U.S. patent application number 10/674732 was filed with the patent office on 2004-04-01 for atrial appendage remodeling device and method.
Invention is credited to Grabek, James R..
Application Number | 20040064138 10/674732 |
Document ID | / |
Family ID | 29737145 |
Filed Date | 2004-04-01 |
United States Patent
Application |
20040064138 |
Kind Code |
A1 |
Grabek, James R. |
April 1, 2004 |
Atrial appendage remodeling device and method
Abstract
The invention describes a method of treating a patient's left
atrial appendage through the pericardial space. The process takes
place through the pericardial space from an access point outside
the pericardium or pericardial space.
Inventors: |
Grabek, James R.;
(Minneapolis, MN) |
Correspondence
Address: |
Beck & Tysver, P.L.L.C.
Suite 100
2900 Thomas Avenue S.
Minneapolis
MN
55416
US
|
Family ID: |
29737145 |
Appl. No.: |
10/674732 |
Filed: |
September 30, 2003 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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10674732 |
Sep 30, 2003 |
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09679968 |
Oct 5, 2000 |
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6666861 |
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Current U.S.
Class: |
606/41 |
Current CPC
Class: |
A61B 18/1492 20130101;
A61B 2018/00595 20130101; A61B 2018/00351 20130101; A61B 2090/3614
20160201 |
Class at
Publication: |
606/041 |
International
Class: |
A61B 018/18 |
Claims
What is claimed is:
1. A method for treating the atria appendage comprising: entering
the chest cavity with a surgical instrument creating a surgical
opening; introducing a pericardial access device through said
opening; entering the pericardial space between the pericardium and
the heart; navigating an electrosurgery device to the atrial
appendage; activating the electrosurgical device to remodel the
atrial appendage.
2. The method of claim 2 wherein said navigating step is carried
out under visual guidance through the endoscopic system.
3. The method of claim 1 wherein said electrosurgical device is a
unipolar electrocautery scissors.
4. The method of claim 1 wherein said electrocautery device is a
bipolar electrocautery scissors.
5. The method of claim 1 wherein said electrocautery device is a
snare loop.
6. The method of claim 1 wherein said electrocautery device
includes at least one saline electrode.
7. The method of shrinking the atrial appendage comprising the
steps: entering the chest cavity with a surgical instrument
creating a surgical opening; introducing a pericardial access
device through said opening of the type having an extended catheter
body with an aspiration lumen for connecting to the pericardium;
entering the pericardial space between the pericardium and the
heart; navigating an electrosurgery device of the type having at
east one saline electrode, to the atrial appendage; activating the
electrosurgical device while irrigating the artrial appendage with
saline from the electrosurgery device, to remodel the atrial
appendage.
9. A method for treating the atrial appendage comprising: entering
the chest cavity with a surgical instrument creating a surgical
opening; introducing a pericardial access device through said
opening; entering the pericardial space between the pericardium and
the heart; navigating an endoscopic stapling device to the atrial
appendage; activating the stapling device to remodel the atrial
appendage by closing off a portion of said atrial appendage.
10. An electrosurgery device for cutting tissue comprising: an
elongate tubular body; a fixed handle attached to said tubular
body; a sliding handle adapted to slide along said tubular body and
located proximate said fixed handle; a snare having a first end
connected to said tubular body and a second end attached to said
movable handle, whereby motion of said movable handle manipulates
the snare.
Description
FIELD OF THE INVENTION
[0001] The present invention relates generally to devices and
techniques for remodeling the atrial appendage of a mammal. The
process takes place through the pericardial space from an access
point outside the pericardium or pericardial space.
BRIEF DESCRIPTION OF THE PRIOR ART
[0002] The atrial appendage is an anatomic feature of the left
atrium of the human heart. It is widely believed that atrial
fibrillation results in a pooling of blood in the atrial appendage
which results in clots.
[0003] The surgical removal of the atrial appendage through a
limited thoracotomy has been proposed by Johnson in U.S. Pat. No.
5,306,234. However, the surgical removal of the appendage remains
problematic since the surgical intervention occurs under general
anesthesia and is considered major surgery. It should also be
realized that even a transluminal minimally invasive approach from
inside the heart is problematic since such an approach requires an
implantable closure device and has the risk of acute stroke.
Typically any closure device left in contact with the interior of
the heart is potentially a thromobogenic surface.
[0004] For these reasons among others there is a continuing need to
improve techniques for occluding or removing the left atrial
appendage.
SUMMARY
[0005] In contrast to the prior art, the present invention teaches
devices and methods of using the devices to remodel the atrial
appendage from locations outside the heart but within the
pericardial space. In use, the pericardial space is accessed via
the chest wall below the rib cage and an endoscope is inserted. It
is preferred to perform the process steps under visual guidance
although robotic and other location technologies may be used in the
alternative. The preferred treatment for the appendage is "wet
cautery" where the size and therefore the volume of the appendage
is reduced. An alternate preferred device cuts and cauterizes while
removing the appendage. Other surgical techniques are useful as
well including conventional electrosurgery and cautery and
conventional suture and staple techniques. In all instances the
volume of the appendage is reduced and in some approaches tissue is
removed as well.
BRIEF DESCRIPTION OF THE DRAWINGS
[0006] The invention is illustrated in the figures where like
reference numeral represent identical structure throughout the
several views wherein:
[0007] FIG. 1 is a schematic diagram of the patient's chest
cavity;
[0008] FIG. 2 is a schematic diagram of pericardial access process
and device;
[0009] FIG. 3 is a schematic diagram of pericardial space
visualization process and device;
[0010] FIG. 4 is a schematic diagram of pericardial space
electrocautery process and device;
[0011] FIG. 5 is a schematic diagram of an electrocautery process
and device;
[0012] FIG. 6 is a schematic diagram of an electrocautery process
and device;
[0013] FIG. 7 is a schematic diagram of an endoscopic suture
placement process; and
[0014] FIG. 8 is a schematic diagram of an endoscopic staple
placement process.
