System for cardiac procedures

A system for accessing a patient's cardiac anatomy which includes an endovascular aortic partitioning device that separates the coronary arteries and the heart from the rest of the patient's arterial system. The endovascular device for partitioning a patient's ascending aorta comprises a flexible shaft having a distal end, a proximal end, and a first inner lumen therebetween with an opening at the distal end. The shaft may have a preshaped distal portion with a curvature generally corresponding to the curvature of the patient's aortic arch. An expandable means, e.g. a balloon, is disposed near the distal end of the shaft proximal to the opening in the first inner lumen for occluding the ascending aorta so as to block substantially all blood flow therethrough for a plurality of cardiac cycles, while the patient is supported by cardiopulmonary bypass. The endovascular aortic partitioning device may be coupled to an arterial bypass cannula for delivering oxygenated blood to the patient's arterial ...

Perfusion shunt device having non-distensible pouch for receiving angioplasty balloon

A perfusion shunt device is used in conjunction with balloon catheters to provide blood perfusion across an inflated balloon in a blood vessel. The perfusion shunt device comprises a flexible conduit structure having one or more blood perfusion paths formed from a proximal end to a distal end thereof. The flexible conduit structure is usually attached directly or indirectly to a proximal shaft structure. Discrete anchors or expansible sleeves or cages are provided for locating the conduit structure over the balloon on the catheter. The flexible conduit structure will not be directly attached to the balloon, but rather will be secured at locations distal to an proximal of the balloon. In this way, constriction and distortion of the conduit structure and/or balloon resulting from balloon expansion are minimized. The device may be loaded over a conventional angioplasty balloon catheter outside of the blood vessel being treated, either before or after an angioplasty procedure. In an alternative ...

System for cardiac procedures

A system for accessing a patient's cardiac anatomy which includes an endovascular aortic partitioning device that separates the coronary arteries and the heart from the rest of the patient's arterial system. The endovascular device for partitioning a patient's ascending aorta comprises a flexible shaft having a distal end, a proximal end, and a first inner lumen therebetween with an opening at the distal end. The shaft may have a preshaped distal portion with a curvature generally corresponding to the curvature of the patient's aortic arch. An expandable means, e.g. a balloon, is disposed near the distal end of the shaft proximal to the opening in the first inner lumen for occluding the ascending aorta so as to block substantially all blood flow therethrough for a plurality of cardiac cycles, while the patient is supported by cardiopulmonary bypass. The endovascular aortic partitioning device may be coupled to an arterial bypass cannula for delivering oxygenated blood to the patient's arterial ...

Composite vascular catheter

An improved vascular catheter having a tubular member of composite structure with a tubular substrate and a resin-impregnated fibrous covering extending over a substantial part of the length thereof. The tubular substrate which is longitudinally flexible but relatively inextendible, is preferably polyimide tubing with a lubricious coating on the inner surface thereof defining an inner lumen. The fibrous covering is preferably epoxy-impregnated aramid or polyester (Dacron) multi-filament fibers. The strands are is snugly wrapped about the tubular substrate and then impregnated with a suitable resin. One or more of the strands in the distal portion are at an angle with respect to the longitudinal axis of the tubular substrate between about 20° and about 45° greater than the angle of one or more strands in the proximal portion. Individual strand wraps in the distal portion are at an angle of about 60° to about 85° and strand wraps in such as the proximal portion are at an angle of about 30 ...

Cardioplegia catheter system

A catheter system is provided for accessing the coronary ostia transluminally from a peripheral arterial access site, such as the femoral artery, and for inducing cardioplegic arrest by direct infusion of cardioplegic solution into the coronary arteries. In a first embodiment, the catheter system is in the form of a single perfusion catheter with multiple distal branches for engaging the coronary ostia. In a second embodiment, multiple perfusion catheters are delivered to the coronary ostia through a single arterial cannula. In a third embodiment, multiple perfusion catheters are delivered to the coronary ostia through a single guiding catheter. In a fourth embodiment, multiple catheters are delivered to the coronary ostia through a single guiding catheter which has distal exit ports that are arranged to direct the perfusion catheters into the coronary ostia. In each embodiment, the catheters are equipped with an occlusion means at the distal end of the catheter for closing the coronary ...

Retrograde delivery catheter and method for inducing cardioplegic arrest

... retrograde delivery catheter includes at its distal end a balloon configured to occlude the coronary sinus of a patient's heart, and has a length and flexibility which allow the distal end to be positioned in the coronary sinus with the proximal end extending transluminally to a peripheral vein such as an internal jugular vein and out of the body through a puncture therein. The delivery catheter has a delivery lumen extending between its proximal and distal ends which is configured to allow a cardioplegic fluid to be delivered at a flow rate of at least 200 ml/min with a pump pressure less than 300 mm Hg, thereby allowing cardioplegic arrest to be maintained using a blood cardioplegic fluid without causing excessive hemolysis. In a method of inducing cardioplegic arrest according to the invention, the patient is placed on cardiopulmonary bypass, the coronary arteries are isolated from remainder of the arterial system, and the delivery catheter is positioned transluminally in the coronary ...

