US20040138744A1 — Transluminal mitral annuloplasty with active anch…

Claim 1

Independent Claim 68 words

1 . A method of performing transluminal mitral annuloplasty, comprising the steps of: providing a catheter, having a prosthesis thereon; inserting the catheter into the venous system; transluminally advancing the prosthesis into the coronary sinus; advancing at least one tissue anchor from a retracted position to an extended position; and manipulating a component of the prosthesis to cause the prosthesis to exert force on the mitral valve annulus.

Claim 2

Dependent Claim 68 words

1 . A method of performing transluminal mitral annuloplasty, comprising the steps of: providing a catheter, having a prosthesis thereon; inserting the catheter into the venous system; transluminally advancing the prosthesis into the coronary sinus; advancing at least one tissue anchor from a retracted position to an extended position; and manipulating a component of the prosthesis to cause the prosthesis to exert force on the mitral valve annulus.

Claim 3

Dependent Claim 25 words

2 . A method as in claim 1 , further comprising the step of percutaneously accessing the venous system prior to the transluminally advancing step.

Claim 4

Dependent Claim 26 words

3 . A method as in claim 2 , wherein the accessing step is accomplished by accessing one of the internal jugular, subclavian and femoral veins.

Claim 5

Dependent Claim 31 words

4 . A method as in claim 1 , further comprising the steps of first measuring the coronary sinus and then selecting an appropriately sized prosthesis prior to the inserting step.

Claim 6

Dependent Claim 26 words

5 . A method as in claim 1 , further comprising the step of measuring hemodynamic function following the manipulating a component of the prosthesis step.

Claim 7

Dependent Claim 27 words

6 . A method as in claim 5 , further comprising the step of determining an ongoing drug therapy taking into account the post implantation hemodynamic function.

Claim 8

Dependent Claim 30 words

7 . A method as in claim 1 , wherein the advancing at least one tissue anchor step comprises advancing the anchor from an axial orientation to an inclined orientation.

Claim 9

Dependent Claim 47 words

8 . A method as in claim 7 , wherein the tissue anchor has a proximal end for piercing tissue and a distal point of attachment to the prosthesis, and the advancing at least one tissue anchor step comprises rotating the anchor about the point of attachment.

Claim 10

Dependent Claim 20 words

9 . A method as in claim 1 , comprising advancing at least two tissue anchors to an extended position.

Claim 11

Dependent Claim 20 words

10 . A method as in claim 8 , comprising advancing at least two tissue anchors to an extended position.

Claim 12

Dependent Claim 48 words

11 . A method as in claim 1 , wherein the manipulating a component of the prosthesis step causes the prosthesis to transform into a curved configuration having a first side facing towards the mitral valve annulus and a second side facing away from the mitral valve annulus.

Claim 13

Dependent Claim 28 words

12 . A method as in claim 11 , additionally comprising the step of advancing at least two tissue anchors in the direction of the mitral valve annulus.

Claim 14

Dependent Claim 37 words

13 . A method as in claim 12 , wherein a first tissue anchor inclines outwardly from the prosthesis in a distal direction and a second tissue anchor inclines outwardly from the prosthesis in a proximal direction.

Claim 15

Dependent Claim 28 words

14 . A method as in claim 1 , wherein the manipulating step comprises axially moving a forming element with respect to the prosthesis, to bend the prosthesis.

Claim 16

Dependent Claim 28 words

15 . A method as in claim 1 , further comprising the step of locking the prosthesis to retain a force on the annulus following the manipulating step.

Claim 17

Dependent Claim 26 words

16 . A method as in claim 15 , wherein the locking step comprises moving an engagement surface from a disengaged configuration to an engaged configuration.

Claim 18

Dependent Claim 18 words

17 . A method as in claim 15 , wherein the locking step comprises providing an interference fit.

Claim 19

Dependent Claim 19 words

18 . A method as in claim 15 , wherein the locking step is accomplished with a threaded engagement.

Claim 20

Dependent Claim 22 words

19 . A method as in claim 5 , wherein the step of monitoring hemodynamic function is accomplished using transesophageal echo cardiography.

Claim 21

Dependent Claim 23 words

20 . A method as in claim 5 , wherein the step of monitoring hemodynamic function is accomplished using surface echo cardiographic imaging.

Claim 22

Dependent Claim 23 words

21 . A method as in claim 5 , wherein the step of monitoring hemodynamic function is accomplished using intracardiac echo cardiographic imaging.

