Patent Application
20080234797
The present invention relates to a device for inserting an implant that can expand radially between a contracted state and a dilated state, the device being of the type comprising:
a hollow support defining at least one opening for retaining the implant situated in the vicinity of the distal end thereof;
at least one threadlike link for retaining the implant, comprising a control portion engaged in the support and a tightening loop connected to the control portion and intended to encircle the implant, the tightening loop projecting outside the support through the retention opening.
Such a device is applied in particular to the insertion into a blood vessel of a tubular endoprosthesis, widely referred to by the English term “stent”, or of an endovalve comprising a tubular endoprosthesis and a valve fixed on the endoprosthesis.
A device of the above-mentioned type is disclosed in EP-A-0 707 462. An endoprosthesis is mounted coaxially on two hollow supports, which are capable of sliding in relation to each other. The endoprosthesis is held in the retracted state using threadlike links that encircle the ends thereof. The threadlike links are engaged respectively in the distal and proximal retention openings arranged respectively in one or other of the supports.
To insert the endoprosthesis, the supports are moved by sliding relative to each other, so that the distance between the retention openings reduces.
The reduction of this distance causes the threadlike links to loosen and consequently leads to the simultaneous deployment of both ends of the endoprosthesis.
Such a device is not entirely satisfactory. Indeed, given the complexity of the insertion device, loading of the endoprosthesis onto the device must be carried out in the factory during manufacture of the insertion device. Consequently, it is not possible for the surgeon to modify the size of the endoprosthesis mounted on the insertion device just before the operation, depending on the morphological characteristics of the patient. The surgeon must therefore provide, in the operating theatre, endoprostheses of varied dimensions to suit the morphology of the patient to be treated, which is expensive.
Moreover, if the endoprosthesis has a flexible valve, said valve must be kept in a physiological solution separate from the insertion device. It is therefore not possible to use such an insertion device with endovalves.
An object of the invention is therefore to obtain an insertion device comprising a support and at least one threadlike retention link forming a tightening loop of adjustable size, in which the expandable implant can easily be loaded onto the insertion device by the surgeon just before an operation.
Accordingly, the invention relates to a device of the above-mentioned type, characterised in that the device comprises at least one tool for placing the or each tightening loop around the implant, the placement tool comprising a rigid member and at least one flexible cord integral with the member and engaged releasably round the tightening loop.
The insertion device according to the invention may comprise one or a plurality of the following characteristics, taken in isolation or according to any technically possible combination(s):
the or each placement tool comprises at least two flexible cords engaged in two positions spaced around the tightening loop;
the member has one end defining at least one rounded shape or point, the or each cord being fixed on the member at a point spaced longitudinally relative to the rounded shape or point; and
the or each cord defines a loop sliding freely along the tightening loop.
Another object of the invention is a treatment kit characterised in that it comprises at least one implant that is radially expandable between a contracted state and a dilated state, and an insertion device as defined above.
The treatment kit according to the invention may comprise the following characteristic: the implant comprises a tubular mesh comprising, for the or each threadlike link, at least one ring for guiding the link, the ring delimiting a passage of substantially complementary size of the member.
Another object of the invention is a method for loading an implant that is radially expandable between a contracted state and a dilated state on an insertion device as defined above, characterised in that it comprises the following stages:
expansion of the tightening loop outside the support by moving the placement tool away from the support;
engagement of the tightening loop around the implant;
contraction of the tightening loop towards the support; and
release of the or each flexible cord relative to the tightening loop.
The method according to the invention may comprise one or a plurality of the following characteristics, taken in isolation or according to any combination(s) that are technically possible:
the implant comprises an endoprosthesis comprising a tubular framework, the method comprising a stage of passing the rigid member and the or each flexible cord through the tubular framework, before engaging the tightening loop around the endoprosthesis; and
the tubular framework defines a ring for guiding the member, the method comprising the passage of the member and of the or each flexible cord through the ring before engaging the loop around the endoprosthesis.
