US20080228201A1 - Mitral valve repair system and method for use - Google Patents

Abstract

The present invention is directed to various systems for repairing tissue within the heart of a patient. The mitral valve repair system of the present invention comprises a guide catheter having a proximal end, a distal end, and at least one internal lumen formed therein, a therapy catheter capable of applying a suture to the tissue, and a fastener catheter capable of attaching a fastener to the suture. The therapy catheter and the fastener catheter are capable of traversing the internal lumen of the guide catheter. In addition, the present invention discloses various methods for repairing tissue within the heart of a patient. In one embodiment, the method of repairing heart valve tissue includes advancing a guide catheter through a circulatory pathway to a location in the heart proximate to a heart valve, advancing a therapy catheter through the guide catheter to the heart valve, stabilizing a first leaflet with the therapy catheter, deploying a first suture into the stabilized first leaflet, disengaging the first leaflet from the therapy catheter while leaving the first suture attached thereto, stabilizing a second leaflet with the therapy catheter, deploying a second suture into the second leaflet, disengaging the second leaflet from the therapy catheter while leaving the second suture attached thereto, and joining the first and second leaflets by reducing the distance between the first and second sutures.

Description

CROSS-REFERENCE TO RELATED APPLICATIONS
• This application is a divisional of U.S. application Ser. No. 10/389,721 filed on Mar. 14, 2003, the contents of which are expressly incorporated herein by reference in their entirety.
BACKGROUND OF THE INVENTION
• In vertebrate animals, the heart is a hollow muscular organ having four pumping chambers: the left atrium, the left ventricle, the right atrium and the right ventricle. The atria are isolated from their respective ventricles by one-way valves located at the respective atrial-ventricular junctions. These valves are identified as the mitral (or bicuspid) valve on the left side of the heart, and tricuspid valve on the right side of the heart. The exit valves from the left and right ventricles are identified as the aortic and pulmonary valves, respectively.
• The valves of the heart are positioned in valvular annuluses that comprise dense fibrous rings attached either directly or indirectly to the atrial and ventricular muscle fibers. Valve leaflets comprising flexible collagenous structures are attached to, and extend inwardly from, the annuluses to meet at coapting edges. The aortic, tricuspid and pulmonary valves each have three leaflets, while the mitral valve only has two. In normal operation, the leaflets of the mitral valve open as left ventricle dilates thereby permitting blood to flow from the left atrium into the left ventricle. The leaflets then coapt (i.e. close) during the contraction cycle of the left ventricle, thereby preventing the blood from returning to the left atrium and forcing the blood to exit the left ventricle through the aortic valve. Similarly, the tricuspid valve regulates flow from the right atrium into the right ventricle, and the pulmonary valve regulates blood exiting the right ventricle.
• For a number of clinical reasons various problems with heart valves can develop. One common form of heart disease involves the deterioration or degradation of the heart valves which leads to stenosis and/or insufficiency. Heart valve stenosis is a condition in which the valve does not open properly. Insufficiency is a condition in which the valve does not close properly. Insufficiency of the mitral valve, most common because of the relatively high fluid pressures in the left ventricle, results in mitral valve regurgitation (“MR”), a condition in which blood reverses its intended course and flows “backward” from the left ventricle to the left atrium during ventricular contractions.
• A number of surgical techniques have been developed to repair degraded or otherwise incompetent heart valves. A common procedure involves replacement of a native aortic or mitral valve with a prosthetic heart valve. These procedures require the surgeon to gain access to the heart through the patient's chest (or possibly percutaneously), surgically remove the incompetent native heart valve and associated tissue, remodel the surrounding valve annulus, and secure a replacement valve in the remodeled annulus. While such procedures can be very effective, there are shortcomings associated with such replacement valves. For example, the invasive nature of the implantation procedure typically results in substantial patient discomfort and requires patients to remain hospitalized for extended recovery periods. In addition, the two basic types of commercially available replacement valves, mechanical valves and tissue valves, each have shortcomings of their own. Mechanical replacement valves typically offer extended operational lifetimes, but the patient is usually required to maintain a regimen of anti-coagulant drugs for the remainder of his or her life. Tissue valves typically offer a higher degree of acceptance by the body which reduces or eliminates the need for anti-coagulants. However, the operational lifetimes of tissue valves is typically shorter than mechanical valves and thus may require a subsequent replacement(s) during the patient's lifetime.
• As an alternative to prosthetic heart valve replacement, it is often preferable to remodel the native heart valve and/or the surrounding tissue. Remodeling of the valve often preserves left ventricular function better than mitral valve replacement because the subvalvular papillary muscles and chordae tendineae are preserved (most prosthetic valves do not utilize these muscles). Valvular remodeling can be accomplished by implanting a prosthetic ring (a.k.a. “annuloplasty ring”) into the valve annulus to reduce and/or stabilize the structure of the annulus in order to correct valvular insufficiency. Annuloplasty rings are typically constructed of a resilient core covered with a fabric sewing material. Annuloplasty procedures can be performed alone, or they can be performed in conjunction with other procedures such as leaflet repair. Although such annuloplasty procedures have become popular and well accepted, reshaping the surrounding annulus and traditional leaflet repairs do not always lead to optimum leaflet coaptation. As a result, some patients may still experience residual mitral valve regurgitation following such annuloplasty procedures.
• A recently developed technique known as a “bow-tie” repair has also been advocated for repairing insufficient heart valves, in particular the mitral valve. The mitral valve bow-tie technique involves suturing the anterior and posterior leaflets together near the middle of their coapting edges, thereby causing blood to flow through two newly formed openings. While this does reduce the volume of blood that can flow from the atrium to the ventricle, this loss is compensated by improved leaflet coaptation which reduces mitral regurgitation. This process as originally developed by Dr. Ottavio Alfieri involved arresting the heart and placing the patient on extracorporeal bypass and required invasive surgery to access and suture the leaflets together. More recently, however, some have advocated a “beating heart” procedure in which the heart is accessed remotely and remains active throughout the bow-tie procedure.
