Surgical device for implanting an artificial mitral valve chorda

Abstract

The invention relates to a device (1) for placing an artificial mitral valve chorda (30), the device comprising: - a central body (10); - two end portions (12, 14) arranged on either side of the central body (10), each comprising a through-opening (122, 142) and comprising two jaws (124, 144) defining the corresponding opening (122, 142); it being possible for each end portion (12, 14) to be placed in two distinct configurations: - a first configuration in which the jaws are in a closed position, in which position an artificial chorda strand passing through the corresponding opening (122, 142) cannot pass between the corresponding jaws (124, 144); - a second configuration in which the jaws are in an open position, in which position an artificial chorda strand passing through the corresponding opening (122, 142) can pass between the corresponding jaws.

Description

Surgical device for implanting an artificial mitral valve chordae tendineae Technical Field

[0001] The present invention relates to the field of medical devices, and more particularly concerns a surgical device facilitating the placement of artificial cords, or neo-cords, in order to reinforce or replace broken or damaged native cords. Previous technique

[0002] The heart is an intrathoracic organ whose function is to circulate blood throughout the body. It acts as a four-chambered pump with two atria, two ventricles, and four valves. These chambers are separated and isolated from each other by watertight partitions called septa. There is a septum between the atria, called the interatrial septum, and a septum between the ventricles, called the interventricular septum. The valves allow for the temporary closure and opening of the chambers during the systolic-diastolic cardiac cycle.

[0003] The mitral valve is located between the left ventricle and the left atrium. It consists of two leaflets (an anterior and a posterior leaflet) connected to the walls of the left ventricle, inside the chamber, by two papillary muscles and numerous fibrous chordae tendineae. During left ventricular contraction, the mitral valve closes. This closure is achieved by the tensioning of the two leaflets by the chordae tendineae. Under this tension, the leaflets unfold, like a parachute, to come into contact at their respective free edges, thus ensuring occlusion and sealing of the system by coaptation.

[0004] The chordae tendineae can weaken and rupture, leading to mitral regurgitation, meaning the mitral valve no longer closes properly. This generally results in blood flowing back from the left ventricle into the left atrium, which obviously impairs the heart's function. Mitral regurgitation requires surgical repair, the indications for which are based on recognized and approved international guidelines.

[0005] In cardiac surgery, mitral valve repairs are performed using numerous techniques pioneered over the past 50 years. These techniques have demonstrated excellent results compared to mitral valve replacements.

[0006] To date, mitral valve repair techniques essentially include: - techniques for partial resection of mitral valve tissue concerning altered or damaged parts of the mitral valve leaflets, or more recently; - techniques for replacing, with artificial neo-cords made of Goretex, the elongated or broken native fibrous cords responsible for mitral insufficiency.

[0007] In recent years, techniques for replacing damaged native chordae tendineae have superseded mitral valve resection. These techniques utilize sutures (generally made of Gore-Tex), called neo-chordae, as replacements for ruptured, elongated, or weakened native chordae tendineae. This technique involves fixing the Gore-Tex suture to one of the anterior and / or posterior papillary muscles of the mitral valve, possibly supported by a Teflon splint or an autologous pericardial patch to avoid weakening the mitral papillary muscle, which is a muscular and fleshy structure. After fixation to the mitral papillary muscle, this neo-chordae consists of two strands or heads emerging from the papillary muscle. Each neo-chordae is then fixed to the free edge of the everted or prolapsed segment of the mitral valve leaflet by tying the two heads together, after carefully determining the desired length of each head.

[0008] Determining the length of a neochord is crucial. It is essential that each neochord be of the correct length to ensure proper tensioning of the valve leaflet. A neochord that is too short or too long can impair mitral valve function. Currently, when implanting a neochord, surgeons are forced to estimate the required length "by eye," which inevitably leads to recurring inaccuracies. While techniques exist to precisely determine the required length for a neochord, they do not accurately translate this measured length into the actual length of the neochord used. Implantation requires a specific technique to ensure that, once implanted, the neochord will be the correct length.

