US20030187499A1 - Medical anastomosis apparatus - Google Patents

Medical anastomosis apparatus Download PDF

Info

Publication number
US20030187499A1
US20030187499A1 US10/351,954 US35195403A US2003187499A1 US 20030187499 A1 US20030187499 A1 US 20030187499A1 US 35195403 A US35195403 A US 35195403A US 2003187499 A1 US2003187499 A1 US 2003187499A1
Authority
US
United States
Prior art keywords
connector
members
conduit
graft
annularly
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Abandoned
Application number
US10/351,954
Inventor
William Swanson
Mark Wahlberg
Jason Galdonik
Todd Berg
Scott Thome
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Individual
Original Assignee
Individual
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Individual filed Critical Individual
Priority to US10/351,954 priority Critical patent/US20030187499A1/en
Publication of US20030187499A1 publication Critical patent/US20030187499A1/en
Abandoned legal-status Critical Current

Links

Images

Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/82Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/86Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure
    • A61F2/88Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure the wire-like elements formed as helical or spiral coils
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/064Surgical staples, i.e. penetrating the tissue
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/064Surgical staples, i.e. penetrating the tissue
    • A61B2017/0641Surgical staples, i.e. penetrating the tissue having at least three legs as part of one single body
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B2017/1135End-to-side connections, e.g. T- or Y-connections
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B2017/1139Side-to-side connections, e.g. shunt or X-connections
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2220/00Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0008Fixation appliances for connecting prostheses to the body
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2220/00Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0008Fixation appliances for connecting prostheses to the body
    • A61F2220/0016Fixation appliances for connecting prostheses to the body with sharp anchoring protrusions, e.g. barbs, pins, spikes
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2220/00Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2220/0075Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements sutured, ligatured or stitched, retained or tied with a rope, string, thread, wire or cable
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2230/00Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0002Two-dimensional shapes, e.g. cross-sections
    • A61F2230/0028Shapes in the form of latin or greek characters
    • A61F2230/005Rosette-shaped, e.g. star-shaped
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2230/00Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0002Two-dimensional shapes, e.g. cross-sections
    • A61F2230/0028Shapes in the form of latin or greek characters
    • A61F2230/0054V-shaped
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2250/00Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2250/0058Additional features; Implant or prostheses properties not otherwise provided for
    • A61F2250/0067Means for introducing or releasing pharmaceutical products into the body

Definitions

  • This invention relates to medical apparatus, and more particularly to apparatus for use in making anastomotic connections between tubular body fluid conduits in a patient.
  • An anastomotic connection is a connection which allows body fluid flow between the lumens of the two conduits that are connected, preferably without allowing body fluid to leak out of the conduits at the location of the connection.
  • a tubular graft supplied with aortic blood may be connected via an anastomosis to the contrary artery downstream from the obstruction.
  • the anastomosis may be between the end of the graft and an aperture in the side wall of the coronary artery (a so-called end-to-side anastomosis), or the anastomosis may be between an aperture in the side wall of the graft and an aperture in the side wall of the coronary artery (a so-called side-to-side anastomosis (e.g., as in published Patent Cooperation Treaty (“PCT”) patent application WO 98/16161, which is hereby incorporated by reference herein in its entirety)).
  • the graft may be natural conduit, artificial conduit, or a combination of natural and artificial conduits.
  • natural conduit it may be wholly or partly relocated from elsewhere in the patient (e.g., wholly relocated saphenous vein or partly relocated internal mammary artery).
  • no relocation of the graft may be needed (e.g., as in above-mentioned application WO 98/16161 in which a length of vein on the heart becomes a “graft” around an obstruction in an immediately adjacent coronary artery).
  • More than one anastomosis may be needed.
  • a second anastomosis may be needed between an upstream portion of the graft conduit and the aorta or the coronary artery upstream from the obstruction in that artery.
  • this second anastomosis may be either an end-to-side anastomosis or (as shown, for example, in above-mentioned application WO 98/16161) a side-to-side anastomosis.
  • no second, upstream anastomosis may be required at all (e.g., if the graft is an only-partly-relocated internal mammary artery).
  • a connector for use in making an anastomotic connection between two tubular body fluid conduits in a patient, the connector being of substantially one-piece or unitary construction which extends annularly about a central longitudinal axis.
  • the structure of the connector includes axially spaced first and second portions, at least one of which includes members that are deflectable radially out from a remainder of the connector structure. In some embodiments both of the axially spaced first and second portions include members that are deflectable radially out from a remainder of the structure.
  • the connector structure is annularly enlargeable, preferably by inflation of a balloon placed temporarily inside the connector.
  • the structure of the connector preferably lends itself to formation by removal of selected material from a single unitary tube.
  • the connector is typically made of metal which is plastically deformable (e.g., in the above-mentioned radial outward deflections and annular enlargement).
  • the members that are deflectable radially out from the first portion of the connector structure are configured to engage the side wall of one of the two tubular body fluid conduits that are to be connected.
  • the members that are deflectable radially out from the second portion of the connector structure are configured to engage the side wall of the other of the two body fluid conduits that are to be connected.
  • one of the two portions of the connector can be secured (preferably pre-secured) to the associated conduit by other means such as sutures.
  • Annular expansion of the connector preferably causes the first and second portions of the connector structure to move toward one another along the central longitudinal axis of the connector, thereby causing the connector to draw the two tubular body fluid conduits together at the anastomosis between them. This helps produce an anastomosis which is fluid-tight (i.e., from which body fluid does not leak).
  • the connectors of this invention can be used to provide either end-to-side or side-to-side anastomoses.
  • the connector may be first attached to one of the body fluid conduits to be connected (e.g., an end portion of a graft conduit), and then delivered along with the attached end of the first conduit to the connection point with the second conduit, where the connector is fully deployed to produce an anastomosis between the first and second conduits.
  • the connector Prior to full deployment the connector preferably has a relatively small circumference, which facilitates delivery and initial installation in the patient, even at relatively remote or inaccessible locations in the patient.
  • the connector can be delivered via lumens of body fluid conduits in the patient and/or relatively small-diameter instrumentation such as a cannula or laparascopic-type device. Final installation can be performed substantially solely by inflation of a balloon temporarily disposed in the connector. No direct manipulation of the connector may be needed. All of these attributes facilitate use of the connector at remote or inaccessible locations in the patient. The connector therefore lends itself to use in less invasive or minimally invasive procedures.
  • Instrumentation for facilitating installation of the connector through the side wall of a body fluid conduit is also disclosed.
  • This instrumentation has a gradually tapered distal nose portion with an outer surface that is free of features that could snag on the side wall of the body fluid conduit to be penetrated by the nose portion.
  • At least the portion of the connector that must pass through the body fluid conduit side wall is completely covered by the instrumentation until that portion of the connector is through the side wall.
  • FIG. 1 is a simplified planar development of the structure of an illustrative embodiment of a connector constructed in accordance with this invention.
  • FIG. 2 is a simplified perspective view of the actual structure of the connector which is shown in planar development in FIG. 1.
  • FIG. 3 is a simplified elevational view of the FIG. 2 structure after some further processing in accordance with the invention.
  • FIG. 4 is a simplified planar development of the structure of FIGS. 1 - 3 showing that structure's capacity for annular enlargement in accordance with the invention.
  • FIG. 5 is a simplified elevational view of the structure of FIG. 3 with some additional structure in accordance with the invention.
  • FIG. 6 is a simplified elevational view, partly in section, of the structure of FIG. 5 with still more additional structure in accordance with the invention.
  • FIG. 7 is a simplified sectional view of the structure of FIG. 6 with additional illustrative apparatus shown for use in delivering and deploying the FIG. 6 structure in a patient in accordance with the invention.
  • FIG. 8 is a simplified elevational view, partly in section, showing an early stage in use of the FIG. 7 apparatus in accordance with the invention.
  • FIG. 9 is a view similar to FIG. 8, but with more elements shown in section, and showing a later stage in use of the FIG. 7 apparatus in accordance with the invention.
  • FIG. 10 is a view similar to FIG. 9 showing a still later stage in use of the FIG. 7 apparatus in accordance with the invention.
  • FIG. 11 is a view similar to FIG. 10 showing the end result of using the FIG. 7 apparatus in accordance with the invention.
  • FIG. 12 is a view similar to FIG. 1 for another illustrative embodiment of a connector constructed in accordance with the invention.
  • FIG. 13 is a view similar to FIG. 4, but for the embodiment of FIG. 12.
  • FIG. 14 is a simplified perspective view showing the connector of FIG. 12 with other elements in accordance with the invention.
  • FIG. 15 is another simplified perspective of a later stage in use of some of the elements shown in FIG. 14.
  • FIG. 16 is another simplified perspective view, partly in section, of a still later stage in use of the elements shown in FIG. 15.
  • FIG. 17 is another view, generally similar to FIG. 16, showing an even later stage in use of the elements shown in FIG. 16.
  • FIG. 18 is a simplified perspective view of a completed anastomosis including the connector of FIG. 12.
  • FIG. 19 is another view, partly in section, of the anastomosis of FIG. 18.
  • FIG. 20 is a simplified perspective view of an illustrative embodiment of a starting structure for use in making connectors in accordance with the invention.
  • FIG. 21 is a simplified elevational view, partly in section, illustrating a possible modification of connectors in accordance with the invention.
  • FIG. 22 is a simplified elevational view, partly in section, illustrating another possible modification of connectors in accordance with the invention.
  • FIG. 23 is a simplified sectional view of an alternative finished anastomosis in accordance with the invention.
  • FIG. 24 is a view similar to FIG. 4 for still another illustrative embodiment of a connector constructed in accordance with the invention.
  • FIG. 25 is a view similar to FIG. 11 for a completed anastomosis employing a connector of the type shown in FIG. 24.
  • FIG. 1 shows a planar development of what is actually an integral, one-piece (unitary), annular structure 10 .
  • the left and right edges of the structure shown in FIG. 1 are actually joined to and integral with one another.
  • FIG. 2 shows the actual structure.
  • a central longitudinal axis 12 about which structure 10 is annular is shown in FIG. 2.
  • An illustrative material for structure 10 is 304 stainless steel.
  • suitable materials include tantalum, tungsten, platinum, and nitinol.
  • Structure 10 may be advantageously produced by starting with a single, unitary metal tube and removing selected material until only the structure shown in FIG. 2 remains. For example, laser cutting may be used to remove material from the starting tube in order to produce structure 10 .
  • connectors 10 can be made in various sizes for various uses, a typical connector has an initial outside diameter in the range from about 0.040 to about 0.065 inches, an initial length of about 4.0 mm, and a material thickness of about 0.004 inches.
  • Connector 10 may be described as including axially spaced first and second portions 20 and 40 , respectively.
  • First portion 20 includes a plurality of annularly spaced members 22 that in this case have free end portions 24 that are sharply pointed and that point toward second portion 40 .
  • Each of members 22 is deflectable radially out from the remainder of structure 10 as shown, for example, in FIG. 3. This outward deflection is preferably at least partly plastic.
  • Second portion 40 also includes a plurality of annularly spaced members 42 that in this case have free end portions 44 that are sharply pointed and that point toward first portion 20 .
  • Each of members 42 is deflectable radially out from the remainder of structure 10 as shown, for example, in FIG. 3. Again, this outward deflection is preferably at least partly plastic.
  • Connector 10 is formed in such a way that it is annularly enlargeable (e.g., by inflation of a balloon that is temporarily disposed inside the connector).
  • the annularly expanded condition of connector 10 is shown in FIGS. 4, 10, and 11 .
  • the annular expandability of connector 10 is provided by making the connector with a plurality of annularly adjacent, annularly enlargeable cells.
  • a typical cell includes annularly spaced, but adjacent, longitudinal members 50 a and 52 a . The axially spaced ends of this pair of members are connected to one another at 54 a and 56 a .
  • the next annularly adjacent similar cell includes elements 50 b , 52 b , 54 b , and 56 b .
  • Annularly adjacent ones of these cells are connected to one another (e.g., as at 66 a ) at locations which are axially medial to their axial end connections 54 and 56 .
  • structure 10 is annularly enlargeable by annularly enlarging each of the above-mentioned cells (see FIG. 4).
  • structure 10 includes other, similarly annularly expandable cells that are axially and annularly offset from the first-described cells.
  • a representative one of these other cells includes annularly adjacent longitudinal members 60 a and 62 a , the axially spaced ends of which are connected at 64 a and 66 a .
  • part of member 60 a is common with part of member 52 a
  • part of member 62 a is common with part of member 50 b .
  • the next annularly adjacent cell of this kind includes components 60 b , 62 b , 64 b , and 66 b .
  • Annularly adjacent cells of this kind are connected to one another at locations like 54 b , which are axially medial the axial endpoints 64 and 66 of those cells.
  • the structure is annularly enlargeable by annularly enlarging these cells as shown, for example in FIG. 4.
  • structure 10 annularly enlarges, it generally axially shortens. In other words, as cells 50 / 52 / 54 / 56 and 60 / 62 / 64 / 66 widen in the annular direction, they shorten in the axial direction.
  • annular enlargement of structure 10 decreases the axial spacing between portions 20 and 40 , and more particularly decreases the axial spacing between member 22 , on the one hand, and members 42 , on the other hand.
  • a typical use of connector 10 is, in a coronary artery bypass procedure, to provide an anastomosis between an axial end portion of a tubular graft conduit and an aperture in a side wall of a coronary artery.
  • connector 10 may be loaded on an uninflated balloon 110 near the distal end of a balloon catheter 100 as shown in FIG. 5.
  • connector 10 and catheter 100 are assembled so that connector 10 extends annularly around uninflated balloon 110 .
  • Graft conduit 120 is then placed annularly around the first portion 20 of connector 10 and the adjacent portion of catheter 100 as shown in FIG. 6.
  • Graft conduit may be natural body tissue (e.g., a length of the patient's saphenous vein harvested for use as a graft, a partly severed internal mammary artery, etc.), an artificial graft (e.g., as shown in Goldsteen et al. U.S. Pat. No. 5,976,178, or published PCT patent application WO 98/19632, both of which are hereby incorporated by reference herein in their entireties), or a combination of natural and artificial conduits (e.g., a length of natural conduit disposed substantially concentrically inside a length of artificial conduit).
  • Graft conduit 120 is placed on assembly 10 / 100 so that radially outwardly deflected members 22 penetrate and pass through the side wall of the graft conduit (e.g., as a result of compressing the graft against the fingers, thereby forcing the fingers to pierce through the graft wall).
  • the sharpened free ends of members 22 facilitate penetration of conduit 120 by members 22 .
  • the blunt rear surfaces of enlarged free end portions 24 resist withdrawal of members 22 from conduit 120 after members 22 have penetrated the conduit.
  • the graft may be additionally or alternatively directly sutured to the connector body. If the alternative of suturing graft 120 to the connector is used, then the first portion 20 of the connector may not need radially outwardly deflectable members 22 for engagement of the graft conduit.
  • balloon 110 may be installed in connector 10 after the graft has been secured to the connector.
  • Illustrative apparatus 200 for delivering connector 10 and graft 120 to a location in a patient requiring a graft and an anastomosis, and for then deploying the connector and graft is shown in FIG. 7.
  • Apparatus 200 includes an optional guide wire 210 , which may be first installed in the patient along the route that the remainder of the apparatus is later to follow to reach the desired location in the patient. The remainder of the apparatus is then slid into the patient along guide wire 210 .
  • guide wire 210 may be omitted, or a leading guide member (e.g., a wire) may be fixedly mounted on the distal (leftward in FIG. 2) end of the remainder of the apparatus.
  • the wire allows precise tracking of the nose cone 220 and delivery system 200 into a patient's body fluid conduit (e.g., a coronary artery 300 as shown in FIGS. 8 - 10 and described below).
  • Apparatus 200 includes a gradually tapered distal nose portion or dilator 220 which extends annularly around a central, longitudinally extending, guide wire lumen 222 .
  • Distal nose portion 220 has a substantially conical outer surface with a cone angle A, which is preferably less than about 15° (e.g., in the range from about 5° to about 15°, more preferably in the range from about 5° to about 10°).
  • Such gradual tapering of nose portion 220 is desirable to enable nose portion to gradually enlarge an aperture in a side wall of a body fluid conduit to which graft 120 is to be connected without snagging on that conduit side wall.
  • Distal nose portion 220 may have cutting edges to further facilitate entry through a body fluid conduit side wall.
  • Distal nose portion 220 is connected to tube 230 , which extends proximally from the nose portion annularly around guide wire 210 .
  • tube 230 may be made of stainless steel hypotube, which allows the depicted apparatus to be pushed or pulled axially along guide wire 210 .
  • a proximal portion of distal nose portion 220 is hollowed out as indicated at 224 to receive balloon 110 , connector 10 , and a distal portion of graft 120 substantially coaxially around a medial portion of tube 230 .
  • balloon 110 is provided as a hollow annulus at or near the distal end of hollow tubular member 100 .
  • the side wall of tube 100 may include a separate lumen (not shown but conventional for balloon catheters) through which pressurized inflation fluid may be supplied from a proximal region of the apparatus to balloon 110 .
  • Elements 100 and 110 are slidable axially along the outer surface of tube 230 . Insertion of elements 10 , 110 , and 120 (FIG.
  • Tube 240 disposed substantially coaxially around element 100 inside graft 120 so that its distal end bears against members 22 , may be used to help load elements 10 , 110 , and 120 into recess 224 , and also to hold connector 10 in place in recess 224 during delivery of the connector to the anastomosis site in the patient.
  • FIG. 8 shows a typical use of apparatus 200 to deliver graft 120 for connection to an aperture in a side wall of a patient's tubular body conduit 300 (e.g., a coronary artery requiring a bypass graft).
  • Guide wire 210 is first installed through a small aperture in the side wall of the conduit.
  • the natural elastic recoil of the conduit 300 side wall seals the aperture around the guide wire so that there is little or no body fluid (e.g., blood) leakage out of the conduit via the aperture.
  • the tapered distal nose portion 220 of apparatus 200 is then gradually forced into the aperture (e.g., by using tube 230 to push portion 220 distally into the aperture) to dilate the aperture.
  • the natural elastic recoil of the conduit 300 side wall tissue continues to keep the aperture sealed or substantially sealed around portion 220 .
  • distal nose portion 220 When distal nose portion 220 has been pushed far enough into the aperture in the side wall of conduit 300 so that connector 10 is part way through the aperture, further distal motion of elements 10 , 100 , 110 , and 120 can be stopped (e.g., by holding a proximal portion of element 100 stationary). Tube 240 is then pulled proximally out of the patient. Thereafter, distal nose portion 220 is pushed farther into conduit 300 (e.g., by continuing to push distally on a proximal portion of element 230 ). This causes distal nose portion 220 to separate from connector 10 , thereby exposing the connector and leaving it in the aperture through the conduit 300 side wall as shown in FIG. 9.
  • the next step in use of apparatus 200 is to inflate balloon 110 as shown in FIG. 10.
  • the balloon is typically sized to a specific anastomosis size (e.g., 3 millimeters diameter, 4 millimeters diameter, etc.).
  • Inflation of the balloon forces connector 10 to annularly enlarge by enlarging cells 50 / 52 / 54 / 56 and 60 / 62 / 64 / 66 in the annular direction.
  • the portions of members 60 and 62 that are adjacent to elements 64 are deflected radially out beyond other portions of the connector inside the side wall of conduit 300 , thereby causing the extreme distal end of graft 120 to similarly flare out inside that side wall.
  • This outward flaring of portions of connector 10 and graft 120 helps secure the connector and graft to the side wall of conduit 300 , and also helps seal the graft to the conduit.
  • the axial shortening of connector 10 that accompanies annular enlargement ensures that graft 120 is drawn into secure and fluid-tight engagement with conduit 300 .
  • the free ends of members 42 preferably penetrate the side wall of conduit 300 to further secure connector 10 and graft 120 in the aperture in the side wall.
  • Members 50 , 52 , 56 , and 24 may also flare out somewhat outside the side wall of graft 300 to help ensure that graft 120 remains open where it connects to conduit 300 . Assuming that the connector is approximately properly positioned relative to the side wall of conduit 300 prior to inflation of balloon 110 , the connector is effectively self-centering on the conduit 300 side wall as the balloon is inflated.
  • the next step in use of apparatus 200 is to deflate balloon 110 and withdraw all of elements 100 , 110 , 210 , 220 , and 230 (e.g., by pulling them proximally out of graft 120 ).
  • connector 10 provides an end-to-side anastomosis between graft 120 and conduit 300 .
  • Body fluid from graft 120 is able to flow into conduit 300 via this connection.
  • Connector 10 presses graft 120 radially outward against the aperture through the side wall of conduit 300 all the way around that aperture, thereby preventing body fluid from leaking out of conduits 120 and 300 .
  • Connector 10 also prevents the end of conduit 120 from pulling out of the side wall of conduit 300 .
  • FIG. 12 Another illustrative embodiment of a connector 410 in accordance with this invention is shown (in simplified planar development) in FIG. 12.
  • a typical initial length of connector 410 is about 4.0 mm, and a typical initial outside diameter is in the range from about 0.040 to about 0.065 inches.
  • a typical shaft length for members 422 is about 0.0539 inches, and a typical shaft width for those members is about 0.0050 inches.
  • connector 410 may be cut from a single integral tube.
  • a typical thickness for the material of connector 410 is about 0.004 inches.
  • Suitable materials for connector 410 include stainless steel, tantalum, tungsten, platinum, and nitinol.
  • Connector 410 may be described as including axially spaced first and second portions 420 and 440 , respectively.
  • First portion 420 includes a plurality of annularly spaced first members 422 having free end portions 424 that initially point axially away from second portion 440 .
  • members 422 are deflectable radially out from other parts of the connector, and, if desired, free end portions 424 can be curved back so that they point toward second portion 440 (see FIG. 15).
  • the first portion 420 of connector 410 may also be said to include the lower portions (below members 454 ) of cells, each of which includes one member 460 , one member 462 , one member 464 , and one member 466 .
  • the left-most cell shown in FIG. 12 includes substantially parallel members 460 a and 462 a joined at their axially spaced ends by members 464 a and 466 a .
  • Annularly adjacent cells are joined by members 454 at points that are axially medial their axial ends.
  • the cell that includes member 462 a is joined to the cell that includes member 460 b by members 454 b .
  • the portions of members 460 and 462 below members 454 are also deflectable radially out from other portions of the connector.
  • the second portion 440 of connector 410 may be said to include the portions of members 460 and 462 above members 454 . These portions of members 460 and 462 are also deflectable radially out (as loops 460 / 462 / 464 ) from other portions of the connector. If desired, loops 460 / 462 / 464 could also have fingers or barbs on them like members 42 in the embodiment of FIGS. 1 - 11 .
  • Connector 410 is annularly enlargeable by deforming members 460 and 462 to enlarge each of the above-described cells in the annular direction as shown in greatly simplified form in FIG. 13.
  • FIG. 14 shows an illustrative embodiment of tooling 500 that can be used to facilitate attachment of a graft conduit 120 to connector 410 .
  • Tooling 500 includes a mandrel with a conical end portion, the pointed free end of which is small enough to fit axially into connector 410 in its initial relatively small annular size.
  • the cone of the mandrel begins to deflect members 422 radially out from other portions of the connector.
  • Graft conduit 120 can be placed around mandrel 500 and shifted axially toward connector 410 until an axial end portion of conduit 120 axially overlaps outwardly deflected members 422 .
  • Mandrel 500 can be pulled proximally out of graft 120 and connector 410 at any suitable time. Use of mandrel 500 in this way helps ensure that members 422 penetrate the side wall of conduit 120 substantially equidistantly in the annular direction around the conduit. This helps avoid excessive stretching of any angular segment of graft 120 when connector 410 is subsequently expanded by balloon 110 .
  • an inflatable balloon like balloon 110 (with tube 100 ) can be inserted into the connector in a manner similar to what is shown in FIG. 6.
  • Elements 100 , 110 , 120 , and 410 can then be loaded into apparatus like 200 in a manner similar to what is shown in FIG. 7 (except that in this case the free ends 424 of members 422 will typically point in the distal direction rather than in the proximal direction as is true for the free ends 24 of members 22 in FIG. 7).
  • Apparatus 200 can then be used to install connector 410 and graft 120 in a patient in a manner similar to the installation shown in FIGS. 8 - 11 .
  • FIG. 16 shows the second portion 440 after it has been conveyed through the side wall of conduit 300 by apparatus 200 and apparatus 200 has been shifted distally farther into conduit 300 to expose the connector.
  • FIG. 17 shows second portion loops 460 / 462 / 464 deployed (radially outwardly deflected), but the remainder of the connector not yet annularly expanded.
  • a shaped balloon or dual balloon system may be utilized to achieve this. For example, one of two axially adjacent balloons may be used to help form distal retention fingers 460 / 462 / 464 as shown in FIG. 17. The second of the two balloons is thereafter used to annularly expand the remainder of the connector and the anastomosis opening.
  • a single “bulbous” shaped balloon may be used to produce a temporary intermediate condition like that shown in FIG. 17, and to then annularly enlarge the remainder of the connector and the anastomosis opening.
  • the distal retention fingers 460 / 462 / 464 may be self-actuating (i.e., spring-biased) and not require balloon assist to spring out to the condition shown in FIG. 17.
  • distal retention fingers 460 / 462 / 464 may be preformed to deflect radially outward in a manner similar to the radially outward preform that is given to elements 22 and 42 in FIG. 3.
  • connector 410 has been annularly expanded by enlargement of the cells 460 / 462 / 464 / 466 in the annular direction.
  • the portions of members 460 and 462 that comprise portion 440 of the connector have been deflected radially out from other portions of the connector inside conduit 300 , thereby functioning to secure connector 410 and graft 120 to conduit 300 .
  • Members 422 are deflected radially out from other portions of the connector and pass through the axial end portion of graft 120 .
  • the free end portions of members 422 point toward the second portion 440 of the connector, thereby ensuring that the end of graft 120 cannot slip away from its body-fluid-sealing abutment with the side wall of conduit 300 .
  • the annularly expanded medial portion of connector 410 holds open the aperture in the side wall of conduit 300 , as well as the attached end of graft 120 , thereby ensuring unobstructed body fluid flow through the anastomosis between conduits 120 and 300 .
  • Connector 610 is configured for use in performing a side-to-side anastomosis between two body fluid conduits 300 a and 300 b as shown in FIG. 25.
  • Connector 610 has a construction like two portions 40 of connector 10 connected together.
  • members 642 a and 642 b are constructed and operate like members 42 in connector 10 .
  • members 660 are constructed and operate generally like members 60 and 62 in connector 10
  • elements 664 and 666 are constructed and operate generally like elements 64 and 66 , respectively, in connector 10 .
  • Connector 610 in an initially relatively small annular size and mounted on a balloon, is insertable through adjacent apertures in the side walls of body fluid conduits 300 a and 300 b .
  • apparatus like 200 can be used to deliver connector 610 to such a site via the lumen of one of conduits 300 and to then position the connector so that it spans both conduits.
  • Apparatus 200 is then shifted relative to connector 610 in a manner generally similar to FIG. 9 to expose the connector.
  • the balloon 110 associated with the connector is then inflated to annularly enlarge the connector to the condition shown in FIG. 25.
  • annular expansion causes members 642 a to penetrate the side wall of conduit 300 a annularly around the anastomotic opening, and also causes members 642 b to penetrate the side wall of conduit 300 b annularly around the anastomotic opening.
  • annular enlargement of connector 610 is accompanied by axial shortening, which helps to draw the side walls of conduits 300 a and 300 b together annularly around the connector, thereby providing the desired fluid-tight anastomosis between the conduits.
  • the number and shape of the annularly enlargeable connector cells can be different from what is shown in the drawings herein.
  • the number of axially adjacent rows of annularly enlargeable cells can be different from the numbers of such rows that are shown herein (i.e., two rows of cells in the case of connectors 10 and 610 or one row of cells in the case of connector 410 ).
  • a connector may have three, four, or more rows of cells.
  • the cells may have any of many forms, depending on the desired degree of expansion and final radial strength.
  • the number of cells, the number of rows of cells, the size of the cells, and the geometry of the cells can all be selected to control the expansion, strength, and sizing of the finished connector.
  • the number and shape of the radially outwardly deflectable connector members can also differ from what is shown herein. Techniques and apparatus different from what is shown and described herein can be used for attaching a connector of this invention to a graft conduit and/or installing the connector in a patient.
  • the connector of this invention may be configured to secure the end of the graft 120 against the outside of the side wall of conduit 300 in an end-to-side anastomosis as shown in FIG. 23.
  • the nose cone 220 of apparatus 200 may not need to cover the proximal fingers 22 or 422 of the connector. Instead, the proximal fingers can extend to an outer circumference which is larger than the outer circumference of nose cone 220 . This allows the proximal fingers to be used as a stop which prevents the connector from going too far through the aperture in the side wall of conduit 300 . In other words, the radially outer ends of proximal fingers 22 or 422 come into contact with the outer surface of the side wall of conduit 300 and thereby stop the connector from going any farther into that conduit.
  • such connectors comprise a unitary structure disposed annularly about a longitudinal axis (e.g., axis 12 in FIG. 2).
  • the connector structure generally has axially spaced first and second portions (e.g., 20 and 40 , 420 and 440 , or 640 a and 640 b in the depicted illustrative embodiments).
  • the first portion generally has a plurality of annularly spaced first members that are deflectable radially out from a remainder or other generally axially medial portion of the structure.
  • these first members include elements 22 .
  • these first members include elements 422 .
  • these first members include elements 642 a .
  • the second portion may also have a plurality of annularly spaced second members that are deflectable radially out from a remainder or other generally axially medial portion of the structure.
  • these second members include elements 44 and (later in use of the connector) the portions of elements 60 and 62 that are above elements 54 in FIG. 1.
  • FIGS. 12 - 19 these first members include elements 422 .
  • these first members include elements 642 a .
  • the second portion may also have a plurality of annularly spaced second members that are deflectable radially out from a remainder or other generally axially medial portion of the structure.
  • these second members include elements 44 and (later in use of the connector) the portions of elements 60 and 62 that are above elements 54 in FIG. 1.
  • the second members include U-shaped structures that are the portions of elements 460 , 462 , and 464 above elements 454 in FIG. 12.
  • these second members include members 642 b .
  • the connector structures of this invention are annularly enlargeable.
  • the connector is annularly enlargeable by enlarging cells 50 / 52 / 54 / 56 and 60 / 62 / 64 / 66 in the annular direction as shown, e.g., in FIG. 4.
  • FIGS. 1 - 11 the connector is annularly enlargeable by enlarging cells 50 / 52 / 54 / 56 and 60 / 62 / 64 / 66 in the annular direction as shown, e.g., in FIG. 4.
  • FIGS. 1 - 11 the connector is annularly enlargeable by enlarging cells 50 / 52 / 54 / 56 and 60 / 62 / 64 / 66 in the annular direction as shown, e.g., in
  • the connector is annularly enlargeable by enlarging cells 460 / 462 / 464 / 466 in the annular direction as shown, e.g., in FIG. 13.
  • the connector is annularly enlargeable by enlarging cells 660 / 664 / 666 in the annular direction.
  • the structure of the connectors of this invention is such that radial enlargement of the connector reduces the axial spacing between the above-mentioned first and second members. This helps the connector draw together in a fluid-tight way the two body fluid conduits that are to be connected by the connector.
  • annular enlargement of cells 60 / 62 / 64 / 66 causes a decrease in the axial spacing between members 22 , on the one hand, and members 42 , on the other hand.
  • FIGS. 1 - 11 for example, annular enlargement of cells 60 / 62 / 64 / 66 causes a decrease in the axial spacing between members 22 , on the one hand, and members 42 , on the other hand.
  • annular enlargement of cells 460 / 462 / 464 / 466 causes a decrease in the axial spacing between members 422 , on the one hand, and the portions of elements 460 and 462 above elements 454 in FIG. 12, on the other hand.
  • annular enlargement of the connector decreases the axial spacing between members 642 a , on the one hand, and members 642 b , on the other hand.
  • the above-described axial shortening of the connector advantageously applies compressive forces (for sealing) to the body fluid conduits being connected.
  • most of the deformation of the connectors of this invention is preferably plastic strain and therefore permanent.
  • the deformation thus referred to includes both the above-described radially outward deflection of members like 22 , 42 , 422 , 642 , etc., and the above-described radial enlargement of the connector.
  • the radially outwardly deflectable members or portions of the connector may be barbs, hooks, spikes, loops, or suture rings.
  • the connectors of this invention may be constructed so that different portions of the connector annularly enlarge in response to different amounts of applied annular enlargement force.
  • the portions of the structure above elements 54 in FIG. 1 may be made so that they are less resistant to inflation of a balloon 110 inside the connector than portions of the structure below elements 54 in FIG. 1.
  • this causes these less resistant portions to annularly enlarge by deflecting radially out inside conduit 300 before the remainder of the connector begins to significantly annularly enlarge.
  • This early response of the less resistant portions inside conduit 300 may help to ensure that the connector does not slip out of engagement with conduit 300 during annular enlargement of the connector.
  • the connector can be shaped, molded, or phased in any desired way by providing a balloon structure 110 which is shaped, molded, or phased in that way.
  • balloon structure 110 may comprise two or more separately inflatable balloons of the same or different inflated circumferential size. Two such balloons may be axially displaced from one another inside the connector so that axially different portions of the connector can be annularly enlarged at different times and/or by different amounts.
  • Radiologically (e.g., x-ray) viewable markers can be used anywhere on the connectors and/or delivery apparatus (e.g., 200 ) of this invention to facilitate radiologic observation of the proper placement and deployment of a connector in a patient if the connector-utilizing procedure is such that more direct visual observation is not possible or sufficient.
  • One way to enhance the radiologic viewability of connectors in accordance with this invention is to make them from clad tubing.
  • Clad tubing has two (or more) substantially concentric layers of metal, each with a desired property. As shown in FIG. 20, for example, clad tubing 500 has a tantalum layer 502 over a stainless steel layer 504 .
  • the tantalum layer 502 provides radiodensity, thereby making a connector 10 , 410 , or 610 that is cut from tube 500 radiologically viewable.
  • the stainless steel layer 504 provides rigidity to the connector.
  • the medial section can be ground to reduce the thickness ratio to favor the tantalum. This improves the ability for balloon expansion.
  • tube 500 (and the resulting connector 10 , 410 , or 610 ) may thus be made of two or more layers of different materials, the tube and the connector are still accurately described as unitary, one-piece, or integral.
  • the connector may be plated with a radiologic material to give it a desired radiodensity.
  • Another example of a material suitable for radiologic layer 502 is platinum.
  • Small polyester or other polymer patches or bands may be used on or in association with a connector of this invention to help seal and coagulate blood. Such patches may be inserted over individual fingers as shown, for example, at 522 in FIG. 21. Alternatively, such a band or web may be provided around the medial portion of connector 10 , 410 , or 610 as shown, for example, at 530 in FIG. 22. A band or web like 530 may also be used to constrain the size of the connector or a graft (such as a vein graft) relative to the connector. Vein grafts may dilate significantly under arterial blood pressure. A band or web can be used to fix its size relative to the connector.
  • a band or web like 530 can be provided to help seal the completed anastomosis
  • a band or web like 530 may preferably be elastic (e.g., of a rubber or rubber-like material such as silicone or polyurethane).
  • the band or web like 530 can be porous, if desired, and may be impregnated with drugs to facilitate healing and/or sealing.
  • polymer patches like 522 in FIG. 21 can include and release coagulant and/or other medication to help prevent bleeding and promote healing. Patches like 522 in FIG. 21 can help prevent members like 22 from pulling back through tissue that the member has penetrated.
  • An important attribute of the connectors of this invention is the characteristic that the medial section is soft enough to allow balloon expansion and strong enough to secure the two body fluid conduits via such elements as 22 and 42 , 422 and 460 / 462 / 464 , or 642 .
  • the center section may be annealed selectively to soften it without compromising the rigidity of the retention elements (e.g., 22 , 42 , 422 , 642 , etc.). This can be done, for example, by laser heat treating the medial section only. The results of this process are relatively low hardness in the medial section and relatively high hardness in the end sections, all within an overall length of about 0.2 inches.
  • the connectors of this invention may also be made of a super-elastic material such as nickel-titanium (“nitinol”), which would allow a similar geometry as stainless steel to self-deploy or actuate in-vivo.
  • nitinol nickel-titanium
  • the connectors of this invention can be initially relatively small in circumference, and that they can be remotely controlled to position them in the patient and to then annularly expand them for final deployment, facilitates use of these connectors and associated apparatus (e.g., apparatus 200 ) at remote and/or inaccessible locations in a patient.
  • a connector of this invention may be delivered into and installed in a patient (using apparatus such as apparatus 200 ) through relatively small instrumentation such as laparascopic apparatus, a cannula, or an intraluminal catheter.
  • a connector and associated apparatus e.g., apparatus 200
  • a connector and associated apparatus can be used in any of the procedures mentioned earlier in this specification, and in particular in procedures and with other elements shown in any of above-mentioned references WO 98/16161, U.S. Pat. No. 5,976,178, U.S. Pat. No. 6,120,432, WO 98/55027, and U.S. Pat. No. 6,475,222.
  • the connector and/or apparatus (e.g., apparatus 200 ) of this invention can be used in more traditional or conventional surgical procedures or in other, known, less invasive or minimally invasive procedures.
  • the connectors and apparatus of this invention they can be used to perform an anastomosis to a beating or still heart without the use of sutures or direct access.
  • a typical connector is initially less than about 1 millimeter in diameter and in the range from about 2 to about 4 millimeters in length. After annular enlargement, a typical connector is more than about 2.5 millimeters in diameter.
  • the pre-yield geometry of these connectors is ideal for delivery and positioning; the post-yield geometry is ideal for vessel securement, seal, and patency.
  • the geometry of the connectors is ideal for annular enlargement.
  • Radial outward deflection of certain connector members is ideal for interfacing the expanding medial section of the connector to each of the two body fluid conduits to be connected (e.g., a graft vessel and an artery vessel).
  • certain connector cells may be configured to open before other cells as desired to optimize deployment positioning.
  • Integral connector fingers such as 22 , 42 , 422 , 642 , etc., can be deflected radially out from the remainder of a connector for the purpose of attachment to body fluid conduits (e.g., a graft and an artery). These fingers are part of the connector body and can be hooks, barbs, loops, or spikes. The geometry of the fingers can also change, as desired, in response to balloon expansion.
  • a balloon catheter can be used to actuate the connector and provide an anastomosis opening and attachment.
  • the nose cone portion 220 of apparatus 200 covers the connector and graft interface, allowing dilation of the other body fluid conduit wall and passage of the connector through that wall.
  • the connector provides the actual anastomotic opening and the connection simultaneously.
  • the device is actuated via a balloon and catheter delivery system.
  • the invention eliminates suturing and reduces the time required to produce an anastomosis. In major circulatory system repair procedures such as cardiac bypass procedures, this can reduce cardiopulmonary pump time, which is of great benefit to the patient.
  • the invention provides optimal flow dynamics, e.g., from a graft to the coronary artery.
  • the blood entrance angle can be engineered into the connector geometry rather than relying on suture skill or technique.
  • the invention eliminates possible suture injury to vessels.
  • the connector and a graft can be delivered percutaneously, e.g., as in several of the references that are mentioned above. Direct access required for suturing is eliminated.
  • An anastomotic connection can be made to a beating heart.

