Asymmetric multiple electrode support structures

Multiple electrode support structures have asymmetric geometries, either axially, or radially, or both. The asymmetric support structures are assembled from spline elements that extend between a distal hub and a proximal base. In one embodiment, the spline elements are circumferentially spaced about the distal hub in a radially asymmetric fashion, creating a greater density of spline elements in one region of the structure than in another region. In the same or another embodiment, the spline elements are preformed in an axially asymmetric fashion along their lengths, creating a different geometry in their distal regions than in their proximal regions.

Assemblies for creating compound curves in distal catheter regions

Compound steering assemblies, usable in both diagnostic and therapeutic applications, enable a physician to swiftly and accurately steer the distal section of the catheter in multiple planes or complex curves to position and maintain ablation and/or mapping electrodes in intimate contact with an interior body surface.

FLEXIBLE STRUCTURES FOR SUPPORTING ELECTRODE ELEMENTS

An electrode support structure has a guide body (12) having a distal end and a stylet (80) having a bendable portion extending along an axis outside the distal end of the guide body (12). The structure also includes at least one flexible spline leg (22) having a body and a far end extending beyond the distal end of the guide body (12) and attached to the bendable portion of the stylet (80). The spline leg (22) is normally flexed between the distal guide body end and the bendable stylet portion in a first direction that extends along and radially outward of the axis of the stylet (80). At least one electrode element (28) is on the flexible spline leg (22). The bendable stylet portion (80) applies tension to flex the spline leg (22) in a second direction.

Structures and methods for deploying electrode elements

An electrode support structure comprises a guide body having at its distal end a flexible spline leg. The spline leg is flexed to define an arcuate shape to facilitate intimate contact against tissue. An electrode element is carried by the spline leg for movement along its axis. The structure includes a control element coupled to the electrode element. The control element remotely imparts force to move the electrode element along the axis of the spline leg. Therefore, in use, the physician can cause the electrode element to travel along a path that the spline leg defines, without otherwise changing the location of the guide body.

Heart support to prevent ventricular remodeling

This is a support device that prevents, reduces, and delays remodeling of diseased cardiac tissue, and also decreases the impact of such remodeling on collateral tissue is disclosed. The invention further reinforces abnormal tissue regions to prevent over-expansion of the tissue due to increased afterload and excessive wall tension. As a result, the support device prevents phenomenon such as systolic stretch from occurring and propagating. The support structure maintains and restores diastolic compliance, wall motion, and ejection fraction to preserve heart functionality. As such, the support device prevents and treats cardiomyopathy and congestive heart failure.

Systems and methods for controlling tissue ablation using multiple temperature sensing elements

Systems and associated methods place a temperature sensing element in an "edge regions" between an energy transmitting electrode and a non-electrically conducting support body, where higher temperatures are likely to exist. Reliable temperature sensing, which is sensitive to variations in temperatures along the electrode, results.

Vacuum coagulation probes

A surgical device integrating a suction mechanism with a coagulation mechanism is provided for improving lesion creation capabilities. The device comprises an elongate member having an insulative covering attached about means for coagulating soft tissue. Openings through the covering expose regions of the coagulation-causing elements and are coupled to lumens in the elongate member which are routed to a vacuum source. A fluid source to passively transport fluid along the contacted soft tissue surface may be provided in order to push the maximum temperature deeper into tissue.

FLEXIBLE STRUCTURES FOR SUPPORTING ELECTRODE ELEMENTS

An electrode support structure has a guide body (12) having a distal end and a stylet (80) having a bendable portion extending along an axis outside the distal end of the guide body (12). The structure also includes at least one flexible spline leg (22) having a body and a far end extending beyond the distal end of the guide body (12) and attache d to the bendable portion of the stylet (80). The spline leg (22) is normally flexed between the distal guide body end and the bendable styles portion in a first direction that extends along and radially outward of the axis of the stylet (80). At least one electrode element (28) is on the flexible spline leg (22). The bendable styles portion (80) applies tension to flex the spline leg (22) in a second direction. ...

METHOD AND DEVICES FOR COAGULATION OF TISSUE

Methods and devices described herein facilitate improved treatment of body organs.

DEVICES, SYSTEMS AND METHODS FOR TISSUE REPAIR

Devices, systems and methods are disclosed for repairing soft tissue. The surgical system allows for the creation of tissue repair by grasping, aligning and sewing or fixing tissue. For example, this system may be used for clipping together excessive capsular tissue and reducing the overall capsular volume. The deployment device includes a central grasping mechanism and an outer clip delivery system. The clip embodiments may be single or multi-component (penetration and locking base components) that penetrate tissue layers and deploy or lock to clip the tissue together. An example of the system is used to reduce the joint capsule tissue laxity and reduces the potential for subluxation or dislocation of the joint by either restricting inferior laxity (anterior or posterior) and resolving or eliminating pathologic anterior or posterior translation.

Devices, systems and methods for tissue repair

Devices, systems and methods are disclosed for repairing soft tissue. The surgical system allows for the creation of tissue repair by grasping, aligning and sewing or fixing tissue. For example, this system may be used for clipping together excessive capsular tissue and reducing the overall capsular volume. The deployment device includes a central grasping mechanism and an outer clip delivery system. The clip embodiments may be single or multi-component (penetration and locking base components) that penetrate tissue layers and deploy or lock to clip the tissue together. An example of the system is used to reduce the joint capsule tissue laxity and reduces the potential for subluxation or dislocation of the joint by either restricting inferior laxity (anterior or posterior) and resolving or eliminating pathologic anterior or posterior translation.

METHODS OF COAGULATING TISSUE

An embodiment of the invention includes a surgical device for coagulating soft tissue such as atrial tissue in the treatment of atrial fibrillation, atrial flutter, and atrial tachycardia; tendon or ligament shrinkage; or articular cartilage removal. The surgical device integrates a suction mechanism with the coagulation mechanism improving the lesion creation capabilities of the device. The surgical device comprises an elongate member having an insulative covering attached about conductive elements capable of coagulating soft tissue when radiofrequency or direct current energy is transmitted to the conductive elements. Openings through the insulative covering expose regions of the conductive elements and are coupled to lumens in the elongate member which are routed to a vacuum source. Suction causes the soft tissue to actively engage the opening thus the integrated, exposed conductive elements to facilitate the coagulation process and ensure the lesions created are consistent, continuous ...

Vascular anastomosis systems

Devices and methods are described herein for implanting a connector to provide an anastomotic connection at a graft/host vessel junction.

Vacuum coagulation and dissection probes

A surgical device integrating a suction mechanism with a coagulation mechanism is provided for improving lesion creation capabilities. The device comprises an elongate member having an insulative covering attached about means for coagulating soft tissue. Openings through the covering expose regions of the coagulation-causing elements and are coupled to lumens in the elongate member which are routed to a vacuum source. A fluid source to passively transport fluid along the contacted soft tissue surface may be provided in order to push the maximum temperature deeper into tissue.

Shoes and braces with superelastic supports

Described are shoes, orthodic appliances, and anatomic braces containing superelastic support members for enhanced performance. The superelastic supports provide dynamic response to deflection. As such, the superelastic supports incorporated in the soles of shoes enhance walking, running, jumping, kicking, or other motion involving the foot. The superelastic supports may be incorporated in the body of shoes to reinforce the ankle joint. The embodiments of the invention also provide superelastic supports in braces to reinforce or stabilize the knees, ankles, elbows, wrists, shoulders, back, neck, hips, or other anatomy commonly associated with a degree of twisting, rotation, bending, or other desired motion. The braces also intensify the motion of anatomic structures, apply a specific resistance at the joint to strengthen the muscles during training or rehabilitation, and/or immobilize or stabilize joints, bones, or other anatomic structures during healing of an injury.

Methods for electrically isolating a portion of the atria

Devices for insertion into an atrial appendage of stasis reducing components such as mesh members, chemical bonding agents or expandable anchors are disclosed.

Systems and methods using annotated images for controlling the use of diagnostic or therapeutic instruments in interior body regions

An interface, used in association with an electrode structure deployed in contact with heart tissue, generates a display comprising an image of the electrode structure at least partially while performing a therapeutic or diagnostic procedure. The interface annotates the image in response to procedure events.

Distal anastomosis system

Distal anastomosis devices and associated methodology are provided for producing an anastomosis at a graft/coronary artery junction.

Systems and methods for forming elongated lesion patterns in body tissue using straight or curvilinear electrode elements

Systems and associated methods position arrays of multiple emitters of ablating energy in straight or curvilinear positions in contact with tissue to form elongated lesion patterns. The elongated lesion patterns can continuous or interrupted, depending upon the orientation of the energy emitters.

System for tissue cavity closure

Surgical systems for less invasive access to and isolation of an atrial appendage are provided. A suturing grasper compresses soft tissue structures and deploys one or more sutures through complimentary pledget(s) carried by the grasper. The pledgets are reinforced, containing support members that define the profile of the stitch and distribute stresses applied by the stitch, once tightened, over a length of tissue. This hardware may be applicable to other surgical and catheter based applications as well including: compressing soft tissue structures lung resections and volume reductions; gastric procedures associated with reduction in volume, aneurysm repair, vessel ligation, or other procedure involving isolation of, resection of, and reduction of anatomic structures.

Diaphragm entry for posterior surgical access

Methods and devices described herein facilitate improved treatment of body organs.

Surgical method and apparatus for positioning a diagnostic or therapeutic element within the body

A surgical method and apparatus for positioning a diagnostic or therapeutic element within the body. The apparatus may be catheter-based or a probe including a relatively short shaft.

Systems for heart treatment

Described are devices and methods for treating degenerative, congestive heart disease and related valvular dysfunction. Percutaneous and minimally invasive surgical tensioning structures offer devices that mitigate changes in the ventricular structure (i.e., remodeling) and deterioration of global left ventricular performance related to tissue damage precipitating from ischemia, acute myocardial infarction (AMI) or other abnormalities. These tensioning structures can be implanted within various major coronary blood-carrying conduit structures (arteries, veins and branching vessels), into or through myocardium, or into engagement with other anatomic structures that impact cardiac output to provide tensile support to the heart muscle wall which resists diastolic filling pressure while simultaneously providing a compressive force to the muscle wall to limit, compensate or provide therapeutic treatment for congestive heart failure and/or to reverse the remodeling that produces an enlarged heart ...

Ultrasound-guided ablation catheter and methods of use

The present invention provides ultrasound-guided ablation catheters and methods for their use. In one embodiment, a tissue ablation apparatus (2) includes a flexible elongate body (12) having proximal (14) and distal (12) ends. A plurality of spaced-apart electrodes (24) are operably attached to the flexible body near the distal end. A plurality of transducer elements (28) are disposed between at least some of the electrodes. Transducers assist the physician in determining whether or not the ablation elements are in contact with the tissue to be ablated.

DIAPHRAGM ENTRY FOR POSTERIOR SURGICAL ACCESS

Methods and devices described herein facilitate improved treatment of body organs.

Diaphragm entry for posterior surgical access

Methods and devices described herein facilitate diaphragm entry for posterior access of body organs.

Surgical method and apparatus for positioning a diagnostic or therapeutic element within the body and pressure application probe for use with same

A surgical method and apparatus for positioning a diagnostic or therapeutic element within the body. The apparatus may be catheter-based or a probe including a relatively short shaft.

Systems and methods for controlling power in an electrosurgical probe

Systems and methods for controlling the power supplied to an electrosurgical probe. The systems and methods may be used to monitor electrode-tissue contact, adjust power in response to a loss of contact, and apply power in such a manner that charring, coagulum formation and tissue popping are less likely to occur.

Anastomotic connector for sutureless anastomosis systems

Anastomosis systems include fittings and compression mechanisms for effecting end-end or end-side couplings of biological or synthetic bypass grafts to vessel locations. The fittings are tubular and surround end regions of the graft. In some applications an end region of the graft is everted and surrounds an exterior of the fitting, in which case the preferred compression mechanism is a retaining ring. A tool is used to evert the graft end region. In other applications, the fitting has an interior groove that receives an expandable retaining ring that urges the graft end region radially outwardly against the fitting. A graft deploying and securing system includes a needle for puncturing vessel tissue, a dilator, and a sheath adapted for containing a graft/fitting combination and guiding the combination into the vessel through an opening formed by the needle and dilator.

VACUUM COAGULATION PROBES

Methods for using a surgical device integrating a suction mechanism with a coagulation mechanism for improving lesion creation capabilities. The device comprises an elongate member having an insulative covering attached about means for coagulating soft tissue. Openings through the covering expose regions of the coagulation-causing elements and are coupled to lumens in the elongate member which are routed to a vacuum source and a fluid source to passively transport fluid along the contacted soft tissue surface in order to push the maximum temperature deeper into tissue.

Aortic aneurysm treatment systems

A system and components for treating aortic aneurysms includes a reinforcing graft and fittings for securing the graft to a host vessel and to branch vessels, for example the iliac and renal arteries. Combinations of fittings and rings or other compression mechanisms secure vessels or grafts frictionally, for end-end or end-side couplings. A variety of tools are disclosed for manipulating retaining rings, everting portions of grafts or vessels in the course of coupling them to fittings, and clamping fittings while positioning the retaining rings.

