US20060184241A1 - Self-molding annuloplasty ring - Google Patents

Abstract

A resilient self molding annuloplasty ring which may be enlarged prior to implantation to facilitate implantation within a dilated or otherwise incompetent valve annulus having sufficient contractive force to render a valve competent. The self-molding annuloplasty ring may further comprise integral attachment devices to aid in the implantation process. The resilient self-molding annuloplasty ring may be stretched to an expanded diameter and attached to a heart valve annulus, then permitted to contract to reduce the diameter of the annulus. The ring may be positioned on an insertion device that maintains the ring in its expanded diameter while attaching to the annulus.

Description

RELATED APPLICATIONS
• The present application is a continuation of Ser. No. 10/777,343, filed Feb. 12, 2004, entitled METHOD OF IMPLANTING A SELF-MOLDING ANNULOPLASTY RING, which is a continuation of Ser. No. 09/938,902, filed Aug. 24, 2001, entitled SELF-MOLDING ANNULOPLASTY RING, now U.S. Pat. No. 6,726,716, which applications are expressly incorporated herein by reference.
BACKGROUND OF THE INVENTION
• The human heart is hollow muscular organ having four pumping chambers separated by four heart valves. The mitral and tricuspid valves, present at the left and right atrio-ventricular junctions, open and close in response to a pressure gradient during each cardiac cycle of relaxation and contraction to control the flow of blood to a particular region of the heart.
• These valves are comprised of a dense fibrous ring known as the annulus, leaflets or cusps attached to the annulus, and a complex of chordae tendineae and papillary muscles securing the leaflets. The size of the leaflets or cusps is such that when the heart contracts the resulting increased blood pressure formed within the ventricular cavity forces the leaflets towards the arterial cavity. As a result, the leaflets or cusps come in apposition to each other thereby closing the atrio-ventricular passage.
• Natural defects and heart disease are common causes of valvular dysfunction within the heart of a patient. One common example of valvular dysfunction occurs when the annulus becomes excessively dilated or the valve geometry results in ineffective valve closure, which results in regurgitation. Due to the increased diameter of the annulus, the leaflets or cusps fail to meet during systolic contraction, thereby resulting in the regurgitation of blood during ventricular contractions. As such, sufficient back pressure exists within the chambers of the heart capable of forcing some blood flow to traverse the atrio-ventricular junction from the ventricle to the atria.
• One manner of repairing this problem involves surgically implanting a prosthetic ring (i.e. “annuloplasty ring”) about the dilated annulus, thereby restoring the annulus to the normal size and shape and allowing the valve leaflets to function normally. Commonly, a surgeon positions the annuloplasty ring near the valve annulus and sutures the device in place.
• One approach to correcting or remodeling the valve annulus has required the implantation of a rigid annuloplasty ring. Typically, an annuloplasty ring having the desired internal diameter is positioned near the heart valve and sutured in place. As a result, the diameter of the valve is reduced to the diameter of the annuloplasty ring. This procedure utilizing current annuloplasty rings has several shortcomings. For example, the tissue comprising the heart, particularly in the area of the heart valves, is flexible. The implantation of a rigid annuloplasty ring restricts the natural flexibility of this tissue, and may impact the heart's function. Also, the diameter of the dilated annulus is substantially larger than the annuloplasty ring, thereby making the implantation surgery unnecessarily time consuming. The surgeon is required to position the prosthesis near a portion of the tissue and suture the ring in place. Thereafter, the opposing tissue is forced to engage the ring and is attached to the annuloplasty ring with sutures. Consequently, the sutures may be under different stress loads, and could result in an increased risk of ring dehiscence.
• There is thus a need for a flexible annuloplasty prosthesis and implantation device that enables a surgeon to precisely position and apply an annuloplasty ring to the dilated valve annulus.
SUMMARY OF THE INVENTION
• The present invention solves the aforementioned problems in that the resilient annuloplasty ring of the present invention may be stretched to the diameter of the dilated valve annulus prior to implantation, thereby simplifying the implantation process. In addition, the contractive force of the resilient annuloplasty ring of the present invention may controllably reduce the diameter of an incompetent dilated valve annulus to more competent diameter. Those skilled in the art will appreciate the present invention is easy to manufacture and may be manufactured from a plurality of materials.
