Coring device and coring and insertion arrangement comprising such a device

Description

BACKGROUND OF THE INVENTION Field of invention

[0001] The present invention relates to a coring device for making an opening in a tissue wall, in particular with a view to placing a heart pump on a beating heart.

[0002] It also relates to an assembly for coring a wall of a beating heart and introducing a portion of an anchoring device for a heart pump through the opening made by coring. Technological background

[0003] Heart failure (HF) is a condition in which a patient's heart is unable to provide the blood flow necessary for the body's metabolic needs.

[0004] It is known to treat heart failure to implant a ventricular assist device (VAD), which is an artificial heart pump.

[0005] This mechanical pump does not replace the heart, which continues to function, but provides assistance to the weakened ventricle in order to increase blood flow in a way that is adapted to the individual's needs.

[0006] This assistance may be temporary while waiting for a graft to become available for a heart transplant.

[0007] However, there is a significant proportion of patients who will not receive such a graft, either because they are not candidates for such a transplant, for example due to severe heart failure, or because no suitable graft is available for these patients.

[0008] In this case, ventricular assistance is used as a destination, i.e. the artificial heart pump is implanted for the long term.

[0009] These heart pumps are therefore the subject of intense research aimed at improving the survival and quality of life of patients with heart failure.

[0010] Many advances have been made in recent years and we now have ventricular assist devices that are more compact, quieter and have a longer service life.

[0011] State-of-the-art implantable heart pumps are thus typically equipped with an integrated electric motor to ensure their operation, the rotational speed of the pump providing the force necessary to circulate blood from the weakened ventricle into the body's circulation.

[0012] Systems for implanting such pumps into an opening in a ventricular wall are known.

[0013] These implantation systems generally comprise a tubular portion at the ends of which are placed, or formed, collars intended to be pressed against each opposite face of the ventricular wall after introduction of the tubular portion into an opening made in this ventricular wall with a coring device.

[0014] These collars thus make it possible to maintain this hollow tubular portion in position, which then defines an open conduit crossing the ventricular wall. Document US 2007 / 167968 A1 shows such a system.

[0015] At the end of this tubular portion, placed outside the heart, a suction pump is introduced which, once installed, ensures the return of the blood present in the ventricle to the body's circulation.

[0016] Although representing a definite improvement in the quality of life of a patient suffering from heart failure, many drawbacks are still observed.

[0017] In particular, making this opening on a beating heart to minimize the side effects of the procedure on the patient can lead to significant blood loss during the implantation of the heart pump.

[0018] Great dexterity and speed of action by practitioners are therefore important factors for success, which is a source of stress for the team carrying out the intervention.

[0019] In addition, since the dimensions of the collars are reduced to facilitate their passage through the opening made in the ventricular wall, the mechanical strength of the implantation system is limited. For example, it does not allow significant forces to be applied to it once in place on the ventricular wall.

[0020] Additionally, it is desirable that the blood ejection end of the pump be centered over the heart valve to ensure optimal ejected blood flow.

[0021] The positioning of the opening in the ventricular wall then contributes to the actual performance of the heart pump in ejecting blood into the aorta.

[0022] However, it is noted that in the absence of markers, this opening is not always well positioned with respect to the heart valve. The flow of blood ejected is therefore not ideal.

[0023] There is therefore a pressing need for a coring device whose original design overcomes the drawbacks described above. Subject of the invention

[0024] The entire invention is defined in claim 1. Embodiments are defined in the dependent claims.

[0025] The present invention aims to overcome the drawbacks of the prior art and to meet the constraints stated above by proposing a set for coring a tissue wall, simple in its design and in its operating mode, reliable and particularly easy to handle for a practitioner.

[0026] Another object of the present invention is such a coring assembly offering several functions and, in particular, being configured to receive, support and ensure centering of a tool for assisting in the installation of a part of the anchoring device relative to the opening made by coring.

[0027] Another object of the present invention is such a coring assembly making it possible to orient the coring head when making the opening in the tissue wall to ensure optimal positioning of the opening made in the tissue wall with respect to the heart valve.

[0028] The present invention also relates to an assembly for coring a wall of a beating heart and introducing a portion of an anchoring device of a heart pump through the opening made by coring, ensuring easy installation of this portion of the anchoring device and consequently allowing maximization of its dimensions.

