IPC분류정보
국가/구분 |
United States(US) Patent
등록
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국제특허분류(IPC7판) |
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출원번호 |
US-0795192
(2010-06-07)
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등록번호 |
US-8690939
(2014-04-08)
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발명자
/ 주소 |
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출원인 / 주소 |
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대리인 / 주소 |
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인용정보 |
피인용 횟수 :
23 인용 특허 :
109 |
초록
▼
A method is provided including coupling a tissue-engaging element to a first portion of cardiac tissue of a heart of a patient and advancing toward the tissue-engaging element an adjustment mechanism along at least one guide member that is removably coupled to the tissue-engaging element. The adjust
A method is provided including coupling a tissue-engaging element to a first portion of cardiac tissue of a heart of a patient and advancing toward the tissue-engaging element an adjustment mechanism along at least one guide member that is removably coupled to the tissue-engaging element. The adjustment mechanism engages a first portion of a first flexible longitudinal member. A second portion of the first flexible longitudinal member is coupled to a second portion of cardiac tissue. Following the coupling of the second portion of the first flexible longitudinal member to the second portion of cardiac tissue, the adjustment mechanism is slid further along the guide member and coupled to the tissue-engaging element. Using the adjustment mechanism, a length of the first flexible longitudinal member is adjusted between the first and second portions of cardiac tissue. Other applications are also described.
대표청구항
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1. A method comprising: coupling a tissue-engaging element to a first portion of cardiac tissue of a heart of a patient;advancing toward the tissue-engaging element an adjustment mechanism along at least a portion of at least one guide member, a distal end of which is removably attached by a docking
1. A method comprising: coupling a tissue-engaging element to a first portion of cardiac tissue of a heart of a patient;advancing toward the tissue-engaging element an adjustment mechanism along at least a portion of at least one guide member, a distal end of which is removably attached by a docking assembly to the tissue-engaging element, the adjustment mechanism engaging at least a first portion of at least a first flexible longitudinal member;coupling a second portion of the first flexible longitudinal member to a second portion of cardiac tissue;following the coupling of the second portion of the first flexible longitudinal member to the second portion of cardiac tissue: sliding the adjustment mechanism further along the guide member; andsecuring the adjustment mechanism within the heart of the patient by locking the adjustment mechanism to the tissue-engaging element;using the adjustment mechanism, adjusting a length of the first flexible longitudinal member between the first and second portions of cardiac tissue; anddetaching the guide member from the docking assembly after the locking of the adjustment mechanism to the tissue-engaging element. 2. The method according to claim 1, wherein coupling the tissue-engaging element to the first portion of cardiac tissue comprises coupling the tissue-engaging element to a papillary muscle of a ventricle of the patient. 3. The method according to claim 1, wherein coupling the tissue-engaging element to the first portion of cardiac tissue comprises coupling the tissue-engaging element to a portion of an inner wall of a ventricle of the patient. 4. The method according to claim 1, wherein adjusting the length of the flexible longitudinal member comprises adjusting a distance between the first and second portions of cardiac tissue. 5. The method according to claim 1, wherein adjusting the length of the flexible longitudinal member comprises adjusting the length of the flexible longitudinal member during beating of the heart of the patient. 6. The method according to claim 1, wherein adjusting the length of the flexible longitudinal member comprises adjusting the length of the flexible longitudinal member during a first period thereof, and wherein the method further comprises further adjusting the length of the flexible longitudinal member during a second period that is after the first period. 7. The method according to claim 1, wherein coupling the tissue-engaging element to the first portion of cardiac tissue comprises coupling the tissue-engaging element to an intracardiac portion of tissue in a manner in which a distal portion of the tissue-engaging element does not extend beyond an epicardium of the heart of the patient. 8. The method according to claim 1, wherein coupling the second portion of the flexible longitudinal member to the second portion of cardiac tissue comprises coupling the second portion of the flexible longitudinal member to at least one leaflet of an atrioventricular valve of the patient. 9. The method according to claim 1, wherein coupling the second portion of the flexible longitudinal member to the second portion of cardiac tissue comprises coupling the second portion of the flexible longitudinal member to exactly one leaflet of an atrioventricular valve of the patient. 10. The method according to claim 1, wherein coupling the second portion of the flexible longitudinal member to the second portion of cardiac tissue comprises coupling, to a leaflet of an atrioventricular valve, a clip that is coupled to the second portion of the flexible longitudinal member. 