Abstract

A connector for use in providing an anastomotic connection between two tubular body fluid conduits in a patient. The connector is preferably a single, integral, plastically deformable structure that can be cut from a tube. The connector has axial spaced portions that include members that are radially outwardly deflectable from other portions of the connector. The connector is annularly enlargeable so that it can be initially delivered and installed in the patient in a relatively small annular size and then annularly enlarged to provide the completed anastomosis. The radially outwardly deflected members of the first and second portions respectively engage the two body fluid conduits connected at the anastomosis and hold those two conduits together in fluid-tight engagement. Apparatus for use in delivering and deploying a connector is also disclosed.

Description

  • This application is a continuation of U.S. patent application Ser. No. 10/078,939, filed Feb. 19, 2002, which is a continuation of U.S. patent application Ser. No. 09/955,231, filed Sep. 17, 2001 (now U.S. Pat. No. 6,440,163), which is a division of U.S. patent application Ser. No. 09/527,668, filed Mar. 17, 2000 (now U.S. Pat. No. 6,309,416), which is a division of U.S. patent application Ser. No. 09/186,774, filed Nov. 6, 1998 (now U.S. Pat. No. 6,113,612). All of these prior applications are hereby incorporated by reference herein in their entireties.[0001]
  • BACKGROUND OF THE INVENTION
  • This invention relates to medical apparatus, and more particularly to apparatus for use in making anastomotic connections between tubular body fluid conduits in a patient. [0002]
  • There are many medical procedures in which it is necessary to make an anastomotic connection between two tubular body fluid conduits in a patient. An anastomotic connection (or anastomosis) is a connection which allows body fluid flow between the lumens of the two conduits that are connected, preferably without allowing body fluid to leak out of the conduits at the location of the connection. As just one example of a procedure in which an anastomosis is needed, in order to bypass an obstruction in a patient's coronary artery, a tubular graft supplied with aortic blood may be connected via an anastomosis to the contrary artery downstream from the obstruction. The anastomosis may be between the end of the graft and an aperture in the side wall of the coronary artery (a so-called end-to-side anastomosis), or the anastomosis may be between an aperture in the side wall of the graft and an aperture in the side wall of the coronary artery (a so-called side-to-side anastomosis (e.g., as in published Patent Cooperation Treaty (“PCT”) patent application WO 98/16161, which is hereby incorporated by reference herein in its entirety)). The graft may be natural conduit, artificial conduit, or a combination of natural and artificial conduits. If natural conduit is used, it may be wholly or partly relocated from elsewhere in the patient (e.g., wholly relocated saphenous vein or partly relocated internal mammary artery). Alternatively, no relocation of the graft may be needed (e.g., as in above-mentioned application WO 98/16161 in which a length of vein on the heart becomes a “graft” around an obstruction in an immediately adjacent coronary artery). More than one anastomosis may be needed. For example, a second anastomosis may be needed between an upstream portion of the graft conduit and the aorta or the coronary artery upstream from the obstruction in that artery. Again, this second anastomosis may be either an end-to-side anastomosis or (as shown, for example, in above-mentioned application WO 98/16161) a side-to-side anastomosis. Alternatively, no second, upstream anastomosis may be required at all (e.g., if the graft is an only-partly-relocated internal mammary artery). [0003]
  • The currently most common technique for making an anastomosis is to manually suture the two tubular body fluid conduits together around an opening between them. Manual suturing is difficult and time-consuming, and the quality of the anastomosis that results is highly dependent on the skill of the person doing the suturing. In the case of coronary artery bypass procedures, one source of difficulty for suturing of an anastomosis may be motion of the heart. There is also increasing interest in procedures which are less invasive or even minimally invasive. Such procedures have potentially important advantages for patients, but they may increase the difficulty of performing manual suturing of an anastomosis by reducing or limiting access to the site within the patient at which the anastomosis must be made. Various examples of such less invasive or minimally invasive procedures are shown in above-mentioned application WO 98/16161, Goldsteen et al. U.S. Pat. No. 5,976,178, Sullivan et al. U.S. Pat. No. 6,120,432, published PCT patent application Wo 98/55027, and Berg et al. U.S. Pat. No. 6,475,222, all of which are hereby incorporated by reference herein in their entireties. [0004]
  • In view of the foregoing, it is an object of this invention to provide apparatus that can be used to make anastomotic connections in lieu of manual suturing. [0005]
  • It is another object of the invention to provide apparatus that can be used to make anastomotic connections even though access to the site of the anastomosis may be limited or even only indirect or remote. [0006]
  • It is still another object of the invention to provide apparatus that can be used to make anastomotic connections without the need for a high degree of manual suturing skill. [0007]
  • It is yet another object of the invention to provide apparatus for making anastomotic connections that is less adversely affected than manual suturing by adjacent or nearby body motion (e.g., motion of the patient's heart). [0008]
  • It is still another object of this invention to provide apparatus for facilitating the making of higher quality anastomotic connections more rapidly and with more consistent results than is possible with prior art methods and apparatus such as manual suturing. [0009]
  • SUMMARY OF THE INVENTION
  • These and other objects of the invention are accomplished in accordance with the principles of the invention by providing a connector for use in making an anastomotic connection between two tubular body fluid conduits in a patient, the connector being of substantially one-piece or unitary construction which extends annularly about a central longitudinal axis. The structure of the connector includes axially spaced first and second portions, at least one of which includes members that are deflectable radially out from a remainder of the connector structure. In some embodiments both of the axially spaced first and second portions include members that are deflectable radially out from a remainder of the structure. The connector structure is annularly enlargeable, preferably by inflation of a balloon placed temporarily inside the connector. The structure of the connector preferably lends itself to formation by removal of selected material from a single unitary tube. The connector is typically made of metal which is plastically deformable (e.g., in the above-mentioned radial outward deflections and annular enlargement). [0010]
  • The members that are deflectable radially out from the first portion of the connector structure are configured to engage the side wall of one of the two tubular body fluid conduits that are to be connected. The members that are deflectable radially out from the second portion of the connector structure are configured to engage the side wall of the other of the two body fluid conduits that are to be connected. Alternatively, one of the two portions of the connector can be secured (preferably pre-secured) to the associated conduit by other means such as sutures. Annular expansion of the connector preferably causes the first and second portions of the connector structure to move toward one another along the central longitudinal axis of the connector, thereby causing the connector to draw the two tubular body fluid conduits together at the anastomosis between them. This helps produce an anastomosis which is fluid-tight (i.e., from which body fluid does not leak). [0011]
  • The connectors of this invention can be used to provide either end-to-side or side-to-side anastomoses. The connector may be first attached to one of the body fluid conduits to be connected (e.g., an end portion of a graft conduit), and then delivered along with the attached end of the first conduit to the connection point with the second conduit, where the connector is fully deployed to produce an anastomosis between the first and second conduits. Prior to full deployment the connector preferably has a relatively small circumference, which facilitates delivery and initial installation in the patient, even at relatively remote or inaccessible locations in the patient. For example, the connector can be delivered via lumens of body fluid conduits in the patient and/or relatively small-diameter instrumentation such as a cannula or laparascopic-type device. Final installation can be performed substantially solely by inflation of a balloon temporarily disposed in the connector. No direct manipulation of the connector may be needed. All of these attributes facilitate use of the connector at remote or inaccessible locations in the patient. The connector therefore lends itself to use in less invasive or minimally invasive procedures. [0012]
  • Instrumentation for facilitating installation of the connector through the side wall of a body fluid conduit is also disclosed. This instrumentation has a gradually tapered distal nose portion with an outer surface that is free of features that could snag on the side wall of the body fluid conduit to be penetrated by the nose portion. At least the portion of the connector that must pass through the body fluid conduit side wall is completely covered by the instrumentation until that portion of the connector is through the side wall. These features of the instrumentation help it penetrate the body fluid conduit side wall with no snagging and with minimal trauma. Thereafter the distal nose portion can be shifted distally relative to the connector to expose the connector in position through the side wall. Other parts of the instrumentation (e.g., an inflatable balloon) can then be operated to complete the deployment of the connector. [0013]
  • Further features of the invention, its nature and various advantages will be more apparent from the accompanying drawings and the following detailed description of the preferred embodiments.[0014]
  • BRIEF DESCRIPTION OF THE DRAWINGS
  • FIG. 1 is a simplified planar development of the structure of an illustrative embodiment of a connector constructed in accordance with this invention. [0015]
  • FIG. 2 is a simplified perspective view of the actual structure of the connector which is shown in planar development in FIG. 1. [0016]
  • FIG. 3 is a simplified elevational view of the FIG. 2 structure after some further processing in accordance with the invention. [0017]
  • FIG. 4 is a simplified planar development of the structure of FIGS. [0018] 1-3 showing that structure's capacity for annular enlargement in accordance with the invention.
  • FIG. 5 is a simplified elevational view of the structure of FIG. 3 with some additional structure in accordance with the invention. [0019]
  • FIG. 6 is a simplified elevational view, partly in section, of the structure of FIG. 5 with still more additional structure in accordance with the invention. [0020]
  • FIG. 7 is a simplified sectional view of the structure of FIG. 6 with additional illustrative apparatus shown for use in delivering and deploying the FIG. 6 structure in a patient in accordance with the invention. [0021]
  • FIG. 8 is a simplified elevational view, partly in section, showing an early stage in use of the FIG. 7 apparatus in accordance with the invention. [0022]
  • FIG. 9 is a view similar to FIG. 8, but with more elements shown in section, and showing a later stage in use of the FIG. 7 apparatus in accordance with the invention. [0023]
  • FIG. 10 is a view similar to FIG. 9 showing a still later stage in use of the FIG. 7 apparatus in accordance with the invention. [0024]
  • FIG. 11 is a view similar to FIG. 10 showing the end result of using the FIG. 7 apparatus in accordance with the invention. [0025]
  • FIG. 12 is a view similar to FIG. 1 for another illustrative embodiment of a connector constructed in accordance with the invention. [0026]
  • FIG. 13 is a view similar to FIG. 4, but for the embodiment of FIG. 12. [0027]
  • FIG. 14 is a simplified perspective view showing the connector of FIG. 12 with other elements in accordance with the invention. [0028]
  • FIG. 15 is another simplified perspective of a later stage in use of some of the elements shown in FIG. 14. [0029]
  • FIG. 16 is another simplified perspective view, partly in section, of a still later stage in use of the elements shown in FIG. 15. [0030]
  • FIG. 17 is another view, generally similar to FIG. 16, showing an even later stage in use of the elements shown in FIG. 16. [0031]
  • FIG. 18 is a simplified perspective view of a completed anastomosis including the connector of FIG. 12. [0032]
  • FIG. 19 is another view, partly in section, of the anastomosis of FIG. 18. [0033]
  • FIG. 20 is a simplified perspective view of an illustrative embodiment of a starting structure for use in making connectors in accordance with the invention. [0034]
  • FIG. 21 is a simplified elevational view, partly in section, illustrating a possible modification of connectors in accordance with the invention. [0035]
  • FIG. 22 is a simplified elevational view, partly in section, illustrating another possible modification of connectors in accordance with the invention. [0036]
  • FIG. 23 is a simplified sectional view of an alternative finished anastomosis in accordance with the invention. [0037]
  • FIG. 24 is a view similar to FIG. 4 for still another illustrative embodiment of a connector constructed in accordance with the invention. [0038]
  • FIG. 25 is a view similar to FIG. 11 for a completed anastomosis employing a connector of the type shown in FIG. 24.[0039]
  • DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
  • FIG. 1 shows a planar development of what is actually an integral, one-piece (unitary), [0040] annular structure 10. In particular, the left and right edges of the structure shown in FIG. 1 are actually joined to and integral with one another. Thus the actual structure is as shown in FIG. 2, although FIG. 1 is useful to more clearly reveal the details of various features of the structure. A central longitudinal axis 12 about which structure 10 is annular is shown in FIG. 2.
  • An illustrative material for [0041] structure 10 is 304 stainless steel. Other examples of suitable materials include tantalum, tungsten, platinum, and nitinol. Structure 10 may be advantageously produced by starting with a single, unitary metal tube and removing selected material until only the structure shown in FIG. 2 remains. For example, laser cutting may be used to remove material from the starting tube in order to produce structure 10. Although connectors 10 can be made in various sizes for various uses, a typical connector has an initial outside diameter in the range from about 0.040 to about 0.065 inches, an initial length of about 4.0 mm, and a material thickness of about 0.004 inches.
  • [0042] Connector 10 may be described as including axially spaced first and second portions 20 and 40, respectively. First portion 20 includes a plurality of annularly spaced members 22 that in this case have free end portions 24 that are sharply pointed and that point toward second portion 40. Each of members 22 is deflectable radially out from the remainder of structure 10 as shown, for example, in FIG. 3. This outward deflection is preferably at least partly plastic.
  • [0043] Second portion 40 also includes a plurality of annularly spaced members 42 that in this case have free end portions 44 that are sharply pointed and that point toward first portion 20. Each of members 42 is deflectable radially out from the remainder of structure 10 as shown, for example, in FIG. 3. Again, this outward deflection is preferably at least partly plastic.
  • The above-mentioned outward deflection of [0044] elements 22 and 42 can be produced by putting the connector on a mandrel and prying elements 22 and 42 radially outward.
  • [0045] Connector 10 is formed in such a way that it is annularly enlargeable (e.g., by inflation of a balloon that is temporarily disposed inside the connector). The annularly expanded condition of connector 10 is shown in FIGS. 4, 10, and 11. The annular expandability of connector 10 is provided by making the connector with a plurality of annularly adjacent, annularly enlargeable cells. For example, a typical cell includes annularly spaced, but adjacent, longitudinal members 50 a and 52 a. The axially spaced ends of this pair of members are connected to one another at 54 a and 56 a. The next annularly adjacent similar cell includes elements 50 b, 52 b, 54 b, and 56 b. Annularly adjacent ones of these cells are connected to one another (e.g., as at 66 a) at locations which are axially medial to their axial end connections 54 and 56. In this way structure 10 is annularly enlargeable by annularly enlarging each of the above-mentioned cells (see FIG. 4).
  • In addition to the cells that are described above, [0046] structure 10 includes other, similarly annularly expandable cells that are axially and annularly offset from the first-described cells. A representative one of these other cells includes annularly adjacent longitudinal members 60 a and 62 a, the axially spaced ends of which are connected at 64 a and 66 a. (It should be noted that part of member 60 a is common with part of member 52 a, and part of member 62 a is common with part of member 50 b.) The next annularly adjacent cell of this kind includes components 60 b, 62 b, 64 b, and 66 b. Annularly adjacent cells of this kind are connected to one another at locations like 54 b, which are axially medial the axial endpoints 64 and 66 of those cells. Thus again the structure is annularly enlargeable by annularly enlarging these cells as shown, for example in FIG. 4.
  • It will be appreciated that as [0047] structure 10 annularly enlarges, it generally axially shortens. In other words, as cells 50/52/54/56 and 60/62/64/66 widen in the annular direction, they shorten in the axial direction. Thus annular enlargement of structure 10 decreases the axial spacing between portions 20 and 40, and more particularly decreases the axial spacing between member 22, on the one hand, and members 42, on the other hand.
  • A typical use of [0048] connector 10 is, in a coronary artery bypass procedure, to provide an anastomosis between an axial end portion of a tubular graft conduit and an aperture in a side wall of a coronary artery. For this kind of use connector 10 may be loaded on an uninflated balloon 110 near the distal end of a balloon catheter 100 as shown in FIG. 5. In other words, connector 10 and catheter 100 are assembled so that connector 10 extends annularly around uninflated balloon 110.
  • [0049] Graft conduit 120 is then placed annularly around the first portion 20 of connector 10 and the adjacent portion of catheter 100 as shown in FIG. 6. Graft conduit may be natural body tissue (e.g., a length of the patient's saphenous vein harvested for use as a graft, a partly severed internal mammary artery, etc.), an artificial graft (e.g., as shown in Goldsteen et al. U.S. Pat. No. 5,976,178, or published PCT patent application WO 98/19632, both of which are hereby incorporated by reference herein in their entireties), or a combination of natural and artificial conduits (e.g., a length of natural conduit disposed substantially concentrically inside a length of artificial conduit). Graft conduit 120 is placed on assembly 10/100 so that radially outwardly deflected members 22 penetrate and pass through the side wall of the graft conduit (e.g., as a result of compressing the graft against the fingers, thereby forcing the fingers to pierce through the graft wall). The sharpened free ends of members 22 facilitate penetration of conduit 120 by members 22. The blunt rear surfaces of enlarged free end portions 24 resist withdrawal of members 22 from conduit 120 after members 22 have penetrated the conduit. The graft may be additionally or alternatively directly sutured to the connector body. If the alternative of suturing graft 120 to the connector is used, then the first portion 20 of the connector may not need radially outwardly deflectable members 22 for engagement of the graft conduit.
  • As an alternative to securing [0050] graft 120 to connector 10 after balloon 110 has been associated with the connector, balloon 110 may be installed in connector 10 after the graft has been secured to the connector.
  • [0051] Illustrative apparatus 200 for delivering connector 10 and graft 120 to a location in a patient requiring a graft and an anastomosis, and for then deploying the connector and graft, is shown in FIG. 7. Apparatus 200 includes an optional guide wire 210, which may be first installed in the patient along the route that the remainder of the apparatus is later to follow to reach the desired location in the patient. The remainder of the apparatus is then slid into the patient along guide wire 210. Alternatively, guide wire 210 may be omitted, or a leading guide member (e.g., a wire) may be fixedly mounted on the distal (leftward in FIG. 2) end of the remainder of the apparatus. The wire allows precise tracking of the nose cone 220 and delivery system 200 into a patient's body fluid conduit (e.g., a coronary artery 300 as shown in FIGS. 8-10 and described below).
  • [0052] Apparatus 200 includes a gradually tapered distal nose portion or dilator 220 which extends annularly around a central, longitudinally extending, guide wire lumen 222. Distal nose portion 220 has a substantially conical outer surface with a cone angle A, which is preferably less than about 15° (e.g., in the range from about 5° to about 15°, more preferably in the range from about 5° to about 10°). Such gradual tapering of nose portion 220 is desirable to enable nose portion to gradually enlarge an aperture in a side wall of a body fluid conduit to which graft 120 is to be connected without snagging on that conduit side wall. This geometry allows optimal passage across a body conduit wall (e.g., a coronary artery wall as shown in FIG. 8 and described below) with minimal wall damage, with minimal force being required, and with no catching or snagging on the wall. Distal nose portion 220 may have cutting edges to further facilitate entry through a body fluid conduit side wall.
  • [0053] Distal nose portion 220 is connected to tube 230, which extends proximally from the nose portion annularly around guide wire 210. Thus the lumen of tube 230 constitutes a proximal continuation of guide wire lumen 222. Tube 230 may be made of stainless steel hypotube, which allows the depicted apparatus to be pushed or pulled axially along guide wire 210.
  • A proximal portion of [0054] distal nose portion 220 is hollowed out as indicated at 224 to receive balloon 110, connector 10, and a distal portion of graft 120 substantially coaxially around a medial portion of tube 230. For this arrangement balloon 110 is provided as a hollow annulus at or near the distal end of hollow tubular member 100. The side wall of tube 100 may include a separate lumen (not shown but conventional for balloon catheters) through which pressurized inflation fluid may be supplied from a proximal region of the apparatus to balloon 110. Elements 100 and 110 are slidable axially along the outer surface of tube 230. Insertion of elements 10, 110, and 120 (FIG. 6) into the annular recess 224 in distal nose portion 220 deflects the radially outermost portions of members 22 back over graft 120 as shown in FIG. 7. Tube 240, disposed substantially coaxially around element 100 inside graft 120 so that its distal end bears against members 22, may be used to help load elements 10, 110, and 120 into recess 224, and also to hold connector 10 in place in recess 224 during delivery of the connector to the anastomosis site in the patient.
  • FIG. 8 shows a typical use of [0055] apparatus 200 to deliver graft 120 for connection to an aperture in a side wall of a patient's tubular body conduit 300 (e.g., a coronary artery requiring a bypass graft). Guide wire 210 is first installed through a small aperture in the side wall of the conduit. The natural elastic recoil of the conduit 300 side wall seals the aperture around the guide wire so that there is little or no body fluid (e.g., blood) leakage out of the conduit via the aperture. The tapered distal nose portion 220 of apparatus 200 is then gradually forced into the aperture (e.g., by using tube 230 to push portion 220 distally into the aperture) to dilate the aperture. The natural elastic recoil of the conduit 300 side wall tissue continues to keep the aperture sealed or substantially sealed around portion 220.
  • When [0056] distal nose portion 220 has been pushed far enough into the aperture in the side wall of conduit 300 so that connector 10 is part way through the aperture, further distal motion of elements 10, 100, 110, and 120 can be stopped (e.g., by holding a proximal portion of element 100 stationary). Tube 240 is then pulled proximally out of the patient. Thereafter, distal nose portion 220 is pushed farther into conduit 300 (e.g., by continuing to push distally on a proximal portion of element 230). This causes distal nose portion 220 to separate from connector 10, thereby exposing the connector and leaving it in the aperture through the conduit 300 side wall as shown in FIG. 9.
  • The next step in use of [0057] apparatus 200 is to inflate balloon 110 as shown in FIG. 10. The balloon is typically sized to a specific anastomosis size (e.g., 3 millimeters diameter, 4 millimeters diameter, etc.). Inflation of the balloon forces connector 10 to annularly enlarge by enlarging cells 50/52/54/56 and 60/62/64/66 in the annular direction. In addition, the portions of members 60 and 62 that are adjacent to elements 64 (as well as elements 64 and 42) are deflected radially out beyond other portions of the connector inside the side wall of conduit 300, thereby causing the extreme distal end of graft 120 to similarly flare out inside that side wall. This outward flaring of portions of connector 10 and graft 120 helps secure the connector and graft to the side wall of conduit 300, and also helps seal the graft to the conduit. The axial shortening of connector 10 that accompanies annular enlargement ensures that graft 120 is drawn into secure and fluid-tight engagement with conduit 300. The free ends of members 42 preferably penetrate the side wall of conduit 300 to further secure connector 10 and graft 120 in the aperture in the side wall. Members 50, 52, 56, and 24 may also flare out somewhat outside the side wall of graft 300 to help ensure that graft 120 remains open where it connects to conduit 300. Assuming that the connector is approximately properly positioned relative to the side wall of conduit 300 prior to inflation of balloon 110, the connector is effectively self-centering on the conduit 300 side wall as the balloon is inflated.
  • The next step in use of [0058] apparatus 200 is to deflate balloon 110 and withdraw all of elements 100, 110, 210, 220, and 230 (e.g., by pulling them proximally out of graft 120). This leaves the axial end portion of graft 120 connected to the side wall of conduit 300 by annularly enlarged connector 10 as shown in FIG. 11. In particular, in this example connector 10 provides an end-to-side anastomosis between graft 120 and conduit 300. Body fluid from graft 120 is able to flow into conduit 300 via this connection. Connector 10 presses graft 120 radially outward against the aperture through the side wall of conduit 300 all the way around that aperture, thereby preventing body fluid from leaking out of conduits 120 and 300. Connector 10 also prevents the end of conduit 120 from pulling out of the side wall of conduit 300.
  • Another illustrative embodiment of a [0059] connector 410 in accordance with this invention is shown (in simplified planar development) in FIG. 12. Again, although connector 410 can be made in various sizes for various uses, a typical initial length of connector 410 is about 4.0 mm, and a typical initial outside diameter is in the range from about 0.040 to about 0.065 inches. A typical shaft length for members 422 is about 0.0539 inches, and a typical shaft width for those members is about 0.0050 inches. As in the case of connector 10, connector 410 may be cut from a single integral tube. A typical thickness for the material of connector 410 is about 0.004 inches. Suitable materials for connector 410 include stainless steel, tantalum, tungsten, platinum, and nitinol.
  • [0060] Connector 410 may be described as including axially spaced first and second portions 420 and 440, respectively. First portion 420 includes a plurality of annularly spaced first members 422 having free end portions 424 that initially point axially away from second portion 440. However, members 422 are deflectable radially out from other parts of the connector, and, if desired, free end portions 424 can be curved back so that they point toward second portion 440 (see FIG. 15).
  • The [0061] first portion 420 of connector 410 may also be said to include the lower portions (below members 454) of cells, each of which includes one member 460, one member 462, one member 464, and one member 466. For example, the left-most cell shown in FIG. 12 includes substantially parallel members 460 a and 462 a joined at their axially spaced ends by members 464 a and 466 a. Annularly adjacent cells are joined by members 454 at points that are axially medial their axial ends. For example, the cell that includes member 462 a is joined to the cell that includes member 460 b by members 454 b. The portions of members 460 and 462 below members 454 are also deflectable radially out from other portions of the connector.
  • The [0062] second portion 440 of connector 410 may be said to include the portions of members 460 and 462 above members 454. These portions of members 460 and 462 are also deflectable radially out (as loops 460/462/464) from other portions of the connector. If desired, loops 460/462/464 could also have fingers or barbs on them like members 42 in the embodiment of FIGS. 1-11.
  • [0063] Connector 410 is annularly enlargeable by deforming members 460 and 462 to enlarge each of the above-described cells in the annular direction as shown in greatly simplified form in FIG. 13.
  • FIG. 14 shows an illustrative embodiment of [0064] tooling 500 that can be used to facilitate attachment of a graft conduit 120 to connector 410. Tooling 500 includes a mandrel with a conical end portion, the pointed free end of which is small enough to fit axially into connector 410 in its initial relatively small annular size. As connector 410 is forced farther onto the conical end portion of mandrel 500, the cone of the mandrel begins to deflect members 422 radially out from other portions of the connector. Graft conduit 120 can be placed around mandrel 500 and shifted axially toward connector 410 until an axial end portion of conduit 120 axially overlaps outwardly deflected members 422. The free end portions of members 422 can then be pried out through the side wall of conduit 120 as shown in FIG. 15 to secure connector 410 to conduit 120. Mandrel 500 can be pulled proximally out of graft 120 and connector 410 at any suitable time. Use of mandrel 500 in this way helps ensure that members 422 penetrate the side wall of conduit 120 substantially equidistantly in the annular direction around the conduit. This helps avoid excessive stretching of any angular segment of graft 120 when connector 410 is subsequently expanded by balloon 110.
  • After [0065] connector 410 has been attached to graft 120 as shown in FIG. 15, an inflatable balloon like balloon 110 (with tube 100) can be inserted into the connector in a manner similar to what is shown in FIG. 6. Elements 100, 110, 120, and 410 can then be loaded into apparatus like 200 in a manner similar to what is shown in FIG. 7 (except that in this case the free ends 424 of members 422 will typically point in the distal direction rather than in the proximal direction as is true for the free ends 24 of members 22 in FIG. 7). Apparatus 200 can then be used to install connector 410 and graft 120 in a patient in a manner similar to the installation shown in FIGS. 8-11. FIG. 16 shows the second portion 440 after it has been conveyed through the side wall of conduit 300 by apparatus 200 and apparatus 200 has been shifted distally farther into conduit 300 to expose the connector. FIG. 17 shows second portion loops 460/462/464 deployed (radially outwardly deflected), but the remainder of the connector not yet annularly expanded. A shaped balloon or dual balloon system may be utilized to achieve this. For example, one of two axially adjacent balloons may be used to help form distal retention fingers 460/462/464 as shown in FIG. 17. The second of the two balloons is thereafter used to annularly expand the remainder of the connector and the anastomosis opening. Alternatively, a single “bulbous” shaped balloon may be used to produce a temporary intermediate condition like that shown in FIG. 17, and to then annularly enlarge the remainder of the connector and the anastomosis opening. As still another possibility the distal retention fingers 460/462/464 may be self-actuating (i.e., spring-biased) and not require balloon assist to spring out to the condition shown in FIG. 17. For example, distal retention fingers 460/462/464 may be preformed to deflect radially outward in a manner similar to the radially outward preform that is given to elements 22 and 42 in FIG. 3.
  • The final [0066] anastomosis employing connector 410 is shown in FIGS. 18 and 19. In particular, as shown in FIGS. 18 and 19 connector 410 has been annularly expanded by enlargement of the cells 460/462/464/466 in the annular direction. The portions of members 460 and 462 that comprise portion 440 of the connector have been deflected radially out from other portions of the connector inside conduit 300, thereby functioning to secure connector 410 and graft 120 to conduit 300. Members 422 are deflected radially out from other portions of the connector and pass through the axial end portion of graft 120. The free end portions of members 422 point toward the second portion 440 of the connector, thereby ensuring that the end of graft 120 cannot slip away from its body-fluid-sealing abutment with the side wall of conduit 300. The annularly expanded medial portion of connector 410 holds open the aperture in the side wall of conduit 300, as well as the attached end of graft 120, thereby ensuring unobstructed body fluid flow through the anastomosis between conduits 120 and 300.
  • Still another illustrative embodiment of a [0067] connector 610 in accordance with this invention is shown in greatly simplified, annularly expanded, planar development in FIG. 24. Connector 610 is configured for use in performing a side-to-side anastomosis between two body fluid conduits 300 a and 300 b as shown in FIG. 25. Connector 610 has a construction like two portions 40 of connector 10 connected together. Thus members 642 a and 642 b are constructed and operate like members 42 in connector 10. Similarly, members 660 are constructed and operate generally like members 60 and 62 in connector 10, and elements 664 and 666 are constructed and operate generally like elements 64 and 66, respectively, in connector 10.
  • [0068] Connector 610, in an initially relatively small annular size and mounted on a balloon, is insertable through adjacent apertures in the side walls of body fluid conduits 300 a and 300 b. For example, apparatus like 200 can be used to deliver connector 610 to such a site via the lumen of one of conduits 300 and to then position the connector so that it spans both conduits. Apparatus 200 is then shifted relative to connector 610 in a manner generally similar to FIG. 9 to expose the connector. The balloon 110 associated with the connector is then inflated to annularly enlarge the connector to the condition shown in FIG. 25. In particular, this annular expansion causes members 642 a to penetrate the side wall of conduit 300 a annularly around the anastomotic opening, and also causes members 642 b to penetrate the side wall of conduit 300 b annularly around the anastomotic opening. As with the other connectors of this invention, annular enlargement of connector 610 is accompanied by axial shortening, which helps to draw the side walls of conduits 300 a and 300 b together annularly around the connector, thereby providing the desired fluid-tight anastomosis between the conduits. When the anastomosis is thus complete, the balloon inside the connector is deflated and all the apparatus is withdrawn through the anastomosis.
  • It will be understood that the foregoing is only illustrative of the principles of this invention, and that various modifications can be made by those skilled in the art without departing from the scope and spirit of the invention. For example, the number and shape of the annularly enlargeable connector cells can be different from what is shown in the drawings herein. The number of axially adjacent rows of annularly enlargeable cells can be different from the numbers of such rows that are shown herein (i.e., two rows of cells in the case of [0069] connectors 10 and 610 or one row of cells in the case of connector 410). For example, a connector may have three, four, or more rows of cells. The cells may have any of many forms, depending on the desired degree of expansion and final radial strength. The number of cells, the number of rows of cells, the size of the cells, and the geometry of the cells can all be selected to control the expansion, strength, and sizing of the finished connector. The number and shape of the radially outwardly deflectable connector members can also differ from what is shown herein. Techniques and apparatus different from what is shown and described herein can be used for attaching a connector of this invention to a graft conduit and/or installing the connector in a patient. Instead of the extreme end of graft 120 being inside conduit 300, the connector of this invention may be configured to secure the end of the graft 120 against the outside of the side wall of conduit 300 in an end-to-side anastomosis as shown in FIG. 23. The nose cone 220 of apparatus 200 may not need to cover the proximal fingers 22 or 422 of the connector. Instead, the proximal fingers can extend to an outer circumference which is larger than the outer circumference of nose cone 220. This allows the proximal fingers to be used as a stop which prevents the connector from going too far through the aperture in the side wall of conduit 300. In other words, the radially outer ends of proximal fingers 22 or 422 come into contact with the outer surface of the side wall of conduit 300 and thereby stop the connector from going any farther into that conduit.
  • Although considerable variation in the connectors of this invention is thus possible and contemplated, in general such connectors comprise a unitary structure disposed annularly about a longitudinal axis (e.g., [0070] axis 12 in FIG. 2). The connector structure generally has axially spaced first and second portions (e.g., 20 and 40, 420 and 440, or 640 a and 640 b in the depicted illustrative embodiments). The first portion generally has a plurality of annularly spaced first members that are deflectable radially out from a remainder or other generally axially medial portion of the structure. For example, in the illustrative embodiment shown in FIGS. 1-11 these first members include elements 22. In the illustrative embodiment shown in FIGS. 12-19 these first members include elements 422. In the illustrative embodiment shown in FIGS. 24 and 25 these first members include elements 642 a. The second portion may also have a plurality of annularly spaced second members that are deflectable radially out from a remainder or other generally axially medial portion of the structure. For example, in the illustrative embodiment shown in FIGS. 1-11 these second members include elements 44 and (later in use of the connector) the portions of elements 60 and 62 that are above elements 54 in FIG. 1. In the illustrative embodiment shown in FIGS. 12-19 the second members include U-shaped structures that are the portions of elements 460, 462, and 464 above elements 454 in FIG. 12. In the illustrative embodiment shown in FIGS. 24 and 25 these second members include members 642 b. Also, in general, the connector structures of this invention are annularly enlargeable. For example, in the illustrative embodiment shown in FIGS. 1-11 the connector is annularly enlargeable by enlarging cells 50/52/54/56 and 60/62/64/66 in the annular direction as shown, e.g., in FIG. 4. Similarly, in the illustrative embodiment shown in FIGS. 12-19 the connector is annularly enlargeable by enlarging cells 460/462/464/466 in the annular direction as shown, e.g., in FIG. 13. And in the embodiment shown in FIGS. 24 and 25 the connector is annularly enlargeable by enlarging cells 660/664/666 in the annular direction.
  • It will be appreciated that, in general, the structure of the connectors of this invention is such that radial enlargement of the connector reduces the axial spacing between the above-mentioned first and second members. This helps the connector draw together in a fluid-tight way the two body fluid conduits that are to be connected by the connector. In the embodiment shown in FIGS. [0071] 1-11, for example, annular enlargement of cells 60/62/64/66 causes a decrease in the axial spacing between members 22, on the one hand, and members 42, on the other hand. Similarly, in the embodiment shown in FIGS. 12-19 annular enlargement of cells 460/462/464/466 causes a decrease in the axial spacing between members 422, on the one hand, and the portions of elements 460 and 462 above elements 454 in FIG. 12, on the other hand. And in the embodiment shown in FIGS. 24 and 25 annular enlargement of the connector decreases the axial spacing between members 642 a, on the one hand, and members 642 b, on the other hand. The above-described axial shortening of the connector advantageously applies compressive forces (for sealing) to the body fluid conduits being connected.
  • In general, most of the deformation of the connectors of this invention is preferably plastic strain and therefore permanent. The deformation thus referred to includes both the above-described radially outward deflection of members like [0072] 22, 42, 422, 642, etc., and the above-described radial enlargement of the connector.
  • The radially outwardly deflectable members or portions of the connector may be barbs, hooks, spikes, loops, or suture rings. [0073]
  • The connectors of this invention may be constructed so that different portions of the connector annularly enlarge in response to different amounts of applied annular enlargement force. For example, in the embodiment shown in FIGS. [0074] 1-11, the portions of the structure above elements 54 in FIG. 1 may be made so that they are less resistant to inflation of a balloon 110 inside the connector than portions of the structure below elements 54 in FIG. 1. In an application of the type shown in FIGS. 1-11 this causes these less resistant portions to annularly enlarge by deflecting radially out inside conduit 300 before the remainder of the connector begins to significantly annularly enlarge. This early response of the less resistant portions inside conduit 300 may help to ensure that the connector does not slip out of engagement with conduit 300 during annular enlargement of the connector. This technique of making different portions of the connector with different strengths can be used to provide any sequence or phasing of annular enlargement of various portions of the connector. Alternatively or additionally, the connector can be shaped, molded, or phased in any desired way by providing a balloon structure 110 which is shaped, molded, or phased in that way. For example, balloon structure 110 may comprise two or more separately inflatable balloons of the same or different inflated circumferential size. Two such balloons may be axially displaced from one another inside the connector so that axially different portions of the connector can be annularly enlarged at different times and/or by different amounts.
  • Radiologically (e.g., x-ray) viewable markers can be used anywhere on the connectors and/or delivery apparatus (e.g., [0075] 200) of this invention to facilitate radiologic observation of the proper placement and deployment of a connector in a patient if the connector-utilizing procedure is such that more direct visual observation is not possible or sufficient. One way to enhance the radiologic viewability of connectors in accordance with this invention is to make them from clad tubing. Clad tubing has two (or more) substantially concentric layers of metal, each with a desired property. As shown in FIG. 20, for example, clad tubing 500 has a tantalum layer 502 over a stainless steel layer 504. The tantalum layer 502 provides radiodensity, thereby making a connector 10, 410, or 610 that is cut from tube 500 radiologically viewable. The stainless steel layer 504 provides rigidity to the connector. The medial section can be ground to reduce the thickness ratio to favor the tantalum. This improves the ability for balloon expansion. Although tube 500 (and the resulting connector 10, 410, or 610) may thus be made of two or more layers of different materials, the tube and the connector are still accurately described as unitary, one-piece, or integral. As an alternative to using clad tubing, the connector may be plated with a radiologic material to give it a desired radiodensity. Another example of a material suitable for radiologic layer 502 is platinum.
  • Small polyester or other polymer patches or bands may be used on or in association with a connector of this invention to help seal and coagulate blood. Such patches may be inserted over individual fingers as shown, for example, at [0076] 522 in FIG. 21. Alternatively, such a band or web may be provided around the medial portion of connector 10, 410, or 610 as shown, for example, at 530 in FIG. 22. A band or web like 530 may also be used to constrain the size of the connector or a graft (such as a vein graft) relative to the connector. Vein grafts may dilate significantly under arterial blood pressure. A band or web can be used to fix its size relative to the connector. Alternatively or additionally a band or web like 530 can be provided to help seal the completed anastomosis For purposes of these various kinds, a band or web like 530 may preferably be elastic (e.g., of a rubber or rubber-like material such as silicone or polyurethane). The band or web like 530 can be porous, if desired, and may be impregnated with drugs to facilitate healing and/or sealing. Similarly, polymer patches like 522 in FIG. 21 can include and release coagulant and/or other medication to help prevent bleeding and promote healing. Patches like 522 in FIG. 21 can help prevent members like 22 from pulling back through tissue that the member has penetrated.
  • An important attribute of the connectors of this invention is the characteristic that the medial section is soft enough to allow balloon expansion and strong enough to secure the two body fluid conduits via such elements as [0077] 22 and 42, 422 and 460/462/464, or 642. To achieve this with a single material and wall thickness, which may be preferable from a manufacturing perspective, the center section may be annealed selectively to soften it without compromising the rigidity of the retention elements (e.g., 22, 42, 422, 642, etc.). This can be done, for example, by laser heat treating the medial section only. The results of this process are relatively low hardness in the medial section and relatively high hardness in the end sections, all within an overall length of about 0.2 inches.
  • The connectors of this invention may also be made of a super-elastic material such as nickel-titanium (“nitinol”), which would allow a similar geometry as stainless steel to self-deploy or actuate in-vivo. [0078]
  • It will be appreciated that the fact that the connectors of this invention can be initially relatively small in circumference, and that they can be remotely controlled to position them in the patient and to then annularly expand them for final deployment, facilitates use of these connectors and associated apparatus (e.g., apparatus [0079] 200) at remote and/or inaccessible locations in a patient. For example, a connector of this invention may be delivered into and installed in a patient (using apparatus such as apparatus 200) through relatively small instrumentation such as laparascopic apparatus, a cannula, or an intraluminal catheter. Thus a connector and associated apparatus (e.g., apparatus 200) of this invention can be used in any of the procedures mentioned earlier in this specification, and in particular in procedures and with other elements shown in any of above-mentioned references WO 98/16161, U.S. Pat. No. 5,976,178, U.S. Pat. No. 6,120,432, WO 98/55027, and U.S. Pat. No. 6,475,222. Alternatively, the connector and/or apparatus (e.g., apparatus 200) of this invention can be used in more traditional or conventional surgical procedures or in other, known, less invasive or minimally invasive procedures. As just some examples of possible uses of the connectors and apparatus of this invention, they can be used to perform an anastomosis to a beating or still heart without the use of sutures or direct access.
  • Again, although the connectors of this invention can be made in various sizes for various uses, a typical connector is initially less than about 1 millimeter in diameter and in the range from about 2 to about 4 millimeters in length. After annular enlargement, a typical connector is more than about 2.5 millimeters in diameter. The pre-yield geometry of these connectors is ideal for delivery and positioning; the post-yield geometry is ideal for vessel securement, seal, and patency. The geometry of the connectors is ideal for annular enlargement. Radial outward deflection of certain connector members such as [0080] 22, 42, 422, 642, etc., is ideal for interfacing the expanding medial section of the connector to each of the two body fluid conduits to be connected (e.g., a graft vessel and an artery vessel).
  • As has been explained, certain connector cells may be configured to open before other cells as desired to optimize deployment positioning. Integral connector fingers such as [0081] 22, 42, 422, 642, etc., can be deflected radially out from the remainder of a connector for the purpose of attachment to body fluid conduits (e.g., a graft and an artery). These fingers are part of the connector body and can be hooks, barbs, loops, or spikes. The geometry of the fingers can also change, as desired, in response to balloon expansion. A balloon catheter can be used to actuate the connector and provide an anastomosis opening and attachment. The nose cone portion 220 of apparatus 200 covers the connector and graft interface, allowing dilation of the other body fluid conduit wall and passage of the connector through that wall. The connector provides the actual anastomotic opening and the connection simultaneously. The device is actuated via a balloon and catheter delivery system.
  • Among the advantages of the invention are that it eliminates suturing and reduces the time required to produce an anastomosis. In major circulatory system repair procedures such as cardiac bypass procedures, this can reduce cardiopulmonary pump time, which is of great benefit to the patient. The invention provides optimal flow dynamics, e.g., from a graft to the coronary artery. The blood entrance angle can be engineered into the connector geometry rather than relying on suture skill or technique. The invention eliminates possible suture injury to vessels. At the high stress site of an anastomosis sutures are eliminated. The connector and a graft can be delivered percutaneously, e.g., as in several of the references that are mentioned above. Direct access required for suturing is eliminated. An anastomotic connection can be made to a beating heart. [0082]