[0029] Another object of the present invention is such an assembly limiting the risks of blood loss for the patient. BRIEF DESCRIPTION OF THE INVENTION

[0030] For this purpose, the invention relates to a coring device for making an opening in a tissue wall, comprising: a body having a longitudinal axis, said body having a proximal end and a distal end, said body comprising an internal housing, a coring head comprising a transection blade, this head being movable between a rest position and an actuated position, said coring head having a coring axis, an actuating mechanism for moving said head between said positions, said mechanism comprising an actuating rod at one end of which said movable head is placed, and the distal end of said body forms a surgical tool holder, or surgical accessory, this tool holder being configured to * on the one hand, receive by fitting a hollow surgical tool and support this tool, this surgical tool then surrounding the distal end of said body when it is placed on said tool holder, being coaxial with said coring axis, and * on the other hand, allow linear, or substantially linear, guidance,said surgical tool as it moves outward from the coring device.

[0031] Advantageously, such a coring device not only makes it possible to make an opening in a tissue wall but also to introduce into the opening made, the distal end of a surgical tool, for example a tool for assisting in the placement of a part of an anchoring device, which saves time, increases comfort for the surgical team and increases safety for the patient.

[0032] It is in fact not necessary for a practitioner, other than the one who made the opening, to intervene quickly after making it to introduce the surgical tool or accessory and there is no change of operating equipment.

[0033] Such a device also allows this surgical tool to be introduced into the opening made, because the configuration of this tool holder ensures alignment, or correspondence, of this opening and the distal end of the surgical tool, which is configured to pass through this opening.

[0034] Such a coring device is particularly useful for making an opening in a ventricular wall of a beating heart for the purpose of placing and assembling an anchoring ring, also known as an anchoring or fixation device, of a heart pump in this opening.

[0035] Such an anchoring ring typically comprises a ring portion comprising a hollow body at the end of which is placed a self-expanding membrane between a first configuration, called deformed, in which it has a tubular, or essentially tubular, shape, and a second configuration, called initial, in which it defines a flange, or collar, extending radially, or substantially radially, from said hollow body, this flange being intended to abut against an inner face of said ventricular wall of the beating heart.

[0036] The surgical tool is then advantageously a hollow body of generally cylindrical shape configured to be received in the opening made in the ventricular wall and to keep this opening open in its maximum dimensions to facilitate the introduction of at least the self-expanding membrane into the ventricular chamber.

[0037] In different particular embodiments of this device, each having its particular advantages and capable of numerous possible technical combinations: this coring device comprises a lumen extending through at least the proximal end of said body, said actuating rod and said coring head for the passage of a flexible guide element.

[0038] The implementation of a flexible guide element such as a guide wire, passing through the ventricular wall and the corresponding heart valve, for example the aortic valve, makes it possible to orient the opening made in the ventricular wall onto this heart valve.

[0039] Advantageously, such an orientation ensures ab initio optimal centering of the pump body on this heart valve, and therefore good performance in terms of ejection of blood through the heart valve.

[0040] Preferably, this light supports such a flexible guide element. said tool holder comprises an external peripheral wall which is tubular and of diameter equal or substantially equal to the diameter of said transection blade.

[0041] By "substantially equal" we mean that this diameter can vary by a few percent compared to the diameter of the opening made in the ventricular wall.

[0042] The hollow surgical tool is then at least partly tubular or substantially tubular in shape, having an internal diameter equal or substantially equal to the diameter of said transection blade so that this surgical tool can slide along said movable head when it is introduced onto, or exits from, the tool support. said tissue wall being a wall of a beating heart intended to receive an anchoring device of a heart pump comprising a flange, or collar, intended to be pressed against the outer surface of said wall of the beating heart, the length of said tool support is at least equal to the sum of the thickness of said tissue wall and the thickness, or longitudinal dimension, of said flange, or collar, intended to be placed against the outer surface of the wall of said heart. the device comprises a part of a foolproofing means, said surgical tool being intended to carry the complementary part of this foolproofing means, to orient said surgical tool on said tool support.

[0043] For purely illustrative purposes, the device may include a lug intended to be received in a corresponding housing placed on the edge of the proximal end of the surgical tool. the device comprises a stop for stopping the movement of said surgical tool along the longitudinal axis of said body and towards said proximal end so that the surgical tool remains positioned on said tool support. said body comprises two body parts nested one inside the other, a first body part being movable in translation relative to the other body part so that its movement in and out of the other body part causes the translational movement of said coring head.

[0044] Preferably, each body part comprises a gripping handle. Advantageously, said actuating mechanism comprises a guide carriage carrying said actuating rod and received in said internal housing, this housing being configured to form a translational guide rail for said guide carriage, said guide carriage being integral with said first translationally movable body part.