Distal anastomosis system

Distal anastomosis devices and associated methodology are described herein. Connector and connector components as well as tools associated therewith are disclosed. The connectors are preferably adapted to produce an end-to-side anastomosis at a graft/coronary artery junction. A fitting alone, or a fitting in combination with a collar may be used as a connector. Each fitting may be deployed by deflecting its shape to provide clearance for a rear segment that rotates about adjoining hinge section(s) so to fit the connector within an aperture formed in a host vessel. Upon return to a substantially relaxed position, a rear segment anchors the fitting it in place. The distal fitting may include additional side features for interfacing with the host vessel/coronary artery. The collar may include features complimentary to those of a fitting and provisions for securing the graft vessel.

Devices, systems and methods for material fixation

Devices, systems and methods for fixation of tendon to bone are described. An exemplary surgical implant is a modified bone anchor that is able to grasp the tendon and hold it firmly in a bone tunnel. Once deployed, the anchor delivers lateral compression to the tendon, providing direct tendon to bone compression to facilitate healing. The anchor has different versions which allow it to be attached to the tendon prior to insertion into the bone tunnel, or be inserted between tendon arms when the surgical procedure dictates. The resulting tendon to bone compression allows for the firm fixation in a manner markedly simpler than traditional techniques. A modification of this anchor can also allow the anchor to grasp and hold suture. This variation facilitates the technique for knotless rotator cuff repair.

Interactive systems and methods for controlling the use of diagnostic or therapeutic instruments in interior body regions

An interface is associated with a structure which, in use, is deployed in an interior body region of a patient. The structure includes an operative element coupled to a controller, which establishes an operating condition for the operative element to perform a diagnostic or therapeutic procedure in the interior body region. The interface generates a first display comprising an image of the structure at least partially while the operative element performs the procedure. The interface also generates a second display comprising one or more data fields reflecting the operating condition of the controller. The interface enables selection of the first display or the second display for viewing on a display screen.

Surgical apparatus for positioning a diagnostic or therapeutic element within the body

A surgical method and apparatus for positioning a diagnostic or therapeutic element within the body. The apparatus may be catheter-based or a probe including a relatively short shaft.

Suture passing devices

An embodiment of the invention includes a surgical device for passing suture through soft tissue. The surgical device can include at least one elongate superelastic member having a thickness and having a first resting configuration that defines at least one curve having a first radius of curvature greater than or equal to 3 times the thickness of the superelastic member. The surgical device also can include a thermally formed opening in the superelastic member, the opening adapted to receive at least one strand of suture. Moreover, the surgical device can include a superelastic member adapted to be straightened into a second configuration having a second radius of curvature larger than the first radius of curvature.

Positioning systems for sutureless anastomosis systems

Anastomosis systems include fittings and compression mechanisms for effecting end-end or end-side couplings of biological or synthetic bypass grafts to vessel locations. The fittings are tubular and surround end regions of the graft. In some applications an end region of the graft is everted and surrounds an exterior of the fitting, in which case the preferred compression mechanism is a retaining ring. A tool is used to evert the graft end region. In other applications, the fitting has an interior groove that receives an expandable retaining ring that urges the graft end region radially outwardly against the fitting. A graft deploying and securing system includes a needle for puncturing vessel tissue, a dilator, and a sheath adapted for containing a graft/fitting combination and guiding the combination into the vessel through an opening formed by the needle and dilator.

Vacuum coagulation and dissection probes

A surgical device integrating a suction mechanism with a coagulation mechanism is provided for improving lesion creation capabilities. The device comprises an elongate member having an insulative covering attached about means for coagulating soft tissue. Openings through the covering expose regions of the coagulation-causing elements and are coupled to lumens in the elongate member which are routed to a vacuum source. A fluid source to passively transport fluid along the contacted soft tissue surface may be provided in order to push the maximum temperature deeper into tissue.

METHOD AND DEVICES FOR COAGULATION OF TISSUE

Methods and devices described herein facilitate improved treatment of body organs. 1. A method of creating a treatment pattern in a target tissue , where the target tissue comprises a first tissue surface and a second tissue surface , where the second tissue surface is on an opposite side of the first tissue surface , the method comprising:positioning a first medical treatment device adjacent to the first tissue surface;forming a first portion of the treatment pattern along the first tissue surface using the medical treatment device such that the first portion of the treatment pattern is incomplete;positioning a second medical device having at least one energy source adjacent to the second tissue surface;applying energy adjacent to the second tissue surface using the energy source;identifying a location of the energy source through the target tissue from the first tissue surface to locate the second medical device; andrepositioning the second medical device on the second tissue surface in response to the location of the first portion of the treatment pattern and using the second medical device to form a second portion of the treatment pattern on the second tissue surface to complete the treatment pattern.2. The method of claim 1 , where the first medical treatment device comprises a first coagulation device.3. The method of claim 2 , where the second medical treatment device further includes at least one coagulation source.4. The method of claim 2 , further comprising advancing a second coagulation device to the target location to create the second coagulation lesion.5. The method of claim 2 , where the first coagulation device and the second medical device comprise opposite poles of an RF energy supply claim 2 , and where energy flows between the first coagulation device and second medical device during application of the RF energy supply.6. The method of claim 1 , where the first medical treatment device comprises a device selected from the group consisting of an ...

Vacuum coagulation probes

Methods for using a surgical device integrating a suction mechanism with a coagulation mechanism for improving lesion creation capabilities. The device comprises an elongate member having an insulative covering attached about means for coagulating soft tissue. Openings through the covering expose regions of the coagulation-causing elements and are coupled to lumens in the elongate member which are routed to a vacuum source and a fluid source to passively transport fluid along the contacted soft tissue surface in order to push the maximum temperature deeper into tissue.

VACUUM COAGULATION PROBES

A surgical device integrating a suction mechanism with a coagulation mechanism is provided for improving lesion creation capabilities. The device comprises an elongate member having an insulative covering attached about means for coagulating soft tissue. Openings through the covering expose regions of the coagulation-causing elements and are coupled to lumens in the elongate member which are routed to a vacuum source. A fluid source to passively transport fluid along the contacted soft tissue surface may be provided in order to push the maximum temperature deeper into tissue.

Ultrasound-guided ablation catheter and methods of use

The present invention provides ultrasound-guided ablation catheters and methods for their use. In one embodiment, a tissue ablation apparatus (2) includes a flexible elongate body (12) having proximal (14) and distal (12) ends. A plurality of spaced-apart electrodes (24) are operably attached to the flexible body near the distal end. A plurality of transducer elements (28) are disposed between at least some of the electrodes. Transducers assist the physician in determining whether or not the ablation elements are in contact with the tissue to be ablated.

Method of ablating body tissue

Electrode structures are formed from flexible, porous, or woven materials. One such structure is made by forming first and second body sections, each including a peripheral edge. The first and second body sections are joined together about their peripheral edges with a seam, thereby forming a composite structure. Another one of such structures is made by forming a body having a three. dimensional shape and opposite open ends, and at least partially closing at least one of the opposite ends by forming a seam. Another one of such structures is formed from a sheet of material having peripheral edges. The sheet is placed on the distal end of a fixture, while the peripheral edges of the sheet are gathered about the proximal end of a fixture, thereby imparting to the sheet a desired shape. At least one pleat is formed to secure the gathered peripheral edges together. The seams or pleats are formed by thermal bonding, or ultrasonic welding, or laser welding, or adhesive bonding, or sewing.

Assemblies for creating compound curves in distal catheter regions

Compound steering assemblies, usable in both diagnostic and therapeutic applications, enable a physician to swiftly and accurately steer the distal section of the catheter in multiple planes or complex curves to position and maintain ablation and/or mapping electrodes in intimate contact with an interior body surface.

Systems and methods for acquiring making time-sequential measurements of biopotentials sensed in myocardial tissue

Systems and methods for generating a composite signal derived from biopotentials sensed in myocardial tissue are disclosed and described. One such method includes inputting a first set of signals comprising biopotentials sensed at a first group of tissue sites during a first time interval; inputting a second set of signals comprising biopotentials sensed at a second group of tissue sites during a second time interval sequentially after the first time interval, wherein at least one of the biopotentials sensed as part of the first set of signals is not sensed as part of the second set of signals, and at least one of the biopotentials sensed as part of the second set of signals is not sensed as part of the first set of signals; and time aligning the first and second sets of signals using biopotentials sensed at the same site as part of both the first and second sets of signals, thereby generating the composite signal arranged for analysis as if all biopotentials were sensed during a common ...

Ablation and imaging catheter

A catheter for ablating and imaging tissue includes a porous electrode structure comprising an interior region for receiving a conductive medium, an elongate tube having a distal tube end that extends within the interior region, and an ultrasonic transducer assembly housed within the distal tube end.

Vascular anastomosis systems

Devices and methods are described herein for implanting a connector to provide an anastomotic connection at a graft/host vessel junction.

Catheter distal assembly with pull wires

A catheter assembly having a sheath, which includes a side wall enclosing an interior bore, and a distal region. The assembly also has a bendable catheter tube, which is carried for sliding movement in the interior bore. A pull wire also runs through the interior bore of the sheath, preferably within a lumen. The catheter tube has a distal portion with a coupling which joins the distal portion of the catheter tube and the distal portion of the pull wire. Relative movement of the pull wire and the sheath causes bending of the catheter tube outwardly through the opening, in response to sliding movement of the catheter tube within the interior bore toward the distal region of the sheath.

Electrophysiological treatment methods and apparatus employing high voltage pulse to render tissue temporarily unresponsive

Systems and methods for diagnosing and treating tissue transmit an electrical energy pulse that temporarily stuns a zone of tissue, temporarily rendering it electrically unresponsive. The systems and methods sense an electrophysiological effect due to the transmitted pulse. The systems and methods alter an electrophysiological property of tissue in or near the zone based, at least in part, upon the sensed electrophysiological effect. The alteration of the electrophysiological property can be accomplished, for example, by tissue ablation or by the administration of medication. In a preferred implementation, radio frequency energy is used to both temporarily stun tissue and to ablate tissue through a common electrode.

Percutaneous bypass graft and securing system

A bypass graft incorporates fixation mechanisms at its opposite ends, for securing these ends to different locations along a blood vessel, or alternatively to different locations wherein one of the locations is a different vessel or an organ defining a cavity. Mechanical fixation features such as collets or grommets can be employed, enhanced by delivery of an electrical current sufficient to heat surrounding tissue to form a thermal bond. A graft deployment system includes a tissue dilator and a needle for perforating tissue, mounted coaxially within the dilator. Intralumenal systems further include a catheter for containing the dilator.

METHOD AND DEVICES FOR PERFORMING BIATRIAL COAGULATION

Methods and devices described herein facilitate improved treatment of body organs.

Catheter distal assembly with pull wires

A catheter assembly having a sheath, which includes a side wall enclosing an interior bore, and a distal region. The assembly also has a bendable catheter tube, which is carried for sliding movement in the interior bore. A pull wire also runs through the interior bore of the sheath, preferably within a lumen. The catheter tube has a distal portion with a coupling which joins the distal portion of the catheter tube and the distal portion of the pull wire. Relative movement of the pull wire and the sheath causes bending of the catheter tube outwardly through the opening, in response to sliding movement of the catheter tube within the interior bore toward the distal region of the sheath.

Devices and methods for creating lesions in endocardial and surrounding tissue to isolate focal arrhythmia substrates

Devices and methods are provided for creating lesions in endocardial tissues surrounding a vessel opening to thereby isolate focal arrhythmia substrates, including an invasive catheter assembly comprising an elongate body having a longitudinal axis and first and second lumens, a first catheter having a distally mounted expandable anchor body disposed in the first lumen, and a second catheter having a distally mounted electrode disposed in the second lumen, the elongate body having a first distal opening accessing the first lumen through which the first catheter may be extended axially relative to the longitudinal axis of the elongate body and a second distal opening accessing the second lumen through which the second catheter may be extended at an angle relative to the longitudinal axis of the elongate body. The disclosed invention also includes an elongate catheter having an expandable electrode body mounted on one end, wherein the electrode body is configured to form an enlarged circumferential ...

Superelastic suture passing devices and methods

An embodiment of the invention includes a surgical device for passing suture through soft tissue. The surgical device can include at least one elongate superelastic member having a thickness and having a first resting configuration that defines at least one curve having a first radius of curvature greater than or equal to 3 times the thickness of the superelastic member. The surgical device also can include a thermally formed opening in the superelastic member, the opening adapted to receive at least one strand of suture. Moreover, the surgical device can include a superelastic member adapted to be straightened into a second configuration having a second radius of curvature larger than the first radius of curvature.

VACUUM COAGULATION & DISSECTION PROBES

A surgical device integrating a suction mechanism with a coagulation mechanism is provided for improving lesion creation capabilities. The device comprises an elongate member having an insulative covering attached about means for coagulating soft tissue. Openings through the covering expose regions of the coagulation-causing elements and are coupled to lumens in the elongate member which are routed to a vacuum source. A fluid source to passively transport fluid along the contacted soft tissue surface may be provided in order to push the maximum temperature deeper into tissue. 1. A surgical device for coagulating soft tissue comprising:an elongate member comprising a side wall and a lumen;a tissue heating element adjacent the side wall; andan opening through the side wall in communication with the lumen and exposing the tissue heating element, the tissue heating element being exposed only at the opening so that a seal causing intimate tissue contact with the tissue heating element can be formed upon connecting the lumen to vacuum.2. The device of claim 1 , wherein the tissue heating element comprises at least one helical winding having at least one pitch and at least one winding width.3. The device of claim 1 , wherein the pitch is greater than or equal to two times the width.4. The device of claim 1 , wherein the pitch is greater than or equal to four times the width.5. The device of claim 1 , wherein an external surface of the side wall along the opening is offset from the conductive element by a distance claim 1 , wherein the width of the opening is greater than or equal to the offset distance.6. The device of claim 5 , wherein the width of the opening is greater than two times the offset distance.7. The device of claim 1 , wherein the tissue heating element comprises an electrode.8. The device of claim 7 , wherein the electrode is adapted to transmit RF energy to heat tissue.9. The device of claim 7 , wherein the electrode is adapted to heat tissue by resistive ...

