JP5089615B2 - 人工心臓弁および他の人工器官の送達の方法および器具 - Google Patents
人工心臓弁および他の人工器官の送達の方法および器具 Download PDFInfo
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/24—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body
- A61F2/2427—Devices for manipulating or deploying heart valves during implantation
- A61F2/2439—Expansion controlled by filaments
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/24—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body
- A61F2/2412—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body with soft flexible valve members, e.g. tissue valves shaped like natural valves
- A61F2/2418—Scaffolds therefor, e.g. support stents
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/24—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body
- A61F2/2427—Devices for manipulating or deploying heart valves during implantation
- A61F2/243—Deployment by mechanical expansion
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/24—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body
- A61F2/2427—Devices for manipulating or deploying heart valves during implantation
- A61F2/243—Deployment by mechanical expansion
- A61F2/2433—Deployment by mechanical expansion using balloon catheter
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/24—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body
- A61F2/2427—Devices for manipulating or deploying heart valves during implantation
- A61F2/2436—Deployment by retracting a sheath
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/95—Instruments specially adapted for placement or removal of stents or stent-grafts
- A61F2/9522—Means for mounting a stent or stent-graft onto or into a placement instrument
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
- A61F2220/005—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements using adhesives
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
- A61F2220/0058—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements soldered or brazed or welded
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
- A61F2230/0017—Angular shapes
- A61F2230/0023—Angular shapes triangular
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2250/0003—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having an inflatable pocket filled with fluid, e.g. liquid or gas
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- Health & Medical Sciences (AREA)
- Cardiology (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Vascular Medicine (AREA)
- Transplantation (AREA)
- Oral & Maxillofacial Surgery (AREA)
- Heart & Thoracic Surgery (AREA)
- Life Sciences & Earth Sciences (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Mechanical Engineering (AREA)
- Prostheses (AREA)
- Surgical Instruments (AREA)
Description