Thoracoscopic devices and methods for arresting the heart

The invention provides devices and methods for thoracoscopically arresting the heart and establishing cardiopulmonary bypass, thus facilitating a variety of less-invasive surgical procedures on and within the heart and great vessels of the thorax. In one embodiment, the invention provides a thoracoscopic system for arresting a patient's heart including a clamp configured for introduction into the patient's thoracic cavity through a percutaneous intercostal penetration in the patient's chest. The clamp is positionable about the patient's ascending aorta between the coronary arteries and the brachiocephalic artery. The clamp is coupled to the distal end of an elongated handle means for manipulating the clamp from a location outside of the patient's thoracic cavity. A means for actuating the clamp is coupled to the proximal end of the handle means. When actuated, the clamp blocks blood flow through the ascending aorta. A delivery cannula may be used to deliver cardioplegic fluid into the ascending ...

Dilatation catheter with reinforcing mandrel

A dilatation catheter for angioplasty procedures having inner and outer tubular members with a reinforcing mandrel fixed within the annular lumen between the the inner and outer tubular members. The catheter is adapted for use with a guidewire having an OD of not more than 0.014 inch (0.356 mm), preferably less than about 0.012 inch (0.305 mm). The mandrel has a small diameter distal section which extends into the portion of the dilatation catheter which extends out of the distal end of the guiding catheter and into the patient's coronary artery during the angioplasty procedure.

Retrograde delivery catheter and method for inducing cardioplegic arrest

A retrograde delivery catheter includes at its distal end a balloon configured to occlude the coronary sinus of a patient's heart, and has a length and flexibility which allow the distal end to be positioned in the coronary sinus with the proximal end extending transluminally to a peripheral vein such as an internal jugular vein and out of the body through a puncture therein. The delivery catheter has a delivery lumen extending between its proximal and distal ends which is configured to allow a cardioplegic fluid to be delivered at a flow rate of at least 200 ml/min with a pump pressure less than 300 mm Hg, thereby allowing cardioplegic arrest to be maintained using a blood cardioplegic fluid without causing excessive hemolysis. In a method of inducing cardioplegic arrest according to the invention, the patient is placed on cardiopulmonary bypass, the coronary arteries are isolated from remainder of the arterial system, and the delivery catheter is positioned transluminally in the coronary ...

Method of perfusing the coronary vasculature

A catheter system is provided for accessing the coronary ostia transluminally from a peripheral arterial access site, such as the femoral artery, and for inducing cardioplegic arrest by direct infusion of cardioplegic solution into the coronary arteries. In a first embodiment, the catheter system is in the form of a single perfusion catheter with multiple distal branches for engaging the coronary ostia. In a second embodiment, multiple perfusion catheters are delivered to the coronary ostia through a single arterial cannula. In a third embodiment, multiple perfusion catheters are delivered to the coronary ostia through a single guiding catheter. In a fourth embodiment, multiple catheters are delivered to the coronary ostia through a single guiding catheter which has distal exit ports that are arranged to direct the perfusion catheters into the coronary ostia. In each embodiment, the catheters are equipped with an occlusion means at the distal end of the catheter for closing the coronary ...

Thoracoscopic devices and methods for arresting the heart

The invention provides devices and methods for thoracoscopically arresting the heart and establishing cardiopulmonary bypass, thus facilitating a variety of less-invasive surgical procedures on and within the heart and great vessels of the thorax. In one embodiment, the invention provides a thoracoscopic system for arresting a patient's heart including a clamp configured for introduction into the patient's thoracic cavity through a percutaneous intercostal penetration in the patient's chest. The clamp is positionable about the patient's ascending aorta between the coronary arteries and the brachiocephalic artery. The clamp is coupled to the distal end of an elongated handle means for manipulating the clamp from a location outside of the patient's thoracic cavity. A means for actuating the clamp is coupled to the proximal end of the handle means. When actuated, the clamp blocks blood flow through the ascending aorta. A delivery cannula may be used to deliver cardioplegic fluid into the ascending ...

Composite vascular catheter

An improved vascular catheter having a tubular member of composite structure with a tubular substrate and a resin-impregnated fibrous covering extending over a substantial part of the length thereof. The tubular substrate which is longitudinally flexible but relatively inextendible, is preferably polyimide tubing with a lubricious coating on the inner surface thereof defining an inner lumen. The fibrous covering is preferably epoxy-impregnated aramid or polyester (Dacron) multi-filament fibers. The strands are is snugly wrapped around the tubular substrate and then impregnated with a suitable resin. One or more of the strands in the distal portion are at an angle with respect to the longitudinal axis of the tubular substrate between about 20° and about 45° greater than the angle of one or more strands in the proximal portion. Individual strand wraps in the distal portion are at an angle of about 60° to about 85° and strand wraps in such as the proximal portion are at an angle of about 30 ...

Method of delivering cardioplegic fluid to a patient's heart

A system for accessing a patient's cardiac anatomy which includes an endovascular aortic partitioning device that separates the coronary arteries and the heart from the rest of the patient's arterial system. The endovascular device for partitioning a patient's ascending aorta comprises a flexible shaft having a distal end, a proximal end, and a fist inner lumen therebetween with an opening at the distal end. The shaft may have a preshaped distal portion with a curvature generally corresponding to the curvature of the patient's aortic arch. An expandable means, e.g. a balloon, is disposed near the distal end of the shaft proximal to the opening in the first inner lumen for occluding the ascending aorta so as to block substantially all blood flow therethrough for a plurality of cardiac cycles, while the patient is supported by cardiopulmonary bypass. The endovascular aortic partitioning device may be coupled to an arterial bypass cannula for delivering oxygenated blood to the patient's arterial ...

