DE102012108026A1 - Surgical apparatus for placing implants on heart, has positioning device that is arranged for positioning of two implants at predetermined positions on the heart - Google Patents

Abstract

The surgical apparatus (10) has a holding device (14) for holding two implants (12) that are provided with surface contact element. A positioning device (18) is arranged for positioning of the implants at predetermined positions on the heart. The implants are arranged on the holding device symmetrically with respect to a center point. The implants can be transferred from a first arrangement to a second arrangement by positioning device, such that distance between implants in second arrangement is smaller than that of first arrangement. An independent claim is included for method for placing implants on heart.

Description

The invention relates to a surgical device for applying implants to the heart, as used in particular in surgical procedures for restoring the natural shape of the heart.

Such a measure may be required for a variety of reasons, e.g. arterial hypertension or aortic valve stenosis secondary to dilatation with rapid loss of contractility of the left ventricle of the heart. Another cause may be aortic insufficiency, severe anemia, or a so-called shuntvitium, which causes a volume overload for the heart, resulting in an increase in left ventricular diameter. Again, over time, with progressive heart failure, the ventricular volume may increase, necessitating surgery. Even after a heart attack, aneurysms can develop on the myocardium due to a strong, short-term overload, which necessitates a corresponding surgical procedure.

The aim of these surgical procedures is a so-called remodeling of the myocardium to restore the physiological shape and size of the left ventricle.

In addition to normal surgical procedures, such as partial ventricular resection, surgical procedures have been used in the past to target mechanical ventricular deformity.

For example, in the WO 2008/011411 A2 proposed to take the heart muscle in a kind of network structure and thus prevent further enlargement of the heart. The network is chosen to be sufficiently flexible so as not to affect the pumping power of the heart.

Conventionally, a certain remedy can be created with a method of operation with the so-called ventricular puncture, in which the heart shape is modeled via sutures, wherein a portion of a flat PTFE felt material is used as a support for the suture and a certain relief of the puncture site.

Such surgical implants are widely used as sutures for surgical sutures. When sewing fabric together, there is sometimes a risk that pressure peaks or stress peaks in the area of a seam may occur when external or internal force is applied, which can cause the fabric to tear. This can be done, for example, within a hollow body (for example an organ) by a movement of the patient or also by an external influence or also by a high natural load on the tissue.

With a closer seam or multiple seams it may be possible to partially mitigate this problem. Often, however, a greater number of sutures or the use of a more dense suture is not possible or undesirable or associated with too much time.

Object of the present invention is to propose a surgical device with which a remodeling of the heart with the help of implants easier and more targeted is possible.

A surgical device of the type mentioned, which achieves this object, is the subject of claim 1.

The present invention improves the remodeling of the heart, in particular with the fact that the implants to be used can be applied simultaneously to the heart. The implants are arranged on a holding device and can then be applied together with the positioning device in a predetermined position on the heart. Positioning the implants can thus not only be made more accurate, but also easily correctable if necessary. In particular, in the paired use of implants, which are used as an abutment in a seam, so a precise alignment of the implants ensures each other, which facilitates the preparation of the seam and accelerates.

The device according to the invention also includes the possibility of provisionally placing the implants on the heart with the possibility of echocardiographic examination of the positioning of the implants and a subsequent permanent fixation on the heart.

This succeeds in particular atraumatic and with a very small amount of time.

In particular, in the fixation of the implants by means of suture, the number of implants is preferably straight, in which case more preferably in each case two implants are arranged on the holding device in pairs opposite each other.

If the implants are fixed to the heart with an externally encircling flexible holding element, for example a band, the number of implants can also be odd.

Preferably, the implants are arranged on the holding device symmetrically to a center, so that the myocardium is detected symmetrically when applying the implants.

More preferably, the positioning device is formed so that the implants can be substantially synchronously transferred from a first arrangement to a second arrangement, wherein the implants in the second arrangement maintain a smaller distance from one another than in the first arrangement. This measure brings about a particularly gentle application of the implants to the heart and avoids the occurrence of uneven forces when applying the implants.

It is likewise preferred if the implants can be transferred substantially linearly from a first arrangement into a second arrangement by means of the positioning device, wherein the implants in the second arrangement maintain a smaller distance from each other than in the first arrangement. This measure can be easily combined with the previously mentioned measure of the synchronous positioning of the implants. In the straight-line transfer of the implants from a first arrangement in a second arrangement, they are typically moved in the radial direction with respect to an imaginary center of the holding device.

Alternatively or additionally, it can be provided that the implants can be transferred substantially continuously from a first arrangement into a second arrangement by means of the positioning device, wherein again the implants in a second arrangement have a smaller distance from one another than in the first arrangement. Due to the stepless transfer and then also fixation in the second arrangement, a particularly finely tuned placement of the implants can be accomplished.

As an alternative to a rectilinear arrangement, it is also conceivable that the implants are transferred synchronously in a pivoting movement and thus also in a circular arc from a first arrangement into a second arrangement, with a stepless transfer in particular also leading to the previously described advantages.

When transferring the implants by means of the positioning device from a first arrangement into a second arrangement, in which the implants maintain a smaller distance from each other, the mutual distance is arranged in pairs, i. In the second arrangement, implants in the second arrangement are reduced relative to one another with respect to the center of the holding device up to approximately 40% of the distance which is given in the first arrangement.

It is also preferred to set the distance from pairwise associated, i. with respect to the center of the holding device opposed implants to reduce when transferring from the first to the second arrangement per Zeitincrement by a substantially equal amount. This again leads to a particularly gentle application of the implants to the heart succeed.

As an alternative to this, it can be provided that the implants are subjected to essentially equal forces during the transfer from the first to the second arrangement. This can then, depending on the resistance that the heart muscle tissue opposes to the implants when transferring from the first to the second arrangement, lead to different courses of movement in the individual implants, whereby gentle application of the implants to the heart muscle is still achieved.

For transferring the implants from a first arrangement into a second arrangement, the positioning device preferably comprises a drive device with a transport medium with which the implants on the holding device can be transferred from the first arrangement into the second arrangement. This transport medium can be a common transport medium, with which all implants are uniformly applied and moved towards each other. In this case, one of the implants can be held stationary.

Alternatively, a plurality of transport media can be used, which can be actuated independently of each other, so that, for example, one of the implants can remain unchanged on the holding device, while the other implants are moved over the positioning device as described above in detail, so that an approximation of all implants takes place and they reach the second predetermined arrangement.

As a transport medium or as transport media comes a variety of mechanical elements in question, depending on how the positioning is designed in detail.

Thus, the implants can be transferred to the holding device via transmission means along guide elements from the first to the second arrangement, wherein the guide elements comprise, for example, linear slide guides or can be designed for example as a spindle drive. All special embodiments are preferred in that they not only bring about a transfer from a first to a second arrangement may, associated with an approach of the implants to each other, but possibly also a return to an intermediate arrangement, if this proves necessary in the course of the procedure.

