を改めることによって三尖弁の逆流の減少を容易にするものである。本発明の幾つかの応用例において、第1の組織係合要素が患者の三尖弁の上流にある組織の第1の部分にインプラントされる。それから第2の組織係合要素が患者の三尖弁の上流にある組織の第2の部分にインプラントされる。典型的には、第1および第2の組織係合要素の両方をインプラントした後、その第1および第2の組織係合要素を接続している長手部材を引くことにより、または、組織係合要素のうちのいずれか一方を引くことにより、三尖弁の弁尖間の距離が調整される。代替的または付加的に、長手部材は、第2の組織係合要素をインプラントする前に調整される。幾つかの応用例では、長手部材は調整機構に少なくとも一部が連結され、調整機構の動作に応答して長手部材が引っ張られまたは緩められる。
nchor、組織アンカー)を含む。幾つかの応用例では、第2の組織係合要素が複数個(例
えば、2個または3個)提供され、心臓弁の近傍にある心臓組織のそれぞれの部分においてインプラントされる。幾つかの応用例では、長手部材は、(a)第1の組織係合要素に直接的に連結され、(b)第2の組織係合要素のうちの1つに直接的に連結され、および(c)他の2つの第2の組織係合要素に長手第二部材によって間接的に連結される。
手部材に対してロックされ、径方向に拡張可能なアンカーの、長手部材に対して少なくとも近位方向の動きが妨げられる。これに応答して、三尖弁の弁尖間の距離が調整され弁を通る逆流を減少および除去する。それにより、弁は修復される。幾つかの応用例では、長手部材を引いてアンカー間の距離を調整するのと併せて、三尖弁の逆流の程度を監視する。
つ以上は、1以上の細長部材と、2以上のリングを備えうる。リングは、典型的には、1以上の細長部材によって互いに連結され、ステントのそれ以外の部材によっては互いに連結されない。典型的には、リングはそれぞれ、ステントが広げられた状態にあるときには、細長部材に対して概ね垂直な平面を画定する。長手部材はステントを組織アンカーに接続する。
患者の心臓弁近傍にある組織の第1の部分に少なくとも第1の組織係合要素をインプラントする工程、
前記患者の心臓の心房と接している血管の部分に少なくとも第2の組織係合要素をインプラントする工程、および
前記血管の部分と前記患者の心臓弁近傍にある組織の前記第1の部分との間の距離を調整することにより、前記弁の少なくとも第1の弁尖を前記弁の少なくとも第2の弁尖へ向けて引き寄せる工程
を備える。
前記弁輪の組織の第2の部分に、長手第二部材により第4の組織係合要素と接続された第3の組織係合要素をインプラントする工程、および
前記長手第二部材が前記長手部材と両者の接合点で係合するように、前記弁輪の組織の第3の部分に、前記第4の組織係合要素をインプラントする工程
を備える。
む。
前記第2の組織係合要素をインプラントする工程は、前記リングによって前記ステントが前記血管の壁に固定されるように前記リングを広げる工程を含む。
前記心臓の組織の第2の部分に、長手部材の遠位端にその近位端が接続された第3の組織係合要素をインプラントする工程、および
前記長手部材の近位端部を前記ステントに係合させる工程
を備える。
前記心臓弁近傍にある組織の前記第1の部分は、前記患者の前記血管の部分の反対にある組織の部分を含み、
組織の前記第1の部分に係合させる工程は、前記患者の前記血管の部分の反対にある前記組織の部分に係合させる工程を含み、かつ
前記弁の第1の弁尖を前記弁の第2の弁尖に向けて引き寄せる工程は、前記患者の前記
血管の部分と前記患者の前記血管の部分の反対にある前記組織の部分との間の距離を調整する工程を含む。
患者の三尖弁の上流にある組織の第1の部分に少なくとも第1の組織係合要素をインプラントする工程、
前記患者の前記三尖弁の上流にある組織の第2の部分に少なくとも第2の組織係合要素をインプラントする工程、および
前記患者の前記三尖弁の上流にある組織の前記第1の部分と前記患者の前記三尖弁の上流にある組織の前記第2の部分との間の距離を調整することにより、前記患者の心臓の右心房の壁の形状を改める工程
を備える。
前記右心房の壁の形状を改める工程は、前記三尖弁の上流にある組織の、前記第1の部分、前記第2の部分および前記第3の部分の間のそれぞれの距離を調整することにより、前記壁の形状を改める工程を含む。
前記患者の前記三尖弁の上流にある組織の前記第1の部分に前記第1の組織係合部をインプラントする工程は、前記右心房の壁の前記第1の部分に前記第1の組織係合要素をインプラントする工程を含む。
前記患者の前記三尖弁の上流にある組織の前記第2の部分に前記第2の組織係合要素をインプラントする工程は、前記右心房の壁の前記第2の部分に前記第2の組織係合要素をインプラントする工程を含む。