DETAILED DESCRIPTION
[0015] FIG. 1 shows the patients heart 10 located within the
patient's chest cavity 12. The ribs 14 and skin 16 show the
boundary of the chest cavity 12. The left atrial appendage (LAA) 18
is exaggerated in size to facilitate the description of the
invention. The heart 10 chambers lie within the so-called
pericardium 20, which is shown in an exaggerated scale. The
pericardium 20 is a bag like structure that surrounds the heart. It
is attached to the great vessels at the "top" of the heart and it
completely encircles the ventricles and the atrium of the heart.
The pericardium 20 provides a low friction surface surrounding the
heart that permits motion of the heart. In essence the pericardium
allows the heart to "beat" without disturbing other near-by
organs.
[0016] The processes of the invention permit the pericardium to
remain "intact". Although several opening to the pericardial space
are illustrated it is emphasized that the smaller the number of
"holes" in the pericardium are preferred.
[0017] FIG. 2 shows initial access to the pericardial space though
the use of a pericardial access device 22, which is described in
more detail in U.S. Pat. No. 5,827,216 among others. This patent is
incorporated by reference herein and the commercially available
device is sold under the trademark "Perducer". The Perducer is
preferred but alternate devices such as that taught by U.S. Pat.
No. 5,931,810 could be freely substituted for the Perducer device.
If multiple access points are required for a particular patient the
two devices may be used together.
[0018] The preferred device 22 has an aperture at its distal end 24
that allows aspiration of the pericardium 20 into the device. An
illustrative source of vacuum is shown as the physician operated
syringe 26. The aspirated tissue drawn into the device 22 can be
pierced by the needle 28. The needle 28 can be translated toward
the aspirated tissue by pushing on the proximal end of the needle
28.
[0019] A guidewire 30 can next be inserted through the lumen of the
needle 28. With the guidewire in the pericardial space, the
physician can withdraw the needle and use the guidewire to insert a
catheter or other device. The access procedure described may be
repeated to provide for multiple access sites or locations into the
pericardial space. Although the device shown is preferred it should
be recognized that other devices may be used as well.
[0020] FIG. 3 shows two access sites labeled 50 and 52
respectively. A guide catheter 40 has been introduced into the
pericardial space 42. This access site or port permits access by
the endoscope 46 which includes a camera 48 and a display system
52. Together these devices provide a visualization system allows
visual navigation and manipulation of additional surgical tools in
the pericardium 20. Although this visualization system is not seen
in the remaining drawings its use should be presumed and the
deletion from the figure is done to clarify the remaining drawings.
It should be noted that most conventional endoscopes in use today
have laparoscopic tool access ports built into the device and many
steps of the invention can be carried out trough the scope rather
than through a separate access site. However, it is expected that a
typical atrial appendage reduction would require two sites, with
one devoted to the introduction of a endoscope.
[0021] FIG. 4 shows a snare like electrocautery tool 60 introduced
into the pericardial space 42. The distal loop 64 has been
navigated visually to "lasso" the atrial appendage. In the device
seen in FIG. 4, one end of the snare loop 64 is attached to a
tubular body 63 while the other end is carried through the lumen of
the tubular body 63 and attached to a sliding handle 15. A fixed
handle 17 is attached to the tubular body 63. Traction applied to
the snare loop 64 by moving the sliding handle relative to the
fixed handle 17 captures the appendage 18. The application of
electrical energy (RF) from the electrocautery unit 70 can either
remove or close the atrial appendage. It is important to note that
this closure process may be essentially bloodless and may be
performed under direct visualization through the endoscope (FIG.
3). This process is an example of "dry" cautery as opposed to "wet"
cautery described in connection with FIG. 6. Although the snare
like device is preferred there are several commercially available
products that can also be used for this step including the loop
excision electrodes sold by ValleyLab of Colorado. In general, any
specific surgeon may prefer to use other familiar tools for the
process. Typically, the electrosurgery unit 70 will be connected
between the loop 64 and a patient ground depicted as 71. The
physician may activate the hand or foot switch 73 to dissect the
appendage.
[0022] FIG. 5 shows the snare loop 64 isolating the atrial
appendage 18 prior to the applicant of electrical energy. In the
figure the physician my grasp an insulator handle and the
connection 19 may not be attached to the generator 70 until after
the lasso procedure has been accomplished. Although the loop
electrocautery device is preferred it should be noted that the
conventional unipolar or bipolar cautery scissors such as those
illustrated as device 13 may be used to cut off the appendage.
[0023] FIG. 6 shows the use of "wet" electrocautery to "reduce" the
atrial appendage. In this procedure the electrical catheter 80 is
irrigated by a fluid flow of saline or other conductive fluid 81.
This wet electrode applies the energy over a wider surface area as
a consequence heat is supplied preferentially to the LAA. It is
expected that the application of heat will cause the appendage to
reduce in size substantially. Fluid assisted electrocautery is
known from U.S. Pat. No. 6,063,081 among others.
[0024] FIG. 7 shows an alternate method of closing off the atrial
appendage. In this situation a suture 90 has been formed into a
loop 92 and passed over the atrial appendage. A laparoscopic knot
pusher 94 is passed down one leg of the suture 90 to place and
tighten a knot formed in the suture. The use of a suture may be
preferred given the size and shape of the appendage 18.
[0025] FIG. 8 illustrates an alternate closure device and process.
In this figure a laparoscopic stapler is used to place one or more
staples to close off the atrial appendage. In the figure the tool
98 has been used to place one staple seen as staple 97 closing off
the appendage.
* * * * *