Space-saving and easy to handle are especially flexible transport media with which the forces of the positioning device are transferred to the individual implants and their support on the holding device, such as. Ribbons, chains, ropes, wires or threads.

In addition, hydraulically or pneumatically operable actuators are conceivable as a transport medium, with which the preferred movement mechanisms previously illustrated are also executable. As already mentioned, it is of particular advantage that the device according to the invention initially permits a provisional application of the implants to the myocardium and then an echocardiographic examination of the effect is possible before the implants are finally fixed.

If it should turn out in the echocardiographic examination that a correction of the position of the implants is necessary, this can be accomplished very simply with the device according to the invention and an echocardiographic examination can be carried out again.

The holding device can be dimensionally stable or flexible.

Frequently, the dimensionally stable holding device will be formed substantially annular or oval, of course, other deviating forms for the holding device are conceivable.

Furthermore, the dimensionally stable holding device of the surgical device according to the invention will preferably extend substantially in one plane and the implants will be held out of this plane in an outstanding manner on the holding device in a common direction.

This greatly facilitates both the final surgical procedures in the fixation of the implants on the heart and the separation of the implants from the holding device, after they are finally positioned and fixed at the correct position of the heart.

Preferably, it is provided that the implants themselves are arranged in a common second plane, which is preferably aligned parallel to the first plane.

Flexible holding devices can also be designed so that they can remain in the body of the patient together with the implants held thereon. This opens up the possibility of repeating the remodeling process at a later time, whereby access to the holding device has to be provided only minimally invasively.

According to one embodiment of the flexible holding device, this comprises flexible, in particular spring-elastic, struts which are connected to one another at one of their ends, while the free ends of the struts each hold an implant.

According to another embodiment of the flexible holding device, this comprises a self-contained annular flexible support element, in particular in the form of a band, on which the implants are held at predetermined variable intervals.

In the case of the two abovementioned embodiments with a flexible holding device, it may further be provided that temporary, optionally deformable, support elements, for example of silicone, are arranged between adjacent implants. These temporary support elements serve in particular to stabilize the shape of the flexible holding device and thus facilitate the attachment of the applicator to the heart. Once this is done, the temporary support elements can be removed.

Furthermore, the implants are preferably held on the holding device with an alignment of their bearing surfaces, in which they are aligned parallel or with a deviation of up to 30 ° in each direction to the axis of symmetry of the implant assembly. In the preferred embodiment of the invention, the positioning device is configured so that the implants can be moved from the first to the second arrangement substantially without the occurrence of torsional forces. This avoids that inadvertent forces act on the heart muscle, while the implants are applied to the heart with the device according to the invention.

This further avoids unintentional relative movement of the implants relative to the heart muscle during application.

In a preferred embodiment, the implants held on the holding device are arranged substantially in a circular shape. This then already essentially corresponds to their relative position when they are applied to the heart in the predetermined position.

The support elements of the implants can either have a substantially planar surface or a structured, in particular a curved, surface, which is already adapted approximately to the surface contour of the heart.

The support elements may in particular also be made of resilient materials, in particular porous, elastically yielding materials, so that an adaptation of the surface of the implants to the structure of the heart results when applying tensile and compressive forces to the implants.

Of particular importance is a preferred embodiment of the invention, in which the holding device is self-locking. This means that when transferring the implants from a first arrangement into a second arrangement, the positioning device can optionally be separated from the holding device, so that a compact holding device with the implants held thereon remains in the arrangement then reached and into the body of the patient In particular, to perform the echocardiographic checks to check the degree of remodeling of the heart muscle. If a change is necessary, the positioning device can be docked to the holding device again and the positioning of the implants can be readjusted.

Particularly preferred are devices according to the invention with a positioning device, which is designed as a single-handed operation, especially one-handed operation in the form of a gun or ratchet, in which preferably the movement of the handle industries with a translation to the holding device and thus the position of the implants is transposed against each other.

Preferred implants which can be applied with the device according to the invention comprise a holding part, on which the bearing surfaces are held, while the holding part itself is held on the holding device of the applicator device according to the invention.

In the case of the surgical implant according to the invention, the holding part can be connected with the support element in a force, shape and / or material fit. Particularly preferred is a non-positive or cohesive connection, since here the formation of the support element, in particular with regard to the desired deformation thereof, can take place substantially independently of other aspects.

According to a further alternative, the support element and the holding part may also be integrally formed.

Preferably, the support element of the implant according to the invention is formed from a porous material, so that in the applied state, ingrowth of the surrounding tissue is possible and thus the surgical implant is additionally and in particular permanently secured at the site selected by the surgeon.

The porous material is preferably open-pored and may be selected, for example, from non-woven materials, felt materials, foamed or sintered materials.

The support element is preferably made of a physiologically compatible plastic material, which is preferably based on a TFE polymer or copolymer or polyurethane.

For special applications, it can also be provided that the support element is made of a resorbable material, for example of lactic acid polymers and copolymers.

For the holding part of an implant according to the invention, materials such as metals or ceramics are available in addition to the physiologically compatible, optionally also resorbable plastic materials. Examples of suitable thermoplastic plastic materials are polyamide, polyolefins, in particular polyethylenes, polycarbonates, polyaryletherketones, polyurethanes, polyesters, in particular polyolefin terephthalate, polysulfone and copolymers thereof and their blends. Particularly preferred are polyolefins and polyaryletherketones, for example, polyethylenes and polyetheretherketones.

Furthermore, thermosets are also suitable as plastic material for the holding parts, in particular based on polyester and polyurethane.

In addition, ceramic materials or metal, in particular steel and titanium or titanium alloys are suitable for the manufacture of the holding parts.

If resorbable support elements are used, preferably a resorbable plastic material is also used for the holding parts, for example lactic acid polymers and copolymers.

Preferably, the holding part of an implant according to the invention has two or more passage openings spaced apart from one another the surgeon can pass a needle with the surgical thread in forming a suture.

In a preferred embodiment, the implant according to the invention has a holding part which is equipped with a holder, by means of which the implant can be positioned by means of an application device.

The connection between the implant and the application device is preferably made detachable, so that after a positioning of the implants and their fixation on the tissue structure, for example via a seam, the application device can be detached from the implants and separated.

The above-mentioned possibility to keep the implants according to the invention on the application device solvable will be explained in more detail below with reference to some examples.

A positive connection between the implant according to the invention and the application device by means of positive locking, for example an undercut, can be carried out so that either a radial removal of the implants is possible or an axial distance, wherein the terms "radially" and "axially" on the Arrangement of the multiple implants relative to each other in their orientation on the application device.

The elasticity necessary for releasing the positive connection between implant and holding part can be realized on the one hand by the holding element and / or also by the side of the application device.

A positive connection can be realized not only at the edges of the implant, but also in principle via a positive engagement within the implant.

