The present invention relates generally to the field of surgery, and more specifically, to treatment of the left atrial appendage.
The left atrial appendage (“LAA”) is a cavity extending from the lateral wall of the left atrium between the mitral valve and the root of the left pulmonary veins. The LAA normally contracts with the rest of the left atrium during a normal heart cycle, keeping blood from becoming stagnant therein, but often fails to contract with any vigor in patients experiencing atrial fibrillation (“AF”) due to the coordinate electrical signals associated with AF, in patients with AF and other abnormal heart conduction. The result is that blood tends to pool in the LAA, which can lead to the formation of blood clots therein. The blood clots can then propagate out from the LAA into the left atrium. Since blood from the left atrium and ventricle supply the heart and brain, blood clots from the LAA can obstruct blood flow thereto, causing heart attacks, strokes, or other organ ischemia. Blood clots form in the LAA in about 90% of patients with atrial thrombus. Patients with AF account for one of every six stroke patients, and thromboemboli originating from the LAA are the suspected culprit in the vast majority of these cases. More than 3 million Americans have AF, which increases their risk of stroke by a factor of 5. Elimination or containment of thrombus formed within the LAA of patients with AF will significantly reduce the incidence of stroke in those patients.
The left atrial appendage (LAA) has been identified as an important source of AF triggers, particularly among patients with structural heart disease, nonparoxysmal AF, and AF recurrence after AF ablation. LAA electrical isolation (LAAEI) has been viable adjunctive strategy to treating patients with AF in addition to PV isolation. LAAEI is an adjunctive strategy to PV isolation for maintenance of SR. Mechanical force displaced radially at the ostium of the LAA will create electrical isolation by compressing the myocyte cells at the contact site and inhibit the exchange of sodium and calcium, thus elimination of the refractory process of cardiac myocytes. The resulting cellular response causes apoptosis or programmed cellular death. This process decouples active cells causing electrically deactivated cells and produces a focal line of non-conductive tissue, ultimately causing tissue necrosis electrically disassociating the LA from LAA tissue.
In AF, the LAA can cause a significant amount of arrhythmogenic sources (ectopic activity, PV-like potentials) which is an important initiating source of AF. In patients with previous ablation procedures, the LAA can continue to initiate and/or maintain the AF arrhythmia. LAA electrical isolation in addition to standard ablation will have an incremental benefit to achieve freedom from ALL atrial arrhythmias in patients with atrial fibrillation. The LAA has limited contractibility when in AF and if it is isolated it would have no contractibility. LAA electrical isolation with a LAA polymer filling the LAA would ensure patient safety and improve AF outcomes while reducing stroke.
Percutaneous LAA occlusion has been demonstrated to be as effective as anticoagulation drugs in reducing the risk of thromboembolic stroke in patients with AF. LAA occlusion is an elegant method of improving success rates of ablation for AF whilst also mitigating stroke risk and reducing the bleeding risks from long-term anticoagulation.
Accordingly, there remains a need for systems and methods that provide solutions to the problems of current systems. The present invention is directed toward meeting these needs.
The present invention describes systems and methods for treating the left atrial appendage (LAA) with an implant to fluidly seal the LAA and prevent blood from flowing from the LAA to the left atrium. The closure implant includes a braided disk, a proximal petal anchor and a distal petal anchor positioned on an implant shaft. The braided disk may be self-expanding and have two diameters: a proximal diameter sized to engage a wall area in the left atrium around the LAA ostium; and a distal diameter sized to fit within the LAA ostium. The proximal and distal petal anchors include asymmetrical petals having a rearward curvature arranged like the petals of a flower configured to engage the wall of the LAA to anchor the implant. The implant is designed to be delivered to the heart using a catheter-based delivery system.
Extending from left atrium 25 is the left atrial appendage (LAA) 60, a cavity structure that normally contracts with the left atrium 25 when the heart pumps. Sometimes, the LAA 60 fails to contract correctly and the result is that blood tends to pool in the LAA 60, which can lead to the formation of blood clots within the LAA 60. The blood clots can then propagate out from the LAA 60 through the LAA ostium 65 into the left atrium 25. Since blood from the left atrium 25 and left ventricle 30 supply the heart and brain, blood clots from the LAA 60 can obstruct blood flow thereto, causing heart attacks, strokes, or other organ ischemia.
