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WO2000074579A2 - Procedes et appareil pour greffe medicale - Google Patents

Procedes et appareil pour greffe medicale Download PDF

Info

Publication number
WO2000074579A2
WO2000074579A2 PCT/US2000/015259 US0015259W WO0074579A2 WO 2000074579 A2 WO2000074579 A2 WO 2000074579A2 US 0015259 W US0015259 W US 0015259W WO 0074579 A2 WO0074579 A2 WO 0074579A2
Authority
WO
WIPO (PCT)
Prior art keywords
body conduit
fingers
tubing
connector
new length
Prior art date
Application number
PCT/US2000/015259
Other languages
English (en)
Other versions
WO2000074579A3 (fr
Inventor
John Logan
Scott Thome
Alex Peterson
Todd A. Berg
Original Assignee
St. Jude Medical Cardiovascular Group, Inc.
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by St. Jude Medical Cardiovascular Group, Inc. filed Critical St. Jude Medical Cardiovascular Group, Inc.
Priority to AU53175/00A priority Critical patent/AU5317500A/en
Priority to EP00938087A priority patent/EP1187566A2/fr
Publication of WO2000074579A2 publication Critical patent/WO2000074579A2/fr
Publication of WO2000074579A3 publication Critical patent/WO2000074579A3/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/32—Surgical cutting instruments
    • A61B17/3205—Excision instruments
    • A61B17/32053—Punch like cutting instruments, e.g. using a cylindrical or oval knife
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/11—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/12—Surgical instruments, devices or methods for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels or umbilical cord
    • A61B17/122—Clamps or clips, e.g. for the umbilical cord
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/00234—Surgical instruments, devices or methods for minimally invasive surgery
    • A61B2017/00238—Type of minimally invasive operation
    • A61B2017/00243—Type of minimally invasive operation cardiac
    • A61B2017/00247—Making holes in the wall of the heart, e.g. laser Myocardial revascularization
    • A61B2017/00252—Making holes in the wall of the heart, e.g. laser Myocardial revascularization for by-pass connections, i.e. connections from heart chamber to blood vessel or from blood vessel to blood vessel
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/11—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis
    • A61B2017/1107—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis for blood vessels
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/11—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis
    • A61B2017/1135—End-to-side connections, e.g. T- or Y-connections