11. The method according to claim 1, wherein locking the adjustment mechanism to the tissue-engaging element comprises locking the adjustment mechanism to a docking station coupled to the tissue-engaging element. 12. The method according to claim 1, wherein advancing the adjustment mechanism comprises transcatheterally advancing the adjustment mechanism. 13. The method according to claim 1, wherein advancing the adjustment mechanism comprises threading the guide member through an opening in the adjustment mechanism prior to the advancing. 14. The method according to claim 1, further comprising: advancing a first portion of a second flexible longitudinal member, toward the tissue-engaging element; andcoupling a second portion of the second flexible longitudinal member to a third portion of cardiac tissue. 15. The method according to claim 14, further comprising coupling the first portion of the second flexible longitudinal member to the tissue-engaging element following the coupling of the second portion of the second flexible longitudinal member to the third portion of cardiac tissue. 16. The method according to claim 14, wherein: the second portion of cardiac tissue includes a portion of tissue of a ventricle of the patient,coupling the second portion of the first flexible longitudinal member to the second portion of cardiac tissue comprises coupling the second portion of the first flexible longitudinal member to the portion of tissue of the ventricle of the patient,the third portion of cardiac tissue includes at least one leaflet of an atrioventricular valve of the heart of the patient, andcoupling the second portion of the second flexible longitudinal member to the third portion of cardiac tissue comprises coupling the second portion of the second flexible longitudinal member to the at least one leaflet of the atrioventricular valve. 17. The method according to claim 1, wherein the at least one guide member comprises first and second guide members, and wherein coupling the tissue-engaging element to the first portion of tissue comprises coupling a tissue-engaging element coupled to at least first and second docking stations of the docking assembly, the first and second docking stations being removably coupled to the first and second guide members, respectively. 18. The method according to claim 17, wherein: advancing the adjustment mechanism comprises:advancing a first adjustment mechanism along the first guide member, the first adjustment mechanism engaging at least the first portion of at least the first flexible longitudinal member; andcoupling the first adjustment mechanism to the first docking station, and the method further comprises:advancing a second adjustment mechanism along the second guide member, the second adjustment mechanism engaging at least a first portion of at least a second flexible longitudinal member; andcoupling the second adjustment mechanism to the second docking station. 19. The method according to claim 18, wherein the method further comprises coupling a second portion of the second flexible longitudinal member to a third portion of cardiac tissue. 20. The method according to claim 19, wherein: the second portion of cardiac tissue includes a portion of tissue of a ventricle of the patient,coupling the second portion of the first flexible longitudinal member to the second portion of cardiac tissue comprises coupling the second portion of the first flexible longitudinal member to the portion of tissue of the ventricle of the patient,the third portion of cardiac tissue includes at least one leaflet of an atrioventricular valve of the heart of the patient, andcoupling the second portion of the second flexible longitudinal member to the third portion of cardiac tissue comprises coupling the second portion of the second flexible longitudinal member to the at least one leaflet of the atrioventricular valve. 21. The method according to claim 1, wherein coupling the second portion of the first flexible longitudinal member to the second portion of cardiac tissue comprises coupling the second portion of the first flexible longitudinal member to a portion of a wall of a ventricle of the patient, and wherein adjusting the length of the flexible member. 22. The method according to claim 21, wherein adjusting the distance between the portion of the wall and the first portion of cardiac tissue comprises adjusting a heart wall malpositioning of the patient. 23. The method according to claim 1, wherein the adjustment mechanism includes a spool coupled to the first portion of the first flexible longitudinal member, and wherein adjusting the length of the first flexible longitudinal member using the adjustment mechanism comprises rotating the spool. 24. The method according to claim 23, further comprising unwinding a portion of the first flexible longitudinal member from around the spool, and wherein adjusting the length of the first flexible longitudinal member comprises applying tension to the first flexible longitudinal member subsequently to the unwinding. 25. The method according to claim 23, wherein adjusting the length of the first flexible longitudinal member comprises: applying tension to the first flexible longitudinal member by winding successive portions of the first flexible longitudinal member around the spool by rotating the spool in a first rotational direction thereof, andslackening the first flexible longitudinal member by unwinding the successive portions of the first flexible longitudinal member from around the spool by rotating the spool in a second rotational direction thereof opposite the first rotational direction. 