Claims
- 1. A device for delivering a conduit into the wall of a patient's heart to place the conduit in communication with a heart chamber, the device comprising:
a support member having a length, a proximal end and a distal end; a conduit supported by the support member; a sheath overlying at least a portion of the conduit, the sheath being movable to selectively expose the portion of the conduit covered by the sheath; and wherein the sheath is moved to expose said portion of the conduit upon positioning the support member and conduit at a desired location within the wall of the heart.
- 2. The device of claim 1, wherein the support member is substantially straight and rigid over the length and has a sharpened tip for forming an opening in the heart wall.
- 3. The device of claim 2, wherein the support member has a tapered portion for dilating the opening formed by the distal end of the shaft.
- 4. The device of claim 2, wherein the support member comprises a hollow member that removably receives a dilator having the sharpened tip for forming an opening in the heart wall.
- 5. The device of claim 1, wherein the conduit comprises a rigid and non-expandable tubular member, and the sheath comprises a sleeve overlying the conduit.
- 6. The device of claim 5, wherein the conduit has two open ends and a plurality of openings disposed between the two ends.
- 7. The device of claim 1, further comprising a positioning member that provides a visual indication of the position of the conduit with respect to the heart wall.
- 8. The device of claim 1, wherein the positioning member is configured to engage a tissue surface and is supported adjacent the distal end of the shaft, the positioning member being movable between collapsed and expanded orientations.
- 9. The device of claim 1, wherein the positioning member is configured to engage a surface of the heart wall and is supported by the sheath.
- 10. The device of claim 9, wherein the sheath has a large diameter section that comprises the positioning member.
- 11. The device of claim 1, wherein the conduit comprises an expandable tubular element and the sheath comprises a retractable sleeve that overlies the tubular element.
- 12. The device of claim 11, wherein the expandable tubular element comprises a stent and the support member comprises a shaft on which the stent is mounted, and the shaft includes an expansion mechanism for expanding the stent.
- 13. A device for delivering a conduit to a selected location in the wall of a patient's heart to place the conduit in communication with a heart chamber, the device comprising:
a support member having a length, a proximal end and a distal end; a conduit disposed on the support member; and a positioning member provided on the support member, the positioning member configured to indicate placement of the conduit in a selected position within the heart wall; wherein the positioning member is disposed a predetermined distance from the conduit and the position of the conduit relative to the heart wall is determined by the position of the positioning member relative to the heart wall.
- 14. A device for delivering a conduit through the wall of a patient's heart and the wall of a coronary vessel to communicate a heart chamber with the coronary vessel, the device comprising:
a support member configured for placement through the wall of a heart so that a portion of the support member extends into a heart chamber; an expandable conduit sized and configured for placement in the heart wall so as to communicate the heart chamber with a coronary vessel, wherein the conduit is supported on the support member in a collapsed orientation and is expanded to an expanded orientation for placement in the heart wall; and wherein the support member has an expansion mechanism that engages the conduit and is actuated to move the conduit from the collapsed orientation to the expanded orientation to securely position the conduit in the heart wall.
- 15. The device of claim 14, wherein the distal end of the support member is sharpened for forming an opening in the wall of the heart, and the support member has a section that is tapered for dilating the opening formed by the distal end.
- 16. The device of claim 14, wherein the support member comprises a hollow member that removably receives a dilator having a sharpened tip for forming an opening in the heart wall.
- 17. The device of claim 14, further comprising a positioning member for engaging tissue to control the position of the conduit with respect to the heart wall.
- 18. The device of claim 17, further comprising a sheath disposed over the conduit so as to substantially cover the exterior of the conduit.
- 19. The device of claim 18, wherein the sheath is a retractable sleeve and the positioning member is supported by the sheath.
- 20. A method for placing a conduit in the wall of a patient's heart, the method comprising steps of:
(a) providing a support member and a conduit; (b) passing the support member and the conduit through a wall of a coronary vessel and through the wall of a patient's heart; (c) positioning the conduit within the wall of the heart; and (d) removing the support member from the wall of the heart.
- 21. The method of claim 20, wherein a sheath overlies the conduit, and further comprising the step of moving the sheath to expose the conduit once the shaft and conduit are positioned in the wall of the heart.
- 22. The method of claim 21, wherein the conduit is expandable and the support member is provided with an expandable member that supports and expands the conduit, and further comprising the step of expanding the conduit within the wall of the heart.
- 23. The method of claim 20, wherein step (b) is carried out by passing a sharpened end of the support member through the wall of the heart.