Another object of the invention is a placement tool for a device for inserting an implant that can expand radially between a contracted state and a dilated state, characterised in that it comprises a rigid member and at least two flexible cords having one end integral with the member and one end free forming a loop intended to be engaged around a tightening loop of the insertion device.
The invention will be better understood on reading the description that follows, given solely by way of example, and made with reference to the accompanying drawings, in which:
In the example illustrated in
The endoprosthesis 16 is formed by a framework consisting of a tubular mesh 22 which has the properties of a spring. The mesh 22 is obtained by weaving at least one thread made of stainless steel, a shape-memorising alloy, or a polymer. In a variant, the mesh is obtained by laser-cutting a tube.
The mesh 22 comprises a plurality of threadlike segments 24 which intersect and delimit transverse lozenge-shaped openings. It also comprises a distal ring 26A and a proximal ring 26B for guiding the insertion device as described below.
The rings 26A, 26B are integral with the segments 24. They are situated respectively in the vicinity of a distal end and a proximal end of the mesh 22.
The mesh 22 of the endoprosthesis 16 can be deployed in the contracted state in which it has a small diameter, and in a dilated state, constituting its rest state, in which it has a large diameter.
In the example illustrated in
The valve 20 is for example produced from a valve of an animal such as a pig. In a variant, it is produced from natural tissue such as bovine or ovine pericardium, or from synthetic material.
Traditionally, the valve 20 comprises a tubular base 28, fixed on the mesh 22 and extended upwards by three flexible leaves 30 for closing the conduit 18.
The leaves 30 can be moved radially towards the axis X-X′ of the conduit 18 between a closed position of the conduit 18, in which they prevent substantially the passage of blood through the conduit 18, and an open position of the conduit 18, in which they are substantially laid flat against the mesh 22 and they allow the blood to pass through the conduit 18.
The valve 20 is arranged axially on the mesh 22 between the guide rings 26A, 26B, at a distance from these rings.
As illustrated in
The insertion device 14 also comprises a sheath 40 for protecting the endovalve 12, mounted so as to slide coaxially on the support 32. According to the invention, the device 14 comprises, for each threadlike link 36A, 36B, a placement tool 42A, 42B connected to the threadlike link 36A, 36B.
The hollow support 32 extends between a proximal end 44 intended to be placed outside the human body to be accessible to the surgeon, and a distal end 46 intended to be implanted in the blood circulation conduit, in particular by the endoluminal route.
The support 32 comprises a hollow tube 48 with a central axis Y-Y′, and for each threadlike link 36A, 36B, a lateral branch 50A, 50B opening into the hollow tube 48, in the vicinity of the proximal end 44.
The hollow tube 48 delimits internally a central passage 52 of axis Y-Y′, which opens axially at the distal 46 and proximal 44 ends of the tube 48 through respective axial openings 54A, 54B. The hollow tube 48 also delimits, for each threadlike retention link 36A, 36B, a transverse retention opening for the endovalve 12, which opens in the vicinity of the distal end 46 and in which the link 36A, 36B is engaged.
In the example illustrated in
The transverse openings 56A, 56B are spaced longitudinally along the axis Y-Y′. The distance separating said openings is substantially equal to the distance separating the distal ring 26A from the proximal ring 26B when the mesh 22 of the endovalve 12 occupies the contracted state thereof against the support 32.
The branches 50A, 50B project transversely relative to the hollow tube 48 in the vicinity of the proximal end 44. They have respective internal passages 58A, 58B connecting the central passage 52 to respective outer openings 60A, 60B.
Locking caps 62A, 62B are mounted on the free ends of the branches 50A, 50B in the region of the openings 60A, 60B and selectively lock in position or release the respective threadlike links 36A, 36B.
The pin 34 comprises a retention rod 64 arranged axially in the passage 52 and a fixing cap 66 screwed to the proximal end 44 of the hollow tube 48.
The shaft 64 can be moved axially in the conduit, between a distal fixing position, in which it extends opposite each transverse retention opening 56A, 56B, an intermediate position in which it extends opposite the proximal retention opening 56B, and at a distance from the distal retention opening 56A towards the proximal end 44, and a proximal released position in which it extends at a distance from the openings 56A, 56B.