前記右心房の壁の形状を改める工程は、前記右心房の壁の、前記第1の部分、前記第2の部分および前記第3の部分の間のそれぞれの距離を調整することにより、前記壁の形状を改める工程を含む。
前記第1の組織係合要素をインプラントする工程は、長手部材が連結された前記第1の組織係合要素をインプラントする工程を含み、
前記第2の組織係合要素には通路が形成されており、かつ前記第2の組織係合要素をインプラントする工程は、前記長手部材を前記通路に通した状態で前記第2の組織係合要素をインプラントする工程を含み、かつ
前記距離を調整する工程は、前記長手部材を近位方向に引っ張り、前記第1組織係合要素と第2組織係合要素とを接近させる工程を含む。
患者の下大静脈の壁の組織の部分に少なくとも第1の組織係合要素の少なくとも一部を係合させる工程、
前記患者の上大静脈の壁の組織の部分に少なくとも第2の組織係合要素の少なくとも一部を係合させる工程、
前記患者の下大静脈の壁の前記組織の部分および前記患者の上大静脈の壁の前記組織の部分からなる群から選択される組織の1以上の部分に張力を付加することにより、心臓弁の少なくとも第1の弁尖を前記弁の少なくとも第2の弁尖に向けて引き寄せる工程、および
前記張力を付加するのと併せて、前記患者の心臓弁の逆流の程度を監視する工程
を備える。
る工程を含む。
ステント、
遠位端を有する長手部材であって、該遠位端に、該長手部材から横に伸びる環状ループを備える長手部材、および
前記環状ループ、前記長手部材、および前記ステントに対して回転し得るように、前記環状ループに連結された組織アンカー
を備える。
は、該運搬ツールオーバーチューブを貫通するように構成されており、かつ該オーバーチューブは、前記アームを包囲する位置に置かれたときに前記アームを径方向に圧縮するように構成されている。本発明の幾つかの応用例において、前記装置はアダプタをさらに備え、前記アダプタは、前記環状ループを貫通する円筒部を画定する形状を有し、かつ前記組織アンカーの近位部に固定的に連結された遠位部を有し、かつ、前記チューブは、前記アームが径方向に圧縮されると、前記アダプタホルダを介して前記アダプタに取り外し可能に連結され、それにより前記組織アンカーに取り外し可能に連結されるように構成されている。
(a)ステント、(b)遠位端を有する長手部材であって、該遠位端に、該長手部材から横に伸びる環状ループを備える長手部材、および(c)前記環状ループに連結された組織アンカーを提供する工程、
前記ステントを患者の血管内に置く工程、
前記環状ループ、前記長手部材、および前記ステントに対して前記組織アンカーを回転させて、前記患者の心臓弁近傍の組織に前記組織アンカーを連結する工程、および
前記組織に前記組織アンカーを連結した後、前記ステントが拡張してインプラント部位の前記血管内にインプラントされるように前記ステントを配置する工程
を備える。
前記組織アンカーを回転させる工程を含む。本発明の幾つかの応用例において、チューブを用いて前記組織アンカーを回転させる工程は、前記チューブの長手部分を前記長手部材と並べて配置し、かつ前記チューブのいかなる部分も前記長手部材の周囲に配置されないようにする工程を含む。本発明の幾つかの応用例において、前記回転させる工程は、前記アダプタホルダに連結されたチューブを用いて前記アンカーを回転させる工程を含み、前記アダプタホルダは、径方向に広がる性向を有するアームを画定する形状を有し、かつ前記アームが径方向に圧縮されると前記組織アンカーに前記チューブを連結するものである。本発明の幾つかの応用例において、前記方法は、前記ステントにより画定される管腔を貫通する大きさの運搬ツールオーバーチューブを提供する工程をさらに備え、前記チューブは、該運搬ツールオーバーチューブを貫通するように構成されており、かつ、該オーバーチューブは、前記アームを包囲する位置に置かれると前記アームを径方向に圧縮するように構成されている。
圧縮状態および拡張状態をとるように構成されたステントであって、
1以上の細長部材と、
該1以上の細長部材によって互いに連結されており、該ステントの他の部材では互いに連結されていない2以上のリングであって、該ステントが拡張状態にあるとき、前記細長部材に対して略垂直な各々の平面を画定する2以上のリング
を備えたステント、
遠位端と、前記ステントに連結された近位端を有する長手部材、および
前記長手部材の前記遠位端に連結された組織アンカー
を備える。
(a)(i)1以上の細長部材と、(ii)該1以上の細長部材によって互いに連結されており、該ステントの他の部材では互いに連結されていない2以上のリングを含むステント、(b)遠位端と、前記ステントに連結された近位端を有する長手部材、および(c)前記長手部材の前記遠位端に連結された組織アンカーを提供する工程、
