Devices, systems, and methods for treating the left atrial appendage
A device for treating a left atrial appendage, including an implant having a contact member configured to engage an inside tissue surface of the left atrial appendage and configured to rotate in at least a first direction from a first position to at least a second position so as to twist the left atrial appendage when the contact member is engaged with an inside tissue surface of the left atrial appendage. Some embodiments can also include a securing element configured to move between a first position in which the securing element is decoupled from the contact member and a second position in which the securing element is coupled with the contact member.
1 . A device for treating a left atrial appendage of a left atrium, comprising:
an implant comprising:
(a) a contact member including a tissue engaging feature configured to engage an inside tissue surface of the left atrial appendage and to rotate about a longitudinal axis in at least a first direction from a first position to at least a second position so as to rotate and thus twist the left atrial appendage when the contact member is engaged with the inside tissue surface of the left atrial appendage; and
(b) a securing element configured to move between a first position in which the securing element is decoupled from the contact member and a second position in which the securing element is coupled with the contact member, wherein the securing element is proximal to the contact member, and wherein a distal-most end of the contact member is rotationally fixed to the securing element about the longitudinal axis to thereby maintain the twist of the left atrial appendage.
2 . The device of claim 1 , wherein the contact member is configured to rotate at least in the first direction from the first position to the second position when a torque is applied to the contact member.
3 . The device of claim 1 , wherein the contact member is configured to rotate at least in the first direction from the first position to at least the second position to twist the left atrial appendage and reduce a size of an ostium of the left atrial appendage from a first size to a second size when the contact member is engaged with the inside tissue surface or the left atrial appendage.
4 . The device of claim 3 , wherein the implant is configured to inhibit the ostium of the left atrial appendage from enlarging back to the first size.
5 . The device of claim 1 , wherein the device is configured such that the contact member can be removed from the left atrial appendage after the securing element has been moved to the second position, and wherein the securing element is configured to prevent a rotation of the tissue of the left atrium and/or the left atrial appendage that has been constricted as a result of the rotation of the contact member from the first position to the second position.
6 . The device of claim 1 , wherein the contact member is configured to move between a first state and a second state, wherein an outside dimension of the contact member is greater in the second state than in the first state.
7 . The device of claim 6 , wherein the contact member is self-expandable such that the contact member will automatically expand from the first state to the second state when a restraint is removed from the implant without further intervention from a user.
8 . The device of claim 6 , wherein the contact member is configured to automatically move from the first state to the second state when a restraint is removed from the contact member, and wherein the contact member is configured to engage a wall portion of the left atrial appendage when the contact member is in the second state and advanced into the left atrial appendage.
9 . The device of claim 1 , wherein the contact member has a plurality of tissue anchors on an outer surface thereof.
10 . The device of claim 9 , wherein the plurality of tissue anchors of the contact member have a proximal facing surface that is angled toward a proximal end of the contact member at an angle from 2 degrees to 10 degrees.
11 . The device of claim 1 , wherein the device is configured to cause a tissue of the left atrium and/or the left atrial appendage to constrict around an outer surface of a body portion of the implant when the contact member is rotated to the second position.
12 . The device of claim 11 , wherein the securing element is configured to engage with the tissue that has constricted around the outer surface of the body portion of the implant to prevent rotation of the implant in a second direction that is opposite to the first direction.
13 . The device of claim 1 , wherein, in an operable position, the securing element is configured to at least inhibit the contact member from rotating back to the first position.
14 . The device of claim 1 , wherein the securing element is configured to prevent a rotation of at least a portion of the left atrial appendage in a second direction when the securing element is implanted in a tissue surface surrounding an ostium of the left atrial appendage, wherein the second direction is opposite to the first direction.
15 . The device of claim 1 , wherein the securing element is configured to at least expand from a first state to a second state, wherein an outside dimension of the securing element is greater in the second state than in the first state.
16 . The device of claim 1 , wherein the securing element comprises a plurality of arms.
17 . The device of claim 16 , wherein at least an end portion of each of the plurality of arms of the securing element point generally away from the contact member when the securing element is in a first state and point generally toward the contact member when the securing element is in a second state.