[0045] The present invention also relates to an assembly for placing a surgical tool or accessory in a tissue wall. According to the invention, this assembly comprises: a coring device as described above, and a hollow surgical tool or accessory configured to be fitted onto the distal end of said coring device while leaving said coring head unobstructed.

[0046] According to the invention, said surgical tool or accessory comprises at its distal end, a tubular or substantially tubular portion configured to maintain the shape and diameter of the opening made by coring in the tissue wall.

[0047] Preferably, this tubular or substantially tubular portion has a length at least equal to the thickness of the tissue wall.

[0048] According to an embodiment of the whole of the invention, the body of the coring device comprising a part of a foolproofing means, this surgical tool or accessory comprises a complementary part of this foolproofing means, to orient said surgical tool or accessory on said tool support.

[0049] According to yet another embodiment, said surgical tool or accessory being a tool for assisting in the installation of an anchoring device for a heart pump through an opening made by coring in the wall of a heart, said hollow assistance tool delimits an internal channel for the passage of said anchoring device, the diameter of which is substantially equal to the diameter of this opening.

[0050] Advantageously, said tubular or substantially tubular portion of this assistance tool has a length at least equal to the sum of the thickness of the wall of said core and the thickness, or longitudinal dimension, of a flange, or collar, intended to be assembled to the external surface of the wall of said core.

[0051] Preferably, the body of the coring device comprising a part of a foolproofing means, this assistance tool comprises a complementary part of this foolproofing means, to orient said surgical tool on said tool support according to a predefined configuration. For example, this predefined arrangement of the surgical tool ensures its orientation relative to a flange, or collar, assembled against the external surface of the wall of said core. Preferably, this flange, or collar, intended to be placed against the external surface of the wall of said core comprising at least one projection, or stud, placed on its lateral face, said surgical tool comprises for each projection, an opening groove intended to receive said corresponding projection, or stud, said groove being configured to ensure by rotation of said surgical tool around the coring axis, a locking of said surgical tool on said flange, or collar

[0052] According to yet another embodiment of the assembly of the invention, this assembly comprises an elongated pushing device comprising at its distal end a head supporting a part of the anchoring device comprising said flange, or collar, in its deformed configuration, said head having an assembly means such as a thread, with said part of the anchoring device and the latter comprising a complementary assembly means to ensure the assembly of these elements, said elongated pushing device being configured to pass through said surgical tool so that said flange, or collar of the anchoring ring can pass through the opening made in the wall of said heart.

[0053] Preferably, this pushing device is in the form of a tube or a rod having a lumen for receiving the flexible guide element. BRIEF DESCRIPTION OF THE DRAWINGS

[0054] Other advantages, aims and particular characteristics of the present invention will emerge from the description which follows, given, for explanatory and in no way limiting purposes, with reference to the appended drawings, in which: there Figure 1 schematically represents a coring device for making an opening in a ventricular wall of a beating heart according to a particular embodiment of the present invention; the Figure 2 shows the coring device of the Fig. 1 , an accessory for assisting in the placement of an anchoring ring being received at the distal end of the latter to define an assembly for coring and introducing a portion of an anchoring ring of a ventricular assist device; the Figure 3 is a partial and enlarged view of the set illustrated in the Fig. 2 showing a foolproof means for orienting the installation assistance accessory; the Figure 4is a schematic representation of the entire Fig. 2 , the coring head being in its actuated position for its introduction into a small orifice, previously made with a cutting tool in the ventricular wall of the heart; the Figure 5 is a perspective and sectional view of the entire Fig. 2 just after making the cut in the ventricular wall; the Figure 6 is a partial and top view of the entire Fig. 2 , when assembling the assistance accessory with the flange previously assembled to the outer surface of said ventricular wall, the distal end of the assistance accessory then being inserted into the opening made; the Figure 7 is a longitudinal sectional view of the entire Fig. 2and the apex of the heart, the coring device being withdrawn, the distal end of the assistance accessory, inserted into the opening made, being visible; the Figure 8 is a perspective view of the assistive accessory of the Fig. 2 assembled to a flange secured to the apex of the heart, a part of an anchor ring comprising a flange in its deformed configuration being introduced into this assistance accessory by means of a pushing device; the Figure 9 is a longitudinal sectional view of the elements illustrated in Fig. 8 ; there Figure 10 is a longitudinal sectional view of the elements illustrated in Fig. 8 , the flange in its deformed configuration being introduced into the ventricular chamber by means of the pushing device; the Figure 11 is a longitudinal sectional view of the elements illustrated in Fig. 8, the flange being in its initial configuration to define a collar, the delivery assistance accessory having been disassembled from the flange mounted to the outer surface of the ventricular wall and being removed; the Figure 12 is a perspective view of the elements illustrated in the Fig. 8 , the assistance accessory having been removed, a seal and a nut being engaged on the thrust device to lock the anchor ring in position; the Figure 13 is a perspective view of the anchor ring of the Fig. 12 mounted in its opening and supporting a heart pump. DETAILED DESCRIPTION OF AN EMBODIMENT OF THE INVENTION

[0055] First of all, note that the figures are not to scale.