前記ステントを圧縮状態で患者の血管内に置く工程、
前記組織アンカーを前記患者の心臓弁近傍の組織に連結する工程、および
前記リングのそれぞれが前記細長部材に対して略垂直な平面を画定し、前記ステントを前記血管の壁に固定するように、前記ステントを拡張状態に移す工程
を備える。
開口を画定する、径方向に拡張可能なアンカー、
遠位端と近位端を有し、前記径方向に拡張可能なアンカーの前記開口を貫通して前記径方向に拡張可能なアンカーとスライド可能に連結された長手部材、および
前記長手部材の前記遠位端に連結された組織アンカー
を備え、前記径方向に拡張可能なアンカーおよび前記長手部材は、前記径方向に拡張可能なアンカーが前記長手部材にロック可能であるように構成されており、それにより、前記径方向に拡張可能なアンカーが前記長手部材に対して、前記長手部材の近位端に向かう少なくとも近位方向に移動するのが防止される。
(a)長手部材、(b)該長手部材にスライド可能に連結された、径方向に拡張されるアンカー、および(c)前記長手部材の遠位端に連結された組織アンカー、を含む張力装置を、最初に配置チューブ内に収納して提供する工程、
前記配置チューブを患者の左心房内に進入させる工程、
心房中隔に孔を設ける工程、
該孔を通して左心房から前記配置チューブを進入させ、前記配置チューブの遠位端を右心房内に配置させる工程、
前記配置チューブの遠位端から前記組織アンカーを配置して、該組織アンカーを三尖弁近傍にある心臓組織の部分に固定する工程、
前記配置チューブを前記左心房内へ引き抜き、それによって前記径方向に拡張可能なアンカーを左心房内の前記中隔の近くで解放する工程、および
前記径方向に拡張可能なアンカーを前記中隔の左心房側に保持しつつ、前記長手部材を近位方向に引っ張り、前記径方向に拡張可能なアンカーが前記長手部材に対して少なくとも近位方向に移動しないように前記径方向に拡張可能なアンカーを前記長手部材にロックする工程
を備える。
遠位組織穿孔先端具を有し、その最大外径が1.8mm以下である支柱、
前記支柱と関節をなすことができるように、前記遠位先端具近くで前記組織アンカーに連結された複数のリブ、
前記支柱に沿ってスライド可能なように、前記支柱に連結されたランナー、および
前記ランナーおよび前記リブの各一つと関節をなすことができるように、前記ランナーおよび前記リブの各一つに連結された複数のストレッチャ
を含む。
前記装置は、前記カテーテル内に収納されたインナーチューブをさらに備え、かつ前記ランナーの近位端は前記インナーチューブに最初は取り外し可能に連結されている。
図1A−Gを参照する。図1A−Gは、本発明の幾つかの応用例に従う、患者の心臓2の三尖弁4を修復するための、第1の組織係合要素60aと第2の組織係合要素60bを備えるシステム20の概略図である。第1の組織係合要素60aは、心臓組織の少なくとも一部である第1のインプラント部位30にインプラントされるように設計された組織アンカー40を含む。注意すべきは、組織アンカー40は、限定ではなく例示のために、螺旋形の組織アンカーを含んでおり、組織アンカー40は、以下に限定されないが、図13A−Eを参照して後述する組織アンカーを含め、心臓組織を穿刺または把持するあらゆる組織アンカーを含みうるということである。第2の組織係合要素60bは、血管(例えば上大静脈10(図1E−Gに示されるようなもの)または下大静脈8(図1A−Dに示されるようなもの))の部分において第2のインプラント部位52にインプラントされるように設計されたステント50を含む。第1と第2の組織係合要素60a、60bは可撓性のある長手部材42によって互いに連結されている。通常、第1のインプラント部位30と第2のインプラント部位52との間の距離は、長手部材42を引いて張力を付加しまたは緩めること、および/または、第1および第2の組織係合要素60a、60bの少なくとも一方に張力を付加することによって調整される。これに応答して、三尖弁4の弁尖間の距離が調整されて弁4を通る逆流が減少または除去され、それによって、弁4は修復される。幾つかの応用例では、長手部材42は、後述のように、第2の組織係合要素60bを操作することによって引っ張られ、または緩められる。
部材42は、ポリテトラフルオロエチレン(PTFE)で被覆される。本発明の幾つかの
応用例では、長手部材42は、ロープ構造を形成するように撚り合わされた複数のワイヤを含む。幾つかの応用例では、長手部材42の少なくとも一部は張力バネ、および/または、複数のコイルを含む。
・カテーテル22は、患者の大腿静脈に導入され、下大静脈8を通り、右心房6内に入ってもよい。
