U.S. patent application number 13/721903 was filed with the patent office on 2013-08-15 for assembly comprising a ring for attachment in a passage surrounded by body tissue as well as an applicator for fitting the ring in the passage.
The applicant listed for this patent is Eric Berreklouw. Invention is credited to Eric Berreklouw.
Application Number | 20130211491 13/721903 |
Document ID | / |
Family ID | 32822971 |
Filed Date | 2013-08-15 |
United States Patent
Application |
20130211491 |
Kind Code |
A1 |
Berreklouw; Eric |
August 15, 2013 |
ASSEMBLY COMPRISING A RING FOR ATTACHMENT IN A PASSAGE SURROUNDED
BY BODY TISSUE AS WELL AS AN APPLICATOR FOR FITTING THE RING IN THE
PASSAGE
Abstract
The present invention relates to an assembly comprising: a ring
having anchoring elements for attaching the ring in a passage
surrounded by body tissue, in particular blood vessel tissue. an
applicator for fitting the ring in the passage; in which the
anchoring elements have an anchoring position in which they
protrude with respect to the ring, and in which the anchoring
elements comprise a memory material, such as a memory metal or
memory polymer, and are designed so that they can be bent from an
anchoring position counter to a spring force into a fitting
position and can be frozen in this fitting position by a
temperature treatment in order to bend the anchoring elements back
from the fitting position by the effect of this spring force into
the anchoring position when a predetermined threshold temperature
is exceeded, and in which the applicator is provided distally with
a carrier for carrying the ring. The assembly according to the
invention is provided with an influencing system for influencing
the temperature of the anchoring elements of the ring carried by
the carrier in such a way that the anchoring elements bend back
from the fitting position to the anchoring position by increasing
the temperature of the anchoring elements to above the threshold
temperature.
Inventors: |
Berreklouw; Eric; (Son,
NL) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Berreklouw; Eric |
Son |
|
NL |
|
|
Family ID: |
32822971 |
Appl. No.: |
13/721903 |
Filed: |
December 20, 2012 |
Related U.S. Patent Documents
|
|
|
|
|
|
Application
Number |
Filing Date |
Patent Number |
|
|
10594363 |
Jul 2, 2008 |
8366766 |
|
|
PCT/NL2005/000230 |
Mar 29, 2005 |
|
|
|
13721903 |
|
|
|
|
Current U.S.
Class: |
623/1.11 |
Current CPC
Class: |
A61B 2017/00778
20130101; A61F 2210/0023 20130101; A61F 2210/0042 20130101; A61F
2250/006 20130101; A61B 17/11 20130101; A61B 2017/00783 20130101;
A61F 2/2409 20130101; A61F 2/95 20130101; A61F 2210/0033 20130101;
A61F 2002/30092 20130101; A61B 2017/1135 20130101; A61F 2210/0028
20130101; A61F 2/064 20130101; A61B 2017/1139 20130101; A61B 17/115
20130101; A61B 2017/1107 20130101 |
Class at
Publication: |
623/1.11 |
International
Class: |
A61F 2/95 20060101
A61F002/95 |
Foreign Application Data
Date |
Code |
Application Number |
Mar 26, 2004 |
NL |
NL 1025830 |
Claims
1.-40. (canceled)
41. Assembly comprising: a ring having, viewed in its axial
direction, a distal side and a proximal side; a sleeve which is
slideable with respect to the ring from an overlapping position
accommodating the ring inside the sleeve, in proximal direction,
into an exposing position in which the ring is released outside the
sleeve; wherein the ring has, at its distal end and proximal end,
anchoring elements for attaching the ring in a passage surrounded
by body tissue, in particular blood vessel tissue; wherein the
anchoring elements have an anchoring position in which they
protrude in radial outward direction with respect to the ring;
wherein the distal anchoring elements are bendable from said
anchoring position counter to a spring force into a fitting
position; wherein the sleeve is provided at its distal end with
axial fingers; wherein a space is left between neighbouring axial
fingers; and wherein the axial fingers are provided in such a
manner that, when the sleeve is in overlapping position, each axial
finger overlaps a respective distal anchoring element to keep said
respective anchoring element in the fitting position and allow
bending the anchoring elements back from the fitting position into
the anchoring position by the effect of the spring force when the
sleeve is slid from the overlap position to the exposing
position.
42. Assembly according to claim 41, wherein the proximal anchoring
elements form a flange provided at the proximal end of the ring,
which flange extends radially outwards for interaction with the
distal anchoring elements, wherein the flange is provided with
passages for the axial fingers, and in which the axial fingers
extend through the passages when the sleeve is in overlapping
position.
43. Assembly according to claim 42, wherein said passages are
slots.
44. Assembly according to claim 42, wherein said flange is an
uninterrupted flange which runs entirely around the outside of the
axial fingers and has slots on its inner side through which the
axial fingers pass when the sleeve is in overlapping position.
45. Assembly according to claim 44, wherein the flange has the
shape of a cylinder sector for applying it from the outside to a
target vessel.
46. Assembly according to claim 42, wherein, viewed in
circumferential direction of the ring, said passages separate said
proximal anchoring elements from each other, and wherein the
proximal and distal anchoring elements are provided in a staggered
manner with respect to each other, seen in the tangential direction
of the ring, in such a manner that, when the sleeve is in
overlapping position, the axial fingers of the sleeve overlap with
the distal anchoring elements and protrude through said passages
between adjacent said proximal anchoring elements.
47. Assembly according to claim 42, wherein the flange is a fixed
flange provided with anchoring pins at its underside, which
anchoring pins extend, when in the fitting position, axially.
48. Assembly according to claim 47, wherein the anchoring pins are
provided directly adjacent the passages; wherein the pins are
bendable from a curved position to an axially straight position
counter a resilient force; wherein, in the curved position, the pin
extends, viewed in axial direction, in front of the passage;
wherein, when in the overlapping position, the axial fingers of the
sleeve extend through slots and keep the pins in the axially
straight position; and wherein the pins return to the curved
position upon sliding the sleeve from the overlapping position to
the exposing position.
49. Assembly according to claim 41, wherein the proximal anchoring
elements are immovable and permanently directed in a radially
outward direction.
50. Assembly according to claim 41, wherein the distal anchoring
elements are made of a resilient material.
51. Assembly according to claim 50, wherein the resilient material
is a memory material, selected from the group consisting of a
memory metal or memory polymer.
52. Assembly according to claim 41, wherein the sleeve comprises a
distal part which tapers in the distal direction to form a diameter
which is smaller than that of the ring, and in which that distal
part comprises said axial fingers which can bend radially outwards
from the tapering position in such a manner that this tapering part
of the sleeve can be displaced over the ring.
53. Assembly according to claim 41, wherein a heart valve, such as
an artificial heart valve, is present in the ring.
54. Assembly according to claim 41, wherein the distal and/or
proximal anchoring elements are coated with textile, which coating
also covers the space between said anchoring elements and the
spaces for passage of the axial fingers.
55. Assembly according to claim 54, wherein the coating is produced
from a deformable, elastic biocompatible material, selected from
the group consisting of Dacron and Teflon.
Description
[0001] The present invention relates to an assembly comprising:
[0002] a ring having anchoring elements for attaching the ring in a
passage surrounded by body tissue, in particular blood vessel
tissue.
[0003] an applicator for fitting the ring in the passage;
in which the anchoring elements have an anchoring position in which
they protrude with respect to the ring, and in which the anchoring
elements comprise a memory material, such as a memory metal or
memory polymer, and are designed so that they can be bent from an
anchoring position counter to a spring force into a fitting
position and can be frozen in this fitting position by a
temperature treatment in order to bend the anchoring elements back
from the fitting position by the effect of this spring force into
the anchoring position when a predetermined threshold temperature
is exceeded; and in which the applicator is provided distally with
a carrier for carrying the ring.
[0004] In the context of this application "freeze", "frozen", etc.
is understood in a general sense to mean fix, fixed, etc. into a
position which is released when a specific threshold temperature is
exceeded. In this context, neither the value of the threshold
temperature, nor the temperature/temperatures at which the heat
treatment takes place are specified. These are dependent on the
composition/properties of the specific materials used. In this
context, freezing does thus not really refer to the physical
concept of solidification.
[0005] An applicator of this type is known from NL 1018302 and from
NL 1020288, WO 03/082121 and WO 03/003926, all four in the name of
the Applicant.
[0006] In addition, various applications by the Applicant, such as
WO 00/24339 and WO 00/44311, disclose attachment devices comprising
an annular element--usually referred to as a tubular element in
said WO publication--with anchoring elements--usually referred to
as flanges or flange legs in said WO publications--comprising a
memory material. These attachment devices have movable anchoring
elements on the underside in combination with a fixed flange on the
upper side or likewise movable anchoring elements on the upper
side. These anchoring elements have an anchoring position in which
they protrude with respect to the ring and can be bent from this
anchoring position counter to a spring force into a fitting
position and can be frozen in this fitting position by means of a
temperature treatment. As is known of memory materials, the
anchoring elements will return to the anchoring position by the
effect of the spring force when a predetermined threshold
temperature is exceeded. This characteristic of memory material,
i.e. that they can be bent from a first position into a second
position, can be frozen into this second position by a temperature
treatment in order to bend back into the first position when a
threshold temperature is exceeded, is widely used in the medical
field, such as with stents, in orthodontics, etc. This effect of
memory materials is thus widely known.
[0007] EP-1,088,529-A2 discloses an assembly comprising a catheter
and a foldable prosthesis comprising a foldable ring structure. The
prosthesis is folded up inside the catheter. One brings the
prosthesis to its destination inside the body by means of the
catheter. The prosthesis is moved out of the catheter and then
unfolded. Subsequently projections are forced to open outwardly and
penetrate into the vassal wall. The prosthesis comprises a shape
memory material to accomplish unfolding of the ring by heating up
to 50.degree. C. and deploying of the projections by heating up to
60.degree. C. Heating is accomplished by using a balloon in which
hot water is introduced.