For producing or canceling a form fit, a switching movement can also be provided, so that a mechanical switching operation is carried out for fixing or releasing or canceling the positive connection.

Also, a form fit according to the principle of operation of the bayonet, which in turn can be solved by a double movement, is possible in the context of the positive connection of the implants according to the invention with at the application device.

A special form of positive connection is a Velcro connection, which is also suitable for holding the implants of the present invention on the application device. In this case, it can be provided that the support element, which preferably has a porous structure, in particular a non-woven structure, covers the holding element of the implant over a large area, if not substantially, so that the counterpart of a hook and loop fastener then fits into the porous structure of the support element can intervene.

Of course, adhesive compounds which can also be designed to be detachable belong to the possible cohesive connections of the implants according to the invention to the application device. A backup of the implants via an adhesive connection can be made in the axial and tangential direction, depending on the particular shape of the implant or the associated holding part. The combination with a bayonet-type connection can prevent the adhesive bond from being subjected to shear.

Finally, a cohesive connection can also be realized as a one-piece design of holding parts of the application device on the one hand and of the holding element of the implant on the other hand, in which case a separation between the implant and the application device can be achieved, for example via a predetermined breaking point.

For non-positive connections in addition to clamp connections and threaded connections can be mentioned. In addition, the implants according to the invention can be held by magnetic forces.

Another alternative of a positive connection can be achieved via a vacuum, wherein suction cups can be used for the passive or active generation of a vacuum. When the vacuum is actively generated, the fluid line required in this case can also support the dissolution by generating an overpressure.

In addition, of course, combinations of positive, positive and cohesive connection are conceivable.

Furthermore, a connection between an implant according to the invention and the holding element can be imagined via a seam, which can then be separated to remove the application device.

In a preferred embodiment of the invention, the surgical implant has a holding part, which on its side facing away from the support element has a receptacle into which a flexible Applizierelement, in particular in the form of a rope, a wire, a thread or a belt, is engageable.

This receptacle can be provided in addition to or as an alternative to the above-described two through openings for creating a seam fixing the implant to the tissue structure, so that additionally or alternatively to a seam connection between implant and tissue structure, fixation of the implants by means of the flexible applicator element can be performed.

The receptacle on the holding part of the surgical implant according to the invention is preferably designed such that the flexible Applizierelement does not protrude beyond the surface of the holding part.

Also, the receptacle can be designed so that it can accommodate more than one flexible Applizierelement, for example, two or three of these Applizierelemente, in particular in a parallel arrangement to each other.

The receptacle is furthermore preferably designed as an abutment for the flexible applicator element, so that the tensile and / or compressive forces exerted on the flexible applicator element can have the largest possible effect on the support element and thus on the tissue of the patient abutting the implant.

Preferably, the holding part can be designed with one or more guide bushings for a needle, so that a guide of the needle is given by the already oriented orientation of the implants and thus also of the holding parts by the holding device of the device according to the invention so that they also slightly opposite Implant meets at the intended location.

The guide bushes such holding parts are preferably present in a plane that are outside of the holding device and thus are freely accessible.

Alternatively or additionally, the implants can also be equipped on their contact surfaces which come into contact with the heart, side remote with a receptacle for a fixing, in particular a flexible band, with the alternative or in addition to the suture a circumferential, atraumatic fixation and Securing the implants can be done in their application position on the heart.

Due to the device according to the invention, the implants can be brought into a predetermined position, an echocardiographic examination of the effect of Remodeling be performed only in this case and only with a satisfactory finding of this review, the final fixation, for example via the flexible band.

• – Bereitstellen einer chirurgischen Vorrichtung zum Applizieren von Implantaten am Herzen mit zwei oder mehr Implantaten mit einem flächigen Auflageelement, mit einer Haltevorrichtung zum Halten zweier oder mehrerer Implantate sowie einer Vorrichtung zum Positionieren der Implantate in vorgegebenen Stellungen am Herzen;
• – Positionieren des Herzens zwischen den zwei oder mehr Implantaten, die an der chirurgischen Appliziervorrichtung gehalten sind;
• – Überführen der zwei oder mehr Implantate aus einer ersten Anordnung in eine zweite Anordnung, in der die Implantate am Herzen anliegen und das Herz in eine vorgegebene Form bringen; und
• – Fixieren der so positionierten Implantate am Herzen und Trennen der Implantate von der chirurgischen Vorrichtung.

The invention further relates to a surgical procedure for remodeling a heart comprising the steps

• - Providing a surgical device for applying implants to the heart with two or more implants with a flat bearing element, with a holding device for holding two or more implants and a device for positioning the implants in predetermined positions on the heart;
• Positioning the heart between the two or more implants held on the surgical applicator;
• Transferring the two or more implants from a first assembly into a second assembly in which the implants abut the heart and bring the heart into a predetermined shape; and
• - Fixing the thus positioned implants to the heart and separating the implants of the surgical device.

Preferably, the surgical procedure is carried out such that before the separation of the implants from the surgical applicator an echocardiographic examination of the remodeling done takes place, optionally with a not entirely satisfactory result of this review, a new positioning of the implants is made.

Preferably, the implants are fixed to the heart muscle only after a satisfactory result of the echocardiographic examination and only then the implants are separated from the surgical device according to the invention.

The separation of the implants of the surgical Appliziervorrichtung can take place according to a variant of the method according to the invention so that the implants are separated from the holding device, so that in the patient essentially only the implants and the suture fixing them and / or the fixing remain. This separation can be done both in the axial and in the radial direction.

According to a further variant, the separation of the implants from the Appliziervorrichtung done so that the holding device, which is preferably designed flexible in this case, remains with the implants in the body of the patient. This allows for a later supplementary remodeling, for example by creating a minimally invasive access to the holding device and repositioning the implants.

These and other advantages of the invention will be explained in more detail below with reference to the drawing. They show in detail:

1 a first embodiment of the surgical application device according to the invention;

2 : a partial aspect of the application device of 1 ;

3A and 3B : a partial aspect of the application device of 1 in two different application positions;

4A and 4B : a partial aspect of the application device of 1 in two different perspectives and positions;

5A and 5B A first and a second variant for a drive principle for the application device of 1 in a schematic representation;

6 A third variant for a drive principle for the application device of 1 in a schematic representation;

7A and 7B A fourth variant for a drive principle for the application device of 1 ;

8th a fifth variant for a drive for the application device of 1 ;

9A and 9B A sixth variant for a drive for the application device of 1 ;

10A and 10B a first and a second modification of the drive of 9A and 9B in a schematic representation;

11 : a third modification of the drive of the 9A and 9B in a schematic representation;

12A and 12B a fourth and fifth modification of the drive of the 9A and 9B in a schematic representation;

13A and 13B a second embodiment of the surgical application device according to the invention;

14A and 14B a third embodiment of the surgical application device according to the invention;

15A and 15B a fourth embodiment of the surgical application device according to the invention;

16A and 16B a fifth embodiment of the surgical application device according to the invention;

17A and 17B a sixth embodiment of the surgical application device according to the invention;

18A and 18B a seventh embodiment of the surgical application device according to the invention;

19 : a detail of the application device of 18A and 18B ;

20A to 20C An eighth embodiment of the surgical application device according to the invention.