Claims (1)

The invention claimed is:
1. Apparatus for inserting an annular anastomotic connector into a side wall of a tubular body tissue conduit comprising:
substantially conical tip structure having a cone angle less than about 15° and configured for passage through the side wall starting with an apex of the cone;
a shaft structure extending from the tip structure in a direction away from the apex and configured to receive the connector annularly around the shaft structure;
an inflatable annular balloon having a first cross-sectional radius at the distal end, and a second cross-sectional radius at the proximal end, wherein the second cross-sectional radius is greater than the first cross-sectional radius, wherein the inflatable annular balloon is configured for disposition annularly around the shaft structure and inside the connector around the shaft structure, wherein expansion of the balloon first causes deformation of distal fingers of the connector and subsequently causes radial expansion of the connector.
US10/351,954 1998-11-06 2003-01-24 Medical anastomosis apparatus Abandoned US20030187499A1 (en)

Priority Applications (1)

Application Number Priority Date Filing Date Title
US10/351,954 US20030187499A1 (en) 1998-11-06 2003-01-24 Medical anastomosis apparatus

Applications Claiming Priority (5)

Application Number Priority Date Filing Date Title
US09/186,774 US6113612A (en) 1998-11-06 1998-11-06 Medical anastomosis apparatus
US09/527,668 US6309416B1 (en) 1998-11-06 2000-03-17 Medical anastomosis apparatus
US09/955,231 US6440163B1 (en) 1998-11-06 2001-09-17 Medical anastomosis apparatus
US10/078,939 US6533812B2 (en) 1998-11-06 2002-02-19 Medical anastomosis apparatus
US10/351,954 US20030187499A1 (en) 1998-11-06 2003-01-24 Medical anastomosis apparatus

Related Parent Applications (1)

Application Number Title Priority Date Filing Date
US10/078,939 Continuation US6533812B2 (en) 1998-11-06 2002-02-19 Medical anastomosis apparatus

Publications (1)

