FIELD
This document relates to medical procedures such as transseptal perforation. More specifically, this document relates to sheaths for use in medical procedures, and related systems and methods.
SUMMARY
The following summary is intended to introduce the reader to various aspects of the detailed description, but not to define or delimit any invention.
Medical sheaths are disclosed. According to some aspects, a medical sheath includes an elongate member having a proximal portion defining a proximal end and a distal portion defining a distal end. A first lumen extends through the elongate member and is open at the proximal and the distal end for passage of a medical device through the lumen. An anchoring mechanism is deployable from the elongate member and includes an anchor that is removably securable to an anatomical feature to secure the elongate member to the anatomical feature, and a connector securing the anchor to the elongate member.
In some examples, the medical sheath further includes a second lumen that extends through the elongate member and is open at the distal portion. The anchor can be movable between a storage position in which the anchor is housed within the second lumen and a deployed position in which the anchor is outside of the second lumen. The sheath can further include a first actuator that is actuatable to move the anchor between the storage position and the deployed position. When in the deployed position, the anchor can be spaced radially from the elongate member.
In some examples, the anchor is movable between a lock configuration for securing to the anatomical feature and a release configuration for releasing the anatomical feature. The sheath can include a second actuator that is actuatable to move the anchor between the lock configuration and the release configuration. The anchor can include a clamp for clamping onto the anatomical feature. In the lock configuration, the clamp can be closed, and in the release configuration, the clamp can be open.
In some examples, the anchoring mechanism further includes a perforating tip for perforating the anatomical feature. The anchor can include an expandable structure, and the expandable structure can be expanded when the anchor is in the lock configuration and can be retracted when the anchor is in the release configuration
In some examples, the sheath includes a handle secured to the proximal portion of the elongate member. The connector can include a wire secured at a first end to the handle and at a second end to the anchor.
Methods for carrying out medical procedures are also disclosed. According to some aspects, a method for carrying out a medical procedure includes a. intravenously advancing a sheath toward a target region in a patient's body; b. securing an anchor of the sheath to an anatomical feature proximate the target region; c. advancing a medical device through a first lumen of the sheath towards the target region; and d. with the anchor of the sheath secured to the anatomical feature, performing a medical procedure on the target region using the medical device.
In some examples, the target region is a fossa ovalis of the patient's heart and the anatomical feature is a limbus of the fossa ovalis.
In some examples, the medical device is a perforation device, and step d. includes perforating the fossa ovalis.
In some examples, between steps a. and b., the method further includes deploying the anchor from a second lumen of the sheath.
In some examples, step b. includes clamping the anchor onto the anatomical feature.
In some examples after step d., the method further includes releasing the anchor from the anatomical feature and retracting the anchor into the sheath.
In some examples, step b. includes creating a perforation in the anatomical feature, passing the anchor through the perforation, and expanding the anchor. Step b. can include using a radiofrequency perforation electrode to create a perforation in the anatomical feature. After step d., the method can include retracting the anchor and withdrawing the anchor from the perforation.
Transseptal perforation systems are also disclosed. According to some aspects, a transseptal perforation system includes a sheath. The sheath includes an elongate member having a proximal portion defining a proximal end and an opposed distal portion defining a distal end. A first lumen extends through the elongate member and is open at the proximal end and the distal end. An anchoring mechanism is deployable from the elongate member and includes an anchor that is removably securable to an anatomical feature to secure the elongate member to the anatomical feature, and a connector securing the anchor to the elongate member. The system further includes a dilator advanceable through the lumen from the proximal end to the distal end and having a dilating tip. The system further includes a perforation device advanceable through the dilator towards the dilating tip and having a perforating tip.
