Electrosurgical Valve Leaflet Excision for TAVI Coronary Obstruction
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Solution Overview
Problem
Transcatheter Aortic Valve Implantation (TAVI) procedures face a rare but catastrophic complication of coronary artery obstruction, particularly with prosthetic valves, where existing methods are inadequate in preventing obstruction and ensuring safe valve implantation.
Innovation Solution
An electrosurgical instrument with a delivery shaft, jaws, and electrically insulated wire portions is used to excise segments of native or prosthetic heart valve leaflets, allowing for the application of electrical current to cut the leaflet segments along a predefined path, preventing obstruction and facilitating safe implantation of artificial valves.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If traditional TAVI procedures are performed without leaflet excision, then the procedure is simpler and faster, but coronary artery obstruction occurs
Solution Approach 1:
The electrosurgical instrument performs leaflet excision before valve implantation to prevent coronary obstruction. The cutting element is advanced through the delivery shaft, positioned against the valve leaflet, and activates electrosurgical current to excise the obstructing leaflet tissue prior to deploying the prosthetic valve
Solution Approach 2:
The patent replaces traditional mechanical cutting methods (knives, scissors) with electrosurgical cutting. The electrosurgical generator delivers high-frequency electrical current through the cutting element to vaporize and separate leaflet tissue, providing precise cutting with minimal mechanical force and reduced risk of tissue damage
2Manufacturing precision
If electrosurgical cutting is used to excise leaflet segments, then precise cutting is achieved, but risk of tissue damage increases
Solution Approach 1:
The electrosurgical cutting element is designed with specific geometric characteristics (sharp edge, controlled surface area) to concentrate electrical current precisely at the cutting interface. This localized energy delivery enables clean cutting of leaflet tissue while minimizing thermal spread to surrounding healthy tissue and coronary arteries
Solution Approach 2:
The delivery shaft serves as an intermediary that isolates the electrosurgical generator from direct contact with cardiac tissue. The cutting element is advanced through the delivery shaft to the target site, allowing precise delivery of electrosurgical energy while the delivery shaft provides mechanical support and electrical insulation
Applied Scientific Principles
This section explains which scientific principles are used to turn an abstract innovation direction into a practical engineering solution.
Function Achieved in This Case
The electrosurgical instrument effectively excises valve leaflet segments, preventing coronary artery obstruction and enabling safe implantation of artificial valves by ensuring unobstructed valve openings, thus addressing the challenges of TAVI procedures.
Implementation Method 1
an electrically exposed cutting portion... when an electrical current is applied to the electrically exposed cutting portion... excises the leaflet segment
Data Source
AI summary
An electrosurgical instrument (20, 120, 220, 420, 620, 720) is provided for excising a segment of a heart valve leaflet, the electrosurgical instrument including a delivery shaft (26, 426) supporting a first jaw (24A, 124A, 224A, 424A, 624A) and a second jaw (24B, 124B, 224B, 424B, 624B), which together are configured to assume (i) an open position, in which the first and the second jaws are spaced apart to allow insertion of a portion of the leaflet therebetween, and (ii) a closed position, in which the first and the second jaws sandwich the inserted leaflet portion. The electrosurgical instrument (20, 120, 220, 420, 620, 720) also includes first and second electrically insulated wire portions (34A, 734A, 34B, 734B) and, longitudinally therebetween, an electrically exposed cutting portion (36, 736). When an electrical current is applied to the electrically exposed cutting portion (36, 736), movement of the electrically exposed cutting portion (36, 736) along a predefined path (42) excises the leaflet segment from the inserted leaflet portion, such that the excised leaflet segment remains entrapped between the first and the second jaws. Other embodiments are also described.