Endovascular cardiac venting catheter and method

A venting catheter, system and method are provided for withdrawing blood and other fluids from a patient's heart to facilitate decompressing the heart during cardioplegic arrest and cardiopulmonary bypass, without the need for a thoracotomy and without puncturing the aorta, pulmonary artery, or heart itself. The venting catheter is configured to be introduced into a peripheral vein and intralumninally advanced through the right side of the heart and into the pulmonary artery. The venting catheter includes a lumen configured to withdraw blood at a rate of at least about 50 ml/min at a pressure of no less than about -350 mmHg. A flow-directing means is provided to facilitate guiding the catheter into the pulmonary artery by being carried by blood flow through the heart. The cardiac venting system may include, in addition to the cardiac venting catheter, a cardiopulmonary bypass system to maintain circulation of oxygenated blood, and means for arresting the patient's heart.

Retrograde delivery catheter and method for inducing cardioplegic arrest

A retrograde delivery catheter includes at its distal end a balloon configured to occlude the coronary sinus of a patient's heart, and has a length and flexibility which allow the distal end to be positioned in the coronary sinus with the proximal end extending transluminally to a peripheral vein such as an internal jugular vein and out of the body through a puncture therein. The delivery catheter has a delivery lumen extending between its proximal and distal ends which is configured to allow a cardioplegic fluid to be delivered at a flow rate of at least 200 ml/min with a pump pressure less than 300 mm Hg, thereby allowing cardioplegic arrest to be maintained using a blood cardioplegic fluid without causing excessive hemolysis. In a method of inducing cardioplegic arrest according to the invention, the patient is placed on cardiopulmonary bypass, the coronary arteries are isolated from remainder of the arterial system, and the delivery catheter is positioned transluminally in the coronary ...

Systems and Methods for Delivering Drugs to Selected Locations Within the Body

Systems and methods for delivering drugs or other substances to target locations outside of blood vessel lumens or other body lumens. In some embodiments, a catheter having a penetrator is advanced into the body lumen and the penetrator is then advanced from the catheter toward a target location outside of that body lumen. The substance is then delivered through a the penetrator itself or through a delivery catheter that has been advanced through the penetrator to the target location. In other embodiments, the blood vessel or other body lumen is blocked at spaced-apart first and second locations and a quantity of the substance is introduced into the closed-off body lumen between the blocked first and second locations. The substance then diffuses into or through the wall of the vessel or body conduit to reach the target location. 1. A method for delivering a therapeutic substance to a target region within a patient's body , said method comprising the steps of:A) blocking, at spaced-apart first and second locations, a body conduit having a lumen and a wall, said body conduit being located at or near the target region; andB) causing a quantity of the substance to be contained between the blocked first and second locations, such that the substance will diffuse into or through the wall of the body conduit to reach the target region.2. A method according to wherein the method is carried out by implanting a first blocker device and a second blocker device at spaced-apart locations within the body conduit lumen to thereby create a substance reservoir zone within the body conduit lumen between the first and second blocker devices.3. A method according to wherein each blocker device comprises an expandable frame and a flexible lumen-blocking membrane attached to the frame.4. A method according to wherein one of the blocker devices is implanted claim 2 , the substance is the deposited within the body conduit lumen and then the other blocker device is implanted claim 2 , ...

Tissue Penetrating Catheters Having Integral Imaging Transducers and Their Methods of Use

A catheter device that is useable to penetrate from a blood vessel in which the catheter device is positioned to a target location comprises a flexible catheter advanceable into the first blood vessel, a tissue penetrator lumen adapted to receive an operative tissue penetrator which is usable to penetrate from the blood vessel to the target location when properly aimed. Further said catheter including an imaging transducer fixedly mounted on or within the catheter body to provide an imaging signal from which an image of the target location can be obtained. The catheter device may include an imageable marker on the catheter to form on the image obtainable from the imaging signal a penetrator path indication that indicates the path that will be followed by the tissue penetrator when the tissue penetrator exits from the catheter. Alternatively, or addition thereto, the imaging transducer may comprise a plurality of imaging elements which are located so that the penetrator path indication can be obtained. A method of utilizing such a catheter device to bypass an arterial obstruction is also disclosed. 1. A percutaneous , transluminal method for creating a flow channel between a first blood vessel that has a wall and a lumen and a second blood vessel that has a wall and a lumen , said method comprising the steps of: i. a catheter having a proximal end and a distal end, said catheter being advanceable into the lumen of the first blood vessel;', 'ii. a tissue penetrator that is advanceable in a lateral direction from the catheter, said tissue penetrator being operative to penetrate from the lumen of a first blood vessel, through the walls of the first and second blood vessels and into the lumen of a second blood vessel when the catheter is positioned and rotationally oriented within the first blood vessel such that the tissue penetrator is aimed at the second blood vessel;', 'iii. an imaging transducer fixedly mounted on the catheter to provide an imaging signal from which ...

