EP0888750A1
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EP
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Myocardial revascularization device
Assignee: Artivion Inc
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Filing: 1998-06-30
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Granted: —
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Expires: 2018-06-30
Abstract
Abstract An apparatus for combined mechanical/laser myocardial revascularization of a human heart is operated by inserting a mechanical piercing device and an elongated flexible lasing apparatus into the chest cavity of a patient; mechanically auto-piercing, micro-tearing or spreading the epicardium of the heart; and then lasing from beneath the epicardium through the myocardium. The apparatus is guided to an area exterior to a ventricle of the patient's heart, and the distal end of the energy delivery device such as an optical fiber apparatus is placed internal to the exterior wall of the heart through an opening which has been created by mechanically piercing, micro-tearing or spreading the epicardium, so that the myocardium and not the epicardium is irradiated with laser energy to allow passage of said energy delivery device such as an optical fiber distal end or said laser energy into the left ventricular cavity without causing a laser irradiation of the epicardium which might be a cause of operative bleeding and for better allowing the sealing of the epicardium after the apparatus is removed. The apparatus includes a hand-held device controllable by the physician having a removable distal head portion with an auto-piercing mechanism and can use a vacuum source to provide a suction force at the head portion. The auto-piercing mechanism is implemented by various ways such as a spring-biased actuating member in the TMR hand-held device and an electro-mechanical operated piercing mechanism. The hand-held TMR device with handle assembly can also be controlled by a computer to provide auto- sequencing of the auto-piercing needle mechanism and the laser firing with auto-fiber advancement.
Inventors
- 👤 Henry N. Padilla
- 👤 Steven A. Daniel
- 👤 Richard L. Mueller
- 👤 Timothy C. Reynolds
- 👤 Stuart D. Harman
Bibliographic Details
Application Number
—
Jurisdiction
EP
Data Source
google_patents
Last Synchronized
2026-10-23 03:31
CPC Classifications
A; A61; A61B; A61B18/00; A61B18/18; A61B18/20; A61B18/22; A61B17/00; A61B17/34; A61B17/3403; A61B18/24; A61B2017/00017; A61B2017/00137; A61B2017/00154; A61B2017/00172; A61B17/00234; A61B2017/00238; A61B2017/00243; A61B2017/00247; A61B17/22; A61B2017/22072; A61B2017/22074; A61B2017/22075; A61B2017/22077; A61B2018/00053; A61B2018/00273; A61B2018/00291; A61B2018/00315; A61B2018/00345; A61B2018/00351; A61B2018/00392; A61B2018/208; A61B90/00; A61B90/36; A61B90/37
Claims Analysis
Total Claims: 20
Claim 1
Independent Claim
92 words
A hand controllable myocardial revascularization device
for performing transmyocardial revascularization (TMR)
procedures on a patient's heart comprising: a handle assembly with a head portion whose distal end is
configured to engage the heart; a channel forming device extending through the handle
assembly and head portion; piercing means surrounding the channel forming device for
making an initial opening in tissue, the piercing means moves
relative to the head portion and is translatable through the
head portion; and advancing means for controllably advancing the piercing
means, whereby the advancing means enables initial tissue
piercing.
Claim 2
Dependent Claim
24 words
The device of claim 1 wherein the advancing means
includes a spring and triggering means for actuating and
allowing displacement of the piercing means.
Claim 3
Dependent Claim
68 words
The device of claim 1 wherein the head portion includes
at least one opening on the distal end contact surface, the at
least one opening communicates through the handle portion
which configurably can connect to a vacuum source, whereby
activation of the vacuum source: a) draws the heart against
the head portion's distal end, b) assists removal of ablated
tissue and c) draws blood into a revascularizing channel.
Claim 4
Dependent Claim
69 words
The device of claim 1 wherein the channel forming
device is an optical fiber and the piercing means includes a
piercing tubular member that is retractable into the head
portion, the piercing tubular member has a tapered tip portion
and an internal bore for allowing slidable displacement of the
optical fiber, a distal section of the piercing tubular member
includes means for axially bending of the piercing tubular
member.