[0009] The invention thus aims to overcome the disadvantages of the prior art, and in particular those set out above, by proposing a surgical device enabling a surgeon to reliably, precisely and repeatably place a neo-cordage of a determined length. Description of the invention

[0010] To this end, the invention relates to a surgical device for the placement of an artificial mitral valve chordae tendineae, the device comprising: - a central body, extending along a longitudinal direction; - two end parts, arranged on either side of the central body along the longitudinal direction, each end part having an opening passing through the corresponding end part along the longitudinal direction, each end part having two jaws delimiting the corresponding opening; each end part being able to be placed in two distinct configurations: - a first configuration, or closed configuration, in which each end part is naturally located, and in which the jaws of the end part are in a closed position, a position in which a strand of artificial rope passing through the corresponding opening cannot pass between the corresponding jaws; - a second configuration, or open configuration, in which each end part can be put in place by pinching a part of the central body, and in which the jaws of the end part are in an open position, a position in which a strand of artificial rope passing through the corresponding opening can pass between the corresponding jaws.

[0011] Thus, the device according to the invention allows for the placement of an artificial cord of the required length by acting as a spacer positioned between the cord's attachment point on the mitral papillary muscle and its fixation point on the mitral valve leaflet. The device is very simple to use and inexpensive. The device according to the invention therefore facilitates and accelerates the placement of an artificial cord, making these operations precise and repeatable.

[0012] In a second embodiment, the invention relates to a surgical device for the implantation of an artificial mitral valve chordae tendineae, the device comprising: - a central body, extending along a longitudinal direction; - two end parts, arranged on either side of the central body along the longitudinal direction, each end part having two opposing jaws; each end part can be placed in two distinct configurations: - a first configuration, or closed configuration, in which each end part is naturally located, and in which the jaws of the end part are in a closed position, a position in which a strand of artificial rope cannot pass between the jaws; - a second configuration, or open configuration, in which each end part can be put in place by pinching a part of the central body, and in which the jaws of the end part are in an open position, a position in which a strand of artificial rope can pass between the jaws.

[0013] In the closed position, the jaws of the same end portion are in contact with each other at least at a contact zone forming part of each jaw, and the contact zone may form all or part of the surfaces of the opposing jaws. In other words, the jaws of an end portion of the device according to the second embodiment may not define an opening when they are in the closed position, and are thus in complete contact with each other.

[0014] The device according to the invention, whether it conforms to the first or second embodiment, may include one or more of the following optional features, considered alone or according to all possible combinations.

[0015] According to one feature, the opening of each end part is offset from the central body in a transverse direction, so that a strand of artificial rope extending through both openings extends along and out of the central body.

[0016] According to one characteristic, pinching the central body at only one of the longitudinal ends allows the passage into open configuration only of the end part located at the corresponding longitudinal end.

[0017] According to one characteristic, the end parts are located at a distance D2 from each other along the longitudinal direction, the distance D2 preferably being greater than or equal to 5 mm.

[0018] According to one characteristic, the device is configured so that each end part spontaneously switches, in the absence of external action on the central body, from the open configuration to the closed configuration.

[0019] According to one characteristic, the spontaneous transition from open configuration to closed configuration is achieved by elasticity.

[0020] According to one characteristic, the central body and the end parts are at least partially made of an elastic material.

[0021] According to one characteristic, the central body has two longitudinal flanks, each longitudinal flank extending along the longitudinal direction and connecting the two end parts, the two longitudinal flanks being connected to each other by two connecting parts each arranged at one longitudinal end of the central body.

[0022] According to one characteristic, each end part has an elastic return device configured to strain the jaws of the corresponding end part towards the closed position.

[0023] According to one characteristic, each elastic return device has a split elastic ring disposed around the corresponding end portion, each elastic ring having two ends delimiting a slot, each elastic ring being positioned on the corresponding end portion so that a closing plane between the corresponding jaws is located opposite the slot in the ring.

[0024] According to one characteristic, each end part has two stops, each disposed on a respective jaw, each end of the corresponding elastic ring bearing against a respective stop.

[0025] According to one characteristic, the opening of at least one of the end parts has dimensions allowing the passage of at least one knot formed from two strands of the artificial rope.