Catheters, Systems and Methods for Percutaneous in Situ Arterio-Venous Bypass

A system of catheter devices and methods for forming channels or passageways between a luminal anatomical structure (e.g., a blood vessel) and a target location (e.g., another blood vessel, an organ, a mass of tissue, etc.) for the purpose of rerouting blood flow or for delivering a substance or instrument, etc. to the target location. 1. A tissue penetrating catheter device useable to penetrate outwardly from the lumen of a blood vessel in which the catheter device is positioned , through the wall of that blood vessel , and to a target location , said device comprising:i) a flexible catheter body which is insertable into the vein, said catheter body having a side•wall, a proximal end, a distal end and an outlet opening formed in the side wall thereof;ii) an first lumen through which a separate imaging catheter may be inserted;iii) a second lumen which extends through said outlet opening;iv) a tissue penetrating member disposed within said second lumen and advanceable out of said outlet opening; and,v) an orientation structure positioned on the catheter body, said orientation structure having a) an imaging catheter-receiving space formed therein in alignment with said first lumen and b) at least one marker member located on one side of the imaging catheter receiving space, said at least one marker being positioned and constructed to create on an image display received from an imaging catheter positioned within the imaging catheter-receiving space, an indication of the path that will be followed by the tissue penetrating member as the tissue penetrating member is advanced from the catheter body.255-. (canceled) This application is a continuation of U.S. patent application Ser. No. 10/370,429 filed Feb. 20, 2003, which is a division of U.S. patent application Ser. No. 09/282,276 filed Mar. 31, 1999 and issued as U.S. Pat. No. 6,544,230, which claims priority to U.S. Provisional Patent Application Ser. No. 60/080,196 entitled Methods and Apparatus for Percutaneous In ...

CATHETERS WITH NON- REMOVABLE GUIDE MEMBERS USEABLE FOR TREATMENT OF SINUSITIS

Balloon catheter, guide catheter and method for dilating openings in paranasal sinuses. A non-removable guide member (e.g., guidewire) extends from the distal end of the balloon catheter. The non-removable guide member initially passes through the opening of the paranasal sinus and is followed by the catheter body on which the balloon is mounted. The balloon is then inflated causing dilation of the opening of the paranasal sinus. In some embodiments, the non-removable guide member may be shapeable so that the operator may place the non-removable guide member in a desired shape prior to insertion of the balloon catheter. In some embodiments, the length of the non-removable guide member may be adjustable such that the operator may adjust the length of the non-removable guide member prior to insertion of the balloon catheter. 1101.-. (canceled)102. A method of dilating an opening within a nose , ear , or throat of a human or animal subject , said method comprising the steps of:(A) providing a balloon and a non-removable guide member, wherein the balloon comprises a distal end, wherein the balloon defines a longitudinal axis, wherein the non-removable guide member extends distally from the distal end of the balloon, wherein the non-removable guide member is configured to bend relative to the longitudinal axis of the balloon;(B) inserting a distal portion of the non-removable guide member to pass through the opening within the nose, ear, or throat;(C) moving the balloon to a location where the balloon is positioned within the opening within the nose, ear, or throat; and(D) inflating the balloon to cause dilation of the opening within the nose, ear, or throat.103. The method of claim 102 , wherein the inserting a distal portion of the non-removable guide member to pass through the opening within the nose claim 102 , ear claim 102 , or throat further comprises inserting the distal portion of the non-removable guide member to pass through an ostium of a paranasal sinus.104. ...

CATHETERS WITH NON-REMOVABLE GUIDE MEMBERS USEABLE FOR TREATMENT OF SINUSITIS

Balloon catheter, guide catheter and method for dilating openings in paranasal sinuses. A non-removable guide member (e.g., guidewire) extends from the distal end of the balloon catheter. The non-removable guide member initially passes through the opening of the paranasal sinus and is followed by the catheter body on which the balloon is mounted. The balloon is then inflated causing dilation of the opening of the paranasal sinus. In some embodiments, the non-removable guide member may be shapeable so that the operator may place the non-removable guide member in a desired shape prior to insertion of the balloon catheter. In some embodiments, the length of the non-removable guide member may be adjustable such that the operator may adjust the length of the non-removable guide member prior to insertion of the balloon catheter. 151.-. (canceled)52. A method for dilating an opening of a paranasal sinus in a human or animal subject , said method comprising the steps of:A) providing a balloon catheter comprising a distal end, a balloon and a non-removable guide member that extends from the distal end of the catheter;B) trans-nasally inserting the balloon catheter and causing a distal portion of the non-removable guide member to pass through an opening of the paranasal sinus;C) moving the balloon catheter to a location where the balloon is positioned within the opening of the paranasal sinus; andD) inflating the balloon to cause dilation of the opening of the paranasal sinus.53. A method according to wherein claim 52 , prior to performance of Steps B-D claim 52 , a guide catheter having a distal end is inserted trans-nasally and positioned adjacent to the opening of the paranasal sinus and wherein Step B comprises inserting the balloon catheter through the guide catheter and causing the non-removable guide member to pass through the opening of the paranasal sinus.5455.-. (canceled)56. A method according to claim 52 , wherein the guide has a curved portion and wherein the ...

