Trans-catheter ventricular reconstruction structures, methods, and systems for treatment of congestive heart failure and other conditions
Embodiments described herein include devices, systems, and methods for reducing the distance between two locations in tissue. In one embodiment, an anchor may reside within the right ventricle in engagement with the septum. A tension member may extend from that anchor through the septum and an exterior wall of the left ventricle to a second anchor disposed along a surface of the heart. Perforating the exterior wall and the septum from an epicardial approach can provide control over the reshaping of the ventricular chamber. Guiding deployment of the implant from along the epicardial access path and another access path into and through the right ventricle provides control over the movement of the anchor within the ventricle. The joined epicardial pathway and right atrial pathway allows the tension member to be advanced into the heart through the right atrium and pulled into engagement along the epicardial access path.
1 . A system for delivering an implant to a heart of a patient, the system comprising:
a catheter having a distal end and a lumen, the catheter being insertable from outside a body of the patient into the heart so that the distal end of the catheter is disposed in a first chamber of the heart adjacent to a septal wall of the heart;
an elongate tension member;
a first anchor pivotably coupled with a distal end of the elongate tension member, the first anchor being pivotable between an insertion configuration and a deployed configuration; and
a second anchor coupleable with the elongate tension member so that the second anchor is slidable distally along the elongate tension member toward an outer wall of the heart and toward the first anchor, the second anchor having a release state in which the second anchor is slidable along the elongate tension member and a lock state in which the second anchor is fixed to the elongate tension member,
wherein:
the catheter, the elongate tension member, and the first anchor are configured so that the elongate tension member and first anchor are insertable within the lumen of the catheter and advanceable through the lumen;;
the first anchor is configured to be advanced in the insertion configuration through the lumen of the catheter and while attached to the distal end of the elongate tension member to within the first chamber of the heart adjacent the septal wall;
the first anchor is configured to be pivoted from the insertion configuration to the deployed configuration within the first chamber for engagement with the septal wall;
the second anchor is configured to be advanced from a first position outside of the patient's body to a second position adjacent the outer wall of the heart; and
the first anchor and the elongate tension member are configured so that applying tension to the elongate tension member pulls the first anchor into engagement with the septal wall,
wherein the distal end of the elongate tension member is coupleable with a guidewire, and
wherein the elongate tension member is configured to be advanced through the lumen of the catheter and through a perforation in the septal wall along with the guidewire.
2 . The system of claim 1 , wherein the guidewire has an end positionable outside the body of the patient while an elongate section of the guidewire traverses through the first chamber of the heart, the septal wall, and a second chamber of the heart.
3 . The system of claim 1 , wherein the anchor is further configured so that the guidewire is insertable through a lumen of the first anchor, and wherein insertion of the guidewire through the lumen of the first anchor facilitates in maintaining the first anchor in the insertion configuration.
4 . The system of claim 3 , wherein the guidewire is removable from the lumen of the first anchor to allow the first anchor to pivot from the insertion configuration to the deployed configuration.
5 . The system of claim 1 , wherein the guidewire is operably coupleable with the first anchor to maintain the first anchor in the insertion configuration, and wherein the guidewire is releasable from the first anchor to allow the first anchor to pivot from the insertion configuration to the deployed configuration.
6 . The system of claim 1 , wherein the elongate tension member is configured so that a proximal end of the elongate tension member is outside the body of the patient while the first anchor is being positioned adjacent the septal wall and while the second anchor is being advanced to the outer wall of the heart.
7 . The system of claim 1 , wherein the second anchor is configured to slide distally along the elongate tension member until the second anchor contacts the outer wall of the heart, and wherein applying tension, via the elongate tension member, between the first anchor and the second anchor causes the septal wall and the outer wall to move toward one another.
8 . The system of claim 7 , wherein the second anchor includes an elongate body that is aligned longitudinally with the elongate tension member as the second anchor is slid distally along the elongate tension member.