• One particular method for performing a beating heart bow-tie procedure (i.e. without extracorporeal bypass) has been proposed by Dr. Mehmet Oz, of Columbia University. (See PCT publication WO 99/00059, published Jan. 7, 1999, the contents of which are incorporated herein by reference). In one embodiment of this procedure, the associated device consists of a forceps-like grasper used to grasp and hold the mitral valve leaflets in a coapted position prior to the connecting step. Since the mitral valve leaflets curve toward and slightly into the left ventricular cavity at their mating edges, the grasper device is passed through a sealed aperture in the apex of the left ventricle. The edges of the mating mitral valve leaflets are then grasped and held together, and subsequently a fastening device such as a clip or suture is utilized to fasten them. The Mehmet Oz disclosure also discloses teeth on the grasper device that are linearly slidable with respect to one another so as to permit alignment of the mitral valve leaflets prior to fastening. Since the procedure is done on a beating heart, it will be readily understood that the pressures and motions within the left ventricle and mitral valve leaflets are severe and render Dr. Oz's procedure very skill-intensive.
• The bow-tie technique has proved to be a viable alternative for treating otherwise incompetent heart valves. Nonetheless, shortcomings associated with the current bow-tie procedures have been identified. Current systems typically include tissue stabilizing devices having mechanical graspers, barbed members, and vacuum devices. Often, use of these devices results in the less than optimal leaflet stabilization and fastener placement. Many of these problems arise from the fact that the surgeon is required to capture, retain and fasten the leaflets in one relatively inflexible procedure. These difficulties are compounded when the leaflets are small or calcified making them difficult to pull together, and in beating heart procedures in which the leaflets are actively functioning. In addition, the size and complexity of most current devices make minimally invasive surgical procedures more difficult, if not impossible. In light of the foregoing, there is presently a need for improved systems for stabilizing multiple tissue heart valve leaflets and placing a fastening device therebetween. More specifically, there is a present need for an improved bow-tie procedure for repairing a patient's mitral valve.
BRIEF SUMMARY OF THE INVENTION
• The present invention solves the problem of effectively stabilizing at least one tissue portion in vivo. Additionally, the present invention provides a device capable of delivering a fastener to the stabilized tissue portion through a catheter from a remote insertion location.
• In one aspect, the present invention is directed to a system for repairing tissue within the heart of a patient and includes a guide catheter having a proximal end, a distal end, and at least one internal lumen formed therein, a therapy catheter capable of applying at least one suture to the tissue, and a fastener catheter capable of attaching at least one fastener to the suture. The therapy catheter and the fastener catheter are capable of traversing the internal lumen of the guide catheter.
• In another aspect, the present invention pertains to a system for repairing tissue within the heart of a patient and comprises a guide catheter having a proximal end, a distal end, and at least one internal lumen formed therein, a therapy catheter having at least one needle lumen in communication with at least one needle port positioned therein, at least one needle positioned within the needle lumen, and a fastener catheter having at least one fastener detachably coupled thereto. In addition, the fastener catheter includes at least one cutting member.
• In yet another aspect, the present invention discloses a system for repairing tissue within the heart of a patient and includes a guide wire capable of being inserted into the patient and advanced through a circulatory pathway, a therapy catheter attachable to the guide wire and capable of applying at least one suture to the tissue, and a fastener catheter attachable to the guide wire and capable of attaching at least one fastener to the suture.
• In a further aspect, the present invention pertains to a guide catheter for delivering a tissue repair device to tissue located within the heart of a patient and comprises an outer wall defining an outer wall lumen, a directing lumen capable of receiving a steering device therein and a flexible support device positioned within the outer wall lumen.
• In another aspect, the present invention discloses a catheter for delivering a suture to tissue within the heart of a patient and includes an elongated body having a distal end, at least one suction recess formed on the distal end, at least one needle port located proximate to the suction recess, at least one needle lumen having at least one needle positioned therein in communication with the needle port, at least one needle receiving port having at least one needle catch located therein positioned proximate to the suction recess, and at least one actuator member in communication with the needle.
• In yet another aspect, the present invention is directed to a catheter for delivering a suture to tissue within the heart of a patient and comprises an elongated body having a distal end with at least one suction recess formed thereon, at least one needle port located proximate to the suction recess, at least one needle lumen having at least one detachable needle attached to suture material positioned therein and in communication with the needle port, at least one needle receiving port located proximate to the suction recess, at least one needle trap capable of receiving the detachable needle positioned within the needle receiving port, and at least one actuator member in communication with the needle.
• In yet another aspect, the present invention pertains to a device for applying a fastener to suture material attached to tissue within the body of a patient and includes a catheter body having a proximal end and a distal end, an inner body defining a suture recess and an actuation recess, and a movable sleeve defining a deployment lumen. The suture recess on the inner body is in communication with a fastener lumen capable of receiving a fastener therein. The actuation recess is in communication with an actuation lumen formed in the inner body. The deployment lumen formed in the movable sleeve is sized to receive the inner body therein and includes a cutting recess having a cutting member located proximate thereto.
• In another aspect, the present invention is directed to a fastener attachable to suture material and comprises a fastener body having at least one attachment lumen formed therein and at least one engagement member attached to the fastener body wherein the engagement member is capable of engaging and retaining the suture material. The engagement member defines an engagement aperture which is in communication with the attachment lumen. The attachment lumen is capable of receiving at least one suture therein.
