Left ventricular conduits to coronary arteries and methods for coronary bypass

Abstract

Left ventricular conduits and related methods are disclosed for achieving bypass of a partially or completely occluded coronary artery. More broadly, conduits for allowing communication of bodily fluids from one portion of a patient's body to another and related methods are disclosed, including conduits for forming a blood flow path from a chamber of the heart to a vessel or from one vessel to another. In other embodiments, the conduits achieve a coronary artery bypass by allowing blood communication between the left ventricle and the coronary artery or between a proximal portion of the coronary artery and a distal portion of the coronary artery. The conduits may be placed completely through the heart wall or extend only partially therein. Conduits may take on a variety of configurations for allowing the control of blood flow therethrough, including curved or tapered shapes. The conduits may also follow a variety of paths, including direct transmyocardial communication between the left ventricle and the coronary artery, or through the myocardium and into the intrapericardial space and then into the coronary artery. The conduits may be implanted through a variety of methods, including minimally invasive techniques. Also disclosed are various preferred embodiments of medical devices and related methods for implanting the conduits including rigid delivery rods for penetrating bodily tissue. The delivery rods may be solid, thus being trocar-like, or hollow to form a self-implantable conduit. Other preferred rod embodiments may have the conduits mounted thereon and take the form of a stylet or the like. The conduits may be one-piece, continuous conduits or made up of a number of plural sections joined together. Disclosures of various anastomosis devices are provided.

1 - 7 . (canceled)  
   
   
       8 . A transmyocardial implant for establishing a blood flow path through a heart wall between a heart chamber and a lumen of a coronary vessel on said heart wall, said implant comprising: 
 a hollow conduit having an open first end and an open second end, said conduit sized to extend at least from said vessel through said heart wall and into said chamber, said conduit having a conduit wall defining a blood flow pathway within an interior of said conduit between said first and second ends;    said first and second ends mutually positioned for said first end to reside within said vessel and opposing a wall of said vessel when said conduit is placed within said heart wall with said second end protruding into said chamber; said conduit wall formed of a material sufficiently rigid to resist deformation and closure of said pathway in response to contraction of said heart wall;    a flow restriction formed in said pathway for reducing a discharge velocity of blood flow discharged from said first end.    
   
   
       9 . A transmyocardial implant according to  claim 8  wherein said flow restriction is selected for said discharge velocity to be less than an occluding trauma inducing velocity.  
   
   
       10 . A transmyocardial implant according to  claim 8  wherein said restriction is a narrowing in said pathway positioned between enlarged crosssectional areas of said pathway.  
   
   
       11 . A transmyocardial implant according to  claim 10  wherein said pathway has a substantially straight longitudinal axis between said first and second ends.  
   
   
       12 . A transmyocardial implant according to  claim 8  wherein said conduit is sized for said first end to extend into said chamber beyond said heart wall.  
   
   
       13 . A transmyocardial implant according to  claim 8  further comprising a tissue growth inducing material surrounding said conduit wall.  
   
   
       14 . A transmyocardial implant according to  claim 13  wherein said tissue growth inducing material is a polyester fabric.  
   
   
       15 . A method for establishing a blood flow path through a heart wall between a heart chamber and a lumen of a coronary vessel on said heart wall, said method comprising: 
 forming a blood flow path from said vessel through said heart wall and into said chamber;    maintaining said blood flow path open during both systole and diastole;    restricting blood flow through said pathway to reducing a discharge velocity of blood flow discharged into said vessel.    
   
   
       16 . A method for placing a conduit in fluid communication with a target vessel in a patient's vascular system, the method comprising steps of: 
 (a) providing a conduit having a first end, a second end and a lumen, the conduit being supported by a conduit delivery device having a portion that is adapted to be positioned adjacent a target vessel in a patient's vascular system;    (b) positioning the portion of the conduit delivery device adjacent the target vessel;    (c) placing one of the first and second ends of the conduit in fluid communication with a lumen of the target vessel; and    (d) removing the conduit delivery device from the conduit;    (e) wherein steps (c) and (d) are performed using only one hand.    
   