• The annuloplasty ring of the present invention comprises a resilient inner sizing member positioned within a flexible outer attachment sheath. The resilient inner sizing member applies a contractive force to the incompetent annulus tissue. The flexible outer attachment sheath permits the surgeon to attach the device to the annulus tissue in a plurality of manners including suturing and stapling. The annuloplasty ring of the present invention may be manufactured from a plurality of biologically compatible materials having sufficient resiliency to permit stretching during implantation and having sufficient contractive force to permit a reduction in the diameter of the incompetent valve annulus.
• An alternate embodiment of the present self molding annuloplasty ring comprises an resilient inner sizing member positioned within a flexible outer attachment sheath, the ring further having a plurality of attachment members positioned thereon. The attachment members may comprise a plurality of devices, including, without limitation, needles, barbs, or hooks. In addition, the attachment members may be manufactured from a biologically compatible material such as, without limitation, stainless steel, titanium, and Nitinol.
• In yet another embodiment of the present invention, a self molding annuloplasty ring having a predetermined contracted diameter is disclosed. This embodiment comprises a resilient inner sizing member positioned within a series of individual support members. A flexible outer attachment sheath is positioned on the exterior of the support members. This embodiment permits the surgeon to predetermine the inner diameter of a repaired valve annulus, thereby rendering an incompetent valve competent. Those skilled in the art will appreciate that the support members may be manufactured from a biologically compatible material such as, without limitation, plastic and elastomer.
• Other objects, features, and advantages of the present invention will become apparent from a consideration of the following description of the preferred embodiments.
BRIEF DESCRIPTION OF THE DRAWINGS
• The apparatus of the present invention will be explained in more detail by way of the accompanying drawings, wherein:
• FIG. 1 shows a top sectional view of the mitral and tricuspid valves and valve annuli within a heart;
• FIG. 2A shows a side view of the annuloplasty ring of the present invention;
• FIG. 2B shows a top view of the annuloplasty ring of the present invention;
• FIG. 2C shows a cross sectional view of the annuloplasty ring of the present invention;
• FIG. 2D shows an alternate embodiment of the annuloplasty ring of the present invention having a support member positioned therein;
• FIG. 2E shows a perspective view of the annuloplasty ring of the present invention;
• FIG. 3A shows a top sectional view of the annuloplasty ring of the present invention positioned within the valve annulus of the mitral valve;
• FIG. 3B shows a top view of an embodiment of the present embodiment having a plurality of attachment devices disposed thereon;
• FIG. 3C shows a cross sectional view of the present embodiment with an attachment device disposed thereon;
• FIG. 3D shows a perspective view of the present embodiment having a plurality of attachment devices disposed thereon;
• FIG. 4A shows a top view of the present embodiment of the present invention in a contracted state having a plurality of size support members positioned thereon;
• FIG. 4B shows a top view of the present embodiment of the present invention in a stretched state having a plurality of size support members positioned thereon; and
• FIG. 4C shows a cross sectional view of the embodiment ofFIGS. 4A and 4B.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
• The following detailed description and the accompanying drawings are intended to describe and show certain presently preferred embodiments of the present invention, and are not intended to limit the scope of the invention in any way.
• The self-molding annuloplasty ring of the present invention is generally used in surgical procedures to repair an incompetent tissue annulus. More specifically, the present invention is used to render an otherwise incompetent heart valve competent by decreasing the diameter of the opening at the valvular junction. As those skilled in the art will appreciate, the present invention may be manufactured with varying degrees of pre-tension and contractive force, thereby permitting variations of the contraction of the anterior and/or posterior annuli. In addition, the present invention simplifies the implantation procedure by permitting pre-stretching of the annuloplasty ring to the diameter of the dilated annulus, and thereafter reducing the annulus with the contractive force exerted by the self-molding annulus ring.
• FIG. 1 shows a cross sectional view of theheart10 having a bicuspid ormitral valve12 positioned near themitral valve annulus14, and atricuspid valve16 positioned near thetricuspid valve annulus18.