Publication Number Publication Date
US20030187499A1 true US20030187499A1 (en) 2003-10-02

Family

ID=22686241

Family Applications (5)

Application Number Title Priority Date Filing Date
US09/186,774 Expired - Lifetime US6113612A (en) 1998-11-06 1998-11-06 Medical anastomosis apparatus
US09/527,668 Expired - Fee Related US6309416B1 (en) 1998-11-06 2000-03-17 Medical anastomosis apparatus
US09/955,231 Expired - Fee Related US6440163B1 (en) 1998-11-06 2001-09-17 Medical anastomosis apparatus
US10/078,939 Expired - Fee Related US6533812B2 (en) 1998-11-06 2002-02-19 Medical anastomosis apparatus
US10/351,954 Abandoned US20030187499A1 (en) 1998-11-06 2003-01-24 Medical anastomosis apparatus

Family Applications Before (4)

Application Number Title Priority Date Filing Date
US09/186,774 Expired - Lifetime US6113612A (en) 1998-11-06 1998-11-06 Medical anastomosis apparatus
US09/527,668 Expired - Fee Related US6309416B1 (en) 1998-11-06 2000-03-17 Medical anastomosis apparatus
US09/955,231 Expired - Fee Related US6440163B1 (en) 1998-11-06 2001-09-17 Medical anastomosis apparatus
US10/078,939 Expired - Fee Related US6533812B2 (en) 1998-11-06 2002-02-19 Medical anastomosis apparatus

Country Status (5)

Country Link
US (5) US6113612A (en)
EP (1) EP1126794A2 (en)
JP (1) JP2002529141A (en)
AU (1) AU1340700A (en)
WO (1) WO2000027313A2 (en)

Cited By (14)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20060206123A1 (en) * 2004-08-27 2006-09-14 Rox Medical, Inc. Device and method for establishing an artificial arterio-venous fistula
EP1827302A2 (en) * 2004-08-27 2007-09-05 Rox Medical Inc. Device and method for establishing an artificial arterio-venous fistula
US20070249985A1 (en) * 2004-08-27 2007-10-25 Rox Medical, Inc. Device and method for establishing an artificial arterio-venous fistula
WO2009129079A1 (en) * 2008-04-17 2009-10-22 Medtronic Vascular Inc. Branch vessel suture stent system
US20100268316A1 (en) * 2004-08-27 2010-10-21 Rox Medical, Inc. Device and method for establishing an artificial arterio-venous fistula
US20120123454A1 (en) * 2010-11-11 2012-05-17 Wilson T. Asfora Sutureless vascular anastomosis connection
USD755384S1 (en) 2014-03-05 2016-05-03 Edwards Lifesciences Cardiaq Llc Stent
US9681951B2 (en) 2013-03-14 2017-06-20 Edwards Lifesciences Cardiaq Llc Prosthesis with outer skirt and anchors
US9724083B2 (en) 2013-07-26 2017-08-08 Edwards Lifesciences Cardiaq Llc Systems and methods for sealing openings in an anatomical wall
US9730791B2 (en) 2013-03-14 2017-08-15 Edwards Lifesciences Cardiaq Llc Prosthesis for atraumatically grasping intralumenal tissue and methods of delivery
US10159485B2 (en) 2010-11-11 2018-12-25 Asfora Ip, Llc Deployment tool for sutureless vascular anastomosis connection
WO2019152799A1 (en) * 2018-02-02 2019-08-08 University Of Louisville Research Foundation, Inc. Sutureless graft anastomotic quick connect system
US11207457B2 (en) * 2004-08-27 2021-12-28 Edwards Lifesciences Corporation Device and method for establishing an artificial arterio-venous fistula
US11918223B2 (en) 2019-02-01 2024-03-05 University Of Louisville Research Foundation, Inc. Sutureless graft anastomotic quick connect system

