WO1998055027A2 - Minimally invasive medical bypass methods and apparatus using partial relocation of tubular body conduit - Google Patents
Minimally invasive medical bypass methods and apparatus using partial relocation of tubular body conduit Download PDFInfo
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- WO1998055027A2 WO1998055027A2 PCT/US1998/009187 US9809187W WO9855027A2 WO 1998055027 A2 WO1998055027 A2 WO 1998055027A2 US 9809187 W US9809187 W US 9809187W WO 9855027 A2 WO9855027 A2 WO 9855027A2
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- plug
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
- A61B17/12099—Occluding by internal devices, e.g. balloons or releasable wires characterised by the location of the occluder
- A61B17/12109—Occluding by internal devices, e.g. balloons or releasable wires characterised by the location of the occluder in a blood vessel
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
- A61B17/12131—Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device
- A61B17/12136—Balloons
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
- A61B17/12131—Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device
- A61B17/12168—Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device having a mesh structure
- A61B17/12172—Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device having a mesh structure having a pre-set deployed three-dimensional shape
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00008—Vein tendon strippers
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/0057—Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00238—Type of minimally invasive operation
- A61B2017/00243—Type of minimally invasive operation cardiac
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00535—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated
- A61B2017/00557—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated inflatable
Definitions
- This invention relates to methods and apparatus for treating medical patients who are in need of re-routed body conduits.
- An example of the use of this invention is in the partial re-routing of a patient's internal mammary artery to provide a bypass around a blockage or constriction in a coronary artery of the patient.
- a well-known technique for relieving the adverse effects of a coronary artery blockage or constriction is to sever one of the patient's internal mammary arteries and reconnect the portion of that artery which comes from the aorta to the blocked or constricted coronary artery downstream from the blockage or constriction.
- the thus re-routed mammary artery supplies the blood flow needed in the downstream portion of the coronary artery.
- a disadvantage of known procedures for re ⁇ routing an internal mammary artery is that these procedures require either a large opening of the patient's chest cavity or several small openings in that cavity.
- the portion of the conduit to be re-routed is then intralumenally relocated so that its severed end is adjacent the desired new point of attachment of the severed end.
- a connector structure attached intralumenally to the severed end of the relocated conduit is then used to form an aperture in the side wall of the other conduit to which the relocated conduit is to be connected. After making this aperture, the connector structure connects the severed end of the relocated conduit to the aperture in the other conduit.
- FIG. 1 is a simplified sectional view of a portion of a patient's circulatory system.
- FIG. 2 is a view similar to a portion of
- FIG. 1 showing an early stage in an illustrative use of the invention.
- FIG. 3 is a view similar to FIG. 2 showing a later stage in the illustrative use of the invention that is shown in part in FIG. 2.
- FIG. 4 is a view similar to FIG. 3 showing a still later stage in the illustrative use of the invention that is shown in part in FIG. 3.
- FIG. 5 is a view similar to a portion of FIG. 4 showing an alternative to FIG. 4 in accordance with the invention.
- FIG. 6 is a view similar to FIG. 4 showing an even later stage in the illustrative use of the invention that is shown in part in FIG. 4.
- FIG. 7 is a view similar to FIG. 1 showing a still later stage in the illustrative use of the invention that is shown in part in FIG. 6.
- FIG. 8 is a view similar to a portion of FIG. 7 showing an even later stage in the illustrative use of the invention that is shown in part in FIG. 7.
- FIG. 9 is a view similar to FIG. 8 showing a still later stage in the illustrative use of the invention that is shown in part in FIG. 8.
- FIG. 10 is a view similar to FIG. 9 showing an even later stage in the illustrative use of the invention that is shown in part in FIG. 9.
- FIG. 11 is a view similar to FIG. 10 showing a still later stage in the illustrative use of the invention that is shown in part in FIG. 10.
- FIG. 12 is a view similar to FIG. 7 showing an alternative to what is shown in FIG. 7 in accordance with the invention.
- FIG. 13 is a view similar to FIG. 8 for the alternative illustrated by FIG. 12.
- FIG. 14 shows an illustrative embodiment of a portion of the FIG. 2 apparatus in more detail.
- FIG. 15 is a view similar to FIG. 14 showing another operating condition of the FIG. 14 apparatus.
- FIG. 1 shows a portion of a patient's circulatory system.
- the depicted portion includes aorta 10, coronary artery 20, brachiocephalic artery 12, right internal mammary artery 14, left common carotid artery 16, left subclavian artery 30, and left internal mammary artery 40.