• Various views of the present invention are illustrated inFIGS. 2A-2E. As shown inFIG. 2A, the self-molding annulus ring20 comprises a firstplanar surface22 and an opposing secondplanar surface24.FIG. 2B shows theannulus ring20 having arectilinear segment26 and anarcuate segment28 connected by twocurved ends30 and32, respectively. As illustrated, thepreferred annuloplasty ring20 is generally “D” shaped to conform to the shape of a typical mitral valve annulus. Alternatively, thering20 may be manufactured in any shape suitable for implantation about an annulus. For example, the present invention may be manufactured in a generally round or oval shape thereby permitting use of the present invention to remodel an otherwise incompetent tricuspid valve.FIG. 2C shows a cross-sectional view of theannuloplasty ring20 having anelastic sizing member36 positioned within anattachment sheath38. While the cross-sectional view illustrated inFIG. 2C is substantially rectangular, it is to be appreciated that the cross-section can alternatively be of another dimension such as triangular, circular or any dimension that cooperates with the native annulus.
• Theelastic sizing member36 preferably comprises a biologically-compatible materials such as, without limitation, elastomer, silicon, or any other material having sufficient resiliency to permit pre-stretching of theannuloplasty ring20 prior to and during implantation, while having sufficient contractive force to decrease the size of the valve annulus to a desired diameter. Theattachment sheath38 provides a suitable material for suturing or otherwise attaching theannulus ring20 to the annulus tissue and promoting tissue growth therein. Theattachment sheath38 preferably comprises a biologically-compatible material such as, without limitation, Dacron (polyethylene terepthalate), polyester knit, PTFE knit, and ePTFE knit. The attachment sheath may also be treated with a biologically-compatible tissue growth factor or other medicament to aid in treating the attachment area. Those skilled in the art will appreciate that the present invention reduces or eliminates the occurrence of systolic anterior motion (SAM), wherein the anterior leaflet of the mitral valve bulges into the left ventricular outflow track (LVOT) thereby obstructing blood flow into the aorta.
• An alternate embodiment of the present invention is shown inFIG. 2D havingsupport members40 positioned between the sizingmember36 and theattachment sheath38. Thesupport members40 are preferably fabricated from a biologically-compatible materials having a comparable modulus of resiliency such as, without limitation, elastomer, rubber, silicon, or another material having sufficient resiliency to permit pre-stretching prior to implantation while providing sufficient support to the valve annulus. Thesupport member40 provides additional support of the valve and valve annulusFIG. 2E shows a perspective view of the annuloplasty ring of the present invention.
• The annuloplasty ring of the present invention may be attached to the annulus or surrounding tissue using a plurality of devices. Referring toFIG. 3A, theannulus ring20 may be attached to the valve annulus, either14 or18, withsutures42.FIG. 3B shows an alternate embodiment of the present invention utilizing attachment devices positioned on the annuloplasty ring. Like the previous embodiments, the present embodiment of thering44 comprises arectilinear segment46 attached to anarcuate portion48 with twocurved ends50 and52 positioned therebetween. A number ofattachment devices54 are positioned around thering44 to facilitate attachment of thering44 to the annulus tissue.FIG. 3C shows the internal materials of the present invention having a sizingmember56 and an tissue-engagingsheath58 disposed thereon.
• Like the previous embodiments, the sizingmember56 is preferably manufactured from a biologically-compatible material such as, without limitation, elastomer, silicon, or any other material having sufficient resiliency to permit pre-stretching of theannuloplasty ring44 prior to and during implantation, while having sufficient contractive force to decrease the size of the valve annulus to a desired diameter. Similarly, the tissue-engagingsheath58 is preferably manufactured from a biologically-compatible material having comparable resiliency, such as, without limitation, Dacron (polyethylene terepthalate), polyester knit, PTFE knit, and ePTFE knit, and may further incorporate tissue growth-enhancing materials. Theattachment device54 may comprise various tissue-engaging devices, including, for example, needles, barbs, or hooks. Those skilled in the art will appreciate theattachment devices54 is preferably manufactured from a biologically-compatible material such as, without limitation, stainless steel, titanium, or Nickel-Titanium alloy (Nitinol).FIG. 3D shows a perspective view of the annuloplasty ring of the present embodiment having a plurality ofattachment devices54 positioned about thedevice body44.
