Method and apparatus for prosthetic valve removal
A method and apparatus for facilitating transapical removal of a prosthetic heart valve, i.e., percutaneously implantable valve (PIV), without open-heart surgery. The apparatus includes a holding tool for holding the PIV, a cutting tool for separating the PrV from fibrotic tissue accumulating around the PIV, and a removal tool for extracting the PIV from the heart.
1. A set of tools for facilitating removal of an implanted cardiovascular valve, the set of tools comprising:
(a) a holding tool for holding the implanted cardiovascular valve, said holding tool including:
a first sliding member;
a second sliding member moveable relative to the first sliding member; and
a first member moveable between a collapsed position and an expanded position, wherein movement of the second sliding member relative to the first sliding member moves the first member between the collapsed and expanded positions, said first member engageable with the implanted cardiovascular valve in the expanded position;
(b) a cutting tool including:
a hollow shaft having a longitudinal axis and defining a recess dimensioned to mount over said first and second sliding members of the holding tool, wherein said holding tool locates the cutting tool relative to the implanted cardiovascular valve; and
a cutting arm extending radially from the shaft, wherein said cutting arm includes cutting means for cutting tissue surrounding the implantable cardiovascular valve, said cutting tool rotatable relative to said holding tool to form a generally annular recess around the periphery of the implantable cardiovascular valve; and
(c) a valve removal tool including:
a body having a recess dimensioned to mount over said first and second sliding members of the holding tool, wherein said holding tool locates the valve removal tool relative to the implanted cardiovascular valve;
capture means mounted to the body and moveable between a collapsed position and an expanded position, for capturing the implanted cardiovascular valve; and
an actuator for actuating movement of the capture means between the collapsed and expanded positions.
2. A set of tools according to claim 1 , wherein said first member is a first articulating joint member connected to the first and second sliding members.
3. A set of tools according to claim 2 , wherein said first articulating joint member of the holding tool is comprised of:
a plurality of articulating legs, each of said legs including a projection for engagement with the implanted cardiovascular valve.
4. A set of tools according to claim 1 , wherein said holding tool further comprises a detachable handle attachable to said first sliding member.
5. A set of tools according to claim 1 , wherein said holding tool further comprises a detachable handle attachable to said second sliding member.
6. A set of tools according to claim 1 , wherein said holding tool further comprises:
a third sliding member;
a fourth sliding member moveable relative to the third sliding member; and
a second member moveable between a collapsed position and an expanded position, wherein movement of the fourth sliding member relative to the third sliding member moves the second member between the collapsed and expanded positions.
7. A set of tools according to claim 6 , wherein said second member is a second articulating joint member connected to the third and fourth sliding members.
8. A set of tools according to claim 7 , wherein said second articulating joint member of the holding tool is comprised of:
a plurality of articulating legs, each of said legs including a projection dimensioned to engage with the implanted cardiovascular valve.
9. A set of tools according to claim 1 , wherein said cutting means includes:
at least one axially-mounted fiber optic guide for projecting a laser beam in a direction generally parallel to the longitudinal axis of the shaft, said at least one axially-mounted fiber optic guide is positioned to cut a channel adjacent to the implanted cardiovascular valve.
10. A set of tools according to claim 1 , wherein said cutting means includes:
at least one transverse-mounted fiber optic guide for projecting a laser beam in a direction transverse to the longitudinal axis of the shaft, said at least one transverse-mounted fiber optic guide is positioned to cut the generally annular recess around the periphery of the implanted cardiovascular valve.
11. A set of tools according to claim 1 , wherein said cutting means includes a source of laser energy that is transmitted via a fiber optic cable.
12. A set of tools according to claim 1 , wherein said cutting means includes a mechanical cutting device.
13. A set of tools according to claim 1 , wherein said cutting means includes an electrosurgical cutting device.
14. A set of tools according to claim 1 , wherein the recess of said cutting tool is dimensioned to receive a stem portion of said holding tool.
15. A set of tools according to claim 1 , wherein said cutting tool further comprises a handle portion for maneuvering said cutting tool.
16. A set of tools according to claim 1 , wherein said capture means of said valve removal tool includes a plurality of articulating amts.
17. A set of tools according to claim 16 , wherein said actuator moves an inner sleeve relative to said body in order to effect movement of said articulating arms between the collapsed and expanded positions.
18. A set of tools according to claim 1 , wherein said capture means of said valve removal tool includes a wire mesh basket.
19. A set of tools according to claim 18 , wherein said actuator applies tension to the wire mesh basket in order to effect movement of said wire mesh basket to the collapsed position.
20. A set of tools according to claim 18 , wherein the recess of said body is dimensioned to receive a stem portion of said holding tool.