WO2019101844A1 - Dispositif d'excision propre d'une valve cardiaque - Google Patents

Dispositif d'excision propre d'une valve cardiaque Download PDF

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Publication number
WO2019101844A1
WO2019101844A1 PCT/EP2018/082186 EP2018082186W WO2019101844A1 WO 2019101844 A1 WO2019101844 A1 WO 2019101844A1 EP 2018082186 W EP2018082186 W EP 2018082186W WO 2019101844 A1 WO2019101844 A1 WO 2019101844A1
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WO
WIPO (PCT)
Prior art keywords
clamping
slidable
heart valve
cutting element
clamping element
Prior art date
Application number
PCT/EP2018/082186
Other languages
English (en)
Inventor
Parla ASTARCI
Xavier BOLLEN
Emiliano NAVARRA
Matthias TUMMERS
Original Assignee
Université Catholique de Louvain
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Université Catholique de Louvain filed Critical Université Catholique de Louvain
Publication of WO2019101844A1 publication Critical patent/WO2019101844A1/fr

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Classifications

    • 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
    • A61B17/3205—Excision instruments
    • A61B17/32053—Punch like cutting instruments, e.g. using a cylindrical or oval knife
    • 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
    • A61B2017/22051—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 with an inflatable part, e.g. balloon, for positioning, blocking, or immobilisation
    • A61B2017/22061—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 with an inflatable part, e.g. balloon, for positioning, blocking, or immobilisation for spreading elements apart
    • 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
    • A61B2017/22051—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 with an inflatable part, e.g. balloon, for positioning, blocking, or immobilisation
    • A61B2017/22065—Functions of balloons
    • A61B2017/22068—Centering
    • 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
    • A61B2017/22097—Valve removal in veins

Definitions

  • a device for the excision of a heart valve is presented.
  • the surgical procedure for excision of a heart valve involves cutting and removing the heart valve to form a circular aperture in which the replacement valve is inserted.
  • Conventional devices require the application of high forces to cut through calcified tissue.
  • the resulting aperture is not precisely located or dimensioned because the cutting edge is not stably positioned during cutting.
  • the surgeon must ensure that debris generated during cutting is recovered.
  • a venous cutter typically is used to create a valveless venous vessel for a venous bypass. Venous valves are not calcified; they are soft structures removed by shaving from the vessel inner surface.
  • WO 2011/010296 discloses a device for a venous valvulotomy. It provides a cylindrical cutting tool that is drawn through the venous lumen, and basket-like elements disposed a fixed distance from the cutting tool for capture of the removed valves.
  • US 3,837,345 discloses a venous valve cutter having sharp spikes that spear and impale the venous valve leaflets; a secondary cutter clips the impaled spikes.
  • the presently described device aims to overcome the problems of the art.
  • the present invention relates to a device (100) for excision of a heart valve comprising: a first (120) and second (140) clamping element in mutual sliding relation, each having an annular clamping surface (122, 142) which annular clamping surfaces (122, 142) mutually co-operate to form an annular clamping region (166) configured for clamping a heart valve annularly, and
  • a slidable cutting element (160) slidable with respect to the annular clamping region (166) configured to circularly excise the heart valve
  • the second clamping element (140) may comprise a plurality of mutually slidable segments (147a-d) configured for repeatable spatial separation in a longitudinal direction.
  • the plurality of mutually slidable segments (1474a-d) may assemble to form a cap (147) , which cap (147) comprises a void space configured for retention of tissue debris.
  • Each segment (147a-c) may comprise a sleeve (145a-c) extending in a proximal direction from the segment (147a-c), and sleeves (145a-c) are mutually nested one within another.
  • the sleeves (145a-c) may be arranged in mutually fixed rotation alignment.
  • a first sleeve (145a) of a first segment (147a) may be configured to abut with a body of second segment (147b) when both segments (147a, 147b) are in the assembled configuration to prevent advancement of the first segment in a distal direction past the second segment.
  • the slidable cutting element (160) may further be rotatable with respect to the annular clamping region (166).
  • the second clamping element (140) may comprise a cap (146), which cap (146) comprises a void space configured for retention of tissue debris.
  • the first clamping element (120) may comprise a hollow tubular member (121 ).
  • the slidable cutting element (160) and second clamping element (140) may mutually co-operate to form a first closed container for retention of tissue debris.
  • the first (120) and second (140) clamping elements may mutually co-operate to form a second closed container for retention of tissue debris, wherein the first container is disposed within the second container.
  • One of the first (120) or second (140) clamping elements may be configured to fittingly receive at least part of the other of the first (120) or second (140) clamping elements.
  • the slidable cutting element (160) may be disposed on a circular edge of a cup-shaped body configured for retention of tissue debris.
  • the first clamping element (120) may be attached to a first elongated tube (124), the slidable cutting element (160) is attached to a second elongated tube (164) arranged within a lumen of the first elongated tube (124), and each of the slidable segments (147a, b,c) of the second clamping element (140) may be attached to a separate longitudinal member (144a,b,c) each arranged within a lumen of the second elongated tube (164).
  • the first clamping element (120) may be attached to a first elongated tube (124), the slidable cutting element (160) is attached to a second elongated tube (164) arranged within a lumen of the first elongated tube (124), and the second clamping element (140) is attached to a longitudinal member (144) arranged within a lumen of the second elongated tube (164).
  • the device (100) may further comprise a heart valve balloon catheter (240) for deployment of an expandable heart valve (260).
  • the first clamping element (120) may be attached to a first elongated tube (124)
  • the slidable cutting element (160) is attached to a second elongated tube (164) arranged within a lumen of the first elongated tube (124)
  • the second clamping element (140) is attached to a longitudinal member (144) arranged within a lumen of the second elongated tube (164)
  • the heart valve balloon catheter (240) may be substantially disposed within a lumen of the longitudinal member (144).
  • the first (120) and second (140) clamping elements and the slidable cutting element (160) may be each expandable in a radial dimension. In particular, they may be expandable in a radial dimension for retraction into a lumen of a deployment catheter (180).
  • the first (120) and second (140) clamping elements and the slidable cutting element (160) may be each radially expandable compliant members biased in an open configuration.