   
       17 . The method of  claim 16 , wherein steps (b), (c) and (d) are performed using only one hand.  
   
   
       18 . The method of  claim 16 , further comprising the step of removing the conduit delivery device from the patient's body, wherein said step of removing the conduit delivery device is performed using only one hand.  
   
   
       19 . The method of  claim 16 , further comprising the step of placing the other of the first and second ends of the conduit in fluid communication with a source of blood so that blood flows from the source of blood, through the conduit, and into the lumen of the target vessel.  
   
   
       20 . The method of  claim 19 , wherein the step of placing the other of the first and second ends of the conduit in fluid communication with the source of blood is performed prior to performing the step of placing the one end of the conduit in fluid communication with the lumen of the target vessel.  
   
   
       21 . The method of  claim 19 , wherein the source of blood is a heart chamber containing blood.  
   
   
       22 . A method for establishing a conduit to place a coronary vessel in fluid communication with a heart chamber containing oxygenated blood, the method comprising steps of: 
 (a) placing a conduit in fluid communication with a heart chamber containing oxygenated blood, wherein at least a portion of the length of the conduit is disposed exterior to the heart wall;    (b) placing the conduit in fluid communication with a lumen of a coronary vessel; and    (c) securing the conduit to the coronary vessel by a sutured anastomosis to place the coronary vessel in fluid communication with the heart chamber.    
   
   
       23 . The method of  claim 22 , wherein a majority of the length of the conduit is disposed exterior to the heart wall, the source of blood is the left ventricle and the coronary vessel is a coronary artery, and the conduit comprises a graft that is secured to the coronary artery by a hand-sewn sutured anastomosis.  
   
   
       24 . A method for placing a conduit in fluid communication with a target vessel in a patient's vascular system by passing a device through an opening in the patient's body, the method comprising steps of: 
 (a) providing a conduit having a first end, a second end and a lumen, wherein the conduit is supported by a conduit delivery device having a portion that is sized and configured to be passed through a port located between adjacent ribs in a patient's body;    (b) passing the portion of the conduit delivery device through the port to a location adjacent the target vessel;    (c) placing one of the first and second ends of the conduit in fluid communication with a lumen of the target vessel;    (d) removing the conduit from the conduit delivery device; and    (e) removing the conduit delivery device from the port.    
   
   
       25 . The method of  claim 24 , wherein the opening is formed between the patient's ribs and a trocar sleeve is positioned in the opening.  
   
   
       26 . The method of  claim 24 , wherein step (c) is performed by securing the one end of the conduit to the target vessel without using suture and to preserve native flow through the target vessel.  
   
   
       27 . A device for providing a supplemental flow of blood from the left ventricle of a heart to a coronary artery thereof in order to bypass an occlusion in said coronary artery, comprising a conduit having a first part to be positioned through the left ventricle wall into the left ventricle cavity and a second part to be positioned in said coronary artery, said first and second parts having longitudinal axes which are at an angle to each other, said conduit further having a flexible part forming a connection between the first part and the second part, whereby a channel is provided from a first open end of the first part to a first open end of the second part.  
   
   
       28 . The device according to  claim 27 , wherein said conduit has a contracted state and a dilated state and is expandable from the contracted state to the dilated state.  
   
   
       29 . The device according to  claim 28 , wherein the first and second parts of the conduit are separately expandable.  
   
   
       30 . The device according to  claim 27 , wherein the flexible part allows varying the angle between the longitudinal axes of the first part and the second part.  
   
   
       31 . The device according to  claim 27 , wherein the second part of the conduit extends from its first open end on one side of the connection between the first part and the second part to a second end on an opposite side of the connection between the first part and the second part.  
   
   
       32 . The device according to  claim 27 , wherein the first part has a second, open end and the second part has a second, open end, and wherein the flexible part connects these open ends, thereby forming said channel from the first open end of the first part to the first open end of the second part.  
   
   
       33 . The device according to  claim 27 , wherein the first part comprises means for anchoring the device inside the left ventricle cavity of the heart.