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Methods and devices for placing a conduit in fluid communication with a target vessel

Methods and devices for placing a conduit in fluid communication with a target vessel description/claims

This application is a continuation of U.S. patent application Ser. No. 09/850,883, filed May 7, 2001, which is a continuation of U.S. patent application Ser. No. 09/304,149, filed May 3, 1999, which is a continuation-in-part of application Ser. No. 09/232,103, filed on Jan. 15, 1999 and entitled “Methods and Devices for Forming Vascular Anastomoses,” the entire subject matter of which is incorporated herein by reference. This application is also a continuation-in-part of application Ser. No. 09/232,062, filed on Jan. 15, 1999 and entitled “Methods and Devices For Bypassing an Obstructed Target Vessel by Placing the Vessel in Communication with a Heart Chamber Containing Blood,” the entire subject matter of which is also incorporated herein by reference.

1. Field of the Invention

The invention relates to methods and devices for placing a conduit in fluid communication with a lumen of a target vessel, and more particularly methods and devices for placing such a conduit in fluid communication with a target vessel and a source of blood.

2. Description of the Related Art

Despite the considerable advances that have been realized in cardiology and cardiovascular surgery, heart disease remains the leading cause of death throughout much of the world. Coronary artery disease, or arteriosclerosis, is the single leading cause of death in the United States today. As a result, those in the cardiovascular field continue to search for new and improved treatments.

Coronary artery disease is currently treated by interventional procedures such as percutaneous transluminal coronary angioplasty (PTCA), atherectomy and coronary stenting, as well as surgical procedures including coronary artery bypass grafting (CABG). The goal of these procedures is to reestablish or improve blood flow through occluded (or partially occluded) coronary arteries, and is accomplished, for example, by enlarging the blood flow lumen of the artery or forming a bypass that allows blood to circumvent the occlusion. What procedure(s) is used typically depends on the severity and location of the blockages. When successful, these procedures restore blood flow to myocardial tissue that had not been sufficiently perfused due to the occlusion.

Another treatment that has been recently proposed places the target vessel in fluid communication with a heart chamber, for example, the left ventricle. The target vessel and the heart chamber may be communicated by a conduit passing through the myocardium. Some of the challenges associated with such procedures include proper positioning of the conduit in the myocardium as well as correct placement of the conduit in a coronary artery.

As shown by these and other attempts to develop new and improved treatments that may be used to deliver blood to myocardial tissue, there remains a need in the art for methods and devices that may be used to place a conduit in fluid communication with a target vessel and a source of blood.

According to one embodiment of the invention, methods and devices are provided for placing a conduit in fluid communication with a target vessel. One preferred method includes steps of providing a conduit having a first end, a second end and a lumen, the conduit being supported by a conduit delivery device. A portion of the device is positioned adjacent a target vessel in a patient's vascular system, one of the first and second ends of the conduit is placed in fluid communication with the target vessel, and the conduit is removed from the delivery device. The steps of positioning the portion of the conduit delivery device adjacent the target vessel and placing one of the first and second ends of the conduit in fluid communication with the target vessel are performed using one hand.

One preferred device includes a conduit having a first end, a second end and a lumen, wherein the conduit is movable between deployed and non-deployed positions and one end of the conduit is adapted to be placed in fluid communication with a target vessel. A sheath overlies at least a portion of the conduit and holds the portion in the non-deployed position. A first actuator imparts relative movement to the conduit and the sheath in order to allow the portion of the conduit to move to the deployed position. A sheath removal mechanism is provided for removing the sheath after the conduit has moved to the deployed position. The first actuator and the sheath removal mechanism are operable using one hand to place the conduit in fluid communication with the target vessel and remove the sheath from the target vessel.

According to another embodiment of the invention, methods and devices are provided for placing a conduit in fluid communication with a target vessel and a source of blood. One preferred method includes steps of providing a conduit having a first end, a second end and a lumen, placing the first end of the conduit in fluid communication with the source of blood, allowing blood to flow into the lumen of the conduit to force substantially all air from the conduit, and placing the second end of the conduit in fluid communication with the target vessel.

