Devices, systems, and methods for treating the left atrial appendage
Disclosed are embodiments of a device for occluding a left atrial appendage (LAA) and other cavities or openings within a body. Some embodiments of the device can include an implant configured to be deployed within the LAA or other cavity, configured to be expanded or moved against a wall portion of the LAA or other cavity, and configured to twist at least a portion of the LAA or other cavity when the implant is rotated. Thereafter, one or more securing elements, staples, sutures, or other fasteners can be implanted in the gathered tissue to hold the tissue in the gathered state, thereby occluding the opening of the LAA or other cavity. In some embodiments, the opening of the LAA or other cavity can be occluded by elongating or otherwise reshaping the opening using an implant device, and securing the opening in the occluded state.
1. A device for treating a left atrial appendage, comprising:
an implant comprising:
a contact member configured to move between a first state and a second state; and
a securing element;
wherein:
at least a portion of the contact member is larger in a radial direction when the implant is in the second state as compared to the first state;
the contact member is configured to be rotatable at least in a first direction from a first position to a second position that is at least 45 degrees from the first position to twist at least a portion of a left atrial appendage in the first direction from a first position to a second position that is at least 45 degrees from the first position of the left atrial appendage when the contact member is engaged with an inner wall of the left atrial appendage; and
the securing element is configured to engage a tissue of the left atrium and/or the left atrial appendage to prevent the left atrial appendage that has been twisted from untwisting back to the first position of the left atrial appendage.
2. The device of claim 1 , wherein the contact member is self-expandable such that at least a portion of the contact member automatically expands from the first state to the second state when a restraint is removed from the contact member.
3. The device of claim 1 , wherein the device is configured to cause a tissue of the left atrium and/or the left atrial appendage to constrict around an outer surface of a body portion of the implant when the contact member is rotated to the second position, and the securing element is configured to engage with the tissue that has constricted around the outer surface of the body portion of the implant to prevent untwisting of at least a portion of the left atrial appendage back to the first position of the left atrial appendage.
4. The device of claim 1 , wherein the securing element has a plurality of tissue anchors configured to engage with an internal wall of the heart adjacent to the left atrial appendage.
5. The device of claim 1 , wherein the securing element has a helical shape and is configured to rotate about a body portion of the implant during the implantation procedure.
6. The device of claim 1 , wherein the contact member has a plurality of tissue engaging features on an outside surface thereof.
7. The device of claim 1 , wherein the second position is at least one-half of a complete rotation relative to the first position.
8. The device of claim 1 , comprising a catheter selectively coupled with the contact member and configured to exert a torque on the contact member to rotate the contact member from the first position until a threshold torque level is reached.
9. The device of claim 8 , wherein a threshold torque level is from approximately 0.25 in-oz of torque to approximately 10 in-oz of torque.
10. The device of claim 1 , comprising a retention member configured to bias the securing element toward the contact member.
11. The device of claim 1 , comprising a retention member configured to couple the securing element with the contact member.
12. The device of claim 11 , wherein the retention member comprises a threaded shaft.
13. The device of claim 11 , wherein the device is configured such that a rotation of the retention member in a first direction causes the securing element to move toward the contact member.
14. The device of claim 1 , wherein the device is configured such that the contact member can be removed from the left atrial appendage after the securing element has been deployed.
15. The device of claim 1 , wherein the device is configured such that the contact member can be removed from the left atrial appendage after the securing element has been deployed.
16. The device of claim 1 , wherein the device is configured to cause a tissue of the left atrium and/or the left atrial appendage to constrict around an outer surface of a body portion of the implant when the contact member is rotated to the second position, and the securing element is configured to compress the tissue that has constricted around the outer surface of the body portion of the implant between a distal surface of the securing element and the contact member to prevent untwisting of at least a portion of the left atrial appendage back to the first position of the left atrial appendage.
17. The device of claim 1 , wherein the securing element is switchable between at least a first state in which the contact member is rotatable relative to the securing element and a second state in which the securing element prevents a rotation of the contact member relative to the securing element.
18. The device of claim 1 , wherein the second position is at least one-quarter of a complete rotation relative to the first position.
19. The device of claim 1 , comprising a catheter having an inner core selectively coupled with the contact member and configured to rotate the contact member from the first position to the second position when the inner core is rotated from a first position to a second position when the contact member is coupled with the inner core.
20. An implant for reducing a size of an ostium of a left atrial appendage, comprising:
a contact member configured to engage a tissue surface of the left atrial appendage and to rotate at least a portion of the left atrial appendage in a first direction to at least cause tissue of a left atrium and/or the left atrial appendage to twist and gather radially inwardly at or adjacent to an ostium of the left atrial appendage;
a securing element configured to secure at least a portion of the tissue that has twisted and gathered radially inwardly at or adjacent to the ostium of the left atrial appendage as a result of rotating at least a portion of the left atrial appendage in the first direction; and
a retention member configured to couple the securing element with the contact member at any of a range of distances between the securing element and the contact member.
21. The implant of claim 20 , wherein the contact member is self-expandable such that at least a portion of the contact member automatically expands from a first state to a second state when a restraint is removed from the contact member.
22. The implant of claim 20 , wherein the implant is configured to cause a tissue of the left atrium and/or the left atrial appendage to constrict around an outer surface of a body portion of the implant when the contact member is rotated to a second position, and the securing element is configured to engage with the tissue that has constricted around the outer surface of the body portion of the implant to prevent untwisting of at least a portion of the left atrial appendage back to the first position of the left atrial appendage.
23. The implant of claim 20 , wherein the contact member has a plurality of anchors or other tissue engaging features on an outside surface thereof.
24. The implant of claim 20 , wherein the securing element has a plurality of tissue anchors configured to engage with an internal wall of a heart adjacent to the left atrial appendage.
25. The implant of claim 20 , wherein the contact member is configured to rotate at least a portion of the left atrial appendage at least one-half of a complete rotation in a first direction.
26. The implant of claim 20 , wherein the contact member is configured to engage a tissue surface of the left atrial appendage without changing a state or shape of the contact member.
27. An implant for reducing a size of an ostium of a left atrial appendage, comprising:
a contact member configured to engage a tissue surface of the left atrial appendage and to rotate at least a portion of the left atrial appendage in a first direction to at least cause tissue of a left atrium and/or the left atrial appendage to twist and gather radially inwardly at or adjacent to an ostium of the left atrial appendage; and
a securing element configured to secure at least a portion of the tissue that has twisted and gathered radially inwardly at or adjacent to the ostium of the left atrial appendage as a result of rotating at least a portion of the left atrial appendage in the first direction;
wherein the implant is configured to cause a tissue of the left atrium and/or the left atrial appendage to constrict around an outer surface of a body portion of the implant when the contact member is rotated to a second position, and the securing element is configured to engage with the tissue that has constricted around the outer surface of the body portion of the implant to prevent untwisting of at least a portion of the left atrial appendage back to the first position of the left atrial appendage.
28. The implant of claim 27 , wherein the contact member is self-expandable such that at least a portion of the contact member automatically expands from a first state to a second state when a restraint is removed from the contact member.
29. The implant of claim 27 , wherein the securing element has a plurality of tissue anchors configured to engage with an internal wall of a heart adjacent to the left atrial appendage.
30. The implant of claim 27 , wherein the contact member is configured to rotate at least a portion of the left atrial appendage at least one-half of a complete rotation in a first direction.