[0008] US 2003/0149476 discloses a heart value prosthesis which is
implantable by means of a catheter. During introduction through the
aorta the catheter is folded up inside the catheter. The prosthesis
is provided with hook-shaped anchoring elements made of a form
storage metal which maintains that the elements sit flat during the
phase of introduction. Erecting of the hooks will occur at the site
of implantation. In case a balloon catheter is used, the balloon
can also be used for cooling. Erection of the hooks will occur
after switching of the cooling means. The hooks will erect after
assuming the body temperature.
[0009] EP 896.813 A2 concerns elements for anchoring implant
devices. Passing of those elements from the retracted to the
expanded position is achieved by virtue of a shape memory
mechanism. The prosthesis is put in place by catheterisation and
for this purpose mounted in well known manner in a catheter. In
order to reach a predetermined transition temperature, the
anchoring elements are heated or, in theory, can be cooled. In case
of heating, the anchoring elements pass from retracted to expanded
position because the temperature in increased to transition
temperature. In case of cooling the memory mechanism functions
exactly opposite. The anchoring elements pass from retracted to
expanded position because the temperature is decreased to
transition temperature.
[0010] In particular when heart valve prostheses are being fitted,
but also when anastomoses are being performed, it is extremely
important that the anchoring is very reliable and accurate.
[0011] It is an object of the present invention to provide an
assembly of the type mentioned in the introduction with which a
very accurate and reliable fitting of a ring provided with
anchoring elements into a passage surrounded by body tissue, in
particular blood vessel tissue, is possible.
[0012] This object is achieved with the assembly of the type
mentioned in the introduction by the fact that the assembly is
provided with an influencing system for influencing the temperature
of the anchoring elements of the ring carried by the carrier in
such a way that the anchoring elements bend back from the fitting
position to the anchoring position by increasing the temperature of
the anchoring elements to above the threshold temperature. A
temperature-influencing system of this type enables a controlled
release of the anchoring elements--after which they bend back from
the fitting position into the anchoring position--by allowing the
temperature of the anchoring elements to rise in a controlled
manner above the threshold temperature by means of the influencing
system.
[0013] In order to reliably prevent one or more anchoring elements
from returning from the fitting position to the anchoring position
prematurely, for example by locally exceeding the threshold
temperature, it is advantageous in this case if the influencing
system comprises a cooling device for cooling the anchoring
elements to a temperature below the threshold temperature. In this
context, the term cooling should be regarded primarily as relative
to the threshold temperature. For example, if the threshold
temperature is about 30.degree. C., a device which maintains the
temperature of the anchoring elements at 25.degree. C. can already
be regarded as a cooling device. However, this does, of course, not
alter the fact that the cooling device may also cool to much lower
temperatures, such as for example to refrigerator temperature or
even lower.
[0014] In order to reliably ensure that all anchoring elements bend
back from the fitting position to the anchoring position, also
referred to as turning over, it is advantageous according to the
invention if the influencing system comprises a heating device for
heating the anchoring elements to a temperature above the threshold
temperature. In this case too, it should be mentioned that the term
heating device relates primarily to the threshold temperature. A
heating device which heats up to maybe a few degrees above the
threshold temperature should in this context already be seen as
being a heating device, even if the threshold temperature is very
low.
[0015] in order both to ensure that the anchoring elements cannot
turn over prematurely from the fitting position to the anchoring
position, and to ensure that the anchoring elements are all turned
over to the anchoring position at a specific desired moment, it is
very advantageous according to the invention, if the influencing
system comprises a cooling device as well as a heating device.
[0016] According to a further advantageous embodiment, the part of
the carrier contacting the ring is made of a heat-conducting
material, such as for example metal, and the influencing system is
connected in a heat-exchanging manner to that part of the carrier
contacting the ring or the influencing system even forms part of
the carrier. In this way, it becomes possible to adjust the
temperature of the ring and the anchoring elements by adjusting the
temperature of the carrier. In this case, the carrier can be
designed in such a manner that it contacts the anchoring elements
which are in the fitting position in order to influence the
temperature thereof more directly, in particular in order to be
able to keep these anchoring elements at a temperature below the
threshold temperature.
[0017] According to a further embodiment, the influencing system on
the assembly according to the invention may comprise a Peltier
element. A Peltier element is an electrical element which is known
as such from the prior art and which, when subjected to direct
current, has a cold side and a warm side. In this case, the
temperature difference between the warm and the cold side can be
controlled. In addition, the cold side and the warm side can be
reversed by reversing the polarity. In general, a Peltier element
is composed of a number of semiconductor components, also known as
p-n junctions, which are mounted between two ceramic panels acting
as electrical insulators. If an electric current flows in one
direction, heat is conveyed from one side of the semiconductor
components to the other side. Reversing the direction of
flow/polarity likewise results in a reversal of the conveying
direction of the heat.
[0018] The influencing system of an assembly according to the
invention may comprise a channel for supplying a fluid, such as a
liquid or gas, to the carrier, optionally in combination with a
Peltier element. Examples of fluids which can then be used in order
to cool to below the threshold temperature are cold water, or cold
gaseous CO.sub.2, N.sub.2 (nitrogen) or N.sub.2O (laughing gas).
Carbondioxyde, nitrogen or laughing gas in liquid form are likewise
possible as cooling fluids. In order to heat to above the threshold
temperature, use can be made of, for example, warm water or a warm
gas.
[0019] According to a further embodiment, the influencing system
may comprise a source for generating an alternating electromagnetic
field, in which case the carrier and/or the ring and/or the
anchoring elements are designed in such a manner that they are
sensitive to heating by this alternating electromagnetic field. It
is generally known to those skilled in the art that a material in
which free electrons are present, can be heated by subjecting it to
an alternating electromagnetic field. A microwave oven and
induction cooking are both based on this principle. This principle
makes it possible to heat an object by means of an electromagnetic
field from a certain distance without involving direct contact.
This is advantageous with the present invention, since hardly any
arrangements have to be made on the applicator, except for the fact
that the carrier of the applicator is optionally made of a material
which is suitable for heating by the effect of an alternating
electromagnetic field. However, instead of the carrier or in
addition to the carrier, it is also possible to make the ring
and/or anchoring elements of a material which can be heated by the
effect of an alternating electromagnetic field.
[0020] With an influencing system comprising a source for
generating an alternating electromagnetic field according to the
invention, it is advantageous if the source has at least one
electrically conductive loop which can be connected to an
alternating current source. This at least one loop may thus also
comprise a multiplicity of loops wound to form a coil. The
advantage of such a loop structure is that is that it produces an
extremely concentrated alternating electromagnetic field in the
plane of the loop, which is still highly concentrated just in front
of the loop. In this case, according to the invention, it is
particularly advantageous if the loop has a passage of a size such
that the ring can be accommodated therein with play, the size of
the passage preferably being at least 1.2 times larger than that of
the ring. In this manner, it is possible to place the loop around
the ring with anchoring elements, or optionally above, such as just
above, or optionally below, such as just below, this ring, it being
possible for the loop to be situated on the outside around the
blood vessel tissue into which the ring has to be fitted. It is
also possible to situate the loop advantageously next to the blood
vessel tissue into which the ring has to be fitted.
[0021] According to a further advantageous embodiment, the
composition of the material of the anchoring elements is chosen
such that the threshold temperature is around or below the human
body temperature. Choosing the threshold temperature to be around
or below the human body temperature prevents the anchoring elements
from in any way being frozen in a position other than the anchoring
position afterwards, i.e. after surgery, that is to say prevent
this from happening inadvertently. A further advantage of choosing
the threshold temperature to be around or below the human body
temperature is that the heating means do not require to be heated
to a temperature which might damage the human body locally. The
threshold temperature will according to the invention in particular
be lower than or equal to 37.5.degree. C. More particularly, the
threshold temperature according to the invention will in particular
be lower than the body temperature; in particular a few degrees
lower than the body temperature, such as for example lower than or
equal to 34.5.degree. C.
[0022] With regard to the threshold temperature, it should be
pointed out that with memory materials, such as memory metals, for
example Nitinol, or plastics with memory properties, there usually
is a temperature range within which the transition from the
temporary shape--the fitting position--to the final shape--the
anchoring position--takes place. With memory metals, a distinction
is drawn essentially between four temperatures. Progressing from a
low to a high temperature, these are the Martensitic finish
temperature, abbreviated Mf, the Martensitic start temperature,
abbreviated Ms, the Austenitic start temperature, abbreviated As,
and the Austenitic finish temperature, abbreviated Af. There are
usually a few degrees C. (for example approx. 5.degree.) between
the Martensitic finish temperature and the Martensitic start
temperature, as well as between the Austenitic start temperature
and the Austenitic finish temperature (for example approximately
10.degree. C.), and there may again be a few degrees (for example
8.degree. C.) between the Martensitic start temperature and the
Austenitic start temperature. As is known from practice, there may
be a difference of more than 20.degree. C. between the Martensitic
finish temperature and the Austenitic finish temperature. What
temperatures these are exactly depends on the composition of the
material and is, as those skilled in the art know, selectable by
choosing the correct material composition and temperature shape
setting. At temperatures below the Martensitic finish
temperature--having started from relatively high temperatures--an
object has definitely reached its temporary shape. Please note that
this is independent of deformability as the material can still be
deformable. Having started from relatively high temperatures, an
object will begin to take on its temporary shape when the
Martensitic start temperature is transgressed. Progressing from a
low to a high temperature, an object with a temporary shape will
start to take on its final shape when the Austenitic start
temperature is exceeded and will have taken on/take on its final
shape when the Austenitic finish temperature is exceeded. In
addition, a distinction is drawn between a one-way effect and a
two-way effect. With the one-way effect, when heated above As
temperature, the material actively takes on the Austenitic shape
which becomes final above Af temperature, but does not
automatically take on a temporary Martensitic shape when it cools
down to below the Ms temperature. The material does start to become
deformable, at its most below the Mf temperature. With the two-way
effect, or bi-stable memory materials, the material actively takes
on the Austenitic shape when heated to above the As temperature and
the Martensitic shape when it cools down to below the Ms
temperature.