BRIEF DESCRIPTION OF THE DRAWINGS
The accompanying drawings are for illustrating examples of articles, methods, and apparatuses of the present disclosure and are not intended to be limiting. In the drawings:
FIG. 1 is a schematic front view of a fossa ovalis and limbus of an atrial septum, showing example desired regions for perforation;
FIG. 2 is a perspective view of a system for transseptal perforation;
FIG. 3 is a front view of a sheath of the system of FIG. 2, showing a first lumen, second lumen, and anchoring mechanism in dotted line;
FIG. 4 is a partial side view of the sheath of FIG. 3, showing the first lumen, second lumen, and anchoring mechanism in dotted line;
FIG. 5 is an end view of the sheath of FIG. 3, showing the first lumen, second lumen, and anchoring mechanism in dotted line;
FIG. 6 is a partial side view of the sheath of FIG. 2, showing the first lumen, second lumen, and anchoring mechanism in dotted line, and showing the anchoring mechanism in a storage position;
FIG. 7 is a partial side view of the sheath of FIG. 2, showing the first lumen, second lumen, and anchoring mechanism in dotted line, and showing the anchoring mechanism in a deployed position and in a lock configuration;
FIG. 8 is a partial side view of the sheath of FIG. 2, showing the first lumen, second lumen, and anchoring mechanism in dotted line, and showing the anchoring mechanism in the deployed position and in a release configuration;
FIG. 9 is a partial side view of another example anchoring mechanism, in a release configuration;
FIG. 10 is a partial side view of the anchoring mechanism of FIG. 9, in a lock configuration;
FIG. 11 is a partial side view of another example anchoring mechanism, in a release configuration;
FIG. 12 is a partial side view of the anchoring mechanism of FIG. 11, in a lock configuration;
FIG. 13 is a partial side view of another example anchoring mechanism, in a release configuration;
FIG. 14A is a partial side view of the anchoring mechanism of FIG. 13, in a lock configuration;
FIG. 14B is a partial side view of the anchoring mechanism of FIG. 13, in an alternative lock configuration;
FIG. 14C is a partial side view of the anchoring mechanism of FIG. 13, in a further alternative lock configuration;
FIG. 15 is a schematic view of a step of a method for transseptal perforation, using the system of FIG. 2;
FIG. 16 is a schematic view of a subsequent step of the method of FIG. 15;
FIG. 17 is a schematic view of a subsequent step of the method of FIGS. 15 and 16;
FIG. 18 is a schematic view of a subsequent step of the method of FIGS. 15 to 17;
FIG. 19 is a schematic view of a subsequent step of the method of FIGS. 15 to 18; and
FIG. 20 is a schematic view of a step another method for transseptal perforation.
DETAILED DESCRIPTION
Various apparatuses or processes or compositions will be described below to provide an example of an embodiment of the claimed subject matter. No example described below limits any claim and any claim may cover processes or apparatuses or compositions that differ from those described below. The claims are not limited to apparatuses or processes or compositions having all of the features of any one apparatus or process or composition described below or to features common to multiple or all of the apparatuses or processes or compositions described below. It is possible that an apparatus or process or composition described below is not an embodiment of any exclusive right granted by issuance of this patent application. Any subject matter described below and for which an exclusive right is not granted by issuance of this patent application may be the subject matter of another protective instrument, for example, a continuing patent application, and the applicants, inventors or owners do not intend to abandon, disclaim or dedicate to the public any such subject matter by its disclosure in this document.
Generally disclosed herein are sheaths that can be used in medical procedures, such as cardiac procedures. For example, the sheaths can be used in transseptal perforation procedures, in which the sheath is advanced to the right atrium of a patient's heart via the femoral vein, and a perforation device (e.g. a radiofrequency (RF) perforation device or a mechanical perforation device) and dilator are guided through the sheath, to the right atrium. When the sheath is adjacent a target region in the right atrium, for example the fossa ovalis of the atrial septum, the perforation device can be advanced out of the sheath and used to create a perforation in the target region, and the dilator can be advanced out of the sheath to dilate the perforation. Such procedures can be carried out, for example, as a medical treatment, or to gain access to the left atrium for a subsequent medical treatment.
The sheaths disclosed herein are configured to anchor to (i.e. be physically secured to) an anatomical feature proximate the target region. For example, in transseptal perforation procedures in which the target region for perforation is the fossa ovalis, the sheath can anchor to the limbus of the fossa ovalis. Anchoring to an anatomical feature can physically stabilize the sheath, which can prevent unintended movement of the sheath, and can in turn facilitate precise positioning of the sheath. For example, in transseptal perforation procedures, depending on the purpose of the procedure, it can be desired to perforate the fossa ovalis at different locations. Referring to FIG. 1, which schematically shows a fossa ovalis 10 and limbus 12 in some instances, it can be desired to perforate the fossa ovalis 10 at a first location 14; in other instances, it can be desired to perforate the fossa ovalis 10 at a second location 16; and in yet other instances, it can be desired to perforate the fossa ovalis 10 at a third location 18. By anchoring the sheath to the limbus 12, the sheath is physically stabilized, which can facilitate precise positioning of the sheath at the first location 14, second location 16, or third location 18.