1 shows a first embodiment of the Appliziervorrichtung invention 10 for applying four implants 12 ,

The device 10 has a holding device 14 with four retaining elements 16 on which the implants are attached 12 are kept detachable. The holding device 14 is on an annular positioning device 18 arranged.

With the positioning device 18 let the retaining elements 16 the holding device 14 from a first arrangement in which the implants held in pairs lie opposite each other 12 have a large distance from each other, in the in 1 in a substantially synchronous manner, in which the implants abut the tissue structure of the heart and bring them, if desired, into a predetermined new shape, as would be the case, for example, in the remodeling of the myocardium.

The positioning device 18 has a lever mechanism for this purpose 20 preferably detachable on the positioning device 18 is held. The lever mechanism 20 is preferably designed so that when a force is applied to the positioning device 18 for positioning the implants 12 no torsional forces on those of the implants 12 enclosed heart muscle.

Are the implants 12 positioned, the lever mechanism 20 The heart is returned to its normal position in the patient's body and the cardiac function is checked echocardiographically, for example. If necessary, the lever mechanism 20 again at the positioning device 18 docked and the position of the implants 12 be changed again.

Is the optimal position of the implants 12 This can be done either by surgical suturing, piercing the myocardium be secured or alternatively or additionally secured by a flexible Applizierelement.

The implants 12 are preferably made of a deformable support element 22 and a dimensionally stable holding part 24 formed and have a substantially rectangular basic shape.

In an alternative, likewise preferred embodiment of the implants, these have an elliptical basic shape.

The support elements 22 have a bearing surface 26 on which in the longitudinal direction of the implant 12 slightly concave arched is designed. In the transverse direction to have the bearing surfaces 26 on both sides slightly inclined recessed edges 28 on, between which a middle strip 30 is formed concave.

In the end areas of the middle strip 30 are two through holes 32 designed for the simplified performing a surgical suture (not shown).

The holding parts 24 embrace the support elements 22 and are preferably cohesively connected or sewn with them.

On her of the support elements 22 facing away from the holding parts 24 one parallel to the longitudinal direction of the implants 12 extending groove (not shown), which in each case in the region of the passage openings arranged below 32 the support elements 22 ends. The groove can receive the suture so that it does not protrude beyond the exterior surface.

The implants 12 have optional on the holding parts 24 on whose support elements 22 the surface facing away from the surface over the entire longitudinal direction of the implants extending recesses (not shown), which can serve as a receptacle for a flexible Applizierelement (not shown), such as a plastic tape, so that the surgeon either or additionally a fixation of the implants in their final position on the fabric structure with the plastic strap can make. The recess preferably receives the applicator completely, so that it does not over the surface of the holding part 24 also available.

Are the implants 12 secured in its final position, next to the lever mechanism 20 also the positioning device 18 with the holding device 14 from the implants 12 separated and removed, leaving the implants 12 in a situation like in the 1 and 2 for the implants 12 shown to remain on the tissue structure.

The 2 shows in detail the articulation of the holding elements 16 on the annular holding device 14 that is chosen so that the retaining elements 16 synchronously against the center of the holding device 14 can be pivoted.

To drive the pivot mechanism ', the positioning device 18 , which is also designed annular, a sprocket 40 up, over the lever mechanism 20 in the 4A and 4B is again shown in detail, in the circumferential direction of the positioning device 18 can be turned.

With progressive rotation of the sprocket 40 opposite the positioning device 18 swing the holding elements 16 from a first arrangement (not shown) against the center of the holding device 14 or the positioning device 18 until they are in a second arrangement or final position, as shown in the 1 and 2 is shown, in which they capture the myocardium in the predetermined application position and bring in the desired shape.

The 3A and 3B show in detail the pivotal mounting of the holding parts 16 on the holding device 14 as well as the mechanism over which the pivotal movement of the holding parts 16 when turning the sprocket 40 the positioning device 18 is accomplished.

3A first shows the state in which the implants at a maximum distance from each other on the holding device 14 are held (first arrangement); the two swivel arms 42 . 44 a holding part 16 lie close together. The swivel arms 42 . 44 are articulated to a bracket 45 hinged at one end, while the other end hinged to the fixture 14 , as in 3A is shown, held. The holder 45 carries the implant 12 ,

The two swivel arms 42 . 44 grab with their on the fixture 14 hinged ends 48 . 50 on a slide tour 46 of which one per implant is provided and by means of the sprocket 40 the positioning device 18 in the axial direction of the holding device 14 are infinitely displaceable. For this purpose, the sprocket 40 on its inner surface, an internal thread (not shown), which in a corresponding external thread of the holding device 14 intervenes. Will now the sprocket 40 opposite the holding device 14 turned, the ring gear moves 40 in one or the other direction along the axial direction of the holding device 14 and also changes the position of the slide guides 46 in the axial direction of the holding device 14 , Alternatively you can the slide tours 46 also combined to form an annular component.

Will be the link guide 46 in the axial direction of the holding device 14 (in the 3A and 3B moved to the left) become the free ends 48 . 50 the swivel arms 42 and 44 be moved about its pivot point, and there is a pivoting movement of the holding parts 16 towards the center of the holding device 14 ,

The free end 48 of the swivel arm 42 comes after a maximum pivoting movement of the holding elements 16 in a flat contact with the sprocket 40 and a further approximation of the implants attached to the retaining elements 16 or the holder 45 are held, towards the center of the holder 14 is blocked. Such a situation is in 3B shown.

The leadership of the free ends of the two pivot arms 42 . 44 in the slide tour 46 is as low backlash as possible to play, so that a precise guidance of the implants is ensured when guiding from the first to the second arrangement.

Furthermore, the pivot arms 42 . 44 preferably formed as part of a parallelogram, so that an alignment of the implants parallel to the axial direction of the holding device 14 while moving from a first to a second position.

The implants - in the present case four pieces, which are in pairs opposite - move at a change of position from a first arrangement in a second arrangement with a pivoting movement, ie on a circular path, synchronously, continuously with the same Weginkrementen per unit time to the center the holding device 14 to. The implants are at any time of the transfer from the first to the second arrangement in a common plane, wherein the support elements of the implants are each aligned approximately parallel to the axial direction of the holding device. The plane of the support elements relative to the axial direction deviates from the parallelism to the axial direction by at most 30 °.

With this device, the distances of the implants from each other from the first, most open arrangement to the second arrangement, in which the implants are most approximated to each other, can be reduced by about 60%.

