Method and apparatus for antegrade transcatheter valve repair or implantation
Methods, apparatuses, and systems for performing a valve replacement or repair. Apparatuses may include systems and may include an outer catheter, one or more interchangeable inner catheters, a guidewire and an expandable chordae tendinae deflector. Also described herein are rapid pacing sheaths that may be used with any of these apparatuses and methods.
1. A system for antegrade delivery of a replacement valve, the system comprising:
an outer catheter configured as a sheath to receive an inner catheter, the sheath comprising:
an elongate body having a lumen configured to receive the inner catheter, wherein the elongate body is configured to extend from outside of a body to a left ventricular apex of the heart;
a hub at a proximal end of the elongate body, the hub comprising a hemostatic valve;
a plurality of electrodes at a distal end region of the elongate body;
a plurality of electrical connectors extending proximally from the elongate body; and
a plurality of conductor cables extending from the plurality of electrical connectors to the plurality of electrodes, so that each electrical connector electrically connects to a corresponding electrode of the plurality of electrodes; and
a pacing controller configured to electrically couple to the plurality of electrical connectors of the sheath, the pacing controller comprising one or more processors and a non-transitory computing device readable medium having instructions stored thereon that are executable by the one or more processors to cause the pacing controller to apply a heart pacing stimulation from the plurality of electrodes.
2. The system of claim 1 , further comprising: an inner catheter wherein the inner catheter comprises: a distal end region that is tapered, an engagement surface proximal to a distal end of the inner catheter, wherein the engagement surface is configured to sealingly couple to a distal end region of the sheath so that an outer surface of the inner catheter is flush with an outer surface of the sheath without a gap.
3. The system of claim 2 , wherein the inner catheter comprises a bend region between the engagement surface and the distal end that is configured to assume a bend of greater than 120 degrees.
4. The system of claim 1 , wherein the sheath further comprises a side port at the proximal end of the elongate body, wherein the side port is in fluid communication with the lumen.
5. The system of claim 1 , wherein the plurality of electrodes are ring electrodes arranged circumferentially around the distal end region.
6. The system of claim 1 , wherein the plurality of conductor cables form a bundle that extends helically around the elongate body from the plurality of electrical connectors to the plurality of electrodes.
7. The system of claim 1 , wherein the plurality of electrodes are arranged in series along the distal end region.
8. The system of claim 1 , wherein the electrodes of the plurality of electrodes are separated from each other by between about 1 cm and 9 cm.
9. The system of claim 1 , further comprising a yoke coupled to the plurality of electrical connectors.
10. A system for antegrade delivery of a replacement valve, the system comprising:
an outer catheter configured as a pacing sheath;
an inner catheter comprising: a distal end region that is tapered, an engagement surface proximal to a distal end of the inner catheter, wherein the engagement surface is configured to sealingly couple to a distal end region of the outer catheter so that an outer surface of the inner catheter is flush with an outer surface of the outer catheter without a gap;
wherein the outer catheter is configured to receive the inner catheter, the outer catheter comprising:
an elongate body having a lumen configured to receive the inner catheter, wherein the elongate body is configured to extend from outside of a body to a left ventricular apex of the heart;
a hub at a proximal end of the elongate body, the hub comprising a hemostatic valve;
a plurality of electrodes arranged along a distal end region of the elongate body, wherein the plurality of electrodes is spaced from the distal end region by a standoff distance;
a plurality of electrical connectors extending proximally from the elongate body; and
a plurality of conductor cables forming a bundle extending helically around the elongate body from the plurality of electrical connectors to the plurality of electrodes, so that each electrical connector electrically connects to a corresponding electrode of the plurality of electrodes; and
a pacing controller configured to electrically couple to the plurality of electrical connectors of the outer catheter, the pacing controller comprising one or more processors and a non-transitory computing device readable medium having instructions stored thereon that are executable by the one or more processors to cause the pacing controller to apply a heart pacing stimulation from the plurality of electrodes.
11. The system of claim 10 , wherein the inner catheter comprises a bend region between the engagement surface and the distal end that is configured to assume a bend of greater than 120 degrees.
12. The system of claim 10 , wherein the outer catheter further comprises a side port at the proximal end of the elongate body, wherein the side port is in fluid communication with the lumen.
13. The system of claim 10 , wherein the plurality of electrodes are ring electrodes arranged circumferentially around the distal end region.
14. The system of claim 10 , wherein the plurality of conductor cables form a bundle that extends helically around the elongate body from the plurality of electrical connectors to the plurality of electrodes.
15. The system of claim 10 , wherein the plurality of electrodes are arranged in series along the distal end region.
16. The system of claim 10 , wherein the electrodes of the plurality of electrodes are separated from each other by between about 1 cm and 9 cm.
17. The system of claim 10 , further comprising a yoke coupled to the plurality of electrical connectors.