Retractor for aortic valve surgery
The aortic valve surgical expander with integrated fluid injection openings addresses the inefficiency of alternating traction sutures and retractors, reducing surgical time and costs by allowing continuous myocardial protective fluid injection during aortic valve surgery.
Patent Information
- Authority / Receiving Office
- WO · WO
- Patent Type
- Applications
- Current Assignee / Owner
- NAGASAKI UNIVERSITY
- Filing Date
- 2025-09-05
- Publication Date
- 2026-06-04
AI Technical Summary
Conventional aortic valve surgery involves alternating use of traction sutures and retractors, leading to prolonged surgical times due to the need for repeated deployment and removal during procedures.
An aortic valve surgical expander with integrated openings for injecting myocardial protective fluid into coronary arteries, allowing continuous surgery without removing the expander from the aorta.
Reduces overall surgical time and lowers costs by enabling simultaneous myocardial protective fluid injection during aortic valve surgery, eliminating the need for traction suture procedures.
Smart Images
Figure JP2025031378_04062026_PF_FP_ABST
Abstract
Description
Deployer for aortic valve surgery
[0001] The present invention relates to a deployer used in aortic valve surgery.
[0002] Conventionally, a retractor made of an elastic body is known as a deployer for exposing and deploying a surgical site and its vicinity. Patent Document 1 discloses a retractor made of metal that is rectangular and can be wound into a cylindrical shape. Non-Patent Document 1 discloses an example of using a retractor in mitral valve surgery. In Non-Patent Document 1, a retractor made of a rectangular elastic body is rolled up and grasped with forceps or the like, and after being inserted near the surgical site, the retractor is deployed to expose the surgical site.
[0003] The deployer disclosed in Non-Patent Document 1 can be used not only in mitral valve surgery but also as a deployer for exposing the aortic valve in aortic valve surgery. Here, aortic valve surgery is performed in the following procedure. (1) Ascending aorta occlusion (2) Injection of myocardial protective fluid from the proximal part of the ascending aorta (3) Confirming cardiac arrest and incising the ascending aorta (4) Resecting the aortic valve (5) Second injection of myocardial protective fluid (6) Suturing the aortic valve annulus (7) Third injection of myocardial protective fluid (8) Transplanting an artificial valve (9) Aortic re-suturing
[0004] In aortic valve surgery, in the procedures (5) and (7) above, in order to make the coronary artery inlet visible, for example, as disclosed in Non-Patent Document 2 (P113, FIG. 3), a surgical suture is used as a traction thread, and the aortic root is pulled and deployed at several points. Also, in the procedures (4) and (6) above, in order to ensure a sufficient surgical field of view, a retractor is attached to the aortic root.
[0005] U.S. Patent Application Publication No. 2017 / 0258462
[0006] Igor Tudorache et al., "Enhanced exposure of subvalvular structures during mitral valve repair with a novel flexible and reusable leflets retractor," The Journal of Thoracic and Cardiovascular Syrgery 2018. Japanese Society for Minimally Invasive Cardiovascular Surgery (ed.), "Fundamentals and Practice of Minimally Invasive Cardiac Surgery," Nankodo Co., Ltd., February 2019, https: / / www.nankodo.co.jp / g / g9784524245369 /
[0007] However, in conventional aortic valve surgery using a dispensing device, the dispensing of the traction suture and the dispensing of the retractor must be performed alternately. As a result, the processing and modification of each procedure takes time, which leads to the problem of a long overall surgical time from the start to the end of the aortic valve surgery.
[0008] Therefore, the present invention aims to provide an aortic valve surgical expander that allows for the injection of myocardial protective solution into the coronary arteries while the expander is attached during aortic valve surgery.
[0009] The aortic valve surgical expander according to the present invention is an aortic valve surgical expander used in aortic valve surgery, comprising: an expander body which is rectangular in plan view and can be bent into a cylindrical shape in the longitudinal direction; and an opening provided in the expander body at a position corresponding to the coronary artery inlet for injecting myocardial protective fluid into the coronary artery.