[0026] According to a characteristic, for one or each pair of jaws, the closing plane or the closing line is secant with the longitudinal direction of the central body.

[0027] According to a characteristic, for one or each pair of jaws, the closing plane or closing line is parallel to the longitudinal direction of the central body.

[0028] According to one feature, one of the end portions is intended to be positioned on the mitral valve leaflet side when an artificial cord is being placed, each jaw of this end portion having a slot allowing a strand of artificial cord to be wedged in place.

[0029] According to one feature, each end part has slots allowing a strand of artificial rope to be wedged in.

[0030] According to one characteristic, each end part of the device has a surface extending in a plane perpendicular to the longitudinal direction and forming a support surface.

[0031] According to one characteristic, the device has a symmetrical shape with respect to a median plane perpendicular to the longitudinal direction.

[0032] According to one characteristic, the distance between the bearing surfaces corresponds to the total length of the device, and is preferably between 5 and 40 mm.

[0033] According to one characteristic, the device is made from a biocompatible material, notably by molding.

[0034] The invention also relates to a kit for laying an artificial rope, the kit comprising several devices conforming to that defined above of different sizes, the size increment between two devices being between 1 and 10 mm.

[0035] According to one feature, the kit also includes a measuring tool, allowing the length of the device to be determined according to the distance between the point of attachment of the artificial cord on the mitral pillar and the mitral ring.

[0036] The invention also relates to a surgical treatment method implementing a device conforming to that defined above. Brief description of the drawings

[0037] Figure 1 is a schematic perspective view of a device according to the invention.

[0038] Figure 2 is a schematic perspective view of the device in Figure 1.

[0039] Figure 3 is a schematic perspective view of the device in Figure 1, showing more particularly the central body.

[0040] Figure 4 shows a measuring tool according to the invention in use.

[0041] Figure 5 is a schematic view showing the use of the device according to the invention, with an artificial rope being laid.

[0042] Figure 6 is a view analogous to the view in Figure 5, showing the step of removing the device according to the invention, after final fixing of the corresponding artificial rope.

[0043] Figure 7 is a view analogous to Figure 5, showing the artificial rope after removal of the device according to the invention.

[0044] Figure 8 is a perspective view of a device according to the invention having a symmetrical shape.

[0045] Figure 9 is a perspective view of a device according to the invention, equipped with elastic return devices.

[0046] Figure 10 is a detailed view of Figure 9.

[0047] Figure 11 is a view of an elastic ring forming one of the elastic return devices. Detailed description

[0048] Figures 1 to 3 depict a surgical device 1 according to the invention. Device 1 is intended to be temporarily implanted in the heart during a surgical procedure aimed at replacing and / or strengthening damaged or ruptured chordae tendineae, according to a method that will be detailed below. Device 1 is intended in particular to facilitate the surgeon's action, by allowing him to ensure that each artificial cord placed will be adjusted to the required length.

[0049] As shown in Figures 1 to 3, the device 1 comprises a central body 10, extending along a longitudinal direction L. The device 1 has a first and a second end portion 12, 14, arranged on either side of the central body 10 along the longitudinal direction L. Each end portion 12, 14 has, along the longitudinal direction L, a free end 120, 140, forming respectively one of the longitudinal ends of the device 1. Each of the free ends 120, 140 is formed by a bearing surface 120a, 140a, or distal surface 120a, 140a, extending in a plane perpendicular to the longitudinal direction L, and each forming a bearing surface of the device 1. The distance DI between the two bearing surfaces 120a, 140a thus corresponds to the total length of the device 1.Each end part 12, 14 has a proximal surface 120b, 140b opposite the support surface 120a, 140a, extending in a plane perpendicular to the longitudinal direction L. The distance D2 between the two proximal surfaces 120b, 140b thus corresponds to the spacing between the end parts 12, 14. The distance D2 is preferably greater than or equal to 5 mm, and for example between 5 and 25 mm or between 8 and 20 mm.