Distal anastomosis system

Distal anastomosis devices and associated methodology are described herein. Connector and connector components as well as tools associated therewith are disclosed. The connectors are preferably adapted to produce an end-to-side anastomosis at a graft/coronary artery junction. A fitting alone, or a fitting in combination with a collar may be used as a connector. Each fitting may be deployed by deflecting its shape to provide clearance for a rear segment that rotates about adjoining hinge section(s) so to fit the connector within an aperture formed in a host vessel. Upon return to a substantially relaxed position, a rear segment anchors the fitting it in place. The distal fitting may include additional side features for interfacing with the host vessel/coronary artery. The collar may include features complimentary to those of a fitting and provisions for strain relief and securing the graft vessel.

Expandable-collapsible electrode structures made of electrically conductive material

Electrode assemblies and associated systems employ a nonporous wall having an exterior for contacting tissue. The exterior peripherally surrounds an interior area. The wall is essentially free of electrically conductive material. The wall is adapted to assume an expanded geometry having a first maximum diameter and a collapsed geometry having a second maximum diameter less than the first maximum diameter. The assemblies and systems include a lumen that conveys a medium containing ions into the interior area. An element free of physical contact with the wall couples the medium within the interior area to a source of electrical energy to enable ionic transport of electrical energy from the source through the medium to the wall for capacitive coupling to tissue contacting the exterior of the wall.

Method and devices for performing biatrial coagulation

Methods and devices described herein facilitate improved treatment of body organs.

Additional sutureless anastomosis embodiments

This invention is related to devices and systems for creating sutureless anastomoses. In particular, this invention is related to devices for deploying and securing the ends of bypass grafts designed to provide a fluid flow passage between at least two vessels or tubular structures. A variety of compressible, expandable fittings, loading and delivery sheaths, tools, and other devices for creating end-end and end-side anastomoses, as well as methods for their use, are disclosed. In addition, robotic, remotely operable systems and devices for creating sutureless anastomoses in minimally invasive applications are disclosed. The systems of this invention do not require stopping or re-routing blood flow to perform an anastomosis between a bypass graft and a host vessel. Accordingly, this invention describes sutureless anastomosis systems that do not require cardiopulmonary bypass support when treating coronary artery disease.

VACUUM COAGULATION PROBES

Methods for using a surgical device integrating a suction mechanism with a coagulation mechanism for improving lesion creation capabilities. The device comprises an elongate member having an insulative covering attached about means for coagulating soft tissue. Openings through the covering expose regions of the coagulation-causing elements and are coupled to lumens in the elongate member which are routed to a vacuum source and a fluid source to passively transport fluid along the contacted soft tissue surface in order to push the maximum temperature deeper into tissue.

Systems and methods for guiding movable electrode elements within multiple-electrodes structures

Systems and related methods guide a movable electrode within an array of multiple-electrodes located within the body. The systems and methods employ the movable electrode or at least one of the multiple-electrodes on the array to generate and then sense electrical or sonic energy in a predetermined fashion to generates an output that locates the movable electrode within the array.

Systems and methods for guiding movable electrode elements within multiple-electrode structures

Systems and related methods guide a movable electrode within an array of multiple-electrodes located within the body. The systems and methods employ the movable electrode or at least one of the multiple-electrodes on the array to generate and then sense electrical or sonic energy in a predetermined fashion to generates an output that locates the movable electrode within the array.

DIAPHRAGM ENTRY FOR POSTERIOR SURGICAL ACCESS

Methods and devices described herein facilitate improved treatment of body organs.

Catheter having improved torque transmission capability and method of making the same

A catheter having improved steering and torque transmission capabilities.

Percutaneous bypass graft and securing system

A bypass graft incorporates fixation mechanisms at its opposite ends, for securing these ends to different locations along a blood vessel, or alternatively to different locations wherein one of the locations is a different vessel or an organ defining a cavity. Mechanical fixation features such as collets or grommets can be employed, enhanced by delivery of an electrical current sufficient to heat surrounding tissue to form a thermal bond. A graft deployment system includes a tissue dilator and a needle for perforating tissue, mounted coaxially within the dilator. Intralumenal systems further include a catheter for containing the dilator.

Anastomosis system

End-side anastomosis fittings are described which may be deployed over a guidewire, in a sheath, or by feeding the fitting through an opening in a host vessel wall. When a fitting as described is deployed within a host vessel, the exterior surface of the leading petal contacts the interior surface of the host vessel. The leading petal is configured so that it is capable of dilating the host vessel wall opening while being being advanced through the opening. The fitting also includes links which define spaces throughout the leading petal. A deflectable rear petal anchors the fitting within the host vessel once it is advanced through the host vessel wall. Additional petals may be included to provide more complete contact. The fitting also includes extensions fitted around the base to improve hemostasis and the fitting itself may be inserted by a deployment sheath which may also serve as a dilator.

Thermal securing anastomosis systems

A sutureless anastomosis systems for securing a bypass graft to a host vessel or other tubular structure including a bypass graft and fitting. A compression mechanism may be used with the system for attachment of the bypass graft to the fitting. An electrode is connected to the fitting and an energy source. The energy source transmits energy to the electrode and causes the adjacent tissue to rise in temperature and bond to a vessel or fitting.

Heart support to prevent ventricular remodeling

This is a support device that prevents, reduces, and delays remodeling of diseased cardiac tissue, and also decreases the impact of such remodeling on collateral tissue is disclosed. The invention further reinforces abnormal tissue regions to prevent over-expansion of the tissue due to increased afterload and excessive wall tension. As a result, the support device prevents phenomenon such as systolic stretch from occurring and propagating. The support structure maintains and restores diastolic compliance, wall motion, and ejection fraction to preserve heart functionality. As such, the support device prevents and treats cardiomyopathy and congestive heart failure.

Systems for recording use of structures deployed in association with heart tissue

A system records use of a structure deployed in operative association with heart tissue in a patient. An image controller generates an image of the structure while in use in the patient. An input receives data including information identifying the patient. An output processes the image in association with the data as a patient-specific, data base record for storage, retrieval, or manipulation.

DEVICES FOR INSTALLING STASIS REDUCING MEANS IN BODY TISSUE

Devices for insertion into an atrial appendage of stasis reducing components such as mesh members, chemical bonding agents or expandable anchors are disclosed. 1. A catheter for installing expandable anchors into a body comprising a catheter body having a distal tip portion manipulatable by external control, said catheter being adapted to be inserted percutaneously into a body, said distal tip portion having a central axially extending opening, an axially movable hollow needle fitted within said central opening and being remotely axially moveable, from a retracted position located within said distal tip portion, to an extended position extending distally therefrom, said hollow needle having a sharp distal tip and a central opening adapted to hold at least one expandable anchor therein, an axially moveable expelling member fitted within the central lumen of said hollow needle adapted to expel a expandable anchor therefrom by means of an externally actuatable control. This invention relates to the reduction of regions of blood stasis and ultimately thrombus formation in such regions, particularly in the atrial appendages for patients with atrial fibrillation. More specifically, the invention relates to procedures and devices for affixing the atrial appendages in an orientation that reduces subsequent formation of thrombus.The atria must enable organized electrical propagation from the SA Node to the AV Node to stimulate the atria to contract in an organized way to transport blood from the atria to the ventricles, and to provide timed stimulation of the ventricles. The atrial appendages are especially important in the transport of blood because they have a sack-like geometry with a neck potentially more narrow than the pouch. In this case, contraction of the appendage is essential to maintain an average absolute blood velocity high enough to eliminate potential stasis regions which may lead to thrombus formation.Atrial fibrillation and abnormalities which may lead to ...

Device for installing stasis reducing means in body tissue

Devices for insertion into an atrial appendage of stasis reducing components such as mesh members, chemical bonding agents or expandable anchors are disclosed.

Subxyphoid epicardial ablation

Methods and devices described herein facilitate ablation patterns on the heart within a pericardial sac and without opening or deflating the lungs.

Expandable-collapsible electrode structures made of electrically conductive material

Electrode assemblies and associated systems employ a nonporous wall having an exterior for contacting tissue. The exterior peripherally surrounds an interior area. The wall is essentially free of electrically conductive material. The wall is adapted to assume an expanded geometry having a first maximum diameter and a collapsed geometry having a second maximum diameter less than the first maximum diameter. The assemblies and systems include a lumen that conveys a medium containing ions into the interior area. An element free of physical contact with the wall couples the medium within the interior area to a source of electrical energy to enable ionic transport of electrical energy from the source through the medium to the wall for capacitive coupling to tissue contacting the exterior of the wall.

Dissecting cannula and methods of use thereof

Methods and devices described herein facilitate improved access of locations within the body by providing a variety of dissection modes on a single access device.

Structures for deploying electrode elements

An electrode support structure comprises a guide body having at its distal end a flexible spline leg. The spline leg is flexed to define an arcuate shape to facilitate intimate contact against tissue. An electrode element is carried by the spline leg for movement along its axis. The structure includes a control element coupled to the electrode element. The control element remotely imparts force to move the electrode element along the axis of the spline leg. Therefore, in use, the physician can cause the electrode element to travel along a path that the spline leg defines, without otherwise changing the location of the guide body.

Loop structures for supporting multiple electrode elements

A catheter assembly comprises a sheath, which includes a side wall enclosing an interior bore, a distal region, and an opening in the sidewall. The assembly also comprises a bendable catheter tube, which is carried for sliding movement in the interior bore. The catheter tube has a distal portion. The assembly further comprises a coupling, which joins the distal region of the sheath and the distal portion of the catheter tube. The coupling causes bending of the catheter tube outwardly through the opening, in response to sliding movement of the catheter tube within the interior bore toward the distal region of the sheath.

Vacuum coagulation probes

Methods for using a surgical device integrating a suction mechanism with a coagulation mechanism for improving lesion creation capabilities. The device comprises an elongate member having an insulative covering attached about means for coagulating soft tissue. Openings through the covering expose regions of the coagulation-causing elements and are coupled to lumens in the elongate member which are routed to a vacuum source and a fluid source to passively transport fluid along the contacted soft tissue surface in order to push the maximum temperature deeper into tissue.

Diaphragm entry for posterior surgical access

Methods and devices described herein facilitate improved treatment of body organs.

Vacuum coagulation probe for atrial fibrillation treatment

An embodiment of the invention includes a surgical device for coagulating soft tissue such as atrial tissue in the treatment of atrial fibrillation, atrial flutter, and atrial tachycardia. The surgical device can include at least one elongate member comprising conductive elements adapted to coagulate soft tissue when radiofrequency or direct current energy is transmitted to the conductive elements. Openings through said conductive elements are routed through lumens in the elongate member to a vacuum source to actively engage the soft tissue surface intended to coagulate into intimate contact with the conductive elements to facilitate the coagulation process and ensure the lesions created are consistent, contiguous, and transmural. The embodiments of the invention can also incorporate cooling openings positioned near the conductive elements and coupled with a vacuum source or an injection source to transport fluid through the cooling openings causing the soft tissue surface to cool thus pushing the maximum temperature deeper into tissue. The embodiments of the invention can also incorporate features to tunnel between anatomic structures or dissect around the desired tissue surface to coagulate thereby enabling less invasive positioning of the soft tissue coagulating device and ensuring reliable and consistent heating of the soft tissue.

Vacuum coagulation probe for atrial fibrillation treatment

An embodiment of the invention includes a surgical device for coagulating soft tissue such as atrial tissue in the treatment of atrial fibrillation, atrial flutter, and atrial tachycardia. The surgical device can include at least one elongate member comprising conductive elements adapted to coagulate soft tissue when radiofrequency or direct current energy is transmitted to the conductive elements. Openings through said conductive elements are routed through lumens in the elongate member to a vacuum source to actively engage the soft tissue surface intended to coagulate into intimate contact with the conductive elements to facilitate the coagulation process and ensure the lesions created are consistent, contiguous, and transmural. The embodiments of the invention can also incorporate cooling openings positioned near the conductive elements and coupled with a vacuum source or an injection source to transport fluid through the cooling openings causing the soft tissue surface to cool thus ...

Dissecting cannula and methods of use thereof

Methods and devices described herein facilitate improved access of locations within the body by providing a variety of dissection modes on a single access device.

Electrode structure for heating and ablating tissue and method for making and assembling the same

Methods of manufacturing cellulosic structures, e.g., for use in expandable-collapsible electrode assemblies for diagnostic and/or therepeutic electrophysiology devices, are disclosed. One such preferred method includes providing a mandrel having a head portion and a neck portion, the head portion having an outer circumference greater than the neck portion, dipping the mandrel into a cellulosic substance, curing the cellulosic substance, and separating the mandrel from the cured cellulosic substance.

Anastomosis systems

An end-side anastomosis system including a fitting comprising: a base for attachment to a graft, said base be configured to form a seal with an opening in a host vessel wall; a leading petal having a cross-section with a radius of curvature approximating a radius of curvature of the host vessel, said leading petal being configured to dilate the host vessel wall opening while advancing said fitting through the opening; and a rear petal, said rear petal being deflectable to be advanced through the host vessel opening.