[0010] According to the present invention, while the aortic valve surgical expander is inserted into the aorta, myocardial protective solution can be injected into the coronary arteries through the opening. This allows the aortic surgery to be continued without removing the aortic valve surgical expander from the aorta, thereby shortening the total surgical time from the start to the end of the aortic valve surgery.
[0011] This is a plan view showing an example of the configuration of an aortic valve surgical unfolder according to the first embodiment. This is a cross-sectional view of the aortic valve surgical unfolder shown in Figure 1 along the line A-A. This is a cross-sectional view of the aortic valve surgical unfolder shown in Figure 1 along the line B-B. This is a perspective view showing the state of the cylindrically wound aortic valve surgical unfolder according to the first embodiment. This is a top view of the aortic valve surgical unfolder 100 shown in Figure 4. This is a flowchart showing an example of the procedure for aortic valve surgery according to the first embodiment. This is a schematic diagram (part 1) for explaining an example of the procedure during aortic valve surgery according to the first embodiment. This is a schematic diagram (part 2) for explaining an example of the procedure during aortic valve surgery according to the first embodiment. This is a plan view showing an example of the configuration of an aortic valve surgical unfolder according to the second embodiment. This is a cross-sectional view of the aortic valve surgical unfolder shown in Figure 9 along the line C-C. This is a cross-sectional view of the aortic valve surgical unfolder shown in Figure 9 along the line D-D. This is a perspective view showing the state of the cylindrically wound aortic valve surgical unfolder according to the second embodiment. This is a top view of the aortic valve surgical unfolder shown in Figure 12. This is a plan view showing an example of the configuration of an aortic valve surgical unfolder according to the third embodiment.
[0012] A wound cleaning device according to a preferred embodiment of this disclosure will be described in detail below with reference to the attached drawings. Note that, for convenience, there may be differences in the dimensional relationships and proportions between the drawings shown below.
[0013] <First Embodiment> [Example of Configuration of Aortic Valve Surgery Unfolder 100] Figure 1 is a plan view showing an example of the configuration of the aortic valve surgery unfolder 100 according to the first embodiment. Figure 2 is a cross-sectional view of the aortic valve surgery unfolder 100 shown in Figure 1 along line A-A. Figure 3 is a cross-sectional view of the aortic valve surgery unfolder 100 shown in Figure 1 along line B-B. Figure 4 is a perspective view showing the aortic valve surgery unfolder 100 wound into a cylindrical shape according to the first embodiment. Figure 5 is a top view of the aortic valve surgery unfolder 100 shown in Figure 4. In the embodiments described below, the direction of the aortic valve surgery unfolder 100, etc., may be described with the patient's head side as the upper side and the patient's leg side as the lower side.
[0014] The aortic valve surgical expander 100 is a retractor-type expander used in aortic valve surgery. As shown in Figures 1 to 3, the aortic valve surgical expander 100 comprises an expander body 110, a first opening 120a, and a second opening 120b. The expander body 110 is a flat plate-shaped member having a predetermined thickness and is approximately rectangular in plan view. The expander body 110 is also an elastic material and is configured to bend into a cylindrical shape. Examples of materials for the expander body 110 include elastic resin and metal. The dimensions of the expander body 110 are as follows, for example: The length L1 of the expander body 110 in the longitudinal direction is, for example, 120 mm. The length W1 of the expander body 110 in the short direction (width) is, for example, 26 mm. The thickness T1 of the expander body 110 varies depending on the material, but is selected so that the force of expansion when attached to the aorta is, for example, about 50 gf.
[0015] When performing aortic surgery, as shown in Figures 4 and 5, the expander body 110 is curved along its longitudinal direction (long side), and the expander body 110 is formed into a cylindrical shape by overlapping one end and the other end along its longitudinal direction. When the cylindrical aortic valve surgery expander 100 is inserted into the aorta without fixing both ends, it expands (stretches) due to its own elastic force and is fixed in a predetermined position with the surgical site, including the aortic valve, exposed.