  • the device (100) may further comprise a deployment catheter (180), wherein the first (120) and second (140) clamping elements and the slidable cutting element (160) are retractable into a lumen of the deployment catheter (180).
  • the first (120) and second (140) clamping elements and the slidable cutting element (160) may be each radially non-expandable.
  • the first (120) and second (140) clamping elements and the slidable cutting element (160) may be controllably radially expandable, optionally the respective radii being lockable.
  • FIG. 1 is a longitudinal cross-sectional view of a device presented herein, where the first and second clamping elements have a fixed radial dimension and are in an open non- clamping configuration.
  • FIG. 2 is a longitudinal cross-sectional view of a device of FIG. 1 , where the first and second clamping elements are in a closed clamping configuration.
  • FIG. 3B is a longitudinal cross-sectional view of a device of FIG. 3A, wherein the first and second clamping elements and the slidable cutting element are in a withdrawn, non- deployable state.
  • FIG. 4 is a longitudinal cross-sectional view of a device of FIG. 3A, further provided with a balloon catheter for delivery of a heart valve.
  • FIG. 5 is a longitudinal cross-sectional view of a device of FIG. 4, further provided with a centering balloon catheter.
  • FIG. 6 is a plan view of an unfolded conical body used for instance in first or second clamping element or in a slidable cutting element.
  • FIG. 7 is a plan view of an unfolded conical body used for instance in first or second clamping element or in a slidable cutting element, show in detail are pivoting holes.
  • FIG. 8A is a photograph of a distal end of a device wherein the first and second clamping elements form a first closed container.
  • FIG. 8B is a photograph of a distal end of a device wherein the second clamping element and slidable cutting element have been advanced distally, and debris captured in the second closed container.
  • FIG. 8C is a photograph of a distal end of a device wherein the second clamping element and slidable cutting element have been separated, and substantially the whole heart valve is captured in the first closed container.
  • FIG. 9 is a longitudinal cross-sectional view of a device presented herein, where the first second clamping has a fixed radial dimension and second clamping element is radially foldable.
  • FIGs. 10A to 10D show a sequence of advancing the device of FIG. 9 through a heart valve, and locking the second clamping element in an open configuration.
  • FIG. 11 is a longitudinal cross-sectional view of a device disposed with a cylindrical cutting element.
  • FIG. 12 is a longitudinal cross-sectional view of a second clamping elements that is formed of segments.
  • FIGs. 12A to 12C show a sequence of advancing the second clamping elements of FIG. 12 through a heart valve.
  • FIGs. 13 A and B show an end view of a segmented second clamping elements with 3 (A) or 4 (B) segments
  • FIGs. 14A or B show a three-dimensional representation of a segmented second clamping element in a separated (A) or operative (B) configuration.
  • FIGs. 15A to F show different views and configurations of a segmented second clamping element attached to a nested arrangement of longitudinal members.
  • the terms“one or more” or“at least one”, such as one or more or at least one member(s) of a group of members, is clear per se, by means of further exemplification, the term encompasses inter alia a reference to any one of said members, or to any two or more of said members, such as, e.g., any >3, >4, >5, >6 or >7 etc. of said members, and up to all said members.
  • the present invention concerns a device for excision of a heart valve.
  • the device is a medical device or a surgical tool.
  • the device is suitable for excision via a percutaneous route (e.g. transapical, transfemoral, transaortic routes) or by open heart surgery.
  • the percutaneous route refers to accessing the heart valve via the vasculature, while the open heart surgery refers to surgically opening the heart.
  • the heart valve may be any, for instance, a native diseased valve or a prosthetic valve.
  • the device comprises a first (120) and second (140) clamping element in mutual sliding relation; the first clamping element (120) may be fixed while the second (140) clamping element is slidable in relation therewith, or vice versa, or both first (120) and second (140) clamping element may be slidable.
  • Each of the first (120) and second (140) clamping elements has an annular clamping surface (122, 142) which annular clamping surfaces mutually co-operate to form an annular clamping region (166) configured for clamping a heart valve annularly.
  • the first (120) and second (140) clamping elements are disposed either side of the heart valve, are drawn together so as to annularly clamp the heart valve.
  • the device further comprises a slidable cutting element (160) that is slidable with respect to the annular clamping region (166) and is configured for circularly excising the heart valve.
  • the slidable cutting element (160) is displaceable within the annulus of the annular clamping zone.
  • the annular clamping region (166) is disposed towards the distal end (30) of the device.
  • the first clamping element (120) may be disposed proximal to the second clamping element (140).
  • a radial dimension of the annular clamping region corresponds to the size of the excision.
  • the device of the invention provides an annular clamping region (166) for gripping heart valve.
  • the inventors have realised that providing a mechanism for clamping the valve that is separate from a cutting mechanism increases the cutting efficiency.
  • the annular clamping region (166) that surrounds the heart valve produces a valve tautness as the slidable cutting element advances.
  • the tension created allows the valve to be more amenable to fast and clean release by the cutting edge (162) compared an absence of tension accordingly less cutting force is required.
  • the diameters of the force-transmitting components can be reduced so leading to a lighter and reduced-profile device. Additionally, there is a reduction in debris as the valve is more cleanly cut.
  • the second (140) clamping element may be elongate.
  • the outer shape of second (140) clamping element preferably may be at least partly conical, most preferably frustoconical.
  • the wide base of the cone preferably provides the open end, while the tip or truncated tip forms the closed end of the second (140) clamping element.
  • the wide base of the cone also provides the second annular clamping surface (142).
  • Other outer shapes are envisaged for instance, cylindrical, barrel, bullet, rivet and the like.
  • the second clamping element (140) may be reversibly deformable from an operative configuration to a deformed configuration.
  • the second annular clamping surface (142) is split and/or size-reduced in a radial dimension or transverse profile for transport and is non-functioning in clamping.
  • the second annular clamping surface (142) is restored and the second clamping element (140) retains its clamping functionality.
  • second clamping element (140) has a reduced radial dimension or transverse profile at least at one longitudinal position, allowing it to be advanced through a narrow passage of the heart valve (134) without substantial hindrance, and without creating additional debris.