Claim 23

Dependent Claim 23 words

22 . A method as in claim 5 , wherein the step of monitoring hemodynamic function is accomplished using fluoroscopy with radiocontrast media.

Claim 24

Dependent Claim 27 words

23 . A method as in claim 5 , wherein the step of monitoring hemodynamic function is accomplished using left atrial or pulmonary capillary wedge pressure measurements.

Claim 25

Dependent Claim 101 words

24 . A method of providing a therapeutic compressive force against a tissue structure which is adjacent to a vessel wall, the vessel wall having a first side and a second side, comprising the steps of positioning a device in the vessel; advancing a proximal tissue anchor from the device into the first side; advancing a distal tissue anchor from the device into the first side; and manipulating a forming element within the device to cause the device to exert a force against the first side of the wall of the vessel in between the proximal anchor and the distal anchor.

Claim 26

Dependent Claim 101 words

24 . A method of providing a therapeutic compressive force against a tissue structure which is adjacent to a vessel wall, the vessel wall having a first side and a second side, comprising the steps of positioning a device in the vessel; advancing a proximal tissue anchor from the device into the first side; advancing a distal tissue anchor from the device into the first side; and manipulating a forming element within the device to cause the device to exert a force against the first side of the wall of the vessel in between the proximal anchor and the distal anchor.

Claim 27

Dependent Claim 16 words

25 . A method as in claim 24 , wherein the positioning step is accomplished percutaneously.

Claim 28

Dependent Claim 18 words

26 . A method as in claim 24 , wherein the tissue structure comprises the mitral valve annulus.

Claim 29

Dependent Claim 17 words

27 . A method as in claim 24 , wherein the tissue structure comprises the left ventricle.

Claim 30

Dependent Claim 15 words

28 . A method as in claim 24 , wherein the vessel comprises a vein.

Claim 31

Dependent Claim 91 words

29 . A method of performing annuloplasty of the mitral valve comprising positioning a prosthesis in the coronary sinus; rotating a first portion of the device with respect to a second portion of the device to cause the device to bend into an arcuate configuration having a proximal concavity and a distal concavity both concave toward the mitral valve and a central concavity concave away from the mitral valve, to provide a compressive force on the mitral valve annulus; and securing the device in the arcuate configuration within the coronary sinus.

Claim 32

Dependent Claim 91 words

29 . A method of performing annuloplasty of the mitral valve comprising positioning a prosthesis in the coronary sinus; rotating a first portion of the device with respect to a second portion of the device to cause the device to bend into an arcuate configuration having a proximal concavity and a distal concavity both concave toward the mitral valve and a central concavity concave away from the mitral valve, to provide a compressive force on the mitral valve annulus; and securing the device in the arcuate configuration within the coronary sinus.

Claim 33

Dependent Claim 24 words

30 . A method as in claim 29 , further comprising the step of percutaneously accessing the venous system prior to the positioning step.

Claim 34

Dependent Claim 26 words

31 . A method as in claim 30 , wherein the accessing step is accomplished by accessing one of the internal jugular, subclavian and femoral veins.

Claim 35

Dependent Claim 24 words

32 . A method as in claim 29 , wherein the securing step comprises engaging a first threaded surface with a second threaded surface.

Claim 36

Dependent Claim 21 words

33 . A method as in claim 29 , further comprising the step of measuring hemodynamic function following the rotating step.

Claim 37

Dependent Claim 27 words

34 . A method as in claim 33 , further comprising the step of determining an ongoing drug therapy taking into account the post implantation hemodynamic function.

Claim 38

Dependent Claim 105 words

35 . A medical apparatus for remodeling a mitral valve annulus adjacent to the coronary sinus, comprising: an elongate body, having a proximal end region and a distal end region, each of the proximal and distal end regions configured to move between a first, flexible configuration for transluminal delivery to at least a portion of the coronary sinus and a second remodeling configuration in which each of the proximal and distal end regions forms a curve which is open in the direction of the mitral valve; and a forming element for manipulating the elongate body between the first transluminal configuration and the second remodeling configuration.

Claim 39

Dependent Claim 105 words

35 . A medical apparatus for remodeling a mitral valve annulus adjacent to the coronary sinus, comprising: an elongate body, having a proximal end region and a distal end region, each of the proximal and distal end regions configured to move between a first, flexible configuration for transluminal delivery to at least a portion of the coronary sinus and a second remodeling configuration in which each of the proximal and distal end regions forms a curve which is open in the direction of the mitral valve; and a forming element for manipulating the elongate body between the first transluminal configuration and the second remodeling configuration.