[0023] In the opinion of the Applicant, the threshold temperature
covers a temperature range between the Austenitic start temperature
(As temperature) and the Austenitic finish temperature (Af
temperature). The term "threshold temperature" is understood to
mean the temperature at which the material takes on its final shape
and thus includes the entire temperature range between the
Austenitic start and finish temperatures. This range may in
practice be, for example, 10.degree. C. If one would like to
indicate one threshold temperature, this would be the temperature
at which the final shape is achieved and at which it can be
guaranteed that this shape will be maintained in the body under
normal physiological temperatures. In the opinion of the Applicant,
this threshold temperature would then have to be the Austenitic
finish temperature.
[0024] According to a further advantageous embodiment of the
invention, the influencing system, especially its heating device,
is designed to raise the temperature of the anchoring elements to
approximately 10 degrees (+/-5 degrees) C. above the threshold
temperature. According to a further advantageous embodiment of the
invention, the influencing system, especially its cooling device,
is designed to lower the temperature of the anchoring elements to
approximately 20 degrees (+/-5 degrees) C. below the threshold
temperature and optionally maintain it there.
[0025] According to a further advantageous embodiment of the
assembly according to the invention, the carrier comprises gripper
parts which can be moved between a position gripping the ring and a
position releasing the ring. In this context, this may in
particular involve the following possibilities: [0026] the gripper
parts can be moved radially between a position gripping the ring
from the inside and a position releasing the ring; and/or [0027]
the gripper parts can be moved in the longitudinal direction
between a position gripping the ring from above and/or below and a
position releasing the ring. In the case of an animal valve
prosthesis which is attached to the ring beforehand, it is
particularly advantageous according to the invention if the gripper
parts can move in the longitudinal direction between a position
gripping the animal valve prosthesis from above and/or from below
and a position releasing the animal valve prosthesis from above
and/or from below. With all these ways of the gripper parts acting
on the ring, the ring is left clear on the outside, so that the
gripper will not interfere with the anchoring elements. The gripper
parts may also act on a fixed top flange. In this case, the gripper
parts can not only grip such a top flange from above, but also from
the side in the horizontal plane and be moved. This applies in
particular to vessel attachment devices which are designed in this
way and around which there is generally sufficient space.
[0028] According to a further advantageous embodiment, the
applicator comprises a sleeve which can slide along the applicator
between a position overlapping the ring provided on the carrier and
a position exposing the ring provided on the carrier. Thus it is
possible to protect the ring with anchoring means against the
outside so that it does not come into contact with surrounding
tissue when this ring with anchoring means is being brought into
the intended position inside the passage surrounded by body tissue.
If an anchoring element frozen in its fitting position were to get
caught behind tissue, this anchoring element could bend over and
damage tissue.
[0029] In order to facilitate bringing the ring with anchoring
means into its intended position inside a passage surrounded by
tissue, in particular via the bloodstream, it is very advantageous
according to the invention, if the sleeve comprises a distal part
which may or may not be fixedly connected to it or form an integral
part thereof and tapers in the distal direction to form a diameter
which is smaller than that of the ring, and if that distal part
consists of axial fingers which can bend radially outwards from the
tapering position in such a manner that this tapering part of the
sleeve can be displaced over the ring, in particular over the
distal anchoring elements in the fitting position and, if
appropriate, also over the proximal anchoring elements. The distal
tapering part may for example taper conically, but may also taper
parabolically. This tapering considerably eases navigation to the
intended position. However, the tapering part will have to be
removed before the anchoring elements are released from the fitting
position to the anchoring position. In order to remove this distal
tapering part without interfering with the ring, it is very
advantageous if this distal part consists of axial fingers which
can move outwards, for example can bend, in such a manner that this
tapering part of the sleeve, also referred to as head, can be
displaced over the ring. The distal tapering part may be placed
over the sleeve from the proximal or from the distal direction or
may form an integral part thereof, but will, generally after the
applicator has been navigated to the intended position, have to be
removed in the proximal direction. With a ring having a fixed top
flange or anchoring means which are already in the fitting position
or fixed proximally, such a tapering part can only be moved up via
or from the sleeve from the proximal direction. Such a tapering
head on the distal part of the sleeve enables the use of the
assembly via a guide wire, especially if the central section of the
applicator is designed to be hollow. In addition, the sleeve or the
tapering part thereof may be provided with parts extending in the
radial direction or a ring extending in the radial direction, which
parts or ring, respectively, may serve to rest on the surrounding
(vessel) tissue. Such parts extending in the radial direction
could, for example, be arranged on the sleeve or the tapering part
thereof in such a manner that they occupy a position on the outside
of the sleeve or the tapering part thereof with respect to the
ring, which is such that the ring is positioned at the desired
distance with respect to the anatomical structures on which they
rest. This results in the navigation of the assembly being
facilitated as such parts can act as a plug and even blind
navigation becomes possible.
[0030] In a ring with anchoring elements, in which the proximal
anchoring elements are designed to be completely or partially fixed
or have been brought into an anchoring position beforehand, while
the distal anchoring elements can be brought into and maintained in
a fitting position, as is known from various applications by the
inventor, inter alia WO 00/24339 and WO 00/44311, it is furthermore
advantageous to provide the sleeve with incisions, creating axial
fingers, in such a manner that the sleeve can be positioned around
the ring and distal anchoring elements by displacing these fingers
in the longitudinal direction between proximal (fixed) anchoring
elements, the incisions being situated at the location of the
proximal anchoring elements.
[0031] According to a further embodiment of the invention, the
sleeve is provided at its distal end with axial fingers and the
ring is provided at its distal end with such anchoring elements, a
space being left between neighbouring axial fingers and the axial
fingers being provided in such a manner that, when the ring is
accommodated in the sleeve, each axial finger overlaps a respective
distal anchoring element. Thus it is possible for further anchoring
elements, for example proximal anchoring elements, to protrude
permanently in the radial direction via the spaces between the
axial fingers or that such further, for example proximal, anchoring
elements are brought into a protruding position before the distal
anchoring elements. According to a further advantageous embodiment,
the ring is in this case provided at its proximal end with a flange
which extends radially outwards for interaction with the distal
anchoring elements, and this flange is provided with passages for
those axial fingers. In this case, the flange may be an
uninterrupted flange which runs entirely around the outside of the
axial fingers and has slots on its inner side for enabling the
axial fingers to pass through. According to another embodiment, it
is also possible in this case for the ring to be provided with
these anchoring elements at its proximal end and for these proximal
and distal anchoring elements to be provided in a staggered manner
with respect to each other, seen in the tangential direction to the
ring, in such a manner that the axial fingers can overlap with the
distal anchoring elements when they protrude through the proximal
anchoring elements, it furthermore optionally being advantageous if
the proximal anchoring elements are in an extended state inside the
part of the sleeve which is proximal with respect to the axial
fingers.
[0032] In a further advantageous embodiment, the proximal and
distal anchoring elements surround the ring in an alternating
manner, seen from above or below. Alternatively, gaps can be made
in the fixed proximal anchoring element or in the fixed proximal
anchoring elements, which describe part of a circle, as a result of
which the axial fingers can be displaced in the longitudinal
direction. These axial fingers can also be of tapering design, as
described before above.
[0033] According to a further advantageous embodiment of the
assembly according to the invention, the applicator can be provided
with parts which can be used to connect to a stabilizer, which can
be connected, for example, to a sternum spreader, operating table,
or fixed part of or in the operating theatre, as is known from
previous applications by the inventor.
[0034] According to a further advantageous embodiment of the
assembly according to the invention, the applicator, gripper arms,
and/or the sleeve is/are designed to be flexible in order to
facilitate the introduction and navigation of the assembly.
[0035] According to another advantageous embodiment, these
components of the assembly, separate from or in addition to the
flexible embodiment, can be of perforated design. Thus it is
possible to move the assembly up in the bloodstream, optionally
while the heart is beating, without impeding the blood flow too
much.
[0036] According to a further advantageous embodiment of the
assembly according to the invention, the ring is provided with a
valve prosthesis, which may or may not be detachable, in particular
a heart valve prosthesis. In case the valve prosthesis comprises
one, two or more valve leaflets, it is very advantageous according
to the invention if the carrier is provided with a longitudinal
member extending in the longitudinal direction, which may extend
through the ring and against which the valve leaflets of the valve
prosthesis supported by the carrier rest in their open position.
Thus it is ensured that the valve leaflets are kept in an open
position in the longitudinal direction while they are being
transported to the intended position in order thus to prevent
damage to those valve leaflets.
[0037] According to a further advantageous embodiment of the
assembly according to the invention, the ring is provided with
anchoring elements for attaching a valve prosthesis to the ring.
This valve prosthesis may be attached to the ring prior to the
introduction of the ring into the body, but may also be attached to
the ring after the ring has been positioned and fastened in the
passage surrounded by body tissue. If desired, these anchoring
elements may be released or removed or replaced if a valve (ring)
prosthesis needs to be removed and, if desired, to be replaced with
another valve prosthesis, without removing the ring with (tissue)
anchoring elements. If the anchoring elements for attaching the
ring to the tissue and/or for attaching a valve prosthesis to the
ring are made of bi-stable Nitinol, it is possible to remove the
entire ring from the tissue and/or only the valve prosthesis from
the ring more easily after cooling.
[0038] According to yet a further embodiment of the invention, the
ring is a valve reconstruction ring. The term valve reconstruction
ring is to be understood as meaning in particular a ring which is
attached in the bloodstream along the surrounding vessel wall
tissue in a natural heart valve in order to narrow the passage at
the location of the valve without removing the valve leaflets. The
purpose thereof is to repair a heart valve which is defective or
not functioning well due to a local dilatation, or to make it
function well again.