  • the transition between operative configuration to a deformed configuration may be realised using, for instance, a multi-segment second clamping element (e.g. FIGs. 12 to 14B, 147a-d), in which the segments are slidable in a longitudinal direction (e.g. along a central axis) of the second clamping element (140, 147a-d) and can be spatially separated in an axial direction.
  • Each segment has a smaller transverse profile compared with the operative (assembled) form, thereby allowing passage of the second clamping element (140) through the heart valve (134) segment by segment.
  • the transition between operative configuration and deformed configuration may alternatively be realised by providing the second clamping element (e.g . FIGs. 9 - 10D, 148) radially foldable from an open (operative) to a deformed (closed) configuration.
  • the second clamping element (140, 147) may be segmented i.e. may comprise a plurality of segments (147a-d) which assemble to form an intact second (140) clamping element in an assembled (operative) configuration, and hence intact second annular clamping surface (142).
  • the segments are slidable in a longitudinal direction (147a-d).
  • the second clamping element (140, 147) segments may be separated longitudinally to form a separated (deformed) configuration. Advancing at least some of the segments (147a-d) in a distal (30) direction results in the separated (deformed) configuration; the segments (147a-d) may be advanced by differing distances.
  • the segments (147a-d) in a proximal (20) direction results in the assembled (operative) configuration; the segments may be withdrawn by differing distances.
  • the segments align to form a functional (operative) second clamping element (140, 147).
  • the radius of the second clamping element (140) at at least one longitudinal position and radial direction may be reduced in the separated (deformed) configuration.
  • the result is a reduction in transverse profile size at at least one longitudinal position.
  • a transverse profile refers to a plane section of the second clamping element (140, 147) perpendicular to a longitudinal axis.
  • the second clamping element (140, 147) may be advanced segment by segment (147a-d) through a narrow passage of the heart valve (134) without substantial hindrance, and without creating additional debris. It is particularly suited for entry by open heart surgery.
  • the segmented second clamping element (140, 147) may have the form of a cap (e.g. FIG. 12) in the assembled state.
  • a circular edge or rim of the cap forms the second annular clamping surface (142).
  • the cap (147) comprises a void space configured for retention of tissue debris.
  • the cap (147) preferably has an open end on which the second annular clamping surface (147) is disposed.
  • the cap (147) open end preferably faces a proximal (20) direction.
  • At the other end of the cap (147) is a closed end that preferably points in a distal (30) direction.
  • FIGs. 12A to 12C depict a sequence where a device (100) is advanced though a heart valve (134).
  • the segments (147a, 147b) are spatially separated in a longitudinal direction thereby deforming the second clamping element (140, 147) into the separated configuration.
  • the distal (30) end first segment (147a) passes through the heart valve (134) without serious obstruction.
  • the second segment (147b) also passes through without serious obstruction.
  • the second clamping element (140, 147) is reassembled by sliding of the first (147a) and second (147b) segments as to form the assembled (operative) configuration and a functioning second annular clamping surface (142). Notice how the assembled segments in FIG. 12C form a second clamping element (140, 147) having a diameter larger than the passage through the heart valve (134).
  • the segments (147a-d) may form an second clamping element (140, 147) having a circular profile (e.g. FIG. 13A, B, 15E) in the operative state when viewed along a longitudinal axis. Each segment may have a similar circumferential length.
  • the segments (147a-d) are configured for repeatable spatial separation in a longitudinal direction.
  • the segments may optionally slidably interlock in the assembled configuration.
  • a distal segment (e.g. 147a) may be disposed with a stop member (149) for engagement with a proximal-adjacent segment (e.g. 147b); the stop member (149) prevents advancement of the proximal-adjacent segment (e.g. 147b) beyond the distal segment (e.g. 147a).
  • the assembled configuration offers stability when the segments are reassembled, enhanced by the stop member or interlockability.
  • FIG. 15C is a longitudinal (A-A’) cross-sectional view of FIG. 15B, revealing attachment of each segment (147a-c) to a separate longitudinal member (144a-c) that extends towards the proximal end of the device (100), wherein the longitudinal members (144a-c) have a nested arrangement as shown in FIG. 15C.
  • FIG. 15D shows a transverse-cross section along plane (C-C’) of FIG. 15C.
  • FIG. 15E shows a transverse-cross section along plane (B-B’) of FIG. 15C.
  • FIG. 15G is an end view of the segmented second clamping element (140, 147) showing a circular profile and circumferentially evenly divided segments (147a-c).
  • FIG. 15F is an alternative view of the clamping element (140, 147) in the deformed state.
  • Each segment (147a, 147b, 147c) may comprise a sleeve (145a, 145b, 145c) that extends from the segment in a proximal direction.
  • FIGs. 16A’ to C’ and 16A to C each depict a view of a separated segment (147a, 147b, 147c) comprising a sleeve (145a, 145b, 145c).
  • FIGs. 15B and C each show a segment (147a, 147b, 147c) comprising a sleeve (145a, 145b, 145c) wherein the segments form a part of the second clamping element (140, 147).
  • FIGs. 16A to C are end views of each segment (147a, 147b, 147c) and associated sleeve (145a, 145b, 145c) looking in a proximal direction.
  • FIGs. 16A’ to C’ are isometric views of each segment (147a, 147b, 147c) and associated sleeve (145a, 145b, 145c) aligned for mutual insertion and nesting.
  • each sleeve may be in contact with an outer surface of one other nested sleeve, with an exception of the inner most sleeve.
  • the sleeve may be longitudinal.
  • the sleeve may be hollow; the inner sleeve may optionally be solid.
  • a sleeve is preferably formed from a rigid material.
  • the sleeves may be concentrically arranged, as shown, for instance, in FIG. 15E.
  • the sleeves are preferable arranged in mutually fixed rotation alignment.
  • the sleeves are preferable arranged in mutually fixed rotational alignment around a longitudinal axis (A-A’) of the sleeves or of the second clamping element (140, 147).
  • the fixed rotational alignment may be achieved, for instance, by using a non-cylindrical shape of sleeve.
  • a sleeve (145a, 145b, 145c) inner and/or outer surface may have a polygonal (e.g. rectangular, triangular, irregular polygon, regular polygon, non-circular) transverse cross-sectional profile.