- artery 40 will usually be referred to simply as an internal mammary artery.
- FIG. 1 shows a narrowing 22 in coronary artery 20.
- internal mammary artery 40 is to be partly re-routed and connected to coronary artery 20 downstream from narrowing 22.
- as much as possible of the rerouting and re-connecting of artery 40 is done intralumenally (i.e., through the lumens of the patient's circulatory system). This avoids or reduces the need to make incisions in the patient to gain access to the patient's interior.
- an illustrative procedure in accordance with this invention begins by inserting a hollow tubular instrument 100 intralumenally into the patient until a distal end of instrument 100 is inside artery 30 upstream from mammary artery 40.
- the entry point for instrument 100 may be a femoral (leg) artery of the patient, a brachial artery of the patient, or any other suitable entry point which is generally remote from the site at which the bypass is to be performed.
- the distal portions of instrument 100 and other instruments used with instrument 100 are remotely controlled from proximal portions of those instruments which remain outside the patient's body at all times.
- Instrument 100 is a catheter-like instrument, and any conventional catheter introducing, guiding, and/or steering technology can be used to introduce instrument 100 into the patient's circulatory system and cause its distal portion to ultimately pass into and along the patient's aorta to the depicted location in artery 30.
- an annular balloon 110 around the distal portion of instrument 100 may be inflated as shown in FIG. 2 to brace the instrument against the interior wall of artery 30.
- Balloon 110 may be a perfusion balloon to allow some blood to flow past the balloon, or balloon 110 may be an occlusion balloon to substantially stop the flow of blood through artery 30.
- balloon 110 is selectively switchable between perfusion and occlusion so that perfusion can be allowed except for relatively brief periods during which occlusion is required.
- instrument 200 is another catheter-like instrument which may extend coaxially through the interior of instrument 100. Instrument 200 is axially movable relative to instrument 100. Any conventional catheter guiding and/or steering technology may be used to get the distal portion of instrument 200 from the distal end of instrument 100 to the desired location in mammary artery 40.
- An annular occlusion balloon 210 on the distal portion of instrument 200 may be inflated at any desired time to temporarily stop the flow of blood along artery 40 and to help anchor the distal portion of instrument 200 in that artery.
- a third elongated instrument 300 is extended distally from the distal end of instrument 200 as shown in FIG. 2.
- the distal end of instrument 300 carries a removable, radially expandable plug 310.
- plug 310 may be constructed generally as shown and described in Goldsteen et al .
- Instrument 300 may also be similar to the plug-deploying instrumentation shown in the immediately above-mentioned Goldsteen et al. reference.
- instrument 300 is capable of selectively releasing plug 310 so that the plug radially expands to fill and occlude artery 40 downstream from the distal end of the instrumentation as shown in FIG. 3.
- FIGS. 14 and 15 An illustrative embodiment of plug 310 and plug-deploying apparatus 300 is shown in more detail in FIGS. 14 and 15 and described in a later portion of this specification.
- the next step in the illustrative procedure being described is to proximally withdraw plug- deploying instrument 300 and substitute cutting instrument 400.
- the distal portion of cutting instrument 400 has one or more cutting blades 410 that resiliently extend radially out from the longitudinal axis of instrument 400 when the distal portion of instrument 400 is extended distally beyond the distal end of instrument 200 as shown in FIG. 3.
- blades 410 extend radially out, they cut through artery 40.
- Instrument 400 is then rotated about its longitudinal axis so that blades 410 cut through artery 40 all the way around its circumference. The upstream portion of artery 40 is thereby severed from the plugged downstream portion of that artery.
- Cutting and cauterizing instrument 500 includes two principal parts. These are rams-horn guide structure 510 and cutting and cauterizing structure 520. Structure 510 is inside structure 520, and these two structures are axially movable relative to one another.
- the distal portion of structure 510 includes resilient rams-horn-shaped guide members 512 that are resiliently biased to project radially out from and then backwardly along the longitudinal axis of structure 510 outside artery 40 when the distal portion of structure 510 is extended distally beyond the distal end of instrument 200 as shown in FIG. 4.
- structure 520 includes an annular structure 522 that is resiliently biased to radially expand when pushed distally beyond the distal end of instrument 200.
- Structure 522 can additionally be guided by members 512 to invert and move back along the outside of artery 40 as structure 520 is pushed distally relative to structure 510.