Systems and methods for controlling power in an electrosurgical probe

Systems and methods for controlling the power supplied to an electrosurgical probe. The systems and methods may be used to monitor electrode-tissue contact, adjust power in response to a loss of contact, and apply power in such a manner that charring, coagulum formation and tissue popping are less likely to occur.

Methods and system for tissue cavity closure

Surgical systems for less invasive access to and isolation of an atrial appendage are provided. A suturing grasper compresses soft tissue structures and deploys one or more sutures through complimentary pledget(s) carried by the grasper. The pledgets are reinforced, containing support members that define the profile of the stitch and distribute stresses applied by the stitch, once tightened, over a length of tissue. This hardware may be applicable to other surgical and catheter based applications as well including: compressing soft tissue structures lung resections and volume reductions; gastric procedures associated with reduction in volume, aneurysm repair, vessel ligation, or other procedure involving isolation of, resection of, and reduction of anatomic structures.

Systems for recording use of structures deployed in association with heart tissue

A system records use of a structure deployed in operative association with heart tissue in a patient. An image controller generates an image of the structure while in use in the patient. An input receives data including information identifying the patient. An output processes the image in association with the data as a patient-specific, data base record for storage, retrieval, or manipulation.

DIAPHRAGM ENTRY FOR POSTERIOR SURGICAL ACCESS

Methods and devices described herein facilitate improved treatment of body organs.

Systems and methods for controlling power in an electrosurgical probe

Systems and methods for controlling the power supplied to an electrosurgical probe. The systems and methods may be used to monitor electrode-tissue contact, adjust power in response to a loss of contact, and apply power in such a manner that charring, coagulum formation and tissue popping are less likely to occur.

Interactive systems and methods for controlling the use of diagnostic or therapeutic instruments in interior body regions

An interface is associated with a structure which, in use, is deployed in an interior body region of a patient. The structure includes an operative element coupled to a controller, which establishes an operating condition for the operative element to perform a diagnostic or therapeutic procedure in the interior body region. The interface generates a first display comprising an image of the structure at least partially while the operative element performs the procedure. The interface also generates a second display comprising one or more data fields reflecting the operating condition of the controller. The interface enables selection of the first display or the second display for viewing on a display screen.

Devices for installing stasis reducing means in body tissue

Devices for insertion into an atrial appendage of stasis reducing components such as mesh members, chemical bonding agents or expandable anchors are disclosed.

Surface coatings for catheters, direct contacting diagnostic and therapeutic devices

A method for manufacturing a catheter assembly including a handle, a guide tube having a proximal end engaged with the handle, and a distal end assembly engaged with a distal end of the guide tube. The method includes applying an active electrode element on the distal end assembly by a process selected from the group consisting of electroplating, vapor deposition, IBAD and pad printing, and applying a regenerated cellulose coating over the distal end assembly. The regenerated cellulose coating is applied by applying a viscous liquid coating to the catheter distal end assembly, regenerating the viscous coating, and then curing the regenerated coating. The cured coating is preferably hydrated.

Systems and methods for controlling tissue ablation using multiple temperature sensing elements

Systems and associated methods place a temperature sensing element in an "edge region" between an energy transmitting electrode and a non-electrically conducting support body, where higher temperatures are likely to exist. Reliable temperature sensing, which is sensitive to variations in temperatures along the electrode, results.

Systems for heart treatment

Described are devices and methods for treating degenerative, congestive heart disease and related valvular dysfunction. Percutaneous and minimally invasive surgical tensioning structures offer devices that mitigate changes in the ventricular structure (i.e., remodeling) and deterioration of global left ventricular performance related to tissue damage precipitating from ischemia, acute myocardial infarction (AMI) or other abnormalities. These tensioning structures can be implanted within various major coronary blood-carrying conduit structures (arteries, veins and branching vessels), into or through myocardium, or into engagement with other anatomic structures that impact cardiac output to provide tensile support to the heart muscle wall which resists diastolic filling pressure while simultaneously providing a compressive force to the muscle wall to limit, compensate or provide therapeutic treatment for congestive heart failure and/or to reverse the remodeling that produces an enlarged heart ...

Vacuum coagulation probes

Methods for using a surgical device integrating a suction mechanism with a coagulation mechanism for improving lesion creation capabilities. The device comprises an elongate member having an insulative covering attached about means for coagulating soft tissue. Openings through the covering expose regions of the coagulation-causing elements and are coupled to lumens in the elongate member which are routed to a vacuum source and a fluid source to passively transport fluid along the contacted soft tissue surface in order to push the maximum temperature deeper into tissue.

Mechanical stent and graft delivery system

A deployment device for stents and grafts includes a catheter, an expansion framework or cage near the catheter distal end, and a means for controlling expansion from a proximal end of the catheter. The cage is formed of a plurality of elongate strands coupled at opposite ends to the catheter and to the control device. Axial movement of the control device relative to the catheter either elongates the strands to radially collapse the cage, or axially reduces the distance between the strand ends for radial enlargement. In one embodiment the control device is a stylet contained in a lumen of the catheter and extending beyond the catheter distal end. The strands are fixed at their opposite ends to the catheter distal end and the stylet distal end. In another embodiment, the strands are coupled to proximal and distal rings along the catheter, with one of the rings being axially movable by a wire to radially expand and reduce the cage.

Surgical method and apparatus for positioning a diagnostic or therapeutic element within the body

A surgical method and apparatus for positioning a diagnostic or therapeutic element within the body. The apparatus may be catheter-based or a probe including a relatively short shaft.

Suture passing devices and methods

An embodiment of the invention includes a surgical device for passing suture through soft tissue. The surgical device can include at least one elongate superelastic member having a thickness and having a first resting configuration that defines at least one curve having a first radius of curvature greater than or equal to 3 times the thickness of the superelastic member. The surgical device also can include a thermally formed opening in the superelastic member, the opening adapted to receive at least one strand of suture. Moreover, the surgical device can include a superelastic member adapted to be straightened into a second configuration having a second radius of curvature larger than the first radius of curvature.

Systems for recording use of structures deployed in association with heart tissue

A system records use of a structure deployed in operative association with heart tissue in a patient. An image controller generates an image of the structure while in use in the patient. An input receives data including information identifying the patient. An output processes the image in association with the data as a patient-specific, data base record for storage, retrieval, or manipulation.

Assemblies for creating compound curves in distal catheter regions

Compound steering assemblies, usable in both diagnostic and therapeutic applications, enable a physician to swiftly and accurately steer the distal section of the catheter in multiple planes or complex curves to position and maintain ablation and/or mapping electrodes in intimate contact with an interior body surface.

DISSECTING CANNULA AND METHODS OF USE THEREOF

Methods and devices described herein facilitate improved access of locations within the body by providing a variety of dissection modes on a single access device.

DIAPHRAGM ENTRY FOR POSTERIOR SURGICAL ACCESS

Methods and devices described herein facilitate improved treatment of body organs. 1. An access device for creating a temporary cavity between organs in a body , the access device comprising:an elongate member having a working channel extending therethrough, the elongate member having a distal portion adapted for insertion into the body and a proximal portion, the elongate member having a column strength to allow insertion of the distal portion between organs;a slot shaped opening at a distal end of the elongate member, where the working channel exits the elongate member at the opening;a rail-member having a far section, a near section, and a mid section located therebetween, where the far section is affixed relative to the elongate member, the near section being moveable relative to the elongate member, such that distal movement of the near section causes the mid-section of the rail-member to assume an arcuate profile distally to the opening.2. The access device of claim 1 , where the rail-member is sufficiently stiff such that the arcuate profile is formed in substantially a single plane.3. The access device of claim 1 , where the rail-member comprises a guide-wire.4. The access device of claim 1 , where the rail member comprises a material selected from the group consisting of shape-memory alloy claim 1 , a super-elastic alloy claim 1 , metal alloy claim 1 , polymer claim 1 , or polymeric blend of materials.5. The access device of claim 1 , where the elongate member further comprises a second working lumen extending therethrough claim 1 , the second working lumen being separate from the working channel and claim 1 , where the working lumen exits the elongate member at a separate opening.6. The access device of claim 5 , where at the proximal portion of the elongate member claim 5 , the working channel and second working lumen are staggered.7. The access device of claim 1 , where at the working lumen is smaller in size than the working channel.8. The access device ...

Vacuum coagulation probes

A surgical device integrating a suction mechanism with a coagulation mechanism is provided for improving lesion creation capabilities. The device comprises an elongate member having an insulative covering attached about means for coagulating soft tissue. Openings through the covering expose regions of the coagulation-causing elements and are coupled to lumens in the elongate member which are routed to a vacuum source. A fluid source to passively transport fluid along the contacted soft tissue surface may be provided in order to push the maximum temperature deeper into tissue.

METHOD AND DEVICES FOR PERFORMING BIATRIAL COAGULATION

Methods and devices described herein facilitate improved treatment of body organs. 1positioning a first coagulation device adjacent to the first atrial surface of the cardiac tissue;creating a first partial coagulation pattern on the first atrial surface with the first coagulation device, where the first partial coagulation pattern comprises at least a first plurality of lesions where at least two of the first plurality of lesions are separated by a gap section, where the gap section allows an electrical impulse to flow therethrough in the cardiac tissue;positioning a second coagulation device adjacent to the second atrial surface of the cardiac tissue; andcreating a second partial coagulation pattern on second surface with the second coagulation device, where the second partial coagulation pattern comprises at least one lesion across the gap to form the complete coagulation pattern such that the electrical impulse cannot flow across the complete coagulation pattern.. A method of coagulating tissue to create a bi-atrial coagulation pattern on a first and a second atrial surfaces where the first atrial surface and the second atrial surface are located on opposite sides of the cardiac tissue, the method comprising: This application is a continuation of U.S. patent application Ser. No. 12/685,583 filed Jan. 11, 2010, now issued U.S. Pat. No. 8,465,479, which is a non-provisional of U.S. Provisional Application No. 61/143,688 filed Jan. 9, 2009 entitled “Minimally Invasive Lesion Pattern and Dissecting instruments Utilizing Endocardial and Epicardial Lesions”. The above filings are hereby incorporated by reference in their entirety.1. Field of the InventionsMethods and devices are disclosed herein for therapeutically treating tissue. In one example, the devices and methods are suitable for minimally invasive surgery. More particularly, methods and devices described herein permit creating an ablation pattern on an organ while reducing excessive trauma to a patient. The ...

Diaphragm entry for posterior surgical access

Methods and devices described herein facilitate diaphragm entry for posterior access of body organs.

Suture Passing Devices and Methods

An embodiment of the invention includes a surgical device for passing suture through soft tissue. The surgical device can include at least one elongate superelastic member having a thickness and having a first resting configuration that defines at least one curve having a first radius of curvature greater than or equal to 3 times the thickness of the superelastic member. The surgical device also can include a thermally formed opening in the superelastic member, the opening adapted to receive at least one strand of suture. Moreover, the surgical device can include a superelastic member adapted to be straightened into a second configuration having a second radius of curvature larger than the first radius of curvature. 1a first elongate member having an opening positioned transverse to a long axis of the elongate member and receiving a strand of suture; wherein said first elongate member includes a substantially curved first resting configuration and is compressible into a substantially straight second, stressed configuration, and returns towards said first resting configuration as a compressive external force is reduced;a second elongate member having a lumen and substantially housing said first elongate member in the second, stressed configuration, the first elongate member completely slideable within the lumen, and wherein the suture is positionable completely outside of the lumen of the second elongate member; anda grasping mechanism comprising a first jaw and a second jaw connected to said second elongate member at a distal end thereof, with one of said jaws moveable relative to the other, and wherein said grasping mechanism clamps soft tissue while said first elongate member is extendable distally through the soft tissue to pass the strand of suture carried within the transverse opening of the first elongate member through the soft tissue outside said grasping mechanism through an opening in one of said jaws of said grasping mechanism.. A surgical device for ...

VACUUM COAGULATION PROBES

Methods for using a surgical device integrating a suction mechanism with a coagulation mechanism for improving lesion creation capabilities. The device comprises an elongate member having an insulative covering attached about means for coagulating soft tissue with at least one diagnostic element coupled to an energy transfer element of the device. Openings through the covering expose regions of the coagulation-causing elements and are coupled to lumens in the elongate member which are routed to a vacuum source and a fluid source to passively transport fluid along the contacted soft tissue surface in order to push the maximum temperature deeper into tissue. 1a body having a housing at a distal end;an energy transfer element located within the housing and having an elongate exposed portion at an opening in the housing such that the exposed portion of the energy transfer element is capable of creating the linear and/or curvilinear coagulation lesion in the soft tissue;a first diagnostic element assembly positioned adjacent to a distal section of the energy transfer element, where the diagnostic element assembly comprises at least one diagnostic electrode.. A surgical device for creating a linear and/or curvilinear coagulation lesion in a soft tissue of an organ, the device comprising: This application is a continuation of U.S. patent application Ser. No. 13/104,848 filed May 10, 2011, which is a non-provisional of U.S. Provisional Application No. 61/332,814 filed May 10, 2010. The above filings are hereby incorporated by reference in its entirety.The subject matter of the following applications is incorporated by reference in their entirety: U.S. patent application Ser. No. 11/737,523, entitled, “Vacuum Coagulation Probes”, filed Apr. 19, 2007; U.S. patent application Ser. No. 11/558,420, entitled, “Coagulation Probes”, filed Nov. 9, 2006; U.S. patent application Ser. No. 11/408,302 entitled “Vacuum Coagulation Probes” filed Apr. 21, 2006; U.S. patent application Ser. ...

