EP0815798A2
Expired / Lapsed
EP
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Contiguous, branched transmyocardial revascularization (TMR) channel, method and device
Assignee: Artivion Inc
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Filing: 1997-07-03
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Granted: —
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Expires: 2017-07-03
Abstract
Abstract Improved methods and devices related to laser-assisted transmyocardial revascularization (TMR), and more particularly, to improved methods and devices for creating branched TMR channels through myocardium in which a single opening is made in an epicardial surface with a plurality of channel branches, having predetermined geometries extending into and through myocardium, depending therefrom. A method of creating branched TMR channels comprises piercing an epicardial surface mechanically or with laser energy, directing laser energy through the opening in a first predetermined angular orientation with respect to the epicardial surface to create a first channel and delivering laser energy in a second predetermined angular orientation to create a second branch. A plurality of branches can thus be created in a single channel structure. A guide block device allows an opening to be made in an epicardial surface mechanically or with laser energy and provides a structure for directing laser energy into myocardium in a plurality of channels depending from the opening. Rotating guide devices and finger held devices with rotating head means include a hand held device with an elongated wand-like handle portion, a rotating head portion and a hollow guide needle means. Preferred embodiments further comprise a laser delivery means advancing mechanism and guide needle rotating means.
Inventors
- 👤 Richard L. Mueller
- 👤 Stuart D. Harman
- 👤 Robert L. Lathrop, Jr.
- 👤 Bruce J. Richardson
Bibliographic Details
Application Number
—
Jurisdiction
EP
Data Source
google_patents
Last Synchronized
2026-10-23 11:26
CPC Classifications
A; A61; A61B; A61B18/00; A61B18/18; A61B18/20; A61B18/22; A61B17/00; A61B17/34; A61B17/3403; A61B18/201; A61B17/00234; A61B2017/00238; A61B2017/00243; A61B2017/00247; A61B17/22; A61B2017/22072; A61B2017/22074; A61B2017/22075; A61B2018/00315; A61B2018/00345; A61B2018/00351; A61B2018/00392; A61B2018/2005; A61B2018/2255; A61B2018/2288
Claims Analysis
Total Claims: 21
Claim 1
Independent Claim
189 words
A rotating guide device for creating branched
transmyocardial revascularization (TMR) channels in
preselected portions of myocardium, the rotating guide
device comprising: a housing positionable on an epicardial surface
adjacent a preselected portion of myocardium, the housing
portion having: an upper surface; and a lower surface; rotating head means disposed within the housing; hollow guide needle means operatively connected to the
rotating head means and having: a central axis; a proximal end; a distal end, the distal end sharpened for
mechanically piercing an epicardial layer, wherein the
hollow guide needle means directs a laser delivery device
for delivery of laser energy through the guide needle means
and through the epicardial layer to preselected portions of
myocardium at a first predetermined angle with respect to
the epicardial layer to create a first branch extending
into myocardium, the laser delivery means retractable
through the hollow guide needle means and the hollow guide
needle means rotatable for delivery of laser energy into
myocardium at a second predetermined angle with respect to
the epicardial layer to create a second branch, the first
and the second branches forming, in combination, a
contiguous, branched TMR channel.
Claim 2
Dependent Claim
48 words
The rotating guide device of claim 1 in which the
guide needle means further comprises a curvature at the
distal end so as to deflect the distal end of a laser
delivery device to an angle with respect to the central
axis of the hollow guide needle means.
Claim 3
Dependent Claim
60 words
The rotating guide device of claim 1 in which
the rotating head is indexed with a predetermined number of
angular positions such that the distal end of the guide
needle is directed to a predetermined number of angular
positions to allow the laser delivery means to deliver
laser energy into myocardium at predetermined angles with
respect to an epicardial surface.
Claim 4
Dependent Claim
15 words
The rotating guide device of claim 1 further
comprising a handle attached to the housing.
Claim 5
Dependent Claim
24 words
The rotating guide device of claim 1 further
comprising a stabilization means forming a secure anchor
point between the device and an epicardial surface.
