Apparatus and method for the ligation of tissue
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 of closing a left atrial appendage comprising:
pericardially advancing a positioning tool to contact the left atrial appendage via a sub-xiphoid approach, wherein the positioning tool comprises an alignment catheter;
pericardially advancing a ligating assembly to the left atrial appendage, wherein the ligating assembly comprises a support and a loop releasably coupled to the support;
opening the ligating assembly;
advancing the ligating assembly over the positioning tool to place the loop around a neck of the left atrial appendage;
confirming the loop encircles the neck of the left atrial appendage using fluoroscopy or echocardiographic guidance prior to releasing the loop; and
releasing the loop to close the left atrial appendage.
2. The method of claim 1 , wherein opening the ligation assembly comprises radially expanding the support.
3. The method of claim 2 , wherein the support comprises a plurality of struts.
4. The method of claim 1 , wherein the loop comprises a suture.
5. The method of claim 4 further comprising cutting the suture after closing the left atrial appendage.
6. The method of claim 1 , wherein releasing the loop to close the left atrial appendage comprises radially contracting the support.
7. The method of claim 6 , wherein releasing the loop to close the left atrial appendage comprises radially contracting the loop.
8. The method of claim 1 , wherein the loop is radiopaque.
9. The method of claim 1 , further comprising removing the support.
10. The method of claim 9 , wherein the loop remains closed around the left atrial appendage after removal of the support.
11. A method of closing a left atrial appendage comprising:
introducing a wire into a pericardial space thereby creating a pericardial access;
grasping the left atrial appendage from outside a patient's heart via the pericardial access using a tissue grasper, wherein the tissue grasper comprises a suction tube and wherein grasping the left atrial appendage comprises applying vacuum to the left atrial appendage;
advancing a ligating assembly over the tissue grasper, the ligating assembly comprising a support and a loop releasably coupled thereto;
opening the ligating assembly and encircling a neck of the left atrial appendage with the loop;
closing the left atrial appendage with the loop;
confirming the loop encircles the neck of the left atrial appendage using fluoroscopy or echocardiographic guidance prior to releasing the loop; and
releasing the loop from the support.
12. The method of claim 11 , wherein at least one of the introducing, grasping, advancing, opening, closing, and releasing steps is performed under fluoroscopic guidance.
13. The method of claim 11 , wherein the support comprises a plurality of struts, and wherein opening the ligating assembly comprises radially expanding the plurality of struts.
14. The method of claim 11 , wherein the loop is attached circumferentially to the support.
15. The method of claim 11 , wherein the loop comprises a suture.
16. The method of claim 11 , wherein closing the left atrial appendage with the loop comprises radially contracting the loop.
17. The method of claim 11 further comprising removing the support.
18. A method of closing a left atrial appendage comprising:
pericardially advancing a positioning tool to contact the left atrial appendage, wherein the positioning tool is advanced percutaneously and comprises an alignment catheter;
pericardially advancing a ligating assembly to the left atrial appendage, wherein the ligating assembly comprises a support and a loop releasably coupled to the support;
opening the ligating assembly;
advancing the ligating assembly over the positioning tool to place the loop around a neck of the left atrial appendage;
confirming the loop encircles the neck of the left atrial appendage using fluoroscopy or echocardiographic guidance prior to releasing the loop; and
releasing the loop to close the left atrial appendage.
19. A method of closing a left atrial appendage comprising:
pericardially advancing a positioning tool to contact the left atrial appendage via a sub-xiphoid approach;
pericardially advancing a ligating assembly to the left atrial appendage, wherein the ligating assembly comprises a support and a loop releasably coupled to the support and wherein the loop is radiopaque;
opening the ligating assembly;
advancing the ligating assembly over the positioning tool to place the loop around a neck of the left atrial appendage;
confirming the loop encircles the neck of the left atrial appendage using fluoroscopy or echocardiographic guidance prior to releasing the loop; and
releasing the loop to close the left atrial appendage.
20. A method of closing a left atrial appendage comprising:
pericardially advancing a positioning tool to contact the left atrial appendage via a sub-xiphoid approach, wherein the positioning tool comprises a grasper comprising a suction tube and wherein advancing the grasper to contact the left atrial appendage comprises applying vacuum to the left atrial appendage;
pericardially advancing a ligating assembly to the left atrial appendage, wherein the ligating assembly comprises a support and a loop releasably coupled to the support;
opening the ligating assembly;
advancing the ligating assembly over the positioning tool to place the loop around a neck of the left atrial appendage;
confirming the loop encircles the neck of the left atrial appendage using fluoroscopy or echocardiographic guidance prior to releasing the loop; and
releasing the loop to close the left atrial appendage.