ABLATION DEVICES AND METHODS OF USE

Methods and devices described herein facilitate improved treatment of body organs. 1. A medical device for treating tissue , the device comprising:an elongate shaft comprising at least a plurality of housing shells located at a distal end of the elongate shaft, where the plurality of housing shells each includes a cavity containing an energy transfer element, where each housing shell comprises an opening that exposes the respective energy transfer element;where each of the plurality of housing shells is coupled to at least one adjacent housing shell along a longitudinal edge such that the plurality of housing shells can be folded longitudinally relative to an adjacent housing shell to assume a compact configuration; andthe plurality of housing shells comprising at least a first housing shell and a second shell each having a free longitudinal edge such that the plurality of housing shells can unfolded from the compact configuration to assume a deployment configuration.2. The medical device of claim 1 , where in the deployment configuration comprises the energy transfer elements of each of the plurality of housing shells are aligned in parallel to the longitudinal axis of the plurality of housing shells to define a tissue treatment surface having a width greater than a width of the compact configuration.3. The medical device of claim 1 , where the plurality of housing shells comprises at least three housing shells.4. The medical device of claim 3 , where the plurality of housing shells comprises at least 6 housing shells.5. The medical device of claim 1 , where a length of the opening along the longitudinal axis of the plurality of housing shells is greater than a width of the opening.6. The medical device of claim 5 , where the energy transfer element spans the length of the opening to create a treatment pattern equal to the length of the opening.7. The medical device of claim 6 , where the energy transfer element spans the width of the opening to create a treatment ...

DIAPHRAGM ENTRY FOR POSTERIOR SURGICAL ACCESS

Methods and devices described herein facilitate improved treatment of body organs. 1accessing a diaphragm through a first incision in an abdomen of the patient;advancing an access device through the diaphragm into a thoracic cavity of the patient, where the access device comprises at least at least one working channel; andpositioning a coagulation device into the thoracic cavity through the working channel and adjacent to the organ; andcoagulating an area on the organ.. A method of coagulating an organ in a patient via a minimally invasive procedure, the method comprising: This application is a continuation of U.S. patent application Ser. No. 11/737,493 filed Apr. 19, 2007, which is a continuation-in-part of U.S. patent application Ser. No. 11/408,315, entitled, “Diaphragm Entry for Posterior Surgical Access”, filed Apr. 21, 2006 (now U.S. Pat. No. 9,561,044 issued Feb. 7, 2017), which is a non-provisional of U.S. Provisional Application No. 60/726,342 filed Oct. 12, 2005. U.S. patent application Ser. No. 11/737,493 is also a continuation-in-part of U.S. patent application Ser. No. 11/558,417 entitled, “Diaphragm Entry for Posterior Surgical Access”, filed Nov. 9, 2006 (now U.S. Pat. No. 8,721,597 issued May 13, 2014), and U.S. patent application Ser. No. 11/558,419 “Diaphragm Entry for Posterior Surgical Access”, filed Nov. 9, 2006 (now U.S. Pat. No. 8,211,011 issued Jul. 3, 2012), entitled. Each of the above filings is hereby incorporated by reference in their entireties.Embodiments of the invention relate to methods for minimally invasive surgery and devices useful in such methods. More particularly, methods and devices described herein permit improved access within a body cavity to perform a surgical procedure, for example ablation and/or coagulation of cardiac tissue during minimally invasive surgical access to the heart. The diaphragmatic access described provides direct visualization of anatomic structures within the thoracic cavity such as the posterior left ...

VACUUM COAGULATION PROBE FOR ATRIAL FIBRILLATION TREATMENT

An embodiment of the invention includes a surgical device for coagulating soil tissue such as atrial tissue in the treatment of atrial fibrillation, atrial flutter, and atrial tachycardia. The surgical device can include at least one elongate member comprising conductive elements adapted to coagulate soft tissue when radiofrequency or direct current energy is transmitted to the conductive elements. Openings through said conductive elements are routed through lumens in the elongate member to a vacuum source to actively engage the soft tissue surface intended to coagulate into intimate contact with the conductive elements to facilitate the coagulation process and ensure the lesions created are consistent, contiguous, and transmural. The embodiments of the invention can also incorporate cooling openings positioned near the conductive elements and coupled with a vacuum source or an injection source to transport fluid though the cooling openings causing the soft tissue surface to cool thus pushing the maximum temperature deeper into tissue. The embodiments of the invention can also incorporate features to tunnel between anatomic structures or dissect around the desired tissue surface to coagulate thereby enabling less invasive positioning of the soft tissue coagulating device and ensuring reliable and consistent heating of the soft tissue. 1. A method for coagulating a soft tissue comprising:placing an elongate member against the soft tissue, the elongate member comprising at least one vacuum lumen and at least one element, where the at least one element is in fluid communication with the vacuum lumen;applying a vacuum source to produce a vacuum in said lumen such that the vacuum passes through the at least one element to draw tissue in contact with a length of the at least one element;transmitting energy through the at least one element to create a contiguous lesion in the soft tissue where the contiguous lesion has a length that corresponds to the length of the at ...

METHOD AND DEVICES FOR COAGULATION OF TISSUE

Methods and devices described herein facilitate improved treatment of body organs. 1. A method of creating a completed treatment pattern in a target tissue , where the target tissue comprises a first tissue surface and a second tissue surface , where the second tissue surface is on an opposite side of the first tissue surface , the method comprising:positioning a first medical treatment device adjacent to the first tissue surface;forming a first portion of an incomplete treatment pattern along the first tissue surface using the medical treatment device;positioning a second medical device having at least one energy source adjacent to the second tissue surface;applying energy adjacent to the second tissue surface using the energy source;positioning the second medical device on the second tissue surface by identifying a location of the energy source through the target tissue such that the second medical device is adjacent to an end of the first portion of the treatment portion but on the second tissue surface; andforming a second portion of the incomplete treatment pattern on the second tissue surface using: the second medical device to such that the first portion of the incomplete treatment pattern and the second portion of the incomplete treatment pattern form the completed treatment pattern.2. The method of claim 1 , where the first medical treatment device comprises a first coagulation device.3. The method of claim 2 , where the second medical treatment device further includes at least one coagulation source.4. The method of claim 2 , further comprising advancing a second coagulation device to the target location to create the second coagulation lesion.5. The method of claim 2 , where the first coagulation device and the second medical device comprise opposite poles of an RF energy supply claim 2 , and where energy flows between the first coagulation device and second medical device during application of the RF energy supply.6. The method of claim 1 , where the ...

ABLATION DEVICES AND METHODS OF USE

Methods and devices described herein facilitate improved treatment of body organs.

Methods to prevent stress remodeling of atrial tissue

Methods and devices are disclosed herein for therapeutically treating atrial tissue to lessen the effects of mechanical stress on atrial tissue, where reducing mechanical stress in the portion of atrial tissue reduces formation of at least one arrhythmia substrate. In one example, the devices and methods are suitable for minimally invasive surgery. More particularly, methods and devices described herein permit creating an ablation pattern on an organ while reducing excessive trauma to a patient.

VACUUM COAGULATION PROBES

Methods for using a surgical device integrating a suction mechanism with a coagulation mechanism for improving lesion creation capabilities. The device comprises an elongate member having an insulative covering attached about means for coagulating soft tissue. Openings through the covering expose regions of the coagulation-causing elements and are coupled to lumens in the elongate member which are routed to a vacuum source and a fluid source to passively transport fluid along the contacted soft tissue surface in order to push the maximum temperature deeper into tissue. 1advancing a treatment device housing an electrode to a surface of tissue, where the treatment device housing comprises an opening exposing the electrode, the treatment device also comprising a vacuum lumen and a fluid perfusion lumen, where both the vacuum lumen and fluid perfusion lumen are fluidly coupled to the opening;positioning the opening against the surface of tissue;applying a vacuum in the vacuum source to reduce pressure in both the vacuum lumen and the opening, whereupon the reduced pressure causes the tissue to form a seal about the opening, where formation of the seal causes the fluid perfusion lumen to reduce in pressure causing fluid flow through the fluid perfusion lumen across the opening and through the vacuum lumen, where breaking of the seal prevents the prevents fluid flow; andobserving the fluid flow to confirm engagement between the electrode and the surface of tissue;applying energy from the electrode to the surface of tissue.. A method of applying energy to tissue, the method comprising: This application is a continuation of U.S. patent application Ser. No. 15/094,830 filed Apr. 8, 2016, which is a continuation of U.S. patent application Ser. No. 13/905,696 filed May 30, 2013, now U.S. Pat. No. 9,308,042, which is a continuation of U.S. patent application Ser. No. 13/366,031 filed Feb. 3, 2012, now U.S. Pat. No. 8,454,598, which is a continuation of U.S. patent application ...

DIAPHRAGM ENTRY FOR POSTERIOR SURGICAL ACCESS

Methods and devices described herein facilitate diaphragm entry for posterior access of body organs. 1. A method of accessing posterior surfaces of a body organ in a patient via a minimally invasive procedure , the method comprising:accessing a diaphragm through a first incision in an abdomen of the patient;creating an opening in the diaphragm;advancing an access device through the diaphragm into the thoracic cavity, wherein the access device comprises at least at least one working channel; andcreating a lesion on the posterior surface of the heart adjacent to a pulmonary vein without dissecting the pulmonary vein from cardiac tissue.2. The method of claim 1 , wherein the access device is inserted into the body to the thoracic cavity in a generally straight profile.3. The method of claim 1 , further comprising coupling a visualization system to the working channel.4. The method of claim 1 , further comprising inserting at least one surgical instrument through the working channel into a temporary cavity.5. The method of claim 1 , further comprising actuating an expandable member on an exterior of the access device to separate adjacent tissue structures to form a temporary cavity adjacent to the posterior surfaces of the body organ in the thoracic cavity.6. The method of claim 5 , wherein the expandable member comprises at least one balloon member.7. The method of claim 5 , wherein the expandable member on the access device conforms to the adjacent tissue structures while separating to stabilize the tissue structures.8. The method of claim 5 , wherein the expandable member expands in a non-uniform radial direction from the access device to create the temporary cavity.9. The method of claim 1 , further comprising creating at least a second incision in the patient to provide anterior visualization of the surgical procedure and where the access device provides posterior visualization of the surgical procedure.10. The method of claim 1 , further comprising forming a ...

DISSECTING CANNULA AND METHODS OF USE THEREOF

Methods and devices described herein facilitate improved access of locations within the body by providing a variety of dissection modes on a single access device. 1. A multi-mode tissue dissecting device for delivering one or more medical devices to a target site , the device comprising:a cannula having a working channel extending therethrough and exiting at a distal opening, where the distal opening permits movement of the medical device in a direction parallel to an axis of the working channel;a dilation wedge, smaller than an outer diameter of the cannula and located at a distal end of the cannula and configured to permit mechanical dilation of a small opening in tissue into a larger opening as a first dissection mode;a dissecting surface located on a portion of the dilation wedge, the dissecting surface having a frictional coefficient greater than that of a frictional coefficient of the cannula such that the dissecting surface grips the tissue as the dissecting surface moves against the tissue to dissection of tissue as a second dissection mode; andan expandable dilation member located about an exterior surface of the cannula to separate tissue when expanded as a third dissection mode.2. The device of claim 1 , further comprising at least one fluid port located within the working channel configured to apply suction or deliver a fluid within the working channel claim 1 , the fluid port in fluid communication with a fluid lumen within the cannula.3. The device of claim 2 , further comprising a gripping portion having an open proximal end allowing for advancement of the medical device therethrough and a first fluid connector for coupling the fluid lumen to a fluid source.4. The device of claim 3 , where a portion of the cannula between the distal end and the gripping portion is flexible and has a column strength allowing for advancement of the cannula into the body.5. The device of claim 2 , where the fluid lumen is located within a wall of the cannula and where ...

VACUUM COAGULATION PROBES

Methods for using a surgical device integrating a suction mechanism with a coagulation mechanism for improving lesion creation capabilities. The device comprises an elongate member having an insulative covering attached about means for coagulating soft tissue. Openings through the covering expose regions of the coagulation-causing elements and are coupled to lumens in the elongate member which are routed to a vacuum source and a fluid source to passively transport fluid along the contacted soft tissue surface in order to push the maximum temperature deeper into tissue. 1. A method of applying energy to tissue , the method comprising:advancing a treatment device housing an electrode to a surface of tissue, where the treatment device housing comprises an opening exposing the electrode, the treatment device also comprising a vacuum lumen and a fluid perfusion lumen, where both the vacuum lumen and fluid perfusion lumen are fluidly coupled to the opening;positioning the opening against the surface of tissue;applying a vacuum in the vacuum source to reduce pressure in both the vacuum lumen and the opening, whereupon the reduced pressure causes the tissue to form a seal about the opening, where formation of the seal causes the fluid perfusion lumen to reduce in pressure causing fluid flow through the fluid perfusion lumen across the opening and through the vacuum lumen, where breaking of the seal prevents the prevents fluid flow; andobserving the fluid flow to confirm engagement between the electrode and the surface of tissue;applying energy from the electrode to the surface of tissue.2. The method of claim 1 , where advancing the treatment device to the surface the soft tissue comprises advancing the treatment device to a liver claim 1 , prostate claim 1 , colon claim 1 , esophagus claim 1 , gastrointestinal region claim 1 , and gynecological region.3. The method of claim 1 , where advancing the treatment device to the surface of the soft tissue comprises advancing the ...