In the example illustrated in
Each threadlike link 36A, 36B thus comprises successively a control portion 70 connecting the control bar 38 to a retention opening 56A, 56B through the hollow support 32, a loop 72 for retaining and tightening the endovalve 12, which projects outside the retention opening 56A, 56B, and an end loop 74 engaged releasably around the retention rod 64.
Each control portion 70 is fixed at a proximal end 76A, 76B to the control bar 38. The ends 76A, 76B are thus fixed on either side of the control bar 38.
Each control portion 70 extends successively through a control cap 62A, 62B, in an inner passage 58A, 58B, in the central passage 52 and inside the hollow tube 48 as far as a retention opening 56A, 56B.
The retention loop 72 is connected to the control portion 70. It extends outside the retention opening 56A, 56B.
As is shown below, the loop 72 is of a variable active length which is adjusted by moving the control bar 38.
The loop 72 is integral at one end with the control portion 70 and at the other end with the loop 74 engaged on the retention rod 64.
The active length of the tightening loop 72 is variable. Thus, when the end 76A, 76B of the control portion 70 is close to the stopper 62A, 62B, the length of the control section 70 reduces and the active length of the tightening loop 72 increases. Conversely, when the control bar 38 is moved so that the end 76A moves away from the stopper 62A, 62B, the active length of the tightening loop 72 reduces.
As illustrated in
The protection sheath 40 is mounted so as to slide along the axis Y-Y′ on the hollow support 32. It can be moved on the support 32 by means of proximal control lugs 78, between a withdrawn position in which it is placed at a distance from the retention openings 56A, 56B, and an advanced position in which it covers the retention openings 56A, 56B.
According to the invention and as illustrated in
As illustrated in
The member 90 is cut in the form of a point or in a rounded shape at each of the ends 92A, 92B thereof. The acute angle formed by the point of the member facilitates the threading of the member 90 into a guide ring 26A, 26B.
The outer diameter of the member 90 corresponds substantially to the inner diameter of a guide ring 26A, 26B.
The cords 94A, 94B are fixed on either side of the member 90.
Each cord 94A, 94B has an end 96 fixed to the member 90, at a distance longitudinally from the bevelled point defined at each end 92A, 92B, and a free end 98 forming a loop.
In the example illustrated in
The strands constituting the cord 94A and the cord 94B are for example connected to each other through the member and fixed on the member by pressing of said member.
During manufacture of the device 14, each free end 98 is engaged freely around the tightening loop 72 of a threadlike link 56A, 56B. It can therefore be slid along the loop 72. The free ends 98 of the respective cords 94A, 94B are spaced along the tightening loop 72.
The cords 94A, 94B can be moved relative to the member 90 between a near position, in which the free ends 98 thereof are placed in the vicinity of each other and in which they define with the member 90 a triangle, and a separated position, illustrated in
The scissors 16 are suitable for cutting the flexible cords 94A, 94B of the placement components 42 to release them from the loop 72.
The method of loading the endovalve 12 on the insertion device 14 is described below.
Initially, the endovalve 12 is kept sterile in a moist medium, such as a solution of physiological serum, for example. The mesh 22 of the endoprosthesis 16 is in the dilated rest state, which keeps the valve 20 in a rest configuration, minimising the stresses that could be applied to it.
Similarly, the insertion device 14 is kept in a sterile sachet. The locking caps 62A, 62B are released to allow movement of the control portions 70. In addition, the tightening loops 72 are withdrawn outside the retention openings 56A, 56B. A placement tool 42A, 42B is engaged on each tightening loop 72.
The cords 94A, 94B of the tools 42A, 42B are thus engaged around strands forming the tightening loop 72A, 72B. In addition, the sheath 40 is in the withdrawn position to facilitate access to the retention openings 56A, 56B.
The retention rod 64 of the pin 34 is in the distal position and the loops 74 of the threadlike links 36A, 36B are engaged around the pin 34.