The implants 12 For example, about the sutures by piercing through two guide bushes on the side of an implant 12 and a corresponding implementation on the opposite side of the guide bushes of the other implant made a closed thread contour or seam, the train loaded on train the implants then presses against the heart outer wall.

The implants are thus securely attached to the heart muscle and can there after a separation of the holding parts 16 remain as implants.

During the movement of the implants, these are, as described above, on the holding parts 16 or their holders 45 secured, with the retaining bolts used 51 an axially continuous opening 52 and a from the passage opening 52 outwardly extending slot-shaped recess 54 have in each case in the assembled state of the implants in pairs against each other. This ensures that during the insertion of a needle through the passage opening 52 the suture through the slit-shaped opening 54 can reach up to the support element opposite surface of the implant, so that upon release of the retaining bolts 51 from the implants after a complete and successful application of the implants to the myocardium this can be done without interference and obstruction by the sutures.

The retaining bolts 51 For example, at their front end, they may be threaded (not shown) with which they engage with the implants 12 can be screwed. Alternatively, they can be attached to the implants 12 be executed latching.

The sprocket 40 is with its internal thread on the holding device 14 or whose external thread preferably guided self-locking, so that without tangential force on the sprocket 40 this in its respective rotational position relative to the holding element 14 remains and thus also the slide guide 46 with respect to the axial direction of the holding device 14 remains fixed, as well as the pivot position of the pivot arms 42 . 44 , This is the holding elements 16 fixed with the attached implants in their then Applizierposition, until again a tangential force on the sprocket 40 he follows.

The 4A and 4B show the removable designed lever mechanism 20 with two handle branches 60 . 62 , Here is the grip industry 62 firmly on the lever mechanism 20 Molded while the grip industry 60 along a guide 64 in the circumferential direction of the positioning device 18 on the lever mechanism 20 is held displaceable. The grip industry 60 acts on a gear 66 that in the sprocket 40 the positioning device 18 can engage and so a torque on the sprocket 40 transfers.

Preferred forms of power transmission of the lever mechanism 20 on the positioning device 18 are in the 5A and 5B shown schematically. The movement of the handle industry 60 does not work directly on the sprocket 40 , but via a switching gear on the gear 66 , which with the sprocket 40 combs.

The use of a gear change 78 according to the 5A and 5B has the advantage of having the same industry industry movement 60 against the established industry 62 either a closing movement of the holding parts 16 with the implants 12 or an opening movement, in the case that the implants have to be repositioned to the heart muscle again.

The lever mechanism, as in two variants in detail in the 5A and 5B is shown, is designed as a ratchet. In the case of a closing movement of the handle industries 60 . 62 Depending on the switching position, a left or a right turn of the gear results 66 ,

The ratchet function is over an upper and a lower ratchet bar 82 respectively. 84 and a gearbox interposed therebetween 78 realized. The gear 78 includes two gears 86 . 88 , which are on a common wave 90 are rotatably mounted. The wave 90 also carries that into the sprocket 40 engaging gear 66 ,

According to the in 5A shown first variant engages the upper ratchet rod in a first switching position 82 with a rack segment 83 in the gear 86 one while the ratchet rod 84 with her rack segment 85 out of engagement with the gear 88 is. By means of an axial displacement of the gears 86 . 88 can the rack segment 83 out of engagement with the gear 86 and the rack segment 85 in engagement with the gear 88 to be brought. The same movement of the grip industry 60 towards the industry 62 leads so, depending on the shift position of the transmission 78 , to a left or right turn of the sprocket 40 the positioning device 18 ,

The ratchet bars are preferred 82 . 84 in the radial direction of the gears 86 . 88 spring-mounted, so that during a return movement of the handle industry 60 no driving forces on the gears 86 . 88 Act.

The 5B shows a second variant of the transmission 78 in which the two ratchets 82 . 84 permanently to the axial position of the two gears 86 . 88 are aligned. An alternating engagement of the rack segments 83 and 85 in the gears 86 respectively. 88 is achieved in this variant in that the pair of ratchet 82 . 84 perpendicular to the axis of the shaft 90 is moved. In a lower switching position thus engages the rack segment 83 in the sprocket of the gear 86 a, while in an upper switching position of the ratchet rod pair, the rack segment 85 in the sprocket of the gear 84 intervenes.

About an interaction of ratchet bars 82 . 84 and ratchet wheels 86 respectively. 88 becomes the translational movement of the industry 60 in a rotational movement of the gear 66 transformed. Due to the different points of attack of the ratchet rods results in each set rotational direction.

The advantage of a ratchet with the described transmission 78 lies in the fact that different rotational movements can be realized in the same sequence of movements. About the transmission 78 can then also a translation of the movement of the handle element 60 or its ratchet wheel on the gear 66 to a larger angular change or rotational movement in the ring gear 40 respectively.

In the 6 is another alternative drive form with a rack pair 98 shown at the two parallel racks 100 . 102 from the handle industry 60 alternately driven on a gear 104 act on a common wave 106 with the gear 66 is mounted. The racks 100 . 102 grab either, as in 6 shown at the top of the gear 104 on or - with a shift of the rack pair 98 such that the rack 102 with the gear 104 is engaged - from below. Again, about the gear 66 the respective resulting rotational movement on the sprocket 40 the positioning device 18 transfer. To return the handle industry 60 becomes the rack pair 98 each out of engagement with the gear 104 brought.

Other alternatives for driving the sprocket 40 the positioning device 18 are in the 7A and 7B shown in the implementation of a drive torque via a gear on the gear 66 can be used. It makes sense to provide a freewheel (not shown) in these solutions. The switching function is then implemented in the transmission.

According to a variant of 7A becomes a drive torque of a drive axle 110 by means of a gear rotatably mounted thereon 112 in a first switching position on a gear 114 transfer, which is on a common shaft 116 with the sprocket 40 driving gear 66 is mounted.

In a second switching position, the gear 112 on the drive axle 110 shifted in the axial direction, so that the gear 112 with an internal gear 118 combs, which also on the shaft 116 is mounted. With the same direction of rotation of the drive axle 110 this results in a reversal of rotation in the rotation of the shaft 116 and the gear 66 and thus the driven sprocket 40 ,

7B shows a further variant in which the drive torque of the drive axle 110 over the rotatably mounted gear 112 in a first switching position via a gear 113 on the on the wave 116 mounted output gear 114 is transferred and thus on the with the ring gear 40 meshing gear 66 ,

In a second switching position that is on the shaft 116 mounted gear 114 shifted in the axial direction, so this with an external gear 119 combs. With the same direction of rotation of the drive axle 110 this results in a reversal of the direction of rotation of the output shaft 116 and the gear held thereon 66 and thus in the case of the driven sprocket 40 ,

Preferably, the translation between the movement of the industry 60 towards the industry 62 designed so that a displacement of the implants from the first arrangement, in which a maximum distance between paired implants is given, until reaching the second arrangement in which the implants are at maximum approximated, eight to twelve movements of the handle are needed. This allows, on the one hand, a rapid adaptation of the arrangement of the implants to the particular conditions of the heart muscle, on the other hand, a sufficiently fine coordination of the positioning of the implants can be made to the heart. At the same time this allows a pitch of the thread of the threaded connection of sprocket 40 and holding device 14 , which acts self-locking.