Claim 6
Dependent Claim
88 words
The rotating guide device of claim 5 in which
the stabilization means comprises: a flexible bellows portion integral with the housing
portion thereby forming an evacuable chamber extending
somewhat beneath the lower surface of the housing portion
when placed adjacent the epicardial layer; and a vacuum port in communication with a vacuum applying
means such that when the rotating guide device is placed
adjacent to the epicardial layer, the evacuable chamber can
be evacuated, thus providing a vacuum seal between the
rotating guide device and the epicardial layer.
Claim 7
Dependent Claim
17 words
The rotating guide device of claim 5 in which
the stabilization means comprises the guide needle means.
Claim 8
Dependent Claim
19 words
The rotating guide device of claim 4 further
comprising a laser delivery means advancing mechanism
mounted within the handle.
Claim 9
Dependent Claim
64 words
The rotating guide device of claim 8 in which
the laser delivery means advancing mechanism consists of a
laser delivery means retaining means and an actuator
wherein the laser delivery means retaining means holds the
laser delivery means in a secure position within the handle
and the actuator allows the laser delivery device to be
advanced and retracted a predetermined distance through the
handle.
Claim 10
Dependent Claim
28 words
The rotating guide device of claim 8 in which
the laser delivery means advancing mechanism comprises an
electric motor to advance the laser delivery means a
predetermined distance.
Claim 11
Dependent Claim
18 words
The rotating guide device of claim 1 in which
the rotating head means comprises a worm gear assembly.
Claim 12
Dependent Claim
76 words
The rotating guide device of claim 4 in which
the handle portion is elongated in the shape of a hand wand
for convenient manual control, the elongated handle having
a proximal end through which a laser delivery means can be
introduced into the handle portion, the handpiece further
comprising: a manifold for guiding the laser delivery means from
the handle portion to the head means and into the hollow
tubular opening of the guide needle means.
Claim 13
Dependent Claim
29 words
A guide needle for forming branched TMR channels
comprising: a hollow tubular body terminating in a distal tip
curved to deflect a fiber optic laser delivery means
mounted therein.
Claim 14
Dependent Claim
76 words
A guide block device for a surgical
transmyocardial revascularization (TMR) procedure, the
guide block device comprising: a body portion for placement on an epicardial surface
of the heart, the body portion having: upper and lower surfaces: an opening extending between the upper and
lowersurfaces; and a bearing surface surrounding and
extending from the opening through the body portion and
defining pivot-point means for angulation of a laser
delivery means to create a contiguous, branched TMR
channel.
Claim 15
Dependent Claim
52 words
The guide block device of claim 14 further
comprising a hollow guide needle, the guide needle having: a proximal end; a central axis; and a distal end sharpened for mechanically piercing an
epicardial layer, the hollow guide needle directing the
laser delivery means to deliver laser energy to preselected
portions of myocardium.
Claim 16
Dependent Claim
51 words
A transmyocardial revascularization (TMR) channel
structure defining a predetermined geometry comprising: an opening in an epicardium of a human heart;a first
branch extending from the first opening into myocardium;
and at least one additional branch into myocardium, the
first branch and at least one additional branch in
communication with each other.
Claim 17
Dependent Claim
29 words
The TMR channel structure of claim 16 wherein at
least one of the additional branches is non-contiguous with
the first branch at all points other than near the opening.
Claim 18
Dependent Claim
24 words
The TMR channel structure of claim 16 further
comprising a cavity disposed between and communicating with
the first and at least one additional branch.
Claim 19
Dependent Claim
34 words
The TMR channel structure of claim 16 further
comprising at least two additional branches extending from
the first branch into myocardium, thereby creating a
plurality of communicating TMR channels in preselected
portions of myocardium.
Claim 20
Dependent Claim
21 words
The TMR channel structure of claim 16 in which at
east one branch of the TMR channel is arcuate in shape.
Claim 21
Dependent Claim
20 words
The TMR channel structure of claim 16 in which at
least one branch of the TMR channel extends through
endocardium.
References Cited (Backward Citations)
No citation records indexed.
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