  • FIG. 15E shows a transverse-cross section along plane (B-B’) wherein the intermediate sleeve (145b) has a rectangular (square) profile, the outermost sleeve (145a) has a rectangular (square) inner surface profile, and the inner most sleeve (145c) has a rectangular (square) outer surface profile.
  • the fixed rotational alignment may alternatively or additionally be achieved, for instance, by providing one or more protrusions on one sleeve that engages with one or more slots or grooves on an adjacent groove.
  • a first sleeve (e.g. 145a) of a first segment may be configured to abut with a body of second segment (e.g. 147b) when both segments (145, 147) are in the assembled (operative) configuration.
  • the second segment e.g. 147b
  • the second segment may comprise a second sleeve (e.g. 145b) and be disposed within the hollow of the first sleeve (e.g. 145a) in the nested arrangement.
  • the second segment (e.g. 147b) body acts as a stop member, preventing advancement of the first segment (e.g.
  • FIGs. 16A’ and 16B’ indicate a first sleeve edge (FIGs. 16B’ 145b-1 ) that is configured to abut with the body (FIGs. 16A’ 147c-1 )of second segment (e.g. 147b).
  • a nested arrangement of sleeves (145a, 145b, 145c) allows transmission of more pushing forces since a hollow tube is less prone to buckling, and adjacent sleeves provide support in radial direction that also resists buckling.
  • the second clamping element (140, 148) may be radially foldable from an open (operative) to a closed (deformed) configuration. It is preferably radially compliant and biased in an open configuration.
  • FIG. 9 depicts an exemplary device (100) provided with a radially compliant second clamping element (140, 148) biased in an open configuration.
  • the radius of the second clamping element (140, 148) may be reduced upon the application of an external force acting in a radial direction.
  • Being radially foldable the second clamping element (140, 148) may be advanced through a narrow passage of the heart valve (134) without substantial hindrance, and without creating additional debris. It is particularly suited for entry by open heart surgery.
  • FIG. 10A to 10C depict a sequence where a device (100) is advanced though a heart valve (134).
  • the distal (30) tip passes through without serious obstruction, and in FIG. 10B a restricting force applied to the second clamping element (140, 148) radially folds it.
  • the second clamping element (140, 148) has passed through the heart valve (134); in the absence of the restricting force, it radially expands back to its native state.
  • the outer shape of the radially expandable second clamping element (140, 148) may be at least partly conical, most preferably frustoconical.
  • the expansion limiter (136) preferably has a conical or frustoconical form that accommodates a conical shape of the second clamping element (140, 148).
  • the first clamping element (120) or tubular member (121 ) may have a fixed radial dimension. Alternatively, the distal end of the first clamping element (120) or tubular member (121 ) may be capable of radial expansion from a closed to an open configuration ( e.g . for percutaneous route).
  • the first clamping element (120) body may contain fine apertures or slots or it may be lined with a fine mesh for the passage of fluid and retention of tissue debris.
  • the first clamping element (120) or tubular member (121 ) may be slidably fixed relative to a handle disposed at the proximal end of the device (100).
  • One or more radio- opaque markers may be provided on the first clamping element (120) or tubular member (121 ), preferably at a fixed distance from the first annular clamping surface (122).
  • the first clamping element (120) may be attached to or extend into a first elongated tube (124).
  • a proximal end of the first clamping element (120) may be attached to a distal end of first elongated tube (124).
  • the first elongated tube (124) may be a hollow tube disposed with a lumen defined by a wall.
  • the lumen of the tubular member (121 ) may be in fluid connection with the lumen of the tubular member (124) or first clamping element (120).
  • the first elongated tube (124) may extend towards the proximal end (20) of the device.
  • the length of the first elongated tube (122) can depend on the route of entry, for instance, it will be longer for a device configured for percutaneous access (e.g. 1 to 3 m) via the vasculature compared with via open heart surgery (e.g. 15 to 40 cm).
  • first (122) and second (142) annular clamping surfaces preferably have a similar shape e.g. circular. The may or may not have the same size.
  • One of first (122) or second (142) annular clamping surfaces may be smaller than the other, thereby allowing one to be fitting received by the other; the second closed container (see below) so formed has greater integrity and stability, and the heart valve is made more taut during clamping.
  • the first closed container is formed after cutting by the slidable cutting element (160). It is appreciated that the respective walls of the slidable cutting element (160) and second clamping element (140) may each contain fine apertures or slots or they may each be lined with a fine mesh for the passage of fluid and retention of tissue debris.
  • the first closed container is configured to contain the cut tissue debris. The inventors have found that, in practice, the first closed container contains the majority of tissue debris, namely most of the heart valve as shown, for instance, in FIG. 8C, where the excised heart valve (168) is indicated.
  • the first clamping element (120) and second clamping element (140) couple at the annular clamping region (166) to form a second closed container.
  • the second closed container is formed prior to and during cutting by the slidable cutting element. It is appreciated that the respective walls of the slidable cutting element (160) and second clamping element (140) may each contain fine apertures or slots or they may each be lined with a fine mesh for the passage of fluid and retention of tissue debris.
  • the second closed container is configured to contain cut tissue debris. The inventors have found that not all debris from cutting is contained within the first closed container. Surprisingly, tissue particles are found outside the cutting ring of the slidable cutting element.
  • the second closed container captures additional debris not captured in the cap (146)
  • FIG. 8A shows the device (100) after excision, and the formation of second closed container by first clamping element (120) and second clamping element (140).
  • FIG. 8B shows the additional debris (128) captured by the second closed container.
  • the first closed container is disposed within the second closed container.
  • the slidable cutting element (160) preferably has an open end for entry into the void space.
  • the cutting edge (162) is disposed on the edge of the open end.
  • the slidable cutting element (160) open end preferably faces a distal (30) direction.
  • At the other end of the slidable cutting element (160) is a closed end that preferably points in a proximal (20) direction.
  • One or more radio-opaque markers provided on the slidable cutting element (160), preferably at a fixed distance from the cutting edge (162).
  • the slidable cutting element (160) is displaceable within the annulus of the annular clamping region (166); the slidable cutting element (160) is displaceable within the closed container formed by the first clamping element (120) and second clamping element (140).
  • the slidable cutting element (160) may be slidable relative to the first clamping element (120) and/or second clamping element (140).