Families Citing this family (422)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20020095164A1 (en) * 1997-06-26 2002-07-18 Andreas Bernard H. Device and method for suturing tissue
US6293955B1 (en) 1996-09-20 2001-09-25 Converge Medical, Inc. Percutaneous bypass graft and securing system
US5989276A (en) 1996-11-08 1999-11-23 Advanced Bypass Technologies, Inc. Percutaneous bypass graft and securing system
US6036702A (en) * 1997-04-23 2000-03-14 Vascular Science Inc. Medical grafting connectors and fasteners
US6896687B2 (en) 1997-05-19 2005-05-24 Pepi Dakov Connectors for hollow anatomical structures and methods of use
NL1007349C2 (en) * 1997-10-24 1999-04-27 Suyker Wilhelmus Joseph Leonardus System for the mechanical production of anastomoses between hollow structures; as well as device and applicator for use therewith.
JP4187411B2 (en) * 1998-01-30 2008-11-26 セント ジュード メディカル エーティージー, インコーポレイテッド Device for use in closing a septal defect
US6994713B2 (en) * 1998-01-30 2006-02-07 St. Jude Medical Atg, Inc. Medical graft connector or plug structures, and methods of making and installing same
US6352543B1 (en) * 2000-04-29 2002-03-05 Ventrica, Inc. Methods for forming anastomoses using magnetic force
US20020144696A1 (en) 1998-02-13 2002-10-10 A. Adam Sharkawy Conduits for use in placing a target vessel in fluid communication with a source of blood
US6651670B2 (en) 1998-02-13 2003-11-25 Ventrica, 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
US20050283188A1 (en) * 1998-05-29 2005-12-22 By-Pass, Inc. Vascular closure device
US20050101983A1 (en) * 1998-05-29 2005-05-12 By-Pass,Inc. Method and apparatus for forming apertures in blood vessels
US7396359B1 (en) * 1998-05-29 2008-07-08 Bypass, Inc. Vascular port device
US6979338B1 (en) * 1998-05-29 2005-12-27 By-Pass Inc. Low profile anastomosis connector
US20040087985A1 (en) * 1999-03-19 2004-05-06 Amir Loshakove Graft and connector delivery
US6726704B1 (en) 1998-05-29 2004-04-27 By-Pass, Inc. Advanced closure device
US20040049221A1 (en) * 1998-05-29 2004-03-11 By-Pass, Inc. Method and apparatus for forming apertures in blood vessels
US20040073247A1 (en) * 1998-05-29 2004-04-15 By-Pass, Inc. Method and apparatus for forming apertures in blood vessels
US6641593B1 (en) 1998-06-03 2003-11-04 Coalescent Surgical, Inc. Tissue connector apparatus and methods
US6945980B2 (en) 1998-06-03 2005-09-20 Medtronic, Inc. Multiple loop tissue connector apparatus and methods
US6613059B2 (en) 1999-03-01 2003-09-02 Coalescent Surgical, Inc. Tissue connector apparatus and methods
US6361559B1 (en) 1998-06-10 2002-03-26 Converge Medical, Inc. Thermal securing anastomosis systems
US6206913B1 (en) 1998-08-12 2001-03-27 Vascular Innovations, Inc. Method and system for attaching a graft to a blood vessel
US7314477B1 (en) 1998-09-25 2008-01-01 C.R. Bard Inc. Removable embolus blood clot filter and filter delivery unit
US7018387B2 (en) * 1998-10-22 2006-03-28 Innovative Interventional Technologies B.V. Mechanical anastomosis system for hollow structures
US6113612A (en) * 1998-11-06 2000-09-05 St. Jude Medical Cardiovascular Group, Inc. Medical anastomosis apparatus
US6508252B1 (en) * 1998-11-06 2003-01-21 St. Jude Medical Atg, Inc. Medical grafting methods and apparatus
US8118822B2 (en) 1999-03-01 2012-02-21 Medtronic, Inc. Bridge clip tissue connector apparatus and methods
US8137364B2 (en) 2003-09-11 2012-03-20 Abbott Laboratories Articulating suturing device and method
US20040092964A1 (en) 1999-03-04 2004-05-13 Modesitt D. Bruce Articulating suturing device and method
US7001400B1 (en) * 1999-03-04 2006-02-21 Abbott Laboratories Articulating suturing device and method
US6964668B2 (en) * 1999-03-04 2005-11-15 Abbott Laboratories Articulating suturing device and method
US7235087B2 (en) 1999-03-04 2007-06-26 Abbott Park Articulating suturing device and method
US7842048B2 (en) 2006-08-18 2010-11-30 Abbott Laboratories Articulating suture device and method
EP1161185A2 (en) * 1999-03-09 2001-12-12 St. Jude Medical Cardiovascular Group, Inc. Medical grafting methods and apparatus
US6695859B1 (en) 1999-04-05 2004-02-24 Coalescent Surgical, Inc. Apparatus and methods for anastomosis
US7160311B2 (en) 1999-04-16 2007-01-09 Integrated Vascular Interventional Technologies, L.C. (Ivit Lc) Locking compression plate anastomosis apparatus
US6569173B1 (en) 1999-12-14 2003-05-27 Integrated Vascular Interventional Technologies, L.C. Compression plate anastomosis apparatus
US7981126B2 (en) 1999-04-16 2011-07-19 Vital Access Corporation Locking compression plate anastomosis apparatus
US6623494B1 (en) 1999-04-16 2003-09-23 Integrated Vascular Interventional Technologies, L.C. (Ivit, Lc) Methods and systems for intraluminally directed vascular anastomosis
AU4242800A (en) 1999-04-23 2000-11-10 St. Jude Medical Cardiovascular Group, Inc. Artificial heart valve attachment apparatus
US6428550B1 (en) 1999-05-18 2002-08-06 Cardica, Inc. Sutureless closure and deployment system for connecting blood vessels
WO2000069364A2 (en) 1999-05-18 2000-11-23 Vascular Innovations, Inc. Implantable medical device such as an anastomosis device
US6673088B1 (en) 1999-05-18 2004-01-06 Cardica, Inc. Tissue punch
US6719769B2 (en) 1999-11-15 2004-04-13 Cardica, Inc. Integrated anastomosis tool with graft vessel attachment device and cutting device
EP1055401B1 (en) * 1999-05-26 2003-10-01 NEC TOKIN Corporation Device for anastomosis of blood vessels
US6699256B1 (en) 1999-06-04 2004-03-02 St. Jude Medical Atg, Inc. Medical grafting apparatus and methods
EP1187566A2 (en) * 1999-06-04 2002-03-20 St. Jude Medical Cardiovascular Group, Inc. Surgical grafting apparatus and methods
US7892246B2 (en) 1999-07-28 2011-02-22 Bioconnect Systems, Inc. Devices and methods for interconnecting conduits and closing openings in tissue
US20030070676A1 (en) * 1999-08-05 2003-04-17 Cooper Joel D. Conduits having distal cage structure for maintaining collateral channels in tissue and related methods
US20030130657A1 (en) * 1999-08-05 2003-07-10 Tom Curtis P. Devices for applying energy to tissue
ATE258768T1 (en) * 1999-08-05 2004-02-15 Broncus Tech Inc METHOD AND DEVICES FOR PRODUCING COLLATERAL CHANNELS IN THE LUNGS
US7815590B2 (en) 1999-08-05 2010-10-19 Broncus Technologies, Inc. Devices for maintaining patency of surgically created channels in tissue
US7422563B2 (en) * 1999-08-05 2008-09-09 Broncus Technologies, Inc. Multifunctional tip catheter for applying energy to tissue and detecting the presence of blood flow
US20040073155A1 (en) * 2000-01-14 2004-04-15 Broncus Technologies, Inc. Methods and devices for maintaining patency of surgically created channels in tissue
AU7341800A (en) * 1999-09-01 2001-03-26 Origin Medsystems, Inc. Method and apparatus for performing anastomosis
US6494889B1 (en) 1999-09-01 2002-12-17 Converge Medical, Inc. Additional sutureless anastomosis embodiments
US8529583B1 (en) 1999-09-03 2013-09-10 Medtronic, Inc. Surgical clip removal apparatus
US6485513B1 (en) 1999-10-08 2002-11-26 The General Hospital Corporation Percutaneous stent graft and method for vascular bypass
US6926730B1 (en) 2000-10-10 2005-08-09 Medtronic, Inc. Minimally invasive valve repair procedure and apparatus
JP2003513696A (en) * 1999-11-05 2003-04-15 オーナックス・メディカル・インコーポレーテッド Apparatus and method for placing multiple sutures during an anastomosis
US6682540B1 (en) 1999-11-05 2004-01-27 Onux Medical, Inc. Apparatus and method for placing multiple sutures
US6602263B1 (en) * 1999-11-30 2003-08-05 St. Jude Medical Atg, Inc. Medical grafting methods and apparatus
US20040068278A1 (en) * 1999-12-06 2004-04-08 Converge Medical Inc. Anastomosis systems
US6736825B2 (en) 1999-12-14 2004-05-18 Integrated Vascular Interventional Technologies, L C (Ivit Lc) Paired expandable anastomosis devices and related methods
US8758400B2 (en) 2000-01-05 2014-06-24 Integrated Vascular Systems, Inc. Closure system and methods of use
US9579091B2 (en) 2000-01-05 2017-02-28 Integrated Vascular Systems, Inc. Closure system and methods of use
US6942674B2 (en) 2000-01-05 2005-09-13 Integrated Vascular Systems, Inc. Apparatus and methods for delivering a closure device
US6461364B1 (en) 2000-01-05 2002-10-08 Integrated Vascular Systems, Inc. Vascular sheath with bioabsorbable puncture site closure apparatus and methods of use
US6391048B1 (en) 2000-01-05 2002-05-21 Integrated Vascular Systems, Inc. Integrated vascular device with puncture site closure component and sealant and methods of use
US7842068B2 (en) 2000-12-07 2010-11-30 Integrated Vascular Systems, Inc. Apparatus and methods for providing tactile feedback while delivering a closure device
US7118546B2 (en) * 2000-01-11 2006-10-10 Integrated Vascular Interventional Technologies, L.C. Apparatus and methods for facilitating repeated vascular access
US6595941B1 (en) 2000-01-11 2003-07-22 Integrated Vascular Interventional Technologies, L.C. Methods for external treatment of blood
WO2001051117A1 (en) 2000-01-11 2001-07-19 Blatter Duane D Vascular occlusal balloons and related vascular access devices and systems
US6656151B1 (en) 2000-01-11 2003-12-02 Integrated Vascular Interventional Technologies, L.C. (Ivit, Lc) Vascular access devices and systems
US7131959B2 (en) * 2003-01-23 2006-11-07 Integrated Vascular Interventional Technologies, L.C., (“IVIT LC”) Apparatus and methods for occluding an access tube anastomosed to sidewall of an anatomical vessel
DE10010073B4 (en) * 2000-02-28 2005-12-22 Fraunhofer-Gesellschaft zur Förderung der angewandten Forschung e.V. Anchoring for implantable heart valve prostheses
JP2003527189A (en) * 2000-03-20 2003-09-16 バイ−パス・インク. Graft transfer system
AU2001244497A1 (en) * 2000-03-20 2001-10-03 By-Pass, Inc. Transvascular bypass method and system
US6551332B1 (en) 2000-03-31 2003-04-22 Coalescent Surgical, Inc. Multiple bias surgical fastener
US6802847B1 (en) 2000-04-29 2004-10-12 Ventrica, Inc. Devices and methods for forming magnetic anastomoses and ports in vessels
US8518062B2 (en) 2000-04-29 2013-08-27 Medtronic, Inc. Devices and methods for forming magnetic anastomoses between vessels
US7232449B2 (en) * 2000-04-29 2007-06-19 Medtronic, Inc. Components, systems and methods for forming anastomoses using magnetism or other coupling means
EP1512383B1 (en) * 2000-06-26 2013-02-20 Rex Medical, L.P. A vascular system for valve leaflet apposition
US6676698B2 (en) * 2000-06-26 2004-01-13 Rex Medicol, L.P. Vascular device with valve for approximating vessel wall
US6695878B2 (en) * 2000-06-26 2004-02-24 Rex Medical, L.P. Vascular device for valve leaflet apposition
US6582452B2 (en) 2000-09-08 2003-06-24 James Coleman Surgical stapler
US8303609B2 (en) * 2000-09-29 2012-11-06 Cordis Corporation Coated medical devices
US6626918B1 (en) 2000-10-06 2003-09-30 Medical Technology Group Apparatus and methods for positioning a vascular sheath
US6776785B1 (en) 2000-10-12 2004-08-17 Cardica, Inc. Implantable superelastic anastomosis device
US6966917B1 (en) * 2000-11-09 2005-11-22 Innovation Interventional Technologies B.V. Deformable connector for mechanically connecting hollow structures
US6471713B1 (en) 2000-11-13 2002-10-29 Cardica, Inc. System for deploying an anastomosis device and method of performing anastomosis
US6554764B1 (en) 2000-11-13 2003-04-29 Cardica, Inc. Graft vessel preparation device and methods for using the same
US6719777B2 (en) * 2000-12-07 2004-04-13 Integrated Vascular Systems, Inc. Closure device and methods for making and using them
US8690910B2 (en) * 2000-12-07 2014-04-08 Integrated Vascular Systems, Inc. Closure device and methods for making and using them
US7806904B2 (en) 2000-12-07 2010-10-05 Integrated Vascular Systems, Inc. Closure device
US6623510B2 (en) 2000-12-07 2003-09-23 Integrated Vascular Systems, Inc. Closure device and methods for making and using them
US6695867B2 (en) 2002-02-21 2004-02-24 Integrated Vascular Systems, Inc. Plunger apparatus and methods for delivering a closure device
US7211101B2 (en) 2000-12-07 2007-05-01 Abbott Vascular Devices Methods for manufacturing a clip and clip
US7905900B2 (en) 2003-01-30 2011-03-15 Integrated Vascular Systems, Inc. Clip applier and methods of use
US7909837B2 (en) 2000-12-13 2011-03-22 Medtronic, Inc. Methods, devices and systems for forming magnetic anastomoses
US7029480B2 (en) * 2001-01-24 2006-04-18 Abott Laboratories Device and method for suturing of internal puncture sites
US6699245B2 (en) 2001-02-05 2004-03-02 A-Med Systems, Inc. Anastomosis system and related methods
US8038708B2 (en) 2001-02-05 2011-10-18 Cook Medical Technologies Llc Implantable device with remodelable material and covering material
US6890338B1 (en) * 2001-02-27 2005-05-10 Origin Medsystems, Inc. Method and apparatus for performing anastomosis using ring having tines with weak sections
EP1387638A2 (en) * 2001-05-14 2004-02-11 St. Jude Medical ATG, Inc. Medical grafting methods and apparatus
US6663663B2 (en) * 2001-05-14 2003-12-16 M.I. Tech Co., Ltd. Stent
US20020183769A1 (en) * 2001-05-30 2002-12-05 St. Jude Medical Atg, Inc. Medical grafting methods and apparatus
US7338514B2 (en) 2001-06-01 2008-03-04 St. Jude Medical, Cardiology Division, Inc. Closure devices, related delivery methods and tools, and related methods of use
IES20010547A2 (en) 2001-06-07 2002-12-11 Christy Cummins Surgical Staple
US7115136B2 (en) 2001-06-20 2006-10-03 Park Medical Llc Anastomotic device
MXPA03012055A (en) * 2001-06-20 2005-07-01 Park Medical Llc Anastomotic device.
US6626920B2 (en) 2001-07-05 2003-09-30 Converge Medical, Inc. Distal anastomosis system
US6972023B2 (en) * 2001-07-05 2005-12-06 Converge Medical, Inc. Distal anastomosis system
US20030229365A1 (en) * 2002-06-10 2003-12-11 Whayne James G. Angled vascular anastomosis system
US6858035B2 (en) 2001-07-05 2005-02-22 Converge Medical, Inc. Distal anastomosis system
US20060064119A9 (en) * 2001-07-05 2006-03-23 Converge Medical, Inc. Vascular anastomosis systems
US6629988B2 (en) * 2001-08-28 2003-10-07 Ethicon, Inc. Composite staple for completing an anastomosis
US20050060042A1 (en) * 2001-09-04 2005-03-17 Broncus Technologies, Inc. Methods and devices for maintaining surgically created channels in a body organ
US7708712B2 (en) 2001-09-04 2010-05-04 Broncus Technologies, Inc. Methods and devices for maintaining patency of surgically created channels in a body organ
US7892247B2 (en) 2001-10-03 2011-02-22 Bioconnect Systems, Inc. Devices and methods for interconnecting vessels
US6814751B2 (en) * 2001-10-12 2004-11-09 Rosengart Todd K Method and apparatus for performing an anastamosis
US7029482B1 (en) * 2002-01-22 2006-04-18 Cardica, Inc. Integrated anastomosis system
US8012164B1 (en) 2002-01-22 2011-09-06 Cardica, Inc. Method and apparatus for creating an opening in the wall of a tubular vessel
US7331992B2 (en) * 2002-02-20 2008-02-19 Bard Peripheral Vascular, Inc. Anchoring device for an endoluminal prosthesis
US9204956B2 (en) 2002-02-20 2015-12-08 C. R. Bard, Inc. IVC filter with translating hooks
AU2003221744A1 (en) * 2002-04-19 2003-11-03 Broncus Technologies, Inc. Devices for maintaining surgically created openings
AU2003231312B2 (en) * 2002-05-06 2008-10-23 Drexel University Tissue joining devices capable of delivery of bioactive agents and methods for use thereof
US7976564B2 (en) 2002-05-06 2011-07-12 St. Jude Medical, Cardiology Division, Inc. PFO closure devices and related methods of use
US7828839B2 (en) * 2002-05-16 2010-11-09 Cook Incorporated Flexible barb for anchoring a prosthesis
US20030225425A1 (en) * 2002-06-03 2003-12-04 David Kupiecki Devices and methods for interconnecting vessels
WO2003101310A1 (en) 2002-06-04 2003-12-11 Christy Cummins Blood vessel closure clip and delivery device
US20030181843A1 (en) * 2002-06-11 2003-09-25 Scout Medical Technologies, Llc Device and method providing arterial blood flow for perfusion of ischemic myocardium
US20030229364A1 (en) * 2002-06-11 2003-12-11 Michael Seiba Device for anastomosis in a radical retropubic prostatectomy
WO2004000134A2 (en) 2002-06-19 2003-12-31 Tyco Healthcare Group, Lp Method and apparatus for anastomosis including annular joining member
US8348963B2 (en) * 2002-07-03 2013-01-08 Hlt, Inc. Leaflet reinforcement for regurgitant valves
JP4166785B2 (en) * 2002-07-22 2008-10-15 ニティ メディカル テクノロジーズ リミテッド Intraductal anastomosis device
US7155273B2 (en) * 2002-07-29 2006-12-26 Taylor Geoffrey L Blanching response pressure sore detector apparatus and method
US8182494B1 (en) 2002-07-31 2012-05-22 Cardica, Inc. Minimally-invasive surgical system
US6969395B2 (en) * 2002-08-07 2005-11-29 Boston Scientific Scimed, Inc. Electroactive polymer actuated medical devices
CA2503258C (en) * 2002-08-28 2011-08-16 Heart Leaflet Technologies, Inc. Method and device for treating diseased valve
US7351247B2 (en) * 2002-09-04 2008-04-01 Bioconnect Systems, Inc. Devices and methods for interconnecting body conduits
US8066724B2 (en) * 2002-09-12 2011-11-29 Medtronic, Inc. Anastomosis apparatus and methods
US20060025788A1 (en) * 2002-09-25 2006-02-02 By-Pass, Inc. Anastomotic leg arrangement
US7361181B2 (en) * 2002-10-04 2008-04-22 St. Jude Medical Atg, Inc. Apparatus and methods for creating anastomoses
EP1551315A2 (en) * 2002-10-04 2005-07-13 St. Jude Medical ATG, Inc. Self-expanding exterior connectors for creating anastomoses to small-diameter vessels and methods of use
US8105345B2 (en) 2002-10-04 2012-01-31 Medtronic, Inc. Anastomosis apparatus and methods
US7108710B2 (en) 2002-11-26 2006-09-19 Abbott Laboratories Multi-element biased suture clip
US7766973B2 (en) 2005-01-19 2010-08-03 Gi Dynamics, Inc. Eversion resistant sleeves
US7678068B2 (en) * 2002-12-02 2010-03-16 Gi Dynamics, Inc. Atraumatic delivery devices
US7608114B2 (en) 2002-12-02 2009-10-27 Gi Dynamics, Inc. Bariatric sleeve
US20070032879A1 (en) * 2002-12-02 2007-02-08 Levine Andy H Anti-buckling sleeve
US7695446B2 (en) * 2002-12-02 2010-04-13 Gi Dynamics, Inc. Methods of treatment using a bariatric sleeve
WO2004049982A2 (en) * 2002-12-02 2004-06-17 Gi Dynamics, Inc. Bariatric sleeve
US7025791B2 (en) 2002-12-02 2006-04-11 Gi Dynamics, Inc. Bariatric sleeve
US7160309B2 (en) * 2002-12-31 2007-01-09 Laveille Kao Voss Systems for anchoring a medical device in a body lumen
US7124570B2 (en) * 2003-01-23 2006-10-24 Integrated Vascular Interventional Technologies, L.C. Apparatus and methods for fluid occlusion of an access tube anastomosed to an anatomical vessel
US8398656B2 (en) 2003-01-30 2013-03-19 Integrated Vascular Systems, Inc. Clip applier and methods of use
US8202293B2 (en) 2003-01-30 2012-06-19 Integrated Vascular Systems, Inc. Clip applier and methods of use
US8905937B2 (en) 2009-02-26 2014-12-09 Integrated Vascular Systems, Inc. Methods and apparatus for locating a surface of a body lumen
US8821534B2 (en) 2010-12-06 2014-09-02 Integrated Vascular Systems, Inc. Clip applier having improved hemostasis and methods of use
US7857828B2 (en) 2003-01-30 2010-12-28 Integrated Vascular Systems, Inc. Clip applier and methods of use
US8758398B2 (en) 2006-09-08 2014-06-24 Integrated Vascular Systems, Inc. Apparatus and method for delivering a closure element
US20040236178A1 (en) * 2003-02-14 2004-11-25 Cardica, Inc. Method for preparing a graft vessel for anastomosis
US8790358B2 (en) 2003-03-28 2014-07-29 St. Jude Medical, Cardiology Division, Inc. Methods and apparatus for making anastomotic connections larger than the graft conduit
DE602004019505D1 (en) * 2003-03-28 2009-04-02 Gi Dynamics Inc DEVICES AGAINST GRAVITY
US8372112B2 (en) 2003-04-11 2013-02-12 St. Jude Medical, Cardiology Division, Inc. Closure devices, related delivery methods, and related methods of use
US20040267306A1 (en) 2003-04-11 2004-12-30 Velocimed, L.L.C. Closure devices, related delivery methods, and related methods of use
US7270670B1 (en) 2003-04-21 2007-09-18 Cardica, Inc. Minimally-invasive surgical system utilizing a stabilizer
DE602004023708D1 (en) * 2003-04-24 2009-12-03 Cook Inc ARTIFICIAL FLAP FLAP WITH IMPROVED FLOW BEHAVIOR
US7717952B2 (en) * 2003-04-24 2010-05-18 Cook Incorporated Artificial prostheses with preferred geometries
US7658759B2 (en) * 2003-04-24 2010-02-09 Cook Incorporated Intralumenally implantable frames
US20040215323A1 (en) * 2003-04-24 2004-10-28 Medtronic Ave, Inc. Membrane eyelet
US7625399B2 (en) * 2003-04-24 2009-12-01 Cook Incorporated Intralumenally-implantable frames
US7998188B2 (en) 2003-04-28 2011-08-16 Kips Bay Medical, Inc. Compliant blood vessel graft
US20050131520A1 (en) * 2003-04-28 2005-06-16 Zilla Peter P. Compliant blood vessel graft
ATE531338T1 (en) 2003-04-28 2011-11-15 Kips Bay Medical Inc ELASTIC VENOUS IMPLANT
GB0310270D0 (en) * 2003-05-03 2003-06-11 Univ Edinburgh Biomolecular devices
WO2004100836A1 (en) * 2003-05-12 2004-11-25 Cook Incorporated Stent graft
WO2004112615A2 (en) * 2003-06-16 2004-12-29 Galdonik Jason A Temporary hemostatic plug apparatus and method of use
US8308682B2 (en) 2003-07-18 2012-11-13 Broncus Medical Inc. Devices for maintaining patency of surgically created channels in tissue
US8002740B2 (en) 2003-07-18 2011-08-23 Broncus Technologies, Inc. Devices for maintaining patency of surgically created channels in tissue
US7182769B2 (en) * 2003-07-25 2007-02-27 Medtronic, Inc. Sealing clip, delivery systems, and methods
US20050043749A1 (en) 2003-08-22 2005-02-24 Coalescent Surgical, Inc. Eversion apparatus and methods
US7462188B2 (en) 2003-09-26 2008-12-09 Abbott Laboratories Device and method for suturing intracardiac defects
US8394114B2 (en) 2003-09-26 2013-03-12 Medtronic, Inc. Surgical connection apparatus and methods
AU2005203522B2 (en) * 2003-09-30 2012-08-02 Ethicon Endo-Surgery, Inc. Applier for a surgical device
US7267680B2 (en) 2003-10-08 2007-09-11 David Walter Wright Anastomosis apparatus and methods of deployment and manufacture
US20050080444A1 (en) * 2003-10-14 2005-04-14 Kraemer Stefan J.M. Transesophageal gastric reduction device, system and method
DE10356793A1 (en) * 2003-12-04 2005-07-07 Variomed Ag Stent to be positioned at branch of vessels, comprising specifically shaped edge for being safely held
US8057420B2 (en) 2003-12-09 2011-11-15 Gi Dynamics, Inc. Gastrointestinal implant with drawstring
US20060212042A1 (en) * 2005-03-17 2006-09-21 Lamport Ronald B Removal and repositioning device
JP4669480B2 (en) 2003-12-09 2011-04-13 ジーアイ・ダイナミックス・インコーポレーテッド Intestinal sleeve
US7879047B2 (en) 2003-12-10 2011-02-01 Medtronic, Inc. Surgical connection apparatus and methods
US20050149073A1 (en) * 2003-12-17 2005-07-07 Arani Djavad T. Mechanisms and methods used in the anastomosis of biological conduits
US7449024B2 (en) 2003-12-23 2008-11-11 Abbott Laboratories Suturing device with split arm and method of suturing tissue
US20050149071A1 (en) * 2003-12-24 2005-07-07 Ryan Abbott Anastomosis device, tools and method of using
US7585306B2 (en) * 2003-12-24 2009-09-08 Maquet Cardiovascular Llc Anastomosis device, tools and methods of using
US20080269784A1 (en) * 2003-12-24 2008-10-30 Ryan Abbott Anastomosis device, tools and methods of using
ATE455520T1 (en) * 2004-01-27 2010-02-15 Med Inst Inc BARB FOR ATTACHING TO A MEDICAL PROSTHESIS
US20050187565A1 (en) 2004-02-20 2005-08-25 Baker Steve G. Tissue fixation devices and a transoral endoscopic gastroesophageal flap valve restoration device and assembly using same
US7632287B2 (en) 2004-02-20 2009-12-15 Endogastric Solutions, Inc. Tissue fixation devices and assemblies for deploying the same
EP2308425B2 (en) 2004-03-11 2023-10-18 Percutaneous Cardiovascular Solutions Pty Limited Percutaneous Heart Valve Prosthesis
US20060004392A1 (en) * 2004-05-13 2006-01-05 Amarant Paul D Anastomosis clamp
US20060004394A1 (en) * 2004-05-13 2006-01-05 Amarant Paul D Double-ended conduit with graded locking sleeves
US20060004393A1 (en) * 2004-05-13 2006-01-05 Amarant Paul D Percutaneous anastomosis connection system
IES20040368A2 (en) 2004-05-25 2005-11-30 James E Coleman Surgical stapler
US7212423B2 (en) * 2004-05-31 2007-05-01 Intel Corporation Memory agent core clock aligned to lane
US8162963B2 (en) 2004-06-17 2012-04-24 Maquet Cardiovascular Llc Angled anastomosis device, tools and method of using
US8409167B2 (en) 2004-07-19 2013-04-02 Broncus Medical Inc Devices for delivering substances through an extra-anatomic opening created in an airway