[0056] THE Figures 1 to 7 schematically show a coring device 10 for making an opening in the ventricular wall of a beating heart, according to a particular embodiment of the present invention.

[0057] This coring device 10 comprises two body parts 11, 12 which are fitted into each other such that one of these parts is slidably mounted in the other body part. This device has a proximal end and a distal end.

[0058] In the context of the present invention, the term "proximal" means the position closest to the healthcare professional, or practitioner, while the term "distal" should be understood here as meaning the furthest from this professional. In other words, the distal end of a part is the end that would be the first engaged in the beating heart while its proximal end would be the last end to be engaged therein.

[0059] This coring device 10 comprises a coring head 13 having a tip having a frustro-conical shape, at its distal end, to facilitate its insertion through an incision made with a cutting tool such as a scalpel, in the ventricular wall of this beating heart. This head 13 also comprises a transection blade 14 placed at its proximal end. This transection blade 14 has a right transverse section of circular shape but could have other suitable shapes such as oval.

[0060] This coring head 13 is movable between a rest position, in which the transection blade 14 is pressed against, or is placed close to, the distal end of the main body of the coring device 10, and an actuated position in which the transection blade 14 is placed at a distance from the distal end of the main body of the coring device 10.

[0061] More specifically, this coring head 13 is actuated by an actuating mechanism comprising an actuating rod 15, at the end of which this head 13 is mounted, this rod 15 being coupled to an internal housing of the main body of the coring device 10.

[0062] This main body here comprises two body parts 11, 12 fitted into one another, a first body part being movable in translation relative to the other body part so that its movement in and out of the other body part causes the translational movement of said coring head 13.

[0063] Each body part comprises a gripping handle 16, 17 having a longitudinal axis Z. These handles 16, 17 are here arranged so that their longitudinal axis is perpendicular to the longitudinal axis defined by the body of the coring device 10.

[0064] Thus, the practitioner can hold with one hand a handle 16 of a first body part 11 while his other hand holds the handle 17 of the other body part 12 to easily move these two body parts relative to each other and thus cause the movement of the coring head 13.

[0065] Advantageously, the geometric axis or coring axis of the coring device 10 is that of the actuating rod 15 on which the coring head 13 is centered.

[0066] The actuating mechanism also comprises a guide carriage 18 supporting the actuating rod 15 and received in the internal housing 19 of the main body. The actuating rod 15 is advantageously centered.

[0067] The guide carriage 18 being integral with the first part of the body movable in translation, this internal housing 19 defines a guide rail in translation of this guide carriage.

[0068] A lumen 20 extends through the proximal end of the main body of the coring device 10, the actuating rod 15 and the coring head 13 to allow the passage of a guide 37. This guide 37 is intended for guiding, in particular the orientation, of the coring head 13 during its approach to the ventricular wall in order to make an opening by coring.

[0069] More specifically, this guide 37 is intended to pass through the aortic valve to guide the coring device 13 and thus fix the orientation of the opening to be made by coring relative to the anatomical location of the aortic valve (or of the pulmonary valve if this coring device 13 is used for the right ventricle).

[0070] Advantageously, the distal end of the main body of the coring device 10 also forms an accessory support 21.

[0071] This accessory support 21 comprises a tubular external peripheral wall whose external diameter is equal to the diameter of the transection blade 14.

[0072] An accessory 22 for assisting in the installation of a part of an anchoring ring of a heart pump is received by fitting onto this accessory support 21. This assistance accessory 22 is hollow and comprises a sheath 23 extending from an intermediate portion thereof towards its distal end.

[0073] As shown in the Fig. 5 , while the coring head 13 is still partially placed in the ventricular chamber, the practitioner can introduce into the opening made in the ventricular wall, a part of the assistance accessory 22, in particular its sheath 23, by moving it in translation on the accessory support 21, which ensures linear guidance.

