Transmyocardial implant with coronary stent

Abstract

A transmyocardial implant includes a hollow rigid conduit having a first portion and a second portion. The first portion is sized to be larger than an initial lumen diameter of a coronary vessel. The first portion is smaller than an enlarged lumen diameter. The second portion is sized to extend from the first portion and through a myocardium into a heart chamber. The implant further includes a stent having a first stent diameter and adapted to be enlarged to an enlarged second stent diameter. In the first stent diameter, the stent is sized to be inserted into the initial lumen diameter. In the second diameter, the stent is sized to dilate the lumen to the enlarged lumen diameter. When the stent is at the second stent diameter, the stent has an internal diameter sized to receive the first portion of the conduit.

Claims

What is claimed is: 1. A transmyocardial implant for establishing a blood flow path through a myocardium between a heart chamber and a lumen of a coronary vessel residing on an exterior of said myocardium where the vessel has an initial lumen diameter and is expandable to an enlarged lumen diameter, said implant comprising: a. a hollow rigid conduit having: i. a first portion and a second portion, said first portion sized to be larger than the initial lumen diameter and smaller than the enlarged lumen diameter, said second portion sized to extend from the first portion and through said myocardium into said chamber; ii. open first and second ends on respective ones of said first and second portions to define a blood flow pathway within an interior of said conduit between said first and second ends; and iii. at least the second portion of said conduit formed of a conduit material sufficiently rigid to resist deformation and closure of said pathway in response to contraction of said myocardium; and b. a stent having a first stent diameter and adapted to be enlarged to an enlarged second stent diameter, said stent in the first stent diameter sized to be inserted into said vessel when said lumen is at said initial lumen diameter, the second diameter sized to dilate the vessel to the enlarged lumen diameter and, when the stent is at the second stent diameter, the stent has an internal diameter sized to receive the first portion of the conduit. 2. An implant according to claim 1 wherein the stent is co-terminus with the first portion. 3. An implant according to claim 1 wherein the stent extends beyond the open first end of the first portion. 4. A method for establishing a blood flow path through a myocardium between a heart chamber and a lumen of a coronary vessel residing on an exterior of said myocardium where the vessel has an initial lumen diameter and is expandable to an enlarged lumen diameter, said method comprising: a. selecting a hollow rigid conduit having: i. a first portion and a second portion, said first portion sized to be larger than the initial lumen diameter and smaller than the enlarged lumen diameter, said second portion sized to extend from said first portion and through said myocardium into said chamber; ii. open first and second ends on respective ones of said first and second portions to define a blood flow pathway within an interior of said conduit between said first and second ends; and iii. at least the second portion of said conduit formed of a conduit material sufficiently rigid to resist deformation and closure of said pathway in response to contraction of said myocardium; b. selecting a stent having a first stent diameter and adapted to be enlarged to an enlarged second stent diameter, said stent in the first stent diameter selected to be inserted into said vessel when said lumen is at said initial enlarged lumen diameter and, when the stent is at the second stent diameter, the stent has an internal diameter sized to receive the first portion of the conduit; c. placing the second portion of the conduit through the myocardium with the second end in communication with the chamber; d. placing the stent in the first stent diameter into the vessel and enlarging the diameter of the stent to the second stent diameter to enlarge the diameter of the lumen; and e. placing the first portion of the conduit into the stent with the stent in the second diameter. 5. A method according to claim 4 comprising placing the first portion of the conduit in the stent with the stent and first portion being co-terminus. 6. A method according to claim 4 comprising placing the first portion of the conduit in the stent with the stent extending beyond the open first end of the first portion.
BACKGROUND OF THE INVENTION 1. Field of the Invention This invention pertains to an implant for passing blood flow directly between a chamber of the heart and a coronary vessel. More particularly, this invention pertains to such an implant with an enhanced design for facilitating placement of a transmyocardial conduit into a coronary vessel. 2. Description of the Prior Art Commonly assigned U.S. Pat. No. 5,755,682 and PCT International Publication No. WO 98/06356 teach an implant for defining a blood flow conduit directly from a chamber of the heart to a lumen of a coronary vessel. An embodiment disclosed in the aforementioned patent and application teaches an L-shaped implant The implant is a conduit having one leg sized to be received within a lumen of a coronary artery and a second leg sized to pass through the myocardium and extend into the left ventricle of the heart. As disclosed in the above-referenced patent and application, the conduit remains open for blood flow to pass through the conduit during both systole and diastole. The conduit penetrates into the left ventricle in order to prevent tissue growth and occlusions over an opening of the conduit Commonly assigned and co-pending U.S. patent application Ser. No. 08/944,313 filed Oct. 6, 1997, entitled "Transmyocardial Implant", and filed in the name of inventors Katherine S. Tweden, Guy P. Vanney and Thomas L. Odland, teaches an implant such as that shown in the aforementioned patent application with an enhanced fixation structure. The enhanced fixation structure includes a fabric fixation structure. The enhanced fixation structure includes a fabric surrounding at least a portion of the conduit to facilitate tissue growth on the exterior of the implant Implants such as those shown in the aforementioned patent and applications include a portion to be placed within a coronary vessel and a portion to be placed within the myocardium. When placing a portion of the implant in the coronary vessel, the vessel is incised a length sufficient to insert the implant When placed within the coronary vessel, the implant discharges flow axially into the vessel. When placing an implant, a portion of the coronary artery is dissected. The dissected portion is incised and the vessel