[0016] The first opening 120a and the second opening 120b are holes for injecting myocardial protective fluid into the right and left coronary arteries, respectively, during aortic valve surgery. The first opening 120a and the second opening 120b are formed at positions corresponding to the inlets of the right and left coronary arteries in the expander body 110. As shown in Figures 1 to 3, the first opening 120a and the second opening 120b are circular in plan view and penetrate the expander body 110 in the thickness direction. The diameter of the openings of the first opening 120a and the second opening 120b is, for example, greater than or equal to the arterial diameter of the right and left coronary arteries. By providing a margin of error in the size of the first opening 120a and the second opening 120b relative to the arterial diameter of the coronary artery inlets, circumferential and vertical positional displacement relative to the inlets of the right and left coronary arteries can be tolerated when the aortic valve surgery expander 100 is placed inside the aorta. Specifically, the opening diameter D1 of the first opening 120a and the second opening 120b is approximately 10 mm, as shown in Figure 1.
[0017] The formation positions of the first opening 120a and the second opening 120b can be determined according to the arterial diameter of the aorta, the positions of the right coronary artery and the left coronary artery, etc. For example, the cross-sectional shape of the aortic root may be approximately circular, and the right coronary artery and the left coronary artery may be formed at 120° intervals in the circumferential direction of the aortic root. The diameter of the aortic root is a constant value, for example, an average value. In this case, as shown in Figure 5, if the diameter of the expander body 110 that unfolds in the aorta is approximately the same as the diameter of the aortic root, the first opening 120a and the second opening 120b are formed at 120° intervals (central angle 120°) in the circumferential direction of the expander body 110, and approximately coincide with the positions of the entrances to the right and left coronary arteries. When the aortic valve surgery expander 100 is used upside down, the first opening 120a is located at the entrance to the left coronary artery, and the second opening 120b is located at the entrance to the right coronary artery.
[0018] As mentioned above, the aortic diameter may vary from patient to patient, such as 30 mm or 40 mm. In this case, the diameter of the aortic valve surgical expander 100 deployed within the aorta will also vary from patient to patient, and the circumferential positions of the first opening 120a and the second opening 120b may also shift slightly depending on the diameter of the aortic valve surgical expander 100. Therefore, multiple aortic valve surgical expanders 100 may be prepared, each with adjusted formation positions of the first opening 120a and the second opening 120b, the longitudinal length of the expander body 110, etc., for each aortic diameter. Furthermore, the positions of the entrances to the right and left coronary arteries may also vary from patient to patient. For example, the entrances to the right and left coronary arteries may be formed at 120°, 150°, or 180° intervals in the circumferential direction of the aorta. In this case as well, multiple aortic valve surgical dispensing devices 100 may be prepared, each with adjusted formation positions for the first opening 120a and the second opening 120b at intervals corresponding to the positions of the inlets of the right and left coronary arteries.
[0019] Furthermore, although the above-described embodiment described an example in which two first openings 120a and second openings 120b are formed in the longitudinal direction of the expander body 110, the invention is not limited to this. For example, three or more openings for injecting myocardial protective fluid can be formed in the longitudinal direction of the expander body 110. In this case, even if a predetermined opening is misaligned from the position of the inlets of the right and left coronary arteries when the aortic valve surgical expander 100 is inserted into the aorta, it is possible to align the other openings with the positions of the inlets of the right and left coronary arteries.
[0020] [Flow of Aortic Valve Surgery] Figure 6 is a flowchart showing an example of the overall flow of aortic valve surgery according to the first embodiment. Figures 7 and 8 are schematic diagrams illustrating an example of the procedure during aortic valve surgery according to the first embodiment. In the following description, we will explain the case in which aortic valve surgery is performed by median sternotomy, but it may also be MICS (Minimally Invasive Cardiac Surgery) surgery performed through the gaps in the ribs, for example.
[0021] In step S1, cardiopulmonary bypass is established for the patient. Specifically, for example, a midline incision is made, and as shown in Figure 7, a delivery vessel 30 is inserted into the ascending aorta 10a and a withdrawal vessel (not shown) is inserted into the right atrium to establish cardiopulmonary bypass. In addition, a cannula 32 for injecting cardiopulmonary bypass solution into the coronary arteries is inserted into the proximal portion 10b of the ascending aorta 10a.