Definitions

  • the graft transfer sheath 180 assists in the mounting of the new length of tubing 122 onto the apparatus 100, and more particularly, the connector support mechanism 134, without compromising the delicate intima of the new length of tubing.
  • the graft transfer sheath 180 is preferably fabricated from a low friction, biocompatible polymer such as, e.g., polyethylene or polytetrafluoroetylene, or similar material.
  • the sheath 180 may alternatively be made of metal, such as, e.g., stainless steel.
  • the sheath 180 may have an elongated body portion 182, a tapered end proximal portion 184, and an internal lumen 186.
  • the tapered tip portion 184 having an atraumatic tip, allows the new length of tubing to be loaded over the sheath 180, in the direction indicated by arrow B.
  • the nosecone 310 is placed over the distal portion 163 of the inner retention member 162.
  • the nosecone 310 may have a body portion 312 which is movable with the inner retention member 162.
  • a plurality of leaves 314 extend proximally from the body portion 312.
  • Each leaf 314 is positioned between struts 218 and 220 of each external finger 206, and covers a graft attachment member 202.
  • each leaf 314 is resiliently biased radially inwardly. Leaves 314 cover the graft attachment member 202 during insertion into the body conduit, and prevents the sharpened tip portions of members 202 from inadvertently tearing or snagging on tissue.
  • FIGS. 18 and 19 An alternative embodiment of the nosecone and cutting mechanism is illustrated in FIGS. 18 and 19. Under certain surgical conditions, it may be useful or preferable to provide one instrument for deploying the connector and graft, and a separate instrument for providing an aperture in the body conduit to which the connector and graft are to be attached.
  • FIG. 18 illustrates an alterative embodiment of the distal end portion 430 of an apparatus 400 for deploying the connector and graft. Apparatus 400 is substantially identical to apparatus 100 as illustrated in FIGS. 1 and 16, above, with several of the substantial differences noted herein. For example, the cutting mechanism 132 depicted in FIGS. 16 and 17 has been eliminated from apparatus 400.
  • a modified nosecone 410 is provided which has an atraumatic tip portion 416, which may be hemispherical or conical.
  • FIG. 20 illustrates an early stage in the use of apparatus 100 in accordance with the invention.
  • the physician provides surgical access to the operative site. Surgical access provides improved visibility to the physician during the procedure. It may also allow management of bleeding by the introduction of equipment to remove blood from the operative cavity as well the introduction of equipment to irrigate the region. This approach also allows for the removal of inconsequential tissue such as fascia and fat from the anastomosis sites . Accordingly, the region above the operative site on the skin surface of the patient is located. As illustrated in FIG. 20, the location of heart 12 in the chest of the patient is found. An incision 14 is made in the chest. Although reference is made to a single incision, it is contemplated that several incisions and access points may be made.
  • a retractor clamp 16 may be applied to the incision to hold it in an open position.
  • the retractor clamp may be configured to partially deflect the ribs apart.
  • a trocar tube or cannula may placed in the incision to facilitate the introduction and removal of surgical instrumentation. If further accessibility is required, a portion of the connective tissue and cartilage between the ribs may be removed to view the operative region and allow access for surgical instrumentation. In yet another alternative where more accessibility is required, one or more of the ribs may be cut adjacent the sternum and deflected. All of these methods of surgically accessing the region adjacent the heart may be less traumatic on the patient than the conventional medial sternotomy.
  • FIG. 20 illustrates the aorta 20, which preferably serves as the existing body conduit and the arterial blood source in the exemplary embodiment. Coronary arteries 22 and 24 are at least partially blocked by occlusions or lesions 26 and 28, respectively.
  • the cannula needle 500 may be retracted proximally from the coronary artery 24.
  • a coring tip 530 similar to the coring tip 324, described above, is advanced distally to the outer surface of the wall of the coronary artery 24 (FIG. 27) .
  • the barb support member 520 is retracted proximally, preferably by withdrawing the catheter 522 (as indicated by arrow F) .
  • the wall of the coronary artery is trapped between the barbs 526 and the coring tip 530.
  • the coring tip 530 is rotated about the longitudinal axis (as indicated by arrow G) and advanced distally into the coronary artery wall in order to cut the section 42 to be removed. Further advancement of coring tip 530 into the wall of the coronary artery 24 removes the section 42 as a cylindrical plug section.
  • Barbs 526 retain the plug 42 inside the coring tip 530 and prevent the plug 42 from entering the bloodstream (FIG. 29) .
  • the distal portion 130 of apparatus 100 is advanced further into the aorta through the aperture created at location 36 by the cutting mechanism 134.
  • the details of the cutting mechanism have been omitted in order to simplify the ensuing discussion.
  • nosecone 310 and annular sleeve 164 which retains internal members 204, are inserted into the lumen of the aorta 20.
  • the physician may subsequently advance the inner retention member 162, and annular sleeve 164 and nosecone 310 therewith (as indicated by arrow H) , while maintaining the support member 152 and the outer retention member 160 stationary. This is preferably accomplished by an actuation member, such as slide control 116 on the proximal handle portion 110.
  • the delivery sheath 124 which retains external fingers in their backwardly deflected positioned, is retracted proximally from its position adjacent the aorta 20 (illustrated in dashed line) to a position spaced further apart, in the direction indicated by arrow K. This permits the external fingers 206 to resiliently expand radially outwardly and contact the external surface of the aorta 20 (in the direction indicated by arrows L) .