• The present invention also discloses various methods of repairing heart valve tissue within the body of a patient. In one aspect, a method of repairing tissue within the heart of a patient is disclosed which includes advancing a guide catheter through a circulatory pathway to a location in the heart proximate to a heart valve, advancing a therapy catheter through the guide catheter to the heart valve, stabilizing a first leaflet with the therapy catheter, deploying a first suture into the stabilized first leaflet, disengaging the first leaflet from the therapy catheter while leaving the first suture attached thereto, stabilizing a second leaflet with the therapy catheter, deploying a second suture into the second leaflet, disengaging the second leaflet from the therapy catheter while leaving the second suture attached thereto, and joining the first and second leaflets by reducing the distance between the first and second sutures.
• An alternate method of repairing tissue within the heart of a patient is disclosed and comprises advancing a guide catheter through a circulatory pathway to a location in the heart proximate to a heart valve, advancing a therapy catheter through the guide catheter to the heart valve, stabilizing a first leaflet with the therapy catheter, deploying a first suture into the stabilized first leaflet, disengaging the first leaflet from the therapy catheter while leaving the first suture attached thereto, stabilizing a second leaflet with said therapy catheter, deploying a second suture into the second leaflet, disengaging the second leaflet from the therapy catheter while leaving the second suture attached thereto, and removing the therapy catheter from the guide catheter. Thereafter, a fastener catheter is positioned over the first and second suture and advanced through the guide catheter to the heart valve. Once positioned, the first and second leaflets are joined by reducing the distance between the first and second sutures and a fastener is deployed from the fastener catheter.
• Other objects, features, and advantages of the present invention will become apparent from a consideration of the following detailed description.
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 perspective view of an embodiment of the guide catheter of the present invention;
• FIG. 2 shows a cross-sectional view of an embodiment of the guide catheter of the present invention;
• FIG. 3 shows a cross-sectional view of an alternate embodiment of the guide catheter of the present invention;
• FIG. 4 shows a cross-sectional view of the embodiment of the guide catheter shown inFIG. 3;
• FIG. 5 shows a perspective view of an embodiment of the therapy catheter of the present invention;
• FIG. 6 shows an embodiment of the therapy device handle of the present invention;
• FIG. 7 shows an perspective view of an embodiment of the elongated body of the present invention having a suture attachment tip attached thereto;
• FIG. 8A shows a cross-sectional view of an embodiment of the elongated body of the present invention;
• FIG. 8B shows a cross sectional view of an alternate embodiment of the elongated body of the present invention;
• FIG. 8C shows a side cross-sectional view of the embodiment of the elongated body shown inFIG. 8B;
• FIG. 9 shows a top cross-sectional view of an embodiment of the elongated body of the present invention;
• FIG. 10 shows a side cross-sectional view of the embodiment of the elongated body shown inFIG. 9 prior to actuation;
• FIG. 11 shows a side cross-sectional view of an embodiment of the elongated body shown inFIG. 10 during actuation;
• FIG. 12 shows a side cross-sectional view of an embodiment of the elongated body shown inFIG. 10 following actuation;
• FIG. 13 shows another side cross-sectional view of an embodiment of the elongated body shown inFIG. 10 during actuation;
• FIG. 14 shows another side cross-sectional view of an embodiment of the elongated body shown inFIG. 10 following actuation;
• FIG. 15 shows a top cross-sectional view of an alternate embodiment of the elongated body of the present invention;
• FIG. 16 shows a side cross-sectional view of the embodiment of the elongated body shown inFIG. 15 prior to actuation;
• FIG. 17 shows a side cross-sectional view of an embodiment of the elongated body shown inFIG. 15 during actuation;
• FIG. 18 shows a side cross-sectional view of an embodiment of the elongated body shown inFIG. 15 following actuation;
• FIG. 19 shows a perspective view of an embodiment of the fastener catheter of the present invention;
• FIG. 20 shows an embodiment of the fastener catheter handle of the present invention;
• FIGS. 21aand21bshow a perspective view of the components of the fastener tip of the present invention;
• FIG. 22 shows a perspective view of the fastener tip of the present invention having a fastener attached thereto;
• FIG. 23 shows a side view of an embodiment of the fastener of the present invention;
• FIG. 24 shows a side view of the fastener of the present invention attached to suture material;
• FIG. 25 shows a perspective view of a guidewire traversing the mitral valve within a heart;
• FIG. 26 shows a perspective view of a guide catheter positioned proximate to the mitral valve within a heart;
• FIG. 27 shows a perspective view of a therapy catheter advancing through a guide catheter to a position proximate to the mitral valve of a heart;
• FIG. 28 shows a perspective view of a therapy catheter stabilizing a first leaflet of the mitral valve of a heart;
• FIG. 29 shows a perspective view of the first leaflet of the mitral valve having a suture applied thereto;
• FIG. 30 shows a perspective view of a therapy catheter stabilizing a second leaflet of the mitral valve of a heart;
• FIG. 31 shows a perspective view of the first and second leaflets of the mitral valve having sutures applied thereto;
• FIG. 32 shows a perspective view of a fastener catheter advancing through a guide catheter to a position proximate to the mitral valve of a heart;
• FIG. 33 shows a perspective view of the fastener catheter of the present invention applying a fastener to suture material attached to the mitral valve;
• FIG. 34 shows a perspective view of the fastener applied to suture material attached to the first and second leaflet of the mitral valve;
• FIG. 35 shows a perspective view of another embodiment of the present invention wherein a dilator is used to introduce the guide catheter onto the left atrium;
• FIG. 36 shows a perspective view of the dilator of the present embodiment traversing the atrial septum;
• FIG. 37 shows a perspective view of the guide catheter of the present embodiment positioned within the left atrium proximate to the mitral valve;
• FIG. 38 shows a perspective view of an alternate embodiment of the therapy catheter advanced through the guide catheter to the mitral valve;
• FIG. 39 shows a perspective view of the embodiment of the therapy catheter shown inFIG. 38 having an inflatable positioning balloon positioned thereon inflated;