[0022] In step S2, the ascending aorta 10a is occluded to induce cardiac arrest. Specifically, after cardiopulmonary bypass is established, the ascending aorta 10a between the delivery vessel 30 and the cardioplegic solution infusion cannula 32 is occluded with a clamp forceps 34, as shown in Figure 7. Then, the first dose of cardioplegic solution is infused through the cardioplegic solution infusion cannula 32 to establish cardiac arrest.
[0023] In step S3, after occluding the ascending aorta 10a, the proximal portion 10b of the ascending aorta 10a is incised. Specifically, as shown in Figure 8, an incision of approximately 180 degrees is made on the front side of the cylindrical proximal portion 10b, and the portion above the incision is bent backward from the paper. Then, as shown in Figure 4, the cylindrically rolled aortic valve surgical expander 100 is grasped with forceps or the like and inserted into the aortic root 10c as shown in Figure 8. At this time, for example, the first opening 120a of the aortic valve surgical expander 100 is positioned at the entrance of the right coronary artery 20a, and the second opening 120b is positioned at the entrance of the left coronary artery 20b.
[0024] In step S4, the calcified aortic valve 12 is then resected. Subsequently, as shown in Figure 8, a selective cardioplegic solution injection cannula 32b is placed on the upper surface of the lower cut surface of the proximal portion 10b where the incision was made, and a second injection of cardioplegic solution is administered to the right coronary artery 20a and the left coronary artery 20b, respectively, to maintain cardiac arrest. The injection of cardioplegic solution is performed with the aortic valve surgery expander 100 attached to the aortic root 10c. The cardioplegic solution is injected from the aortic root 10c through the first opening 120a into the inlet of the right coronary artery 20a, and also from the aortic root 10c through the second opening 120b into the inlet of the left coronary artery 20b. This maintains the effect of the cardioplegic solution.
[0025] In step S5, sutures are placed around the aortic valve annulus. During or after suture placement, a third injection of myocardial protective solution is performed, also with the aortic valve surgical expander 100 attached to the aortic root 10c.
[0026] Next, in step S6, the aortic valve surgical dispensing device 100 is removed from inside the aortic root 10c.
[0027] Next, in step S7, the artificial valve is implanted. Specifically, the artificial valve is placed in the aortic valve annulus, and the replacement is completed when the aortic valve 12 is replaced by the artificial valve. For example, a mechanical valve or a bioprosthetic valve can be used as the artificial valve. Once the implantation of the artificial valve is complete, the incised ascending aorta 10a is sutured.
[0028] In step S8, the heartbeat is restarted. Specifically, after thoroughly removing any remaining air from the heart, the clamp forceps 34 are removed from the ascending aorta 10a to release the aortic 10 and restart the heartbeat. Once the heartbeat has restarted and stabilized, the cardiopulmonary bypass machine is removed by withdrawing the drainage tube from the right atrium and the supply tube 30 from the ascending aorta 10a. Subsequently, protamine is administered, and after confirming hemostasis, the chest is closed.
[0029] According to the first embodiment, during aortic valve surgery, the aortic valve surgical expander 100 can be inserted into the aorta, and myocardial protective fluid can be injected into the inlets of the right coronary artery 20a and the left coronary artery 20b through the first opening 120a and the second opening 120b. This allows the aortic surgery to be continued without removing the aortic valve surgical expander 100 from the aorta, thereby shortening the total surgical time from the start to the end of the aortic valve surgery. Furthermore, since the procedure of using traction sutures, etc., when injecting myocardial protective fluid into the inlets of the right coronary artery 20a and the left coronary artery 20b can be omitted, material costs can be reduced, and surgical costs can be lowered.
[0030] Furthermore, in the first embodiment, the diameters of the first opening 120a and the second opening 120b are formed to be approximately the same as or greater than the diameters of the inlets of the right coronary artery 20a and the left coronary artery 20b. This allows for the smooth injection of myocardial protective fluid into the inlets of the right coronary artery 20a and the left coronary artery 20b, even when the aortic valve surgical expander 100 is inserted into the aorta.
[0031] <Second Embodiment> In the second embodiment, the opening shapes of the first opening 220a and the second opening 220b are formed in a rectangular shape extending in the longitudinal direction of the unfolding device body 210. In the following, descriptions that are substantially the same as those of the first embodiment may be omitted or simplified.