- 24. The method of claim 20, wherein step (b) is carried out by first forming an opening extending at least partially through the wall of the heart and then passing the support member through the opening.
- 25. The method of claim 20, wherein the conduit is passed through a wall of a coronary vessel and through the wall of the heart into a heart chamber containing oxygenated blood, and the conduit is positioned so as to place the heart chamber in communication with the interior of the coronary vessel.
- 26. The method of claim 24, wherein the coronary vessel is a coronary artery and the heart chamber is the left ventricle.
- 27. The method of claim 25, further comprising positioning a support member within the coronary vessel to support the wall of the vessel during at least steps (b) and (c).
- 28. The method of claim 25, wherein the support member is positioned within the coronary vessel while carrying out steps (b) and (c) and then is removed from the vessel.
- 29. A method for placing a conduit in the wall of a patient's heart at a selected position with respect to the heart wall, the method comprising steps of:
(a) providing a support member and a conduit, the support member having a positioning member disposed at a predetermined location with respect to the conduit; (b) passing the support member and the conduit through a wall of a coronary vessel and through the wall of a patient's heart; (c) locating the positioning member against tissue to place the conduit at a selected location within the wall of the heart; and (d) removing the support member and leaving the conduit in the wall of the heart.
- 30. A method for placing and expanding a conduit in the wall of a patient's heart, the method comprising steps of:
(a) providing a support member and a conduit, the conduit being supported in a collapsed orientation and movable to an expanded orientation; (b) placing the support member and the conduit in a wall of a patient's heart; (c) positioning the conduit within the wall of the heart; (d) expanding the conduit to the expanded orientation; and (e) removing the support member and leaving the conduit in the wall of the heart.
- 31. The method of claim 30, wherein the conduit is passed through a wall of a coronary vessel and through the wall of the heart into a heart chamber containing oxygenated blood, the conduit placing the heart chamber in communication with the interior of the coronary vessel.
- 32. The method of claim 31, wherein the coronary vessel is a coronary artery and the heart chamber is the left ventricle.
- 33. The method of claim 31, wherein the conduit is positioned in the wall of the heart so that one end of the conduit extends partially into the heart chamber.
- 34. The method of claim 30, further comprising a positioning member for engaging the heart wall to control the position of the conduit with respect to the heart wall.
- 35. A device for forming a channel that extends at least partially through the wall of a patient's heart and communicates with a heart chamber, the device comprising:
a shaft having a length, a proximal end and a distal end; and a tissue removal mechanism movably supported on the shaft so as to be movable along the length of the shaft, the tissue removal mechanism including a tissue-removing portion that is actuated to remove a section of tissue from a patient's heart to form a channel that extends at least partially through the heart wall and communicates with a heart chamber; wherein the tissue removal mechanism is moved along at least a portion of the length of the shaft into contact with the section of heart tissue and is actuated to remove the section of tissue.
- 36. The device of claim 35, wherein the tissue-removing mechanism comprises a coring tool slidably mounted on the shaft and the tissue-removing portion comprises a sharpened edge on the tool.
- 37. The device of claim 36, wherein the tissue-removing mechanism is moved along a portion of the length of the shaft to contact the section of tissue and then is rotated with respect to the shaft to cut the section of tissue from the heart wall.
- 38. A device for removing a portion of the wall of a coronary vessel located adjacent the wall of a patient's heart, the device comprising:
a shaft having a proximal end and a distal end; a tissue-removing mechanism disposed adjacent the distal end of the shaft, wherein the tissue-removing mechanism is disposed at a predetermined distance with respect to the distal end of the shaft so that the distal end of the shaft may be placed at a location adjacent the wall of a coronary vessel that positions the tissue-removing mechanism against the wall of the coronary vessel; and an actuator coupled to the tissue-removing mechanism for selectively actuating the mechanism to remove a portion of the wall of the coronary vessel without removing a substantial portion of the wall of the heart located adjacent the coronary vessel.
- 39. The device of claim 38, wherein the tissue-removing mechanism comprises an ablating instrument having at least one portion that contacts and ablates a portion of the wall of the coronary artery when the actuator is actuated.
- 40. The device of claim 39, wherein the ablating instrument is mounted on a movable sleeve coupled to the shaft, the actuator being coupled to the sleeve to move the ablating instrument into contact with the portion of the wall of the coronary artery to be removed.
- 41. The device of claim 40, wherein the ablating instrument utilizes RF energy and includes a plurality of flexible conductive elements that, upon actuation of the actuator, move into contact with the portion of the wall of the coronary artery and apply RF energy to remove said portion of the wall of the coronary artery.