• FIG. 40 shows a perspective view of the embodiment of the therapy catheter shown inFIG. 38 engaging a first leaflet;
• FIG. 41 shows a perspective view of the first leaflet of the mitral valve having a suture attached thereto;
• FIG. 42 shows a perspective view of the embodiment of the therapy catheter shown inFIG. 38 engaging the second leaflet of the mitral valve;
• FIG. 43 shows a perspective view of the first and second leaflets of the mitral valve having sutures attached thereto; and
• FIG. 44 shows another perspective view of the first and second leaflets of the mitral valve having sutures attached thereto.
DETAILED DESCRIPTION OF THE INVENTION
• Disclosed herein is a detailed description of various embodiments of the present invention. This description is not to be taken in a limiting sense, but is made merely for the purpose of illustrating the general principles of the invention. The overall organization of the detailed description is for the purpose of convenience only and is not intended to limit the present invention.
• The mitral valve repair system of the present invention is designed for use in a surgical treatment of bodily tissue. As those skilled in the art will appreciate, the exemplary mitral valve repair system disclosed herein is designed to minimize trauma to the patient before, during, and subsequent to a minimally invasive surgical procedure while providing improved tissue stabilization and enhanced placement of a fastening device thereon. The mitral valve repair system of the present invention includes a guide catheter capable of being introduced into body of a patient and advanced to an area of interest, a therapy catheter capable of traversing or otherwise engaging the guide catheter and applying a suture to a repair site, and a fastener catheter capable of applying a fastening device to the attached suture. While the guide catheter, therapy catheter, and fastener catheter cooperatively enable a surgeon to deliver a suture to a repair site in vivo, the various components of the present invention may be used individually. For example, the therapy catheter, the fastener catheter, or both may be coupled to a guidewire and advanced to a repair site in vivo without the use of the guide catheter. The mitral valve repair system of the present invention is useful in repairing dysfunctional mitral valve tissue by stabilizing discreet valvular tissue pieces and deploying a fastening device therethrough. However, the mitral valve repair system may be used to repair tissue throughout a patient's body as desired. For example, the present invention may also be used to repair arterial septal defects (ASD), ventricular septal defects (VSD), and defects associated with patent foramen ovale (PFO).
• FIGS. 1-4 show various illustrations of the guide catheter of the present invention. As shown inFIG. 1, theguide catheter10 comprises aguide body12 having aproximal end14 and adistal end16. Those skilled in the art will appreciate that theguide catheter10 of the present invention may be manufactured from a variety of materials, including, without limitation, various plastics, thermoplastics, silicones, elastomers, ceramics, composite materials, or various combinations of the aforementioned materials. In addition, theguide catheter10 may be manufactured in various lengths and widths as desired by the user.FIGS. 2-4 show various embodiments of theguide catheter10. As shown inFIG. 2, theguide catheter10 includes anouter wall18 defining at least oneinternal lumen20.FIGS. 3-4 illustrate alternate embodiments wherein theouter wall18 defines aninternal lumen20 and includes at least onedirecting lumen22 formed therein. The directinglumen22 is sized to receive a guidewire (not shown) or steering device (not shown) therein. In another embodiment, at least one flexible support structure such as a coiled wire support (not shown) may be embedded within theouter wall18 of theguide catheter10.
• FIG. 5 shows a perspective view of an embodiment of thetherapy catheter30 of the present invention. As shown inFIG. 5, thetherapy catheter30 includes anelongated body32 having a therapy device handle34 located at the proximal end and asuture attachment tip36 located at the distal end. Like theguide body12 of theguide catheter10, theelongated body32 may be manufactured in a variety of shape, sizes, lengths, widths, and biologically-compatible materials as desired.
• FIG. 6 shows a more detailed illustration of the therapy device handle34 of the present invention. As shown, the therapy device handle34 comprises ahandle body38 having at least asuction connector40 and aelongated body receiver42 attached thereto. Thesuction connector40 is capable of coupling to a vacuum source (not shown). Theelongated body receiver42 is capable of receiving the elongated body32 (FIG. 5) thereon. Afirst actuator44 is located within afirst actuator recess46 formed on thehandle body38. Similarly, asecond actuator48 is positioned within asecond actuator recess50 formed in thehandle body38. As shown inFIG. 6, asuction actuator52, configured to open or close the fluid path betweensuction connector40 andelongated body receiver42, may be located within asuction actuator recess54 proximal to the first andsecond actuators44,48.
• FIGS. 7-10 show various illustrations of theelongated body32 and thesuture attachment tip36 of the present invention. As shown inFIG. 7, theelongated body32 includes asuction recess56 having afirst needle port58A and asecond needle port58B located proximate thereto. Theelongated body32 or thesuture attachment tip36 may include aguidewire port60 capable of receiving aguidewire62.FIG. 8A shows a cross sectional view of theelongated body32. As shown, theelongated body32 comprises anouter wall64 defining asuction lumen66. Thesuction lumen66 is in fluid communication with the suction recess56 (FIG. 7) and the vacuum source (not shown) attached to thesuction connector40 located on the therapy device handle34 (FIG. 6). Afirst needle lumen68 having afirst needle70 located therein may be formed in or otherwise positioned proximate to theouter wall64 of theelongated body32. Similarly, asecond needle lumen72 having asecond needle74 located therein may be formed in or otherwise positioned proximate to theouter wall64 of theelongated body32. The first andsecond needles70,74 are coupled to or otherwise in communication with the first andsecond actuators44,48 located on the therapy device handle34 (FIG. 6). The forward and rearward movement of the first andsecond actuators44,48 results in the longitudinal movement of the first andsecond needles70,74 thereby permitting the first and second needles,70,74 to extend from and retract into the first andsecond needle lumens68,72. Those skilled in the art will appreciate that the first andsecond needles70,74 may be capable of individual or simultaneous movement. Afirst suture lumen76 having afirst suture78 located therein and asecond suture lumen80 having asecond suture82 located therein may be formed within or located proximate to theouter wall64 of theelongated body32. Of course one of skill in the art will recognize that references herein to “sutures” include not just traditional suture material, but also any material of sufficient length and flexibility to accomplish the purposes of this tissue repair system. In one embodiment, aguidewire lumen84 sized to receiveguidewire62 therein may be positioned within or proximate to theouter wall64 of theelongated body32 and may be in communication with theguidewire port60 formed on thesuture attachment tip36.
