JP6869967B2 - 経皮的グレン並びにフォンタン手術を実施するための装置及び方法 - Google Patents
経皮的グレン並びにフォンタン手術を実施するための装置及び方法 Download PDFInfo
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
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- 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
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- A61B2017/00238—Type of minimally invasive operation
- A61B2017/00243—Type of minimally invasive operation cardiac
- A61B2017/00247—Making holes in the wall of the heart, e.g. laser Myocardial revascularization
- A61B2017/00252—Making holes in the wall of the heart, e.g. laser Myocardial revascularization for by-pass connections, i.e. connections from heart chamber to blood vessel or from blood vessel to blood vessel
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Description
Claims (15)
- 増強されたエンドグラフトシャントプロテーゼであって、
第1の血管の壁に対する前記プロテーゼの固定の一助となる遠フランジと、
遠領域であって、前記遠領域が通る前記第1の血管の壁に形成される穴の開状態を維持するのに十分な剛性を有し、前記遠フランジの近傍から延伸する遠領域と、
前記遠領域の近傍から延伸する伸展性中間領域であって、前記遠領域よりも伸展性を有し、内側の管状の布及び外側の管状の布の少なくとも1つに取り付けられた複数の起伏状のストラットリングを含み、組み合わせ構造が柔軟性及び伸展性を提供して折り曲げられた際に完全な開通性を許容し、最大で90度まで折り曲げられるようにさらに構成された伸展性中間領域と、
互いに接続された複数の隣接する起伏状のストラットリングを有し、第2の血管の壁に対して固定され、押し付けられるのに十分な剛性を有する近領域と、
テザーを含む起伏状の近端であって、前記テザーは開口に通され、前記テザーに張力が加えられた場合に放射状に内側につぶれる前記プロテーゼの近端と、
を備え、
前記プロテーゼの側壁を介した少なくとも1つの窓部を画定し、体液の漏出を前記窓部を介して許容する、
ことを特徴とするプロテーゼ。 - 前記近領域は、前記第2の血管の壁の内壁に対する並置を向上させるフレア状あるいはベル状であることを特徴とする請求項1に記載のプロテーゼ。
- 押しつけられていない場合、放射状に外側に自己拡張するよう構成及び配置され、
前記遠フランジは、マルチポイントのスターの形状である、
ことを特徴とする請求項1に記載のプロテーゼ。 - 前記遠フランジは、前記プロテーゼの中央長手方向に略平行な第1の方向から自己拡張及び反転するように構成され、前記プロテーゼの壁に対して70度以上90度未満の鋭角を形成する先端を有する折り曲げられたフランジへと変化することを特徴とする請求項1に記載のプロテーゼ。
- 前記各ストラットリングは、起伏する「ジグザグ」パターンへと形成されたニチノールワイヤから形成されること特徴とする請求項1に記載のプロテーゼ。
- 前記プロテーゼは、前記ストラットの内側に配置された内側管状布層と、前記ストラットの外側に配置された外側管状布層と、を含むことを特徴とする請求項1に記載のプロテーゼ。
- 前記プロテーゼは、前記プロテーゼの前記近端にフランジをさらに含み、
各フランジ端は、前記プロテーゼが第1のボディ内腔と第2のボディ内腔との壁に設けられた開口を介してマウントされる際に、前記第1のボディ内腔及び前記第2のボディ内腔に押しつけられるよう構成される、ことを特徴とする請求項1に記載のプロテーゼ。 - 前記各フランジ端は、それぞれ、弾性部材によって中央領域において構造的に連結されている管状の構造領域に取り付けられており、張力は、前記弾性部材によってプロテーゼに維持されて、前記フランジ端の前記第1の血管及び前記第2の血管の内壁に対する固定の一助となる、ことを特徴とする請求項7に記載のプロテーゼ。
- 前記プロテーゼは、調整可能な伸縮長さを有することを特徴とする請求項1に記載のプロテーゼ。
- 前記プロテーゼの内径は、前記プロテーゼの長さが調整された場合でも略不変であることを特徴とする請求項9に記載のプロテーゼ。
- 請求項1に記載のプロテーゼがマウントされたデリバリシステムであって、
前記プロテーゼは、長手方向内側部材と、退避可能なさやの内側とにマウントされることを特徴とするデリバリシステム。 - 前記プロテーゼを介して通された前記テザーの両端が、前記デリバリシステムの近領域を介してその外側の近傍に延伸する、ことを特徴とする請求項11に記載のデリバリシステム。
- さらに、前記デリバリシステムの遠端の近傍に放射線不透過性マーカの第1の組と、前記デリバリシステム及び前記プロテーゼの相対的な位置を示し、手術の際に患者の外部から視認可能なマーカの第2の組とを備え、前記第1及び第2のマーカは、手術の間に互いの位置が維持されるように構成される、ことを特徴とする請求項12に記載のデリバリシステム。
- 前記第1の組のマーカは、酸化鉄から形成された前記デリバリシステムの非外傷性遠端に位置し、MRIあるいは他の画像診断技術による案内を容易にし、前記デリバリシステムを正確に位置決めし、前記第2の組のマーカは、前記デリバリシステムの前記部分の長手方向における相対位置を示す、ことを特徴とする請求項13に記載のデリバリシステム。
- 前記マーカは、前記プロテーゼの前記遠フランジが、動脈の前記壁の内面に対して引っ張られるのに好適に構成されるようになったときに、その旨を示す、ことを特徴とする請求項13に記載のデリバリシステム。
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US201562219118P | 2015-09-15 | 2015-09-15 | |
US62/219,118 | 2015-09-15 | ||
US201662363716P | 2016-07-18 | 2016-07-18 | |
US62/363,716 | 2016-07-18 | ||
PCT/US2016/052005 WO2017049003A1 (en) | 2015-09-15 | 2016-09-15 | Devices and methods for effectuating percutaneous glenn and fontan procedures |
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JP2018528009A JP2018528009A (ja) | 2018-09-27 |
JP2018528009A5 JP2018528009A5 (ja) | 2018-11-08 |
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JP6869967B2 (ja) | 2015-09-15 | 2021-05-12 | ザ ユナイテッド ステイツ オブ アメリカ, アズ リプレゼンテッド バイ ザ セクレタリー, デパートメント オブ ヘルス アンド ヒューマン サービスThe United States Of America, As Represented By The Secretary, Department Of Health And Human Service | 経皮的グレン並びにフォンタン手術を実施するための装置及び方法 |
EP3691568A4 (en) * | 2017-09-01 | 2021-08-25 | Transmural Systems LLC | PERCUTICAL SHUNT DEVICES AND RELATED PROCEDURES |
JP2022501113A (ja) * | 2018-09-19 | 2022-01-06 | エヌエックスティー バイオメディカル, エルエルシーNxt Biomedical, Llc | 生物学的構造の腔と管との間の接続およびシャントを形成するための方法および技術 |
US20200101270A1 (en) * | 2018-09-24 | 2020-04-02 | Michael Warren Sutherland | Pulmonary arterial compliance enhancement and control device |
AU2020219093A1 (en) | 2019-02-07 | 2021-08-26 | Nxt Biomedical, Llc | Rivet shunt and method of deployment |
EP4009903A1 (en) * | 2019-08-06 | 2022-06-15 | Edwards Lifesciences Corporation | External cardiac bypass shunting |
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US20190321043A1 (en) | 2019-10-24 |
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US20170071722A1 (en) | 2017-03-16 |
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