Claim 40

Dependent Claim 24 words

36 . A medical apparatus as in claim 35 , wherein the elongate body comprises a tube having a plurality of transverse slots therein.

Claim 41

Dependent Claim 26 words

37 . A medical apparatus as in claim 36 , wherein the elongate body transforms into the remodeling configuration by changing the width of the slots.

Claim 42

Dependent Claim 17 words

38 . A medical apparatus as in claim 35 , further comprising a coating on the body.

Claim 43

Dependent Claim 32 words

39 . A medical apparatus as in claim 35 , wherein the apparatus is movable from the implantation configuration to the remodeling configuration in response to proximal retraction of the forming element.

Claim 44

Dependent Claim 32 words

40 . A medical apparatus as in claim 35 , wherein the apparatus is movable from the implantation configuration to the remodeling configuration in response to distal advancement of the forming element.

Claim 45

Dependent Claim 31 words

41 . A medical apparatus as in claim 35 , wherein the apparatus is movable from the implantation configuration to the remodeling configuration in response to rotation of a threaded shaft.

Claim 46

Dependent Claim 25 words

42 . A medical apparatus as in claim 35 , further comprising an anchor for retaining the apparatus at a deployment site within a vessel.

Claim 47

Dependent Claim 20 words

43 . A medical apparatus as in claim 42 , wherein the anchor comprises a distal extension of the apparatus.

Claim 48

Dependent Claim 24 words

44 . A medical apparatus as in claim 42 , wherein the anchor comprises a surface structure for engaging the wall of the vessel.

Claim 49

Dependent Claim 25 words

45 . A medical apparatus as in claim 35 , wherein the anchor comprises at least one barb for piercing the wall of the vessel.

Claim 50

Dependent Claim 28 words

46 . A medical apparatus as in claim 45 , comprising a first barb on the proximal end region and a second barb on the distal end region.

Claim 51

Dependent Claim 134 words

47 . An implant for positioning within a patient, comprising: an elongate flexible body having a proximal end and a distal end, and a longitudinal axis extending therebetween, and first and second opposing sides extending along the implant body; the first side having at least one fixed axial length section, and the second side having at least one fixed axial length section, axially offset from the fixed axial length section on the first side; at least a first forming element extending through the body to a distal point of attachment to the body; and a detachable coupling on a proximal portion of the body, for removably attaching the body to a deployment catheter; wherein manipulation of the first forming element deflects at least a first portion of the body away from the longitudinal axis.

Claim 52

Dependent Claim 134 words

47 . An implant for positioning within a patient, comprising: an elongate flexible body having a proximal end and a distal end, and a longitudinal axis extending therebetween, and first and second opposing sides extending along the implant body; the first side having at least one fixed axial length section, and the second side having at least one fixed axial length section, axially offset from the fixed axial length section on the first side; at least a first forming element extending through the body to a distal point of attachment to the body; and a detachable coupling on a proximal portion of the body, for removably attaching the body to a deployment catheter; wherein manipulation of the first forming element deflects at least a first portion of the body away from the longitudinal axis.

Claim 53

Dependent Claim 16 words

48 . An implant as in claim 47 , wherein the body comprises a tubular wall.

Claim 54

Dependent Claim 42 words

49 . An implant as in claim 47 , comprising a plurality of voids in the wall along the second side, opposing the fixed axial length section on the first side, thereby permitting adjustment of the axial length of the second side.

Claim 55

Dependent Claim 27 words

50 . An implant as in claim 49 wherein at least some of the voids comprise slots through the wall, extending generally transverse to the longitudinal axis.

Claim 56

Dependent Claim 21 words

51 . An implant as in claim 50 comprising at least 10 transverse slots in the wall of the second side.

Claim 57

Dependent Claim 21 words

52 . An implant as in claim 51 comprising at least 20 transverse slots in the wall of the second side.

Claim 58

Dependent Claim 19 words

53 . An implant as in claim 50 , wherein the first forming element comprises an axially movable element.

Claim 59

Dependent Claim 18 words

54 . An implant as in claim 53 , wherein the first forming element comprises a pull wire.

Transluminal mitral annuloplasty with active anchoring

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