  • the slidable cutting element (160) may be rotatable about a central axis, more in particular.
  • the slidable cutting element (160) may be rotatable within the annulus of the annular clamping region (166); the slidable cutting element (160) may be rotatable within the closed container formed by the first clamping element (120) and second clamping element (140).
  • the slidable cutting element (160) may be rotatable relative to the first clamping element (120) and/or second clamping element (140).
  • the annular clamping region (166) may be rotationally fixed relative to the first (120) and second (140) clamping elements.
  • the first (120) and second (140) clamping elements may be mutually rotationally fixed (e.g. non rotatable), preferably in the annular clamping region (166).
  • the cutting edge (162) may be sharpened. Additionally or alternatively, it may be disposed with an abrasive or cutting material such as diamond or graphite. Alternatively, or in addition, the cutting edge (162) may be jagged e.g. it may have teeth, triangular, square or otherwise. Preferably, the cutting edge (162) is designed to minimise the amount of debris produced. Preferably, the cutting edge (162) is designed to reduce the particle size of debris produced, so that it can be better retained or stored in the void space.
  • the slidable cutting element (160) is configured for a cutting action which may be a rotation (continuous, intermittent, mono- or bi-directional, or alternative), a linear movement, a combination of these.
  • the slidable cutting element (160) may be configured for rotation around an axis that is preferably its central (longitudinal) axis. Rotation of the slidable cutting element (160) provides a rotating blade at the cutting edge (162) which results in a more efficient excision that may require less force compared with merely punching-out the defective heart valve.
  • cutting actions besides rotation
  • the cutting action may be an oscillation in the longitudinal direction that rapidly advances and withdraws the cutting edge, to provide a hammering action.
  • the rotation and hammering action may be combined.
  • the slidable cutting element (160) or cup-shaped body may have a fixed radial dimension (e.g. for entry by open heart surgery) or may be capable of radial expansion from a closed to an open configuration (e.g. for percutaneous route).
  • the slidable cutting element (160) or cup-shaped body may be slidable relative to a handle disposed at the proximal end of the device (100).
  • the first (120) and second (140) clamping elements are in mutual sliding relation.
  • the second (140) clamping element may slide i.e. be displaceable relative to the first (120) clamping element.
  • the second (140) clamping element may attached to a longitudinal member (144) that extends towards the proximal end of the device (100).
  • the longitudinal member (144) is configured for the transmission of a displacement force from the proximal end (20) to the distal end (30) of the device (100).
  • the second (140) clamping element may be displaced relative to the first (120) responsive actuation of the longitudinal member (144) at the proximal end (20) of the device (100).
  • the longitudinal member (144) at the proximal end (20) may be actuated manually by the surgeon or alternatively robotically.
  • the longitudinal member (144) may be disposed within a lumen of the first elongated tube (122).
  • the longitudinal member (144) may be disposed within a lumen of the second elongated tube (164).
  • the longitudinal member (144) may be provided with a lumen for a guidewire or for a heart valve balloon catheter (200).
  • each segment in mutual sliding relation.
  • a first segment (147a) may slide i.e. be displaceable relative to a second segment (147b), and to subsequent segments (147c, d).
  • Each segment (147a-d) may attached to a separate longitudinal member (144a, 144b) that extends towards the proximal end of the device (100).
  • the longitudinal member (144a. 144b) is configured for the transmission of a displacement force from the proximal end (20) to the distal end (30) of the device (100).
  • the second segment (147b) may be displaced relative to the first segment (147a) responsive actuation of the longitudinal member (144a.
  • Each longitudinal member (144a. 144b) at the proximal end (20) may be actuated manually by the surgeon or alternatively robotically.
  • Each longitudinal member (144a. 144b) may be disposed within a lumen of the first elongated tube (122).
  • Each longitudinal member (144a. 144b) may be disposed within a lumen of the second elongated tube (164).
  • the second (140) clamping element may be displaced relative to the first (120) responsive synchronised actuation of the longitudinal members (144a. 144b) at the proximal end (20) of the device (100).
  • the longitudinal member (144a. 144b) at the proximal end (20) may be actuated together manually by the surgeon or alternatively robotically.
  • the longitudinal members (144a-c) attached to the separate segments (147a-d) of the second clamping element (140) may be arranged as a bundle or be at least partly mutually nested or provided in any other arrangement permitting transmission of displacement forces, or in a combination of these. Where they are arranged as a bundle, longitudinal members (144a-c) are disposed side-by-side and typically within the confines of an outer cover, for instance, within the lumen of the first elongated tube (122).
  • the longitudinal members (144a-c) may be solid. In FIGs. 12A to 12C, the longitudinal members (144a-b) are arranged as a bundle. An advantage of a bundle is flexibility, however, they may be subject to buckling under high compression forces.
  • At least one longitudinal members (144a-c) is formed as a hollow tube into which one or more other longitudinal members (144a-c) is disposed.
  • two or more, preferably all the longitudinal members (144a-c) may be formed as a hollow tube, whereby the tubes are nested, one within another.
  • an inner surface of each hollow tube may be in contact with an outer surface of one other nested tube, with an exception of the inner most tube.
  • the longitudinal members (144a-c) have a nested arrangement, which is also concentric.
  • Each tube of the nested longitudinal members (144a-c) may have a circular transverse- cross section.
  • FIG. 15D shows a transverse-cross section along plane (C-C’) of FIG. 15C.
  • a nested arrangement allows transmission of more pushing forces since a hollow tube is less prone to buckling, and adjacent tubes provide support in radial direction that also resists buckling.
  • a nested longitudinal member (144a-c) may be attached to a nested sleeve (145a-c).
  • the slidable cutting element (160) is slidable and optionally rotatable relative to the annular clamping region (166).
  • the slidable cutting element (160) may slide i.e. be displaceable relative to the annular clamping region (166).
  • the slidable cutting element (160) is slidable and optionally rotatable relative to the first clamping element (120) or first elongated tube (122).
  • the slidable cutting element (160) may be attached to a second elongated tube (164) that extends towards the proximal end of the device (100).
  • the second elongated tube (164) is a hollow tube disposed with a longitudinal lumen defined by a wall.