[0050] Each end portion 12, 14 has an opening 122, 142 passing through the corresponding end portion in the longitudinal direction L. The dimensions of each opening 122, 142 are compatible with the passage, through the opening, of at least one strand (or leader) of artificial cordage, preferably with the passage of at least two strands. In addition, at least one of the end portions 12 has an opening 122 allowing the passage of one or more knots formed by strands of artificial cordage. In the case where, as shown in Figures 1 to 3, the shape of the two end portions 12, 14 is not identical, the end portion 12 having an opening 122 allowing the passage of knots formed by the artificial cordage will be, as explained below, the one positioned on the side of the mitral valve leaflet.Preferably, the dimensions of the cross-section of the opening 122 are greater than or equal to 1.5 mm, and for example between 2 and 3 mm. In the case where the opening 122 has a cylindrical shape, the diameter of the opening 122 is preferably between 1.5 and 4 mm, and for example between 2 and 3 mm.

[0051] Each opening 122, 142 in the end portions is delimited by two peripheral walls forming opposing jaws 124, 144. The jaws 124, 144 are normally in a closed configuration, in which they are joined and delimit the corresponding opening 122, 142 around its entire circumference (around an axis parallel to the longitudinal direction L). However, the jaws 124, 144 can, by user action, be placed in an open configuration, in which they are no longer joined, and in which the corresponding opening 122, 142 is no longer closed around its entire circumference (around an axis parallel to the longitudinal direction L). The transition from the closed to the open configuration of the jaws 124, 144 is achieved thanks to the flexibility of the material constituting the device 1.

[0052] Thus, the device 1 according to the invention is configured so that each end part 12, 14 can be put into two distinct configurations: - a closed configuration, in which the respective jaws 122, 124 of the end part are joined and prevent a strand of artificial rope passing through the corresponding opening from passing between the jaws; - an open configuration, in which the respective jaws 122, 124 of the end part are sufficiently separated to allow one or more strands of artificial rope to pass through the corresponding opening.

[0053] As mentioned above, the device 1 is configured so that, in the absence of external action, each end portion 12, 14 is normally in its closed configuration. The transition from the closed to the open configuration is advantageously achieved by pinching (or crushing) the central body 10, for example, using surgical forceps, as shown in Figure 2. Figure 2 shows that applying a pinching force F to the central body 10 near one of its longitudinal ends 104 causes the nearest end portion to flex in the direction of the jaw opening E.

[0054] The central body 10 preferably comprises two opposing longitudinal flanks 100, each extending along the longitudinal direction L. Each longitudinal flank 100 connects each of the two end portions 12, 14. More precisely, each longitudinal flank 100 is connected to one of the jaws 122, 142 of each end portion 12, 14, and is not connected to the opposite jaw. The longitudinal sides 100 are further connected to each other by two connecting parts 102, each located at a longitudinal end 104 of the central body 10. Each connecting part 102 is configured to form a flexible hinge. The connecting parts 102 are shown in the figures as separate from each other. In the example, the connecting parts 102 are located at a distance E from each other which is greater than or equal to 5 mm, as shown in Figure 2. In addition, the longitudinal sides 100 are connected to each other by a joining part 106, located at a lateral edge of each longitudinal side 100, on the side opposite the connecting parts 102. In the example, the joining part 106 connects the longitudinal sides 100 along their entire length, from one end part 12, 14 to the other.In an unrepresented variant, the connecting parts 102 can be configured to be contiguous, the longitudinal sides 100 then being connected to each other along their entire length by the connecting parts 102.

[0055] As described above, the configuration of device 1, in which the end portions 12, 14 are spaced apart, combined with the flexibility and elasticity of the material constituting device 1, allows a user to control the opening of the jaws 124, 144 of an end portion 12, 14 by applying a pinching action to the central body 10 near that end portion, and more specifically by applying a pinching action to the longitudinal flanks. More particularly, device 1 allows the opening of the jaws 124, 144 of each end portion 12, 14 to be controlled separately, as shown in Figure 2. Allowing only one end portion 12, 14 to open at a time is a significant advantage in the context of using the device of the invention.Indeed, as described below, once an artificial cord has been installed using the device of the invention, and then fixed to both the mitral pillar and the valve leaflet, it is essential to remove the device by releasing each end one after the other, as shown in Figure 6. In other words, the device according to the invention allows one of the end parts to be put into an open configuration while leaving the other end part in the closed configuration.