人工弁およびその他の器具を体内管腔の治療部位に送達するための器具と、それを使用する方法について以下に説明する。送達器具は、具体的には、経皮的大動脈弁置換等の低侵襲的介入処置での使用のために構成される。図2は、送達カテーテル形状の器具の好適な実施形態を示す。送達カテーテル100は、カテーテルの近位端に位置するハンドル機構102と、器具の遠位端に位置する配置機構104と、ハンドル機構102と配置機構104との間に延在し、かつそれらを相互連結する軸106と、を備える。カテーテル100は、好ましくは、カテーテルの全長に貫通するガイドワイヤ用管腔を備え、ガイドワイヤ108が、「ワイヤ誘導(over−the−wire)」構造において送達カテーテルを貫通できるようにする。任意の実施形態(図示せず)において、カテーテル100は、「迅速交換(rapid−exchange)」構造を備え、本構造により、ガイドワイヤは、カテーテルの遠位端付近に位置する出口ポートを通ってカテーテル軸から出るようになる。配置機構104および軸106の断面輪郭は、患者の血管内で、心臓弁の1つ以上の弁根等の標的部位に進めることが可能であるように十分小さいサイズである。好適な侵入経路は、当業者に既知の方法で大腿動脈を通る。従って、配置機構104は、約24Frの好適な最大直径を有する。しかしながら、配置機構104の最大および最小の横方向寸法は、必要または所望の結果を得るために変更してもよいことを理解されたい。
好適な送達カテーテルおよび使用方法について上に説明されている。器具の部品、特徴、およびその他の側面のいくつかに関する多数の変形例が考えられ、それについて以下に説明する。
図1A〜Cに関連して上に図示および説明されるような弁ならびに’126号出願およびその他出願に記載される弁等の人工弁30は、典型的には、送達カテーテルから解放されると完全に配置されるが、場合により、弁が配置されないまたは完全に配置されないということが発生する。このような状況のほとんどの場合において、配置不成功または完全な配置不成功は、多パネル弁30の1つ以上のパネル36が、その反転状態から拡張された状態に変化しないことに起因する。このような一例について図24Bに図示する。ここで、3つのパネルの人工弁30の2つのパネル36は拡張しているが、上部パネル36は、部分的に反転状態のままである。これらの未配置および未完全配置弁を能動的に補正するためいくつかの機構および方法について本明細書に説明する。
Claims (17)
- 患者の脈管構造によって該患者の治療部位に人工器具を送達するための機器であって、
近位端および遠位端を有するカテーテルであって、該カテーテルの該遠位端は人工器具を担持するように構成され、該人工器具は、長手方向軸と、治療部位に送達するための完全に収縮された状態と、該治療部位に配置するための拡張された状態とを有するカテーテルと、
該カテーテルの該遠位端に関連付けられる1つ以上のテザーであって、該1つ以上のテザーは、該人工器具を軸方向に係合し、かつ選択的に拘束するように構成されるテザーとを備え、
該カテーテルの該遠位端に担持され、かつ該人工器具を実質的に包囲する管状部材をさらに備え、該管状部材には複数のスロットが設けられ、該人工器具が前記完全に収縮された状態とは異なる部分的に収縮された状態にある場合に、該人工器具の一部は、該複数のスロットのうちの少なくとも1つを選択的に貫通し、
複数の巻き付けピンを担持するハブをさらに備え、該複数の巻き付けピンは、該ハブから遠位に延出し、かつ該管状部材によって実質的に包囲され、該人工器具は、該人工器具がその完全に収縮された状態およびその部分的に収縮された状態にある場合に、該巻き付けピンに担持される、機器。 - 前記テザーは、前記完全に収縮された状態とは異なる部分的に収縮された状態において、前記人工器具を選択的に拘束するように構成される、請求項1に記載の機器。
- 前記テザーは、前記人工器具をその拡張された状態に選択的に拘束するように構成される、請求項1に記載の機器。
- 前記人工器具に対する前記管状部材の回転により、該人工器具の一部が、前記複数のスロットのうちの少なくとも1つを貫通するようになる、請求項1に記載の機器。
- 前記カテーテルの前記近位端に位置する制御部材をさらに備え、該制御部材は、前記人工器具に対して前記管状部材を回転させるように構成され、該人工器具に対して近位方向に該管状部材を引き込むように構成され、その結果、該管状部材は該人工器具を実質的に包囲しない、請求項4に記載の機器。
- 前記人工器具は、前記管状部材と、前記複数の巻き付けピンを担持するハブとの相対的回転によって、その完全に収縮された状態からその部分的に収縮された状態に変換される、請求項1に記載の機器。
- 前記カテーテルの前記近位端に位置する制御部材をさらに備え、該制御部材は、前記人工器具に対して前記管状部材を回転させるように構成される、請求項1に記載の機器。
- 前記制御部材は、前記人工器具に対して近位方向に前記管状部材を引き込むように構成され、その結果、該管状部材は該人工器具をもはや実質的に包囲せず、さらに、該制御部材は該人工器具に対して近位方向に前記複数の巻き付けピンを独立して引き込むように構成され、その結果、該人工器具が該巻き付けピン上で担持されない、請求項7に記載の機器。
- 前記人工器具は、部分的に収縮された状態を形成するように反転する区分を有する多区分支持部材を備える、請求項1、2、3、4、5、6、7または8に記載の機器。
- 前記人工器具は、3つのパネル付きで3つのヒンジ付きの支持部材を備え、前記部分的に収縮された状態は、3頂点星型形状を備える、請求項1、2、3、4、5、6、7または8に記載の機器。
- 前記人工器具が前記カテーテルから係合解除された後に、該人工器具をその完全に拡張された状態に変換するように構成される配置部材をさらに備える、請求項1に記載の機器。
- 前記配置部材は、前記カテーテルの軸部分を動作可能に係合するように構成される第1の可動部材と、該軸部分に沿って該可動部材を動かすことによって、半径方向に選択的に拡張可能である半径方向拡張可能部材とを備える、請求項11に記載の機器。
- 前記配置部材は、前記人工器具の内部に選択的に位置する膨張可能部材を備え、その結果、該膨張可能部材の膨張により、該人工器具がその完全に拡張された状態に移行する、請求項11に記載の機器。
- 前記配置部材は、前記人工器具の外部に選択的に取り付けられる膨張可能部材を備え、その結果、該膨張可能部材の膨張により、該人工器具がその完全に拡張された状態に移行する、請求項11に記載の機器。
- 前記配置部材は、前記人工器具の内面を係合するローラと、該人工器具の外面を係合するピンチャを備える、請求項11に記載の機器。
- 前記配置部材は、前記人工器具の内面を係合するセパレータと、前記人工器具の外面を係合するガイド部材とを含む、請求項11に記載の機器。
- 前記配置部材は、前記人工器具に形成されるヒンジに取り付けられるねじれバネを備える、請求項11に記載の機器。
Applications Claiming Priority (4)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US11/364,724 US8403981B2 (en) | 2006-02-27 | 2006-02-27 | Methods and devices for delivery of prosthetic heart valves and other prosthetics |
US11/364,715 US7749266B2 (en) | 2006-02-27 | 2006-02-27 | Methods and devices for delivery of prosthetic heart valves and other prosthetics |