  • the second elongated tube (164) is configured for the transmission of a displacement force from the proximal end (20) to the distal end (30) of the device (100).
  • the second elongated tube (164) may be displaceable relative to the annular clamping region (166), more particularly relative to the first elongated tube (122), responsive actuation of the second elongated tube (164) at the proximal end (20) of the device (100).
  • the second elongated tube (164) at the proximal end (20) may actuated manually by the surgeon or alternatively robotically.
  • the second elongated tube (162) may be further configured for the transmission of torque from the proximal end (20) to the distal end (30) of the device (100) such that rotation of the cutting edge (162) can be actuated by rotation of the second elongated tube (162) at the proximal end (20).
  • the rotation may be motorised, for example, by attachment of the drive shaft of an electric motor to the proximal end (20) of the second elongated tube (164).
  • slidable cutting element (160) configured for rotation relative to the first (120) and second (140) clamping element i.e. first (120) and second (140) clamping element remain rotationally static.
  • the rotation may be clockwise, counter-clockwise, or may oscillate between the clockwise and counter-clockwise directions.
  • the second elongated tube (164) may be disposed within a lumen of the first elongated tube (122).
  • the longitudinal member (142) may be disposed within the lumen of the second elongated tube (164).
  • the longitudinal member (142), second elongated tube (164) and first elongated tube (122) may be disposed in co-axial alignment.
  • the device (100) may further comprise a heart valve balloon catheter (200) for deployment of an expandable heart valve (260) as shown, for instance, in FIG. 4.
  • the heart valve balloon catheter (200) may be substantially disposed within a lumen of the longitudinal member (144).
  • the heart valve balloon catheter (200) may be slidable within the lumen of the longitudinal member (144).
  • the heart valve balloon catheter (200) typically comprises an inflation lumen (202) extending towards a proximal end of the catheter (200).
  • the inflation lumen is bound by a wall of an inflation tubing (224).
  • the inflation lumen (202) is in fluid communication with a lumen (242) of an expandable balloon (240).
  • the expandable balloon (240) expands or contracts responsive to fluid pressure in the inflation lumen (202).
  • the heart valve balloon catheter (200) further comprises a guidewire lumen (222).
  • the device (100) may further comprise a centering balloon (340) as shown, for instance, in FIG. 5.
  • This centering balloon (340) is useful for the percutaneous route.
  • the centering balloon (340) assists with correct positioning of the device in the aorta, ensures the device is correctly aligned with the aortic valve, and firmly locks the position of the device during the resection.
  • the centering balloon (340) may further be shaped to limit expansion of the second clamping element (140).
  • the centering balloon (340) may be disposed on a catheter, for instance, on the heart valve balloon catheter (200).
  • the heart valve balloon catheter (200) as mentioned above typically comprises a heart valve balloon inflation lumen (222) extending towards a proximal end of the catheter (200) for inflation of the heart valve balloon (240); it may further comprise the expandable centering balloon (340) and a separate centering balloon inflation lumen (302) extending towards a proximal end of the catheter (200) for inflation of the centering balloon (340).
  • the centering balloon inflation lumen (302) is bound by a wall of an inflation tubing (224).
  • the centering balloon inflation lumen (302) is in fluid communication with a lumen (342) of an expandable centering balloon (340).
  • the expandable centering balloon (340) expands or contracts responsive to fluid pressure in the centering balloon inflation lumen (302).
  • the device may be provided at the proximal end with a handle for gripping by the user (e.g. surgeon).
  • the first elongated tube (124) may be disposed in fixed relation to the handle.
  • the device (100) is preferably configured for excision of a human heart valve.
  • the device (100) is a surgical device.
  • the device (100) may be configured for access to the heart valve via open heart surgery.
  • the first (120) and second (140) clamping elements and the slidable cutting element (160) may each be radially non-expandable, as shown, for instance, in FIGs. 1 and 2.
  • the first (120) and second (140) clamping elements and the slidable cutting element (160) may each be controllably radially expandable. This allows the same device (100) to be used for a variety of different heart valve sizes.
  • the respective radial dimensions may be lockable.
  • Controllable radial expansion of the first (120) and second (140) clamping elements and the slidable cutting element (160) may be achieved using, for instance, using an inflatable balloon to control a radial dimension.
  • the device (100) may be configured for access to the heart valve via a percutaneous route i.e. via the vasculature.
  • the first (120) and second (140) clamping elements and the slidable cutting element (160) may each be radially expandable to reduce their radial dimension during passage through the vasculature, as shown, for instance, in FIGs. 3A and 3B.
  • the first (120) and second (140) clamping elements and the slidable cutting element (160) may each have an open (FIG. 3A) and closed (FIG. 3B) configuration.
  • each of the first (120) and second (140) clamping elements and the slidable cutting element (160) has a narrower profile compared with that in the respective open configurations.
  • each of the first (120) and second (140) clamping elements and the slidable cutting element (160) is able to pass substantially unhindered through the lumen of a delivery catheter (180).
  • Each of the first (120) and second (140) clamping elements and the slidable cutting element (160) is capable of expanding from a closed (e.g. FIG. 3B) configuration to an open (e.g. FIG.
  • each of the first (120) and second (140) clamping elements and the slidable cutting element (160) remains closed while the delivery catheter is advanced, and expands during deployment.
  • Each of the first (120) and second (140) clamping elements and the slidable cutting element (160) is also capable of contracting from an open configuration to a closed configuration for when they are withdrawn back into the delivery catheter.
  • the slidable cutting element (160) may be configured to compress or compact or fold the excised heart valve by contraction of the cup-shaped body from the open to the closed state. The contraction is typically radial. Compression or compaction or folding forces may be transmitted to the slidable cutting element (160) by its withdrawal into the lumen of the first elongated tube (124). It will be appreciated that other mechanisms for compression or compaction are envisaged by the present invention.
  • the first clamping element (120) has a maximum outer transverse-cross-sectional diameter of 0.5 cm, 0.6 cm, 0.7 cm, 0.8 cm, 0.9 cm, 1 cm, 1.1 cm, 1.2 cm, 1.3 cm, 1.4 cm, 1.5 cm or a value in the range between any two of the aforementioned values, preferably between 0.8 cm to 1.1 cm, most preferably about 0.9 cm.