AU2005269719A1 (en) * 2004-07-19 2006-02-09 Broncus Technologies, Inc. Methods and devices for maintaining patency of surgically created channels in a body organ
US7704267B2 (en) 2004-08-04 2010-04-27 C. R. Bard, Inc. Non-entangling vena cava filter
US7515970B2 (en) 2004-08-18 2009-04-07 Cardiac Pacemakers, Inc. Transeptal lead
US9486216B2 (en) * 2004-09-27 2016-11-08 David W. Wright Fastener apparatus for tissue and methods of deployment and manufacture
ITMI20042131A1 (en) * 2004-11-05 2005-02-05 Ethicon Endo Surgery Inc DEVICE AND METHOD FOR OBESITY THERAPY
US7794473B2 (en) * 2004-11-12 2010-09-14 C.R. Bard, Inc. Filter delivery system
US20060116697A1 (en) 2004-11-30 2006-06-01 Esophyx, Inc. Flexible transoral endoscopic gastroesophageal flap valve restoration device and method
US7771382B2 (en) * 2005-01-19 2010-08-10 Gi Dynamics, Inc. Resistive anti-obesity devices
DE102005003632A1 (en) 2005-01-20 2006-08-17 Fraunhofer-Gesellschaft zur Förderung der angewandten Forschung e.V. Catheter for the transvascular implantation of heart valve prostheses
US20060167481A1 (en) 2005-01-25 2006-07-27 Esophyx, Inc. Slitted tissue fixation devices and assemblies for deploying the same
US7763037B2 (en) * 2005-03-18 2010-07-27 Castlewood Surgical, Inc. System and method for attaching a vein, an artery, or a tube in a vascular environment
US7967838B2 (en) 2005-05-12 2011-06-28 C. R. Bard, Inc. Removable embolus blood clot filter
US7914569B2 (en) 2005-05-13 2011-03-29 Medtronics Corevalve Llc Heart valve prosthesis and methods of manufacture and use
US7976488B2 (en) 2005-06-08 2011-07-12 Gi Dynamics, Inc. Gastrointestinal anchor compliance
US8926633B2 (en) 2005-06-24 2015-01-06 Abbott Laboratories Apparatus and method for delivering a closure element
US20070005082A1 (en) 2005-06-29 2007-01-04 Esophyx, Inc. Apparatus and method for manipulating stomach tissue and treating gastroesophageal reflux disease
US8313497B2 (en) 2005-07-01 2012-11-20 Abbott Laboratories Clip applier and methods of use
US7883517B2 (en) 2005-08-08 2011-02-08 Abbott Laboratories Vascular suturing device
US8083754B2 (en) 2005-08-08 2011-12-27 Abbott Laboratories Vascular suturing device with needle capture
US8267947B2 (en) 2005-08-08 2012-09-18 Abbott Laboratories Vascular suturing device
US8062327B2 (en) 2005-08-09 2011-11-22 C. R. Bard, Inc. Embolus blood clot filter and delivery system
US20070038232A1 (en) 2005-08-12 2007-02-15 Kraemer Stefan J M Apparatus and method for securing the stomach to the diaphragm for use, for example, in treating hiatal hernias and gastroesophageal reflux disease
US8920442B2 (en) 2005-08-24 2014-12-30 Abbott Vascular Inc. Vascular opening edge eversion methods and apparatuses
US20070060895A1 (en) * 2005-08-24 2007-03-15 Sibbitt Wilmer L Jr Vascular closure methods and apparatuses
US8758397B2 (en) * 2005-08-24 2014-06-24 Abbott Vascular Inc. Vascular closure methods and apparatuses
US9456811B2 (en) 2005-08-24 2016-10-04 Abbott Vascular Inc. Vascular closure methods and apparatuses
DE102005046333B3 (en) * 2005-09-27 2006-10-19 Viega Gmbh & Co. Kg Press-tool for connecting pipes has jaws whose rear ends can overlap as they are opened, allowing them to be used on large diameter pipes
US20070088373A1 (en) 2005-10-18 2007-04-19 Endogastric Solutions, Inc. Invaginator for gastroesophageal flap valve restoration device
WO2007058857A2 (en) 2005-11-10 2007-05-24 Arshad Quadri Balloon-expandable, self-expanding, vascular prosthesis connecting stent
JP2009519731A (en) 2005-11-18 2009-05-21 シー・アール・バード・インコーポレイテツド Vena cava filter with filament
US20070123994A1 (en) * 2005-11-29 2007-05-31 Ethicon Endo-Surgery, Inc. Internally Placed Gastric Restriction Device
US9161754B2 (en) 2012-12-14 2015-10-20 Endogastric Solutions, Inc. Apparatus and method for concurrently forming a gastroesophageal valve and tightening the lower esophageal sphincter
DE102006009996A1 (en) * 2006-03-03 2007-09-06 Albrecht Dr. Elsässer stent
US8808310B2 (en) 2006-04-20 2014-08-19 Integrated Vascular Systems, Inc. Resettable clip applier and reset tools
US8333785B2 (en) * 2006-05-02 2012-12-18 C. R. Bard, Inc. IVC filter with translating hooks
WO2007133366A2 (en) 2006-05-02 2007-11-22 C. R. Bard, Inc. Vena cava filter formed from a sheet
CA2655158A1 (en) 2006-06-05 2007-12-13 C.R. Bard Inc. Embolus blood clot filter utilizable with a single delivery system or a single retrieval system in one of a femoral or jugular access
BRPI0603437A2 (en) * 2006-06-06 2010-07-06 Luiz Gonzaga Granja Jr extraluminal stent anastomosis prosthesis
WO2007146021A2 (en) 2006-06-06 2007-12-21 Cook Incorporated Stent with a crush-resistant zone
US7819836B2 (en) * 2006-06-23 2010-10-26 Gi Dynamics, Inc. Resistive anti-obesity devices
US8556930B2 (en) 2006-06-28 2013-10-15 Abbott Laboratories Vessel closure device
USD611144S1 (en) 2006-06-28 2010-03-02 Abbott Laboratories Apparatus for delivering a closure element
US20080013298A1 (en) * 2006-07-14 2008-01-17 Nirmal Sharma Methods and apparatus for passive attachment of components for integrated circuits
US9585743B2 (en) 2006-07-31 2017-03-07 Edwards Lifesciences Cardiaq Llc Surgical implant devices and methods for their manufacture and use
EP3360509B1 (en) 2006-07-31 2022-06-22 Syntheon TAVR, LLC Sealable endovascular implants
US9408607B2 (en) * 2009-07-02 2016-08-09 Edwards Lifesciences Cardiaq Llc Surgical implant devices and methods for their manufacture and use
EP2218425B1 (en) * 2006-09-08 2012-05-09 Edwards Lifesciences Corporation Integrated heart valve delivery system
US8834564B2 (en) 2006-09-19 2014-09-16 Medtronic, Inc. Sinus-engaging valve fixation member
US11304800B2 (en) 2006-09-19 2022-04-19 Medtronic Ventor Technologies Ltd. Sinus-engaging valve fixation member
US8414643B2 (en) 2006-09-19 2013-04-09 Medtronic Ventor Technologies Ltd. Sinus-engaging valve fixation member
WO2008085994A2 (en) 2007-01-08 2008-07-17 Endogastric Solutions Connected fasteners, delivery device and method
CN105343932A (en) * 2007-01-30 2016-02-24 匹兹堡大学 Bioerodible wraps and uses therefor
EP2121055B1 (en) 2007-02-13 2014-04-02 Abbott Cardiovascular Systems Inc. Mri compatible, radiopaque alloys for use in medical devices
US8801647B2 (en) * 2007-02-22 2014-08-12 Gi Dynamics, Inc. Use of a gastrointestinal sleeve to treat bariatric surgery fistulas and leaks
US7896915B2 (en) 2007-04-13 2011-03-01 Jenavalve Technology, Inc. Medical device for treating a heart valve insufficiency
EP1982658A1 (en) 2007-04-16 2008-10-22 Corlife GbR Vessel connector and kit with applicator for surgery
US10004507B2 (en) 2007-06-18 2018-06-26 Asfora Ip, Llc Vascular anastomosis device and method
US8361092B1 (en) 2007-06-18 2013-01-29 Wilson T. Asfora Vascular anastomosis device and method
US9504469B2 (en) 2007-06-18 2016-11-29 Asfora Ip, Llc Vascular anastomosis device and method
US8574244B2 (en) 2007-06-25 2013-11-05 Abbott Laboratories System for closing a puncture in a vessel wall
US8226681B2 (en) 2007-06-25 2012-07-24 Abbott Laboratories Methods, devices, and apparatus for managing access through tissue
US9566178B2 (en) 2010-06-24 2017-02-14 Edwards Lifesciences Cardiaq Llc Actively controllable stent, stent graft, heart valve and method of controlling same
US9814611B2 (en) 2007-07-31 2017-11-14 Edwards Lifesciences Cardiaq Llc Actively controllable stent, stent graft, heart valve and method of controlling same
US9282967B2 (en) 2007-08-02 2016-03-15 Bioconnect Systems, Inc. Implantable flow connector
US8690816B2 (en) 2007-08-02 2014-04-08 Bioconnect Systems, Inc. Implantable flow connector
US8486094B2 (en) 2007-08-21 2013-07-16 Castlewood Surgical, Inc. System and method for providing an obturator for enhanced directional capabilities in a vascular environment
US8728101B2 (en) * 2007-08-21 2014-05-20 Castlewood Surgical, Inc. System and method for providing an obturator for enhanced directional capabilities in a vascular environment
US8834551B2 (en) 2007-08-31 2014-09-16 Rex Medical, L.P. Vascular device with valve for approximating vessel wall
EP2210248B1 (en) * 2007-11-13 2016-04-20 Cook Medical Technologies LLC Intraluminal bypass prosthesis
US20090307066A1 (en) * 2007-12-11 2009-12-10 Interactive Marketing, Incorporate Coupon dispensing methods and systems
US8893947B2 (en) 2007-12-17 2014-11-25 Abbott Laboratories Clip applier and methods of use
US20090157101A1 (en) 2007-12-17 2009-06-18 Abbott Laboratories Tissue closure system and methods of use
US7841502B2 (en) 2007-12-18 2010-11-30 Abbott Laboratories Modular clip applier
US8157853B2 (en) 2008-01-24 2012-04-17 Medtronic, Inc. Delivery systems and methods of implantation for prosthetic heart valves
EP3744291B1 (en) 2008-01-24 2022-11-23 Medtronic, Inc. Stents for prosthetic heart valves
US9044318B2 (en) 2008-02-26 2015-06-02 Jenavalve Technology Gmbh Stent for the positioning and anchoring of a valvular prosthesis
BR112012021347A2 (en) 2008-02-26 2019-09-24 Jenavalve Tecnology Inc stent for positioning and anchoring a valve prosthesis at an implantation site in a patient's heart
US8177836B2 (en) 2008-03-10 2012-05-15 Medtronic, Inc. Apparatus and methods for minimally invasive valve repair
US7655037B2 (en) * 2008-04-17 2010-02-02 Cordis Corporation Combination barb restraint and stent attachment deployment mechanism
US9282965B2 (en) 2008-05-16 2016-03-15 Abbott Laboratories Apparatus and methods for engaging tissue
CN102245129B (en) 2008-07-21 2015-03-18 詹妮弗·K·怀特 Repositionable endoluminal support structure and its applications
US8900250B2 (en) 2008-08-19 2014-12-02 Cook Medical Technologies, LLC Apparatus and methods for removing lymph nodes or anchoring into tissue during a translumenal procedure
EP2491869B1 (en) 2008-08-29 2013-11-20 Cook Medical Technologies LLC Stapling device for closing perforations
US8394139B2 (en) * 2008-08-29 2013-03-12 Cook Medical Technologies Llc Barbed anchors for wire stent
US8192461B2 (en) 2008-09-11 2012-06-05 Cook Medical Technologies Llc Methods for facilitating closure of a bodily opening using one or more tacking devices
CA2749026C (en) 2008-09-29 2018-01-09 Impala, Inc. Heart valve
EP2341871B1 (en) 2008-10-01 2017-03-22 Edwards Lifesciences CardiAQ LLC Delivery system for vascular implant
US8398676B2 (en) 2008-10-30 2013-03-19 Abbott Vascular Inc. Closure device
US9055946B2 (en) * 2008-11-26 2015-06-16 Phraxis Inc. Anastomotic connector
JP5724134B2 (en) 2008-12-09 2015-05-27 クック・メディカル・テクノロジーズ・リミテッド・ライアビリティ・カンパニーCook Medical Technologies Llc Retractable anchoring device
EP2389122B1 (en) 2008-12-19 2015-03-04 Cook Medical Technologies LLC Clip devices
US8905961B2 (en) * 2008-12-19 2014-12-09 St. Jude Medical, Inc. Systems, apparatuses, and methods for cardiovascular conduits and connectors
US20100160939A1 (en) * 2008-12-19 2010-06-24 St. Jude Medical, Inc. Systems, apparatuses, and methods for cardiovascular cutting devices and valves
US8728012B2 (en) * 2008-12-19 2014-05-20 St. Jude Medical, Inc. Apparatus and method for measuring blood vessels
US9566146B2 (en) * 2008-12-19 2017-02-14 St. Jude Medical, Inc. Cardiovascular valve and valve housing apparatuses and systems
US8323312B2 (en) 2008-12-22 2012-12-04 Abbott Laboratories Closure device
US8858594B2 (en) 2008-12-22 2014-10-14 Abbott Laboratories Curved closure device
US9414820B2 (en) 2009-01-09 2016-08-16 Abbott Vascular Inc. Closure devices, systems, and methods
US9173644B2 (en) 2009-01-09 2015-11-03 Abbott Vascular Inc. Closure devices, systems, and methods
US9486191B2 (en) 2009-01-09 2016-11-08 Abbott Vascular, Inc. Closure devices
US9089311B2 (en) 2009-01-09 2015-07-28 Abbott Vascular Inc. Vessel closure devices and methods
US20100179589A1 (en) 2009-01-09 2010-07-15 Abbott Vascular Inc. Rapidly eroding anchor
US20100185234A1 (en) 2009-01-16 2010-07-22 Abbott Vascular Inc. Closure devices, systems, and methods
US8906037B2 (en) 2009-03-18 2014-12-09 Endogastric Solutions, Inc. Methods and devices for forming a tissue fold
US8518060B2 (en) 2009-04-09 2013-08-27 Medtronic, Inc. Medical clip with radial tines, system and method of using same
JP2012523894A (en) * 2009-04-15 2012-10-11 カルディアック バルブ テクノロジーズ,インコーポレーテッド Vascular implant and its placement system
US8668704B2 (en) 2009-04-24 2014-03-11 Medtronic, Inc. Medical clip with tines, system and method of using same
WO2010138579A1 (en) 2009-05-28 2010-12-02 Wilson-Cook Medical Inc. Tacking device and methods of deployment
EP2445418B1 (en) * 2009-06-26 2015-03-18 Cook Medical Technologies LLC Linear clamps for anastomosis
EP3505136A1 (en) 2009-07-29 2019-07-03 C.R. Bard Inc. Tubular filter
US20110054492A1 (en) 2009-08-26 2011-03-03 Abbott Laboratories Medical device for repairing a fistula
US9730790B2 (en) 2009-09-29 2017-08-15 Edwards Lifesciences Cardiaq Llc Replacement valve and method
JP2013509258A (en) 2009-10-28 2013-03-14 ユニバーシティ オブ ピッツバーグ オブ ザ コモンウェルス システム オブ ハイヤー エデュケイション Bioerodible wrap and uses therefor
EP2496148B1 (en) 2009-11-03 2013-11-20 Cook Medical Technologies LLC Planar clamps for anastomosis
US8740970B2 (en) * 2009-12-02 2014-06-03 Castlewood Surgical, Inc. System and method for attaching a vessel in a vascular environment
US8449599B2 (en) 2009-12-04 2013-05-28 Edwards Lifesciences Corporation Prosthetic valve for replacing mitral valve
US8870950B2 (en) 2009-12-08 2014-10-28 Mitral Tech Ltd. Rotation-based anchoring of an implant
US9295541B2 (en) 2009-12-31 2016-03-29 Neograft Technologies, Inc. Graft devices and methods of fabrication
US20110224785A1 (en) 2010-03-10 2011-09-15 Hacohen Gil Prosthetic mitral valve with tissue anchors
US8303624B2 (en) 2010-03-15 2012-11-06 Abbott Cardiovascular Systems, Inc. Bioabsorbable plug
US8652204B2 (en) 2010-04-01 2014-02-18 Medtronic, Inc. Transcatheter valve with torsion spring fixation and related systems and methods
US8603121B2 (en) 2010-04-14 2013-12-10 Cook Medical Technologies Llc Systems and methods for creating anastomoses
WO2011139594A2 (en) 2010-04-27 2011-11-10 Medtronic, Inc. Artificial bursa for intra-articular drug delivery
US8579964B2 (en) 2010-05-05 2013-11-12 Neovasc Inc. Transcatheter mitral valve prosthesis
CN103002833B (en) 2010-05-25 2016-05-11 耶拿阀门科技公司 Artificial heart valve and comprise artificial heart valve and support through conduit carry interior prosthese
WO2012012407A2 (en) 2010-07-19 2012-01-26 Neograft Technologies, Inc. Graft devices and methods of use
US11653910B2 (en) 2010-07-21 2023-05-23 Cardiovalve Ltd. Helical anchor implantation
US8992604B2 (en) 2010-07-21 2015-03-31 Mitraltech Ltd. Techniques for percutaneous mitral valve replacement and sealing
US9763657B2 (en) 2010-07-21 2017-09-19 Mitraltech Ltd. Techniques for percutaneous mitral valve replacement and sealing
US9132009B2 (en) 2010-07-21 2015-09-15 Mitraltech Ltd. Guide wires with commissural anchors to advance a prosthetic valve
US8758399B2 (en) 2010-08-02 2014-06-24 Abbott Cardiovascular Systems, Inc. Expandable bioabsorbable plug apparatus and method
US8603116B2 (en) 2010-08-04 2013-12-10 Abbott Cardiovascular Systems, Inc. Closure device with long tines
US8663252B2 (en) 2010-09-01 2014-03-04 Abbott Cardiovascular Systems, Inc. Suturing devices and methods
US9370353B2 (en) 2010-09-01 2016-06-21 Abbott Cardiovascular Systems, Inc. Suturing devices and methods
EP2618784B1 (en) 2010-09-23 2016-05-25 Edwards Lifesciences CardiAQ LLC Replacement heart valves and delivery devices
US9788933B2 (en) 2010-10-29 2017-10-17 Cook Medical Technologies Llc Medical device delivery system and deployment method
WO2012063242A1 (en) 2010-11-12 2012-05-18 Erodium Medical Ltd. Percutaneous heart bypass graft surgery apparatus
US8617184B2 (en) 2011-02-15 2013-12-31 Abbott Cardiovascular Systems, Inc. Vessel closure system
EP2688516B1 (en) 2011-03-21 2022-08-17 Cephea Valve Technologies, Inc. Disk-based valve apparatus
US9149276B2 (en) 2011-03-21 2015-10-06 Abbott Cardiovascular Systems, Inc. Clip and deployment apparatus for tissue closure
US9554897B2 (en) 2011-04-28 2017-01-31 Neovasc Tiara Inc. Methods and apparatus for engaging a valve prosthesis with tissue
US9308087B2 (en) 2011-04-28 2016-04-12 Neovasc Tiara Inc. Sequentially deployed transcatheter mitral valve prosthesis
US8709034B2 (en) 2011-05-13 2014-04-29 Broncus Medical Inc. Methods and devices for diagnosing, monitoring, or treating medical conditions through an opening through an airway wall
US9345532B2 (en) 2011-05-13 2016-05-24 Broncus Medical Inc. Methods and devices for ablation of tissue
US9414822B2 (en) 2011-05-19 2016-08-16 Abbott Cardiovascular Systems, Inc. Tissue eversion apparatus and tissue closure device and methods for use thereof
US8556932B2 (en) 2011-05-19 2013-10-15 Abbott Cardiovascular Systems, Inc. Collapsible plug for tissue closure
WO2012174361A1 (en) 2011-06-15 2012-12-20 Phraxis Inc. Arterial venous spool anchor
WO2012174389A1 (en) 2011-06-15 2012-12-20 Phraxis Inc. Anastomotic connector and system for delivery
FR2976782B1 (en) 2011-06-22 2014-05-09 Cousin Biotech ANASTOMOTIC DEVICE AND METHOD FOR MANUFACTURING SUCH A DEVICE.
WO2013016349A2 (en) 2011-07-25 2013-01-31 Neograft Technologies, Inc. Vessel treatment methods and devices for use in a graft device
WO2013021374A2 (en) 2011-08-05 2013-02-14 Mitraltech Ltd. Techniques for percutaneous mitral valve replacement and sealing
US8852272B2 (en) 2011-08-05 2014-10-07 Mitraltech Ltd. Techniques for percutaneous mitral valve replacement and sealing
US20140324164A1 (en) 2011-08-05 2014-10-30 Mitraltech Ltd. Techniques for percutaneous mitral valve replacement and sealing
EP3417813B1 (en) 2011-08-05 2020-05-13 Cardiovalve Ltd Percutaneous mitral valve replacement
US9955957B2 (en) 2011-09-09 2018-05-01 Endogastric Solutions, Inc. Methods and devices for manipulating and fastening tissue
US9572571B2 (en) 2011-09-09 2017-02-21 Endogastric Solutions, Inc. Methods and devices for manipulating and fastening tissue
US8915929B2 (en) 2011-09-09 2014-12-23 Endogastric Solutions, Inc. Methods and devices for manipulating and fastening tissue
US9827093B2 (en) 2011-10-21 2017-11-28 Edwards Lifesciences Cardiaq Llc Actively controllable stent, stent graft, heart valve and method of controlling same
WO2013078235A1 (en) 2011-11-23 2013-05-30 Broncus Medical Inc Methods and devices for diagnosing, monitoring, or treating medical conditions through an opening through an airway wall
US9332976B2 (en) 2011-11-30 2016-05-10 Abbott Cardiovascular Systems, Inc. Tissue closure device
EP3281608B1 (en) 2012-02-10 2020-09-16 CVDevices, LLC Medical product comprising a frame and visceral pleura
US8864778B2 (en) 2012-04-10 2014-10-21 Abbott Cardiovascular Systems, Inc. Apparatus and method for suturing body lumens
US8858573B2 (en) 2012-04-10 2014-10-14 Abbott Cardiovascular Systems, Inc. Apparatus and method for suturing body lumens
US10434293B2 (en) 2012-04-15 2019-10-08 Tva Medical, Inc. Implantable flow connector
US9314600B2 (en) 2012-04-15 2016-04-19 Bioconnect Systems, Inc. Delivery system for implantable flow connector
US9414823B2 (en) * 2012-04-25 2016-08-16 Medtronic Ventor Technologies Ltd. Hole-closure device
US9168122B2 (en) 2012-04-26 2015-10-27 Rex Medical, L.P. Vascular device and method for valve leaflet apposition
US9345573B2 (en) 2012-05-30 2016-05-24 Neovasc Tiara Inc. Methods and apparatus for loading a prosthesis onto a delivery system
US9241707B2 (en) 2012-05-31 2016-01-26 Abbott Cardiovascular Systems, Inc. Systems, methods, and devices for closing holes in body lumens
ES2713401T3 (en) 2012-06-15 2019-05-21 Phraxis Inc Arterial and venous anchoring device forming an anastomotic connector
WO2014078754A1 (en) * 2012-11-19 2014-05-22 Covidien Lp Tissue fixation device
US9364209B2 (en) 2012-12-21 2016-06-14 Abbott Cardiovascular Systems, Inc. Articulating suturing device
US10064625B2 (en) 2013-01-06 2018-09-04 Medical Connection Technology—Mediconntech—M.C.T. Ltd Connector
WO2014115149A2 (en) 2013-01-24 2014-07-31 Mitraltech Ltd. Ventricularly-anchored prosthetic valves
CA2900862C (en) 2013-02-11 2017-10-03 Cook Medical Technologies Llc Expandable support frame and medical device
US10583002B2 (en) 2013-03-11 2020-03-10 Neovasc Tiara Inc. Prosthetic valve with anti-pivoting mechanism
US9572665B2 (en) 2013-04-04 2017-02-21 Neovasc Tiara Inc. Methods and apparatus for delivering a prosthetic valve to a beating heart
US8870948B1 (en) 2013-07-17 2014-10-28 Cephea Valve Technologies, Inc. System and method for cardiac valve repair and replacement
CN105491978A (en) 2013-08-30 2016-04-13 耶拿阀门科技股份有限公司 Radially collapsible frame for a prosthetic valve and method for manufacturing such a frame
US9668861B2 (en) 2014-03-15 2017-06-06 Rex Medical, L.P. Vascular device for treating venous valve insufficiency
US10524910B2 (en) 2014-07-30 2020-01-07 Mitraltech Ltd. 3 Ariel Sharon Avenue Articulatable prosthetic valve
US20160089130A1 (en) * 2014-09-30 2016-03-31 Biomet Sports Medicine, Llc Soft Tissue Attachment
WO2016093877A1 (en) 2014-12-09 2016-06-16 Cephea Valve Technologies, Inc. Replacement cardiac valves and methods of use and manufacture
US9974651B2 (en) 2015-02-05 2018-05-22 Mitral Tech Ltd. Prosthetic valve with axially-sliding frames
CA3162308A1 (en) 2015-02-05 2016-08-11 Cardiovalve Ltd. Prosthetic valve with axially-sliding frames
EP3632378A1 (en) 2015-05-01 2020-04-08 JenaValve Technology, Inc. Device and method with reduced pacemaker rate in heart valve replacement
US10849746B2 (en) 2015-05-14 2020-12-01 Cephea Valve Technologies, Inc. Cardiac valve delivery devices and systems
EP3294221B1 (en) 2015-05-14 2024-03-06 Cephea Valve Technologies, Inc. Replacement mitral valves
CA2990872C (en) 2015-06-22 2022-03-22 Edwards Lifescience Cardiaq Llc Actively controllable heart valve implant and methods of controlling same
US10092400B2 (en) 2015-06-23 2018-10-09 Edwards Lifesciences Cardiaq Llc Systems and methods for anchoring and sealing a prosthetic heart valve
US10531866B2 (en) 2016-02-16 2020-01-14 Cardiovalve Ltd. Techniques for providing a replacement valve and transseptal communication
US11065138B2 (en) 2016-05-13 2021-07-20 Jenavalve Technology, Inc. Heart valve prosthesis delivery system and method for delivery of heart valve prosthesis with introducer sheath and loading system
US11331187B2 (en) 2016-06-17 2022-05-17 Cephea Valve Technologies, Inc. Cardiac valve delivery devices and systems
GB201611910D0 (en) * 2016-07-08 2016-08-24 Valtech Cardio Ltd Adjustable annuloplasty device with alternating peaks and troughs
US10350062B2 (en) 2016-07-21 2019-07-16 Edwards Lifesciences Corporation Replacement heart valve prosthesis
USD800908S1 (en) 2016-08-10 2017-10-24 Mitraltech Ltd. Prosthetic valve element
US10856975B2 (en) 2016-08-10 2020-12-08 Cardiovalve Ltd. Prosthetic valve with concentric frames
CA3051272C (en) 2017-01-23 2023-08-22 Cephea Valve Technologies, Inc. Replacement mitral valves
EP4209196A1 (en) 2017-01-23 2023-07-12 Cephea Valve Technologies, Inc. Replacement mitral valves
CN110392557A (en) 2017-01-27 2019-10-29 耶拿阀门科技股份有限公司 Heart valve simulation
US10426449B2 (en) 2017-02-16 2019-10-01 Abbott Cardiovascular Systems, Inc. Articulating suturing device with improved actuation and alignment mechanisms
US11246704B2 (en) 2017-08-03 2022-02-15 Cardiovalve Ltd. Prosthetic heart valve
US10575948B2 (en) 2017-08-03 2020-03-03 Cardiovalve Ltd. Prosthetic heart valve
US10888421B2 (en) 2017-09-19 2021-01-12 Cardiovalve Ltd. Prosthetic heart valve with pouch
US10537426B2 (en) 2017-08-03 2020-01-21 Cardiovalve Ltd. Prosthetic heart valve
US11793633B2 (en) 2017-08-03 2023-10-24 Cardiovalve Ltd. Prosthetic heart valve
US10751056B2 (en) 2017-10-23 2020-08-25 High Desert Radiology, P.C. Methods and apparatus for percutaneous bypass graft
GB201720803D0 (en) 2017-12-13 2018-01-24 Mitraltech Ltd Prosthetic Valve and delivery tool therefor
GB201800399D0 (en) 2018-01-10 2018-02-21 Mitraltech Ltd Temperature-control during crimping of an implant
CN111818877B (en) 2018-01-25 2023-12-22 爱德华兹生命科学公司 Delivery system for assisting in recapture and repositioning of replacement valves after deployment
EP4331540A1 (en) 2022-09-02 2024-03-06 PerAGraft GmbH Systems for minimally invasive creation of anastomoses