• FIGS. 4A-4C show an alternative embodiment of the present invention that includes size constraining support members.FIG. 4A shows theannuloplasty ring60 of the present embodiment in a contracted state, wherein thering60 comprises arectilinear segment62, anarcuate segment64, and twocurved ends66 and68 positioned therebetween. Thering60 is comprised of a series ofsupport members70 positioned about the device. Thesupport members70 are positioned immediately adjacent to each other in the contracted state, though it is to be understood that the resilient inner sizing member is biased toward a fully relaxed diameter that is smaller than the diameter in the contracted state. In other words, the plurality ofsupport members70 constrain contraction of the inner sizingmember72 to a contracted diameter that is larger than the fully relaxed diameter.FIG. 4B shows thering60 stretched prior to implantation, having the resilientinner sizing member72 positioned within thesupport members70. As shown inFIG. 4C, eachsupport member70 has a receivinglumen74 formed therein which is capable of receiving the inner sizingmember72. Theattachment sheath76 may be positioned on the exterior of thesupport members70. Prior to implantation, thering60 is pre-stretched to a fully expanded diameter roughly equivalent to the diameter of the dilated valve annulus and the attachment sheath is attached to the tissue using, for example, sutures, staples, or barbs. Once thering60 is suitably positioned with the valve annulus and attached thereto, the insertion device (not shown) is removed and thering60 contracts causing eachsize support member70 to engage theadjacent support members70, thereby limiting the degree of contraction that thering60 may achieve. Again, the plurality ofsupport members70 constrain contraction of the inner sizingmember72 to a contracted diameter that is smaller than the fully expanded diameter but larger than the fully relaxed diameter.
• Thesupport members70 are preferably manufactured from a biologically-compatible material such as, without limitation, stainless steel, titanium, or plastic. Like the previous embodiment, the inner sizingmember72 is preferably manufactured from a biologically compatible material such as, without limitation, elastomer, silicon, or any other material having sufficient resiliency to permit pre-stretching of theannuloplasty ring60 prior to and during implantation, while having sufficient contractive force to decrease the size of the valve annulus to a desired diameter. Similarly, theattachment sheath76 is preferably manufactured from a resilient biologically-compatible material such as, without limitation, Dacron (polyethylene terepthalate), polyester knit, PTFE knit, and ePTFE knit, or may incorporate tissue growth-enhancing materials.
• The present invention further discloses a method of repairing a dilated or otherwise incompetent annulus. An exemplary open-chest surgical repair of a mitral valve will be disclosed herein. It should be understood the method disclosed herein is not intended to limit the scope of the present invention in any way.
• The mitral valve partially forms the atrio-ventricular junction between the left atrium and left ventricle of the heart and is most easily reached through the wall of the left atrium. Those skilled in the art will appreciate that the wall of the left atrium is may be accessed through a medial stemotomy procedure. To gain access to the mitral valve during the stemotomy, the surgeon rotates the heart to an anterior position, thereby providing access to the left atrium. An incision is made in the left atrium, thereby providing access to the mitral valve and the valve annulus.
• To insert the annuloplasty ring of the present invention, thering20 is stretched for positioning on an insertion device. Those skilled in art will appreciate the present invention may be inserted on a plurality of insertion devices know in the art. Additionally, the annuloplasty ring may be positioned on the insertion device at the time of manufacture or immediately prior to implantation. Ideally, the annuloplasty ring should be stretched to a size commensurate with the diameter of the dilated valve annulus. The ring, positioned on the insertion device, is positioned proximate to the valve annulus and attached to surrounding tissue in a plurality of known and accepted manners, including, suturing, stapling, or any other biologically-compatible attachment technique. With the ring sufficiently attached, the insertion device is removed, resulting in the annuloplasty ring contracting to its pre-stretched diameter, thereby rendering the valve competent. Those skilled in the art will appreciate the contractive force of the annuloplasty ring will determine the amount of post-implantation valvular dilation, thereby permitting the surgeon to accurately predict the post-implantation valve diameter.
• While the foregoing describes the preferred embodiments of the invention, various alternatives, modifications, and equivalents may be used. By way of example but not of limitation, alternative insertion devices, and alternative attachment devices may be used. It will thus be obvious that certain other modifications may be practiced within the scope of the appended claims.