[0032] [Example of the configuration of the aortic valve surgical unfolding device 200] Figure 9 is a plan view showing an example of the configuration of the aortic valve surgical unfolding device 200 according to the second embodiment. Figure 10 is a cross-sectional view of the aortic valve surgical unfolding device 200 shown in Figure 9 along the line C-C. Figure 11 is a cross-sectional view of the aortic valve surgical unfolding device 200 shown in Figure 9 along the line D-D. Figure 12 is a perspective view showing the aortic valve surgical unfolding device 200 wound into a cylindrical shape according to the second embodiment. Figure 13 is a top view of the aortic valve surgical unfolding device 200 shown in Figure 12.
[0033] As shown in Figures 9 to 11, the aortic valve dispensing device 200 comprises a dispensing device body 210, a first opening 220a, and a second opening 220b. The dispensing device body 210 is a flat plate-shaped member having a predetermined thickness and is approximately rectangular in plan view. The dispensing device body 210 is also an elastic material and is configured to bend into a cylindrical shape. Examples of materials for the dispensing device body 210 include elastic resin and metal. The dimensions of the dispensing device body 210 are as follows, for example: The length L2 of the dispensing device body 210 in the longitudinal direction is, for example, 120 mm. The length W2 of the dispensing device body 210 in the short direction (width) is, for example, 26 mm. The thickness T2 of the dispensing device body 210 varies depending on the material, but is selected so that the dispensing force when attached to the aorta is, for example, about 50 gf.
[0034] When performing aortic surgery, as shown in Figures 12 and 13, the longitudinal direction (long side) of the expander body 210 is curved, and the expander body 210 is made cylindrical by overlapping one end and the other end in the longitudinal direction of the expander body 210. Hereinafter, the overlapping portion of the expander body 210 where one end and the other end in the longitudinal direction overlap is referred to as the overlapping portion 210a. When the cylindrical aortic valve surgical expander 200 is inserted into the aorta without fixing both ends, it expands (stretches) due to its own elastic force and is fixed in a predetermined position with the aortic valve exposed.
[0035] The first opening 220a and the second opening 220b are holes for injecting myocardial protective fluid into the right and left coronary arteries, respectively, during aortic valve surgery, as shown in Figures 9 to 13. The first opening 220a and the second opening 220b are formed at positions corresponding to the respective entrances to the right and left coronary arteries in the expander body 210. Each of the first opening 220a and the second opening 220b is rectangular in plan view, having a long side and a short side, and penetrates the expander body 210 in the thickness direction. The long sides of the first opening 220a and the second opening 220b extend along the longitudinal direction of the expander body 210. The short sides of the first opening 220a and the second opening 220b extend along the short direction of the expander body 210.
[0036] The length D2a of the long side of the first opening 220a and the second opening 220b is set to be several times the arterial diameter of each coronary artery in order to allow for circumferential positional displacement relative to the inlet of each coronary artery when the device is inserted into the aorta. The length D2a of the long side of the first opening 220a and the second opening 220b is, for example, 50 mm, as shown in Figure 9. The length D2b of the short side of the first opening 220a and the second opening 220b is set to be greater than or equal to the arterial diameter of each coronary artery in order to allow for vertical positional displacement relative to the inlet of each coronary artery when the device is inserted into the aorta. The length D2b of the short side of the first opening 220a and the second opening 220b is, for example, 10 mm, as shown in Figure 9. The first opening 220a and the second opening 220b are formed side by side in the longitudinal direction of the unfolding device body 210 with a margin 210b in between, and are formed approximately in the center in the short direction (width direction) of the unfolding device body 210.
[0037] In the second embodiment, as shown in Figures 12 and 13, when the unfolding device body 210 is rolled into a cylindrical shape, the portion of the unfolding device body 210 circumferentially, excluding the overlapping portion 210a and the margin 210b, becomes either the first opening 220a or the second opening 220b. In other words, substantially the entire circumference of the cylindrical unfolding device body 210 becomes either the first opening 220a or the second opening 220b. Therefore, even if the right and left coronary arteries are formed at different intervals in the circumferential direction of the aorta depending on the patient, at least one of the first opening 220a and the second opening 220b can be aligned with the entrance of the right coronary artery and the entrance of the left coronary artery. The aortic valve surgery unfolding device 200 can also be used in aortic valve surgery, as explained in Figures 6 to 8 of the first embodiment described above.
