Apparatus and method for the ligation of tissue
View Patent ↗A novel catheter-based system which ligates the left atrial appendage (LAA) on the outside of the heart, preferably using a combination of catheters and/or instruments, e.g., a guide catheter positioned inside the left atrial appendage which may assist in locating the left atrial appendage and/or assist in the optimal placement of a ligature on the outside of the appendage, and a ligating catheter and/or instrument outside the heart in the pericardial space to set a ligating element at the neck of the left atrial appendage.
1. A method for closing a left atrial appendage of a patient's heart, comprising:
advancing a guide member transeptally into the left atrial appendage, wherein the guide member comprises an expandable element;
advancing a ligating assembly from the outside of a patient's heart to a position adjacent to the left atrial appendage, wherein the ligating assembly comprises a support and a loop releasably attached to the support;
advancing the ligating assembly over an exterior surface of the left atrial appendage and over the expandable element so that the loop encircles the base of the left atrial appendage;
expanding the expandable element within the left atrial appendage;
closing the left atrial appendage with the ligating assembly;
confirming that the loop encircles the base of the left atrial appendage using fluoroscopy, echocardiographic guidance, or a combination thereof, prior to releasing the loop from the support;
releasing the loop from the support;
contracting and withdrawing the expandable element from the left atrial appendage; and
re-tightening the loop.
2. The method of claim 1 , further comprising expanding the ligating assembly prior to advancing the ligating assembly over the exterior of the left atrial appendage, wherein the support comprises a plurality of struts, and wherein expanding the ligating assembly comprises radially expanding the plurality of struts.
3. The method of claim 2 , wherein the plurality of struts radially expand into a bell-shaped crown.
4. The method of claim 1 , wherein the loop comprises a ligature.
5. The method of claim 2 , wherein the loop follows an arcuate path about the distal ends of the plurality of struts while the plurality of struts are radially expanded.
6. The method of claim 1 , wherein the loop comprises a suture and the left atrial appendage is closed by tightening the suture around the left atrial appendage.
7. The method of claim 2 , wherein the loop is released from the plurality of struts as the left atrial appendage is closed.
8. The method of claim 1 , wherein the loop is radially contracted.
9. The method of claim 1 , wherein the ligating assembly is advanced over a guidewire.
10. The method of claim 2 , wherein the plurality of struts expands after exiting the distal end of a elongate tubular member.
11. The method of claim 2 , wherein the plurality of struts are arranged in an arcuate configuration.
12. The method of claim 1 , wherein the loop comprises polypropylene or PTFE.
13. The method of claim 1 , further comprising grasping the left atrial appendage, wherein a tip of the left atrial appendage is grasped from outside the patient's heart.
14. The method of claim 13 , wherein grasping the left atrial appendage comprises applying a vacuum to the left atrial appendage.
15. The method of claim 1 , wherein the ligating assembly is mounted on a distal region of an elongate member.
16. The method of claim 15 , wherein the elongate member is inserted through an incision and advanced to a position adjacent the left atrial appendage.
17. The method of claim 16 , wherein the incision is made over a second costal cartilage.
18. The method of claim 16 , wherein the incision is made below the xyphoid process.
19. The method of claim 1 , wherein the loop is radiopaque.
20. The method of claim 1 , further comprising removing the ligating assembly.
21. The method of claim 20 , wherein the loop remains closed around the left atrial appendage after removal of the ligating assembly.
22. The method of claim 1 , wherein the ligating assembly is advanced through a pericardial space to a position adjacent the left atrial appendage.
23. The method of claim 22 , wherein access to the pericardial space is obtained using a series of dilators.