・カテーテル22は、尺側皮静脈に導入され、鎖骨下静脈を通り、上大静脈10を通り、右心房6内に入ってもよい。
・カテーテル22は、外頸静脈に導入され、鎖骨下静脈を通り、上大静脈10を通り、右心房6内に入ってもよい。
切な起点を用いて、右心房6内に患者の下大静脈8を通って進入する。代替的に、図1Eに示されるように、カテーテル22は、通常は所定の患者に対して決められる適切な起点を用いて、右心房6内に患者の上大静脈10を通って進入する。
ンドル部は、その導入場所の適所に(例えば、テープや絆創膏などによって)固定される。代替的または付加的に、カテーテル22の遠位部には膨張導管に連結された膨張要素が備えられる。膨張導管は、カテーテル22の遠位端部から患者の体外の部位までカテーテル22に沿って伸びている。長手部材42の調整の前に、膨張要素は膨らまされ、カテーテル22が進入する血管系の組織と接触し、それによってカテーテル22は適所に固定される。通常、膨張要素は環状の膨張要素を含み、環状の膨張要素は、膨むと封止部(seal)として機能し、カテーテル22の遠位端を適所に保持する。
a、60bをインプラントした後、第1と第2の組織係合要素60a、60bの間の距離は、図5A−Bまたは5Cを参照して後述するように、調整機構によって調整される。そのような応用例では、第1と第2の組織係合要素60a、60b間の長手部材42の長さは、図5A−Bまたは図5Cに示されるように、調整機構150によって調整されうる。調整機構150は、通常、第1と第2の組織係合要素60a、60b間の長手部材42の距離を短くする機械部品を含む。幾つかの応用例では、調整機構150は、長手部材42に恒久的に連結されてもよく(図示せず)、第1と第2の組織係合要素60a、60b間の長さを短くするために、調整部品(例えば、スプール、クリンピングビーズ、ラチェット部品、または変形部品)を備える。スプールはその周りに長手部材42の一部を巻き取るものであり、クリンピングビーズは長手部材42の一部を縮れさせて短くするものであり、変形部品は、長手部材42の一部を変形させるものである。他の応用例では、調整機構150は、図5Aに示されるように、調整ツール144のみを備える。そのような応用例では、調整ツール144は、第1と第2の組織係合要素60a、60b間の長さを短くするために、調整部品(例えば、長手部材42の一部を縮れさせて短くするクリンピングビーズ、または、長手部材42の一部を変形させる変形部品)を備えてもよい。いずれの応用例においても、調整機構150で第1と第2の組織係合要素60a、60b間の距離を調整している間、三尖弁4の逆流のレベルを監視するようにしてもよい。
、前記リングは、名目上の大静脈の径よりも10〜25%大きい。例えば、20mmの大静脈を有する患者では、外科医は、外径が22〜25mmの大きさのリングを使用し得る。幾つかの応用例では、リング62の各々は、ステント50が拡張状態にあるとき、少なくとも10mm、35mm以下、および/または10〜35mmの間の外径を有する。一般に、ステントが拡張した状態で、長手方向に最も離れた位置にある2個のリング62間の距離は、少なくとも10mm、40mm以下、および/または、10〜40mmの間である(ステント50が厳密に2個のリングを備えている応用例では、この距離は、その2個のリングの間の距離である)。ステント50が厳密に2個のリングを備えている応用例では、細長部材64の長さは、前述の距離に等しい。
な方式でアンカー40を環状ループ216およびアダプタ218に連結することにより、アンカー40は、運搬システム200の長手方向中心軸周りに、環状ループ216内で自由に、回転することができる。つまり、運搬ツールシステム200は、後述のように、長手部材42およびステント50(有れば)を回転させることなく、アンカー40を回転させる。
0、32の組織を引くと、それに応答して、前尖14が中隔尖12に向けて引き寄せられ、二尖化が達成される。また、その引っ張りに応答して、第1および第3のインプラント部位30、32の間の組織の部分が締め上げられる。
、第1および第2の長手部材42a、42bのうちの一つにそれぞれ恒久的に連結されてもよく(図示せず)、その場合の各機構150は、調整部品(例えば、スプール、クリンピングビーズ、ラチェット部品、または変形部品)を備える。スプールはその周りに長手部材42a、42bの各一部を巻き取るものであり、クリンピングビーズは長手部材42a、42bの各一部を縮れさせて短くするものであり、変形部品は、長手部材42a、42bの各一部を変形させるものである。他の応用例では、調整機構150は、図5Aに示されるように、調整ツール144のみを備える。そのような応用例では、調整ツール144は、調整部品(例えば、長手部材42a、42bの各一部を縮れさせて短くするクリンピングビーズ、または、長手部材42a、42bの各一部を変形させる変形部品)を備えてもよい。いずれの応用例でも、第1および第2の長手部材42a、42bの各長さを調整している間、弁4の逆流の程度を監視するようにしてもよい。