[0056] To facilitate the opening movement of the jaws 124, 144, it may be provided that each end part 12, 14 has, at the junction between the jaws 124, 144, a thinned part 126, 146.

[0057] The device 1 according to the invention will preferably be made in one piece, for example by molding. The device 1 is made of a biocompatible material having the required flexibility and elasticity characteristics. By way of example, the following materials may be used: biocompatible polyethylene type PE2410T, polypropylene 1013H1, polypropylene HP840MO, etc.

[0058] The main steps of using the device according to the invention are described below, in the context of replacing a broken native rope with an artificial rope, in relation to figures 4 to 7.

[0059] The first step in implanting an artificial cord is to determine the required length of the new cord once it is in place. As mentioned above, this determination is, in the prior art, rather imprecise, as it depends on the location on the mitral pillar where the artificial cord will be attached. The following describes how the device according to the invention, combined with a measuring tool according to the invention, makes it possible to reliably and accurately measure the length of an artificial cord and to implant it to the required length.

[0060] Figure 4 partially represents a cardiac organ on which an artificial cord implantation procedure is underway. More specifically, Figure 4 represents the step of measuring the required length of the artificial cord being implanted, using a measuring tool 20 according to the invention.

[0061] Figure 4 shows a partially represented cardiac organ 200. The heart organ 200 comprises a left atrium 202 and a left ventricle 204. The mitral valve is located between these two chambers 202, 204. The mitral valve has two mitral papillary muscles 206 and two mitral leaflets 208. The two mitral leaflets 208 are attached to the inner wall of the left atrium at the level of a mitral annulus 210. In Figure 4, it can be seen that the first stage of artificial chordae tendineae 30 implantation has been carried out. This stage consists of fixing the artificial chordae tendineae 30 to the corresponding mitral papillary muscle 206, possibly using a splint. Once this first stage is complete, the mitral papillary muscles 206 are attached to the mitral papillary muscles 206. Once this step is completed, the measuring tool 20 allows for the measurement of a gross length Lb. The gross length Lb is measured between the mitral ring 210 and the attachment point 206a of the artificial chordae tendineae 30 on the mitral papillary muscle 206, by positioning the measuring tool 20 so that it connects the attachment point 206a of the artificial chordae tendineae 30 and the original attachment point of the broken native chordae tendineae 40 on the corresponding mitral valve leaflet 208. This gross length Lb allows the effective length Le of the artificial chordae tendineae 30 to be obtained by subtracting the desired coaptation height, that is, the length over which the two opposing mitral valve leaflets 208 overlap when the mitral valve is closed. The coaptation height is generally estimated to be between 8 and 10 mm. The method for determining the useful length of the artificial cord 30 is rigorous, standardized and reproducible for all surgeons.

[0062] As can be seen in Figure 4, the measuring tool 20 according to the invention advantageously comprises a gripping portion 20a, a first rod 20b, and a second rod 20c sliding within the first rod 20b. The free end of the first rod 20b has a stop 20d allowing it to be positioned on the mitral annulus in a repeatable manner. The gross length Lb thus corresponds to the distance between the stop 20d located at the free end of the first rod 20b and the free end of the second rod 20c. Advantageously, a dial 20e allows the measurement of the total length Lb to be displayed on the gripping portion 20a.

[0063] Once the useful length Le of the artificial cord has been determined, the surgeon chooses a device 1 according to the invention having a total length equal to or very close to the length Le. The device 1 is advantageously provided for a range of lengths between 5mm and 40mm, with an increment between 1 and 10 mm, in particular between 2 and 8 mm, and for example equal to about 5 mm.