Landscapes

  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Prostheses (AREA)
  • Media Introduction/Drainage Providing Device (AREA)

Abstract

Instrument permettant de faciliter la coupe d'une ouverture dans une paroi latérale d'un conduit corporel chez un patient. Une structure tubulaire possède un passage et possède une partie terminale distale affutée configurée pour couper une partie du conduit corporel afin d'y créer l'ouverture. Une structure de retenue des tissus est axialement mobile dans le passage situé à l'intérieur de la structure tubulaire. La structure de retenue des tissus comporte une partie de perçage destinée à permettre le passage de ladite structure dans le conduit corporel d'un côté entrée jusqu'à un côté sortie. La structure de retenue des tissus possède également un élément de retenue destiné à assurer la fixation de la partie du conduit corporel à la structure de retenue des tissus pendant le mouvement de la structure de retenue des tissus de manière à rapprocher le côté entrée du conduit corporel avec la partie distale affutée de la structure tubulaire pour permettre à la structure distale affutée de couper le conduit corporel. Ledit instrument possède également un connecteur destiné à attacher une nouvelle longueur de tube au conduit corporel au niveau de l'ouverture ménagée par coupe.
PCT/US2000/015259 1999-06-04 2000-06-02 Procedes et appareil pour greffe medicale WO2000074579A2 (fr)

Priority Applications (2)

Application Number Priority Date Filing Date Title
AU53175/00A AU5317500A (en) 1999-06-04 2000-06-02 Medical grafting apparatus and methods
EP00938087A EP1187566A2 (fr) 1999-06-04 2000-06-02 Procedes et appareil pour greffe medicale

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US13776499P 1999-06-04 1999-06-04
US60/137,764 1999-06-04

Publications (2)

Publication Number Publication Date
WO2000074579A2 true WO2000074579A2 (fr) 2000-12-14
WO2000074579A3 WO2000074579A3 (fr) 2001-07-12

Family

ID=22478950

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/US2000/015259 WO2000074579A2 (fr) 1999-06-04 2000-06-02 Procedes et appareil pour greffe medicale

Country Status (3)

Country Link
EP (1) EP1187566A2 (fr)
AU (1) AU5317500A (fr)
WO (1) WO2000074579A2 (fr)

Cited By (14)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6517558B2 (en) 1999-01-15 2003-02-11 Ventrica, Inc. Methods and devices for forming vascular anastomoses
US6719768B1 (en) 2000-04-29 2004-04-13 Ventrica, Inc. Magnetic components for use in forming anastomoses, creating ports in vessels and closing openings in tissue
US6802847B1 (en) 2000-04-29 2004-10-12 Ventrica, Inc. Devices and methods for forming magnetic anastomoses and ports in vessels
WO2004086985A1 (fr) * 2003-03-28 2004-10-14 St Jude Medical Atg, Inc. Dispositif de realisation de raccordement anastomotique plus large que le conduit de greffe
US6814743B2 (en) 2001-12-26 2004-11-09 Origin Medsystems, Inc. Temporary seal and method for facilitating anastomosis
EP1683491A1 (fr) * 2000-11-09 2006-07-26 Innovative Interventional Technologies B.V. Applicateur de dispositifs d'anastomose
US7232449B2 (en) 2000-04-29 2007-06-19 Medtronic, Inc. Components, systems and methods for forming anastomoses using magnetism or other coupling means
US7708712B2 (en) 2001-09-04 2010-05-04 Broncus Technologies, Inc. Methods and devices for maintaining patency of surgically created channels in a body organ
WO2014179310A1 (fr) 2013-04-29 2014-11-06 Regenerative Sciences, Llc Dispositif de rapprochement percutané de tendon-muscle-ligament
US9913969B2 (en) 2006-10-05 2018-03-13 Broncus Medical Inc. Devices for delivering substances through an extra-anatomic opening created in an airway
US10272260B2 (en) 2011-11-23 2019-04-30 Broncus Medical Inc. Methods and devices for diagnosing, monitoring, or treating medical conditions through an opening through an airway wall
US10631938B2 (en) 2011-05-13 2020-04-28 Broncus Medical Inc. Methods and devices for diagnosing, monitoring, or treating medical conditions through an opening through an airway wall
CN117838029A (zh) * 2024-01-19 2024-04-09 中国人民解放军总医院第八医学中心 一种泌尿外科微创手术定位装置
JP7538283B2 (ja) 2018-03-29 2024-08-21 テルモ株式会社 医療デバイス