portion of the implant is inserted into the lumen. A stay suture secures the artery to the implant. The stay suture is spaced around the artery and vessel portion a distanced space from the open end of the vessel portion. In a preferred embodiment, the implant is rigid. After an artery is incised to receive an implant, the artery may collapse in diameter. Also, the artery may have an initial diameter smaller than the outside diameter of the implant The implant may be inserted into the artery to expand the artery. However, this insertion may include a rubbing against the fragile artery wall resulting in damage. SUMMARY OF THE INVENTION According to a preferred embodiment of the present invention, a transmyocardial implant is disclosed for establishing a blood flow path through a myocardium between a heart chamber and a lumen of a coronary vessel residing on an exterior of the heart The implant includes a hollow rigid conduit having a first portion and a second portion. The first portion is sized to be larger than an initial lumen diameter and smaller than an enlarged lumen diameter. The second portion is sized to extend from the first portion and through the myocardium into a heart chamber. The implant further includes a stent having a first stent diameter and adapted to be enlarged to an enlarged second stent diameter. In the first stent diameter, the stent is sized to be inserted into the initial lumen diameter. In the second diameter, the stent is sized to dilate the lumen to the enlarged lumen diameter. When the stent is at the second stent diameter, the stent has an internal diameter sized to receive the first portion of the conduit. BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is a perspective view of a transmyocardial conduit; FIG. 2 is a perspective view of stent shown in a reduced first diameter; FIG. 3 is the view of FIG. 2 showing the stent in an enlarged second diameter; FIG. 4 is a side sectional schematic view showing an occluded artery on a heart wall; FIG. 5 is the view of FIG. 4 following dissection of a portion of the artery, ligation distal to the obstruction and incision of the artery distal to the ligation; FIG. 6 is the view of FIG. 5 following placement of the reduced diameter stent of FIG. 2 into the artery; FIG. 7 is the view of FIG. 6 following expansion of the stent to the enlarged second diameter; FIG. 8 is the view of FIG. 7 following placement of the implant of FIG. 1; and FIG. 9 is an alternative embodiment to the embodiment depicted in FIG. 8. DESCRIPTION OF THE PREFERRED EMBODIMENT With initial reference to FIG. 1, a transmyocardial conduit 10 is shown in the form of an L-shaped rigid tube. The conduit 10 may be formed of titanium or other rigid biocompatible material such as pyrolytic carbon or titanium coated with pyrolytic carbon. The material of the conduit 10 is preferably a rigid material in order to withstand contraction forces of the myocardium. By way of example, the tube will have an outside diameter D O of about 2.5 millimeters and an internal diameter D I of about 2.0 millimeters to provide a wall thickness of about 0.25 millimeters. The conduit 10 has a first portion (or vessel end) 12 sized to be received within the lumen of a coronary vessel such as the lumen 80 of a coronary artery 82 illustrated in FIG. 4. The conduit 10 has a second portion (or myocardium end) 14 extending at a right angle to the axis of portion 12. The second portion 14 is sized to extend from the coronary artery 82 directly through the myocardium 84 and protrude into the left ventricle 86 of a patient's heart. The second portion 14 is sized to have a length sufficient for the portion 14 to protrude into the left ventricle 86. The vessel end 12 has a first opening 16. The myocardium end 14 has a second opening 18 in communication with an interior 21 of the conduit 10. Therefore, blood can freely flow through the conduit 10 between the left ventricle 86 and the lumen 80 of the coronary artery 82. Blood flows axially out of opening 16 parallel with the axis of lumen 80. As discussed more fully in the aforementioned commonly assigned and copending U.S. patent application Ser. No. 08/944,313, the portion 14 may be provided with tissuegrowth-inducing material (not shown in the present application) such as a polyester sleeve to immobilize the conduit 10 within the myocardium 84. The implant of the present invention further includes a stent 20. The stent 20 is a tubular member of lattice formed of biocompatible material. The stent 20 has an initial diameter D 1 sized smaller than the conduit outer diameter D O and further sized for the stent 20 to be inserted into lumen 80. The stent 20 is expandable to an enlarged second diameter D 2 sized to expand the artery 82. Further, the stent 20 is sized to receive the second portion 12 of the conduit 10 when the stent 20 is expanded to the enlarged second diameter D 2 . It will be appreciated that coronary stents such as stent 20 are commercially available in a wide variety of sizes, shapes, materials and mode of expansion (e.g., self-expanding or balloon expandable). Stent 20 can be any member whose outside dimensions expand to enlarge lumen 80 and whose internal dimensions permit insertion of the vessel portion 12. With reference to FIG. 5, a surgeon dissects a portion of the artery 82 away from the myocardium 84. The surgeon ligates the artery 82 distal to an obstruction 87 with sutures 85. The surgeon then forms an incision through the artery 82 distal to the ligating suture 85. The stent 20 (in the reduced diameter D 1 of FIG. 2) is slipped into the lumen 80 through the open end 82a of the artery 82 (FIG. 6). The stent 20 is expanded to the enlarged diameter D 2 . The expansion causes a corresponding expansion of the lumen 80 at the incised artery end 82a (FIG. 7). The conduit 10 is placed by inserting the second portion 14 through the myocardium 84 with open end 18 in communication with the left ventricle 86. The first portion 12 is inserted into the enlarged stent 20 (FIG. 8). Stay sutures 89 are placed 15 around the artery 82 overlying the stent 20 and vessel portion 12. The stay sutures 89 are tightened to crimp the artery 82, stent 20 and vessel portion 12 together. In FIG. 8, the stent 20 is shown as being co-terminus with the vessel portion 12 (i.e., an end of the stent 20 is aligned with the open end 16). FIG. 9 illustrates an alternative where the stent 20 extends beyond the open end 16. With the structure thus described, the artery 82 is enlarged to receive the vessel portion 12. The enlargement results from radial expansion forces due to the expansion of the stent 20. This enlargement minimizes arterial damage. From the foregoing, the invention has been described in a preferred embodiment Modifications and equivalents of the disclosed concepts are intended to be included within the scope of the claims.