Retrograde delivery catheter and method for inducing cardioplegic arrest

A retrograde delivery catheter includes at its distal end a balloon configured to occlude the coronary sinus of a patient's heart, and has a length and flexibility which allow the distal end to be positioned in the coronary sinus with the proximal end extending transluminally to a peripheral vein such as an internal jugular vein and out of the body through a puncture therein. The delivery catheter has a delivery lumen extending between its proximal and distal ends which is configured to allow a cardioplegic fluid to be delivered at a flow rate of at least 200 ml/min with a pump pressure less than 300 mm Hg, thereby allowing cardioplegic arrest to be maintained using a blood cardioplegic fluid without causing excessive hemolysis. In a method of inducing cardioplegic arrest according to the invention, the patient is placed on cardiopulmonary bypass, the coronary arteries are isolated from remainder of the arterial system, and the delivery catheter is positioned transluminally in the coronary sinus from a peripheral vein. A cardioplegic fluid is then delivered to the coronary sinus through the delivery catheter at a flow rate of at least 200 ml/min and a pump pressure less than 300 mm Hg. The heart may be vented by withdrawing blood from the pulmonary artery through a catheter introduced through a peripheral vein, or withdrawing blood from the aortic root through an aortic catheter introduced through a peripheral artery.

System for cardiac procedures

A system for accessing a patient's cardiac anatomy which includes an endovascular aortic partitioning device that separates the coronary arteries and the heart from the rest of the patient's arterial system. The endovascular device for partitioning a patient's ascending aorta comprises a flexible shaft having a distal end, a proximal end, and a first inner lumen therebetween with an opening at the distal end. The shaft may have a preshaped distal portion with a curvature generally corresponding to the curvature of the patient's aortic arch. An expandable means, e.g. a balloon, is disposed near the distal end of the shaft proximal to the opening in the first inner lumen for occluding the ascending aorta so as to block substantially all blood flow therethrough for a plurality of cardiac cycles, while the patient is supported by cardiopulmonary bypass. The endovascular aortic partitioning device may be coupled to an arterial bypass cannula for delivering oxygenated blood to the patient's arterial system. The heart muscle or myocardium is paralyzed by the retrograde delivery of a cardioplegic fluid to the myocardium through patient's coronary sinus and coronary veins, or by antegrade delivery of cardioplegic fluid through a lumen in the endovascular aortic partitioning device to infuse cardioplegic fluid into the coronary arteries. The pulmonary trunk may be vented by withdrawing liquid from the trunk through an inner lumen of an elongated catheter. The cardiac accessing system is particularly suitable for removing the aortic valve and replacing the removed valve with a prosthetic valve.

System for cardiac procedures

A system for accessing a patient's cardiac anatomy which includes an endovascular aortic partitioning device that separates the coronary arteries and the heart from the rest of the patient's arterial system. The endovascular device for partitioning a patient's ascending aorta comprises a flexible shaft having a distal end, a proximal end, and a first inner lumen therebetween with an opening at the distal end. The shaft may have a preshaped distal portion with a curvature generally corresponding to the curvature of the patient's aortic arch. An expandable means, e.g. a balloon, is disposed near the distal end of the shaft proximal to the opening in the first inner lumen for occluding the ascending aorta so as to block substantially all blood flow therethrough for a plurality of cardiac cycles, while the patient is supported by cardiopulmonary bypass. The endovascular aortic partitioning device may be coupled to an arterial bypass cannula for delivering oxygenated blood to the patient's arterial system. The heart muscle or myocardium is paralyzed by the retrograde delivery of a cardioplegic fluid to the myocardium through patient's coronary sinus and coronary veins, or by antegrade delivery of cardioplegic fluid through a lumen in the endovascular aortic partitioning device to infuse cardioplegic fluid into the coronary arteries. The pulmonary trunk may be vented by withdrawing liquid from the trunk through an inner lumen of an elongated catheter. The cardiac accessing system is particularly suitable for removing the aortic valve and replacing the removed valve with a prosthetic valve.

Retrograde delivery catheter and method for inducing cardioplegic arrest

A retrograde delivery catheter includes at its distal end a balloon configured to occlude the coronary sinus of a patient's heart, and has a length and flexibility which allow the distal end to be positioned in the coronary sinus with the proximal end extending transluminally to a peripheral vein such as an internal jugular vein and out of the body through a puncture therein. The delivery catheter has a delivery lumen extending between its proximal and distal ends which is configured to allow a cardioplegic fluid to be delivered at a flow rate of at least 200 ml/min with a pump pressure less than 300 mm Hg, thereby allowing cardioplegic arrest to be maintained using a blood cardioplegic fluid without causing excessive hemolysis. In a method of inducing cardioplegic arrest according to the invention, the patient is placed on cardiopulmonary bypass, the coronary arteries are isolated from remainder of the arterial system, and the delivery catheter is positioned transluminally in the coronary sinus from a peripheral vein. A cardioplegic fluid is then delivered to the coronary sinus through the delivery catheter at a flow rate of at least 200 ml/min and a pump pressure less than 300 mm Hg. The heart may be vented by withdrawing blood from the pulmonary artery through a catheter introduced through a peripheral vein, or withdrawing blood from the aortic root through an aortic catheter introduced through a peripheral artery.

Method of delivering cardioplegic fluid to a patient's heart

A system for accessing a patient's cardiac anatomy which includes an endovascular aortic partitioning device that separates the coronary arteries and the heart from the rest of the patient's arterial system. The endovascular device for partitioning a patient's ascending aorta comprises a flexible shaft having a distal end, a proximal end, and a fist inner lumen therebetween with an opening at the distal end. The shaft may have a preshaped distal portion with a curvature generally corresponding to the curvature of the patient's aortic arch. An expandable means, e.g. a balloon, is disposed near the distal end of the shaft proximal to the opening in the first inner lumen for occluding the ascending aorta so as to block substantially all blood flow therethrough for a plurality of cardiac cycles, while the patient is supported by cardiopulmonary bypass. The endovascular aortic partitioning device may be coupled to an arterial bypass cannula for delivering oxygenated blood to the patient's arterial system. The heart muscle or myocardium is paralyzed by the retrograde delivery of a cardioplegic fluid to the myocardium through patient's coronary sinus and coronary veins, or by antegrade delivery of cardioplegic fluid through a lumen in the endovascular aortic partitioning device to infuse cardioplegic fluid into the coronary arteries. The pulmonary trunk may be vented by withdrawing liquid from the trunk through an inner lumen of an elongated catheter. The cardiac accessing system is particularly suitable for removing the aortic valve and replacing the removed valve with a prosthetic valve.