[0039] According to yet a further embodiment of the invention, the
ring is an anastomosis attachment device. In this context,
reference can be made to various embodiments as described in
previous patent applications in the name of the Applicant, such as
WO 00/24339 and WO 00/44311.
[0040] According to yet a further embodiment of the invention, the
ring is provided with anchoring elements for attaching a cannula
and/or port and/or operating channel. Possibilities of this kind
are described in the aforementioned WO 00/44311, see for example
FIGS. 40 and 53, by the inventor.
[0041] According to yet a further embodiment of the invention, the
assembly can be combined with a vacuum stabilizer which is
positioned at the location of and/or around the passage in the
(vessel) tissue, where the ring is to be positioned, thus
facilitating the navigation or forming a bloodless operating
channel, or stimulating tissue contact. Vacuum stabilizers of this
type are described in previous applications in the name of the
Applicant, such as NL 1020288 and WO 03/082121.
[0042] According to the invention, it is furthermore advantageous
if the assembly is fitted with one or more sensors and/or one or
more marks distally, in particular near the carrier. Sensors and/or
marks of this type make it easier not only to navigate the distal
end of the assembly to the intended position, but also to
accurately position the ring at the intended position.
[0043] According to a further aspect, the invention relates to an
applicator suitable for an assembly according to the invention.
[0044] According to yet a further aspect, the invention relates to
a ring suitable for an assembly according to the invention. The
ring for the assembly according to the invention respectively the
ring of the assembly according to the invention concerns especially
a non-foldable ring (in contrast to stent like rings which can be
folded up to have a considerable smaller diameter).
[0045] This application further relates to a second invention,
which is the subject of claims 31-34. This second invention can be
applied separate from the first invention (claims 1-30) or in
combination with the first invention.
[0046] For a good heart valve prosthesis there are two important
requirements. It must be reliably secured to the surrounding body
tissue and the prosthesis may not leak. Concerning leakage,
applicant noticed that vessel tissue, such as valve annulus tissue,
can, especially in case of weak tissue, expand on long term with
the result that the valve prosthesis is loosening and that leakage
around the prosthesis becomes possible.
[0047] The second invention has as its object to provide a heart
valve prosthesis overcoming this objection. This object is achieved
by providing a heart valve prosthesis according to claim 31. The
constriction system having pins moving in radially inward
direction, after having penetrated the tissue, ensure that the
surrounding body tissue, in general vessel tissue, such as annulus
tissue, has improved contact with the ring member. The pins tend to
constrict the body tissue while moving inward. This does not only
reduce the long term risk of leakage but also improves the sealing
on short term.
[0048] In case the ring or other parts of the valve prosthesis are
provided, for example covered, with a material enhancing ingrowth
of tissue, the sealing by ingrowth of tissue is improved as
well.
[0049] For the skilled man it will be clear that the required
movement of the pins from the first penetrated to the second
penetrated position can be achieved in various manners or various
combination of manners.
[0050] One of the manners is using spring force. In this respect
the embodiment according to claim 32 of the second invention is
advantageous. According to this embodiment one can use a mechanical
restriction, such as retractable pens or strips, to keep the pins
temporarily in the first penetrating position. But one can also
make use of memory metals or plastics (as already extensively
described in relation to the first invention), which can be, so to
say, frozen in the first penetrating position to be released to go
back to the second position when the temperature increases above a
certain threshold temperature.
[0051] Another manner is to arrange the pins on a carrier which can
be shortened to move the pins in said radially inward direction. In
this way it is possible not to bend the pins but just to move them
radially, although additionally bending the pins is possible as
well. Such a carrier can comprise a radial arm for each pin, which
radial arm can be shortened for example by making use of memory
effects of so called memory metals or plastics. The carrier can
also comprise a ring which can be reduced in diameter, for example
by making use of memory effects of so called memory metals or
plastics.
[0052] The constriction system can, according to claim 34, comprise
a ring element, which can be separate from the ring member. Such a
constriction system can be deployed at its location before the
remainder of the prosthesis is deployed. This makes it possible to
restrict the body tissue to a diameter smaller than required for
the ring member. This ensures a tight fitting with the ring member,
decreasing the risk of leakage.
[0053] The present invention will be described in more detail below
with reference to the examples illustrated in the drawing, in
which:
BRIEF DESCRIPTION OF THE DRAWINGS
[0054] FIG. 1 diagrammatically shows an assembly according to the
invention, in a state in which it is suitable for being taken to
the intended position in the body;
[0055] FIG. 2 is a similar view to that of FIG. 1, except that the
assembly is now in a position in which the ring with the anchoring
elements is in the anchoring position and is released by the
applicator;
[0056] FIG. 3 shows a diagrammatic view of a protective sleeve for
the applicator from FIG. 1;
[0057] FIG. 4 shows a diagrammatic view of the central section of
the applicator from FIGS. 1, 2;
[0058] FIG. 5 shows a diagrammatic view of one of the grippers of
the applicator from FIGS. 1 and 2;
[0059] FIG. 6a shows a specific embodiment of the distal end of the
protective sleeve, shown in particular in FIG. 3;
[0060] FIG. 6b shows a distal end of the protective sleeve from
FIG. 6a with a loading tube inserted into it;
[0061] FIGS. 7a and 7b show a loading device for loading a ring
with anchoring elements onto an applicator, with FIG. 7a showing
the loading device in the initial position and FIG. 7b showing the
loading device in an intermediate position;
[0062] FIG. 8 shows the operation of an alternative loading device
in a highly diagrammatic manner;
[0063] FIG. 9 shows an illustrative example of a section of a ring
with anchoring elements in perspective view in which, by way of
explanation, the anchoring elements are shown in the anchoring
position on the left-hand side and in the fitting position on the
right-hand side.
[0064] FIG. 10 shows, by way of example and with the entire
applicator omitted, a ring with anchoring elements from the
assembly according to the invention, with FIG. 10a showing the
anchoring elements in the fitting position and FIG. 10b showing the
anchoring elements in the anchoring position, namely at the
location of the annulus of a heart valve;
[0065] FIG. 11 shows a sectional view of a further embodiment of a
sleeve or gripper which can be used with the assembly according to
the invention in a position in which it carries the ring (FIG. 11a)
and a position in which it releases the ring (FIG. 11b);
[0066] FIGS. 12a and 12b show a variant of FIG. 1la and FIG. 11b,
respectively; and
[0067] FIG. 13 diagrammatically shows an example of an influencing
system working with an electrostatic field, with FIG. 13a showing a
diagrammatic plan view of a loop for generating an electrostatic
field and FIG. 13b showing a diagrammatic sectional view of a
section of blood vessel tissue with an artificial heart valve to be
fitted;
[0068] FIG. 14 shows a diagrammatic perspective view of a variant
of the device from FIGS. 11 and 12, but in this case used in a
fastening device for an end-to-side anastomosis;
[0069] FIG. 15 shows in sectional view an embodiment of the second
invention of this application; and
[0070] FIG. 16 shows diagrammatically another embodiment of the
second invention of this application.
[0071] The present invention relates to an assembly consisting of
an applicator and a ring with anchoring elements as well as
separately to the applicator on the one hand and the ring on the
other hand. An assembly according to the invention is shown in
FIGS. 1 to 5, with FIGS. 3, 4 and 5 showing the basic components of
the applicator separately and FIGS. 1 and 2 the assembled
applicator with a ring provided with anchoring elements.
[0072] The applicator 1 consists of an optional sleeve part 2 (see
FIG. 3), also referred to as protective sleeve, a central section 3
and a number of in this example two, grippers 4 (see FIG. 5), which
together form the carrier.
[0073] As FIG. 2 shows, the grippers 4 are attached to the central
section 3 so that they can pivot about pivot point 5. The grippers
4 are provided at their distal end with a recess 6 into which the
ring of the assembly fits. By means of the adjusting screw 7
provided proximal from the pivot points 5, the proximal parts of
the gripper arms 4 can be adjusted between a position shown in FIG.
1, in which the recesses 6 grip the ring 8 from the inside, and a
position in which the proximal parts of the gripper arms are
spread, the distal gripper ends 9 having accordingly been moved
towards each other in order to release the ring 8 from inside, as
is shown in FIG. 2. An applicator with gripper arms which function
in a comparable manner is also shown in WO 03/082121, see inter
alia FIGS. 3-6, in the name of the Applicant. The adjusting screw 7
has, as it were, been replaced in this case by a displaceable
sleeve with recesses and gripper arms provided with protrusions
which interact with the recess in the displaceable sleeve for
bringing about a similar motion effect of the gripper arms. Within
the scope of the present invention still to be described in more
detail below, the applicator known from this WO 03/082121 could,
after some modification in connection with the influencing system
for the temperature, be used very well as an applicator for an
assembly according to the present invention. In case the applicator
is used in combination with valve or vessel attachment devices with
fixed top flange, as is known, inter alia, from previous
applications WO 00/24339 and WO 00/44311 by the inventor, the
gripper arms may also act on the fixed top flange or features which
have been fitted thereon from the outside inwards and/or from top
to bottom. FIGS. 11, 12 and 14 show examples thereof.
[0074] The applicator in accordance with the assembly of the
invention is optionally, but preferably provided with a sleeve 2
(shown separately in FIG. 3). As illustrated in FIGS. 1 and 2, this
sleeve 2 is displaceable along the central section 3 of the
applicator between a bottom or distal position and a top or
proximal position. The sleeve 2 is provided with a slot 10 in order
to enable the adjusting screw 7 to pass through. The purpose of the
sleeve 2 is to protect the ring 8 with anchoring elements against
the outside while the ring 8 with anchoring elements is taken to
its intended position in the body. By way of further example, two
different embodiments of a ring 8 with anchoring elements are
illustrated in more detail in FIG. 9 and FIG. 10. As will become
clear from the following description of these figures, the sleeve 2
protects the anchoring elements against the surrounding tissue, so
that these anchoring elements cannot inadvertently get caught in
this surrounding tissue. Furthermore, the sleeve 2 prevents the
anchoring elements--as will become clear later on--from prematurely
returning from a fitting position to the anchoring position in case
the assembly does not function properly.
