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System for tissue cavity closure

a tissue cavity and tissue technology, applied in the field of tissue cavity closure systems, can solve the problems of significant bleeding, inability to adequately create the desired suture stitch, abrasion and trauma between the metallic staple and the soft tissue surface, etc., to achieve less invasive treatment, prevent tissue expansion, and reduce the volume of the atria

Inactive Publication Date: 2006-01-05
ATRICURE
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  • Summary
  • Abstract
  • Description
  • Claims
  • Application Information

AI Technical Summary

Benefits of technology

The invention is about a device and method for treating atrial fibrillation and other conditions involving the heart. The device is designed to isolate the atrial appendage, which is a pouch-like structure in the heart that can form a site for blood clots. The device uses a reinforced stitch to compress the atrial appendage and prevent clots from forming there. The invention offers a less invasive way to treat these conditions, reducing the need for large incisions and minimizing hospital stays and recovery times. The device includes a suturing grasper that passes needles and suture through the atrial appendage to create a reinforced stitch. The needles can be superelastic or malleable, and the device can be used in other procedures where access is limited. Overall, the invention provides a more effective and efficient way to treat atrial fibrillation and other heart conditions.

Problems solved by technology

However, during beating heart procedures and minimally invasive access to the heart commonly associated with mini-sternotomies, mini-thoracotomies, port access, and subxiphoid access, such manual surgical techniques require too much time, are accompanied with significant bleeding, and are not able to adequately create the desired suture stitch to completely close the orifice into the atrial appendage.
The stapling approach, however successful, causes abrasion and trauma between the metallic staple and the soft tissue surface.
These approaches leave foreign material exposed to blood flow which material increases the risk of thromboembolism and increases the possibility that patients undergoing this procedure still require anticoagulation regimen such as Coumadin to prevent clots from forming in the heart.
In addition, the risk of dislodgement for such patches is high, whether associated with fracture of the patch attachment means, degradation of the patch materials, mechanical damage to the device during manual compression of the heart (e.g. CPR) or other unexpected mechanical manipulation.
Any dislodgement of such patch-type devices is life-threatening.
These approaches either do not adequately attach the isolation device to the tissue surface or are associated with high stresses at the attachment point, which can lead to tissue abrasion, tearing, or other unwanted tissue response.

Method used

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Experimental program
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embodiment 109

[0040]FIG. 3 shows a side view of heart 91 that contains pledgeted stitch 109 isolating left atrial appendage 97 by juxtaposing opposing endocardial walls of left atrium 94 between two reinforced pledgets 109 such that clots within and the trabeculated interior surface of the left atrial appendage is separated from blood flow. In addition, left atrial volume is significantly reduced. Each suture strand 118 extends from outside the first reinforced pledget where continuous length of strand 115 defines an anchor, through an opening or puncture site in the first reinforced pledget, through the juxtaposed atrial walls, through an opening or puncture site in the second reinforced pledget, and outside the second reinforced pledget where suture strand free ends are tied into a knot or otherwise anchored to prevent relaxation of tightened stitch 112. Once the stitch is tightened, the reinforced pledgets are positioned intimately against the epicardial surfaces of the left atrial appendage a...

embodiment 1

[0042] In embodiment 1 in FIGS. 5A to 5D and FIGS. 6A to 6C, appendage isolation grasper 1 is shown with single reinforced pledget 109 housed in lower jaw 181 (upper jaw 208 does not show a reinforced pledget purely for illustration purposes; in practice the upper jaw may or may not contain a reinforced pledget, depending on the application), and two resilient (or deformable) needles 211. FIGS. 5A to 5D show the grasper with the jaws in a closed orientation and with two resilient (or deformable) needles fully deployed. FIGS. 6A to 6C show the grasper with the upper jaw in an open orientation.

[0043] Appendage isolation grasper 1 incorporates two lumens into which the needles are compressed into a low profile for insertion through trocar, cannulae, or introducer. Lower jaw 181 incorporates two separate channels 190 associated with confining lumens and containing exit points 195 through which needles 211 pass. The lower jaw channels are curved to guide / direct the needles upward through...

embodiment 451

[0056]FIGS. 11A to 11C show a perspective view, a top view and a side view of another reinforced pledget embodiment 451. This reinforced pledget embodiment incorporates two openings 454 separated by an axially oriented central link 457 and defining spaces through a support structure 463 through which suture strand free ends 121 are advanced using actuated needles 211 of appendage isolation system 1. The length (“I2”) of the central link is chosen based on the distribution requirements. As the flattened profile increases, the length of the central link is increased to accommodate the desire to distribute the forces along a greater length. The openings through the support structure match channel exit point spacing 193 for the grasper.

[0057]FIGS. 12A to 12C show a perspective view, a top view and a side view of a reinforced pledget embodiment 496. This reinforced pledget embodiment is fabricated from a resilient polymer through which suture strand free ends 121 can be advanced using ac...

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Abstract

Surgical systems for less invasive access to and isolation of an atrial appendage are provided. A suturing grasper compresses soft tissue structures and deploys one or more sutures through complimentary pledget(s) carried by the grasper. The pledgets are reinforced, containing support members that define the profile of the stitch and distribute stresses applied by the stitch, once tightened, over a length of tissue. This hardware may be applicable to other surgical and catheter based applications as well including: compressing soft tissue structures lung resections and volume reductions; gastric procedures associated with reduction in volume, aneurysm repair, vessel ligation, or other procedure involving isolation of, resection of, and reduction of anatomic structures.

Description

RELATED APPLICATION [0001] This application is a non-provisional of U.S. Provisional Application No. 60,580,890 filed Jun. 18, 2004, the entirety of which is incorporated by reference.FIELD OF THE INVENTION [0002] This invention relates to devices and methods for less invasive treatment of atrial fibrillation or other application involving placing a pledgeted mattress suture stitch(es) to compress opposing tissue or to prevent its expansion. BACKGROUND OF THE INVENTION [0003] Surgical atrial fibrillation treatment involves eliminating the electrical propagation wavelets that trigger and sustain atrial fibrillation, and mitigating the risk of stroke by reducing the volume of enlarged the atria through isolation or resection of the atrial appendages. A previous surgical technique for resecting an atrial appendage involves manually advancing a suture, via an attached, curved, fixed needle, through the atrial appendage. This approach is performed under direct visualization during open h...

Claims

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Application Information

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Patent Type & Authority Applications(United States)
IPC IPC(8): A61B17/122
CPCA61B17/0401A61B17/0469A61B17/0643A61B17/10A61B17/122A61B2017/0647A61B2017/00243A61B2017/00349A61B2017/0404A61B2017/0406A61B2017/0472A61B17/1285
Inventor WHAYNE, JAMES G.FLEISCHMAN, SIDNEY D.
Owner ATRICURE
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