Patent Application
20240041524
The technical field generally relates to endovascular procedures and more particularly relates to systems and methods for use in a Transvenous/transcatheter Aortic Valve Replacement (TAVR) procedure.
Transcatheter aortic valve replacement (TAVR) is a minimally invasive heart procedure to replace a narrowed aortic valve that fails to open properly (i.e., aortic valve stenosis). The transcatheter aortic valve replacement is also called transcatheter aortic valve implantation (TAVI). The treatment by transvenous and transcatheter aortic valve repair (TAVR) is becoming more prevalent and accepted as a treatment option for patients because widespread training has made available the treatment option to medical personnel. Hence, more medical personnel have gained first-hand knowledge of this newer advanced medical procedure and recognize the patient benefits that can be realized.
The TAVR procedure allows for the implanting (i.e., replacing) of a heart valve without having to open the chest cavity. The resultant minimal invasive surgery for a heart valve replacement makes surgical valve replacement are more feasible treatment plan. This is because TAVR can now be considered an option for patients considered at intermediate or high risk of complications from traditional open-chest surgical aortic valve replacement.
However, there are differences in both approaches; for example, in the open chest replacement surgery, the degraded valve is completely removed. In TAVR, the damaged, native valve is left in place. The valve can have anatomical abnormalities, calcification, or infection. However, inserting a new valve over the native valve can cause complications in the TAVR procedure, including valve migration, valve embolization, paravalvular leakage, and blockage of the coronary arteries restricting blood flow to the heart. These complications can also occur, sometimes more frequently, during a valve-in-valve TAVR, where the transcatheter valve is deployed within a previously implanted bioprosthetic valve.
Therefore, deploying a TAVR valve on top of the existing damaged valve, either native or bioprosthetic, may not be performed because of the expected complications in the procedure. To alleviate the complications from implantation of a new valve, a catheter may be used to remove old valve leaflets at the location to prepare the implant site for a cleaner valve deployment and operation.
It is desired for a catheter configured to remove the old valve leaflets and prepare the site for the new valve replacement procedure.
Accordingly, technologically improved systems and methods for valve resection and reshaping using a catheter with an ablation tool to perform valve leaflet removal in a TAVR procedure is desirable. The following disclosure provides these technological enhancements, in addition to addressing related issues.
This summary is provided to describe select concepts in a simplified form that are further described in the Detailed Description. This summary is not intended to identify key or essential features of the claimed subject matter, nor is it intended to be used as an aid in determining the scope of the claimed subject matter.
In one exemplary embodiment, an apparatus including a leaflet resection catheter for a Transcatheter Aortic Valve Replacement (TAVR) procedure is provided. The apparatus includes a catheter configured at a distal end with a guidewire to deploy the catheter within a vessel lumen to a situs of an aortic valve for leaflet resection; an accessory tool configured with a set of grasping elements attached at a catheter's distal end to enable the accessory tool to travel down the vessel lumen to the situs of the aortic valve to exert a pulling action to draw the aortic valve leaflet in a direction towards the catheter's distal end to draw a portion of the aortic valve leaflet into a protective sleeve of the catheter at the catheter's distal end, and one or more fibers of a ring of fibers surrounding the catheter's distal end to resect tissue that includes a portion of the aortic valve leaflet drawn into the protective sleeve at the catheter's distal end.
Furthermore, other desirable features and characteristics of the system and method will become apparent from the subsequent detailed description and the appended claims, taken in conjunction with the accompanying drawings and the preceding background.
The present application will hereinafter be described in conjunction with the following drawing figures, wherein like numerals denote like elements, and:
The following detailed description is merely illustrative in nature and is not intended to limit the embodiments of the subject matter or the application and uses of such embodiments. As used herein, the word “exemplary” means “serving as an example, instance, or illustration.” Thus, any embodiment described herein as “exemplary” is not necessarily to be construed as preferred or advantageous over other embodiments. The embodiments described herein are exemplary embodiments provided to enable persons skilled in the art to make or use the invention and not to limit the scope of the invention that is defined by the claims. Furthermore, there is no intention to be bound by any expressed or implied theory presented in the preceding technical field, background, summary, or the following detailed description.