VACUUM COAGULATION PROBES

A surgical device integrating a suction mechanism with a coagulation mechanism is provided for improving lesion creation capabilities. The device comprises an elongate member having an insulative covering attached about means for coagulating soft tissue. Openings through the covering expose regions of the coagulation-causing elements and are coupled to lumens in the elongate member which are routed to a vacuum source. A fluid source to passively transport fluid along the contacted soft tissue surface may be provided in order to push the maximum temperature deeper into tissue. 1. A surgical device for coagulating soft tissue of organs and for use with a vacuum source to improve contact with the soft tissue and a track to position the device , the device comprising:a shaft;an energy transfer element;an elongate housing being flexible to conform to a surface of the soft tissue, the housing being located at a distal portion of the shaft and having a main cavity containing the energy transfer element, the housing having at least one opening in a side wall to expose the main cavity and allow the energy transfer element to contact the soft tissue, the housing further including a track lumen extending along the housing having an opening at a distal end of the housing such that the track lumen allows for the housing to be advanced over the track, where the track lumen is fluidly isolated from the main cavity.2. The surgical device of claim 1 , where the housing is sufficiently flexible to conform to a shape of the track.3. The surgical device of claim 1 , where the track lumen extends out of the proximal end of the housing.4. The surgical device of claim 1 , further comprising a track tubing extending through a portion of the housing claim 1 , where the track lumen is within the track tubing.5. The surgical device of claim 4 , where the housing further comprises a perfusion lumen fluidly coupled to the main cavity to allow fluid delivery into the main cavity.6. The surgical ...

SUBXYPHOID EPICARDIAL ABLATION

Methods and devices described herein facilitate ablation patterns on the heart within a pericardial sac and without opening or deflating the lungs. 1creating a minimally invasive incision to access a chest cavity of the patient;creating an opening in a pericardium of the patient and positioning a dilation device into the pericardial space;creating a path within the pericardial space by expanding the dilation device, deflating the dilation device, and then repositioning and re-expanding the dilation device;advancing a treatment device through the path to position the treatment device against a surface of the heart; andcreating the lesion on the surface of the heart using the treatment device.. A method of creating a lesion on a surface of a heart in a body of a patient during a minimally procedure, the method comprising: This application is a continuation of U.S. patent application Ser. No. 14/864,697 filed Sep. 24, 2015, which is a continuation of U.S. patent application Ser. No. 13/107,747 filed May 13, 2011, now U.S. Pat. No. 9,173,705, which claims the benefit of U.S. Patent Provisional Applications 61/334,499 filed May 13, 2010 and 61/334,519 filed May 13, 2010, the entireties of each of which are incorporated by reference herein.Methods and devices for access devices to allow improved manipulation of organs and/or instruments within the body by creating working spaces within the body and adjacent to a target site. The methods and devices can be used in various parts of the body. One particular application includes the use of the access devices and methods to advanced devices to a surface of the heart to create atrial lesion patterns one or more atrial surfaces of the heart.Scope based surgical tools (e.g., elongated cannula/tubular devices that allow viewing of internal body tissues) provide surgeons with an ability to view a surgical site through a lens/fiber optic/camera of the scope and also provide an ability to access the surgical site through a working ...

Subxyphoid epicardial ablation

Methods and devices described herein facilitate ablation patterns on the heart within a pericardial sac and without opening or deflating the lungs.

METHODS TO PREVENT STRESS REMODELING OF ATRIAL TISSUE

Methods and devices are disclosed herein for therapeutically treating atrial tissue to lessen the effects of mechanical stress on atrial tissue, where reducing mechanical stress in the portion of atrial tissue reduces formation of at least one arrhythmia substrate. In one example, the devices and methods are suitable for minimally invasive surgery. More particularly, methods and devices described herein permit creating an ablation pattern on an organ while reducing excessive trauma to a patient. 1. A method for reducing and preventing atrial fibrillation in an atrial tissue of a heart , the method comprising:identifying an affected region of the atrial tissue, where the affected region of the atrial tissue is subject to a mechanical stress produced as a result of an existing medical condition; andproducing a treated section of the atrial tissue by applying energy thereto, such that the treated section of the atrial tissue provides increased mechanical support to the affected region of the atrial tissue, where the increased mechanical support reduces the mechanical stress in the affected region of tissue to reduce the occurrence of atrial fibrillation within the atrial tissue.2. The method of claim 1 , wherein the existing medical condition comprises a condition selected from the group consisting of obesity claim 1 , hypertension claim 1 , and cardiomyopathy.3. The method of claim 1 , wherein producing a treated section of the atrial tissue comprises producing a treated section of a left atrium.4. The method of claim 1 , wherein producing a treated section of the atrial tissue comprises producing a plurality of parallel and adjacent lesions on a posterior left atrium surface.5. The method of claim 4 , wherein at least two of the plurality of parallel and adjacent lesion overlap.6. The method of claim 1 , wherein producing a treated section of the atrial tissue comprises producing a plurality of lesions on an oblique sinus region of the atrium.7. The method of claim 1 ...

METHODS OF COAGULATING TISSUE

An embodiment of the invention includes a surgical device for coagulating soft tissue such as atrial tissue in the treatment of atrial fibrillation, atrial flutter, and atrial tachycardia; tendon or ligament shrinkage; or articular cartilage removal. The surgical device integrates a suction mechanism with the coagulation mechanism improving the lesion creation capabilities of the device. The surgical device comprises an elongate member having an insulative covering attached about conductive elements capable of coagulating soft tissue when radiofrequency or direct current energy is transmitted to the conductive elements. Openings through the insulative covering expose regions of the conductive elements and are coupled to lumens in the elongate member which are routed to a vacuum source. Suction causes the soft tissue to actively engage the opening thus the integrated, exposed conductive elements to facilitate the coagulation process and ensure the lesions created are consistent, continuous, and transmittal. The embodiments of the invention can also incorporate cooling mechanisms associated with the conductive elements and coupled to a fluid source to passively transport fluid along the contacted soft tissue surface to cool thus pushing the maximum temperature deeper into tissue. 1. A method for creating a lesion in a length of soft tissue , the method comprising:placing an elongate member against the soft tissue, the elongate member composing a side wall, at least one first lumen, at least one conductive element attached to said side wall, and at least one opening through said side wall coupled to said lumen and exposing said conductive element against a soft tissue surface such that said opening engages said soft tissue surface;applying a vacuum source to said first lumen causing said soft tissue to contact said conductive element;where the opening further comprises a flexible extension about the opening that is adapted to deform to sealingly engage the soft tissue ...

VACUUM COAGULATION PROBES

A surgical device integrating a suction mechanism with a coagulation mechanism is provided for improving lesion creation capabilities. The device comprises an elongate member having an insulative covering attached about means for coagulating soft tissue. Openings through the covering expose regions of the coagulation-causing elements and are coupled to lumens in the elongate member which are routed to a vacuum source. A fluid source to passively transport fluid along the contacted soft tissue surface may be provided in order to push the maximum temperature deeper into tissue. 1a elongate shaft having a first elongate housing comprising a side wall and at least one main lumen, the housing being flexible to accommodate bending around the organs and to accommodate conformation to the soft tissue;an element located in the elongate housing; andan opening through the side wall exposing the element;a lip located about at least a portion of the opening and connected to the housing, the lip having a free portion being unconnected to the housing such that the free portion of the lip conforms to tissue improving the ability of the lip to form a seal against the soft tissue upon application of the vacuum source to the main lumen.. A surgical device for coagulating soft tissue of organs and for use with a vacuum source to improve contact with the soft tissue, the device comprising: This application is a continuation of U.S. patent application Ser. No. 11/408,302 filed Apr. 21, 2006, which is a continuation-in-part of U.S. patent application Ser. No. 11/208,465 filed Aug. 18, 2005 (now U.S. Pat. No. 7,572,257 issued Aug. 11, 2009), which is a continuation-in-part of U.S. patent application Ser. No. 10/425,251 filed Apr. 29, 2003 (now U.S. Pat. No. 7,063,698, issued Jun. 20, 2006), each of which is incorporated herein by reference in its entirety.Atrial fibrillation surgery involving radiofrequency, D.C., microwave, or other thermal ablation of atrial tissue has a limitation in ...

Diaphragm entry for posterior surgical access

Methods and devices described herein facilitate improved treatment of body organs.

Diaphragm entry for posterior surgical access

Methods and devices described herein facilitate diaphragm entry for posterior access of body organs.

METHOD AND DEVICES FOR COAGULATION OF TISSUE

Methods and devices described herein facilitate improved treatment of body organs. 1positioning a first medical treatment device adjacent to the first tissue surface;forming a first portion of the treatment pattern along the first tissue surface using the medical treatment device such that the first portion of the treatment pattern is incomplete;positioning a second medical device having at least one energy source adjacent to the second tissue surface;applying energy adjacent to the second tissue surface using the energy source;identifying a location of the energy source through the target tissue from the first tissue surface to locate the second medical device; andrepositioning the second medical device on the second tissue surface in response to the location of the first portion of the treatment pattern and using the second medical device to form a second portion of the treatment pattern on the second tissue surface to complete the treatment pattern.. A method of creating a treatment pattern in a target tissue, where the target tissue comprises a first tissue surface and a second tissue surface, where the second tissue surface is on an opposite side of the first tissue surface, the method comprising: This application is a continuation of U.S. patent application Ser. No. 13/541,580 filed Jul. 3, 2012, which is a continuation of U.S. patent application Ser. No. 12/685,596 filed Jan. 11, 2010, which is a non-provisional of U.S. Provisional Application No. 61/143,688 filed Jan. 9, 2009 entitled “Minimally Invasive Lesion Pattern and Dissecting Instruments Utilizing Endocardial and Epicardial Lesions”. The above filings are hereby incorporated by reference in its entirety.Methods and devices are disclosed herein for therapeutically treating tissue. In one example, the devices and methods are suitable for minimally invasive surgery. More particularly, methods and devices described herein permit creating an ablation pattern on an organ while reducing excessive trauma to ...

Suture Passing Devices and Methods

An embodiment of the invention includes a surgical device for passing suture through soft tissue. The surgical device can include at least one elongate superelastic member having a thickness and having a first resting configuration that defines at least one curve having a first radius of curvature greater than or equal to 3 times the thickness of the superelastic member. The surgical device also can include a thermally formed opening in the superelastic member, the opening adapted to receive at least one strand of suture. Moreover, the surgical device can include a superelastic member adapted to be straightened into a second configuration having a second radius of curvature larger than the first radius of curvature.

DIAPHRAGM ENTRY FOR POSTERIOR SURGICAL ACCESS

Methods and devices described herein facilitate diaphragm entry for posterior access of body organs. 1accessing a diaphragm through a first incision in an abdomen of the patient;creating an opening in the diaphragm;advancing an access device through the diaphragm into the thoracic cavity, where the access device comprises at least at least one working channel and an expandable member on an exterior of the device; andforming a temporary cavity by actuating the expandable member to separate adjacent tissue structures in the thoracic cavity.. A method of accessing posterior surfaces of a body organ in a patient via a minimally invasive procedure, the method comprising: This application is a continuation of U.S. patent application Ser. No. 11/408,315 filed Apr. 21, 2006, which claims the benefit under 35 U.S.C. §119(e) of U.S. Provisional Application No. 60/726,342 filed Oct. 12, 2005, the contents of each are incorporated herein by reference.The subject matter of this application may be incorporated with the subject matter in the following applications: U.S. patent application Ser. No. 11/208,465 entitled “Vacuum Coagulation & Dissection Probes”; U.S. patent application Ser. No. 10/425,251 entitled “Vacuum Coagulation Probes”; U.S. Provisional application No. 60/726,342 entitled Diaphragm Entry for Posterior Access Surgical Procedures; and U.S. Pat. No. 6,893,442 the entirety of each of which is hereby incorporated by reference in their entireties.Embodiments of the invention relate to methods for minimally invasive surgery and devices useful in such methods. More particularly, methods and devices described herein permit improved access within a body cavity to perform a surgical procedure, for example ablation and/or coagulation of cardiac tissue during minimally invasive surgical access to the heart. The diaphragmatic access described provides direct visualization of anatomic structures within the thoracic cavity such as the posterior left atrium, the posterior side ...

VACUUM COAGULATION PROBES

A surgical device integrating a suction mechanism with a coagulation mechanism is provided for improving lesion creation capabilities. The device comprises an elongate member having an insulative covering attached about means for coagulating soft tissue. Openings through the covering expose regions of the coagulation-causing elements and are coupled to lumens in the elongate member which are routed to a vacuum source. A fluid source to passively transport fluid along the contacted soft tissue surface may be provided in order to push the maximum temperature deeper into tissue. 1. A surgical device for coagulating a tissue and for use with a vacuum source , the surgical device comprising:a shaft having an elongate housing at a distal portion of the shaft, the elongate housing comprising at least one main lumen, the elongate housing being flexible;an energy delivery element located in the elongate housing;an opening in the housing where the energy delivery element is recessed within the housing at the opening; anda portion of the housing surrounding the opening being flexible to seal against the tissue such that upon application of the vacuum source to the at least one main lumen causes the tissue to be pulled into the opening to contact the energy delivery element.2. The surgical device of claim 2 , where the elongate housing comprises a fluid delivery lumen extending parallel to and outside of the at least one main lumen to minimize a width of the surgical device claim 2 , the fluid delivery lumen in fluid communication with the energy delivery element at a first end and where the at least one main lumen is in fluid communication with the energy delivery element at a second end such that application of the vacuum source and creation of a seal while delivering fluid causes circulation of the fluid over a length of the energy delivery element and back through the at least one main lumen.3. The surgical device of claim 3 , further comprising a handle at a proximal end ...