- 42. The device of claim 41, wherein each of the conductive members has an end secured to the sleeve and an end secured to the distal end of the shaft, and wherein actuation of the actuator imparts relative movement to the sleeve and shaft to deflect the conductive elements into contact with said portion of the wall of the coronary artery.
- 43. A device for forming a channel through at least a portion of the wall of a patient's heart by utilizing electrical energy, the device comprising:
a shaft having a length, a proximal end and a distal end, the shaft being sized and configured to be placed in a heart wall with at least the distal end of the shaft extending into the heart wall; an electrode disposed adjacent the distal end of the shaft, the electrode adapted to apply electrical energy to tissue in order to ablate the tissue; and a coupling adapted to be connected to a source of electrical energy.
- 44. The device of claim 43, wherein the shaft comprises a wire formed of a conductive material, and a major portion of the wire is coated with an insulating material to form the shaft while the distal end of the wire is uncoated with an insulating material to form the electrode.
- 45. The device of claim 44, wherein the proximal end of the wire is adapted to be detachably secured to an electrocautery instrument, and the coupling comprises a portion of the proximal end of the wire that receives current from an energy source via the instrument.
- 46. A method for forming a channel that extends through the wall of a patient's heart to communicate a coronary vessel with a heart chamber, the method comprising:
placing a shaft through an outer wall of a coronary vessel and into an interior lumen of the vessel, the shaft having a portion configured to remove tissue from the heart wall; placing the shaft through an inner wall of the coronary vessel and placing said portion of the shaft in contact with the heart wall; and using the shaft to remove tissue from the heart wall to form a channel that extends through the heart wall and communicates the coronary vessel with a heart chamber.
- 47. The method of claim 46, wherein said portion of the shaft has a tissue-removing mechanism comprising a coring tool having a sharpened edge that is used to cut tissue.
- 48. The method of claim 47, wherein the coring tool is rotated to cut the section of tissue from the heart wall.
- 49. A method for removing a portion of the wall of a coronary vessel of a patient's heart without removing a substantial portion of the wall of the heart, the method comprising steps of:
positioning an instrument adjacent the wall of a coronary vessel located adjacent the wall of a patient's heart; and using the instrument to remove a portion of the wall of the coronary vessel without removing a substantial portion of the wall of the heart.
- 50. The method of claim 49, wherein the coronary vessel is a coronary artery and the instrument removes a portion of the inner wall of the coronary artery without removing any of the heart wall.
- 51. The method of claim 49, wherein the instrument also removes a portion of the heart wall.
- 52. The method of claim 50, wherein the instrument is coupled to a source of electrical energy that is used to ablate the tissue from the coronary vessel.
- 53. The method of claim 52, wherein the instrument is coupled to a source of RF energy.
- 54. A method for forming a channel that extends through the wall of a patient's heart and communicates a coronary vessel with a heart chamber, the method comprising:
providing an instrument including an electrode; positioning the instrument and the electrode through a wall of a coronary vessel; placing the electrode in contact with the heart wall adjacent the coronary vessel; and applying electrical energy to the electrode to ablate the tissue of the heart wall.
- 55. The method of claim 54, wherein the shaft comprises a wire formed of a conductive material and an insulating material is disposed over the wire except for a distal end of the wire, and the distal end of the wire forms the electrode and is placed in contact with the heart wall
- 56. The method of claim 55, wherein the step of providing an instrument including an electrode is carried out by detachably securing a proximal end of wire to an electrocautery instrument that receives current from an energy source.
- 57. The method of claim 54, wherein the energy source is an RF energy source.
- 58. The method of claim 54, further comprising placing a conduit in the channel so as to communicate the coronary vessel with the heart chamber.
- 59. A method for introducing a medical device through a coronary vessel and the wall of a patient's heart to perform a medical procedure, the method comprising steps of:
positioning a guide member through a coronary vessel and the wall of a patient's heart into a heart chamber; providing a medical device configured to carry out a medical procedure on the heart; and using the guide member to introduce the medical device into the heart wall.
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application is a continuation-in-part of application Ser. No. 09/023,492, filed Feb. 13, 1998, and entitled “Methods and Devices Providing Transmyocardial Blood Flow to the Arterial Vascular System of the Heart,” the entire subject matter of which application is incorporated herein by reference.
Continuations (1)
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Number |
Date |
Country |
Parent |
09170994 |
Oct 1998 |
US |
Child |
10441257 |
Dec 2003 |
US |
Continuation in Parts (1)
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Number |
Date |
Country |
Parent |
09023492 |
Feb 1998 |
US |
Child |
09170994 |
Oct 1998 |
US |