Patent Application
20080015403
In the accompanying drawings, the preferred embodiment of the invention and preferred methods of practicing the invention are illustrated in which:
Referring now to the drawings wherein like reference numerals refer to similar or identical parts throughout the several views, and more specifically to
Preferably, the actuator 16 is a rotary actuator adapted to be attached to the apical aspect of the heart 12 so the apex of the heart 12 can be turned counterclockwise, as viewed from the apex, with respect to the base of the heart 12 to apply torsion to restore natural wringing motion to the heart 12. The actuator 16 is preferably adapted to be attached to the epicardial surface of the heart 12 so as not to contact blood.
Preferably, the actuator 16 provides normal apical rotation or supernormal torsion to the heart 12. The actuator 16 preferably coincides with the systolic phase of the cardiac cycle. Preferably, the power source 14 includes an electric, pneumatic, or low-volume hydraulic power source 14. The power source 14 is preferably a muscle energy converter 18.
The present invention pertains to a method for assisting a heart 12 of a patient. The method comprises the steps of powering an actuator 16 in contact with the heart 12 with a power source 14. There is the step of wringing blood concurrently from both the right and left ventricles of the heart 12 without contacting circulating blood of the patient with the actuator 16.
Preferably, the wringing step includes the step of turning the apex of the heart 12 counterclockwise with a rotary actuator 16 attached to the apical aspect of the heart 12, as viewed from the apex, with respect to the base of the heart 12 to apply torsion to restore natural wringing motion to the heart 12. There is preferably the step of coinciding the wringing with the actuator 16 with the systolic phase of the cardiac cycle.
In the operation of the preferred embodiment, the technology described herein, called an Apical Torsion Device (ATD), is designed to enhance the pumping action of a failing heart by effectively ‘wringing’ blood from both the right and left ventricles concurrently. This is accomplished by attaching a rotary actuator 16 to the apical aspect of the heart 12 so that the apex can be turned counterclockwise (as viewed from the apex) with respect to the base of the heart 12 as shown below. The applied torsion serves to restore the natural wringing motion observed to occur in healthy hearts—a contractile trait that is far less prominent in most diseased hearts. The actuator 16 is placed on the epicardial surface so as not to contact the blood and can be used either to restore normal apical rotation (9-12 degrees) or provide supra-normal torsion (15 degrees or more) to further improve ventricular emptying. Device actuation is to coincide with the systolic phase of the cardiac cycle and will assist ejection directly by mechanical means and indirectly by lowering wall stress (thereby allowing cardiomyocytes to shorten more completely). The actuator 16 can conceivably be powered electrically, pneumatically, or by low-volume hydraulics. The hydraulic version-the preferred embodiment-would allow the device to be used in conjunction with a muscle-powered pump previously developed here at ASRI (see U.S. Pat. No. 6,945,926: Improved Muscle Energy Converter). Combined, these two technologies would form a totally self-contained circulatory support system devoid of blood contacting surfaces and external power sources.
The preferred embodiment of how the actuator itself is to be anchored in this case is to fix the actuator directly to the sternum or to the ribs closest to the cardiac apex (ribs 5 and 6 in most people) using a mechanical screw-and-plate type clamping means used most commonly in surgical orthopedic applications (e.g., U.S. Pat. Nos. 7,048,739 and 5,752,958, incorporated by reference herein).
Connection to the heart will be made using a circular cup-shaped device placed over the cardiac apex so that the sides of the cup 20 extend about 2-3 cm up from the apical tip. Fixation may be made in one of several ways: 1) two or more heavy-gauge needles can be pushed across the diameter of the cup (through the apex) and secured on opposite sides to “skewer” the device into place; 2) the device can be fitted with numerous barbs to secure the epicardium to the inner surface of the cup; 3) the cup can be made with an array of holes through which numerous sutures can be passed and subsequently used to sew the apex to the cup; and 4) the inner surface of the cup can be made rough to encourage fixation via collagen ingrowth (to be used in combination with one of the aforementioned fixation methods).
The rotary actuator will be positioned beneath the fixation cup and connected directly to it by a short metallic shaft. The shaft will rotate in response to fluid entering the actuator housing, preferably from the MEC. (The MEC will be connected to the actuator via a simple hydraulic tube.) There are a number of ways to create a hydraulic rotary actuator. One is to use an expandable bellows to push the shaft through a spiral groove in a manner analogous to a helical sliding spline. Another would be to use a simple rack-and-pinion mechanism. A third would be to employ a Scotch-yoke arrangement. While these three mechanisms do not constitute an exhaustive list by any means, they are certainly among but these are certainly the most common techniques used to effect rotary movement by hydraulic means.
The following patents, all of which are incorporated by reference herein, describe the respective type of embodiments described above.
Although the invention has been described in detail in the foregoing embodiments for the purpose of illustration, it is to be understood that such detail is solely for that purpose and that variations can be made therein by those skilled in the art without departing from the spirit and scope of the invention except as it may be described by the following claims.