Referring now to FIG. 2, an example medical system 100 is shown. In the example shown, the system 100 is a transseptal perforation system, for advancing towards a patient's heart and perforating a fossa ovalis of the patient's heart. The system 100 includes a sheath 102 (also referred to herein as a ‘medical sheath’), a dilator 104, and a perforation device 106 having a perforating tip 108. In the example shown, the perforation device 106 is a radiofrequency (RF) perforation device, and the perforating tip 108 includes a radiofrequency perforation electrode.
In use, the sheath 102 can be advanced intravenously via the femoral vein towards the right atrium of the patient's heart. The dilator 104 and perforation device 106 can both be advanced towards the patient's heart via the sheath 102. The RF perforation device 106 can be connected to a radiofrequency generator 110, which can in turn be connected to one or more grounding pads (not shown). When in the desired position in the patient's heart, for example adjacent the fossa ovalis, the RF perforation device 106 can be activated to perforate the fossa ovalis.
Referring to FIGS. 3 to 5, the sheath 102 is shown in greater detail. In the example shown, the sheath 102 generally includes an elongate member 112, a handle 114, and an anchoring mechanism 116 (which is shrouded within the elongate member 112 and shown in dotted line in FIGS. 3 to 5). The elongate member 112 has a proximal portion 118 that defines a proximal end 120 of the elongate member 112, and a distal portion 122 that defines a distal end 124 of the elongate member 112. The handle 114 is secured to the proximal portion 118 of the elongate member 112. A first lumen 126 (shown in dotted line) extends through the elongate member 112 from the proximal end 120 to the distal end 124, for passage of a medical device (e.g. dilator 104 and/or perforation device 106) through the elongate member 112.
Referring still to FIGS. 3 to 5, as mentioned above, the anchoring mechanism 116 is securable to an anatomical feature, to anchor the sheath 102 to that anatomical feature and provide physical stability to the sheath 102. The anchoring mechanism 116 is deployable from the sheath 102 and generally includes an anchor 128, which can be any suitable structure that is removably securable to an anatomical feature, and a connector 130, which connects the anchor 128 to the elongate member 112. The connector 130 can connect the anchor 128 directly to the elongate member 112, or can connect the anchor 128 indirectly to the elongate member 112 (e.g. by connecting the anchor 128 to the handle 114, which is in turn connected to the elongate member 112).
Referring still to FIGS. 3 to 5, in the example shown, the elongate member 112 includes a second lumen 132 (shown in dotted line) that extends through the elongate member 112 from the distal portion 122 to the proximal end 120, for storage of the anchoring mechanism 116. The second lumen 132 is open at a side surface of the elongate member 112, at opening 134.
Referring to FIGS. 6 and 7, the anchor 128 is movable between a storage position, shown in FIG. 6, in which the anchor 128 is housed within the second lumen 132, and a deployed position, shown in FIG. 7, in which the connector 130 passes through the opening 134 to position the anchor 128 outside of the second lumen 132, to be secured to an anatomical feature.
Referring still to FIGS. 6 and 7, in the example shown, the connector 130 is in the form of a resiliently flexible wire. The wire has a first end (not shown) that is secured to the handle 114, and a second end that is secured to the anchor 128. The wire can be shaped so that when the anchor 128 is in the deployed position, the anchor 128 is spaced radially from the elongate member 112 (e.g. the wire can be made from a shape memory material). Alternatively, the wire can be steerable (e.g. using a steering mechanism that is controlled via a control in the handle 114).