Citations (50)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US489316A (en) * 1893-01-03 Auguste marie michel
US4214587A (en) * 1979-02-12 1980-07-29 Sakura Chester Y Jr Anastomosis device and method
US4368736A (en) * 1980-11-17 1983-01-18 Kaster Robert L Anastomotic fitting
US4503569A (en) * 1983-03-03 1985-03-12 Dotter Charles T Transluminally placed expandable graft prosthesis
US4523592A (en) * 1983-04-25 1985-06-18 Rollin K. Daniel P.S.C. Anastomotic coupling means capable of end-to-end and end-to-side anastomosis
US4592754A (en) * 1983-09-09 1986-06-03 Gupte Pradeep M Surgical prosthetic vessel graft and catheter combination and method
US4617932A (en) * 1984-04-25 1986-10-21 Elliot Kornberg Device and method for performing an intraluminal abdominal aortic aneurysm repair
US4665906A (en) * 1983-10-14 1987-05-19 Raychem Corporation Medical devices incorporating sim alloy elements
US4787899A (en) * 1983-12-09 1988-11-29 Lazarus Harrison M Intraluminal graft device, system and method
US5104399A (en) * 1986-12-10 1992-04-14 Endovascular Technologies, Inc. Artificial graft and implantation method
US5122156A (en) * 1990-12-14 1992-06-16 United States Surgical Corporation Apparatus for securement and attachment of body organs
US5135467A (en) * 1989-12-07 1992-08-04 Medtronic, Inc. Implantable system and method for coronary perfusions assistance
US5207695A (en) * 1989-06-19 1993-05-04 Trout Iii Hugh H Aortic graft, implantation device, and method for repairing aortic aneurysm
US5211658A (en) * 1991-11-05 1993-05-18 New England Deaconess Hospital Corporation Method and device for performing endovascular repair of aneurysms
US5211683A (en) * 1991-07-03 1993-05-18 Maginot Thomas J Method of implanting a graft prosthesis in the body of a patient
US5234447A (en) * 1990-08-28 1993-08-10 Robert L. Kaster Side-to-end vascular anastomotic staple apparatus
US5275622A (en) * 1983-12-09 1994-01-04 Harrison Medical Technologies, Inc. Endovascular grafting apparatus, system and method and devices for use therewith
US5304220A (en) * 1991-07-03 1994-04-19 Maginot Thomas J Method and apparatus for implanting a graft prosthesis in the body of a patient
US5316023A (en) * 1992-01-08 1994-05-31 Expandable Grafts Partnership Method for bilateral intra-aortic bypass
US5354336A (en) * 1991-01-29 1994-10-11 Autogenesis Technologies, Inc. Method for bonding soft tissue with collagen-based adhesives and sealants
US5387235A (en) * 1991-10-25 1995-02-07 Cook Incorporated Expandable transluminal graft prosthesis for repair of aneurysm
US5397355A (en) * 1994-07-19 1995-03-14 Stentco, Inc. Intraluminal stent
US5443497A (en) * 1993-11-22 1995-08-22 The Johns Hopkins University Percutaneous prosthetic by-pass graft and method of use
US5452733A (en) * 1993-02-22 1995-09-26 Stanford Surgical Technologies, Inc. Methods for performing thoracoscopic coronary artery bypass
US5489295A (en) * 1991-04-11 1996-02-06 Endovascular Technologies, Inc. Endovascular graft having bifurcation and apparatus and method for deploying the same
US5507769A (en) * 1994-10-18 1996-04-16 Stentco, Inc. Method and apparatus for forming an endoluminal bifurcated graft
US5522880A (en) * 1990-06-11 1996-06-04 Barone; Hector D. Method for repairing an abdominal aortic aneurysm
US5545214A (en) * 1991-07-16 1996-08-13 Heartport, Inc. Endovascular aortic valve replacement
US5562728A (en) * 1983-12-09 1996-10-08 Endovascular Tech Inc Endovascular grafting apparatus, system and method and devices for use therewith
US5676670A (en) * 1996-06-14 1997-10-14 Beth Israel Deaconess Medical Center Catheter apparatus and method for creating a vascular bypass in-vivo
US5693083A (en) * 1983-12-09 1997-12-02 Endovascular Technologies, Inc. Thoracic graft and delivery catheter
US5695504A (en) * 1995-02-24 1997-12-09 Heartport, Inc. Devices and methods for performing a vascular anastomosis
US5755778A (en) * 1996-10-16 1998-05-26 Nitinol Medical Technologies, Inc. Anastomosis device
US5840064A (en) * 1994-03-31 1998-11-24 United States Surgical Corporation Method and apparatus for treating stenosis or other constriction in a bodily conduit
US5843164A (en) * 1994-11-15 1998-12-01 Advanced Carrdiovascular Systems, Inc. Intraluminal stent for attaching a graft
US5843170A (en) * 1994-09-02 1998-12-01 Ahn; Sam Seunghae Apparatus and method for performing aneurysm repair
US5843175A (en) * 1997-06-13 1998-12-01 Global Therapeutics, Inc. Enhanced flexibility surgical stent
US5904697A (en) * 1995-02-24 1999-05-18 Heartport, Inc. Devices and methods for performing a vascular anastomosis
US5922022A (en) * 1997-09-04 1999-07-13 Kensey Nash Corporation Bifurcated connector system for coronary bypass grafts and methods of use
US5972017A (en) * 1997-04-23 1999-10-26 Vascular Science Inc. Method of installing tubular medical graft connectors
US5976159A (en) * 1995-02-24 1999-11-02 Heartport, Inc. Surgical clips and methods for tissue approximation
US6017352A (en) * 1997-09-04 2000-01-25 Kensey Nash Corporation Systems for intravascular procedures and methods of use
US6030395A (en) * 1997-05-22 2000-02-29 Kensey Nash Corporation Anastomosis connection system
US6074416A (en) * 1997-10-09 2000-06-13 St. Jude Medical Cardiovascular Group, Inc. Wire connector structures for tubular grafts
US6106549A (en) * 1997-10-12 2000-08-22 Taheri; Syde A. Modular graft assembly
US6110188A (en) * 1998-03-09 2000-08-29 Corvascular, Inc. Anastomosis method
US6113612A (en) * 1998-11-06 2000-09-05 St. Jude Medical Cardiovascular Group, Inc. Medical anastomosis apparatus
US6156063A (en) * 1997-02-20 2000-12-05 Endologix, Inc. Method of deploying bifurcated vascular graft
US6241741B1 (en) * 1998-03-09 2001-06-05 Corvascular Surgical Systems, Inc. Anastomosis device and method
US6293955B1 (en) * 1996-09-20 2001-09-25 Converge Medical, Inc. Percutaneous bypass graft and securing system