9 . A system for delivering an implant to a heart of a patient, the system comprising:
a catheter having a distal end and a lumen, the catheter being configured for insertion from outside a body of the patient and into the heart so that the distal end of the catheter is disposed in a chamber of the heart adjacent to a first wall of the heart;
an elongate tension member;
a first anchor coupled to a distal end of the elongate tension member so that the first anchor is pivotable between an insertion configuration and a deployed configuration, the first anchor being advanceable through the lumen while in the insertion configuration to a position adjacent the first wall of the heart and the first anchor being configured to be pivoted from the insertion configuration to the deployed configuration within the chamber of the heart; and
a second anchor coupled with the elongate tension member so that the second anchor is slidable along the elongate tension member toward the first anchor, the second anchor having a release state in which the second anchor is slidable along the elongate tension member towards the heart and a lock state in which the second anchor is secured to the elongate tension member,
wherein the distal end of the elongate tension member is advanceable through the body of the patient so that a proximal end of the elongate tension member is disposed outside the body of the patient while the first anchor is positioned adjacent the first wall of the heart;
wherein the elongate tension member, the catheter, and the first anchor while in the insertion configuration are configured so that the elongate tension member is insertable within the lumen of the catheter and is advanceable through the lumen of the catheter with the distal end of the elongate tension member attached to the first anchor;
wherein the elongate tension member and the second anchor are configured so that applying tension to the elongate tension member pulls the first anchor into engagement with the first wall of the heart and pulls the first wall towards a second wall of the heart which abuts the second anchor, and
wherein the first anchor is configured so that a guidewire is insertable within a lumen of the first anchor to maintain the first anchor in the insertion configuration.
10 . The system of claim 9 , wherein the second anchor is slideable along the elongate tension member until the second anchor abuts the second wall of the heart, and wherein the first and second anchors are configured such that applying tension, via the elongate tension member, between the first anchor and the second anchor causes the first wall and the second wall to move toward one another.
11 . The system of claim 10 , wherein the second anchor includes an elongate body that is alignable longitudinally with the elongate tension member as the second anchor is slid along the elongate tension member.
12 . The system of claim 9 , wherein the second anchor is advanceable along the elongate tension member from a position outside of the patient's body towards the second wall of the heart.
13 . The system of claim 9 , wherein the elongate tension member is insertable within the lumen of the catheter while the second anchor is positioned outside of the patient's body.
14 . A system for delivering an implant to a heart of a patient, the system comprising:
a catheter having a distal end and a lumen, the catheter being configured for insertion from outside a body of the patient and into the heart so that the distal end of the catheter is disposed in a chamber of the heart adjacent to a first wall of the heart;
an elongate tension member;
a first anchor coupled to a distal end of the elongate tension member so that the first anchor is pivotable between an insertion configuration and a deployed configuration, the first anchor being advanceable through the lumen while in the insertion configuration to a position adjacent the first wall of the heart and the first anchor being configured to be pivoted from the insertion configuration to the deployed configuration within the chamber of the heart; and
a second anchor coupled with the elongate tension member so that the second anchor is slidable along the elongate tension member toward the first anchor, the second anchor having a release state in which the second anchor is slidable along the elongate tension member towards the heart and a lock state in which the second anchor is secured to the elongate tension member,
wherein the distal end of the elongate tension member is advanceable through the body of the patient so that a proximal end of the elongate tension member is disposed outside the body of the patient while the first anchor is positioned adjacent the first wall of the heart;
wherein the elongate tension member, the catheter, and the first anchor while in the insertion configuration are configured so that the elongate tension member is insertable within the lumen of the catheter and is advanceable through the lumen of the catheter with the distal end of the elongate tension member attached to the first anchor;
wherein the elongate tension member and the second anchor are configured so that applying tension to the elongate tension member pulls the first anchor into engagement with the first wall of the heart and pulls the first wall towards a second wall of the heart which abuts the second anchor, and
wherein the distal end of the elongate tension member is coupleable with a guidewire, and wherein the elongate tension member is configured to be advanced through the lumen of the catheter and through a perforation in the first wall along with the guidewire.