Preferably, the applicator device according to the invention is designed such that the translation is greater when approaching the paired implants than when opening, i. when moving in the opposite direction, since when closing by the resistance of the heart muscles greater forces must be overcome.

Alternatively it can be provided that the closing mechanisms described above are designed so that when opening the opposite rotational movement is only released and does not need to be supported.

The movement of the handle branches against each other is preferably supported by a spring so that the industry 60 When opening is moved by spring force.

The 8th shows one way, the lever mechanism 20 with the positioning device 18 and the retaining ring 14 connect to. For this purpose, the handle unit 20 on the retaining ring 14 and the positioning device 18 be clicked. The resulting positive connection can be solved by a lever again.

In 8th is a simplified embodiment of the drive mechanism of the positioning device 18 shown, in which only the movement of the implants in the closing direction is possible. The sprocket 40 ' is in each case in the position reached by the engagement of a latching element 120 held. There is no need for a self-locking thread in the connection between the sprocket 40 ' and the sprocket 40 ' carrying holding device 14 , Here then also the slope of the thread of the threaded connection of holding device can be 14 and the sprocket 40 ' increase, as it does not depend on a self-locking. The number of movements of the branches 60 . 62 for positioning the implants can be minimized here.

The sprocket 40 ' has in this embodiment in the axial direction aligned teeth with a steep and a gently sloping edge, while in the previously discussed embodiments of the ring gear 40 was formed with radially projecting teeth. Preferably, the drive device is designed so that the handle part can be fixed by 180 ° to the positioning and holding device fix. As a result, a rotation reversal can be accomplished in this embodiment as well.

In the 9A and 9B a variant is shown in which a sprocket 40 '' is used, the teeth are aligned with a steep and a gently sloping flank again in the axial direction. The sprocket 40 '' has a radially inner and a radially outer sprocket track 130 . 132 on. A driver 134 the positioning device 18 Depending on the switching position, it engages either inside or outside the sprocket track 130 respectively. 132 and allows only by means of a switch the reversal of the direction of rotation without the handle part 20 from the positioning device 18 would have to be disconnected.

A similar principle is shown once more in a schematic representation of the 10A and 10B in which the intervention of a driver 136 is shown for both directions of rotation (one in dash-dot representation).

The engagement between the driver is preferred 136 and the sprocket 40 '' maintained spring loaded upright. The driver 136 preferably has tooth gaps 138 on, which have a rectangular cross-section.

Another alternative is schematically in the 11 shown. Here is a sprocket 40 ''' used, which has radial (steep) tooth flanks, in which a driver 140 engaged spring loaded. The driver 140 includes two parallel rows of teeth 142 . 144 , which can be selected by turning the driver accordingly 140 180 ° about its axis of rotation 141 with the sprocket 40 ''' can be brought into engagement. The teeth of the rows of teeth 142 . 144 each have a steep and a gently sloping edge.

Depending on which of the rows of teeth 142 . 144 with the sprocket 40 ''' is engaged, can a right or a left turn of the sprocket 40 ''' be effected.

The 12A and 12B show further exemplary modifications of the previously discussed drive devices of the positioning device 18 ,

In 12A is opposite to in 10 variant shown a pin-like driver 150 present with the handle industry 60 is coupled.

For reversing the direction of rotation of the sprocket 40 '' becomes the driver 150 on a knob 152 stored, with by a 180 ° rotation of the driver 150 instead of the in 12A shown engagement in the radially inner sprocket track 130 in engagement with the radially outer gear rim track 132 can be brought (dash-dotted representation).

According to the variant of 12B the direction of rotation is changed as follows:
A driver 170 is with two tooth segments 172 . 174 formed in the circumferential direction of the double ring gear 40 '' are arranged in parallel. The two tooth segments 172 . 174 of the driver 170 are in the axial direction of the sprocket 40 '' adjustable. So can optionally the inside sprocket segment 172 or the outer sprocket segment 174 be locked in an engaged position, in which case the engagement of the driver 170 with the inner tooth trace 176 or the outer tooth trace 178 of the sprocket 40 '' results. This in turn creates the possibility of the sprocket 40 '' to move in a clockwise or counterclockwise direction.

The 13A and 13B show an applicator according to the invention 200 in which the implants are not held on an annular holding device, but on a holding device 202 with three gripping arms 204 . 205 . 206 holding three implants in a circular array at substantially equal angular intervals for application (implants not shown). The holding device 202 is at a positioning device 210 with a pistol grip 212 held. The implants are again applied with a synchronous movement of the gripping arms 204 . 205 . 206 with the same path increments per time unit. For provisional fixation of an application position of the implants, the branches of the handle 212 via a locking device 214 being held.

The securing of the implants to the myocardium can take place, for example, via a band (not shown) fixing the implants on its outer side. The myocardium need not be punctured in this arrangement and this type of fixation. Preferably, the band for fixing the implants already in the assembly of the implants to the still open Appliziervorrichtung 200 assembled. To keep the band under tension is a tensioning device 220 intended. As the implants approach each other, the ligament tension will become constant with the tensioner 220 adjusted, so that the tape remains securely held on the outer surfaces of the implants. A locking of the branches of the handle 212 is then no longer necessary.

After application of the implants to the heart muscle, the Appliziervorrichtung 200 are withdrawn, with the implants remain fixed on the strained band on the heart muscle. It is now possible to examine echocardiographically whether the implants have already adequately achieved the remodeling of the heart muscle. Optionally, via the tensioning device 220 the band can be readjusted in its tension or the device 200 can be placed on the implants again and over the pistol grip 212 a supplementary adjustment of the positions of the implants are made.

In the 14 and 15 two holding devices for an applicator according to the invention are shown, in which the implants can be moved linearly and radially to a center of the holding device. A positioning device with the corresponding drive can be configured, as already described in connection with FIGS 1 to 12 has been described in detail and in several variants.

The linear guide in the embodiments of 14 and 15 is designed in each case so that a force only on two opposite holding parts must be made to move all four retaining elements synchronously to the center.

Even with the applicator devices according to the invention, which include this type of holding devices, an echocardial examination can be carried out before securing the implants by means of a ventricular puncture.

The 14A and 14B show a third embodiment of the applicator according to the invention on a part of the positioning device 250 and the holding device 252 reduced. The holding device 252 includes four holding parts 254 on which implants can be used in pairs.

The positioning device 250 includes four similarly designed angle elements 256 with two legs oriented substantially at right angles to each other 258 . 260 , one of which, here thighs 258 , as sliding guide with a groove 262 is formed while the other leg 260 complementary to the cross section of the groove 262 as a sliding element 264 is trained.

