Tissue cutting systems and methods
The disclosure provides various embodiments of systems to facilitate the cutting of tissue structures and other tissue structures percutaneously.
1 . A device to cut tissue, comprising:
an elongate body having a proximal end and a distal end, wherein the elongate body has a curved section that is configured to conform to and curve around a left ventricular outflow tract obstruction in a left ventricular outflow tract of a heart of a patient, and further wherein the elongate body defines a proximal exit port disposed at a location proximate a proximal region of the curved section and a distal entrance port disposed at a location proximate a distal region of the curved section;
an elongate tether operably coupled to the elongate body, wherein the elongate tether and elongate body are configured to be longitudinally displaceable with respect to one another, and wherein the elongate tether is configured to exit from the proximal exit port formed in the elongate body and re-enter the elongate body at the a distal entrance port, and further wherein the elongate tether is configured to slide through the proximal exit port and distal entrance port while under tension in a reciprocating manner while the elongate body is held stationary to cut through the left ventricular outflow tract obstruction as a proximal section of the elongate tether located proximally with respect to the proximal exit port is tensioned and untensioned; and
a cutting element disposed on the elongate tether, wherein reciprocating sliding longitudinal movement of the elongate tether through and with respect to the proximal exit port and reciprocating sliding movement through and with respect to the distal entrance port causes the cutting element to reciprocate and cut through anatomical tissue of the obstruction while the elongate body remains stationary.
2 . The device of claim 1 , wherein the cutting element includes at least one blade coupled to the tether that is configured to cut through tissue when the tether is reciprocated and held against the left ventricular outflow tract obstruction.
3 . The device of claim 1 , wherein the cutting element includes an electrically conductive element configured to be coupled to an electrical power source in order to electrify the electrically conductive element.
4 . The device of claim 1 , wherein the elongate body is configured to be held stationary adjacent anatomical tissue, and the at least one cutting element is disposed on the elongate tether.
5 . The device of claim 4 , wherein the elongate tether is configured to be received at least partially within a lumen defined in the elongate body.
6 . The device of claim 1 , wherein a distal end of the elongate tether is coupled to a distal portion of the elongate body by an elastic element that can stretch longitudinally, and further wherein the elastic element is configured to retract the elongate tether in a distal direction in a sliding relationship through the distal entrance port when tension is reduced on the proximal end of the tether.
7 . The device of claim 6 , wherein the elastic element includes a tension spring.
8 . The device of claim 4 , wherein the elongate tether includes a cutting electrode mounted thereon configured to be coupled to an electrosurgical power source.
9 . The device of claim 8 , further comprising a depth sensing electrode to sense the depth of the tissue that the elongate tether is passing through.
10 . The device of claim 1 , wherein the elongate body includes a flexible distal section disposed distally of the distal entrance port to conform to the anatomy of a patient's ventricle.
11 . The device of claim 1 , wherein the elongate tether is configured to conform to a concave surface of the curved section of the elongate body when the elongate body is placed over the obstruction.
12 . The device of claim 11 , wherein the elongate tether is configured to cut into the obstruction as the cutting element reciprocates until the cutting element traverses a straight path between the proximal exit port and the distal entrance port.
13 . The device of claim 1 , wherein the cutting element is formed at least in part from radiopaque material.
14 . The device of claim 1 , wherein the cutting element includes a diamond coated wire.
15 . The device of claim 1 , wherein the cutting element includes an ultrasonically driven cutting element.
16 . The device of claim 1 , wherein the curve of the curved section is preformed into the elongate body.
17 . The device of claim 1 , wherein the elongate body extends distally beyond the distal entrance port into an elongate preformed curved shape configured and arranged to traverse along and past an apex of a left ventricle of a patient to hold the curved section of the elongate body in place over the obstruction within the left ventricle of the patient.
18 . The device of claim 1 , further comprising a deployable anchor in a region of the distal entrance port of the elongate body, the deployable anchor being configured to be deployed distally of the obstruction to penetrate into the myocardium to anchor the curved section of the elongate member in place over the obstruction.
19 . The device of claim 1 , wherein the distal end of the tether is configured to be prevented from being removed from the distal entrance port.