Referring back to FIG. 3, the sheath 102 further includes an actuator for moving the anchor 128 between the storage and deployed positions. In the example shown, the actuator is part of the handle 114, and includes a rotatable dial 138. Rotating of the dial 138 in a first direction (e.g. clockwise) causes the connector 130 to be drawn inwardly into the second lumen 132 towards the handle 114, to move the anchor 128 to the storage position. Rotating of the dial 138 in a second direction (e.g. counter-clockwise) causes the connector 130 to be fed outwardly from the second lumen 132 through the opening 134, to move the anchor 128 to the deployed configuration.
Referring now to FIGS. 7 and 8, the anchor 128 is movable between a lock configuration, shown in FIG. 7, for securing to the anatomical feature, and a release configuration, shown in FIG. 8, for releasing the anatomical feature. In the example shown, the anchor is in the form of a clamp, for clamping onto the anatomical feature. In the lock configuration, the clamp is closed and held in the closed position, and the release configuration, the clamp is open.
Various alternative configurations of the anchor are possible. For example, the anchor can include a perforating tip (in such examples, the perforating tip of the perforation device can be referred to as a first perforating tip, and the perforating tip of the anchor can be referred to as a second perforation tip). for perforating the anatomical feature (e.g. the limbus of the fossa ovalis), and an expandable structure that can be passed through the perforation and expanded to prevent the anchor from being withdrawn back through the perforation. The perforating tip can include a mechanical perforating tip, or a radiofrequency perforation electrode. Examples of such anchors are shown in FIGS. 9 to 114C. In the example of FIGS. 9 and 10, the anchor 928 includes a radiofrequency perforation electrode 940, and an umbrella-like structure 942 that is expandable and retractable. The radio frequency electrode 940 can perforate the anatomical feature, and the structure 942 can pass through the perforation while in the retracted configuration (shown in FIG. 9). Once the structure 942 has passed through the perforation, it can be expanded to the expanded configuration (shown in FIG. 10), to secure the anchor 928 against the anatomical feature. In the example of FIGS. 11 and 12, the anchor 1128 includes a radiofrequency perforation electrode 1140, and a balloon-like structure 1142 that is inflatable and deflatable. The radiofrequency perforation electrode 1140 can perforate the anatomical feature, and the structure 1142 can pass through the perforation while in the deflated configuration. Once the structure 1142 has passed through the perforation, it can be inflated, to secure the anchor 1128 against the anatomical feature. In the example of FIGS. 13 and 14A to C, the anchor 1328 includes a radiofrequency perforation electrode 1340 and a steerable or shape memory wire 1342 that can be steered from a straight configuration (shown in FIG. 13) to a curved configuration (shown in FIG. 14A), or from a straight configuration to a spiral configuration (shown in FIG. 14B), or from a straight configuration to a pigtail configuration (shown in FIG. 14C). The radiofrequency perforation electrode 1340 can perforate the anatomical feature, and the wire 1342 can pass through the perforation while in the straight configuration. Once the wire 1342 has passed through the perforation, it can be steered to the curved or spiral or pigtail configuration, to secure the anchor 1328 against the anatomical feature. In further examples, the anchor can include more than one wire (e.g. two steerable or shape memory wires) In the examples of FIGS. 9 to 14C, the sheath 102 can be connected to the RF generator, to power the radiofrequency perforation electrode (940, 1140, 1340).
Referring back to FIG. 3, in the example shown, the sheath 102 further includes a second actuator 144 for moving the anchor 128 between the lock configuration and the release configuration. In the example shown, the second actuator 144 is on the handle 114, and includes a switch. Actuating the switch can cause the anchor 128 to move between the lock configuration and the release configuration (e.g. can cause the clamp to open and close). In alternative examples, a single actuator can move the anchor between the storage position and the deployed position and also between the lock configuration and the release configuration.
A method for carrying out a medical procedure, and specifically for transseptal perforation, will now be described with reference to FIGS. 15 to 19. The method will be described with reference to the system 100 of FIG. 2; however, the system 100 of FIG. 2 can be used according to different methods, and the method can employ different systems.
As a first step (not shown), a guidewire can be advanced via the femoral vein towards the heart, and “parked” in the superior vena cava (SVC). The dilator 104 can then be inserted into the sheath 102, with the tip of the dilator 104 shrouded within the sheath 102. With the anchor 128 in the storage position, the sheath 102 and dilator 104 can then be intravenously advanced towards the SVC, over the guidewire. The guidewire can then be removed.