Claims (20)

1. A self-molding annuloplasty ring for implantation in a dilated heart valve annulus having a dilated size, comprising:

a resilient inner sizing member positioned within an outer attachment sheath, the annuloplasty ring defining a shape having a first diameter in the absence of an external force, the resilient inner sizing member having sufficient elasticity to permit pre-stretching such that the annuloplasty ring attains an expanded diameter larger than the first diameter and equivalent to the dilated size of the dilated valve annulus, the resilient inner sizing member being biased toward its relaxed diameter and having sufficient contractive force to decrease the dilated size of the dilated valve annulus when the expanded diameter annuloplasty ring is attached thereto.

2. The device ofclaim 1, further comprising support structure on the annuloplasty ring that limits inward contraction of the inner sizing member to a contracted diameter that is larger than its relaxed diameter.

3. The device ofclaim 2, wherein the support structure includes a series of support members positioned along the inner sizing member which engage one another to limit inward contraction of the inner sizing member.

4. The device ofclaim 3, wherein each support member comprises a body member having a lumen formed therein, the lumen being sized to receive the inner sizing member.

5. The device ofclaim 1, wherein the annuloplasty ring further comprises a plurality of attachment devices positioned thereon and extending outward from the outer attachment sheath.

6. The device ofclaim 5, wherein the plurality of attachment devices is selected from the group consisting of:

needles;

barbs; and

hooks.

7. The device ofclaim 5, wherein the material of the plurality of attachment devices is selected from the group consisting of:

stainless steel;

titanium; and

a nickel-titanium alloy.

8. The device ofclaim 1 wherein the inner sizing member comprises a biologically compatible elastomer.

9. The device ofclaim 1, wherein the outer attachment sheath comprises a medicament to induce tissue growth.

10. The device ofclaim 1, wherein the annuloplasty ring has a closed shape selected from the group consisting of:

a “D” shape;

a generally round shape; and

an oval shape.

11. An annuloplasty device for implantation in a dilated heart valve annulus, comprising:

an insertion device; and

an annuloplasty ring having a resilient inner sizing member positioned within an outer attachment sheath, the annuloplasty ring being expandable from a first diameter to a larger expanded diameter, the annuloplasty ring being positioned on the insertion device and maintained at its expanded diameter;

wherein, on the insertion device the resilient inner sizing member is biased so as to urge the annuloplasty ring toward its first diameter such that if the insertion device is removed the annuloplasty ring contracts.

12. The device ofclaim 11, wherein the insertion device has a size commensurate with the diameter of the dilated valve annulus.

13. The device ofclaim 11, further comprising support structure on the annuloplasty ring that limits inward contraction of the inner sizing member to a contracted diameter that is larger than its relaxed diameter.

14. The device ofclaim 13, wherein the support structure includes a series of support members positioned along the inner sizing member which engage one another to limit inward contraction of the inner sizing member.

15. The device ofclaim 11, wherein the annuloplasty ring further comprises a plurality of attachment devices positioned thereon and extending outward from the outer attachment sheath.

16. The device ofclaim 15, wherein the plurality of attachment devices is selected from the group consisting of:

needles;

barbs; and

hooks.

17. The device ofclaim 15, wherein the material of the plurality of attachment devices is selected from the group consisting of:

stainless steel;

titanium; and

a nickel-titanium alloy.

18. The device ofclaim 11 wherein the inner sizing member comprises a biologically compatible elastomer.

19. The device ofclaim 11, wherein the outer attachment sheath comprises a medicament to induce tissue growth.

20. The device ofclaim 11, wherein the annuloplasty ring has a closed shape selected from the group consisting of:

a “D” shape;

a generally round shape; and

an oval shape.

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