The implant 100 includes a braided disk 105, a proximal petal anchor 110 and a distal petal anchor 115 positioned on an implant body or shaft 120. The braided disk 105 includes a covering material configured to fluidly seal the LAA 60 from the left atrium 25 to reduce risk of clot formation and migration that might otherwise result (e.g., in a patient with AF or otherwise compromised LA function).
In the embodiment shown, the braided disk 105 includes two diameters: a proximal diameter 135 sized to engage a wall area around the LAA ostium 65 in the left atrium 25; and a distal diameter 140 sized to fit within the LAA ostium 65. The distal diameter 140 may keep the braided disk 105 centered in the LAA ostium 65. The proximal and distal diameters 135, 140 may be adjustable diameters that are configured to expand to fit different size LAA ostium 65 openings or shapes. In other embodiments, the braided disk 105 may have more than two diameters. In some embodiments, the expandable braided disk 105 may further be configured to impart a force circumferentially about the LAA ostium 65 to disrupt cell to cell conduction within the tissue and electrically isolate the LAA 60.
The braided disk 105 includes an expandable mesh structure covered with a covering material to form a fabric seal. The braided disk 105 is made from a shaped memory mesh, such as nitinol, that is configured to self-expand after being compressed. The expandable braided disk 105 may be made of a nitinol wire mesh. The covering material may be a biocompatible material. In some embodiments, the covering comprises a material selected from the group consisting of: a woven material; a fabric; a wire mesh; polyethylene terephthalate; a sponge; cellulose; synthetic fiber; cotton; rayon; hydrogel; a coagulant; a biodegradable material; a non-biodegradable material and combinations of one, two, or more of these.
In the embodiment shown, the proximal petal anchor 110 includes asymmetrical petals 125a, 125b and the distal petal anchor 115 includes asymmetrical petals 130a, 130b arranged like the petals of a flower configured to engage the wall of the LAA 60 to anchor the implant 100. The petals are self-expanding and are made of a shape-memory wire, such as a nitinol wire, that may be pre-shaped in a petal shape to allow the petals to be delivered to the LAA in a collapsed or compressed shape within a delivery system. Then once delivered, shape-memory wire self-expands the petal back into the pre-shaped petal when released from the delivery system in the LAA.
The steerable introducer sheath with dilator includes an internal lumen that is configured and dimensioned to slidably receive the inner steerable sheath. The inner steerable sheath includes an internal lumen that is configured and dimensioned to slidably receive the catheter. The catheter is releasably coupled to the implant 100 at the connect/disconnect feature to deliver the implant 100 to the LAA 60. Once the implant 100 is deployed in the LAA 60, the connect/disconnect feature is disconnected and withdrawn.
As discussed above, the petals are made from a wire of shape-memory material that is configured to form the shape of the petal segment. The shape-memory material allows the petals to be collapsed or compressed for delivery to the LAA and then self-expand once in position. The petal wires may extend proximally and be manipulated to change the size and/or shape of the petal. Each petal wire may be manipulated separately to change size and/or shape, or the petals in each petal group may be linked to manipulated all the petals in the petal group at the same time. The adjustable petal wires for each petal allows adjustability of the petals to accommodate the anatomy or placement requirements of the implant. For example, the size of the petal may be changed to keep the implant in the center of the LAA, or may be changed to engage defects in the LAA, such as a bump in the wall.
The proximal end of the implant 100 includes a coupler 145 having a central opening 150 and slots 155. The distal end of the shaft 215 includes one or more engagement arms 145 having springlike properties that allow them to deflect and spring back to the original position.
Example embodiments of the methods and systems of the present invention have been described herein. As noted elsewhere, these example embodiments have been described for illustrative purposes only and are not limiting. Other embodiments are possible and are covered by the invention. Such embodiments will be apparent to persons skilled in the relevant art(s) based on the teachings contained herein. Thus, the breadth and scope of the present invention should not be limited by any of the above-described exemplary embodiments but should be defined only in accordance with the following claims and their equivalents.
This application claims priority to U.S. Provisional Patent Application No. 63/213,620, filed Jun. 22, 2021, the entire disclosure of which is incorporated by reference herein.
Number | Date | Country | |
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63213620 | Jun 2021 | US |