• FIGS. 8B-8C show various illustrations of an alternate embodiment of the present invention, wherein aninflatable positioning balloon252 is positioned on theouter wall64 of theelongated body32. As shown, theinflatable positioning balloon252 is in fluid communication with aninflation lumen84′ positioned within theelongated body32. Theinflation lumen84′ may be in fluid communication with an inflation source in ways known to those skilled in the art and may be attached to or otherwise in communication with the therapy device handle34 (FIG. 5), thereby permitting the position of thetherapy catheter30 to be manipulated without using a guidewire. Moreover, thepositioning balloon252 can be used to hold the therapy device steady once in position.
• FIGS. 9-10 show various illustrations of the present invention prior to use. As shown, a firstneedle receiving port86A may be positioned within or proximate to thesuction lumen56 co-aligned with and opposing thefirst needle port58A. Similarly, a secondneedle receiving port86B may be positioned within or proximate to thesuction lumen56 co-aligned with and opposing thesecond needle port58B. The firstneedle receiving port86A is in communication with thefirst suture lumen76 and contains at least afirst needle catch88A attached to thefirst suture78 therein. Likewise, the secondneedle receiving port86B is positioned proximate to thesuction recess56 opposing thesecond needle port58B. The secondneedle receiving port86B is in communication with thesecond suture lumen80 and contains asecond needle catch88B attached to thesecond suture82 therein.
• FIGS. 11-12 show an embodiment of the therapy catheter of the present invention during various stages of use. As shown inFIG. 11, forward movement of thefirst actuator44 within the first actuator recess46 (FIG. 6) results in thefirst needle70 advancing through thefirst needle port58A and traversing thesuction recess56. Continued actuation of thefirst actuator44 results in thefirst needle70 advancing through the firstneedle receiving port86A and engaging thefirst needle catch88A positioned within thefirst suture lumen76. Thefirst needle catch88A engages and is retained on thefirst needle70. The user may then retract thefirst needle70, thereby pulling the first suture across thesuture recess56. To retract thefirst needle70, the user rearwardly moves thefirst actuator44. As shown inFIG. 12, thefirst needle70 having thefirst needle catch88A attached thereto is retracted through the firstneedle receiving port86A, traverses thesuction recess56, and enters thefirst needle lumen68 through thefirst needle port58A.FIG. 12 shows thefirst suture78 traversing thesuction recess56.
• Similarly, as shown inFIG. 13, forward movement of the second actuator48 (FIG. 6) results in thesecond needle74 advancing through exiting thesecond needle port58B and traversing thesuction recess56. Like the actuation process described above, the continued actuation of thesecond actuator48 results in thesecond needle74 advancing through the secondneedle receiving port86B and engaging thesecond needle catch88B positioned within thesecond suture lumen80. Thesecond needle catch88B is then engaged and retained on thesecond needle74. Thereafter, the user may retract thesecond needle74 thereby pulling the second suture across suture recesssecond needle port58B. To retract thesecond needle74, the user rearwardly moves thesecond actuator48. As shown inFIG. 14, thesecond needle74 having thesecond needle catch88B attached thereto is retracted through the secondneedle receiving port86B, traverses thesuction recess56, and enters thesecond needle lumen72 through thesecond needle port58B. Thesecond suture82, which is attached to thesecond needle catch88B, thus traverses thesuction recess56.
• FIG. 15 illustrates an alternate embodiment of the present invention. As shown, theelongated body32 includes asuction recess90 formed thereon which is in fluid communication with asuction lumen92 formed therein which in turn is in communication with a vacuum source (not shown) attached to the suction connector40 (FIG. 6). First andsecond needle ports94A,94B, respectively, are positioned within or proximate to thesuction recess90. Similarly, first and secondneedle receiving ports96A,96B, respectively, are positioned within or proximate to thesuction recess90 and are co-aligned with and opposed to the first andsecond needle ports94A,94B. Thefirst needle port94A communicates with afirst needle lumen98. Afirst deployment rod100 having a firstdetachable needle102 attached thereto is located within thefirst needle lumen98. The firstdetachable needle102 is coupled to afirst suture104 located within thefirst needle lumen98. Similarly, thesecond needle port94B communicates with asecond needle lumen106. Asecond deployment rod108 having a seconddetachable needle110 attached thereto is located within thesecond needle lumen106. The seconddetachable needle110 is coupled to asecond suture112 located within thesecond needle lumen106. The firstneedle receiving port96A leads to a firstneedle trap lumen114A formed in or positioned proximate tosuction recess90. Afirst needle trap116A capable of receiving and retaining the firstdetachable needle102 therein is positioned within the firstneedle trap lumen114A. Similarly, the second needle receiving port96B leads to a secondneedle trap lumen114B formed in or positioned proximate to thesuction recess90. Like thefirst needle trap116A, asecond needle trap116B capable of receiving and retaining the seconddetachable needle110 therein is positioned within the secondneedle trap lumen114B.
• FIGS. 16-18 show the embodiment ofFIG. 15 during use. Forward movement of thefirst actuator44 results infirst needle rod100 extending fromfirst needle lumen98.FIG. 17 shows thefirst needle rod100 with a firstdetachable needle102 attached thereto extended through thefirst needle port94A traversing thesuction recess90, and entering into the firstneedle trap lumen114A through the firstneedle receiving port96A. The first detachable needle then engages thefirst needle trap116A. Thereafter, thefirst needle rod100 is retracted into thefirst needle lumen98, thereby leaving firstdetachable needle102 infirst needle trap116A. To retract thefirst needle rod100, the user moves the first actuator44 a rearward direction which causes thefirst needle rod100 to retract into thefirst needle lumen98.FIG. 18 shows thefirst needle rod100 retracted into thefirst needle lumen98. As a result, thefirst suture104 which is attached to the firstdetachable needle102 traverses thesuction recess90. Those skilled in the art will appreciate that a second needle (not shown) may be deployed in a similar manner.
• FIGS. 19-21 show various illustrations of the fastener catheter of the present invention. As shown inFIG. 19, thefastener catheter130 comprises afastener catheter body132 having a fastener catheter handle134 attached at the proximal end and afastening tip136 at the distal end. Thefastener catheter130 may be manufactured in a variety of shapes, sizes, lengths, widths, and biologically-compatible materials as desired.