[0038] According to the second embodiment, the same effects as those of the first embodiment described above can be achieved. That is, during aortic valve surgery, with the aortic valve surgical expander 200 installed in the aorta, myocardial protective solution can be injected into the inlets of the right coronary artery 20a and the left coronary artery 20b through the first opening 220a and the second opening 220b. As a result, aortic surgery can be continued without removing the aortic valve surgical expander 200 from the aorta, thereby shortening the total surgical time from the start to the end of the aortic valve surgery. Furthermore, in the second embodiment, the length of the long side of the first opening 220a and the second opening 220b is several times the diameter of the inlets of the right coronary artery 20a and the left coronary artery 20b. Therefore, when installing the aortic valve surgical expander 200 in the aorta, it is easy to align the first opening 220a and the second opening 220b with the inlets of the right coronary artery 20a and the left coronary artery 20b.
[0039] <Third Embodiment> In the third embodiment, the opening shapes of the first opening 320a and the second opening 320b are formed in an oval shape extending in the longitudinal direction of the unfolding device body 310, and the unfolding device body 310 is provided with a stiffness adjustment part for adjusting the bending stiffness. In the following, descriptions that are substantially common to the first and second embodiments may be omitted or simplified.
[0040] [Example of the configuration of the aortic valve surgical dispensing device 300] Figure 14 is a plan view showing an example of the configuration of the aortic valve surgical dispensing device 300 according to the third embodiment. The aortic valve surgical dispensing device 300 comprises a dispensing device body 310, a first opening 320a, a second opening 320b, a center mark 330, a first stiffness adjustment part 340a, and a second stiffness adjustment part 340b.
[0041] The deployant body 310 is a flat plate-shaped member having a predetermined thickness and is approximately rectangular in plan view. The deployant body 310 is also an elastic body and is configured to bend into a cylindrical shape. Examples of materials for the deployant body 310 include elastic resin and metal. The dimensions of the deployant body 310 are as follows, as an example: The length L3 of the deployant body 310 in the longitudinal direction is, for example, 110 mm. The length W3 of the deployant body 310 in the short direction (width) is, for example, 16 mm. The thickness of the deployant body 310 varies depending on the material, but is selected so that the force that deploys when attached to the aorta is, for example, about 50 gf. One end 310c and the other end 310d in the longitudinal direction of the deployant body 310 are each formed in an arc shape so as not to have any acute angles. This prevents one end 310c and the other end 310d of the expander body 310 from becoming trapped in the first opening 320a, the second opening 320b, the first rigidity adjustment section 340a, and the second rigidity adjustment section 340b when the expander body 310 is bent into a cylindrical shape and inserted into the aorta.
[0042] The first opening 320a and the second opening 320b are oval-shaped and extend in the longitudinal direction of the unfolding device body 310, and are arranged side by side on either side of a margin 310o provided at the center of the longitudinal direction of the unfolding device body 310. The length D3a of the first opening 320a and the second opening 320b in the longitudinal direction is selected to be, for example, 26 mm in order to allow for circumferential positional displacement relative to the entrance of each coronary artery when inserted into the aorta. The length D3b of the first opening 320a and the second opening 320b in the short direction is selected to be, for example, 8 mm in order to allow for vertical positional displacement relative to the entrance of each coronary artery when inserted into the aorta.
