Cardiovascular access and device delivery system
A system and method of accessing a heart of a patient is provided. A cardiac access channel is established through an apical wall of the heart to provide direct access through the apical wall to the left ventricle. A vascular access channel is established through the skin to a peripheral blood vessel. A first end of an elongate member is advanced from the outside of the apical wall through the cardiac access channel and into the left ventricle. A second end disposed opposite the first end remains outside the patient. The elongate member is drawn into and through the vascular access channel to externalize the first end of the elongate member while leaving the second end outside the apical wall of the heart.
1. A system for accessing a heart of a patient, comprising:
a cardiac access sheath having a channel therein and a distal end configured to be advanced through an apical wall of the heart to provide direct access via the channel through the apical wall to the left ventricle of the heart;
an arterial access catheter having a distal end configured to be advanced toward the heart of the patient;
a venous access catheter having a distal end configured to be advanced from a peripheral venous site through an intra-atrial septum and into a left atrium; and
a rail having a first end configured to be inserted into the patient through the channel of the cardiac access sheath and to couple with the arterial access catheter, the rail having an intermediate portion and a second end opposite the first end, the first end configured to be advanced through the arterial access catheter to be disposed outside a patient through a first percutaneous access site while the intermediate portion is disposed in a chamber of the heart and while the second end is disposed outside the patient through the apical wall of the heart; and
a snare configured to be advanced within the venous access catheter to extend from the venous access catheter to capture the intermediate portion of the rail between the cardiac access sheath and the arterial access catheter after the first end of the rail has coupled with the arterial access catheter.
2. The system of claim 1 , wherein the cardiac access sheath comprises a sharp distal portion configured to pierce a wall of the heart.
3. The system of claim 1 , wherein the intermediate portion of the rail is configured to extend from a radial artery, through the heart, to a peripheral vein.
4. The system of claim 1 , wherein the intermediate portion of the rail is configured to extend from a femoral artery, through the heart, to a peripheral vein.
5. The system of claim 1 , wherein the intermediate portion of the rail is configured to extend from a transapical access point to a peripheral vein.
6. The system of claim 1 , wherein the intermediate portion of the rail is configured to extend from a transapical access point to a peripheral artery.
7. The system of claim 1 further comprising a device for closing a cardiac access channel, comprising:
an elongate body having a proximal end and a distal end;
the proximal end having a first opening for delivering a closure medium and a second opening for delivering a pressurizing medium;
the distal end having a first fillable member comprising a distal face, an enclosure disposed at the distal face and extending proximally therefrom, and one or more pores disposed through the enclosure at the distal face thereof, the first fillable member being in fluid communication with the first opening such that the closure medium can be delivered to the first fillable member;
the distal end having a second fillable member in fluid communication with the second opening such that the pressurizing medium can be delivered to the second fillable member;
wherein the first and second fillable members are arranged such that when the first fillable member contains the closure medium and the second fillable member contains the pressurizing medium, the closure medium is disposed through the pore(s) one or more pores.
8. The system of claim 7 , wherein the second fillable member is at least partially disposed within a volume of the first fillable member.
9. The system of claim 7 , wherein the one or more pores disposed through the enclosure at the distal face of the first fillable member comprises an array of pores having first and second transverse dimensions of at least four times the size of the cardiac access channel to be closed.
10. The system of claim 7 , wherein the first and second dimensions are at least 12 mm.