US11/364,724 | 2006-02-27 | ||
PCT/US2007/062818 WO2007101159A2 (en) | 2006-02-27 | 2007-02-26 | Methods and devices for delivery of prosthetic heart valves and other prosthetics |
Publications (3)
Publication Number | Publication Date |
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JP2009528089A JP2009528089A (ja) | 2009-08-06 |
JP2009528089A5 JP2009528089A5 (ja) | 2011-04-14 |
JP5089615B2 true JP5089615B2 (ja) | 2012-12-05 |
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JP2008556580A Expired - Fee Related JP5089615B2 (ja) | 2006-02-27 | 2007-02-26 | 人工心臓弁および他の人工器官の送達の方法および器具 |
Country Status (7)
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US (6) | US8403981B2 (ja) |
EP (1) | EP1988852A4 (ja) |
JP (1) | JP5089615B2 (ja) |
CN (1) | CN101426452B (ja) |
AU (1) | AU2007220062A1 (ja) |
CA (1) | CA2643832A1 (ja) |
WO (2) | WO2007101160A2 (ja) |
Cited By (1)
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JP2013517011A (ja) * | 2010-01-12 | 2013-05-16 | バルブ メディカル エルティーディー | 自己組織化モジュール式経皮弁並びに折畳み、組立て、及び送達の方法 |
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US6626899B2 (en) | 1999-06-25 | 2003-09-30 | Nidus Medical, Llc | Apparatus and methods for treating tissue |
US9526609B2 (en) | 2003-12-23 | 2016-12-27 | Boston Scientific Scimed, Inc. | Methods and apparatus for endovascularly replacing a patient's heart valve |
US7381219B2 (en) | 2003-12-23 | 2008-06-03 | Sadra Medical, Inc. | Low profile heart valve and delivery system |
US8603160B2 (en) | 2003-12-23 | 2013-12-10 | Sadra Medical, Inc. | Method of using a retrievable heart valve anchor with a sheath |
US7959666B2 (en) * | 2003-12-23 | 2011-06-14 | Sadra Medical, Inc. | Methods and apparatus for endovascularly replacing a heart valve |
US20050137687A1 (en) | 2003-12-23 | 2005-06-23 | Sadra Medical | Heart valve anchor and method |
US7976539B2 (en) | 2004-03-05 | 2011-07-12 | Hansen Medical, Inc. | System and method for denaturing and fixing collagenous tissue |
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Cited By (1)
Publication number | Priority date | Publication date | Assignee | Title |
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JP2013517011A (ja) * | 2010-01-12 | 2013-05-16 | バルブ メディカル エルティーディー | 自己組織化モジュール式経皮弁並びに折畳み、組立て、及び送達の方法 |
Also Published As
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WO2007101159A2 (en) | 2007-09-07 |
JP2009528089A (ja) | 2009-08-06 |
US7749266B2 (en) | 2010-07-06 |
EP1988852A2 (en) | 2008-11-12 |
CA2643832A1 (en) | 2007-09-07 |
US20070203560A1 (en) | 2007-08-30 |
WO2007101159A3 (en) | 2008-07-24 |
US20120165926A1 (en) | 2012-06-28 |
US20070203561A1 (en) | 2007-08-30 |
AU2007220062A1 (en) | 2007-09-07 |
WO2007101160A2 (en) | 2007-09-07 |
WO2007101160A3 (en) | 2008-02-21 |
CN101426452A (zh) | 2009-05-06 |
US20100179634A1 (en) | 2010-07-15 |
US20100312332A1 (en) | 2010-12-09 |
CN101426452B (zh) | 2013-05-29 |
US8403981B2 (en) | 2013-03-26 |
US20130090727A1 (en) | 2013-04-11 |
EP1988852A4 (en) | 2010-04-14 |
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