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 positioning a ligating device near a patient's heart comprising:
advancing a first alignment element transeptally into a left atrial appendage;
expanding an expandable element relative to the first alignment element;
advancing a second alignment element into a pericardial space from outside a patient's heart;
aligning the first and second alignment elements to assist in positioning the ligating device, wherein the ligating device comprises a ligating element that is releasably secured to a nitinol structure; and
advancing the ligating element to the left atrial appendage.
2. The method of claim 1 , wherein aligning the first and second alignment elements assists in positioning the ligating device in the pericardial space.
3. The method of claim 2 , wherein aligning the first and second alignment elements assists in positioning the ligating device at a neck of the left atrial appendage.
4. The method of claim 1 further comprising ligating the left atrial appendage with the ligating element.
5. The method of claim 1 , wherein advancing the ligating element to the left atrial appendage comprises advancing the ligating element relative to the second alignment element.
6. The method of claim 1 , wherein the alignment elements are aligned end-to-end.
7. The method of claim 1 , wherein each of the first and second alignment elements comprise magnets.
8. The method of claim 1 , wherein the first alignment element is part of a guide device.
9. The method of claim 8 , wherein the guide device further comprises the expandable element.
10. The method of claim 9 , wherein the expandable element is an inflatable balloon.
11. The method of claim 9 further comprising expanding the expandable element within the left atrial appendage.
12. The method of claim 11 further comprising ligating the left atrial appendage with a ligating element, wherein the expanded expandable element is used to assist in positioning the ligating element around a neck of the left atrial appendage.
13. The method of claim 9 , wherein the first alignment element comprises a magnet and the expandable element is positioned near a distal end of the guide device and proximal to the magnet.
14. The method of claim 1 , wherein the second alignment element is part of the ligating device.
15. The method of claim 1 , where in the first alignment element is visualized as it is advanced into the left atrial appendage.
16. The method of claim 15 , wherein the first alignment element is visualized using fluoroscopy or ultrasound.
17. The method of claim 1 , wherein the pericardial space is accessed by making an incision below the xiphoid process.
18. The method of claim 1 , wherein the pericardial space is accessed by using a series of dilators.