るように、調整機構150により調整され得る。調整機構150は、一般に、第1と第2のステント130、132間の長手部材42の距離を短くする機械部品を含む。幾つかの応用例では、第1と第2のステント130、132の間の長さを短くするために、調整機構150は、長手部材42に恒久的に連結されてもよく(図示せず)、調整部品(例えば、スプール、クリンピングビーズ、ラチェット部品、または変形部品)を備える。スプールはその周りに長手部材42の一部を巻き取るものであり、クリンピングビーズは長手部材42の一部を縮れさせて短くするものであり、変形部品は、長手部材42の一部を変形させるものである。他の応用例では、調整機構150は、図5Aに示されるように、調整ツール144のみを備える。そのような応用例では、第1と第2のステント130、132間の長さを短くするために、調整ツール144は調整部品(例えば、長手部材42の一部を縮れさせて短くするクリンピングビーズ、または、長手部材42の一部を変形させる変形部品)を備えてもよい。いずれの応用例においても、調整機構150で第1と第2の組織係合要素60a、60b間の距離を調整している間、弁4の逆流の程度を監視するようにしてもよい。
。図の通り、第1のインプラント部位30は、限定ではなくて例示のために、弁4の壁在側にある弁4の弁輪の組織の第1の部分を含む。幾つかの応用例では、第1のインプラント部位30は、心臓2の心房6の壁の第1の部分を含みうる。限定ではなくて例示の目的で示されるように、第1のインプラント部位30は、前尖14と後尖16の間の継ぎ目にある弁輪の組織の部分を含む。注意すべきは、弁4の弁輪の近傍でそれに沿った適切な場所であればどこでも第1のインプラント部位30にしうるということである。
くするものであり、変形部品は、長手部材42の一部を変形させるものである。
、第2のステント50に接続されていない)ということである。さかとげ114で、第2の長手部材42bを、第1の長手部材42aと接続されているステント50に連結させることができ、それによって、第3のインプラント部位32にかかる張力を維持でき、少なくとも前尖14と中隔尖12の接合を維持することができる。
部材42を引っ張っている間、三尖弁4の逆流の程度を監視する。長手部材42は、逆流が減少し止まるまで引っ張られる。医者が弁4の逆流が減少または停止し弁が修復されたと判断すると、前述のように、第2の組織係合要素60b(例えば、ステント50)が大静脈にあるアンカー配置チューブ24から展開され、それによって図8Eおよび図9Eに示されるように、組織係合要素を第2のインプラント部位52にインプラントする。
らに他の応用例では、図12A−Bを参照して後述される展開などのため、長手部材42は、図12Bに示されるように、アンカー956に固定される。
。この先端具(tip)972には複数のアーム974が取り付けられている。アーム974
は、先端具972からそれぞれ概ね遠位方向および径方向に外側に向けて広がっている。アームは、組織内に完全に挿入され、それによって、アンカーを組織に連結するのを助ける。幾つかの応用例では、アンカー40の最大幅W1は少なくとも6.5mm、39mm以下、および/または6.5から39mmの間であり、例えば13mmである。幾つかの応用例では、アンカー40の長さL2は、アンカーの軸に沿ってアーム974の先端からアンカーの先端具972の先端までの測定で、少なくとも5mm、30mm以下、および/または、5から30mmの間であり、例えば10mmである。幾つかの応用例では、先端具972の最大外径D1は、少なくとも1mm、6mm以下、および/または、1から6mmの間であり、例えば2mmである。
0に対して移動すると、アンカーは径方向に縮小された(閉じた)状態に戻る。このようにしてアンカーはカテーテル内に引き戻され(元の位置に収納され)、別の位置に再度配置できる。外科医は、アンカーの位置を最終的に決めたのちインナーチューブを回してアンカーを切り離す。
ーから長手部材の螺着を外すなど、またはその他の分離技術を用いて行われる。代替的に、長手部材は、第1のアンカーに連結されたままで、心房内で切断される。
Claims (6)
- 患者の三尖弁を修復するためのシステムであって、当該システムは:
第1の組織アンカーを有し、該第1の組織アンカーは、心臓の組織にインプラントされるように構成された第1の組織係合要素を定めており;
第1のステントを有し、該第1のステントは、前記患者の心臓の心房に接している血管の一部分内にインプラントされるように構成された第2の組織係合要素を定めており;
第1の可撓性の長手部材を有し、該第1の可撓性の長手部材は、第1の組織アンカーと第1のステントとを連結し、かつ、第1の組織アンカーと第1のステントとの間に張力を加えるように構成されており;
第2の組織アンカーを有し、該第2の組織アンカーは、心臓の組織にインプラントされるように構成された第3の組織係合要素を定めており;
第2のステントを有し、該第2のステントは、前記血管の一部分内にインプラントされるように構成された第4の組織係合要素を定めており、かつ、第1のステントの管腔内で伸びるように構成されており;
第2の可撓性の長手部材を有し、該第2の可撓性の長手部材は、第2の組織アンカーと第2のステントとを連結し、かつ、第2の組織アンカーと第2のステントとの間に張力を加えるように構成されている;
前記システム。 - 第1のおよび第2の可撓性の長手部材の各々が、
編組ポリエステル縫合糸と、
ロープ構造を形成するように撚り合わされた複数のワイヤと
からなる群から選択される要素を有する、請求項1に記載のシステム。 - 第1の組織係合要素は、前記心臓の組織を穿刺することによって該心臓の組織にインプラントされるように構成されている、請求項1に記載のシステム。
- 第3の組織係合要素は、前記心臓の組織を穿刺することによって該心臓の組織にインプラントされるように構成されている、請求項1に記載のシステム。
- 当該システムが、経血管カテーテルと共に使用するように構成され、かつ、
第2のステントが、
血管に送達するために圧縮された状態になって、前記経血管カテーテル内に取り外し可能に配置されるように構成され、かつ、
前記経血管カテーテルの後退時に第1のステントの内腔内で拡張する、
請求項1に記載のシステム。 - 当該システムが、経血管カテーテルをさらに有し、かつ、
第2のステントが、
血管に送達するために圧縮された状態になって、前記経血管カテーテル内に取り外し可能に配置されており、かつ、
前記経血管カテーテルの後退時に第1のステントの内腔内で拡張するように構成されている、
請求項1に記載のシステム。
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2010
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- 2011-01-20 CN CN201180015301.6A patent/CN102869318B/zh not_active Expired - Fee Related
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CN102869318B (zh) | 2016-03-02 |
CA2787663A1 (en) | 2011-07-28 |
US20130046380A1 (en) | 2013-02-21 |
WO2011089601A1 (en) | 2011-07-28 |
JP2018198971A (ja) | 2018-12-20 |
JP5939988B2 (ja) | 2016-06-29 |
US20110184510A1 (en) | 2011-07-28 |
US20160367367A1 (en) | 2016-12-22 |
US20170079797A1 (en) | 2017-03-23 |
EP2525741A1 (en) | 2012-11-28 |
US11559400B2 (en) | 2023-01-24 |
JP2016179185A (ja) | 2016-10-13 |
EP2525741A4 (en) | 2015-05-06 |
US8475525B2 (en) | 2013-07-02 |
JP6395897B2 (ja) | 2018-09-26 |
US20190350709A1 (en) | 2019-11-21 |
CN102869318A (zh) | 2013-01-09 |
JP2017176850A (ja) | 2017-10-05 |
US20230233322A1 (en) | 2023-07-27 |
IL221031A0 (en) | 2012-09-24 |
JP2013517830A (ja) | 2013-05-20 |
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