• FIG. 20 shows a more detailed illustration of a preferred fastener catheter handle134 of the present invention. As shown, the fastener catheter handle134 comprises afastener handle body138 having anauxiliary connector140 and afastener body receiver142 attached thereto. Theauxiliary connector140 may be capable of coupling to a variety of devices including, for example, a vacuum source or a visualization device. Thefastener body connector142 is capable of receiving and coupling to the fastener catheter body132 (FIG. 19). Afastener actuator144 may be positioned within afastener actuator recess146 formed on thefastener handle body138. Thefastener actuator144 positioned within thefastener actuator recess146 may be capable of being positioned in three distinct locations. For example, in a non-actuated condition, thefastener actuator144 may be located in afirst position148. Thereafter, the user may partially actuate thefastener catheter130 by positioning thefastener actuator144 in asecond position150, thereby deploying a fastening device (not shown) from the fastener catheter130 (FIG. 19). The user may then fully actuate thefastener catheter130 by moving thefastener actuator144 to athird position152 within thefastener actuator recess146, thereby actuating a cutting member (discussed below) located on or proximate to thefastening tip136.
• FIGS. 21aand21billustrate, in exploded fashion, pieces offastening tip136. Aninner body154 includes asuture recess160 formed in the side thereof, which in turn is in communication with aninternal fastener lumen158.Inner body154 also includes apin162 extending radially outward therefrom.Sleeve156 comprises anaxial deployment lumen166 of sufficient diameter to receiveinner body154 therein.Sleeve156 also comprises acutting recess168 formed in an axial side thereof and a cuttingmember170 on a proximal edge of cuttingrecess168.Slot172 extends parallel to the axis of thedeployment lumen166 and may extend radially through to fastener lumen.Pin recess172 receivespin162 in sliding relation.
• FIGS. 23-24 illustratefastener180 of the present invention.Fastener180 may be manufactured from a variety of materials including, for example, Nickel-Titanium alloys, shape-memory alloys, stainless steel, titanium, various plastics, and other biologically-compatible materials.Fastener180 has aninternal lumen188 extending axially therethrough and one or more engagement member(s)184 formed on an end thereof. Between the engagement members is definedengagement aperture186 which is in communication withattachment lumen188.Attachment lumen188 andengagement aperture186 are sized to receive afirst suture lead176A and asecond suture lead176B therein. Prior to deployment, engagement member(s)184 are deflected radially away from the axis of thefastener180 such thatengagement aperture186 has a relative large first diameter sufficient to permit suture leads176A and176B to slide therethrough. Upon deployment, i.e. after the suture leads176A and176B have been retracted,engagement members184 are deflected or permitted to spring back toward the axis of the device such that theengagement aperture186 assumes a second smaller diameter compressing and securing suture leads176A and176B in place. Preferably the engagement member(s)184 tend to spring toward a natural position at the axis offastener180.FIG. 24 shows thefastener180 in the deployed configuration in which asuture loop178 has passed through twodiscreet tissue portions200A,200B and suture leads176A,176B are secured infastener180. Each engagement member(s)184 may further include apointed tip190 which, when the engagement member(s) are in the deployed position, engages and further restricts movement of the suture leads176A,176B.
• Anoperational fastening tip136 withfastener180 attached thereto and ready for deployment can be seen inFIG. 22.Inner body154 has been placed insidesleeve156 such thatsuture recess160 is in alignment with cuttingrecess168.Pin172 is in slidable communication withslot162 thereby permitting relative linear motion, but preventing relative rotational motion, betweeninner body154 andsleeve156.Fastener180 has been placed on the end of thefastening tip136 by deflecting theengagement members184 radially outward until they can be placed around the outer circumference of theinner body154. Accordingly, the fastener is secured to the end ofinner body154 by means of the frictional engagement between theengagement members184 and the outer surface ofinner body154.Suture loop178 extends from thefastener180. Suture leads176A and176B extend through thelumen188, throughengagement aperture186, exit the side ofinner body154 throughsuture recess160, and exit the side ofsleeve156 through cuttingrecess168.
• Deployment of the fastener is a two step process. Oncesuture178 has been secured through one or more tissue segments, thefastener tip136 is coaxed toward the tissue and the suture leads176A and176B are pulled away from the tissue until the suture loop is sufficiently cinched around the target tissue.Sleeve156 is then held in place adjacent the tissue while theinner body154 is pulled axially away. This causessleeve156 to push (i.e. slide)fastener180 off the outer surface of theinner body154. Whenfastener180 has been completely removed frominner body154engagement members184 spring axially inward thereby reducing the diameter ofengagement aperture186 and securing suture leads176A and176B. The second deployment step, cutting suture leads176A and176B, is accomplished when theinner body154 is pulled sufficiently throughsleeve156 that the suture leads are pinched between the trailing edge ofsuture recess160 and cuttingmember170 and ultimately cut by cuttingmember170.
• Remote deployment offastener180 is accomplished by attachinginner body154 tofastener actuator144, and attachingsleeve156 to thefastener catheter handle134. Thus, axial movement of thefastener actuator144 relative to thehandle134 causes similar relative movement betweeninner body154 andsleeve156. For example, in the non-actuated position148 (seeFIG. 20) the distal end ofinner body154 will extend from sleeve156 a sufficient distance to holdfastener180 thereon. In thesecond position150 theinner body154 will have been withdrawn into sleeve156 a sufficient distance to deploy thefastener180, and in thethird position152 theinner body154 will have been withdrawn a sufficient distance to cut the suture leads176A and176B.
• The present invention also discloses various methods of using the disclose mitral valve repair system to repair discreet tissue portions in vivo. The following paragraphs describe methods of repairing a dysfunctional mitral valve, though those skilled in the art will appreciate that the present invention and procedure may be adapted for use on other valves or in other procedures requiring the attachment of two or more pieces of tissue.