[0075] FIG. 9 shows an inside perspective view of a section of the
ring 8 with anchoring elements 11 and 12. The left side shows the
anchoring elements 11 and 12 in the anchoring position, while the
right side shows the anchoring elements 11 and 12 in the fitting
position. Anchoring elements 11 are on the proximal side of the
ring 8 and anchoring elements 12 are on the distal side of the ring
8. In the fitting position, the anchoring elements 11 and 12 are,
as it were, in their extended state and in the anchoring position
shown on the left, they are in a state where they point radially
outwards. Anchoring elements 11 may already be in a fitting
position or permanently point in a radially outward direction prior
to being fitted. It is also possible for the proximal anchoring
element to be an uninterrupted radially outwardly pointing flange.
The ring 8 and anchoring elements 11, 12 from FIG. 9 are made of a
memory material, in particular a memory metal such as Nitinol or a
memory polymer. In the initial position, the anchoring elements 11
and 12 here are in the anchoring position--shown on the left. From
this anchoring position, the anchoring elements 11 and 12 can be
bent counter to a spring force into the fitting position shown on
the right. By means of a temperature treatment, the anchoring
elements 11 and 12 can be frozen in this fitting position in such a
manner that when a specific threshold temperature is exceeded, the
anchoring elements 11 and 12, by the effect of the spring
force--which had to be overcome when the anchoring elements were
bent from the anchoring position to the fitting position--return to
the anchoring position. Such an effect of memory metals and memory
polymers is a well-known phenomenon as such.
[0076] The anchoring elements 11 and 12 shown in FIG. 9 are as it
were lip-shaped and in each case provided with a recess 13. The
recess 13 in the lip-shaped anchoring elements 11 and 12 may also
be omitted, as can be seen in FIG. 10, for example. Here, anchoring
elements 11 and 12 are shown which are all of identical shape,
height and width and which are distributed evenly over the
circumference of the ring. Particularly in the case of a vessel
attachment device, which is used with a vessel of small diameter,
such as a coronary artery, it may furthermore be advantageous if
the anchoring elements 11 and/or 12, or a number of such elements,
are of different shape, height and width, and/or are distributed
unevenly over the circumference of the ring. In case of attachment
to, for example, a small coronary artery, it may be desirable, in
particular, to make the anchoring elements 12 longer and, if
appropriate, also wider on the lateral sides of such a small
vessel, while it may be advantageous to make these elements smaller
or even omit them at the location of the axial inflow and/or
outflow angles, in order to prevent, as much as possible, an
obstruction of the blood flow at the location of the inflow and/or
outflow angles.
[0077] The ring 8 with anchoring elements 11 and 12 as shown in
FIG. 9 may be used for attaching a heart valve prosthesis inside a
blood vessel, for example on the annulus at the location of the
heart valve to be replaced. However, the ring 8 with anchoring
elements 11 and 12 may also form part of a device for performing an
anastomosis, for attaching a cannula, temporary port or operating
channel to a blood vessel, To this end, a passage may be formed in
the wall of the receiving blood vessel, the peripheral shape of
which is identical to, or at least approximately identical to, the
peripheral contour of the ring 8. The anchoring elements 11 and 12
can then be released from the extended fitting position, once the
ring has been placed in this passage, in order to bend back to the
anchoring position. In this anchoring position, the anchoring
elements 11 and 12 will then act on the blood vessel wall from
opposite sides. In the case of an end-to-side anastomosis, the ring
is attached to the target vessel in this manner. Attachment of the
graft vessel can be brought about in many different ways, either
prior to attachment to the target vessel or subsequent to
attachment to the target vessel. It is possible, for example, to
suture the graft vessel to the ring 8 beforehand. Alternatively, it
is possible to pull the graft vessel through the ring 8 beforehand
and, together with the distal end, turn it over around the distal
anchoring elements 12, so that the overturned part is pressed
against the inside of the wall of the target vessel after the
anchoring elements 12 have been bent back to the radially outwardly
extending position. It is also possible to use a separate coupling
piece at the location of the graft vessel, as is known from
previous applications by the inventor. With a side-to-side
anastomosis, a ring can be fitted in the wall of each of the
vessels to be connected at the location of the opening in the wall,
following which both rings, or the outer sides thereof, are
connected to each other. If the vessel attachment device (that is
to say, a device for attaching to a blood vessel in order to
perform an anastomosis, comprising, like the assembly according to
the invention, a ring with anchoring elements) is designed
semi-cylindrically, both vessel attachment devices can be connected
to one another, as it were forming one another's mirror image, with
mutual contact and coupling elements being located around the
passage, but according to an advantageous embodiment also as one
another's parallel image, the contact, and if desired, the coupling
elements extending over a much larger area. Any minor blood leaks
around one or both rings will in this case be sealed by the other
vessel attachment device. This is especially true for vessel
attachment devices which use a fixed top flange. In this case, use
can then also be made of the ring, top anchoring elements, but
preferably the fixed top flange itself, or coupling elements
connected to the latter, in order to bring about the actual
coupling. For example, by bending over the outer edge of the fixed
top flange of one of the two vessel attachment devices, a `female`
is created, into which the fixed top flange of the other vessel
attachment device, the `male`, can be pressed. The use of two
vessel attachment devices in parallel positions means that one of
the two vessel attachment devices will not follow the cylindrically
convex shape of the vessel wall, to which it is connected, but
will, on the contrary, give it a mirrored concave shape. In
coronary bypass surgery, for which this invention will inter alia
be used, this does not in itself have to be a problem, as the
situation which is usually encountered there, is that one of the
two vessels in question is relatively large compared to the other
vessel. It is obvious that the `inverted` vessel attachment device
can be connected to the relatively large vessel, so that there are
no adverse effects for the blood flow at the location of the
eventual vessel connection between the two vessels. It is also
possible to use one ring at a time at the location of the opening
in the wall of the two vessels to be connected, the anchoring
elements 11 and 12 then being located on the inside of both
vessels. Many other attachment techniques described in previous
patent applications by the inventor can be applied here as
well.
[0078] FIG. 10 shows, by way of further example, another ring with
anchoring elements which can be used in combination with the
assembly according to the invention. Here, identical parts have
been given the same reference numerals as in FIG. 9. The ring is
therefore again denoted by 8, the proximal anchoring elements by
11, the distal anchoring elements by 12. The ring 8 with anchoring
elements 11, 12 shown in FIG. 10 is in particular intended for
attachment inside a blood vessel on the annulus 14 at the location
of a heart valve. The anchoring elements 11, 12, as shown in FIG.
10, are illustrated as closed lips, although the recesses 13 from
FIG. 9 could be used here as well. A further difference with FIG. 9
is that the ring 8 is provided with yet further anchoring elements
15. The anchoring elements 15 are in the shape of L-shaped lips.
FIG. 10a shows the ring 8 with anchoring elements 11, 12 and 15 in
the fitting position, while FIG. 10b shows the ring 8 with
anchoring elements 11, 12 and 15 in the anchoring position. As can
be seen, in the anchoring position, the proximal anchoring elements
11 and distal anchoring elements 12 lie against the annulus 14 in
order to clamp it. In the anchoring position, the anchoring
elements 15 have penetrated the annulus 14 by means of the points
16. In order to keep the points 16 bent inwards in the fitting
position, the ring 8 is provided with recesses 17 in which the
L-shaped lips--which may be formed by punching--are accommodated.
As for the manner in which the anchoring elements 11, 12 and 15 can
temporarily be brought from the anchoring position into the fitting
position, reference is made to the earlier description in
connection with FIG. 9. Furthermore, it should be noted that the
anchoring elements 15 in FIGS. 10a and 10b are shown as moving
around a bending axis which is tangentially oriented with respect
to the ring 8. However, it will be clear that these lips can also
be rotated through 90.degree. so that the bending axis is axially
oriented with respect to the ring. In this connection, see also WO
00/44311 by the inventor.
[0079] The drawings show rings of an assembly according to the
invention which have an essentially fixed diameter, a foldable ring
might be conceivable as well.
[0080] The text which follows will deal more specifically with the
present invention itself, namely with the influencing system
provided on or near the applicator for influencing the temperature
of the anchoring elements of the ring supported by the carrier in
such a manner that the anchoring elements bend back from the
fitting position to the anchoring position by increasing the
temperature of the anchoring elements to above the threshold
temperature. An influencing system of this type can be designed in
many ways.
[0081] A relatively simple embodiment comprises a supply line 19
provided on the central section 3 (FIG. 4) for a fluid and a
channel 20 formed in the central section 3 (FIG. 4) which connects
the supply line to the distal part of the central section 3, and
outflow openings 18 for the fluid provided on the distal part of
the central section 3. These outflow openings 18 may be distributed
distally over the circumference of the central section 3. The
outflow openings 18 will preferably be provided or directed in such
a manner that fluid emerging from them contacts the ring with
anchoring elements as much as possible, that is at least the
anchoring elements. The fluid may be, for example, a liquid, such
as water or preferably a sterile saline solution, the temperature
of which can be varied depending on whether the temperature of the
anchoring elements has to be kept below the threshold value or
rather has to be brought above the threshold value in order to
cause the anchoring elements to bend back--also referred to as
turning over. The fluid may also be gaseous, for example CO.sub.2
or laughing gas. Such a fluid is routinely available in the
operating theatre and has a very good cooling action. By means of
such a gas, the anchoring elements can be kept at a temperature
below the threshold temperature particularly reliably. If the
threshold temperature then has to be exceeded in a controlled
manner, it is easily possible to switch to a warmer fluid, such as
for example a warm fluid which can be supplied via the same supply
system 19, 20 and 18. The supply system 19 is shown here in the
middle on the side of the central section of the applicator 3, but
can be connected to the latter at another location, such as for
example the proximal end of the central section 3.