Through the mutual meshing of groove 262 and sliding element 264 creates a mutual slide guide, which allows, with two opposing force introduction points a synchronous movement of the four holding parts 254 to the middle of the device 252 make. The limitation of movement is by mutual abutment or abutment surfaces of the angle elements 256 Are defined.

While 14A the Appliziervorrichtung in maximum open state shows is in the 14B the closed state with maximum approximation of the implants shown.

Another principle is in the 15A and 15B shown.

The holding device 270 In this embodiment of an application device according to the invention comprises four holding elements 272 . 273 . 274 . 275 placed in opposite positions on a positioning device 280 are held. The attached to the holding elements implants 282 are aligned in pairs.

The positioning device 280 comprises two essentially U-shaped carriages 284 . 286 , In the middle of this sled 284 . 286 are the holding parts 273 . 275 fixed while the holding parts 272 and 274 in guides 290 . 292 are held displaceable at 45 °.

The U-shaped sledges 284 . 286 each have parallel aligned webs 294 . 295 and 296 . 297 subdivided legs, wherein each of the webs 294 . 295 are spaced apart so that they between them the webs 296 . 297 can be taken in a guided manner.

The mutually facing, abutting surfaces of the webs 294 . 296 and 295 . 297 are preferably with a tooth grid 298 provided, which the two sleds 284 . 286 in a given position keeps each other self-locking.

When approaching the two sleds 284 . 286 be the two holding parts 273 and 275 consistently aligned, while the two holding parts 272 and 274 in the guides 290 . 292 synchronous to the movement of the holding parts 273 . 275 to be moved toward each other towards the center of the device. Again, the orientation of the holding parts is maintained each other.

In the 16A and 16B is another alternative applicator 300 of the present invention, in which also no circular holding device is used. The Appliziervorrichtung 300 has a holding device 302 for each of the implants to be applied (the latter in the 16 not shown), four pivotable in parallel planes holding arms 304 . 305 . 306 . 307 includes, each with one end hinged to a support frame 310 are held. At the free ends of the support arms 304 . 305 . 306 . 307 the implants are placed.

In an open position, this Appliziervorrichtung invention 300 are placed laterally over the heart, while the applicators previously discussed are axially, ie coming from the apex, to place on the heart muscle.

By means of a positioning device, which in the 16A and 16B only partially shown, can be the lever arms 304 . 305 . 306 . 307 swivel synchronously, with the arms out of the 16A shown open position in a 16B shown closed position or second arrangement of the implants are transferred. The implants placed with this device can also be secured via a ventricular puncture or else via a fixing means, such as a band, running on the outside of the implants. With the fixation by means of ventricular puncture, this type of placement has a certain disadvantage, since it can not be ensured that the opposing implants are exactly aligned with each other so that the provided in the implants openings for the passage of the needle with the suture in alignment with each other are arranged. However, a great advantage of this Appliziervorrichtung invention is the small axial space requirement, ie a maximum view of the surgeon on the heart to be treated.

In the 17A is another Appliziervorrichtung invention 350 shown, in contrast to the previously discussed inventive Appliziervorrichtungen a flexible instead of a dimensionally stable holding device 352 having. Also in this device are implants 354 . 355 . 356 . 357 aligned in pairs on a bracket consisting of several bands 352 arranged.

This remains with a transfer of the implants 354 . 355 . 356 . 357 the implant 354 stationary while the two implants 355 . 357 both are moved synchronously against each other.

The implant 356 is compared with twice the path increment per unit of time compared to the implants 355 . 357 moves, so that again a synchronous, even approach of the implants 354 . 356 results.

On the holding device 352 is a roll-up mechanism for this purpose 360 with a knob 362 provided in which the bands via corresponding hubs 370 be wound up with the required different lengths per time increment.

For better handling of the Appliziervorrichtung 350 This can initially be provided in the original state with a silicone ring or silicone segments, the or the individual implants 354 . 355 . 356 . 357 stabilized in a correct Applizieranordnung or stabilize, as in connection with the 17B will be described in more detail. In particular, this helps to prevent the ligament from twisting while it is being applied to the heart muscle.

In this embodiment of the applicator according to the invention, it is again possible to check the resulting shape of the heart echocardiographically before the implants are finally - be it about suture with appropriate ventricular punctures or a fixation of the tapes in their final form - set.

17B shows a variant of the Appliziervorrichtung the 17A denoted by the reference numeral 400 is provided, are used in the three bands to synchronously transfer the implants from a first arrangement to a second arrangement.

The Appliziervorrichtung 400 again has a holding device constructed of bands 402 on, on the four implants 404 . 405 . 406 . 407 placed in pairs in opposite directions. First, the flexible fixture 402 in circular form by silicone ring segments inserted between the implants 410 . 411 . 412 . 413 temporarily stabilized so that it can be more easily placed on the myocardium.

When the implants are transferred from a first arrangement into a second arrangement, the implant remains 404 stationary while the implant 406 with a double path increment per unit time by band 420 is moved compared to the implants 405 and 407 that by means of the bands 422 and 424 to be moved.

The actuator 430 points first, similar to those in 17A shown embodiment of the invention, a Aufrollmechanik 434 but which instead of a knob 362 a handle industry pair 436 has, whose pivotal movement by means of a transmission gear 438 with the roll-up mechanism 434 is coupled.

The handle industry pair 436 can be removed after applying the implants of the Aufrollmechanik 434 release, leaving the heart with the holding device 402 and the reeling mechanics 434 can be placed in the body of the patient.

Again, an echocardiographic check of the achieved heart shape can be made before the implants are finally fixed to the heart by means of a ventricular puncture.

Alternatively, the holding device can remain at the heart with the advantage that after disconnecting the actuator 430 at a later time a repositioning or remodeling can be performed by means of minimally invasive surgery.

Instead of the bands, other flexible transport media may also be used in the previously described embodiments of the applicators according to the invention, such as e.g. Chains, wires, ropes, threads etc.

If wires, ropes or threads are used, preferably two juxtaposed parallel threads, wires or ropes are used as Torsionssicherung.

In addition, in these devices according to the invention (type of 17A and 17B ) conceivable that the Appliziervorrichtung total spent on a minimally invasive procedure in the interior of a patient's body and then applied there.

In the case that the introduction of the Appliziervorrichtung 350 respectively. 400 Difficulty may also be another lateral access or another access above a higher level Intercostal space done with the then Appliziervorrichtung invention 350 respectively. 400 prepositioned on the epicard. If necessary, also tubular shaft instruments can be used to help.