[0064] Once the artificial chordae tendineae is fixed to the mitral papillary muscle and the length of device 1 is chosen, device 1 is inserted into the left ventricle by sliding it along the artificial chordae tendineae. More precisely, device 1 is threaded around the artificial chordae tendineae being implanted, so that the latter is secured in the two openings 122, 142 of device 1, and then device 1 is slid along the artificial chordae tendineae until device 1 rests on the mitral papillary muscle, as shown in Figure 5. The surgeon can then perform the procedure of fixing the artificial chordae tendineae to the mitral valve leaflet. corresponding, and more specifically to the valvular tissue. During this step, by ensuring that the device is gripped between the mitral papillary muscle on one side and the mitral valve leaflet on the other, the surgeon ensures that the artificial chordae tendineae will be positioned at the required length, that is, the length determined using the method detailed above. It is understood that the device 1 according to the invention then acts as a spacer.

[0065] Once the artificial chordae tendineae is fixed to both the mitral papillary muscle and the corresponding mitral valve leaflet, the surgeon can proceed with the removal of the device 1 according to the invention. As shown in Figure 6, and as explained above, the device is removed simply and easily by releasing each end of the device one after the other, pinching the central body 10 with surgical forceps to open the corresponding jaws 124, 144 and thus releasing the artificial chordae tendineae from the device 1. It is important to note that once the artificial chordae tendineae is installed and fixed, the device is interposed and wedged between the mitral papillary muscle on one side and the valve leaflet on the other. Therefore, releasing the device will involve sliding it against the tissues with which it is in contact.Being able to release each end separately, one after the other, facilitates removal of the device while limiting the risk of damaging the tissues. Furthermore, as shown in Figure 6, releasing an end of the device requires opening the corresponding end portion by pinching the central body in the immediate vicinity of that end portion. However, the device according to the invention allows the user to grasp the device in the immediate vicinity of the end to be released, which increases the precision of the device's manipulation and therefore its ease of use. Moreover, the fact that the connecting parts 102 have a closed shape, unlike the jaws 124, 144, further enhances this feature.This feature is very important because it prevents any of the numerous native ropes from becoming snagged or trapped within the device, between the longitudinal sides, which would considerably hinder its removal. The device according to the invention thus avoids any risk of interference with its environment.

[0066] After the removal of the device, as seen in figure 7, the laying of the artificial rope is completed, and the latter is laid respecting the useful length Le determined beforehand.

[0067] Advantageously, for each pair of jaws 124, 144, the closing plane or line 124a, 144a intersects the longitudinal direction L of the central body 10. In other words, the closing plane or line 124a, 144a of the jaws of the end portions 12, 14 is inclined relative to the longitudinal direction L. This configuration prevents the spontaneous extraction of a strand of artificial rope trapped in the opening of an end portion of the device. Thus, the device's positioning after installation is reinforced.

[0068] Advantageously, for the end portion 12 intended to be positioned on the side of the mitral valve leaflet during the implantation of an artificial chordae tendineae, each jaw 124 of this end portion 12 has a slot 124b allowing for the clamping of a strand of the artificial chordae tendineae. This configuration prevents any spontaneous extraction of a chordae tendineae strand during the surgical procedure, before the strut has been fixed to the mitral valve leaflet.

[0069] Figure 8 shows a device 1 according to the invention which, unlike device 1 of Figures 1 to 3, has a symmetrical shape with respect to a median plane perpendicular to the longitudinal direction L. Thus, the end portions are symmetrical with respect to each other, as are their respective openings 122, 142. This configuration has the advantage that the device does not have to be positioned in a particular orientation, as each end portion can be positioned on the side of the mitral papillary muscle or the mitral valve leaflet. In the example in Figure 8, each end portion 12, 14 has slots 124b, 144b allowing a strand of rope to be wedged in place.

[0070] Figures 9 to 11 illustrate a device 1 according to the invention. In the device 1 of Figures 9 and 10, each end portion 12, 14 includes a spring return device 128, 148, configured to return and hold the end portion in the closed position. More specifically, each spring return device 128, 148 is configured to actuate the jaws 124, 144 of the corresponding end portion 12, 14 towards the closed position. The spring return devices allow to avoid any spontaneous opening of the jaws and thus to avoid any spontaneous extraction of an artificial rope.