Exemplary embodiments provide a technical solution to this problem in the form of a leaflet resection catheter deployment system for use in a TAVR procedure (
Provided embodiments include an improved catheter-based procedure for deploying a new TAVR valve on top of an existing damaged valve by the medical personnel gaining access to the heart valve, and inserting the catheter, and tracking it to the position. The catheter cutting apparatus is configured to excise valve leaflets and prepare the site for valve replacement. The outer sheath of the catheter is pulled back, exposing the grasping catheter to grab the leaflet tissue, and to draw the ring of fibers to ablate the leaflet from either the native or bioprosthetic valve.
Provided embodiments disclosed enable the performance of a medical procedure using an accessory tool for the forwardly grasping of tissue (i.e., the leaflets). The accessory tool is configured as a grasping catheter that can enable the user to pull a grasped leaflet into a catheter sheath and the excising of the leaflet tissue within the cutting sheath to prevent damage to surrounding tissue.
The figures and descriptions below provide more detail.
Turning now to
The direction is generally, from the perspective of the distal tip of the catheter 5, forward and aft, longitudinally, within a vessel lumen. To perform TAVR, the doctor may access your heart through a blood vessel in your leg or through a tiny incision in your chest. The doctor may use other approaches to access your heart. A hollow tube (catheter 40) is inserted through the access point. Your medical provider can use various advanced imaging techniques to guide the catheter 40 through a vessel lumen to the heart valve location for rescission of the leaflet tissue at the valve location. The deployment system 100 includes a guidewire lumen 10, an accessory tool 20, and a opposite direction laser cutting catheter 30.
The accessory tool 20 includes proximal elements 22, 24 (or grasping elements) and a distal element 26, which protrudes outward from the catheter 40. The proximal elements 22, 24 are coupled together on the distal side to enable the proximal elements to be positionable on opposite sides of the leaflets (not shown) to capture or retain the leaflets therebetween.
The mitral valve is composed of two leaflets, the anterior leaflet, which is a semi-circular shape and attaches to two-fifths of the annular circumference. There is continuity between the anterior leaflet of the mitral valve and the left and non-coronary cusp of the neighboring aortic valve, referred to as the aortic-mitral curtain. These two components of the aorto-mitral curtain are on two separate anatomical planes, situated at an angle of 120°, which corresponds to the planes of the aortic and mitral annulus, respectively, which can be grasped because of the angular location by the proximal elements 22, 24. When the flaps (i.e., leaflets) of the mitral valve do not close tightly enough, it causes blood to leak backward into the left atrium. This occurs due to valve leaflets bulging back—a condition called mitral valve prolapse and can be corrected by the valve replacement. The proximal elements 22, 24 may be made of cobalt-chromium, nitinol, or stainless steel, and the distal elements 26 can also be made of cobalt-chromium and stainless steel, or another material. In the alternative exemplary embodiment, the accessory tool can be a vacuum suction (instead of proximal elements) to grasp the aortic valve leaflet during the ablation of tissue of the aortic valve leaflet. The accessory tool is configured to pass through an introducer (not shown) of at least a range of 14f to 18f for use with a standard TAVR deployment catheter. In an exemplary embodiment, a sheath introducer is a long, wide bore, single lumen catheter with a wide plastic hub on the proximal end, which has a central smaller hole (one-way-valved to prevent back-flow of blood), through which various other vascular catheters can be inserted. In an exemplary embodiment, the sheath introducer comes in multiple diameters and lengths.
The laser cutting catheter 30 includes a ring of fibers 32 in a plurality of arrangements of an entirety, a semicircle, a one-third circle, or another fractional circle of the circumference of the catheter 40 distal end to ablate tissue of the aortic valve leaflet. The laser cutting catheter 30, in another exemplary embodiment, can reshape a valvular structure to better fit a replacement valve at the situs of the valve replacement. Also, a power source (not shown) is connected at a proximal end of the catheter 40 to energize a laser (via the fibers 32) to ablate tissue of the aortic valve leaflet grasped by the proximal elements 22, 24.
Turning to
In an alternative exemplary embodiment, at task 320, the user inserts a catheter configured at a distal end with an accessory tool including a set of grasping elements attached at a catheter's distal end to enable the accessory tool to travel down a vessel lumen to a situs of the aortic valve. The accessory tool grasps an aortic valve leaflet between the set of grasping elements of the accessory tool at the catheter's distal end to exert a pulling action to draw the aortic valve leaflet in a direction towards the catheter's distal end. Further, the accessory tool by the pulling action draws a portion of the aortic valve leaflet into a protective sleeve of the catheter at the catheter's distal end. The cutting sheath catheter resects tissue of a portion of the aortic valve leaflet drawn into the protective sleeve at the catheter's distal end. The tissue resection is of tissue of a portion of the aortic valve leaflet that has been drawn within the protective sleeve and held between the set of grasping elements.