An additional advantage of the flexible holding devices 352 respectively. 402 the embodiment of the Appliziervorrichtung invention described above 350 respectively. 402 is that the coronary arteries or the epicardium are spared because direct contact with the epicardium can be largely or completely avoided by the support points of the bands. This has the particular advantage that during the rolling of the bands, ie when transferring the implants from a first arrangement into the second arrangement, in which the implants occupy a smaller distance from each other, no friction between the bands and the epicardium occurs. A possible risk of injury is thereby minimized or eliminated.

Another embodiment of the invention is in the 18A and 18B in the form of an applicator 450 shown with a holding device 452 which essentially consists of four web-like holding elements 454 . 455 . 456 . 457 is formed, which are connected together at one of its ends and at its other, each free end a holding part 460 . 461 . 462 . 463 for an implant 466 wear (in 18 is just one of the implants 466 shown).

The implants 466 are again aligned in pairs and lying opposite each other on the fixture 452 prepositioned and can by means of a flexible support medium (not shown), in particular a belt or the like., Via a Aufrollmechanik 470 located on one of the footbridges (here jetty 456 ), wound up, approximated to each other.

The roll-up mechanism 470 forms together with the flexible support medium in this embodiment, the positioning device.

The operating principle of the applicator 450 differs from the functional principle of Appliziervorrichtungen previously discussed in that here - depending on the resistance of the heart wall and the restoring force of the typically designed as a spring element webs 454 . 455 . 456 . 457 - Different path increments of the implants 460 per unit time.

The bridges 454 . 455 . 456 . 457 can be made of metal or a plastic. For different heart sizes are different lengths of the bars 454 . 455 . 456 . 457 needed.

After fixation of the implants 466 on the myocardium can the holding device 452 be removed, as well as the Aufrollmechanik 470 with the tape.

In the occurring forces, it may well happen that not only an elastic deformation of the webs 454 . 455 . 456 . 457 but also a partial plastic deformation, but with regard to the fixation of the implants 466 is unproblematic about a band.

Again, a fixation of the implants 466 via a ventricular puncture and an echocardiographic examination must be carried out beforehand.

19 shows in detail the roll-up mechanism 470 as part of the positioning device in partially opened form with the drive shown there for the transport medium, in particular the band with which the implants 466 be transferred from a first arrangement in a second arrangement in which the spacings of the implants are reduced to each other.

In the 20A and 20B is another Appliziervorrichtung invention 500 shown in which a holding device 502 four implants 504 on an annular base element 506 via spring-loaded articulated arms 510 from a first, open arrangement holds in a second, closed arrangement transferred. Double-jointed arms 510 are with the holding parts 512 for the implants 504 connected so that an arrangement of opposing implants is always ensured in parallel alignment. As a positioning device (not shown) can in this Appliziervorrichtung invention 500 one around the outsides of the implants 504 extending belt with a winding device (not shown), similar to the one in FIG 19 shown, are used.

When releasing the tension of the band is due to the on the webs 510 acting spring force (see. 20C ) the implant 504 returned to its original position.

QUOTES INCLUDE IN THE DESCRIPTION

This list of the documents listed by the applicant has been generated automatically and is included solely for the better information of the reader. The list is not part of the German patent or utility model application. The DPMA assumes no liability for any errors or omissions.

Cited patent literature

• WO 2008/011411 A2 [0005]

Claims (25)

 A surgical device for applying implants to the heart, comprising two or more implants with a flat support element; a holding device for holding two or more implants; such as a device for positioning the implants in predetermined positions on the heart. Apparatus according to claim 1, characterized in that the number of implants is straight, wherein preferably two implants are arranged on the holding device in pairs opposite each other. Apparatus according to claim 1 or 2, characterized in that the implants are arranged on the holding device symmetrically to a center. Device according to one of claims 1 to 3, characterized in that the implants by means of the positioning substantially synchronously from a first arrangement into a second arrangement can be transferred, wherein the implants in the second arrangement maintain a smaller distance from one another than in the first arrangement. Device according to one of claims 1 to 4, characterized in that the implants are substantially rectilinearly transferred from a first arrangement into a second arrangement by means of the positioning device, wherein the implants in the second arrangement maintain a smaller distance from one another than in the first arrangement. Device according to one of claims 1 to 5, characterized in that the implants are substantially continuously transferred by means of the positioning device from a first arrangement into a second arrangement, wherein the implants in the second arrangement maintain a smaller distance from one another than in the first arrangement. Device according to one of claims 1 to 6, characterized in that the implants can be transferred by means of the positioning device from a first arrangement in a second arrangement, wherein the implants in the second arrangement maintain a smaller distance from one another than in the first arrangement, wherein the mutual Distance from paired implants in the second arrangement is reduced to about 40% of the distance in the first arrangement. Device according to one of claims 4 to 7, characterized in that the distance of pairs of mutually associated implants during transfer from the first to the second arrangement per Zeitinkrement is reduced by a substantially equal amount. Device according to one of claims 4 to 7, characterized in that the implants are applied during the transfer from the first to the second arrangement with substantially equal forces. Device according to one of claims 1 to 9, characterized in that the positioning device comprises a drive device with a transport medium with which the implants on the holding device from the first arrangement in the second arrangement can be transferred. Apparatus according to claim 10, characterized in that at least a portion of the implants are assigned independently operable transport media, preferably selected from tapes, chains, ropes, wires and threads. Apparatus according to claim 10 or 11, characterized in that the transport medium comprises hydraulically or pneumatically actuable actuators. Device according to one of claims 10 to 12, characterized in that the implants are in the second arrangement by means of the transport or the particular releasably fixed. Device according to one of claims 1 to 13, characterized in that the holding device is dimensionally stable and is preferably formed substantially annular or oval. Device according to one of claims 1 to 14, characterized in that the holding device extends substantially in a plane and that the implants are held in a common direction out of this plane outstanding on the holding device. Apparatus according to claim 15, characterized in that the implants are arranged in a common second plane, which is preferably aligned parallel to the first plane. Device according to one of claims 1 to 13, characterized in that the holding device is flexible and optionally made of a physiologically compatible material. Apparatus according to claim 17, characterized in that the holding device comprises flexible struts, which at one of its ends are connected to each other and at the free ends of each implant is held. Device according to one of claims 1 to 18, characterized in that the implants are held on the holding device with an orientation of their support surfaces in which they are aligned parallel or with a deviation of up to about 30 ° in each direction to the axis of symmetry of the arrangement , Device according to one of claims 1 to 19, characterized in that the positioning device moves the implants from the first to the second arrangement substantially torsion-free. Device according to one of claims 1 to 20, characterized in that the holding device is self-locking. Device according to one of claims 1 to 21, characterized in that the positioning device comprises a one-handed operation. Apparatus according to claim 22, characterized in that the one-hand operation is designed as a ratchet or ratchet. Method according to one of claims 1 to 23, characterized in that the support elements of the implants have a structured surface, which serves the contact with the heart. Device according to one of claims 1 to 24, characterized in that the implants comprise a holding part, on which the bearing surfaces are held, while the holding part is held on the holding device.

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