Transseptal access device and method of use
Systems, devices, and methods are provided for transseptal access of septa within a patient. The device can be advanced to a septum, e.g., towards a fossa ovalis. Instead of applying positive pressure to “tent” the septum, a negative pressure is applied to a lumen within a sheath, e.g., within an elongated member slidable within the sheath, via a negative pressure source such as a syringe on the proximal end of the sheath. This results in the septum pulling inward. The sheath employs a stationary needle-like central core component contained within the lumen of the sheath that punctures the septum when the same is pulled passed it by the negative pressure. The stationary needle-like central core component may be hollow and may form a portion of the elongated member or may be coupled to a distal end thereof.
1. A device for transseptal access, comprising:
an elongated member having a proximal end and a distal end, the elongated member having defined therein a pressure lumen; and
a funnel coupled to the elongated member at the distal end of the elongated member, the funnel having a convoluted shape, the funnel having a proximal end with a first radius and a distal end with a second radius, the second radius greater than the first radius, the funnel having a retracted configuration and an expanded configuration, the expanded configuration defining an interior;
such that the elongated member and the funnel are configured to be delivered to a septal location through a transseptal sheath; and
such that upon removal of the funnel from the sheath, the funnel transitions from the retracted configuration to the expanded configuration; and
wherein the pressure lumen is configured to transmit a negative pressure from a proximal end of the pressure lumen to the interior of the funnel to create a suction effect to hold the funnel against the septum of the heart, and further comprising a piercing element configured to pierce the septum of the heart when the suction effect is holding the funnel against the septum of the heart, wherein the piercing element is stationary.
2. The device of claim 1 , wherein the piercing element is attached to a tubular element that moves within the elongated member.
3. The device of claim 2 , further comprising a mechanical mechanism configured to enable steering.
4. The device of claim 2 , wherein the piercing element is advanced distally or proximally by a mechanical slide located at a handle of the device, the mechanical slide attached to the tubular member.
5. The device of claim 2 , wherein the piercing element is advanced distally or proximally by a knob located at a handle of the device, the knob coupled to the tubular member.
6. The device of claim 1 , further comprising a governor coupled to the piercing element, to inhibit movement of the piercing element past a pre-specified point.
7. The device of claim 1 , wherein the piercing element is coupled to the elongated member.
8. The device of claim 1 , wherein in the retracted configuration, the funnel substantially surrounds the stationary piercing element.
9. The device of claim 1 , wherein in the expanded configuration, the funnel distal end extends further in a distal direction than does the piercing element.
10. The device of claim 1 , wherein the piercing element is a dilator with a sharp tip.
11. The device of claim 1 , wherein the funnel is formed from multiple segments.
12. The device of claim 1 , wherein the first radius is between about 3 French to 10 French and the second radius is between about 2.5 mm and 15 mm.
13. The device of claim 12 , wherein the first radius is between about 5 French to 8 French and the second radius is between about 5 mm and 10 mm.
14. The device of claim 1 , further comprising a fitting attached to the pressure lumen, the fitting configured to attach a negative pressure source thereto.
15. The device of claim 14 , wherein the fitting is configured to attach a syringe thereto.
16. The device of claim 14 , wherein the negative pressure source is configured to draw a negative pressure of between about that drawn by a 5 cc syringe and that drawn by a 100 cc syringe.
17. The device of claim 16 , wherein the negative pressure source is configured to draw a negative pressure of between about that drawn by a 10 cc syringe and that drawn by a 20 cc syringe.
18. The device of claim 1 , further comprising a rib or spine member attached to the funnel.
19. The device of claim 1 , wherein the elongated member has further defined a guidewire lumen therein, the guidewire lumen extending from the proximal end and into the interior of the funnel.