• To repair a dysfunctional or otherwise incompetent heart valve, a guidewire capable of traversing the circulatory system and entering the heart of the patient is introduced into the patient through an endoluminal entry point. For example, the endoluminal entry point may be formed in a femoral vein or right jugular vein. Thereafter, the guidewire is advanced through the circulatory system, eventually arriving at the heart. The guidewire is directed into the right atrium, traverses the right atrium and is made to puncture with the aid of a tran-septal needle or pre-existing hole, the atrial septum, thereby entering the left atrium. As shown inFIG. 25, theguidewire220 may then be advanced through themitral valve222 and into theleft ventricle226. Theguidewire220 traverses theaortic valve228 into theaorta230 and is made to emerge at the left femoral artery through an endoluminal exit point. Once theguidewire220 is positioned, the endoluminal entry or exit port is dilated to permit entry of a catheter therethrough. A protective sheath may be advanced in the venous area to protect the vascular structure.
• As shown inFIG. 26, theguide catheter10 of the present invention may be attached to theguidewire220 and advanced through the dilated guidewire entry port to a point proximate to themitral valve222. Those skilled in the art will appreciate that the mitral valve repair system of the present invention may approach the mitral valve from an antegrade position or from a retrograde position as desired by the user. Once the guide catheter is suitably positioned in the heart, thetherapy catheter30 may be advanced through theguide catheter10 to a position proximate to themitral valve222.FIG. 27 shows thetherapy catheter30 emerging from theguide catheter10 proximate to themitral valve222. Thereafter, the user may actuate thesuction actuator52 located on thehandle body38 of the therapy device handle34 (FIG. 6). As a result, a suction force is applied from thesuction recess56 formed on thesuture attachment tip36 of the therapy catheter30 (FIG. 7) to the tissue located proximate thereto. As shown inFIG. 28, afirst valve leaflet240A is engaged and retained by the suction force applied through thesuction recess56. With thefirst valve leaflet240A stabilized, the user may apply asuture242A thereto as described above. To apply the first suture to thefirst valve leaflet240A, the user actuates thefirst actuator44 located on the therapy device handle34, which results in thefirst needle70 advancing through thefirst valve leaflet240A and engaging and retaining thefirst needle catch88A, thereby applying afirst suture242A to the tissue (FIGS. 6-7). Thereafter, the user may terminate application of suction force to thefirst valve leaflet240A thereby releasing the sutured tissue.FIG. 29 shows thefirst valve leaflet240A having afirst suture242A applied thereto. As shown inFIG. 30, thetherapy catheter30 may then be rotated and positioned to engage asecond valve leaflet240B. Once again, the user may actuate thesuction actuator52 to apply suction force to thesecond valve leaflet240B through thesuction recess56. With thesecond valve leaflet240B stabilized as shown inFIG. 30, the user may apply asuture242B thereto by actuating thesecond actuator48 located on the therapy device handle34, which results in thesecond needle74 advancing through thesecond valve leaflet240B and engaging and retaining thesecond needle catch88B, thereby applying asecond suture242B to the tissue. As shown inFIG. 31, the user may terminate the application of suction to the stabilized tissue and remove the therapy catheter from the patient, thereby leaving the first andsecond sutures242A,242B attached to the first andsecond valve leaflets240A,240B. Note that first andsecond sutures242A and242B are actually portions of the same suture such that when the therapy catheter is removed there is a single suture loop through thevalve leaflets240A and240B.
• As shown inFIGS. 32-33, thefastener catheter130 may be attached to theguidewire220 and will be attached to first andsecond sutures242A,242B. Thereafter, thefastener catheter130 may be inserted into theguide catheter10 and advanced to a position proximate to themitral valve222. The user then draws the first andsecond sutures242A,242B taut while advancing thefastener catheter130 to themitral valve22, thereby decreasing the distance between the first andsecond valve leaflets240A,240B. The user then actuates thefastener actuator144 which causes thesleeve156 to engage and apply thefastener180 to the first andsecond sutures242A,242B adjacent the leaflets, as described above. Continued actuation of thefastener actuator144 causes the cuttingmember170 to engage and cut the first andsecond sutures242A,242B. As shown inFIG. 34, after thefastener catheter130, theguide catheter10, and theguidewire220 are removed from the patient, thefastener180 remains applied to themitral valve222.
• FIGS. 35-44 describe an alternate method of repairing tissue, specifically valve leaflets in this embodiment, in vivo. As shown inFIG. 35-37, aguide catheter10 is advanced through the circulatory system to the right atrium of the heart. Once positioned, adilator250 is advanced through theguide catheter10 and is made to puncture the atrial septum, thereby entering the left atrium. Thereafter, theguide catheter10 is advanced into the left atrium through the punctured atrial septum and positioned proximate to themitral valve222. As shown inFIG. 38, thetherapy catheter30 may be inserted into theguide catheter10 and advanced to a position proximate to themitral valve222. As shown inFIG. 39, an inflatable positioning balloon252 (discussed above) located on thetherapy catheter30 is inflated to orient and steady the catheter. Thesuction actuator52 on the therapy device handle34 is then actuated to apply a suction force to the suction recess56 (see.FIG. 6). Theinflated balloon252 engages thesecond valve leaflet240B which forces thesuction recess56 towards thefirst valve leaflet240A, thereby resulting in the stabilization of thefirst valve leaflet240A as shown inFIG. 40. As shown inFIG. 41, the user may then apply thefirst suture242A to thefirst valve leaflet240A as described above. Once the suture is applied, the user may deflate theinflatable positioning balloon252 and rotates thetherapy catheter30 approximately 180°. Thereafter, the user inflates thepositioning balloon252 and actuatessuction actuator52 to apply a suction force to thesuction recess56. As shown inFIG. 42, theinflatable positioning balloon252 is again inflated and made to engage the first valve leaflet240 thereby forcing thesuction recess56 to engage thesecond valve leaflet240B and permitting the stabilization of thesecond valve leaflet240B as shown inFIG. 42. Thereafter, the user applies thesecond suture242B to thesecond valve leaflet240B as described above.FIGS. 43-44 show the first andsecond valve leaflets240A,240B having a first andsecond suture242A,242B applied thereto. Thereafter, thetherapy catheter30 is removed from the patient's body and thefastener catheter130 is used to apply a fastener to the first andsecond sutures242A,242B as described above.
• In closing, it is understood that the embodiments of the invention disclosed herein are illustrative of the principals of the invention. Other modifications may be employed which remain within the scope of the present invention. Accordingly, the present invention is not limited to the embodiments shown and described in this disclosure.