Claim 5
Dependent Claim
60 words
The device of claim 4 wherein the handle assembly
includes adjustment means for moving the optical fiber within
the handle assembly and head portion, the adjustment means
forms part of the handle assembly, whereby the optical fiber's
distal end can move beyond the head portion, and means for
presetting displacement of the optical fiber, thereby limiting
the optical fiber's displacements.
Claim 6
Dependent Claim
50 words
The device of claim 4 wherein the handle assembly further
includes rotational adjusting means for orienting the tapered
tip portion, the rotational adjusting means attaches to the
tubular member and the handle assembly, the piercing means
includes means for offsetting an angle of the optical fiber
from the piercing means.
Claim 7
Dependent Claim
28 words
The device of claim 5 wherein the adjustment means
includes a movable shuttle which connects to the optical fiber
and moves independently and inter-lockingly with the advancing
means.
Claim 8
Dependent Claim
18 words
The device of claim 1 wherein the advancing means
includes an actuator means for advancing the piercing means.
Claim 9
Dependent Claim
47 words
The device of claim 8 wherein the actuator means
includes a thumbwheel attached to the handle assembly, a belt
drive that rides on a pair of gear members, and a rotatably
mounted needle piercing element that translates within one of
the gear members bore with internal threads.
Claim 10
Dependent Claim
33 words
The device of claim 8 wherein the actuator means includes
a motor which drives a shaft whose distal end has a gear that
engages and rotatably drives a rotatably mounted needle
piercing element.
Claim 11
Dependent Claim
12 words
The device of claim 10 wherein the gear is a worm gear.
Claim 12
Dependent Claim
12 words
The device of claim 10 wherein the gear is a bevel gear.
Claim 13
Dependent Claim
43 words
The device of claim 8 wherein the actuator means includes
a motor which drives a shaft with a cam shaped distal surface
that engages and cooperatively engages a spring biased
reciprocating needle element whereby shaft rotations cause
displacements of the needle piercing element.
Claim 14
Dependent Claim
41 words
The device of claim 8 wherein the actuator means includes
a motor which drives a translating shaft having a surface
which engages a leaf-spring biased reciprocating needle
element whereby translating movements of the shaft cause
displacements of the needle piercing element.
Claim 15
Dependent Claim
40 words
The device of claim 8 wherein the actuator means includes
a motor which drives a pivotal shaft, a distal end of the
shaft engages a reciprocating needle element whereby pivoting
of the shaft cause displacements of the needle piercing
element.
Claim 16
Dependent Claim
32 words
The device of claim 5 wherein the adjustment means for
moving the optical fiber includes means for operably advancing
the optical fiber at a rate coordinated with a configurable
laser energy source.
Claim 17
Dependent Claim
35 words
The device of claim 8 wherein the adjustment means for
moving the optical fiber includes means for operably advancing
the optical fiber at a rate coordinated with the configurable
laser energy source for ablating tissue.
Claim 18
Dependent Claim
53 words
The device of claim 8 wherein the actuator includes a
motor and a means for controlling the motor, the motor is
controlled by movements of the thumbwheel, the thumbwheel
engages a first switching means for controlling advancement of
the piercing means and a second switching means for
controlling retraction of the piercing means.
Claim 19
Dependent Claim
185 words
A myocardial revascularization system for a procedure
on a patient's heart, the system comprising: a) a processor and a laser energy source controlled thereby; b) a handle assembly with head portion whose distal end is
configured to engage the heart; an optical fiber having a
proximal end connecting to the controllable laser energy
source, the optical fiber extending through the handle
assembly with a distal end of the optical fiber within the
head portion; adjustment means for moving the optical fiber
within the handle assembly and head portion; piercing means
for: a) making an initial opening in a surface of a heart and
b) allowing the optical fiber's movement there-through when
moved by the adjustment means, the piercing means moves
axially and rotationally relative to the head portion and is
translatable through the head portion; and c) advancing means for sequentially and controllably
advancing the piercing means and the adjustment means, the
processor controls the advancing means, whereby the advancing
means provides initial tissue piercing and operably advances
the optical fiber at a rate coordinated with the laser energy
source firing for controlled tissue ablation.
Claim 20
Dependent Claim
41 words
The system of claim 19 wherein the adjustment means
includes a first motor which attaches to the hand-held
assembly that drives the adjustment means and a second motor
which attaches to the handle assembly, the second motor drives
the piercing means.
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