Techniques for guide-wire based advancement of a tool
Apparatus comprises: (A) a housing ( 248 ), percutaneously deliverable to a heart of a subject, slidable along a guidewire ( 242 ), and shaped to define at least one opening ( 249 ); (B) a guide member ( 250 ), percutaneously deliverable to the heart, percutaneously removable from the subject, couplable to the housing, and having: (i) a distal portion, comprising a chord-engaging element ( 252 ), configured to be percutaneously slidably coupled to and decouplable from at least one chordae tendineae ( 244 ), and (ii) a proximal portion, comprising a longitudinal element ( 251 ); and (C) a deployment tool, configured (i) to be reversibly coupled to a tissue anchor ( 50,280 ), (ii) to be slidably coupled to the longitudinal element of the guide member, and (iii) to anchor the tissue anchor to a papillary muscle ( 254 ) of the subject. Other embodiments are also described.
1. A method for use with a papillary muscle of a heart of a subject, the papillary muscle being coupled to one or more chordae tendineae of the heart of the subject, the method comprising:
advancing a guide member to the chordae tendineae, the guide member having a proximal portion that includes a longitudinal element, and a distal portion that includes a chord-engaging element, configured to be slidably coupled to the chordae tendineae;
coupling the chord-engaging element to at least one of the one or more chordae tendineae;
sliding the chord-engaging element over the at least one of the chordae tendineae toward the papillary muscle;
advancing a tool toward the papillary muscle of the subject by sliding the tool along the longitudinal element; and
following the step of advancing the tool, anchoring a tissue anchor to ventricular muscle tissue using the tool.
2. The method according to claim 1 , wherein the chord-engaging element includes a helical chord-engaging element, and wherein coupling the chord-engaging element to the at least one of the chordae tendineae comprises wrapping the helical chord-engaging element around the at least one of the chordae tendineae.
3. The method according to claim 1 , wherein anchoring the tissue anchor comprises anchoring the tissue anchor to ventricular muscle tissue in a vicinity of the papillary muscle.
4. The method according to claim 3 , wherein anchoring the tissue anchor comprises anchoring the tissue anchor to ventricular muscle tissue within 1 cm of the papillary muscle.
5. The method according to claim 3 , wherein anchoring the tissue anchor comprises anchoring the tissue anchor to the papillary muscle.
6. The method according to claim 1 , wherein anchoring the tissue anchor comprises anchoring a tissue anchor that is reversibly couplable to a guidewire.
7. The method according to claim 1 , wherein the deployment tool includes a lance, and the method further comprises, prior to anchoring the tissue anchor, stabilizing the tool with respect to the ventricular muscle tissue by penetrating the ventricular muscle tissue with the lance.
8. The method according to claim 7 , further comprising retracting the lance into the deployment tool.
9. The method according to claim 1 , wherein the step of advancing the guide member comprises advancing, to the heart of the subject, a housing that is slidable along the guide member.
10. The method according to claim 9 , further comprising, prior to advancing the housing, advancing a guidewire to a ventricle of the heart, wherein advancing the housing comprises sliding the housing over the guidewire.
11. The method according to claim 10 , wherein advancing the guidewire comprises advancing a distal portion of the guidewire between at least two of the chordae tendineae of the subject.
12. The method according to claim 9 , further comprising, subsequent to advancing the housing, sliding the chord-engaging element distally out of the housing.
13. The method according to claim 12 , further comprising, subsequent to the step of coupling and prior to advancing the tool, proximally withdrawing the housing and decoupling the housing from the guide member while maintaining the coupling of the chord-engaging element to the at least one of the one or more chordae tendineae.
14. The method according to claim 12 , wherein sliding the chord-engaging element distally out of the housing comprises facilitating transitioning of the chord-engaging element from a generally straight state into a helical state.
15. A method for use with a papillary muscle of a heart of a subject, the papillary muscle being coupled to one or more chordae tendineae of the heart of the subject, the method comprising:
advancing a guidewire to a ventricle of the heart;
providing (1) a guide member having (a) a proximal portion that includes a longitudinal element, and (b) a distal portion that includes a chord-engaging element, configured to be slidably coupled to the chordae tendineae, and (2) a housing that is slidable along the guide member;
advancing the housing to the heart and the guide member to the chordae tendineae, wherein advancing the housing comprises sliding the housing over the guidewire;
coupling the chord-engaging element to at least one of the one or more chordae tendineae;
sliding the chord-engaging element over the at least one of the chordae tendineae toward the papillary muscle; and
advancing a tool toward the papillary muscle of the subject by sliding the tool along the longitudinal element.
16. The method according to claim 15 , wherein advancing the guidewire comprises advancing a distal portion of the guidewire between at least two of the chordae tendineae of the subject.
17. A method for use with a papillary muscle of a heart of a subject, the papillary muscle being coupled to one or more chordae tendineae of the heart of the subject, the method comprising:
providing (1) a guide member having (a) a proximal portion that includes a longitudinal element, and (b) a distal portion that includes a chord-engaging element, configured to be slidably coupled to the chordae tendineae, and (2) a housing that is slidable along the guide member;
advancing the housing to the heart and the guide member to the chordae tendineae;
subsequently to advancing the housing, sliding the chord-engaging element distally out of the housing;
coupling the chord-engaging element to at least one of the one or more chordae tendineae;
sliding the chord-engaging element over the at least one of the chordae tendineae toward the papillary muscle; and
advancing a tool toward the papillary muscle of the subject by sliding the tool along the longitudinal element.
18. The method according to claim 17 , further comprising, subsequent to the step of coupling and prior to advancing the tool, proximally withdrawing the housing and decoupling the housing from the guide member while maintaining the coupling of the chord-engaging element to the at least one of the one or more chordae tendineae.
19. The method according to claim 17 , wherein sliding the chord-engaging element distally out of the housing comprises facilitating transitioning of the chord-engaging element from a generally straight state into a helical state.