[0071] In the example shown in Figures 9 to 11, each elastic return device 128, 148 is formed by a spring ring, or elastic loop 16 (split), visible in Figure 11. An elastic loop 16 is mounted on each end portion 12, 14, so as to grip the corresponding jaws 124, 144. Preferably, each end portion 12, 14 has a cylindrical external surface. As seen in Figure 11, each elastic ring 16 has an internal diameter d, and includes a slot 16a of width e, delimited by the two ends 16b of the elastic ring 16. In order to allow the opening of the jaws 124, 144, each elastic ring 16 is positioned so that the closing plane 124a, 144a of the jaws 124, 144 is located opposite the slot 16a.To prevent the position of the elastic ring 16 from changing, each end portion 12, 14 has two stops 128a, 148a, so that each end 16b of each ring 16 bears against a respective stop 128a, 148a, thus preventing any spontaneous rotation of the elastic rings 16. For each end portion 12, 14, each stop 128a, 148a is positioned on a respective jaw 124, 144. Preferably, the internal diameter d of each elastic ring 16 is (before assembly) less than or equal to the external diameter of the corresponding end portion. Preferably, each end portion 12, 14 has an additional thickness forming a longitudinal stop 128b, 148b, allowing the corresponding elastic ring 16 to be positioned along its longitudinal axis. In the example shown in Figures 9 to 11, the internal diameter d is, for example, between 2.5 and 3.5 mm. The width e of the slot 16a is, for example, between 1.5 and 2.5 mm.Each elastic ring 16 is preferably made of a metallic material, such as steel, being for example formed from a spring wire.

[0072] In an unshown variant, the shape of the two end portions 12, 14 is not identical. One end portion 12 has an opening 122 compatible with the passage of knots formed by the artificial rope (being, for example, configured as the opening 122 in Figures 1 to 3). The opposite end portion 14 has a smaller opening 142. The opening 142 of this end portion 14 may be small enough that, when the end portion 14 is in the closed configuration, the jaws 144 grip the corresponding artificial rope strand(s). By allowing a slight tightening of the jaws 144 on the artificial rope, any unintentional rotation of the device 1 around this artificial rope during operation is prevented, which would complicate the removal of the device 1.

[0073] In a second embodiment defined above and not shown in the figures, the jaws of one of the end portions may not form an opening when closed, and thus be in full contact with each other. In this embodiment of the device according to the invention, one of the end portions (preferably the one intended to be positioned on the mitral pillar side) thus achieves a slight clamping of the jaws on the artificial cord. This arrangement prevents any unintentional rotation of the device 1 around the artificial cord during operation, which would complicate the removal of the device 1.

Claims

Demands

1. A surgical device (1) for the placement of an artificial mitral valve chordae tendineae (30), the device (1) comprising: a central body (10), extending along a longitudinal direction (L); two end portions (12, 14), arranged on either side of the central body (10) along the longitudinal direction (L), each end portion (12, 14) having an opening (122, 142) passing through the corresponding end portion (12, 14) along the longitudinal direction (L), each end portion (12, 14) having two jaws (124, 144) delimiting the corresponding opening (122, 142); each end portion (12, 14) being able to be placed in two distinct configurations: - a first configuration, or closed configuration, in which each end part (12, 14) is naturally located, and in which the jaws (124, 144) of the end part (12, 14) are in a closed position, a position in which a strand of artificial rope passing through the corresponding opening (122, 142) cannot pass between the corresponding jaws (124, 144); - a second configuration, or open configuration, in which each end part (12, 14) can be put in place by pinching a part of the central body (10), and in which the jaws (124, 144) of the end part (12, 14) are in an open position, a position in which a strand of artificial rope (30) passing through the corresponding opening (122, 142) can pass between the corresponding jaws (124, 144).

2. Device (1) according to the preceding claim, wherein the opening (122, 142) of each end part (12, 14) is offset from the central body (10) in a transverse direction (T), so that a strand of artificial rope (30) extending through the two openings (122, 142) extends along and out of the central body (10).