[0043] The center mark 330 is a mark for aligning the first opening 320a and the second opening 320b with the inlet of the right coronary artery 20a and the inlet of the left coronary artery 20b, respectively, when bending the deployer body 310 into a cylindrical shape and inserting it into the aorta. The center mark 330 is formed between the first opening 320a and the second opening 320b, at the central position or substantially central position of the longitudinal length L3 of the deployer body 310. Also, the center mark 330 is preferably formed at a position closer to the user side in the short direction of the deployer body 310, specifically, at a position above the center in the short direction of the deployer body 310, so that it can be easily visually recognized by a user such as a doctor during the operation. The center mark 330 is formed, for example, by an opening having a circular shape in plan view that penetrates the deployer body 310 in the thickness direction, similar to the first opening 320a and the like. As other configurations of the center mark 330, for example, it may be colored with a color different from that of the deployer body 310, or a seal or the like having a color different from that of the deployer body 310 may be attached to the deployer body 310, or the surface of the deployer body 310 may be cut out to form it. Thereby, when bending into a cylindrical shape and inserting it into the aorta, when inserting the center mark 330 so that it is at the intermediate position between the left and right coronary arteries, when expanding (stretching) by its own elastic force, the first opening 320a and the second opening 320b can be aligned with the inlets of the left and right coronary arteries while exposing the aortic valve.
[0044] The first rigidity adjustment part 340a has a function of making the bending rigidity at a position above the center on one end side in the short direction (width) of the deployer body 310 lower than the bending rigidity at a position below the center on the other end side in the short direction of the deployer body 310. In the present embodiment, a position above the center of the longitudinal length W3 of the deployer body 310 in the short direction of the deployer body 310 may be referred to as the upper side in the short direction of the deployer body 310, and a position below the center of the longitudinal length W3 of the deployer body 310 in the short direction of the deployer body 310 may be referred to as the lower side in the short direction of the deployer body 310. The first rigidity adjustment part 340a is formed between one end part 310c of the deployer body 310 and the first opening 320a, on the upper side in the short direction of the deployer body 310. The first rigidity adjustment part 340a is constituted, for example, by an oval-shaped opening extending along the longitudinal direction of the deployer body 310.
[0045] The second stiffness adjustment section 340b, like the first stiffness adjustment section 340a, has the function of making the stiffness of the upper side of the deployant body 310 in the short direction lower than the stiffness of the lower side of the deployant body 310 in the short direction. The second stiffness adjustment section 340b is located between the other end 310d of the deployant body 310 and the second opening 320b, and is formed on the upper side of the deployant body 310 in the short direction. The second stiffness adjustment section 340b is, for example, composed of an oval-shaped opening that extends along the longitudinal direction of the deployant body 310.
[0046] The length D3c in the long side direction of the first stiffness adjustment section 340a and the second stiffness adjustment section 340b is selected to be, for example, 19 mm. The length D3d in the short side direction of the first stiffness adjustment section 340a and the second stiffness adjustment section 340b is selected to be, for example, 4 mm. By providing the first stiffness adjustment section 340a and the second stiffness adjustment section 340b in this way, the bending stiffness of the lower side of the entire expander body 310 is increased. Therefore, when the expander body 310 is bent into a cylindrical shape during aortic valve surgery, the expander body 310 can be made to have a roughly trapezoidal shape when viewed from the side. In this case, the trapezoidal shape has a lower base that is longer than the upper base, and widens from the top to the bottom. This allows the lower end peripheral edge of the expander body 310 to protrude outward more than other parts, and the lower end peripheral edge of the expander body 310 can function as a fall prevention section that prevents the aortic valve surgery expander 300 from falling upward during surgery.
[0047] As for other configurations of the rigidity adjustment section, the thickness of the upper part of the expander body 310 in the short direction may be formed to be thinner than the thickness of the lower part of the expander body 310 in the short direction, or the surface of the upper part of the expander body 310 in the short direction may be cut out. Also, by forming the first opening 320a and the second opening 320b on the upper part of the expander body 310 in the short direction, the first opening 320a and the second opening 320b may function as rigidity adjustment sections in addition to their function as inlet ports for myocardial protective solution. Furthermore, although an example in which the first rigidity adjustment section 340a and the second rigidity adjustment section 340b are provided at two locations on the expander body 310 has been described, the invention is not limited to this. For example, the rigidity adjustment section may be provided at one location on the expander body 310, or it may be provided at three or more locations.
[0048] According to the third embodiment, the same operational effects as those of the first embodiment, such as shortening the above-described operation time, can be achieved. Further, according to the third embodiment, when bending the deployer body 310 into a cylindrical shape and inserting it into the aorta, the center mark 330 can be aligned with the center position between the inlet of the right coronary artery 20a and the inlet of the left coronary artery 20b, and the aortic valve surgery deployer 300 can be arranged. Thereby, the first opening 320a and the second opening 320b can be accurately and quickly aligned with the inlets of the left and right coronary arteries, respectively.