[0082] As mentioned before, the influencing system for influencing
the temperature of the anchoring elements may be designed in a
different manner. Thus, it is conceivable to provide the gripper
arms 4 with a channel system 21--diagrammatically indicated by
dashed lines in FIG. 5--through which a fluid can be passed. This
channel system 21 may optionally be provided with gripper arms 9 of
an outflow opening similar to 18 at the distal end. However, it is
very easily conceivable to provide the gripper arms 4 with a closed
channel system and optionally to design the connecting port with
two coaxial channels for supply and discharge. Fluid is then
supplied to the distal end 9 of each gripper arm via this closed
channel system and also discharged via the closed channel system
via that end without allowing it to freely flow away. The
temperature of the anchoring elements will then be controlled more
indirectly, namely via the conduction of heat/cold from the distal
ends 9 of the gripper arms 4 to the ring 8 and/or anchoring
elements 11, 12, 15. In particular if the ring 8 and the anchoring
elements are made of metal and the distal gripper ends 9 of the
gripper arms are likewise made of metal, this conduction of
heat/cold can work very well.
[0083] Yet another possibility for an influencing system for the
applicator could be the provision of cooling/heating elements, such
as Peltier elements, on the applicator. Peltier elements cam be
made of very compact design and can easily cover a temperature
range of 20.degree. C. temperature difference. Peltier elements may
for example be provided on the inside of the distal gripper end 9,
seen in the radial direction, it being of great advantage if the
distal gripper ends 9, as well as the ring and gripper elements are
made of a metal or ceramic material which conducts heat well. This
is for a good conduction of heat/cold. At least one electrical
power lead will have to be provided for the Peltier elements. With
one electrical power lead, the applicator could even serve as
another power lead. When using two power leads, basically no
current needs to flow via the applicator itself. By switching the
polarity of the Peltier element at a desired moment, the side of
the Peltier element which contacts the distal gripper end 9 can
first be cooled and then, after switching the polarity, heated. It
will be clear that such a Peltier element or even another cooling
system may also be provided elsewhere on the applicator. However,
in that case, it is important that the applicator conducts the
heat/cold well to the distal gripper ends. The response time of the
temperature at the anchoring elements will in this case be slightly
longer. The influencing systems described before serve only as
examples of possibilities which are all within reach of those
skilled in the art. However, those skilled in the art will realize
that other influencing systems are also possible. What is important
is that the temperature of the anchoring elements in particular can
be adjusted, in particular controlled.
[0084] With the assembly according to the invention, it is, by way
of example, possible to proceed as follows: [0085] the ring with
anchoring elements in the fitting position is placed on the
applicator, for example by means of loading devices to be described
below with reference to FIGS. 7-8; [0086] if necessary, the
temperature of the anchoring elements is optionally temporarily
brought to below the Martensitic finish temperature; [0087] the
anchoring elements are kept in the fitting position by cooling them
to below the threshold temperature by means of the influencing
system and/or by means of the sleeve 2, optionally with the
tapering distal part connected thereto; in the absence of sleeve 2,
the influencing system is preferably used to ensure that the
anchoring elements have a temperature below the threshold
temperature; however, if the threshold temperature is above ambient
temperature and the body temperature of the patient during the
operation, then neither the action of the influencing system, nor
the sleeve 2 are required, although it is preferable to use one or
both; [0088] the applicator, in particular the distal end thereof,
is transported to the intended position in the body of the patient;
[0089] if applicable, when it has reached the intended position
inside the body of the patient, the sleeve 2, optionally with the
tapering distal part connected thereto, is pushed up from the
position shown in FIG. 1 to the position shown in FIG. 2; the ring
with anchoring elements at the distal end is completely exposed; in
order to facilitate shifting of the sleeve a pistol grip can be
provided like the pistol grip as shown in FIG. 3 of applicant's
earlier WO-03/003926. In case of a pistol grip one squeezes two
handle parts towards each other in order to shift the sleeve or
tapering distal part in proximal direction. [0090] if required, the
ring with anchoring elements will be positioned more accurately in
the intended position; [0091] if desired, the applicator may be
temporarily fixed to the fixed surroundings, such as the sternum
spreader, the operating table, or the fixed parts of the operating
theatre; [0092] once the ring with anchoring elements has been
positioned sufficiently accurately in the intended position, a) the
influencing system will be activated in order to raise the
temperature of the anchoring elements to above the threshold
temperature, as a result of which the anchoring elements turn over
into the anchoring position, and b) the distal ends of the gripper
arms 4 will be moved together in order to release the ring; in this
case, phase a) increasing the temperature to above the threshold
temperature, will preferably be carried out first, followed by
phase b) releasing the ring, but this may optionally take place
completely or partly simultaneously or, if circumstances require,
even in reverse order; [0093] the applicator is subsequently
removed; [0094] in case a vessel connection is intended, such as
for example, a side-to-side anastomosis, the abovementioned actions
will first be carried out at the location of the opening in the one
vessel and subsequently on the other vessel on order then to
connect both rings with one another. This connection can be
achieved, for example, by pushing both rings "fixedly into one
another", in the manner described above previously.
[0095] The shovel-shaped flat part 51 at the distal end of the
central section 3 of the applicator is particularly useful if there
is a valve prosthesis in the ring 8 which valve prosthesis has been
arranged in the ring beforehand. The purpose of the flat
shovel-shaped part 20 then is to keep the valve leaflets of the
valve prosthesis still, in an open position, in order to reduce the
risk of damage to these valve leaflets during execution of the
implantation procedure, and preferably to avoid it altogether.
[0096] In order to facilitate moving the distal end of the
applicator to the intended position inside the body of the patient,
the distal end of the sleeve 2 may be provided see FIG. 6a--with a
distal part 21 comprising axial fingers 22 which can be bent
outwards in the radial direction from the tapering position shown
in FIG. 6--see FIG. 6b for this--in such a manner that this
tapering part of the sleeve can be displaced over the ring for
loading the ring onto the applicator which will be explained below,
or for sliding the sleeve 2 upwards from the position shown in FIG.
1 to the position shown in FIG. 2 which has been explained above.
The tapering distal part 21 facilitates navigation through the
bloodstream or through other passages.
[0097] FIG. 6b furthermore shows a loading tube 23 which is placed
between the axial fingers 22. When the loading tube 23 is removed,
the axial fingers 22 will return to the shape shown in FIG. 6a. The
loading tube 23 assists in sliding a ring 8 with anchoring elements
in the fitting position inside in the direction of the arrow 24 in
order to attach this ring on the distal ends 9 of the gripper arms
4.
[0098] The tapering distal part 21 may also be connected to the
bottom edge of sleeve 2 after the ring has been loaded in to the
gripper arms 8 of the applicator and sleeve 2, following which part
21, from the proximal or distal direction, can be pushed over the
distal part of the sleeve 21 and be fastened to it, for example by
screws 3. This greatly facilitates loading using the loading tube
23 or directly using the loading device to be described below, as
the axial fingers 22 then do not have to be spread or bent. In case
no use is made of sleeve 2, the tapering distal part 21 or the
loading tube 23 can also be used separately, as a means for keeping
the bottom, and optionally the top, anchoring elements temporarily
in the fitting position. If the ring has been placed on the
applicator, the distal part 21 or the loading tube 23 may be
removed immediately before positioning and the ring with the
applicator can be positioned in the desired location, optionally
using cooling to below the Martensitic finish temperature.
Facilities may then be provided on the distal part 21 or the
loading tube 23 and on the distal end of the applicator by means of
which both components can be coupled to and uncoupled from one
another. Another possibility is to use the tapering distal part 21
instead of using the sleeve and to load the ring into the distal
part 21 from the axial side (the non tapering side) of the distal
part. This can be done with a loading device like the one described
below. This results in a space saving assembly enabling the
operator to have a better view on the site of operation.
[0099] FIG. 7 highly diagrammatically shows an example of a loading
device for loading a ring with anchoring elements in the fitting
position into the applicator.
[0100] The loading device from FIG. 7 consists of a central gripper
25, comparable to the gripper arms 4 of the applicator. The ring
with anchoring elements in the fitting position is placed on the
gripper ends 26 of the gripper 25. The ring with anchoring elements
in the fitting position is indicated by dashed lines in FIG. 7a and
denoted by 27. In order to make it easier to push the gripper ends
26 through the ring, the gripper ends 26 are adjustable with
respect to each other in the radial direction, for example can
pivot about point 28. Subsequently, a flat--as opposed to
cylindrical--ring 31, split into two parts 30 and 31, is placed
from both sides between the radially protruding anchoring elements
of the ring 27. Each split half ring is supported on a supporting
arm 29. The supporting arms 29 are secured to a bush 33 by means of
screws 32. Then, the anchoring elements on the right-hand side in
FIG. 7a are extended into the fitting position by turning the nut
34. Turning the nut 34 results in the block 35 being placed against
the bush 33 and in the gripper 25 being pulled inwards with respect
to the split ring 30, 31. When the anchoring elements on the
right-hand side in FIG. 7a have been extended, the loading tube 23
is placed against the split ring 30, 31. Subsequently, the nut 34
is turned in the opposite direction while the block is being held
against the bush 33. The gripper 25 will then be withdrawn through
the ring 30, 31 and slide into the loading tube 23. As soon as the
split ring 30, 31 abuts the anchoring elements shown on the
left-hand side in FIG. 7b--see in particular FIG. 7b, where they
are still radially directed in the anchoring position--these
left-hand anchoring elements 27 will be extended into the fitting
position by the split ring 30, 31 in order to enable the ring 27 in
the fitting position to be pushed entirely into the loading tube
23.