Systems and methods for delivering drugs to selected locations within the body

A method is provided for delivering a drug to a selected tissue region within a patient's body with a catheter having a deployable puncturing element, a drug delivery element and an orientation element on a distal portion thereof. The distal portion of the catheter is percutaneously introduced into a blood vessel, and directed endovascularly to a vessel location adjacent to the selected tissue region. The puncturing element is oriented towards the selected tissue region, and deployed to access the selected tissue region. A drug is delivered with the drug delivery element to the selected tissue region.

Systems and methods for delivering drugs to selected locations within the body

A transvascular system for delivering a drug to a tissue region from a blood vessel, such as a coronary vein, includes a catheter having a distal portion with puncturing, orientation, drug delivery, and imaging elements. The puncturing element is deployable for penetrating the vessel wall to access the tissue region. The orientation element, e.g. a “cage” including a plurality of struts and/or a radiopaque marker, has a predetermined relationship with the puncturing element, the imaging element detecting the location of the orientation element with respect to the tissue region to orient the puncturing element. The catheter is percutaneously introducing into the vessel, the puncturing element is oriented towards the tissue region, the puncturing element is deployed to access the tissue region, and the drug is delivered to the tissue region. An ablation device may also be deployed to create a cavity in the tissue region for receiving the drug therein, or an indwelling catheter may be advanced into and left in the tissue region. An implantable reservoir device is also disclosed, including an enclosed membrane on an expandable frame that defines a reservoir and includes a porous region. The reservoir device may be deployed and expanded within a blood vessel, and may be filled in situ or prefilled with a drug that passes through the porous region. Alternatively, a pair of expandable endovascular blockers may be used to isolate a section of a blood vessel which may be filled with a drug that may be absorbed by the surrounding tissue.

Endovascular system for arresting the heart

The invention provides an endovascular device (20) for partitioning the ascending aorta and a system for arresting the heart to facilitate the performance of precedures such as heart valve replacement or coronary artery bypass grafting without the need for a thoracotomy. According to the invention, an endovascular device (20) for partitioning a patient's ascending aorta comprises a flexible shaft (22) having a distal end (24), a proximal end (26), and a first inner lumen (29) therebetween with an opening (31) at the distal end (24). The shaft (22) may have a preshaped distal portion (32) with a curvature generally corresponding to the curvature of the patient's aortic arch Expandable means (28) are disposed near the distal end (24) of the shaft (22) proximal to the opening (31) in the first inner lumen (29) for occluding the ascending aorta so as to block substantially all blood flow therethrough for a plurality of cardiac cycles. Means (90) for delivering cardioplegic fluid may be connected to the proximal end (26) of the device to infuse cardioplegic fluid into the coronary arteries for arresting the heart. The endovascular device of the invention is readily positionable in the ascending aorta, resists displacement caused by systolic blood flow, and maintains axial alignment with the center of the ascending aorta and aortic valve.

Method for delivering a fluid to the coronary ostia

A catheter system is provided for accessing the coronary ostia transluminally from a peripheral arterial access site, such as the femoral artery, and for inducing cardioplegic arrest by direct infusion of cardioplegic solution into the coronary arteries. In a first embodiment, the catheter system is in the form of a single perfusion catheter with multiple distal branches for engaging the coronary ostia. In a second embodiment, multiple perfusion catheters are delivered to the coronary ostia through a single arterial cannula. In a third embodiment, multiple perfusion catheters are delivered to the coronary ostia through a single guiding catheter. In a fourth embodiment, multiple catheters are delivered to the coronary ostia through a single guiding catheter which has distal exit ports that are arranged to direct the perfusion catheters into the coronary ostia. In each embodiment, the catheters are equipped with an occlusion means at the distal end of the catheter for closing the coronary ostia and isolating the coronary arteries from the systemic blood flow. The occlusion means can take the form of an inflatable occlusion balloon cuff, a tapered occlusion device or an O-ring encircling the distal end of the catheter. An optional ventricular venting catheter can be included in the system for venting blood and fluids from the left ventricle of the heart. The catheter system is combined with a femoral-to-femoral cardiopulmonary bypass system to provide a system for cardioplegic arrest and total cardiopulmonary support during minimally invasive cardiac surgical procedures.

