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 first guide member transeptally into the left atrial appendage, wherein the first guide member has a first alignment element for coupling with a counterpart alignment element on a second guide member, the first alignment element located at a distal end of the first guide member;
advancing a second guide member from the outside of the patient's heart into a pericardial space of the patient, wherein the second guide member has a second alignment element located at a distal end thereof;
aligning the first and second alignment elements, such that the alignment members couple;
advancing a ligating element over the left atrial appendage, wherein the ligating element is advanced with respect to the second guide member; and
closing the left atrial appendage using the ligating element.
2. The method of claim 1 , wherein the first guide member further comprises radiopaque material, and wherein the first guide member is visualized using fluoroscopy.
3. The method of claim 1 , wherein the first guide member is visualized using ultrasound.
4. The method of claim 1 , wherein the first guide member further comprises an expandable element located near the distal end.
5. The method of claim 4 , further comprising expanding the expandable element within the left atrial appendage before closing the left atrial appendage using the ligating element.
6. The method of claim 4 , wherein the expandable element is an inflatable balloon.
7. The method of claim 1 , wherein the first and second alignment elements are magnets.
8. The method of claim 1 , wherein the pericardial space is accessed by making an incision below the xyphoid process.
9. The method of claim 1 , wherein the pericardial space is accessed by making an incision over the second costal cartilage.
10. The method of claim 1 , wherein the ligating element comprises a nitinol structure with a suture.
11. The method of claim 1 , wherein the ligating element comprises a suture.
12. The method of claim 11 , wherein the suture is made from polypropylene or PTFE.
13. The method of claim 1 , wherein the first guide member is coupled to an expandable element.
14. The method of claim 13 , wherein the expandable element is an inflatable balloon.
15. The method of claim 1 , wherein the pericardial space is accessed by using a series of dilators.