Description

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Patent Citations (10)

    Publication numberPublication dateAssigneeTitle
    US-5064435-ANovember 12, 1991Schneider (Usa) Inc.Self-expanding prosthesis having stable axial length
    US-5562727-AOctober 08, 1996Aeroquip CorporationIntraluminal graft and method for insertion thereof
    US-5655548-AAugust 12, 1997Circulation, Inc.Method for treatment of ischemic heart disease by providing transvenous myocardial perfusion
    US-5667523-ASeptember 16, 1997Impra, Inc.Dual supported intraluminal graft
    US-5755682-AMay 26, 1998Heartstent CorporationMethod and apparatus for performing coronary artery bypass surgery
    US-5817100-AOctober 06, 1998Kabushikikaisya Igaki Iryo SekkeiStent device and stent supplying system
    US-5824071-AOctober 20, 1998Circulation, Inc.Apparatus for treatment of ischemic heart disease by providing transvenous myocardial perfusion
    US-5984956-ANovember 16, 1999Heartstent CorporationTransmyocardial implant
    WO-9806356-A1February 19, 1998Heartstent CorporationMethod and apparatus for performing coronary artery bypass surgery
    WO-9917683-A1April 15, 1999Heartstent CorporationImplant transmyocardique

NO-Patent Citations (0)

    Title

Cited By (72)