3. Device (1) according to any one of the preceding claims, wherein pinching the central body (10) at only one of the longitudinal ends (104) allows passage into the open configuration only of the end part (12, 14) located at the level of the corresponding longitudinal end (104).

4. Device (1) according to any one of the preceding claims, wherein the end parts (12, 14) are located at a distance (D2) from each other along the longitudinal direction (L), the distance (D2) preferably being greater than or equal to 5 mm.

5. Device (1) according to any one of the preceding claims, the device (1) being configured so that each end part (12, 14) passes spontaneously, in the absence of external action on the central body (10), from the open configuration to the closed configuration.

6. Device (1) according to the preceding claim, wherein the spontaneous transition from the open configuration to the closed configuration is achieved by elasticity.

7. Device (1) according to the preceding claim, wherein the central body (10) and the end parts (12, 14) are at least partially made of an elastic material.

8. A device (1) according to any one of the preceding claims, wherein the central body (10) comprises two longitudinal flanks (100), each longitudinal flank (100) extending along the longitudinal direction (L) and connecting the two end portions (12, 14), the two longitudinal flanks (100) being connected to each other by two connecting portions (102) each disposed at a longitudinal end (104) of the central body (10).

9. A device (1) according to any one of the preceding claims, wherein each end portion (12, 14) comprises an elastic return device (128, 148) configured to actuate the jaws (124, 144) of the corresponding end portion (12, 14) towards the closed position.

10. Device (1) according to the preceding claim, wherein each elastic return device (128, 148) comprises a split elastic ring (16) disposed around the corresponding end portion (12, 14), each elastic ring (16) having two ends (16b) defining a slot (16a), each elastic ring being positioned on the corresponding end portion (12, 14) so ​​that a closing plane (124a, 144a) between the corresponding jaws (124, 144) is located opposite the slot (16a) of the ring (16).

11. Device (1) according to the preceding claim, wherein each end part (12, 14) has two stops (128a, 148a) each disposed on a respective jaw (124, 144), each end (16b) of the corresponding elastic ring (16) bearing on a respective stop (128a, 148a).

12. Device (1) according to any one of the preceding claims, wherein the opening (122) of at least one of the end parts (12) has dimensions allowing the passage of at least one knot formed from two strands of the artificial rope (30).

13. Device (1) according to any one of the preceding claims, wherein, for one or each pair of jaws (124, 144), the closing plane (124a, 144a) or the closing line is secant with the longitudinal direction (L) of the central body (10).

14. Device (1) according to any one of the preceding claims, wherein, for one or each pair of jaws (124, 144), the closing plane (124a, 144a) or the closing line is parallel to the longitudinal direction (L) of the central body (10).

15. Device (1) according to any one of the preceding claims, wherein one of the end parts (12, 14) is intended to be disposed on the side of the mitral valve leaflet during the placement of an artificial cord (30), each jaw (124) of this end part (12) having a slot (124b) allowing the jamming of a strand of artificial cord (30).

16. Device (1) according to the preceding claim, wherein each end part (12, 14) has slots (124b, 144b) allowing the jamming of a strand of artificial rope (30).

17. Device (1) according to any one of the preceding claims, wherein each end part (12, 14) of the device (1) has a surface (120a, 140a) extending in a plane perpendicular to the longitudinal direction (L) and forming a support surface.

18. Device (1) according to any one of the preceding claims, the device (1) having a symmetrical shape with respect to a median plane perpendicular to the longitudinal direction (L).

19. Device (1) according to any one of claims 17 and 18, wherein the distance (Dl) between the bearing surfaces (120a, 140a) corresponds to the total length of the device (1), and is preferably between 5 and 40 mm.

20. Device (1) according to any one of the preceding claims, the device (1) being made of a biocompatible material, in particular by molding.

21. Kit for laying an artificial rope (30) comprising several devices (1) conforming to any one of the preceding claims of different sizes, the size increment between two devices being between 1 and 10 mm.

22. Kit according to the preceding claim, further comprising a measuring tool (20), enabling the length of the device (1) to be determined as a function of the distance between the attachment point of the artificial cord (30) on the mitral pillar and the mitral ring.

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