Systems and methods for visualizing tissue during diagnostic or therapeutic procedures

A catheter tube carries an imaging element for visualizing tissue. The catheter tube also carries a support structure, which extends beyond the imaging element for contacting surrounding tissue away from the imaging element. The support element stabilizes the imaging element, while the imaging element visualizes tissue in the interior body region. The support structure also carries a diagnostic or therapeutic component to contact surrounding tissue.

Systems and methods for visualizing interior regions of the body

An imaging system for visualizing an interior body region comprises a catheter tube having a proximal end and a distal end adapted for introduction into the interior body region. The distal end carries an element that forms a three-dimensional support structure for contacting peripheral tissue in the interior body region. The three-dimensional support structure has an open interior. The distal end also carries an imaging element for visualizing the interior body region. The three-dimensional support structure peripherally surrounds the imaging element, thereby keeping peripheral tissue from contacting the imaging element. A steering mechanism on the proximal end of the catheter tube moves the imaging element within the open interior of the three-dimensional support structure. The system provides a stable platform through which accurate displays of interior body images can be created for viewing and analysis by the physician, so the appropriate treatment or therapy can be prescribed.

Systems for locating and guiding operative elements within interior body regions

Systems and methods for locating an operative element within an interior body space use a locating probe, which includes at least one transmitting element to transmit an electric waveform output within at least a portion of the space. The systems and methods also use a sensing element, which is adapted to be carried by the operative element to sense a local electric waveform within the space. A processing element coupled to the sensing element generates a processed output that locates the sensing element relative to the locating probe based, at least in part, upon a differential comparison of the waveform output and the sensed local waveform.

Interface for performing a diagnostic or therapeutic procedure on heart tissue with an electrode structure

An interface for performing a diagnostic or therapeutic procedure on heart tissue with an electrode structure includes a controller which operates to establish an operating condition for the electrode structure, a processing unit coupled to the controller, a memory storage device including process software adapted to be executed by the processing unit and a graphical user interface including a display screen coupled to the processing unit. The process software performs a first control application and a second control application, each control application prescribing procedures for carrying out a given task using the electrode structure, at least one of the control applications prescribing a clinical procedure affecting heart tissue. The process software further performs a first function to create on the display screen separate first and second display regions, a second function to show in the first display region a selection menu display comprising a first field for selecting the first control application for execution and a second field for selecting the second control application for execution, and a third function to show in the second display region a first graphical display during execution of the first control application and a second graphical display during execution of the second control application.

Systems and methods for controlling power in an electrosurgical probe

Systems and methods for controlling the power supplied to an electrosurgical probe. The systems and methods may be used to monitor electrode-tissue contact, adjust power in response to a loss of contact, and apply power in such a manner that charring, coagulum formation and tissue popping are less likely to occur.

Systems and methods for identifying the physical, mechanical, and functional attributes of multiple electrode arrays

Systems and methods identify the physical, mechanical, and functional attributes of multiple electrode arrays. The systems and methods provide a structure adapted for contact with tissue in an interior body region. The structure possesses a physical property affecting tissue contact. The systems and methods include an identification code that uniquely identifies the physical property of the structure, such as size of the structure, or shape of the structure, or symmetry or lack of symmetry of the structure, or a stiffness value of the structure, or combinations thereof. The systems and methods also include an identification element attached in association with the structure to retain the identification code. The identification element is adapted to provide an output representative of the identification code. The structure also carries at least one electrode. The electrode possesses-a physical property, or both. The identification code uniquely identifies both the physical property of the structure and the physical or functional property of the electrode. The identification element retains one or more of these physical or functional properties for output and consideration prior to use of the structure.

Systems and methods for sensing sub-surface temperatures in body tissue

Systems and methods supply ablation energy to an electrode in contact with tissue to form a tissue-electrode interface. The system and methods sense, simultaneously with ablation, at least two tissue temperature conditions using at least two tissue temperature sensing elements which are held within a carrier that is substantially isolated from thermal conductive contact with the electrode. The carrier holds the tissue temperature sensing elements in a spaced apart relationship in thermal conductive contact with tissue at different depths beneath the tissue-electrode interface. The systems and methods control the supply of ablation energy to the electrode based, at least in part, upon temperatures sensed by the tissue temperature sensing elements.

Systems and methods for sensing temperature within the body

Systems and methods well suited for use in catheter based tissue ablation systems employ thermocouples (80) for temperature sensing at an energy emitter site (30). The sensed temperature is used to control the energy output from the energy source to maintain tissue temperature within desired parameters. The systems combine accuracy with compact, low profile construction.

System for controlling tissue ablation using temperature sensors

This invention is a system and associated method to ablate body tissue using multiple emitters (30) of ablating energy. The system and method convey ablating energy individually to each emitter (30) in a sequence of power pulses. The system and method periodically sense the temperature of each emitter (30) and compare the sensed temperatures to a desired temperature established for all emitters (30) to generate a signal individually for each emitter (30) based upon the comparison. The system and method individually vary the power pulse to each emitter (30) based upon the signal for that emitter to maintain the temperatures of all emitters essentially at the desired temperature during tissue ablation.

Surgical method and apparatus for positioning a diagnostic a therapeutic element within the body

A surgical method and apparatus for positioning a diagnostic or therapeutic element within the body. The apparatus may be catheter-based or a probe including a relatively short shaft.

Vacuum coagulation probes

Expandable-collapsible electrode structures for capacitive coupling to tissue

Electrode assemblies and associated systems employ a nonporous wall having an exterior for contacting tissue. The exterior peripherally surrounds an interior area. The wall is essentially free of electrically conductive material. The wall is adapted to assume an expanded geometry having a first maximum diameter and a collapsed geometry having a second maximum diameter less than the first maximum diameter. The assemblies and systems include a lumen that conveys a medium containing ions into the interior area. An element free of physical contact with the wall couples the medium within the interior area to a source of electrical energy to enable ionic transport of electrical energy from the source through the medium to the wall for capacitive coupling to tissue contacting the exterior of the wall.

Folding electrode structures

Improved folding electrode assemblies and associated methods employ a structure comprising a wall peripherally enclosing an interior. The structure is adapted to selectively assume a geometry that changes between an expanded geometry having a first maximum diameter and a collapsed geometry having a second maximum diameter less than the first maximum diameter. At least one folding region in the wall is adapted to fold upon itself along a predefined fold line as the structure geometry changes. The folding region is formed when a portion of the wall is coated with an electrically conductive material for the purpose of transmitting electrical ablating energy, while another portion of the wall is left free of the electrically conductive material. Alternatively, the folding region is formed by forming an array of apertures in the wall.

Vacuum coagulation probes

An embodiment of the invention includes a surgical device for coagulating soft tissue such as atrial tissue in the treatment of atrial fibrillation, atrial flutter, and atrial tachycardia; tendon or ligament shrinkage; or articular cartilage removal. The surgical device integrates a suction mechanism with the coagulation mechanism improving the lesion creation capabilities of the device. The surgical device comprises an elongate member having an insulative covering attached about conductive elements capable of coagulating soft tissue when radiofrequency or direct current energy is transmitted to the conductive elements. Openings through the insulative covering expose regions of the conductive elements and are coupled to lumens in the elongate member which are routed to a vacuum source. Suction causes the soft tissue to actively engage the opening thus the integrated, exposed conductive elements to facilitate the coagulation process and ensure the lesions created are consistent, continuous, and transmural. The embodiments of the invention can also incorporate cooling mechanisms associated with the conductive elements and coupled to a fluid source to passively transport fluid along the contacted soft tissue surface to cool thus pushing the maximum temperature deeper into tissue.

COAGULATION PROBE FOR SOFT FABRICS.

Sistema de control de potencia para electrofisiología, para su utilización con un dispositivo electrofisiológico, que tiene una serie de electrodos sobre un cuerpo de soporte y un mango fijado a dicho cuerpo de soporte, y que incluye un dispositivo de control de potencia para electrofisiología adaptado para suministrar selectivamente energía a la serie de electrodos, caracterizado por: una unidad de potencia de control remoto (325), que define un elemento estructural separado del mango del dispositivo electrofisiológico, incluyendo un cuerpo principal (327a), una serie de interruptores marcha/paro (327b) sobre el cuerpo principal (327a) asociados respectivamente con la serie de electrodos del cuerpo de soporte del dispositivo electrofisiológico, y un aparato de conexión adaptado para conectar la serie de interruptores marcha/paro (327b) al dispositivo de control de potencia para electrofisiología. Power control system for electrophysiology, for use with an electrophysiological device, which has a series of electrodes on a support body and a handle fixed to said support body, and which includes a power control device for electrophysiology adapted for Selectively supply power to the electrode series, characterized by: a remote control power unit (325), which defines a structural element separate from the handle of the electrophysiological device, including a main body (327a), a series of on / off switches (327b) on the main body (327a) associated respectively with the series of electrodes of the electrophysiological device support body, and a connection apparatus adapted to connect the series of on / off switches (327b) to the power control device for electrophysiology

Vacuum coagulation probes

A surgical device integrating a suction mechanism with a coagulation mechanism is provided for improving lesion creation capabilities. The device comprises an elongate member having an insulative covering attached about means for coagulating soft tissue. Openings through the covering expose regions of the coagulation-causing elements and are coupled to lumens in the elongate member which are routed to a vacuum source. A fluid source to passively transport fluid along the contacted soft tissue surface may be provided in order to push the maximum temperature deeper into tissue.

Systems for recording use of structures deployed in association with heart tissue

A system records use of a structure deployed in operative association with heart tissue in a patient. An image controller generates an image of the structure while in use in the patient. An input receives data including information identifying the patient. An output processes the image in association with the data as a patient-specific, data base record for storage, retrieval, or manipulation.

Systems and methods for visualizing interior tissue regions using expandable imaging structures

An imaging structure has a periphery adapted to selectively assume an expanded geometry and a collapsed geometry. The periphery of the imaging structure carries an array of spaced apart ultrasound transducers.

Systems for visualizing interior tissue regions including an actuator to move imaging element

An imaging element characterizes tissue morphology by analyzing perfusion patterns of a contrast media in tissue visualized by the imaging element, to identify infarcted tissue. In a preferred implementation, a catheter tube introduced into a heart region carries the imaging element, as well as a support structure spaced from the imaging element, which contacts endocardial tissue. The imaging element is moved as the imaging element visualizes tissue. A selected electrical event is sensed in surrounding myocardial tissue, which regulates movement of the imaging element. The support element stabilizes the moving imaging element as it visualizes tissue, providing resistance to dislodgment or disorientation despite the presence of dynamic forces.

Branched structures for supporting multiple electrode elements

A catheter assembly comprises a first branch body having a first axis, a second branch body extending in a non-parallel relationship with respect to the first axis, and at least one electrode carried by the second branch body. In use, the first branch body can be located within a pulmonary vein within the left atrium, while the electrode carried by the second branch body is located in contact with endocardial tissue outside the pulmonary vein. Ablation energy can be transmitted from the electrode to contacted endocardial tissue while the first branch body is located within the pulmonary vein.

Atrial appendage stasis reduction procedures and devices

Devices and procedures are shown for non-surgically repositioning an atrial appendage (17) using a grasping catheter (40), and for affixing the appendage in the new position, thereby minimizing thrombus formation, especially for patients with atrial fibrillation.

Surface coatings for catheters, direct contacting diagnostic and therapeutic devices

A catheter including a distal end assembly having an external surface coating. Where the distal end assembly includes electrodes or other electrical components, the coating is preferably electrically conductive. Such an electrically conductive coating is formed from a material comprising regenerated cellulose, although other materials such as a hydrogel or a plastic having an electrically conductive component are utilizable. Where the distal end assembly includes optical or ultrasonic components, the regenerated cellulose coating is suitable. The robustness of the surface coating permits the manufacture and utilization of electrode configurations that are formed on a non-conductive base member by processes such as pad printing, vapor deposition, ion beam assisted deposition, electroplating and other printed circuit manufacturing processes. Additionally, because the surface coating produces a smooth outer surface to the distal end assembly, lead wires and temperature sensing devices can be bonded to the exterior surface of electrodes and then coated to produce a smooth outer surface; thus providing a simple, inexpensive manufacturing method for the attachment of such components to the electrodes.

Catheterdistal assembly with pull wires

A catheter assembly having a sheath, which includes a side wall enclosing an interior bore, and a distal region. The assembly also has a bendable catheter tube, which is carried for sliding movement in the interior bore. A pull wire also runs through the interior bore of the sheath, preferably within a lumen. The catheter tube has a distal portion with a coupling which joins the distal portion of the catheter tube and the distal portion of the pull wire. Relative movement of the pull wire and the sheath causes bending of the catheter tube outwardly through the opening, in response to sliding movement of the catheter tube within the interior bore toward the distal region of the sheath.