[0074] This assistance tool being made of a rigid material such as titanium, its sheath 23 maintains the opening in its maximum extension and delimits by its internal channel, a path for the free passage of a part of anchoring ring comprising a tubular portion and at the distal end of the latter, a self-expanding membrane 24 in its first configuration, called deformed, in which the latter has a tubular, or essentially tubular, shape. This self-expanding membrane 24 is for example, made of nitinol.

[0075] Another flange, or second flange 25, of the anchoring ring having been previously assembled, for example by suture, with the outer surface of the ventricular wall, the assistance accessory 22 comprises at its proximal end, a hollow cylindrical connecting head 26 forming a projection of the sheath 23 by partially surrounding the latter. This connecting head 26 is intended to be assembled to this second flange 25 to achieve a removable coupling of the accessory with the second flange / apex assembly of the heart. This second flange 25 is for example made of dacron.

[0076] As illustrated in the Figure 6, this second flange 25 being pressed against the outer surface of the ventricular wall, it comprises at least one stud 35 positioned on its side wall, the connecting head 26 of the assistance accessory 22 comprising for each stud 35, a coupling groove 36 placed on its edge and configured to receive this corresponding stud. More precisely, each groove 36 opens at the distal end of this connecting head 26 so that the latter partially covering the second flange 25 of the anchoring ring, each stud 35 is engaged in its corresponding groove.

[0077] Each groove 36 further has the same curved shape so that, by rotation of the assistance accessory 22 around the coring axis, locking of this assistance accessory 22 on the second flange 25 is obtained.

[0078] This assistance accessory 22 also comprises a sealing element to ensure the sealing of the connecting head 26 / second flange 25 assembly when the nipple(s) have been brought to the bottom of their corresponding groove on the connecting head 26.

[0079] There Figure 7 is a sectional view of the coring device, the coring head being set back from the opening made in the ventricular wall, and more precisely, being placed in the internal housing of the body of the coring device. The sheath 23 of the assistance accessory 22 has been introduced through this opening into the ventricular chamber and the connecting head 26 is assembled to the second flange 25 of the external anchoring ring to the heart. The practitioner can then remove the coring device 10 without risking displacement of the assistance accessory 22 from the opening made in the ventricular wall.

[0080] The sheath 23 of this assistance accessory 22 makes it possible to keep this opening fully accessible to ensure the free passage of the anchoring ring part comprising a tubular portion 27 and at the distal end of the latter, a self-expanding membrane 24 in its first configuration.

[0081] This withdrawal of the coring device 10 causes the first loss of sealing at the level of the ventricular wall so that the practitioner must quickly connect to this hollow accessory, a pushing device 28 carrying this part of the anchoring ring for the introduction of its end into the ventricular chamber 29.

[0082] After having introduced the self-expanding membrane 24 into this ventricular chamber, and the latter having adopted its second configuration in which it defines a flange, or collar, extending radially from the tubular portion 27, the practitioner moves back the pushing device 28 to press this flange against the inner face of the ventricular wall 29 of the beating heart.

[0083] Thus, the two flanges 24, 25 being pressed on either side against this ventricular wall 29, the practitioner only has to engage a sealing element 30 such as an O-ring seal and a clamping means 31 on the pushing device 28 and slide the latter along the external surface of this pushing device 28 to lock the anchoring ring in position. This clamping means 31 finalizes the assembly of the anchoring ring by blocking any movement of the flanges 24, 25 relative to each other. This provides a strong mechanical connection of the anchoring ring and the apex of the heart as well as its sealing.

[0084] This clamping means 31 may be a nut if the external surface of the tubular portion 27, or hollow body, has a thread or as illustrated in Figure 13, a clamping ring. The latter presses the sealing element 30 against the second flange 25 assembled to the outer surface of the ventricular wall 29.

[0085] Advantageously, the tubular portion 27 / self-expanding membrane 24 assembly comprises a second sealing element comprising an anti-reflux valve (not shown) placed in the internal channel delimited by this tubular portion 27. For example, this is a self-repairing membrane, also called an auto-seal membrane, integrated into the internal channel delimited by the tubular portion 27, or hollow body, of the anchoring ring. This anti-reflux valve prevents any leakage of blood through this internal channel. It thus makes it possible, after removal of the coring device, to restore the seal by placing the anchoring device on the heart.