- structure 522 may be made of a tubular braid of nitinol wires of the general type used for the frameworks of the artificial grafts shown and described in such references as Goldsteen et al. U.S. patent application No. 08/745,618, filed November 7, 1996, and Bachinski et al. U.S. patent application No. 08/839,080, filed April 23, 1997 (Docket No.
- braids or other similar structures of nitinol can be made extremely flexible and elastic so that structure 522 can have a relatively small diameter inside instrument 200, but when pushed axially beyond the distal end of instrument 200, structure 522 greatly enlarges and can be made to invert and turn back on itself, all as shown in FIG. 4.
- the extreme distal tip 524 of structure 522 is made cutting and cauterizing.
- tip 524 may be heated electrically so that it burns through and cauterizes any tissue that connects mammary artery 40 to surrounding body structures.
- Structure 522 is pushed distally far enough so that tip 524 moves back up along the outside of artery 40 by a sufficient distance to free the desired length of artery 40 from tissue connections to other body structures. For example, several inches of the length of severed mammary artery 40 may thus be freed from connections to other body structures.
- intralumenally cutting and cauterizing tissue connections to severed mammary artery 40 this may be done through a trocar or other similar instrument inserted through the patient's chest wall. This alternative is illustrated by FIG. 5, which shows trocar tube 600 being used to introduce tissue cutting instrument 610 and tissue cauterizing instrument 620 into the patient to cut and cauterize tissue connections to severed mammary artery 40.
- occlusion balloon 210 is deflated, and after instrument 200 has been suitably retracted, a second occlusion balloon 220 (which is closer than balloon 210 to the distal end of instrument 200) is inflated.
- balloon 110 preferably occludes artery 30.
- Steerable video instrumentation 700 may be similar to the steerable video instrumentation shown and described in any of Goldsteen et al. U.S. patent application No. 08/745,618, filed November 7, 1996, Bachinski et al. U.S. patent application No. 08/842,391, filed April 23, 1997 (Docket No. 293/006), and Sullivan et al . U.S. patent application No. 08/844,992, filed April 23, 1997 (Docket No. 293/007), all of which are hereby incorporated by reference herein.
- instrumentation 700 typically includes a light source for illuminating the interior of the patient beyond the distal end of instrumentation 700.
- Instrumentation 700 also typically includes video components for capturing an image of the interior of the patient beyond the distal end of the instrumentation and for transmitting that image back to a video display which is outside the patient. Instrumentation 700 still further includes steering components that can be controlled from outside the patient to cause the distal portion of the instrumentation to curve and otherwise deflect laterally. And instrumentation 700 may include an axially reciprocable longitudinal member 750 for making an initial penetration of the side wall of coronary artery 20 after other components of the instrumentation have been used to position the distal portion of instrumentation 700 adjacent the coronary artery. FIG.
- FIG. 7 shows the condition of the patient after the distal portion of instrumentation 700 has been steered to a location adjacent coronary artery 20 downstream from narrowing 22, and also after longitudinal member 750 has been extended from the distal end of instrumentation 700 through the side wall of the coronary artery and into the lumen of that artery.
- instrumentation 700 takes with it the severed portion of mammary artery 40 as instrumentation 700 is steered to coronary artery 20.
- the severed end of the upstream portion of mammary artery 40 is also adjacent coronary artery 20 in FIG. 7.
- Longitudinal member 750 may be a sharply pointed wire that is capable of being pushed through the wall of coronary artery 20 and down into the lumen of the coronary artery.
- member 750 After member 750 has been pushed down into the lumen of coronary artery 20, it helps to keep the severed end of mammary artery 40 adjacent the coronary artery as shown in FIG. 7.
- the next step in the illustrative procedure being described is to proximally withdraw instrumentation 700, except for longitudinal member 750.
- connector instrumentation 800 is inserted into the patient through instrument 200 and concentrically around longitudinal member 750 as shown in FIG. 8.
- Connector instrumentation 800 includes an inner tubular member 810 concentrically surrounded by an outer tubular member 820. Inside the distal portion of outer tubular member 820 is a connector structure 830. Connector structure 830 includes a serpentine ring 832. Struts 834 extend distally from the distal peaks of the convolutions of ring 832. Struts 834 are bound into a cone shape by annular band 836. An annular elastic web 838 (e.g., of silicone) is preferably provided between struts 834.