    Publication numberPublication dateAssigneeTitle
    US-7008397-B2March 07, 2006Percardia, Inc.Cardiac implant and methods
    US-2004097988-A1May 20, 2004Ventrica, Inc.Methods and devices for placing a conduit in fluid communication with a target vessel
    US-2004049171-A1March 11, 2004Heartstent CorporationDevice for placing transmyocardial implant
    US-6610100-B2August 26, 2003Percardia, Inc.Designs for left ventricular conduit
    US-6302892-B1October 16, 2001Percardia, Inc.Blood flow conduit delivery system and method of use
    US-2003130719-A1July 10, 2003Martin Eric C.Bifurcated stent for percutaneous arterialization of the coronary sinus and retrograde perfusion of the myocardium
    US-2005021124-A1January 27, 2005Brendan Cunniffe, Niall Duffy, Noel Coyle, Francis Richard William AlanStents and stent delivery system
    US-2004186507-A1September 23, 2004Percardia, Inc.Stent delivery system and method of use
    US-2004147868-A1July 29, 2004Earl Bardsley, Peter Boekstegers, Patrick Cahalan, Michael Igoe, Jianlu Ma, Mcvittie Anna, Laurence RothMyocardial implant with collar
    US-6679910-B1January 20, 2004Latin American Devices LlcIntraluminal stent
    US-2005033401-A1February 10, 2005Brendan Cunniffe, Niall Duffy, Noel Coyle, Francis Richard William Alan, Ronan ThorntonMethods and devices for placing a fistula device in fluid communication with a target vessel
    US-6694983-B2February 24, 2004Percardia, Inc.Delivery methods for left ventricular conduit
    US-6641610-B2November 04, 2003Percardia, Inc.Valve designs for left ventricular conduits
    US-2005288618-A1December 29, 2005Scimed Life Systems, Inc.Myocardial treatment apparatus and method
    US-2008171101-A1July 17, 2008Rapacki Alan R, Carson Dean F, Sharkawy A AdamManufacturing conduits for use in placing a target vessel in fluid communication with a source of blood
    US-6387119-B2May 14, 2002Percardia, Inc.Delivery methods for left ventricular conduit
    US-6949118-B2September 27, 2005Percardia, Inc.Encased implant and methods
    US-6409751-B1June 25, 2002Percardia, Inc.Stent delivery system and method of use
    US-6605113-B2August 12, 2003Percardia Inc.Vascular graft bypass
    US-2004113306-A1June 17, 2004Rapacki Alan R, Carson Dean F, Sharkawy A AdamManufacturing conduits for use in placing a target vessel in fluid communication with a source of blood
    WO-0066035-A1November 09, 2000Heartstent CorporationCompliant transmyocardial implant
    US-6254564-B1July 03, 2001Percardia, Inc.Left ventricular conduit with blood vessel graft
    US-2003135260-A1July 17, 2003Kohler Robert Edward, Mowry David H.Encased implant and methods
    US-6406491-B1June 18, 2002Heartstent CorporationCompliant transmyocardial implant
    US-6881199-B2April 19, 2005Percardia, Inc.Left ventricular conduit with blood vessel graft
    US-8512360-B2August 20, 2013Medtronic, Inc.Conduits for use in placing a target vessel in fluid communication with source of blood
    US-7993356-B2August 09, 2011Medtronic, Inc.Delivering a conduit into a heart wall to place a coronary vessel in communication with a heart chamber and removing tissue from the vessel or heart wall to facilitate such communication
    US-2003125798-A1July 03, 2003Martin Eric C.Stent for arterialization of the coronary sinus and retrograde perfusion of the myocardium
    US-6638237-B1October 28, 2003Percardia, Inc.Left ventricular conduits and methods for delivery
    US-6290728-B1September 18, 2001Percardia, Inc.Designs for left ventricular conduit
    US-6253768-B1July 03, 2001Percardia, Inc.Vascular graft bypass
    US-6196230-B1March 06, 2001Percardia, Inc.Stent delivery system and method of use
    US-6916304-B2July 12, 2005Percardia, Inc.Transmyocardial implant with flow reduction
    US-2004168691-A1September 02, 2004Sharkawy A. Adam, Carson Dean F., Gittings Darin C., Lepulu Keke J., Foley Mark J., Buch Wally S., Rapacki Alan R.Conduits for use in placing a target vessel in fluid communication with source of blood
    US-6409697-B2June 25, 2002Heartstent CorporationTransmyocardial implant with forward flow bias
    US-8597226-B2December 03, 2013Jenavalve Technology, Inc.Methods and conduits for flowing blood from a heart chamber to a blood vessel
    US-6635214-B2October 21, 2003Ventrica, Inc.Manufacturing conduits for use in placing a target vessel in fluid communication with a source of blood