[0049] Further, according to the third embodiment, by providing the first rigidity adjustment part 340a and the second rigidity adjustment part 340b, when bending the deployer body 310 into a cylindrical shape during aortic valve surgery, the deployer body 310 can be made into a substantially trapezoidal shape when viewed from the side. Thereby, when the entire side surface of the deployer body 310 contacts the aorta, the pressing force (biasing force) on the lower side thereof becomes stronger, and the aortic valve surgery deployer 300 can be prevented from dropping upward during surgery. Also, when bending the deployer body 310 into a cylindrical shape, since the rigidity adjustment part is provided so that the lower base is longer than the upper base, when removing the aortic valve surgery deployer 300 from the aortic root 10c, the aortic valve surgery deployer 300 can be smoothly removed from the aorta.
[0050] As described above, the preferred embodiments of the present disclosure have been described in detail with reference to the accompanying drawings, but the technical scope of the present disclosure is not limited to such examples. Also, various modified examples and improvements naturally belong to the technical scope of the present disclosure within the scope of the technical idea described in the claims of those skilled in the art. For example, with respect to the configuration in which the one end portion 310c and the other end portion 310d in the longitudinal direction of the deployer body 310 described in the third embodiment are formed so as not to have an acute angle portion, it can also be applied to the deployer body 110 of the first embodiment and the deployer body 210 of the second embodiment described above. Specifically, both end portions in the longitudinal direction of the deployer body 110 according to the first embodiment and the deployer body 210 according to the second embodiment can be formed in an arc shape (R shape) similar to both end portions in the longitudinal direction of the deployer body 310 according to the third embodiment.
[0051] This disclosure can be used as a dispensing device during aortic valve surgery.
[0052] 10 Aorta 20a Right coronary artery 20b Left coronary artery 100, 200 Aortic valve surgery expander 110, 210, 310 Expander body 120a, 220a, 320a First opening 120b, 220b, 320b Second opening 330 Center mark (mark) 340a First stiffness adjustment part (stiffness adjustment part) 340b Second stiffness adjustment part (stiffness adjustment part) D1 Diameter of the first and second openings D2a Length of the long side of the first and second openings D2b Length of the short side of the first and second openings
Claims
1. An aortic valve surgical expander used in aortic valve surgery, comprising: an expander body which is substantially rectangular in plan view and can be bent into a cylindrical shape in the longitudinal direction; and an opening provided in the expander body at a position corresponding to the coronary artery inlet for injecting myocardial protective fluid into the coronary artery.
2. The aortic valve surgical expander according to claim 1, wherein the opening has a first opening for injecting the myocardial protective solution into the right coronary artery, which is the coronary artery, and a second opening for injecting the myocardial protective solution into the left coronary artery, which is the coronary artery, and the first opening and the second opening are formed at a predetermined distance apart in the longitudinal direction of the expander body.
3. The aortic valve surgical dispensing device according to claim 2, wherein the first opening and the second opening are circular in shape when viewed from above.
4. The aortic valve surgical expander according to claim 3, wherein the diameters of the first opening and the second opening are greater than or equal to the diameters of the inlets of the right coronary artery and the left coronary artery.
5. The aortic valve surgical dispensing device according to claim 2, wherein the first opening and the second opening are rectangular in plan view, with a long side extending along the longitudinal direction of the dispensing device body and a short side extending along the short direction of the dispensing device body.
6. The aortic valve dispensing device according to claim 5, wherein the length of the long side is several times or more the diameter of the inlet of the right coronary artery and the left coronary artery, and the length of the short side is greater than or equal to the diameter of the inlet of the right coronary artery and the left coronary artery.
7. The aortic valve surgical expander according to claim 1, comprising a mark for aligning the opening with the inlet of the coronary artery, wherein the mark is located at the center or approximately the center of the expander body in the longitudinal direction.
8. The aortic valve surgical dispensing device according to claim 1, further comprising a stiffness adjustment unit for adjusting the bending stiffness of the dispensing device body in the short direction.