Just before the introduction of the endovalve 12 into a patient, during an operation, the surgeon puts the endovalve 12 in place on the insertion device 14.
Accordingly, he inserts the endovalve 12 coaxially at the distal end 46 of the support 32 by introducing the support 32 into the blood circulation conduit 18 through the leaves of the valve 20.
Then, he fits the proximal tightening loop 72 around the endoprosthesis 16 of the endovalve 12. Accordingly, and as illustrated in
As illustrated in
Then, taking the member 90, the surgeon separates the cords 94A, 94B at a distance from each other by means of his fingers 100 to move the free ends 98 of the cords 94A, 94B away from each other.
This action causes the tightening loop 72 to expand outside the support 32 and leads to an increase in the active length thereof as illustrated in
Once this has been done, he engages the tightening loop 72 coaxially around the outer surface of the endoprosthesis 16, pivoting the loop 72 about an axis perpendicular to the axis X-X′, using the placement tool 42B. He thus causes the endovalve 12 and the support 32 to penetrate into the inside of the loop 72. As illustrated in
Next, the surgeon applies traction to the end 76B of the control section by means of the control bar 38 by moving said end 76B away from the stopper 62B. During said traction, the active length of the tightening loop 72 reduces, which causes the radial contraction of the proximal end of the endoprosthesis 16 towards the support 32.
He then engages the distal tightening loop 72 in a similar way to that described for the proximal loop, by engagement of the member 90 and cords 94A, 94B through the distal guide ring 26A. Next, he tightens the distal tightening loop 72 by means of the control bar 38 until the distal end of the endoprosthesis 16 contracts radially against the support 34. The endoprosthesis 16 is then in the contracted state.
When he considers that the insertion device 14 is operating correctly, he uses the scissors 16 to cut the cords 94A, 94B and thus release the placement tools 42A, 42B from the tightening loops 72.
Once this has been done, he moves the sheath 40 towards the distal end 46 of the support 3225 to cover the endoprosthesis 16 in the contracted state thereof and introduces it into the human body.
The procedure for implanting the endovalve 12 in the human body is then carried out, as described in application FR-A-2 863 160 of the Applicant.
Accordingly, the insertion device 14, on which the endovalve 12 is mounted, is introduced up to the point of implantation by endoluminal means, by sliding on a surgical guide, then the sheath 40 is withdrawn towards the proximal end 44. The endovalve 12 is then inserted by successive or simultaneous deployment of the tightening loops 72 under the action of the control bar 38. When the insertion is satisfactory, the pin 34 is withdrawn to allow the retention rod 64 thereof to pass to the release position. The threadlike retention links 36A, 36B are then withdrawn outside the human body by traction on the control bar 38, and the support 32 is withdrawn.
With the help of the invention that has just been described, it is thus possible to have an insertion device 14 where an endoprosthesis 16 or endovalve 12 can be easily loaded onto said device by the surgeon just before the operation. The presence of a rigid member 90 facilitates the engagement of the tightening loops 72 through the endoprosthesis 16 or endovalve 12 and around it. The presence of the flexible cords 94A, 94B allows the active length of said loops 72 to be made to expand in a simple manner.
In a variant, the mesh 22 does not have a guide ring. In this case, the end of the member 90 is introduced through a closed link, defined between the threadlike segments 24 of the mesh 22, when mounting the tightening loops 72.
In another variant (not illustrated), the insertion device 14 comprises a single threadlike link forming at least one tightening loop encircling the endoprosthesis 16, after it has been loaded on the device 14.
In a variant, the endoprosthesis 16 is mounted laterally along the support 32 when it is loaded on the device 14. Thus, the outer surface of the endoprosthesis 16, and not its inner surface delimiting the conduit 18, is kept applied against the support 32 by the links 36A, 36B.
In another variant, the or each link 36A, 36B encircles the endoprosthesis 16 at a point situated at a distance from the ends of the endoprosthesis 16 over the length thereof.
| Number | Date | Country | Kind |
|---|---|---|---|
| 07 53959 | Mar 2007 | FR | national |