- An annular elastic web 838 e.g., of silicone
- the first step in the use of instrumentation 800 is to push connector structure 830 distally out of the distal end of tubular member 820 as shown in
- FIG. 9 This may be done by somewhat inflating annular balloon 812 on the distal portion of tubular member 810 and pushing members 810 and 812 distally relative to member 820.
- ring 820 expands elastically by itself (or is expanded plastically by further inflation of balloon 812 inside ring 832) to firmly annularly engage the inner surface of the distal portion of mammary artery 40.
- the next step is to force the cone of struts
- any or all of elements 810, 812, and 820 can be pushed distally to push elements 834 and 838 through the coronary artery wall, gradually enlarging the initial aperture previously made by longitudinal member 750 as elements 834 and 838 enter that aperture.
- struts 834 and web 838 are through the side wall of coronary artery 20 to the desired degree, balloon 812 is further inflated inside the cone of struts 834. This causes band 836 to break or otherwise cease to hold struts 834 in their initial cone shape. When released from band 836, struts 834 flare radially out inside coronary artery 20 as they are resiliently biased to do (see FIG. 11) . Web 838 continues to provide an annular structure between the struts. In the condition shown in FIG. 11 connector 830 provides a permanent tubular connection between the severed end of mammary artery 40 and the side wall of coronary artery 20.
- FIG. 12 A possible modification of the above- described procedure is shown beginning with FIG. 12.
- another catheter-type instrument 900 is inserted into the patient's circulatory system so that a distal portion of that instrument extends from aorta 10 into coronary artery 20 through narrowing 22 to the point at which it is desired to connect the severed end of mammary artery 40. Insertion of instrument 900 can be done at any time relative to insertion and use of the other instrumentation described above. Instrument 900 can serve as a source of radiologic fluid in coronary artery 20.
- instrument 900 can include radiologic markers in the coronary artery region. These possible radiologic uses of instrument 900 can help the physician make the proper approach to the coronary artery with the severed end of mammary artery 40. As still another possibility, instrument 900 can provide a source of light in coronary artery 20 to help the physician, using the video features of instrumentation 700, make the proper approach with the severed end of mammary artery 40 to the coronary artery.
- Instrument 900 may include a longitudinal member 910 which may be somewhat like above-described member 750. At any suitable time after instrument 900 is properly positioned in coronary artery 20, the distal portion of member 910 may be pushed out through the coronary artery wall as shown in FIG. 12. Member 910 may then be used in any of several ways. For example, the distal end of member 910 may provide a light source or another type of highly visible target for facilitating proper relocation of the severed end of mammary artery 40 using the video components of instrument 700. Alternatively or additionally, instrument 700 may include a snare 750a (e.g., at the distal end of longitudinal member 750) for engaging the distal portion of member 910 outside the coronary artery.
- a snare 750a e.g., at the distal end of longitudinal member 750
- member 750 may be proximally withdrawn while more of member 910 is fed into the patient until member 910 forms one continuous structure at least between arteries 20 and 40, and more preferably into the patient via instrument 900, out the wall of coronary artery 20, into the severed end of mammary artery 40, and out of the patient via instrument 700.
- member 910 provides a very stable structure for maintaining mammary artery 40 in its desired new location and for guiding connector instrumentation 800 to the location at which connector structure 830 must be installed between the severed end of the mammary artery and the side wall of the coronary artery.
- FIG. 13 shows how FIG. 8 is modified for the alternative of FIG. 12, the only difference between FIGS. 8 and 13 being that member 910 replaces member 750.
- the exact same modification is all that is required to adapt FIGS. 9-11 for this alternative procedure.
- Providing one continuous structure like member 910 into the patient, through an operative site, and then out of the patient again is similar to what is done in above-mentioned Goldsteen et al. application No. 08/745,618, and additional details regarding this type of technique and instrumentation suitable for implementing this type of technique will be found in that reference, and also in Bachinski et al. U.S. patent application No. 08/842,391, filed April 23, 1997 (Docket No. 293/006), and Bachinski et al. U.S. patent application No. 08/844,910, filed April 23, 1997 (Docket No. 293/010), all of which are hereby incorporated by reference herein.
- Connector structure 830 is only one example of many types of connectors that may be used.
- connector structure 830 may have prongs that extend radially out from ring 832 and that can enter the tissue of mammary artery 40 to help secure the connector to that artery.
- Connector structure 830 may also have hooks and/or barbs on the distal ends of struts 834 to help the struts better and more securely engage coronary artery 20 when struts 834 are deployed as shown in FIG. 11.