Families Citing this family (20)

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NL1007349C2 (nl) 1997-10-24 1999-04-27 Suyker Wilhelmus Joseph Leonardus Systeem voor het mechanisch vervaardigen van anastomoses tussen holle structuren; alsmede inrichting en applicator voor gebruik daarbij.
CN1303250A (zh) 1998-05-29 2001-07-11 拜帕斯公司 血管手术方法和装置
US6979338B1 (en) 1998-05-29 2005-12-27 By-Pass Inc. Low profile anastomosis connector
US7063711B1 (en) 1998-05-29 2006-06-20 By-Pass, Inc. Vascular surgery
US6461320B1 (en) 1998-08-12 2002-10-08 Cardica, Inc. Method and system for attaching a graft to a blood vessel
US6206913B1 (en) 1998-08-12 2001-03-27 Vascular Innovations, Inc. Method and system for attaching a graft to a blood vessel
US7018387B2 (en) 1998-10-22 2006-03-28 Innovative Interventional Technologies B.V. Mechanical anastomosis system for hollow structures
US7578828B2 (en) 1999-01-15 2009-08-25 Medtronic, Inc. Methods and devices for placing a conduit in fluid communication with a target vessel
US7025773B2 (en) 1999-01-15 2006-04-11 Medtronic, Inc. Methods and devices for placing a conduit in fluid communication with a target vessel
US6428550B1 (en) 1999-05-18 2002-08-06 Cardica, Inc. Sutureless closure and deployment system for connecting blood vessels
US6673088B1 (en) 1999-05-18 2004-01-06 Cardica, Inc. Tissue punch
AU5150600A (en) 1999-05-18 2000-12-05 Vascular Innovations, Inc. Tissue punch
US7048751B2 (en) 2001-12-06 2006-05-23 Cardica, Inc. Implantable medical device such as an anastomosis device
US6776785B1 (en) 2000-10-12 2004-08-17 Cardica, Inc. Implantable superelastic anastomosis device
US7335216B2 (en) 2002-01-22 2008-02-26 Cardica, Inc. Tool for creating an opening in tissue
US7029482B1 (en) 2002-01-22 2006-04-18 Cardica, Inc. Integrated anastomosis system
US7223274B2 (en) 2002-01-23 2007-05-29 Cardica, Inc. Method of performing anastomosis
US8308682B2 (en) 2003-07-18 2012-11-13 Broncus Medical Inc. Devices for maintaining patency of surgically created channels in tissue
US7585306B2 (en) 2003-12-24 2009-09-08 Maquet Cardiovascular Llc Anastomosis device, tools and methods of using
JP2014521381A (ja) 2011-05-13 2014-08-28 ブロンカス テクノロジーズ， インコーポレイテッド 組織の切除のための方法およびデバイス

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US5695504A (en) * 1995-02-24 1997-12-09 Heartport, Inc. Devices and methods for performing a vascular anastomosis
US5690662A (en) * 1995-10-12 1997-11-25 The Trustees Of Columbia University In The City Of New York Device and method to create a smooth opening on a tubular structure such as an artery or a vein
DE19650204C2 (de) * 1996-12-04 2000-09-21 Aesculap Ag & Co Kg Chirurgische Stanze
US5893369A (en) * 1997-02-24 1999-04-13 Lemole; Gerald M. Procedure for bypassing an occlusion in a blood vessel
US5827316A (en) * 1997-06-05 1998-10-27 Atrion Medical Products, Inc. Rotating aortic punch
DE69833882T2 (de) * 1998-01-30 2006-08-17 St. Jude Medical ATG, Inc., Maple Grove Medizinischer transplantatverbinder oder stopfen sowie verfahren zu ihrer herstellung
US6152937A (en) * 1998-11-06 2000-11-28 St. Jude Medical Cardiovascular Group, Inc. Medical graft connector and methods of making and installing same
US6113612A (en) * 1998-11-06 2000-09-05 St. Jude Medical Cardiovascular Group, Inc. Medical anastomosis apparatus