  • the maximum outer transverse-cross-sectional diameter of the second clamping element (140) is preferably less than that of the first clamping element (120) in the closed configuration.
  • the maximum outer transverse-cross-sectional diameter of the slidable cutting element (160) is preferably less than that of the second clamping element (140) in the closed configuration.
  • each of the first clamping element (120) has a maximum outer transverse-cross-sectional diameter of 1.5 cm, 1.6 cm, 1.7 cm, 1.8 cm, 1.9 cm, 2 cm, 2.1 cm, 2.2 cm, 2.3 cm, 2.4 cm, 2.5 cm, 2.6 cm, 2.7 cm, 2.8 cm or a value in the range between any two of the aforementioned values, preferably between 2 cm to 2.5 cm, most preferably about 2.2 cm.
  • the maximum outer transverse-cross-sectional diameter of the second clamping element (140) is preferably less than that of the first clamping element (120) in the open configuration.
  • the maximum outer transverse-cross-sectional diameter of the slidable cutting element (160) is preferably less than that of the second clamping elements (140) in the open configuration.
  • Each of the first (120) and second (140) clamping elements and the slidable cutting element (160) may be radially expandable.
  • One or more of the first (120) and second (140) clamping elements and the slidable cutting element (160) may be longitudinally expandable.
  • One or more of the first (120) and second (140) clamping elements and the slidable cutting element (160) may be non-longitudinally expandable.
  • each of the first (120) and second (140) clamping elements and the slidable cutting element (160) is radially expandable and non-longitudinally expandable.
  • each of the first (120) and second (140) clamping elements and the slidable cutting element (160) in the open configuration may be adjustable.
  • Each of the first (120) and second (140) clamping elements and the slidable cutting element (160) may be self-expanding from the closed configuration to the open configuration; in other words, when it is sheathed using a constricting over sheath, each of the first (120) and second (140) clamping elements and the slidable cutting element (160) is in a closed configuration. When unsheathed, each of the first (120) and second (140) clamping elements and the slidable cutting element (160) expands to the open configuration.
  • a sheath may be, for instance, a delivery catheter (180), a first elongate tube (124), the first clamping element (120) or a lasso.
  • Expansion and/or contraction of each of the first (120) and second (140) clamping elements and the slidable cutting element (160) may be actuated by an expansion actuation mechanism.
  • Such mechanism may utilize sheathing/unsheathing, or the like. It will be appreciated that the expansion is reversible i.e. each of the first (120) and second (140) clamping elements and the slidable cutting element (160) is capable of expansion and contraction.
  • One or more, preferably all of the first (120) and second (140) clamping elements and the slidable cutting element (160) may be elongate.
  • the outer shape of one or more, preferably all of the first (120) and second (140) clamping elements and the slidable cutting element (160) in the open configuration preferably may be at least a partly conical, most preferably frustoconical.
  • the wide base of the cone preferably provides the open end, while the tip or truncated tip forms the closed end of the slidable cutting element (160).
  • the wide base of the cone preferably provides the open end of the slidable cutting element (160), while the tip or truncated tip forms the closed end.
  • the wide base of the cone preferably provides the open end of the cap (146) of the second clamping element (140), while the tip or truncated tip forms the closed end of the cap (146).
  • the first clamping element (120) is conical, wide base of the cone preferably provides the first clamping element (120).
  • Other outer shapes in the open configuration are envisaged for instance, cylindrical, barrel, bullet, rivet and the like.
  • the outer shape in the closed configuration is preferably cylindrical, but other shapes are envisaged such as barrel, bullet, rivet and the like.
  • one or more, preferably all of the first (120) and second (140) clamping elements and the slidable cutting element (160) is formed from a self-expanding cone. It is preferably formed from a shape memory material such a NiTinol.
  • the self-expanding cone forms a conical shape.
  • the self-expanding cone forms a cylindrical shape.
  • the self-expanding cone is preferably conical in the native state. When a radial force is applied, the self-expanding cone may be moved radially inwards, thereby reducing the diameter towards the closed configuration.
  • the self-expanding cone may be made using processes similar to making a self-expanding stents.
  • the self-expanding cone may be made from a flat, perforated structure that is subsequently rolled to form the conical structure that is woven, wrapped, drilled, etched or cut to form passages.
  • the flat structure is typically the arc of an annulus.
  • Self-expanding cone may be braided, from flexible metal, such as special alloys, from NiTinol, or from phynox. Self-expandable cone made from NiTinol may be laser cut.
  • the self-expanding cone (500) has a wall (502) optionally provided with one or more apertures (524, 526, 528). It will be appreciated that self-expanding cone (500) has a proximal (20) and distal (30) end, corresponding to the proximal (20) and distal (30) end of the device (100).
  • the self- expanding cone (500) contains a longitudinal slit that cuts across the cone wall (502).
  • the longitudinal slit is preferably in the direction of the central axis (508) of the expandable cone.
  • the longitudinal slit preferably extends from the proximal (20) edge to the distal (30) edge of the self-expanding cone (500).
  • the longitudinal slit is preferably continuous.
  • the longitudinal slit preferably opens the self-expanding cone (500).
  • proximal and distal ends of the self-expanding cone (500) are not continuous as a result of the longitudinal slit.
  • the longitudinal slit provides two outer side edges (536, 538), which overlap in the open and closed configurations. The edges (536, 538), slide or pivot relative to each other as the cone transitions from the open to the closed state, and vice versa.
  • the self-expanding cone (500) contracts into the closed configuration by wrapping the wall (502) of the self-expanding cone (500) into a spiral.
  • the expandable cone (500) is formed from a material able to transmit the requisite clamping or cutting forces to the tissue, and which is able to contract and expand, such as surgical stainless steel or NiTinol. It is appreciated that the use of a shape memory material such as NiTinol, which, in the native state adopts the shape of the (open) cone, would assist in expansion of the self-expanding cone (500) as it is advanced through the delivery catheter (180).
  • the outer annular edge of the sheet - that is the larger (arced) curved edge - forms the cutting edge.
  • the outer side (flanking) edges (536, 538) - that is the two edges that the limit the angle of the segment - overlap.
  • each flanking edge lies adjacent to a wall of the annulus segment.