- suitable materials for connector structure 830 are nitinol or stainless steel for all components other than web 838, and silicone for web 838.
- FIGS. 14 and 15 show an illustrative embodiment of elements 300 and 310 in more detail.
- plug 310 has the shape of a tube with a closed end (toward the right in FIGS. 14 and 15).
- Plug 310 is made from an elastic mesh framework 320 covered with an elastic covering 330 which substantially fills the apertures in the mesh.
- framework 320 may be a braid of nitinol wires
- covering 330 may be a web of silicone.
- Plug 310 is made so that its substantially relaxed state is as shown in FIG. 15. In this substantially relaxed condition plug 310 has a relatively large diameter (the vertical dimension as viewed in FIG. 15) and a relatively short length (the horizontal dimension as viewed in FIG. 15) .
- plug 310 can be elastically deformed to the size and shape shown in FIG. 14 by stretching it axially over the outside of tubular member 300. When thus stretched, the length of the tube increases substantially, but its diameter decreases.
- plug 310 is releasably held in that condition by a loop of wire 340 which passes out through aperture 350 in the side wall of tube 300 and through a portion of the side wall of the tubular part of the plug as shown in FIG. 14.
- plug 310 is inserted into the patient (FIG. 2) in the condition shown in FIG. 14.
- the tension on wire loop 340 is relaxed. This allows plug 310 to begin to return to a shape more like its relaxed shape. In particular, plug 310 begins to axially shorten and to increase in diameter.
- one tail of wire loop 340 is released and the other tail of the loop is pulled proximally out of the patient. Eventually the released tail is pulled completely out of plug 310 as shown in FIG. 15 and the plug is thereby completely released from the apparatus.
- plug 310 may be somewhat different from the plug shapes shown in above-mentioned Goldsteen et al. application No. 08/839,198 (Docket No. 293/004), plug 310 may in other respects be constructed as shown and described in that reference.
- the depicted connector structure 830 is only one example of many connector structures that can be used, other examples being shown and described in several of the references that are mentioned above.
- the particular internal mammary bypass procedure shown and described herein is only one example of medical treatments to which the invention or various aspects of the invention can be applied.
- the invention is equally applicable to relocating and reconnecting other portions of a patient's circulatory system tubing or other non-circulatory system tubing of a patient.
- Radiologic markers can be provided at any desired locations on any of the instrumentation of the invention to help the physician radiologically monitor instrumentation positions within the patient.
- any of the instrumentation of the invention can be used to - I I
Abstract
Description
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Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
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AU72882/98A AU7288298A (en) | 1997-06-05 | 1998-05-05 | Minimally invasive medical bypass methods and apparatus using partial relocationof tubular body conduit |
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
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US86980897A | 1997-06-05 | 1997-06-05 | |
US08/869,808 | 1997-06-05 |
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WO1998055027A2 true WO1998055027A2 (en) | 1998-12-10 |
WO1998055027A3 WO1998055027A3 (en) | 2001-06-07 |
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PCT/US1998/009187 WO1998055027A2 (en) | 1997-06-05 | 1998-05-05 | Minimally invasive medical bypass methods and apparatus using partial relocation of tubular body conduit |
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Cited By (28)
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US6110188A (en) * | 1998-03-09 | 2000-08-29 | Corvascular, Inc. | Anastomosis method |
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US6253768B1 (en) | 1999-08-04 | 2001-07-03 | Percardia, Inc. | Vascular graft bypass |
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US6485496B1 (en) | 1997-10-24 | 2002-11-26 | Wilhelmus Joseph Leonardus Suyker | Mechanical anastomosis system for hollow structures |
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US10993805B2 (en) | 2008-02-26 | 2021-05-04 | Jenavalve Technology, Inc. | Stent for the positioning and anchoring of a valvular prosthesis in an implantation site in the heart of a patient |
US11564794B2 (en) | 2008-02-26 | 2023-01-31 | Jenavalve Technology, Inc. | Stent for the positioning and anchoring of a valvular prosthesis in an implantation site in the heart of a patient |
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US11185405B2 (en) | 2013-08-30 | 2021-11-30 | Jenavalve Technology, Inc. | Radially collapsible frame for a prosthetic valve and method for manufacturing such a frame |
US11337800B2 (en) | 2015-05-01 | 2022-05-24 | Jenavalve Technology, Inc. | Device and method with reduced pacemaker rate in heart valve replacement |
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WO1998055027A3 (en) | 2001-06-07 |
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