One preferred device includes a conduit having a first end, a second end and a lumen, wherein the first end of the conduit is adapted to be placed in fluid communication with a target vessel and the second end of the conduit is adapted to be placed in communication with a source of blood. A support shaft has a section that is removably coupled to the first end of the conduit for placing the first end of the conduit in fluid communication with the target vessel, but de-coupled from the second end of the conduit to allow the second end of the conduit to be placed in communication with the source of blood prior to placing the first end of the conduit in fluid communication with the target vessel.

According to another embodiment of the invention, methods and devices are provided for establishing a conduit to place a coronary vessel in fluid communication with a heart chamber containing oxygenated blood. One preferred method includes steps of placing a conduit in fluid communication with a heart chamber containing oxygenated blood, wherein at least a major portion of the length of the conduit is disposed exterior to the heart wall. The conduit is also placed in fluid communication with a lumen of a coronary vessel, and is secured to the coronary vessel by a sutured anastomosis so as to place the coronary vessel in fluid communication with the heart chamber.

According to another embodiment of the invention, methods and devices are provided for deploying a conduit in a target vessel. One preferred method includes steps of providing a conduit having a first end, a second end and a lumen, wherein the conduit is movable between deployed and non-deployed positions and at least a portion of the conduit is held in the non-deployed position by a retention member. At least the non-deployed portion of the conduit is placed in a lumen of a target vessel, and the retention member is moved in a first direction with respect to the conduit to move the non-deployed portion of the conduit to the deployed position. The retention member is moved in a second direction that is substantially opposite the first direction to remove the retention member from the target vessel.

One preferred device includes a conduit having a first end, a second end and a lumen, wherein the conduit is movable between deployed and non-deployed positions and one end of the conduit is adapted to be placed in fluid communication with a target vessel. A retention member overlies at least a portion of the conduit to hold the portion in the non-deployed position. An actuator is coupled to the retention member and is moved in a first direction to move the retention member and allow the portion of the conduit to move to the deployed position. The actuator is then moved in a second direction to remove the retention member from the target vessel, the second direction being transverse to the first direction.

According to another embodiment of the invention, methods and devices are provided for placing a conduit in fluid communication with a target vessel while preserving native blood flow through the target vessel. One preferred method includes steps of providing a vessel coupling and a conduit, wherein the vessel coupling has a first portion configured to secure the conduit to a target vessel so that the conduit is in fluid communication with the target vessel. The vessel coupling is moved generally along a first direction to place the first portion of the vessel coupling at least partially within the lumen of the target vessel, and the first portion of the vessel coupling is then moved generally along a second direction within the lumen of the target vessel to deploy the vessel coupling and secure the conduit to the target vessel, wherein the second direction is transverse to the first direction.

One preferred device includes a vessel coupling including a first portion joined to a second portion, wherein the first portion of the vessel coupling is sized and configured to be attached to a target vessel while allowing native blood flow through the target vessel to move past the site of attachment. The second portion of the vessel coupling is sized and configured to be coupled to a conduit that is adapted to form a flow path between the target vessel and a source of blood. The first portion of the vessel coupling includes a plurality of support members sized and configured to engage a wall of the target vessel, each support member including a plurality of generally straight support struts.

According to another embodiment of the invention, methods and devices are provided for forming a blood flow path through tissue. One preferred device includes a tubular member having a first end, a second end and a lumen, wherein the tubular member is configured to be placed in tissue and the lumen of the tubular member is sized and configured to receive a conduit adapted to form a blood flow path through the tissue. At least one of the first and second ends of the tubular member is configured to extend through the tissue so as to place the conduit in fluid communication with a hollow body structure containing blood, and a structure is coupled to the one end of the tubular member for maintaining the one end substantially open. The structure includes at least one opening through which blood from the hollow body structure may enter the conduit.

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