At task 325, one or more fibers transmit the laser to ablate tissue whilst the aortic valve leaflet is held by the set of grasping elements within the protective sleeve, thereby preventing tissue damage outside the protective sleeve. At task 330, in response pulling action of the accessory tool while grasping an aortic valve leaflet tissue between the set of grasping elements, enabling a reactive action of simultaneous pulling the leaflet in a direction into the protective sleeve whilst moving the distal end of the catheter in the opposite direction towards the aortic valve leaflet that is drawn into the protective sleeve at the catheter's distal end. At task 335, the ring of fibers about a circumference of the catheter's distal end in entirety or part of enable the ablating of tissue of the aortic valve leaflet. At task 340, laser transmitted via the fibers enables the reshaping of a valvular structure to better fit a replacement valve at the situs. At task 345, a power source is connected at a proximal end of the catheter to energize the laser for ablating the tissue of the aortic valve leaflet.
In an alternative exemplary embodiment, at task 350, the cutting sheath catheter is powered mechanical cutter located within the protective sleeve to prevent unwanted tissue damage.
At task 360, the cutting sheath catheter is configured as an outer cutting sheath with a hemostatic valve on a proximal end of the catheter to enable the accessory tool to pass through the vessel lumen whilst sealing off arterial pressures. At task 365, the accessory tool is configured to pass through an introducer of at least a range of 14f to 18f for use with a standard TAVR deployment catheter.
At task 370, in an alternate exemplary embodiment, the catheter is configured with an accessory tool that includes a vacuum suction to grasp the aortic valve leaflet during the ablation of tissue of the aortic valve leaflet.
Those of skill in the art will appreciate that the various illustrative logical blocks, modules, circuits, and algorithm steps described in connection with the embodiments disclosed herein may be implemented as electronic hardware, computer software, or combinations of both. Some of the embodiments and implementations are described above in terms of functional and/or logical block components (or modules) and various processing steps.
However, it should be appreciated that such block components (or modules) may be realized by any number of hardware, software, and/or firmware components configured to perform the specified functions. To clearly illustrate the interchangeability of hardware, various illustrative components, blocks, modules, and steps have been described above generally in terms of their functionality. Whether such functionality is implemented as hardware or software depends upon the application and design constraints imposed on the overall system.
Skilled artisans may implement the described functionality in varying ways for each application, but such implementation decisions should not be interpreted as causing a departure from the scope of the present invention. In addition, those skilled in the art will appreciate that the embodiments described herein are merely exemplary implementations.
In this document, relational terms such as first and second, and the like may be used solely to distinguish one entity or action from another entity or action without necessarily requiring or implying any actual such relationship or order between such entities or actions. Numerical ordinals such as “first,” “second,” “third,” etc. simply denote different singles of a plurality and do not imply any order or sequence unless specifically defined by the claim language. The sequence of the text in any of the claims does not imply that process steps must be performed in a temporal or logical order according to such sequence unless it is specifically defined by the language of the claim. When “or” is used herein, it is the logical or mathematical or, also called the “inclusive or.” Accordingly, A or B is true for the three cases: A is true, B is true, and A and B are true. In some cases, the exclusive “or” is constructed with “and;” for example, “one from the set A and B” is true for the two cases: A is true, and B is true.
Furthermore, depending on the context, words such as “connect” or “coupled to” used in describing a relationship between different elements do not imply that a direct physical connection must be made between these elements. For example, two elements may be connected to each other physically, electronically, logically, or in any other manner, through one or more additional elements.
While at least one exemplary embodiment has been presented in the foregoing detailed description of the invention, it should be appreciated that a vast number of variations exist. It should also be appreciated that the exemplary embodiment or exemplary embodiments are only examples and are not intended to limit the scope, applicability, or configuration of the invention in any way. Rather, the foregoing detailed description will provide those skilled in the art with a convenient road map for implementing an exemplary embodiment of the invention. It is understood that various changes may be made in the function and arrangement of elements described in an exemplary embodiment without departing from the scope of the invention as set forth in the appended claims.
| Filing Document | Filing Date | Country | Kind |
|---|---|---|---|
| PCT/EP2021/086048 | 12/16/2021 | WO |
| Number | Date | Country | |
|---|---|---|---|
| 63129458 | Dec 2020 | US |