Family Cites Families (21)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
GB489316A (en) * 1936-05-05 1938-07-25 Davis & Geck Inc Improvements in or relating to devices for use in surgery
US5628783A (en) * 1991-04-11 1997-05-13 Endovascular Technologies, Inc. Bifurcated multicapsule intraluminal grafting system and method
DE69228184T2 (en) * 1991-07-04 1999-09-16 Earl Owen TUBULAR, SURGICAL IMPLANT
US5366504A (en) * 1992-05-20 1994-11-22 Boston Scientific Corporation Tubular medical prosthesis
AU669338B2 (en) * 1991-10-25 1996-06-06 Cook Incorporated Expandable transluminal graft prosthesis for repair of aneurysm and method for implanting
GB2269104A (en) * 1992-04-09 1994-02-02 Taha Roudan Lazim Vascular graft apparatus
DE69322862T2 (en) * 1992-04-21 1999-08-12 Baxter Int VASCULAR IMPLANT SYSTEM
US6036699A (en) * 1992-12-10 2000-03-14 Perclose, Inc. Device and method for suturing tissue
CA2125258C (en) * 1993-08-05 1998-12-22 Dinah B Quiachon Multicapsule intraluminal grafting system and method
US5609627A (en) * 1994-02-09 1997-03-11 Boston Scientific Technology, Inc. Method for delivering a bifurcated endoluminal prosthesis
AU708360B2 (en) * 1994-09-15 1999-08-05 C.R. Bard Inc. Hooked endoprosthesis
DE69532966T2 (en) * 1994-11-09 2004-10-21 Endotex Interventional Sys Inc COMBINATION OF DELIVERY CATHETER AND IMPLANT FOR AN ANEURYSMA
US5591226A (en) * 1995-01-23 1997-01-07 Schneider (Usa) Inc. Percutaneous stent-graft and method for delivery thereof
EP0810845A2 (en) * 1995-02-22 1997-12-10 Menlo Care Inc. Covered expanding mesh stent
AU726713B2 (en) * 1995-10-13 2000-11-16 Transvascular, Inc. Methods and apparatus for bypassing arterial obstructions and/or performing other transvascular procedures
AU729466B2 (en) * 1995-10-13 2001-02-01 Transvascular, Inc. A device, system and method for interstitial transvascular intervention
AU1275997A (en) 1996-10-11 1998-05-11 Transvascular, Inc. Methods and apparatus for bypassing arterial obstructions and/or performing other transvascular procedures
DE69732791T2 (en) * 1996-11-07 2005-09-15 St. Jude Medical ATG, Inc., Maple Grove Medical graft connector
US5976178A (en) 1996-11-07 1999-11-02 Vascular Science Inc. Medical grafting methods
AU5197098A (en) 1996-11-07 1998-05-29 Vascular Science Inc. Artificial tubular body organ grafts
US7396359B1 (en) 1998-05-29 2008-07-08 Bypass, Inc. Vascular port device

Patent Citations (52)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US489316A (en) * 1893-01-03 Auguste marie michel
US4214587A (en) * 1979-02-12 1980-07-29 Sakura Chester Y Jr Anastomosis device and method
US4368736A (en) * 1980-11-17 1983-01-18 Kaster Robert L Anastomotic fitting
US4503569A (en) * 1983-03-03 1985-03-12 Dotter Charles T Transluminally placed expandable graft prosthesis
US4523592A (en) * 1983-04-25 1985-06-18 Rollin K. Daniel P.S.C. Anastomotic coupling means capable of end-to-end and end-to-side anastomosis
US4592754A (en) * 1983-09-09 1986-06-03 Gupte Pradeep M Surgical prosthetic vessel graft and catheter combination and method
US4665906A (en) * 1983-10-14 1987-05-19 Raychem Corporation Medical devices incorporating sim alloy elements
US4787899A (en) * 1983-12-09 1988-11-29 Lazarus Harrison M Intraluminal graft device, system and method
US5693083A (en) * 1983-12-09 1997-12-02 Endovascular Technologies, Inc. Thoracic graft and delivery catheter
US5562728A (en) * 1983-12-09 1996-10-08 Endovascular Tech Inc Endovascular grafting apparatus, system and method and devices for use therewith
US5397345A (en) * 1983-12-09 1995-03-14 Endovascular Technologies, Inc. Artificial graft and implantation method
US5275622A (en) * 1983-12-09 1994-01-04 Harrison Medical Technologies, Inc. Endovascular grafting apparatus, system and method and devices for use therewith
US4617932A (en) * 1984-04-25 1986-10-21 Elliot Kornberg Device and method for performing an intraluminal abdominal aortic aneurysm repair
US5104399A (en) * 1986-12-10 1992-04-14 Endovascular Technologies, Inc. Artificial graft and implantation method
US5207695A (en) * 1989-06-19 1993-05-04 Trout Iii Hugh H Aortic graft, implantation device, and method for repairing aortic aneurysm
US5135467A (en) * 1989-12-07 1992-08-04 Medtronic, Inc. Implantable system and method for coronary perfusions assistance
US5522880A (en) * 1990-06-11 1996-06-04 Barone; Hector D. Method for repairing an abdominal aortic aneurysm
US5234447A (en) * 1990-08-28 1993-08-10 Robert L. Kaster Side-to-end vascular anastomotic staple apparatus
US5122156A (en) * 1990-12-14 1992-06-16 United States Surgical Corporation Apparatus for securement and attachment of body organs
US5354336A (en) * 1991-01-29 1994-10-11 Autogenesis Technologies, Inc. Method for bonding soft tissue with collagen-based adhesives and sealants
US5489295A (en) * 1991-04-11 1996-02-06 Endovascular Technologies, Inc. Endovascular graft having bifurcation and apparatus and method for deploying the same
US5456712A (en) * 1991-07-03 1995-10-10 Maginot; Thomas J. Graft and stent assembly
US5304220A (en) * 1991-07-03 1994-04-19 Maginot Thomas J Method and apparatus for implanting a graft prosthesis in the body of a patient
US5211683A (en) * 1991-07-03 1993-05-18 Maginot Thomas J Method of implanting a graft prosthesis in the body of a patient
US5545214A (en) * 1991-07-16 1996-08-13 Heartport, Inc. Endovascular aortic valve replacement
US5387235A (en) * 1991-10-25 1995-02-07 Cook Incorporated Expandable transluminal graft prosthesis for repair of aneurysm
US5211658A (en) * 1991-11-05 1993-05-18 New England Deaconess Hospital Corporation Method and device for performing endovascular repair of aneurysms
US5316023A (en) * 1992-01-08 1994-05-31 Expandable Grafts Partnership Method for bilateral intra-aortic bypass
US5452733A (en) * 1993-02-22 1995-09-26 Stanford Surgical Technologies, Inc. Methods for performing thoracoscopic coronary artery bypass
US5443497A (en) * 1993-11-22 1995-08-22 The Johns Hopkins University Percutaneous prosthetic by-pass graft and method of use
US5840064A (en) * 1994-03-31 1998-11-24 United States Surgical Corporation Method and apparatus for treating stenosis or other constriction in a bodily conduit
US5397355A (en) * 1994-07-19 1995-03-14 Stentco, Inc. Intraluminal stent
US5843170A (en) * 1994-09-02 1998-12-01 Ahn; Sam Seunghae Apparatus and method for performing aneurysm repair
US5507769A (en) * 1994-10-18 1996-04-16 Stentco, Inc. Method and apparatus for forming an endoluminal bifurcated graft
US5843164A (en) * 1994-11-15 1998-12-01 Advanced Carrdiovascular Systems, Inc. Intraluminal stent for attaching a graft
US5695504A (en) * 1995-02-24 1997-12-09 Heartport, Inc. Devices and methods for performing a vascular anastomosis
US5904697A (en) * 1995-02-24 1999-05-18 Heartport, Inc. Devices and methods for performing a vascular anastomosis
US5976159A (en) * 1995-02-24 1999-11-02 Heartport, Inc. Surgical clips and methods for tissue approximation
US5676670A (en) * 1996-06-14 1997-10-14 Beth Israel Deaconess Medical Center Catheter apparatus and method for creating a vascular bypass in-vivo
US6293955B1 (en) * 1996-09-20 2001-09-25 Converge Medical, Inc. Percutaneous bypass graft and securing system
US5755778A (en) * 1996-10-16 1998-05-26 Nitinol Medical Technologies, Inc. Anastomosis device
US6156063A (en) * 1997-02-20 2000-12-05 Endologix, Inc. Method of deploying bifurcated vascular graft
US5972017A (en) * 1997-04-23 1999-10-26 Vascular Science Inc. Method of installing tubular medical graft connectors
US6030395A (en) * 1997-05-22 2000-02-29 Kensey Nash Corporation Anastomosis connection system
US5843175A (en) * 1997-06-13 1998-12-01 Global Therapeutics, Inc. Enhanced flexibility surgical stent
US6017352A (en) * 1997-09-04 2000-01-25 Kensey Nash Corporation Systems for intravascular procedures and methods of use
US5922022A (en) * 1997-09-04 1999-07-13 Kensey Nash Corporation Bifurcated connector system for coronary bypass grafts and methods of use
US6074416A (en) * 1997-10-09 2000-06-13 St. Jude Medical Cardiovascular Group, Inc. Wire connector structures for tubular grafts
US6106549A (en) * 1997-10-12 2000-08-22 Taheri; Syde A. Modular graft assembly
US6110188A (en) * 1998-03-09 2000-08-29 Corvascular, Inc. Anastomosis method
US6241741B1 (en) * 1998-03-09 2001-06-05 Corvascular Surgical Systems, Inc. Anastomosis device and method
US6113612A (en) * 1998-11-06 2000-09-05 St. Jude Medical Cardiovascular Group, Inc. Medical anastomosis apparatus

Cited By (37)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US9468441B2 (en) 2004-08-27 2016-10-18 Rox Medical, Inc. Device and method for establishing an artificial arterio-venous fistula
US20130131773A9 (en) * 2004-08-27 2013-05-23 Rox Medical, Inc. Device and method for establishing an artificial arterio-venous fistula
EP1827302A2 (en) * 2004-08-27 2007-09-05 Rox Medical Inc. Device and method for establishing an artificial arterio-venous fistula
US20060206123A1 (en) * 2004-08-27 2006-09-14 Rox Medical, Inc. Device and method for establishing an artificial arterio-venous fistula
US9820745B2 (en) 2004-08-27 2017-11-21 Rox Medical, Inc. Device and method for establishing an artificial arterio-venous fistula
EP1827302A4 (en) * 2004-08-27 2010-03-10 Rox Medical Inc Device and method for establishing an artificial arterio-venous fistula
US20100268316A1 (en) * 2004-08-27 2010-10-21 Rox Medical, Inc. Device and method for establishing an artificial arterio-venous fistula
US7828814B2 (en) 2004-08-27 2010-11-09 Rox Medical, Inc. Device and method for establishing an artificial arterio-venous fistula
US20110092877A1 (en) * 2004-08-27 2011-04-21 Brenneman Rodney A Device and method for establishing an artificial arterio-venous fistula
US8088171B2 (en) 2004-08-27 2012-01-03 Rox Medical, Inc. Device and method for establishing an artificial arterio-venous fistula
US20070173867A1 (en) * 2004-08-27 2007-07-26 Brenneman Rodney A Device and method for establishing an artificial arterio-venous fistula
US9706997B2 (en) 2004-08-27 2017-07-18 Rox Medical, Inc. Device and method for establishing an artificial arterio-venous fistula
US8523800B2 (en) 2004-08-27 2013-09-03 Rox Medical, Inc. Device and method for establishing an artificial arterio-venous fistula
US8734472B2 (en) 2004-08-27 2014-05-27 Rox Medical, Inc. Device and method for establishing an artificial arterio-venous fistula
US8926545B2 (en) * 2004-08-27 2015-01-06 Rox Medical, Inc. Device and method for establishing an artificial arterio-venous fistula
US8932341B2 (en) * 2004-08-27 2015-01-13 Rox Medical, Inc. Method for establishing an artificial arterio-venous fistula
US9023097B2 (en) 2004-08-27 2015-05-05 Rox Medical, Inc. Device and method for establishing an artificial arterio-venous fistula
US10751057B2 (en) 2004-08-27 2020-08-25 Edwards Lifesciences Corporation Device and method for establishing an artificial arterio-venous fistula
US20070249985A1 (en) * 2004-08-27 2007-10-25 Rox Medical, Inc. Device and method for establishing an artificial arterio-venous fistula
US11207457B2 (en) * 2004-08-27 2021-12-28 Edwards Lifesciences Corporation Device and method for establishing an artificial arterio-venous fistula
US10232098B2 (en) 2004-08-27 2019-03-19 Rox Medical, Inc. Device and method for establishing an artificial arterio-venous fistula
US9510832B2 (en) 2004-08-27 2016-12-06 Rox Medical, Inc. Device and method for establishing an artificial arterio-venous fistula
US10098643B2 (en) 2004-08-27 2018-10-16 Rox Medical, Inc. Device and method for establishing an artificial arterio-venous fistula
WO2009129079A1 (en) * 2008-04-17 2009-10-22 Medtronic Vascular Inc. Branch vessel suture stent system
US20120123454A1 (en) * 2010-11-11 2012-05-17 Wilson T. Asfora Sutureless vascular anastomosis connection
US9820743B2 (en) 2010-11-11 2017-11-21 Asfora Ip, Llc Sutureless vascular anastomosis connection
US9649112B2 (en) 2010-11-11 2017-05-16 Asfora Ip, Llc Sutureless vascular anastomosis connection
US10111667B2 (en) 2010-11-11 2018-10-30 Asfora Ip, Llc Sutureless vascular anastomosis connection
US10159485B2 (en) 2010-11-11 2018-12-25 Asfora Ip, Llc Deployment tool for sutureless vascular anastomosis connection
US9566068B2 (en) 2010-11-11 2017-02-14 Asfora Ip, Llc Sutureless vascular anastomosis connection
US9498220B2 (en) * 2010-11-11 2016-11-22 Asfora Ip, Llc Sutureless vascular anastomosis connection
US9730791B2 (en) 2013-03-14 2017-08-15 Edwards Lifesciences Cardiaq Llc Prosthesis for atraumatically grasping intralumenal tissue and methods of delivery
US9681951B2 (en) 2013-03-14 2017-06-20 Edwards Lifesciences Cardiaq Llc Prosthesis with outer skirt and anchors
US9724083B2 (en) 2013-07-26 2017-08-08 Edwards Lifesciences Cardiaq Llc Systems and methods for sealing openings in an anatomical wall
USD755384S1 (en) 2014-03-05 2016-05-03 Edwards Lifesciences Cardiaq Llc Stent
WO2019152799A1 (en) * 2018-02-02 2019-08-08 University Of Louisville Research Foundation, Inc. Sutureless graft anastomotic quick connect system
US11918223B2 (en) 2019-02-01 2024-03-05 University Of Louisville Research Foundation, Inc. Sutureless graft anastomotic quick connect system

Also Published As

Publication number Publication date
AU1340700A (en) 2000-05-29
US6113612A (en) 2000-09-05
US20020022853A1 (en) 2002-02-21
WO2000027313A3 (en) 2000-09-21
EP1126794A2 (en) 2001-08-29
US6440163B1 (en) 2002-08-27
WO2000027313A2 (en) 2000-05-18
JP2002529141A (en) 2002-09-10
US6533812B2 (en) 2003-03-18
US20020077695A1 (en) 2002-06-20
US6309416B1 (en) 2001-10-30

Similar Documents

Publication Publication Date Title
US6533812B2 (en) Medical anastomosis apparatus
US6602263B1 (en) Medical grafting methods and apparatus
US7211095B2 (en) Medical grafting connectors and fasteners
US6960219B2 (en) Medical grafting methods and apparatus
US8632555B2 (en) Medical graft connector and methods of making and installing same
US20030109887A1 (en) Medical graft component and methods of installing same
WO1998019629A2 (en) Medical grafting connectors and fasteners
US20020183769A1 (en) Medical grafting methods and apparatus
US20040068217A1 (en) Self-expanding exterior connectors for creating anastomoses to small-diameter vessels and methods of use

Legal Events

Date Code Title Description
STCB Information on status: application discontinuation

Free format text: ABANDONED -- FAILURE TO RESPOND TO AN OFFICE ACTION