[0101] The ring with anchoring elements in the fitting position can
then easily be placed on the carrier of the applicator. If
appropriate, the ring with extended anchoring elements will first
be subjected to a temperature treatment. This temperature treatment
for freezing the anchoring elements in the extended position may,
however, also take place after the ring has been loaded onto the
applicator, and optionally be carried out by means of the
applicator itself. In order to load the applicator, the loading
tube 23 only has to be placed in line with the sleeve 2 or at least
in line with the gripper arms 4, as is shown, for example in FIG.
6b. The gripper arms 4 can then be pushed into the loading tube 23
in order to grip the ring from the inside. Subsequently sliding the
ring with gripper elements in the fitting position from the loading
tube 23 into the sleeve 2 ensures that the anchoring elements
remain in the fitting position. If the temperature of the anchoring
elements is below the threshold temperature at the point in time
when the ring is being transferred, the sleeve 2 is not strictly
required, at least not for loading the ring with anchoring elements
on the applicator. The distal end of the gripper arms 4 may, if
appropriate, be brought to a low temperature, that is to say a
temperature below the threshold temperature, in advance, in order
to better ensure the anchoring elements remain "frozen" in the
fitting position. As mentioned above, the loading device can also
be used to load a fastening device or ring directly onto an
applicator or into a sleeve, without using a separate loading tube
23.
[0102] FIG. 8 highly diagrammatically shows another principle for a
loading device which can be used with an assembly according to the
invention. The steps in the loading process with the embodiment of
FIG. 8 are shown from left to right. On the far left, a section of
a ring 8 with anchoring elements 11 and 12 in the anchoring
position is shown diagrammatically. Furthermore, two split flat
rings 36, 37 are shown in the far left position, just above the
anchoring elements 11 and 12, which rings 36, 37 are similar to the
flat ring 30, 31 from FIG. 7. In this case, 36 and 37 in each case
are one split part. The other split part has in each case not been
shown. In a way similar to that of FIG. 7, the split rings 36, 37
are pushed between the anchoring elements 11, 12, as is shown in
the second step from the left. The third step from the left shows
how the split rings 36 and 37 are moved apart in accordance with
arrow 38 in order to move the anchoring elements 11 and 12 from the
anchoring position into an extended fitting position. This third
step also already shows two pressure elements 39 and 40. These
pressure elements 39 and 40 are pressed from the outside onto the
anchoring elements 11, 12 in the fitting position, following which
the split rings are removed. This leads to the phase shown as the
fourth step from the left. Referring to the fifth step from the
left, the distal ends 9 of the gripper arms 4 are inserted into the
ring 8 in order to grip the ring from the inside. During this
procedure, the distal end of the sleeve 2 is also pushed against
the proximal pressure element 39. Then, as is shown in the step on
the far right of FIG. 8, the gripper arms 4 are pulled into the
sleeve 2, the sleeve 2 pressing the proximal pressure element 39
towards the distal pressure element 40 while the proximal anchoring
elements 11 and the ring 8 are completely accommodated in the
sleeve 2. Although it has not been shown, it will be clear that the
gripper arms 4 are then further pulled into the sleeve 2 until the
distal end of the sleeve 2 also overlaps the distal anchoring
elements 12.
[0103] FIG. 11 diagrammatically shows an example of a sleeve of
different design--as an alternative, for example, to sleeve 2 from
FIG. 3 in which the gripper arms are (may be) present, but have not
been shown here--or a gripper of alternative design--as an
alternative, for example, to the gripper as shown in FIG. 5, in
which case the sleeve in the embodiment of FIGS. 1-5 could be
omitted and in which case some sort of retaining element is needed
in order to keep the ring in place with respect to the blood vessel
tissue when the gripper which is designed as a sleeve is being
pulled back. FIG. 11 shows only the distal lower end of the sleeve,
or gripper (referred to below as sleeve/gripper). FIG. 11a shows
the state in which the sleeve/gripper 64 accommodates the ring 62
in the fitting position, FIG. 11b shows the situation where the
sleeve/gripper 64 has released the ring 62.
[0104] Referring to FIGS. 11a and 11b, it can be seen that the
sleeve/gripper 64 has axial fingers 67 at its distal lower end.
Furthermore, it can be seen that the ring 62 has distal anchoring
elements 63 and proximal anchoring elements 66. In this ease, the
proximal anchoring elements are immovable and permanently directed
in a radially outward direction. In this case, the proximal
anchoring elements 66 and distal anchoring elements 63 are
staggered with respect to one another. In the position shown in
FIG. 11, the axial fingers 67 protrude through the proximal
anchoring elements 66 in order to overlap and thus protect the
distal anchoring elements 63 and to ensure that they are kept in an
extended position at all times as long as the sleeve/gripper 64 is
not withdrawn in accordance with arrow 68.
[0105] In addition, in FIG. 11a reference numeral 60 denotes a
blood vessel, 61 an annulus, such as is present around the natural
heart valve, and 65 an artificial heart valve. With respect to the
artificial heart valve 65, it should be mentioned that this can
already be present in essentially every embodiment of the ring as
described above.
[0106] FIG. 12 shows a variant of FIG. 11, FIG. 12a corresponding
to FIG. 11a and FIG. 12b corresponding to FIG. 11b. Similar parts
are denoted by the same reference numerals as in FIG. 11, but
increased by 10. The difference between FIGS. 11 and 12 essentially
is that in FIG. 12, the proximal anchoring element is an
uninterrupted, radially outwardly extending flange. In order to
make space for the axial fingers 77 of the sleeve 74, a number of
slots 79 are provided at the bottom of the flange 76 in the
circumferential direction, into which the axial fingers 77 can be
inserted.
[0107] With reference to that which is shown in FIGS. 11 and 12, it
should be noted that an assembly of this type of, on the one hand,
a sleeve/gripper and a ring with anchoring elements, on the other
hand, may readily be used without the influencing system for
influencing the temperature and without the anchoring elements
being made of a memory material. The anchoring elements, in
particular the distal anchoring elements, may for example equally
well be made of a standard resilient material which does not have
to be memory material at all. In this context, it will be clear
that an assembly of a sleeve/gripper on the one hand and a ring
with anchoring elements on the other hand, as shown in FIGS. 11 and
12 may also readily be employed in combination with the previous
PCT applications by the inventor, i.e. WO 00/24339, WO 00/44311, WO
03/003926 and/or WO 03/082121.
[0108] After the fastening device has been attached, there may be
space between or through the legs of anchoring elements 63, 66 and
73, via which leaks may occur, both of blood coming from above, as
well as from blood coming from below the ring. The risk of such
leaks can be reduced by inserting and attaching the ring in the
annulus tissue under a certain tension, so that this tissue will
completely or partially seal the space between the legs. In
addition, after the axial fingers 67 in FIG. 11 and axial fingers
77 in FIG. 12 are removed, blood leaks may occur between the top
anchoring elements 66 in FIG. 11 or through slots 79 in FIG. 12.
For these reasons, it is advantageous according to the invention,
if the anchoring elements and/or fixed top flange are coated with
textile, this coating not only covering the anchoring elements
themselves, but also the space at the location of the slots 79 and
between the anchoring elements, completely or partially, or even
beyond their periphery. At the location of the spaces between the
top anchoring elements 66, such a textile coating may temporarily
be pressed out of the way by the axial fingers 67. Once the axial
fingers 67 are withdrawn, the coating takes up this space again. In
the case of slots 79, similar openings can be made in the coating
of the top flange through which the axial fingers 77 are
temporarily moved up. Once these axial fingers are withdrawn, the
coating takes up this space again. Such an elastic motion by the
coating can, inter alia, be achieved by producing the coating from
elastic material, such as for example plastics like Dacron or
Teflon, such as are currently already being employed in suture
rings for valve prostheses. It is also possible to provide an
additional textile edge which is free on the lateral side in the
middle of the openings between the anchoring elements 66 and slots
79, if desired even close to the transition from the ring to the
valve, which, in case this textile edge is arranged on the upper
side of the ring, will be pushed downwards by the bloodstream and,
in case this textile edge is arranged on the underside of the ring,
will be pushed upwards by the bloodstream, in both cases resulting
in a seal. In the text above, textile coating is intended to mean,
inter alia, materials such as are being used in the production of
suture rings for valve prostheses, but a textile coating may also
consist of other deformable elastic biocompatible materials. A
coating of this type may consist of multiple layers, optionally
supplemented by materials which serve as an optionally elastic
filling in order to achieve the desired shape or mechanical
effect.
[0109] With reference to that which is shown in FIGS. 11 and 12, it
will furthermore be clear that, although that which has been shown
in FIGS. 11 and 12 relates to a heart valve prosthesis, this may
equally well be applied in attachment devices for performing an
anastomosis, such as those which have been described in the
abovementioned four PCT applications by the inventor. To this end,
reference is made by way of example to FIG. 14, which is very
similar to FIG. 8 from WO 00/24339, which relates to an attachment
device 100 for performing an end-to-side anastomosis. Reference may
be made to WO 00/24339 for details of an attachment device of this
type. In this case, 103 is a cylinder sector-shaped flange which is
applied to the target vessel from outside. 104 denotes anchoring
elements, referred to as bottom flange legs in WO 00/24339, which
can turn over in a radially outward direction by the effect of a
spring force, optionally assisted by the action of a memory metal,
in such a manner that the wall of the target vessel is clamped
between the anchoring elements 104 and the cylindrical part 103. A
raised ring with holes 106 therein is provided on the cylindrical
part 103, around the passage 105 formed therein, in order to be
able to attach a graft blood vessel to the ring 107 using suture
thread.
[0110] With reference to FIG. 12 and the additional pins 120 of
FIG. 15 (described further below), it is to be noted that the
anchoring of the ring 72 to the annulus can be improved by
providing the fixed flange 76 at its underside with anchoring pins.