Endovascular system for arresting the heart

Endovascular system for arresting the heart

Retrograde delivery catheter and method for inducing cardioplegic arrest

A retrograde delivery catheter (10) includes at its distal end a balloon (11) configured to occlude the coronary sinus (21) of a patient's heart, and has a length and flexibility which allow the distal end to be positioned in the coronary sinus (21) with the proximal end extending trans-luminal to a peripheral vein such as an internal jugular vein (44) and out of the body through a puncture (24) therein. The delivery catheter (20) has a delivey lumen (128) extending between its proximal and distal ends which is configured to allow a cardioplegia fluid to be delivered at a flow rate of at least 200 ml/min with a pump pressure less than 300 mm Hg, thereby allowing cardioplegia arrest to be maintained using a blood cardioplegia fluid without causing excessive hemolysis. In a method of inducing cardioplegia arrest according to the invention, the patient is placed on cardiopulmonary bypass (18), the coronary arteries (50, 51) are isolated from remainder of the arterial system, and the delivery catheter (10) is positioned trans-luminal in the coronary sinus (21) from a peripheral vein.

Methods and apparatus for connecting openings formed in adjacent blood vessels or other anatomical structures

This invention is methods and apparatus for connecting two anatomical passageways, such as blood vessels, in side-to-side fashion. Openings are formed in the sidewalls of the passageways, and a connector apparatus (10) of the present invention is implanted within such openings, and extends between the passageways or blood vessels (BV1, BV2) so as to connect the passageways or blood vessels (BV1, BV2) such that the openings are held in direct alignment with one another, thereby allowing body fluids to pass from one passageway into the other.

Methods and apparatus for bypassing arterial obstructions and/or performing other transvascular procedures

This invention is methods, devices, and systems for re-vascularization, and/or performing other medical procedures at a vascular or non-vascular intra-corporeal locations within a mammalian body. The methods generally comprise the formation of at least one extravascular passageway from a blood vessel to a vascular or non-vascular target location. In the re-vascularization methods the extravascular passageway is utilized as a conduit for accessing or performing procedures at the vascular or non-vascular target location. Also disclosed are catheter devices (100, 103) and systems (138) which are usable to form the extravascular passageways of the invention, as well as apparatus for modifying, maintaining and/or closing such extravascular passageways.

Retrograde delivery catheter and method for inducing cardioplegic arrest

retrograde delivery catheter includes at its distal end a balloon configured to occlude the coronary sinus of a patient's heart, and has a length and flexibility which allow the distal end to be positioned in the coronary sinus with the proximal end extending transluminally to a peripheral vein such as an internal jugular vein and out of the body through a puncture therein. The delivery catheter has a delivery lumen extending between its proximal and distal ends which is configured to allow a cardioplegic fluid to be delivered at a flow rate of at least 200 ml/min with a pump pressure less than 300 mm Hg, thereby allowing cardioplegic arrest to be maintained using a blood cardioplegic fluid without causing excessive hemolysis. In a method of inducing cardioplegic arrest according to the invention, the patient is placed on cardiopulmonary bypass, the coronary arteries are isolated from remainder of the arterial system, and the delivery catheter is positioned transluminally in the coronary sinus from a peripheral vein. A cardioplegic fluid is then delivered to the coronary sinus through the delivery catheter at a flow rate of at least 200 ml/min and a pump pressure less than 300 mm Hg. The heart may be vented by withdrawing blood from the pulmonary artery through a catheter introduced through a peripheral vein, or withdrawing blood from the aortic root through an aortic catheter introduced through a peripheral artery.

Catheters, systems and methods for percutaneous in situ arterio-venous bypass

A system of catheter devices and methods for forming channels or passageways between a luminal anatomical structure (e.g., a blood vessel) and a target location (e.g., another blood vessel, an organ, a mass of tissue, etc.) for the purpose of rerouting blood flow or for delivering a substance or instrument, etc. to the target location.

Composite vascular catheter

Cardioplegia catheter system

A catheter system is provided for accessing the coronary ostia (176, 180) transluminal from a peripheral arterial access site, such as the femoral artery, and for inducing cardioplegia arrest by direct infusion of cardioplegia solution into the coronary arteries. In a first embodiment, the catheter system is in the form of a single perfusion catheter (20) with multiple distal branches (24, 26, 28) for engaging the coronary ostia (176, 180). In a second embodiment, multiple perfusion catheters (82, 84) are delivered to the coronary ostia (176, 180) through a single arterial cannula (104). In a third embodiment, multiple perfusion catheters (112, 114, 116) are delivered to the coronary ostia (176, 180) through a single guiding catheter (126). In a fourth embodiment, multiple catheters (140, 142, 144) are delivered to the coronary ostia (176, 180) through a single guiding catheter (130) which has distal exit ports (134, 136, 138) that are arranged to direct the perfusion catheters into the coronary ostia (176, 180). In each embodiment, the catheters (20) are equipped with an occlusion means (30, 50) at the distal end of the catheter (20) for closing the coronary ostia (176, 180), and isolating the coronary arteries from the systemic blood flow.

Composite vascular catheter

An improved vascular catheter having a tubular member of composite structure with a tubular substrate and a resin-impregnated fibrous covering extending over a substantial part of the length thereof. The tubular substrate which is longitudinally flexible but relatively inextendible, is preferably polyimide tubing with a lubricious coating on the inner surface thereof defining an inner lumen. The fibrous covering is preferably epoxy-impregnated aramid or polyester (Dacron) multi-filament fibers. The strands are is snugly wrapped about the tubular substrate and then impregnated with a suitable resin. One or more of the strands in the distal portion are at an angle with respect to the longitudinal axis of the tubular substrate between about 20° and about 45° greater than the angle of one or more strands in the proximal portion. Individual strand wraps in the distal portion are at an angle of about 60° to about 85° and strand wraps in such as the proximal portion are at an angle of about 30° to about 60°. The composite tubular member is preferably utilized in balloon dilatation catheters used in angioplasty procedures.