  • the sheet (520) or wall (502) thereof may contain one or more apertures or windows (524, 526, 528), (FIG. 6) thereby giving the wall (502) of the expandable cone (500). They allow fluids to escape during compression or compaction.
  • the apertures or windows, or expandable cone (500) may be disposed with a lining material (525, 527, 529) (e.g. a sheet with a fine mesh).
  • the lining material reduces or prevents the leakage of debris or particulate matter from receptacle void.
  • the lining material is preferably a polymeric fine mesh.
  • the wall (502) of the expandable cone may comprise two holes (530, 532) located adjacent to the outer side edges (536, 538) of the annulus segment and to the inner annular edge (522) (FIG. 7). When the annulus segment is bent into a cone, the two holes (530, 532) align and act as a pivot point for the expansion (fanning-out) and contraction of the expandable cone (500).
  • the aligned holes (530, 532) may be secured using a rivet or other means.
  • the sheet of material (520) may further be provided with a tab (534) that extends from the inner annular edge (522); such tab may be aligned with a reciprocating groove in the first elongate member (52) to anchor or secure the expandable cone 500 in relation to the first elongate member (52).
  • the tab may transmit torque.
  • the tab has a T-shape, the base of the T extending from the inner annular edge (522).
  • one or more of the first (120) and second (140) clamping elements and the slidable cutting element (160) is each formed from a plurality of elongate strips arranged around a ring, each elongate strips pivoted at one and the same end and the other end providing respectively the first (120) and second (140) clamping elements and the slidable cutting element (160).
  • a pivoted elongate strip may take the form of a compliant member fixed at one end in relation to the ring, the other end forming an open conical shape in the native state.
  • a pivoted elongate strip may alternatively take the form of a rigid member fixed at one end in relation to the ring using a hinge joint.
  • the hinged strip In the native state, the hinged strip may adopt a position contributing to the open conical shape using a spring. In the native state, no application of force may be required to maintain the open configuration. When a radial force is applied, the pivoted strip may be moved radially inwards, thereby reducing the diameter towards the closed configuration.
  • a movement limiter (a stop) may be provided, which restricts the opening of the pivoted elongate strips to a certain size.
  • the limiter may comprise interconnections between adjacent elongate strips.
  • the limiter may comprise loop of variable diameter that passes around the outside of the cone thereby stopping the cone from opening past a certain diameter.
  • the diameter may be controlled by the operator from the proximal (20) end, for instance, by feeding a length of wire to the loop "lasso" from the proximal end.
  • the limiter may comprise loop of fixed diameter that passes around the outside of the cone thereby stopping the cone from opening beyond a certain diameter. By displacing the loop in a longitudinal manner, the size of the opening can be controlled by the operator from the proximal (20) end.
  • the size of the cone in the open configuration may be set, for instance, by the extent the cone is advanced forward from a sheath (e.g. delivery catheter (180), first elongated tube (124)).
  • An elongate strip may be made from any biocompatible material, for instance, stainless steel, titanium, NiTinol, or from a polymeric substance such as polycarbonate.
  • the present invention also relates to a method for excision of a heart valve using a device (100) as described herein comprising the steps:
  • first (120) and second (140) clamping elements either side of the heart valve
  • Closing the first (120) and second (140) clamping elements together thereby clamping the heart valve in an annular clamping region (166) may form a first closed container. After excision of the clamped heart valve, the device (100) may be withdrawn while the first closed container is closed; thus additional debris is removed from the subject

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  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
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  • Surgical Instruments (AREA)

Abstract

L'invention concerne un dispositif (100) pour l'excision d'une valve cardiaque, comprenant un premier (120) et un second (140) élément de clamplage en relation de coulissement mutuel, ayant chacun une surface de clampage annulaire (122, 142), lesdites surfaces de clampage annulaires coopérant mutuellement pour former une région de clampage annulaire (166) conçue pour clamper une valve cardiaque de façon annulaire, et un élément de coupe coulissant (160) coulissant et rotatif par rapport à la région de clampage annulaire (166), conçu pour exciser de manière circulaire la valve cardiaque, l'élément de coupe coulissant (160) pouvant être déplacé à l'intérieur d'un anneau de la région de clampage annulaire (166), le second élément de clampage (140) comportant une pluralité de segments mutuellement coulissants (147a-d) conçus pour la séparation spatiale dans la direction longitudinale.
PCT/EP2018/082186 2017-11-22 2018-11-22 Dispositif d'excision propre d'une valve cardiaque WO2019101844A1 (fr)

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EP17203149.4 2017-11-22

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Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3837345A (en) 1973-08-31 1974-09-24 A Matar Venous valve snipper
US20050075659A1 (en) * 2003-03-30 2005-04-07 Fidel Realyvasquez Apparatus and methods for minimally invasive valve surgery
WO2011010296A1 (fr) 2009-07-24 2011-01-27 London Equitable Limited In Its Capacity As Trustee Of The Think Tank Trust Dispositif de traitement de malformations valvulaires dans des veines périphériques, telles que les veines jugulaires internes, et trousse associée
WO2013135792A1 (fr) * 2012-03-14 2013-09-19 Universite Catholique De Louvain Dispositif d'excision de valvule cardiaque
WO2017157884A1 (fr) * 2016-03-14 2017-09-21 Université Catholique de Louvain Dispositif d'excision propre d'une valvule cardiaque

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3837345A (en) 1973-08-31 1974-09-24 A Matar Venous valve snipper
US20050075659A1 (en) * 2003-03-30 2005-04-07 Fidel Realyvasquez Apparatus and methods for minimally invasive valve surgery
WO2011010296A1 (fr) 2009-07-24 2011-01-27 London Equitable Limited In Its Capacity As Trustee Of The Think Tank Trust Dispositif de traitement de malformations valvulaires dans des veines périphériques, telles que les veines jugulaires internes, et trousse associée
WO2013135792A1 (fr) * 2012-03-14 2013-09-19 Universite Catholique De Louvain Dispositif d'excision de valvule cardiaque
WO2017157884A1 (fr) * 2016-03-14 2017-09-21 Université Catholique de Louvain Dispositif d'excision propre d'une valvule cardiaque

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