Those anchoring pins extend in the insertion position axially in
order to facilitate easy penetration of the annulus, this is called
the first penetration position. The anchoring is improved when,
after piercing the pin 120--like shown on the left side of FIG.
15--straight and axially into the annulus, this pin is bend in an
arbitrary direction to a second penetrated position. By providing
such a bend the pin will less easily come loose from the annulus.
Although FIG. 15 shows, at the right side, the pin 120 bend in
radially inward direction, this bending direction can for just
anchoring also be different, for example in radially outward
direction or in tangential direction or a direction in between. The
stronger the bend of the pin, the stronger the anchoring effect.
With reference to FIG. 12, one could provide pins 120 directly
adjacent the small side of a slit 79. By bending the pin then from
a tangentially curved direction--in which it extends in front of
the slit--to an axially straight direction and inserting the
fingers 77 through the slits 79, the fingers keep the pins 120 in
the first position ready for penetration into the annulus.
Withdrawing the fingers will then firstly allow the lower flange 73
to bend outwards--when the temperature exceeds the threshold--and
secondly allow the pins to return to the tangentially curved
direction to extend in front of the slits 79 again. The pins can
return to this position by using memory shape effects as discussed
earlier or just by using normal spring bias effects coming free
when a mechanical constraint (the fingers) is removed. It will be
clear that the pins can also be arranged adjacent the longer sides
of the slits when it is desired to allow the to bend in radially
inward or outward direction. Further, it will be clear that this
additional anchoring effect can also be used with applicants
earlier inventions as described in WO-00/24339, WO-00/44311,
WO-03/003926 and WO-03/082121, without the first invention (claims
1-30) or the second invention (claims 31-34) of this application
being applied.
[0111] In addition, FIG. 14 shows approximately half of a cut-away
sleeve 101 with axial fingers 102 at its distal lower end. The
axial fingers 102 are in this case shown excessively long for the
purposes of clarity of the drawing. It will be clear that the axial
fingers 102 can be shortened to a length which is approximately
that of the anchoring elements 104. Slots 108 are formed in the
cylinder sector-shaped part 103, through which the axial fingers
102 can protrude in order to block the anchoring elements 104 from
the outside. As soon as the sleeve 101 is withdrawn in an upward
direction in accordance with arrow 110, the anchoring elements 104
will be able to fold out in order to clamp tissue from the wall of
the target vessel against the cylinder sector-shaped part 103. As
has been described before regarding the shape and distribution of
the anchoring elements 104, it may furthermore be advantageous to
accordingly give the axial fingers 102 a different shape, length
and width and to distribute them unevenly over the circumference of
the ring. It will be clear that the principle of attaching a vessel
attachment device of this type can also be applied to bring about a
side-to-side anastomosis, in which case a vessel attachment device
of this type is fitted at the location of the opening in the side
wall of the two vessels concerned in the manner shown. These two
vessel attachment devices can now be coupled to one another in
mirrored or preferably parallel manner. In order to actually bring
about the coupling of both vessel attachment devices in mirrored
manner, facilities can be arranged on the attachment device around
opening 105. For example, a ring in the shape of a flat disk 107,
optionally extending over the entire circumference, optionally
provided with slots 108, having a `female` or `male` shape. In the
case of the parallel coupling, it is preferable to use the
cylinder-shaped parts 103 of both vessel attachment devices
themselves. This is made easier if the raised ring 107 is omitted
and lateral extensions are provided on, for example, the lateral
edges of the cylinder sector-shaped part 103 of at least one of the
two vessel attachment devices, which provides this part with wings,
as it were. The cylinder sector-shaped part 103 or the lateral
extensions thereof of both or at least one of the two vessel
attachment devices can be treated by deforming it or by punching
openings into it. Examples of such treatments are bending, rolling
up or providing the material with corners. By treating both vessel
attachment devices in a different manner, it is possible to turn
the one cylinder sector-shaped part 103 into a receiving `female`
part and the other cylinder sector-shaped part 103 into an
insertable `male` part. In this manner, it is possible to press the
cylinder sector-shaped parts 103 of the two vessel attachment
devices together and/or hook them up and attach them to one
another. Those skilled in the art will know many ways of connecting
the two vessel attachment devices. It is also possible to impart or
apply a different magnetic charge to each of the two cylinder
sector-shaped parts 103, to glue both parts together, or to secure
them or clip them with one or more additional components. A further
advantage of connecting two vessel connecting devices in a parallel
manner is that any blood leakage through slots 108 after the
removal of the axial fingers 102 is prevented. With a mirrored
coupling, it is possible to arrange an additional ring around the
opening 105 over slots 108. With an end-to-side anastomosis,
sealing of the slots 108 can be achieved by using a coupling piece
overlapping these slots on the graft vessel, as is known from
previous applications by the Applicant. Slots 108 or other openings
in the cylinder sector-shaped part 103 can also be used to apply a
vacuum through, in order to temporarily achieve a good tissue
contact between the attachment device and the tissue. The use of
vacuum in such situations has been described in previous
applications by the inventor.
[0112] FIG. 13 highly diagrammatically shows an example of an
influencing system which comprises a source for generating an
alternating electromagnetic field. 80 denotes a vessel wall, 81 the
annulus of a heart valve, 82 a ring provided with distal anchoring
elements 83 and proximal anchoring elements 84 and 85 denotes an
artificial heart valve. The ring 82 and anchoring elements 83 and
84 are made of memory metal, such as Nitinol, that is to say at
least the ring 82 and anchoring elements 83, 84 comprise a memory
metal. For the sake of clarity, the applicator has been entirely
omitted from FIG. 13. A sleeve which may optionally be used with
the applicator may already have been withdrawn prior to the
temperature-influencing operation to be described below or may be
withdrawn subsequent to the temperature-influencing operation to be
described below. During the temperature-influencing operation to be
described below, the ring 82 will preferably still be securely held
by a gripper in order to keep it in place, though.
[0113] The temperature-influencing operation by means of a source
for an alternating electromagnetic field can be effected by placing
a loop 89, indicated diagrammatically in FIG. 13a, with connecting
ends 91 and 92 and bending it back around the blood vessel 80 as
has been indicated in FIG. 13a in section. The loop 89 can be
placed around the blood vessel 80 as the connecting ends 91 and 92
allow the loop to be bent open or otherwise by designing the loop,
for example split. The split embodiment can be achieved by
providing a plug-and-socket connection for the one sleeve part and
for the other sleeve part at the location of the reference numeral
93. The loop 89 is connected to the alternating current source 90
by means of the connecting ends 91, 92. This alternating current
source will create an alternating electromagnetic field in the loop
which, inside the loop, is directed in particular in the direction
of arrow 94 and will be highly concentrated in said location. This
results in the ring 82 comprising memory metal and anchoring
elements 83 and 84 heating up in a very short time to above the
threshold temperature. As soon as the threshold temperature is
exceeded by a sufficient amount, the distal anchoring elements 83
will fold out in accordance with arrow 86 and the proximal
anchoring elements will fold out according to arrow 87 in order to
fasten the ring 82 to the annulus 81. It will be clear to those
skilled in the art that by means of FIG. 13 only an example of an
influencing system working by means of an alternating
electromagnetic field has been described. It is, for example, not
strictly necessary for the loop 89 to be laid around the blood
vessel 80. The loop 89 may also positioned next to the blood vessel
or in the lumen of the blood vessel above and/or below the ring.
Furthermore, it is entirely conceivable for the loop 89 to be
replaced by a coil having a number of loops. In addition, as those
skilled in the art will realize, it is not necessary to use a loop
for generating an electromagnetic field. This may also be achieved
by other methods known from the prior art.
[0114] FIG. 15 shows the second invention in a first embodiment.
FIG. 15 is essentially based on FIG. 12. The sleeve 74 with fingers
77 and valve leaves 75 are no shown. Further same reference numbers
as in FIG. 12 are used. It is shown that the pins 120 lie adjacent
the outer, longer side of the slits 79. The pins are in straight
position (FIG. 15a), called the first penetrated position,
prebiased towards the bend position, called the second penetrated
position, as shown on the right of FIG. 15 in FIG. 15b. Although
here the fingers 77 of the sleeve are mentioned as mechanical
constraints, it is to be noted that those fingers 77 and the
corresponding slots 79 can be left away, when one uses the memory
shape effect of suitable metals or plastics to keep the pins in
straight position and allow them to return to the bend position
after increasing the temperature above a certain threshold. As the
pins move radial inward--according to FIG. 15 by bending--only
after they have been fully pierced into the annulus, this movement
is fully utilized to press the annulus correspondingly in radial
inward direction, the annulus is so to say constricted (although
its diameter might be unchanged because the ring 72 actually
prevents the annulus from restriction.
[0115] FIG. 16 shows that the pins can also be arranged to be able
to move radially inward by means of another construction. FIG. 16
shows a ring member 130 carrying valve leaflets (not shown). The
ring 130 is provided with a lower flange 131 which can bend from
straight axial position to radial position to lie against the
underside of a valve annulus (not shown). The ring 130 is also
provided with an upper flang 132, which can like lower flange bend
from an axial straight position to a radial position, but which can
also, as shown, be permanent in radial extending position. The
upper flange comprises arm segments 132 extending essentially
radial. Those arm segments 132 carry at their ends pins 133. The
arm segments 132 are arranged so that they can shorten by returning
under influence of shape memory effects or otherwise to a shortened
condition in which they have a zig-zag-like shape. For improving
the anchoring effect it is conceivable to allow the pins 133 to
bend as well, see discussion above at the end of FIG. 12.
[0116] It is also conceivable to arrange for a separate
constriction ring, which is to lie around the ring member of a
valve prosthesis, preferably in between the lower and upper flanges
as invented earlier by applicant, see WO-00/24339, WO-00/44311,
WO-03/003926 and WO-03/082121.
* * * * *