As a second step (not shown), the perforation device 106 can be advanced through the first lumen 126 of the sheath, via the dilator 104, until the perforating tip 108 is just shy of the distal end of the dilator 104.
Referring to FIG. 15, as a third step, the distal end 124 of the sheath 102 can then be advanced towards a target region in the patient's heart 1500, e.g. to the right atrium 1502 of the patient's heart 1500, to position the distal end 124 of the sheath 102 adjacent the target region. In the example shown, the target region is the fossa ovalis 1504 of the atrial septum.
Referring to FIG. 16, the anchor 128 can then be secured to an anatomical feature proximate the target region. In the present example, the anatomical feature is the limbus 1506 of the fossa ovalis 1504. This can be done by actuating the first actuator (i.e. the dial 138, not shown in FIG. 16) to deploy the anchor 128 from the second lumen 132 (not shown in FIG. 16), via the opening 134 (not shown in FIG. 16), and then actuating the second actuator 144 (not shown in FIG. 16) to clamp the anchor 128 onto the limbus 1506 of the fossa ovalis 1504. Optionally, this step can be carried out under fluoroscopy or using another imaging modality, to facilitate securing of the anchor 128 to the anatomical feature.
In alternative examples (e.g. examples using the devices of FIGS. 9 to 14), the limbus 1506 can be perforated using an RF electrode of the anchoring mechanism, and the anchor can then be passed through the perforation and expanded. Such an example is shown in FIG. 20, in which the anchor 928 of FIGS. 9 and 10 is shown deployed from the sheath 102 and in the expanded configuration, with the radiofrequency perforation electrode 940 passed through the limbus 1506 of the fossa ovalis 1504.
Referring back to FIG. 16, with the anchor 128 secured to the anatomical feature, the sheath 102 can be precisely positioned at a desired location (e.g. adjacent one of the locations 14, 16, 18 described above with reference to FIG. 1). As mentioned above, by having the sheath 102 anchored to the anatomical feature, the sheath 102 is physically stabilized, which can allow for precise positioning of the sheath 102 at the desired location. When the sheath 102 is at the desired location, the fossa ovalis 1504 can be perforated. Particularly, referring to FIG. 17, the dilator 104 can be advanced so that the dilating end thereof is proud of the sheath 102, and the perforation device 106 (not visible in FIG. 17) can be advanced so that the perforating tip 108 is proud of or flush with the dilator 104 and is adjacent the fossa ovalis 1504. The RF generator 112 (not shown in FIGS. 15 to 19) can then be engaged, to supply power to the RF electrode of the perforating tip 108. Referring to FIG. 18, the perforating tip 108 can then be advanced through the fossa ovalis 1504.
Once the fossa ovalis 1504 has been perforated, the anchoring mechanism 128 can be released from the limbus 1506. In the example shown, the anchoring mechanism 128 can be released from the limbus 1506 by actuating the second actuator 144 (not shown in FIGS. 15 to 19) to move the clamp to the open configuration, and then actuating the first actuator (i.e. dial 138, not shown in FIGS. 15 to 19) to retract the clamp back into the second lumen 132. In examples involving an anchoring mechanism that includes a radiofrequency perforation electrode (i.e. the examples of FIGS. 9 to 14), the anchor can be retracted, and then withdrawn back through the perforation, into the second lumen.
Referring to FIG. 19, the dilator 104 can then be advanced from the sheath 102 to dilate the perforation, and the sheath 102 can then be advanced through the perforation, to the left atrium. Once access to the left atrium has been gained, a subsequent medical treatment (not shown) can be carried out.
While the above description provides examples of one or more processes or apparatuses or compositions, it will be appreciated that other processes or apparatuses or compositions may be within the scope of the accompanying claims.
To the extent any amendments, characterizations, or other assertions previously made (in this or in any related patent applications or patents, including any parent, sibling, or child) with respect to any art, prior or otherwise, could be construed as a disclaimer of any subject matter supported by the present disclosure of this application, Applicant hereby rescinds and retracts such disclaimer. Applicant also respectfully submits that any prior art previously considered in any related patent applications or patents, including any parent, sibling, or child, may need to be re-visited.
Patent Application
20210290268