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Cited By (24)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6517558B2 (en) 1999-01-15 2003-02-11 Ventrica, Inc. Methods and devices for forming vascular anastomoses
US6719768B1 (en) 2000-04-29 2004-04-13 Ventrica, Inc. Magnetic components for use in forming anastomoses, creating ports in vessels and closing openings in tissue
US6802847B1 (en) 2000-04-29 2004-10-12 Ventrica, Inc. Devices and methods for forming magnetic anastomoses and ports in vessels
US7232449B2 (en) 2000-04-29 2007-06-19 Medtronic, Inc. Components, systems and methods for forming anastomoses using magnetism or other coupling means
EP1987783A3 (fr) * 2000-11-09 2009-03-18 Innovative Interventional Technologies B.V. Applicateur et procédé de connexion mécanique de structures creuses, en particulier des petits vaisseaux sanguins, ainsi que des dispositifs auxiliaires
EP1683491A1 (fr) * 2000-11-09 2006-07-26 Innovative Interventional Technologies B.V. Applicateur de dispositifs d'anastomose
US7708712B2 (en) 2001-09-04 2010-05-04 Broncus Technologies, Inc. Methods and devices for maintaining patency of surgically created channels in a body organ
US7544203B2 (en) 2001-12-26 2009-06-09 Maquet Cardiovascular Llc Temporary seal and method for facilitating anastomosis
US6814743B2 (en) 2001-12-26 2004-11-09 Origin Medsystems, Inc. Temporary seal and method for facilitating anastomosis
US7947062B2 (en) 2001-12-26 2011-05-24 Maquet Cardiovascular Llc Temporary anastomotic seal and method
US9345461B2 (en) 2001-12-26 2016-05-24 Maquet Cardiovascular Llc Temporary anastomotic seal and method
US11123052B2 (en) 2001-12-26 2021-09-21 Maquet Cardiovascular Llc Temporary anastomotic seal and method
US8790358B2 (en) 2003-03-28 2014-07-29 St. Jude Medical, Cardiology Division, Inc. Methods and apparatus for making anastomotic connections larger than the graft conduit
WO2004086985A1 (fr) * 2003-03-28 2004-10-14 St Jude Medical Atg, Inc. Dispositif de realisation de raccordement anastomotique plus large que le conduit de greffe
US10369339B2 (en) 2004-07-19 2019-08-06 Broncus Medical Inc. Devices for delivering substances through an extra-anatomic opening created in an airway
US11357960B2 (en) 2004-07-19 2022-06-14 Broncus Medical Inc. Devices for delivering substances through an extra-anatomic opening created in an airway
US9913969B2 (en) 2006-10-05 2018-03-13 Broncus Medical Inc. Devices for delivering substances through an extra-anatomic opening created in an airway
US10631938B2 (en) 2011-05-13 2020-04-28 Broncus Medical Inc. Methods and devices for diagnosing, monitoring, or treating medical conditions through an opening through an airway wall
US12016640B2 (en) 2011-05-13 2024-06-25 Broncus Medical Inc. Methods and devices for diagnosing, monitoring, or treating medical conditions through an opening through an airway wall
US10272260B2 (en) 2011-11-23 2019-04-30 Broncus Medical Inc. Methods and devices for diagnosing, monitoring, or treating medical conditions through an opening through an airway wall
EP2996577A4 (fr) * 2013-04-29 2017-04-19 Regenerative Sciences, LLC Dispositif de rapprochement percutané de tendon-muscle-ligament
WO2014179310A1 (fr) 2013-04-29 2014-11-06 Regenerative Sciences, Llc Dispositif de rapprochement percutané de tendon-muscle-ligament
JP7538283B2 (ja) 2018-03-29 2024-08-21 テルモ株式会社 医療デバイス
CN117838029A (zh) * 2024-01-19 2024-04-09 中国人民解放军总医院第八医学中心 一种泌尿外科微创手术定位装置

Also Published As

Publication number Publication date
EP1187566A2 (fr) 2002-03-20
WO2000074579A3 (fr) 2001-07-12
AU5317500A (en) 2000-12-28

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