[0086] For purely illustrative purposes, this anti-reflux valve is made of silicone. This clamping ring 31 has on its side wall an orifice 32 receiving a fixing 33 for locking in position a heart pump 34 introduced into the internal channel delimited by the hollow body of the anchoring ring, the distal end of this heart pump 34 being engaged in the ventricular chamber of the beating heart. When the heart pump 34 is removed from the heart, for example for handling, received in the tubular portion 27, this second sealing element closes and becomes watertight again.

Claims

1. Assembly for fitting a surgical tool or accessory in a tissue wall comprising: - a coring device for forming an opening in a tissue wall, comprising: - a body having a longitudinal axis, said body having a proximal end and a distal end, said body comprising an inner housing, - a coring head (13) comprising a transection blade (14), this head being movable between a rest position and an actuated position, said coring head having a coring axis, - an actuation mechanism for moving said head between said positions, said mechanism including an actuation rod (15) at one end of which said coring head is placed; characterised in that - the distal end of said body forms a surgical tool support (21), this tool support (21) is configured * on the one hand, to receive by engagement a hollow surgical tool or accessory (22) and to support this tool or accessory, this tool or accessory surrounding the distal end of said body when it is placed on said tool support (21), by being coaxial with said coring axis, and, * on the other hand, to enable a linear guidance of said surgical tool or accessory (22) during the movement thereof from the coring device towards the opening formed in the tissue wall, - said tool support (21) comprises an outer peripheral wall which is tubular and has a diameter equal to or substantially equal to the diameter of said transection blade (14), and - said hollow surgical tool or accessory (22) configured to be engaged on the distal end of said coring device while leaving said coring head (13) exposed, said surgical tool or accessory (22) including at the distal end thereof, a tubular or substantially tubular portion configured to maintain the shape and the diameter of the opening formed by coring in the tissue wall, said tubular or substantially tubular portion having a length at least equal to the thickness of the tissue wall.

2. Fitting assembly according to claim 1, characterised in that said device comprises a lumen (20) extending through at least the proximal end of said body, said actuation rod (15) and said coring head (13) for the passage of a flexible guide element.

3. Fitting assembly according to claim 1 or 2, characterised in that said tissue wall being a wall of a beating heart intended to receive a device for anchoring a cardiac pump comprising a flange, or collar, (25) intended to be pressed against the outer surface of said wall of the beating heart, the length of said tool support (21) is at least equal to the sum of the thickness of said tissue wall (29) and the thickness, or longitudinal dimension, of said flange, or collar, (25) intended to be placed against the outer surface of the wall of said heart; the assembly including said flange or collar (25).

4. Fitting assembly according to any one of the preceding claims, characterised in that it includes a part of a foolproof means, said surgical tool (22) being intended to carry the complementary part of this foolproof means, to orient said surgical tool (22) on said support.

5. Fitting assembly according to any one of the preceding claims, characterised in that it includes a stop to stop the movement of said surgical tool (22) along said longitudinal axis and in the direction of said proximal end so that the surgical tool (22) remains positioned on said tool support (21).

6. Fitting assembly according to any one of the preceding claims, characterised in that said body includes two body parts (11, 12) engaged with one another, a first body part being movable in translation in relation to the other body part so that the movement thereof in and out of the other body part causes said coring head (13) to move in translation.

7. Fitting assembly according to claim 6, characterised in that each body part (11, 12) comprises a gripping handle (16, 17).

8. Fitting assembly according to claim 6 or 7, characterised in that said actuation mechanism comprises a guide carriage (18) supporting said actuation rod (15) and received in said inner housing (19), this housing (19) being configured to form a translational guide rail of said guide carriage (18), said guide carriage being integral with said first body part movable in translation.

9. Fitting assembly according to any one of the preceding claims, characterised in that the body of the coring device includes a part of a foolproof means, said surgical tool or accessory (22) including a complementary part of this foolproof means, for orienting said surgical tool or accessory (22) on said tool support (21).

10. Fitting assembly according to any one of the preceding claims, characterised in that said surgical tool or accessory (22) is a tool for assisting the fitting of a device for anchoring a cardiac pump through an opening formed by coring in a wall of a heart, said hollow assistance tool delimiting an internal channel for the passage of said anchoring device, the diameter of which is substantially equal to the diameter of this opening.

11. Fitting assembly according to claim 10, including a flange, or collar, being intended to be placed against the outer surface of the wall of said heart, this flange comprising at least one protrusion, or stud, placed on the lateral face thereof, said assistance tool includes for each protrusion, an opening groove intended to receive said corresponding protrusion, or stud, said groove being configured to ensure by rotating said surgical tool (22) about the coring axis, locking said surgical tool (22) on said flange, or collar.