26. The method according to claim 23, further comprising unlocking the spool prior to the adjusting the length of the first flexible longitudinal member, and locking the spool following the adjusting the length of the first flexible longitudinal member. 27. The method according to claim 1, wherein: the second portion of tissue includes at least one leaflet of an atrioventricular valve of the patient,the first flexible longitudinal member comprises an artificial chordea tendinea, and locking the adjustment mechanism to the tissue-engaging element comprises: advancing, between leaflets of the atrioventricular valve and into the ventricle, at least one shaft of a delivery tool, to which shaft the adjustment mechanism is removably coupled; andwhile the shaft remains coupled to the adjustment mechanism, coupling, using a coupling element holder of the delivery tool, at least one leaflet-engaging element to the at least one leaflet, wherein the second portion of the artificial chordea tendinea is coupled to the at least one leaflet-engaging element. 28. The method according to claim 27, wherein advancing the at least one shaft comprises transcatheterally advancing the at least one shaft. 29. The method according to claim 27, wherein coupling the at least one leaflet-engaging element to the at least one leaflet comprises coupling the at least one leaflet-engaging element to exactly one leaflet. 30. The method according to claim 27, wherein using the coupling element holder of the delivery tool comprises sliding the coupling element holder with respect to the guide member. 31. The method according to claim 1, wherein: the first flexible longitudinal member includes first and second cord portions thereof, each of the first and second cord portions having respective free ends,the first and second cord portions of the first flexible longitudinal member extend from the adjustment mechanism, andcoupling the second portion of the first flexible longitudinal member to the second portion of cardiac tissue comprises coupling each free end of the first and second cord portions to respective first and second leaflets of an atrioventricular valve of the patient. 32. The method according to claim 31, wherein adjusting the length of the first flexible longitudinal member comprises: adjusting a length of the first cord portion of the first flexible longitudinal member between the adjustment mechanism and the first leaflet;adjusting a length of the second cord portion of the first flexible longitudinal member between the adjustment mechanism and the second leaflet; andby the adjusting the lengths of the first and second cord portions of the first flexible longitudinal member, drawing together the first and second leaflets. 33. The method according to claim 32, wherein drawing together comprises drawing together the first and second leaflets using a bead through which the first and second cord portions of the first longitudinal member pass. 34. The method according to claim 33, wherein using the bead comprises advancing the bead to ventricular surfaces of the first and second leaflets, and wherein advancing the bead to the ventricular surfaces comprises creating an edge-to-edge repair of the first and second leaflets. 35. The method according to claim 1, wherein locking the adjustment mechanism to the tissue-engaging element comprises securing the first portion of the first flexible longitudinal member to the first portion of cardiac tissue by locking the adjustment mechanism to the tissue-engaging element. 36. The method according to claim 1, wherein coupling the second portion of the first longitudinal member to the second portion of cardiac tissue comprises coupling the second portion of the first flexible longitudinal member to the second portion of cardiac tissue by securing, to the second portion of cardiac tissue, a second tissue-engaging element that is removably coupled to the guide member. 37. The method according to claim 1, wherein sliding the adjustment mechanism further along the guide member comprises sliding the adjustment mechanism further along the guide member, toward the tissue-engaging element, and away from the second portion of the first flexible longitudinal member. 38. The method according to claim 1, wherein sliding the adjustment mechanism further along the guide member comprises moving the first portion of the first flexible longitudinal member with respect to the guide member and toward the tissue-engaging element by the sliding of the adjustment mechanism further along the guide member. 39. A method comprising: coupling a tissue-engaging element to a first portion of cardiac tissue of a heart of a patient;advancing toward the tissue-engaging element an adjustment mechanism along at least a portion of at least one guide member that is removably attached to the tissue-engaging element, the adjustment mechanism engaging at least a first portion of at least a first flexible longitudinal member;coupling a second portion of the first flexible longitudinal member to a second portion of cardiac tissue;following the coupling of the second portion of the first flexible longitudinal member to the second portion of cardiac tissue: sliding the adjustment mechanism further along the guide member; andsecuring the adjustment mechanism within the heart of the patient by locking the adjustment mechanism to the tissue-engaging element; andsubsequently, using the adjustment mechanism, adjusting a length of the first flexible longitudinal member between the first and second portions of cardiac tissue.
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