Tissue ligation devices and tensioning devices therefor
Described here are closure devices and methods for ligating tissue, such as the left atrial appendage, and tensioning devices and mechanism for actuating these devices. The tensioning mechanisms and devices may allow a user to apply one or more predetermined forces to a suture or other portion of the closure devices. The closure devices may comprise a suture loop releasably attached to a snare loop assembly, and a tensioning mechanism or device may be configured to tighten the suture loop and/or release the suture loop from the snare loop assembly.
1. A method of closing a target tissue comprising:
advancing a closure device to a target tissue, wherein the closure device comprises a snare loop, and a suture loop releasably coupled to the snare loop, and wherein a tail of the suture loop is coupled directly to a distal end of a tensioning device, wherein the tensioning device comprises a spring and a handle;
advancing the snare loop and suture loop around the target tissue;
pulling the tensioning device proximally relative to the closure device until a first predetermined force is applied to the suture loop, wherein the distal end of the tensioning device moves distally relative to the tensioning device handle during pulling; and
pulling the tensioning device proximally relative to the closure device until a second predetermined force is applied to the suture loop.
2. The method of claim 1 , wherein the target tissue is a left atrial appendage.
3. The method of claim 1 , wherein the first predetermined force is about 7 pounds.
4. The method of claim 3 , wherein the second predetermined force is approximately equal to the first predetermined force.
5. The method of claim 1 , wherein the second predetermined force is approximately equal to the first predetermined force.
6. The method of claim 1 , wherein the second predetermined force is greater than the first predetermined force.
7. The method of claim 1 further comprising applying a tension to the suture loop to release the suture loop from the snare loop assembly.
8. The method of claim 1 further comprising waiting a time period between pulling the tensioning device to apply the first predetermined force and pulling the tensioning device to apply the second predetermined force.
9. The method of claim 8 , wherein the time period is at least thirty seconds.
10. The method of claim 8 , wherein the time period is at least two minutes.
11. The method of claim 1 , wherein the tensioning device indicates when the first and second predetermined tensions are applied.
12. The method of claim 1 , wherein the spring is coupled between the handle and the distal end of the tensioning device.
13. The method of claim 1 , wherein the tensioning device further comprises an elongate member, and wherein the tail of the suture loop is coupled to the elongate member.
14. The method of claim 13 , wherein a first end of the spring is attached to the elongate member.
15. The method of claim 14 , wherein a second end of the spring is attached to the tensioning device handle.
16. The method of claim 1 further comprising closing the snare loop around the target tissue, applying a tension to the suture loop to release the suture loop from the snare loop assembly, and opening the snare loop after releasing the suture loop from the snare loop.
17. A method of closing a target tissue comprising:
advancing a closure device to a target tissue, the closure device comprising a snare loop, and a suture loop releasably coupled to the snare loop;
advancing the closure device around the target tissue;
applying a tension to the suture loop to release the suture loop from the snare loop;
coupling a tail of the suture loop directly to a distal end of a tensioning device, wherein the tensioning device comprises a spring and a handle;
pulling the tensioning device proximally relative to the closure device until a first predetermined force is applied to the suture loop, wherein the distal end of the tensioning device moves distally relative to the tensioning device handle during pulling; and
pulling the tensioning device proximally relative to the closure device until a second predetermined force is applied to the suture loop.
18. The method of claim 17 further comprising waiting a time period between pulling the tensioning device to apply the first predetermined force and pulling the tensioning device to apply the second predetermined force, wherein the time period is at least four minutes.