Claims (20)

1. A method of repairing tissue within the heart of a patient, comprising;

advancing a guide catheter through a circulatory pathway to a location in the heart proximate to a heart valve;

advancing a therapy catheter through the guide catheter to the heart valve;

stabilizing a first leaflet with the therapy catheter;

deploying a first suture material into the stabilized first leaflet;

disengaging the first leaflet from the therapy catheter while leaving the first suture material attached thereto;

stabilizing a second leaflet with the therapy catheter;

deploying a second suture material into the second leaflet;

disengaging the second leaflet from the therapy catheter while leaving the second suture material attached thereto;

removing the therapy catheter from the guide catheter;

advancing a fastener catheter along the first and second suture material through the guide catheter to the heart valve; and

joining the first and second leaflets by reducing a distance between the first and second sutures with a fastener deployed from the fastener catheter.

2. The method ofclaim 1, further comprising:

cutting the first and second suture portions.

3. The method ofclaim 2, wherein the fastener catheter comprises a suture cutter, and cutting the first and second suture portions is performed by the fastener catheter suture cutter, and wherein the method further comprises:

removing the fastener catheter from the patient.

4. The method ofclaim 1, wherein the therapy catheter comprises a suction recess on a first side of the therapy catheter, and the method further comprises:

rotating the therapy catheter, wherein rotating the therapy catheter occurs after disengaging the first leaflet from the therapy catheter, and prior to stabilizing the second leaflet with the therapy catheter.

5. The method ofclaim 1, wherein the fastener comprises a memory material and is configured to receive the first and second suture portions and to secure the first and second suture portions when released from the fastener, and the method further comprises:

releasing the fastener from the fastener catheter, whereby the fastener is secured to the first and second suture portions.

6. The method ofclaim 1, wherein the fastener comprises one or more engagement members configured to engage and secure the first and second suture portions.

7. A method of repairing tissue within the heart of a patient, comprising;

advancing a guide catheter through a circulatory pathway to a location in the heart;

advancing a therapy catheter through the guide catheter into the heart and adjacent a first heart tissue portion;

stabilizing the first heart tissue portion with the therapy catheter;

deploying a first suture material into the stabilized first heart tissue portion;

disengaging the first heart tissue portion from the therapy catheter while leaving the first suture material attached thereto;

stabilizing a second heart tissue portion with the therapy catheter;

deploying a second suture material into the second heart tissue portion;

disengaging the second heart tissue portion from the therapy catheter while leaving the second suture material attached thereto;

removing the therapy catheter from the guide catheter;

advancing a fastener catheter along the first and second suture material through the guide catheter and into the heart; and

joining the first and second sutures with a fastener deployed from the fastener catheter.

8. The method ofclaim 7, wherein further comprising:

pulling the first suture portion and the second suture portion while advancing the fastener catheter along the first and second suture material.

9. The method ofclaim 8, wherein the fastener catheter is advanced along the first and second suture material until the fastener catheter is adjacent the first heart tissue portion and the second heart tissue portion, thereby decreasing the distance between the first heart tissue portion and the second heart tissue portion.

10. The method ofclaim 7, wherein advancing the fastener catheter comprises advancing the fastener catheter to a position adjacent the first heart tissue portion.

11. The method ofclaim 7, wherein advancing the fastener catheter comprises advancing the fastener catheter to a position adjacent the second heart tissue portion.

12. The method ofclaim 7, wherein the fastener catheter comprises a suture cutter, and the method further comprises:

cutting the first and second suture portions; and

removing the fastener catheter from the patient.

13. The method ofclaim 7, further comprising:

repositioning the therapy catheter, wherein repositioning the therapy catheter adjacent the second heart tissue portion occurs after disengaging the first heart tissue portion from the therapy catheter, and prior to stabilizing the second heart tissue portion with the therapy catheter.

14. The method ofclaim 13, wherein repositioning the therapy catheter comprises rotating the therapy catheter.

15. The method ofclaim 7, wherein the first heart tissue portion and the second heart tissue portion are at or adjacent a patent foramen ovale.

16. The method ofclaim 7, wherein the first heart tissue portion comprises a first valve leaflet.

17. The method ofclaim 7, wherein the second heart tissue portion comprises a second valve leaflet.

18. A method of repairing tissue within the heart of a patient, comprising;

advancing a guide catheter through a circulatory pathway to a location in the heart proximate to a heart valve;

advancing a therapy catheter through the guide catheter to the heart valve; inflating an inflatable positioning balloon on the therapy catheter;

engaging a second leaflet with the inflatable positioning balloon thereby directing the therapy catheter to a first leaflet;

stabilizing the first leaflet with the therapy catheter;

deploying a first suture material into the stabilized first leaflet;

disengaging the first leaflet from the therapy catheter while leaving the first suture material attached thereto;

engaging the first leaflet with the inflatable positioning balloon thereby directing the therapy catheter to the second leaflet;

stabilizing a second leaflet with the therapy catheter;

deploying a second suture material into the second leaflet;

disengaging the second leaflet from the therapy catheter while leaving the second suture material attached thereto;

deflating the inflatable positioning balloon;

removing the therapy catheter from the guide catheter;

advancing a fastener catheter along the first and second suture material through the guide catheter to the heart valve; and

joining the first and second leaflets by reducing a distance between the first and second sutures with a fastener deployed from the fastener catheter.

19. The method ofclaim 18, further comprising:

cutting the first and second suture portions.

20. The method ofclaim 19, wherein the fastener catheter comprises a suture cutter, and cutting the first and second suture portions is performed by the fastener catheter suture cutter, and wherein the method further comprises:

removing the fastener catheter from the patient.

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