    US-2005214342-A1September 29, 2005Percardia, Inc.Cardiac implant and methods
    US-8216174-B2July 10, 2012Jenavalve Technology, Inc.Methods and conduits for flowing blood from a heart chamber to a blood vessel
    GB-2369064-AMay 22, 2002Heartstent CorpCompliant transmyocardial implant
    US-6582444-B2June 24, 2003Percardia, Inc.Blood flow conduit delivery system and method of use
    US-2003216679-A1November 20, 2003Percardia, Inc.Valve designs for left ventricular conduits
    US-2007055344-A1March 08, 2007Gittings Darin C, Sharkawy A A, Rapacki Alan R, Laroya Gilbert SDevices and methods for use in performing transmyocardial coronary bypass
    US-6605053-B1August 12, 2003Percardia, Inc.Conduit designs and related methods for optimal flow control
    US-8156942-B2April 17, 2012Medtronic Vascular, Inc.Method of implanting a transmyocardial stent
    US-6808498-B2October 26, 2004Ventrica, Inc.Placing a guide member into a heart chamber through a coronary vessel and delivering devices for placing the coronary vessel in communication with the heart chamber
    US-9414752-B2August 16, 2016Elwha LlcEmbolism deflector
    US-2003216801-A1November 20, 2003Heartstent CorporationTransmyocardial implant with natural vessel graft and method
    US-2004210190-A1October 21, 2004Percardia, Inc.Interventional diagnostic catheter and a method for using a catheter to access artificial cardiac shunts
    US-6261304-B1July 17, 2001Percardia, Inc.Delivery methods for left ventricular conduit
    US-7727268-B2June 01, 2010Medtronic Vascular, Inc.Methods and devices for placing a fistula device in fluid communication with a target vessel
    US-6562066-B1May 13, 2003Eric C. MartinStent for arterialization of the coronary sinus and retrograde perfusion of the myocardium
    US-2002099404-A1July 25, 2002Mowry David H.Intravascular ventriculocoronary artery bypass delivery modalities
    US-2007233225-A1October 04, 2007Rapacki Alan R, Gittings Darin C, Laroya Gilbert S, Foley Mark JDelivering a conduit into a heart wall to place a coronary vessel in communication with a heart chamber and removing tissue from the vessel or heart wall to facilitate such communication
    US-2003220661-A1November 27, 2003Heartstent CorporationTransmyocardial implant delivery system
    US-2005043781-A1February 24, 2005Mark FoleyMethods and devices providing transmyocardial blood flow to the arterial vascular system of the heart
    US-2009005852-A1January 01, 2009Gittings Darin C, Rapacki Alan R, Adam Sharkawy, Buch Wally SMethods and Devices for Placing a Conduit in Fluid Communication with a Target Vessel
    US-7285235-B2October 23, 2007Medtronic, Inc.Manufacturing conduits for use in placing a target vessel in fluid communication with a source of blood
    US-2003158509-A1August 21, 2003Tweden Katherine S., Michael SchollmeyerCardiac implant and methods
    US-6893413-B2May 17, 2005Eric C. MartinTwo-piece stent combination for percutaneous arterialization of the coronary sinus and retrograde perfusion of the myocardium
    US-7704222-B2April 27, 2010Jenavalve Technology, Inc.Methods and conduits for flowing blood from a heart chamber to a blood vessel
    US-9295393-B2March 29, 2016Elwha LlcEmbolism deflector
    US-2009123516-A1May 14, 2009The Board Of Regents Of The University Of Texas SystemDrug delivery from implants using self-assembled monolayers-therapeutic sams
    US-6976990-B2December 20, 2005Percardia, Inc.Intravascular ventriculocoronary bypass via a septal passageway
    US-7037329-B2May 02, 2006Eric C. MartinBifurcated stent for percutaneous arterialization of the coronary sinus and retrograde perfusion of the myocardium
    US-2007290497-A1December 20, 2007Arendt Albert L, Jones John L, Zielinski Michael BChildren's ride-on vehicles with reconfigured bodies and methods for forming the same
    US-2002143285-A1October 03, 2002Heartstent CorporationTransmyocardial implant with flow reduction
    US-7736327-B2June 15, 2010Jenavalve Technology, Inc.Methods and conduits for flowing blood from a heart chamber to a blood vessel
    US-2004077988-A1April 22, 2004Heartstent CorporationHealing transmyocardial implant
    US-2004106931-A1June 03, 2004Percardia, Inc.Left ventricular conduits and methods for delivery
    US-6808504-B2October 26, 2004Percardia, Inc.Multi-lumen implant
    US-7326219-B2February 05, 2008Wilk Patent DevelopmentDevice for placing transmyocardial implant