Endovascular cardiac venting catheter and method

A venting catheter, system and method are provided for withdrawing blood and other fluids from a patient's heart to facilitate decompressing the heart during cardioplegic arrest and cardiopulmonary bypass, without the need for a thoracotomy and without puncturing the aorta, pulmonary artery, or heart itself. The venting catheter is configured to be introduced into a peripheral vein and intralumninally advanced through the right side of the heart and into the pulmonary artery. The venting catheter includes a lumen configured to withdraw blood at a rate of at least about 50 ml/min at a pressure of no less than about -350 mmHg. A flow-directing means is provided to facilitate guiding the catheter into the pulmonary artery by being carried by blood flow through the heart. The cardiac venting system may include, in addition to the cardiac venting catheter, a cardiopulmonary bypass system to maintain circulation of oxygenated blood, and means for arresting the patient's heart.

Methods and apparatus for bypassing arterial obstructions and/or performing other transvascular procedures

Thoracoscopic devices and methods for arresting the heart

The invention provides devices and methods for thoracoscopically arresting the heart and establishing cardiopulmonary bypass, thus facilitating a variety of less invasive surgical procedures on and within the heart and great vessels of the thorax. In one embodiment, the invention provides a thoracoscopic system for arresting a patient's heart including a clamp (32) configured for introduction into the patient's thoracic cavity through a percutaneous intercostal penetration in the patient's chest. The clamp is positionable about the patient's ascending aorta between the coronary arteries and the brachio-cephalic artery. The clamp (32) is coupled to the distal end of an elongated handle means (36) for manipulating the clamp (32) from a location outside of the patient's thoracic cavity. A means for actuating the clamp (36) is coupled to the proximal end (23) of the handle means (36). When actuated, the clamp (32) blocks blood flow through the ascending aorta. A delivery cannula (44) may be used to deliver cardio-plegic fluid into the ascending aorta upstream from the clamp (32) to arrest cardiac function.

Tissue penetrating catheters having integral imaging transducers and their methods of use

A catheter device that is useable to penetrate from a blood vessel in which the catheter device is positioned to a target location comprises a flexible catheter advanceable into the first blood vessel, a tissue penetrator lumen adapted to receive an operative tissue penetrator which is usable to penetrate from the blood vessel to the target location when properly aimed. Further said catheter including an imaging transducer fixedly mounted on or within the catheter body to provide an imaging signal from which an image of the target location can be obtained. The catheter device may include an imageable marker on the catheter to form on the image obtainable from the imaging signal a penetrator path indication that indicates the path that will be followed by the tissue penetrator when the tissue penetrator exits from the catheter. Alternatively, or addition thereto, the imaging transducer may comprise a plurality of imaging elements which are located so that the penetrator path indication can be obtained. A method of utilizing such a catheter device to bypass an arterial obstruction is also disclosed.

Endovacular cardiac venting catheter and method

A venting catheter, system and method are provided for withdrawing blood and other fluids from a patient's heart to facilitate decompressing the heart during cardioplegic arrest and cardiopulmonary bypass, without the need for a thoracotomy and without puncturing the aorta, pulmonary artery, or heart itself . The venting catheter is configured to be introduced into a peripheral vein and intraluminally advanced through the right side of the heart and into the pulmonary artery. The venting catheter includes a lumen configured to withdraw blood at a rate of at least about 50 ml/min at a pressure of no less than about −350 mmHg. A flow-directing means is provided to facilitate guiding the catheter into the pulmonary artery by being carried by blood flow through the heart. The cardiac venting system may include, in addition to the cardiac venting catheter, a cardiopulmonary bypass system to maintain circulation of oxygenated blood, and means for arresting the patient's heart.

Systems and methods for delivering drugs to selected locations within the body

A trans-vascular system (10) for delivering a drug to a tissue region from a blood vessel, such as a coronary vein, includes a catheter (12) having a distal portion (26) with puncturing (14), orientation (16), drug delivery (62), and imaging elements (18). The puncturing element (14) is deployed for penetrating the vessel wall to access the tissue region. The orientation element (16), e.g., a "cage" including a plurality of struts (38, 40), and/or a radiopaque marker has a predetermined relationship with the location of the orientation element (16) with respect to the tissue region to orient the puncturing element (14). The catheter (12) is percutaneously introducing into the vessel, the puncturing element (14) is oriented towards the tissue region, the puncturing element (14) is deployed to access the tissue region, and the drug is delivered to the tissue region. An ablation device (230) may also be deployed to create a cavity in the tissue region for receiving the drug therein, or an indwelling catheter (214) may be advanced into, and left in the tissue region. An implanted reservoir device (350) is also disclosed, including an enclosed membrane (354) on an expandable frame (352) that defines a reservoir, and includes a porous region. The reservoir device may be deployed, expanded within a blood vessel, and may be filled in situ or pre-filled with a drug that passes through the porous region. Alternatively, a pair of expandable endovascular blockers may be used to isolate a section of a blood vessel which may be filled with a drug that may be absorbed by the surrounding tissue.

Kardioplegia-kathetersystem

Vorrichtung zur umgehung von arteriellen verengungen und/oder zur ausführung anderer transvaskularer eingriffe

Methods and apparatus for blocking flow through blood vessels

Thoracoscopic devices and methods for arresting the heart