Systems for guiding movable electrode elements within multiple-electrode structures

Distal anastomosis system

Distal anastomosis devices and associated methodology are described herein. Connector (2) and connector components as well as tools associated therewith are disclosed. The connectors (2) are preferably adapted to produce an end-to-side anastomosis at a graft/coronary artery junction. A fitting (10) alone, or a fitting (10) in combination with a collar (12) may be used as a connector (2). Each fitting (10) may be deployed by deflecting its shape to provide clearance for a rear segment (18) that rotates about adjoining hinge section (s) (28) so to fit the connector within an aperture formed in a host vessel. Upon return to a substantially relaxed position, a rear segment (18) anchors the interfacing with the host vessel/coronary artery. The collar (12) may include features complimentary to those of a fitting (10) and provisions for strain relief and securing the graft vessel.

Radially expanding prostheses and systems for their deployment

An implantable graft 244 comprising: a flexible, tubular graft material layer 246 defining an outer surface and having first and second ends, and at least one longitudinally extending support member 248 affixed to the graft material layer 246 and comprising a terminal end 250 extending beyond the graft material layer outer surface,    wherein the support member 248 is deformable from a first shape such that upon removal of a force causing the support member to deform, the support member expands radially to return to the first shape;    characterised in that the graft material layer 246 surrounds a portion of the support member 248 to join the support member to the graft material layer.

Multiple electrode support structures having optimal bio-mechanical characteristics

An electrode support structure comprises a distal hub (48) and a proximal base (12) aligned along a major axis with the distal hub (48). An array of generally flexible spline elements (180) extends between the hub (48) and the base (12). The spline elements (180) each have an elongated axis that, at the base (12), extends generally parallel to the major axis and, at the hub (48), extends at an angle measured relative to the major axis of between 45 degrees and 110 degrees. The spline elements (180) collectively define a distal surface (66) lying within an envelope that approximates the curvature of endocardial tissue and within which envelope the distal hub (48) lies. According to this aspect of the invention, the distal surface (66), when contacting endocardial tissue, increases in surface area in response to force applied generally along the major axis to mediate tissue pressure.

Systems and methods using annotated images for controlling the use of diagnostic or therapeutic instruments in instruments in interior body regions

An interface, used in association with an electrode structure deployed in contact with heart tissue, generates a display comprising an image of the electrode structure at least partially while performing a therapeutic or diagnostic procedure. The interface annotates the image in response to procedure events.

Sutureless anastomosis systems

Anastomosis systems include fittings (20, 24), and compression mechanisms for effecting end to end (24) or end to side (20) couplings of biological or synthetic bypass grafts (16) to vessel locations. The fittings (20, 24) are tubular, and surround end regions of the graft. In some applications an end region of the graft is everted, and surrounds an exterior of the fitting (20, 24), in which case the preferred compression mechanism is a retaining ring (34). A tool (54) is used to evert the graft end region. In other applications, the fitting (20, 24) has an interior groove that receives an expandable retaining ring (34) that urges the graft end region radially outwardly against the fitting. A graft deploying and securing system includes a needle (172) for puncturing vessel tissue, a dilator (174), a sheath (176) adapted for containing a graft fitting combination and guiding the combination into the vessel through an opening formed by the needle (172), and dilator (174).

Thermal securing anastomosis systems

A sutureless anastomosis systems for securing a bypass graft to a host vessel or other tubular structure including a bypass graft and fitting. A compression mechanism may be used with the system for attachment of the bypass graft to the fitting. An electrode is connected to the fitting and an energy source. The energy source transmits energy to the electrode and causes the adjacent tissue to rise in temperature and bond to a vessel or fitting.

Atrial appendage stasis reduction devices

Devices and procedures are shown for non-surgically repositioning an atrial appendage (17) using a grasping catheter (40), and for affixing the appendage in the new position, thereby minimizing thrombus formation, especially for patients with atrial fibrillation.

Systems and methods for sensing sub-surface temperatures in body tissue during ablation with actively cooled electrodes

Systems and associated methods for ablating body tissue employ an electrode (16) for contacting tissue to form a tissue electrode interface. The electrode is adapted to be connected to a source of ablation energy (12) to conduct ablation energy for transmission by the electrode into tissue at the tissue electrode interface. The systems and methods also include an element to cool the electrode (50, 56). The systems and methods hold a tissue temperature sensing element in a carrier in thermal conductive contact with tissue beneath the tissue electrode interface. The systems and methods include a controller that is coupled to the tissue temperature sensing element to control either the supply of ablation energy (98), or the rate at which the electrode is cooled (92, 95), or both, based at least in part upon temperature senses by the temperature sensing element.

Radially expanding prostheses and systems for their deployment

Vacuum coagulation probes

A surgical device integrating a suction mechanism with a coagulation mechanism is provided for improving lesion creation capabilities. The device comprises an elongate member having an insulative covering attached about means for coagulating soft tissue. Openings through the covering expose regions of the coagulation-causing elements and are coupled to lumens in the elongate member which are routed to a vacuum source. A fluid source to passively transport fluid along the contacted soft tissue surface may be provided in order to push the maximum temperature deeper into tissue.

Systems and methods for forming elongated lesion patterns in body tissue using straight or curvilinear electrode elements

Systems and associated methods position arrays of multiple emitters of ablating energy in straight or curvilinear positions in contact with tissue to form elongated lesion patterns. The elongated lesion patterns can continuous or interrupted, depending upon the orientation of the energy emitters.

Soft tissue coagulation probe

A soft tissue coagulation probe (250), comprising: a relatively short shaft (254) defining a distal end and a proximal end; a handle (266) associated with the proximal end of the shaft (254); and at least two spaced soft tissue coagulation electrodes (294) associated with the shaft (254) and located in spaced relation to the handle (266), the respective size and spacing of the at least two soft tissue coagulation electrodes (294) being such that simultaneous transmission of energy thereby to an indifferent electrode (519) will produce an area of coagulated tissue that spans the at least two soft tissue coagulation electrodes (294).

Structures for supporting multiple electrode elements

A catheter assembly comprises a first branch body having a first axis, a second branch body extending in a non-parallel relationship with respect to the first axis, and at least one electrode carried by the second branch body. In use, the first branch body can be located within a pulmonary vein within the left atrium, while the electrode carried by the second branch body is located in contact with endocardial tissue outside the pulmonary vein. Ablation energy can be transmitted from the electrode to contacted endocardial tissue while the first branch body is located within the pulmonary vein.

Interactive systems and methods for controlling the use of diagnostic or therapeutic instruments in interior body regions

Curvilinear electrode and method for forming lesions

Systems and associated methods form larger and deeper lesion patterns by shaping a support body with multiple electrodes (30) in ways that increase the density of the electrodes (30) per given tissue area. The support body (12) can carry either elongated, continuous electrodes (80) or arrays of non-contiguous, segmented electrodes (30).

Systems and methods for examining heart tissue

Systems and methods use an array (20) of multiple electrodes (24) supported for operative association with a region of heart tissue, in tandem with a roving second electrode (36) supported for movement relative to the multiple electrodes for operative association with selected different regions of endocardial tissue within the heart. An analog or digital processing element (32) conditions one of the multiple electrodes and the roving electrode to emit a pacing signal while the other one of the multiple electrodes and the roving electrode records paced electro-grams occurring as a result of the pacing signal. A template of cardiac event of known diagnosis sensed using the array of multiple electrodes is input. A sample of a cardiac event acquired by pacing from at least one roving electrode and sensed with the array of multiple electrodes is input. The processing element and method electronically compare the sample to a template and generate an output.

Systems for recording the use of cardiac devices

A system records use of a structure deployed in operative association with heart tissue in a patient. An image controller generates an image of the structure while in use in the patient. An input receives data including information identifying the patient. An output processes the image in association with the data as a patient-specific, data base record for storage, retrieval, or manipulation.

Soft tissue coagulation probe

A soft tissue coagulation probe (250), comprising: a relatively short shaft (254) defining a distal end and a proximal end; a handle (266) associated with the proximal end of the shaft (254); and at least two spaced soft tissue coagulation electrodes (294) associated with the shaft (254) and located in spaced relation to the handle (266), the respective size and spacing of the at least two soft tissue coagulation electrodes (294) being such that simultaneous transmission of energy thereby to an indifferent electrode (519) will produce an area of coagulated tissue that spans the at least two soft tissue coagulation electrodes (294).

Systems and methods for sensing temperature within the body

Systems and methods well suited for use in catheter-based tissue ablation systems employ thermocouples for temperature sensing. The systems and methods combine accuracy with compact, low profile construction.

FLEXIBLE ELECTRODE STRUCTURE

Systems and methods for locating and guiding operative elements within interior body regions

This invention concerns systems and methods for locating an operative element (12) within an interior body space use a locating probe (14), which includes at least one transmitting element to transmit an electric waveform output within at least a portion of the space. The systems and methods also use a sensing element (16) which is adapted to be carried by the operative element to sense a local electric waveform within the space. A processing element coupled to the sensing element generates a processed output that locates the sensing element relative to the locating probe based, at least in part, upon a differential comparison of the waveform output and the sensed local waveform.

Distal anastomosis system

Distal anastomosis devices and associated methodology are described herein. Connector (2) and connector components as well as tools associated therewith are disclosed. The connectors (2) are preferably adapted to produce an end-to-side anastomosis at a graft/coronary artery junction. A fitting (10) alone, or a fitting (10) in combination with a collar (12) may be used as a connector (2). Each fitting (10) may be deployed by deflecting its shape to provide clearance for a rear segment (18) that rotates about adjoining hinge section (s) (28) so to fit the connector within an aperture formed in a host vessel. Upon return to a substantially relaxed position, a rear segment (18) anchors the interfacing with the host vessel/coronary artery. The collar (12) may include features complimentary to those of a fitting (10) and provisions for strain relief and securing the graft vessel.

Electrophysiological treatment methods and apparatus employing high voltage pulse to render tissue temporarily unresponsive

Systems and methods for diagnosing and treating tissue transmit an electrical energy pulse that temporarily stuns a zone of tissue, temporarily rendering it electrically unresponsive. The systems and methods sense an electrophysiological effect due to the transmitted pulse. The systems and methods alter an electrophysiological property of tissue in or near the zone based, at least in part, upon the sensed electrophysiological effect. The alteration of the electrophysiological property can be accomplished, for example, by tissue ablation or by the administration of medication. In a preferred implementation, radio frequency energy is used to both temporarily stun tissue and to ablate tissue through a common electrode.

Systems and methods for analyzing biopotential morphologies in body tissue

Systems and methods analyze bio-potential morphologies in body tissue. The systems and methods use a template of a bio-potential event of known cause in body tissue. The systems and methods compare this template to a sample of a bio-potential event externally triggered in body tissue. The systems and methods generate an output based upon this comparison. The systems and methods can be used to compare an event specific to the template of a cardiac event (T(i)) of known diagnosis to a sample of a placed cardiac event (P(i)). The comparison yields a matching coefficient (MCOEFF(i)) indicating how alike the input sample is to the input template. The matching coefficient can be used by the physician, for example, to aid in the location of sites that are potentially appropriate for ablation.

Tissue characterization and treatment using pacing

Heart tissue is characterized by using pacing without inducing ventricular tachycardia (VT). With the tissue characterization, a patient's risk of developing VT can be determined and a slow conduction zone in the patient's heart can be determined. The characterization involves applying pacing signals with varying pacing cycle intervals to a chamber of the patient's heart to pace the patient's heart. The response signals generated by the paced heart are received and used as the basis for characterizing the patient's heart tissue.

Systems for recording the use of cardiac devices

A system records use of a structure deployed in operative association with heart tissue in a patient. An image controller generates an image of the structure while in use in the patient. An input receives data including information identifying the patient. An output processes the image in association with the data as a patient-specific, data base record for storage, retrieval, or manipulation.

Systems and methods for guiding movable electrode elements within multiple-electrode structures

Systems and related methods guide a movable electrode (36) within an array of multiple electrodes (24) located within the body. The systems and methods employ the movable electrode (36) or at least one of the multiple electrodes (24) on the array to generate and then sense electrical or sonic energy in a predetermined fashion to generate an output that locates the movable electrode (36) within the array.

Structures for supporting porous electrode elements

A catheter assembly comprising a elongated, flexible support structure having an axis. The assembly also includes an elongated porous electrode assembly carried by the support structure along the axis for contact with tissue. The elongated porous electrode assembly comprises a wall having an exterior peripherally surrounding an interior area, a lumen to convey a medium containing ions into the interior area, and an element coupling the medium within the interior area to a source of electrical energy. At least a portion of the wall comprising a porous material is sized to allow passage of ions contained in the medium to thereby enable ionic transport of electrical energy through the porous material to the exterior of the wall to form a continuous elongated lesion pattern in tissue contacted by the wall. The support structure can have a curvilinear geometry, e.g., a loop shape, and the elongated porous electrode assembly conforms to the curvilinear geometry.

Dissecting cannula and methods of use thereof

Methods and devices described herein facilitate improved access of locations within the body by providing a variety of dissection modes on a single access device.

Curvilinear electrode and method for forming lesions

Systems and associated methods form larger and deeper lesion patterns by shaping a support body with multiple electrodes in ways that increase the density of the electrodes per given tissue area. The support body can carry either elongated, continuous electrodes or arrays of non-contiguous, segmented electrodes.

Branched structures for supporting multiple electrode elements

A catheter assembly comprises a first branch (44) having a first axis, a second branch (32) extending in a non-parallel relationship with respect to the first axis and at least one electrode (28) carried by the second branch body (32). In use, the first branch body (44) can be located within a pulmonary vein within the left atrium, while the electrode (28) carried by the second branch body (32) is located in contact with endocardial tissue outside the pulmonary vein. Ablation energy can be transmitted from the electrode (28) to contacted endocardial tissue while the first branch (44) body is located within the pulmonary vein.