18 . The device of claim 16 , comprising a restraint configured to be movable in an axial direction relative to at least a portion of the securing element between a first axial position in which the plurality of arms of the securing element are restrained by the restraint and a second axial position in which the plurality of arms of the securing element are not restrained by the restraint, wherein the second axial position is closer to the at least a portion of the securing element than the first axial position.
19 . The device of claim 18 , wherein the restraint is configured to be movable in the axial direction relative to at least a portion of the securing element from the second position in which the plurality of arms of the securing element are not restrained by the restraint to the first position in which the plurality of arms of the securing element are restrained by the restraint to facilitate repositioning and/or removal of the implant.
20 . The device of claim 18 , comprising a threaded member configured such that rotating the threaded member will cause the restraint to move from the first position to the second position.
21 . The device of claim 20 , wherein the restraint is rotatable relative to the threaded member so that the restraint is not forced to rotate as the threaded member is rotated.
22 . The device of claim 1 , wherein the securing element comprises a plurality of struts and a plurality of interconnections between adjacent struts of the plurality of struts.
23 . The device of claim 1 , wherein the securing element has a helical shape and is configured to rotate about a body portion of the implant during an implantation procedure.
24 . The device of claim 1 , wherein the securing element is movable between a first state in which the securing element can spin freely relative to the contact member and a second state in which the securing element is rotationally locked to the contact member.
25 . The device of claim 24 , wherein one of the securing element and the contact member has recesses and the other of the securing element and the contact member has protrusions configured to selectively engage with the recesses such that the protrusions are spaced apart from the recesses when the securing element is in the first state and the protrusions are engaged with the recesses when the securing element is in the second state.
26 . The device of claim 1 , further comprising a retention element configured to selectively couple the securing element to the contact member at any of a range of selectable distances when the securing element is in the second position.
27 . The device of claim 26 , wherein the retention element comprises a threaded shaft configured to threadedly engage with the contact member, the threaded shaft being coupled with the securing element.
28 . The device of claim 26 , wherein the retention element is adjustable so as to move the securing element between at least a first position and a second position, wherein the securing element is closer to the contact member when the retention element is in the second position as compared to when the retention element is in the first position.
29 . The device of claim 28 , wherein the retention element comprises a threaded member, wherein a rotation of the threaded member in a first direction causes the securing element to move toward the contact member and a rotation of the threaded member in a second direction causes the securing element to move away from the contact member.
30 . The device of claim 28 , wherein the retention element is configured to slide at least in an axial direction over an inner core component of a delivery catheter.
31 . The device of claim 1 , wherein the second position of the contact member is at least one-quarter of a complete rotation relative to the first position.
32 . The device of claim 1 , wherein the second position of the contact member is at least one-half of a complete rotation relative to the first position.
33 . The device of claim 1 , comprising a catheter selectively coupled with the contact member and configured to exert a torque on the contact member to rotate the contact member from the first position until a threshold predetermined torque level is reached.
34 . A device for occluding an anatomical structure, comprising: an implant comprising: (a) a contact member including a tissue engaging feature configured to grip an inside tissue surface of the anatomical structure and to thereby rotate about a longitudinal axis in at least a first direction from a first position to at least a second position so as to twist the anatomical structure when the contact member is gripped against the inside tissue surface of the anatomical structure, wherein a distal-most end of the contact member is configured to rotate with a proximal-most end of the contact member during the rotation about the longitudinal axis; and (b) a securing element configured to move between a first position in which the securing element is decoupled from the contact member and a second position in which the securing element is coupled with the contact member, wherein the securing element is rotatably coupled to the contact member to thereby be configured to maintain the twist of the anatomical structure.
35 . A device for twisting an anatomical structure, comprising:
an implant comprising:
(a) a contact member including a tissue engaging feature configured to engage an inside tissue surface of the anatomical structure and to rotate about a longitudinal axis in at least a first direction from a first position to at least a second position so as to twist the anatomical structure when the contact member is engaged with the inside tissue surface of the anatomical structure; and
(b) a securing element configured to move between a first position in which the securing element is decoupled from the contact member and a second position in which the securing element is coupled with the contact member, wherein the securing element is rotatably coupled to the contact member to thereby be configured to maintain the twist of the anatomical structure.