Methods and devices for improving cardiac function in hearts

Abstract

Various methods and devices are disclosed for improving cardiac function in hearts having zones of infarcted (akinetic) and aneurysmal (dyskinetic) tissue regions. The methods and devices reduce the radius of curvature in walls of the heart proximal infarcted and aneurysmal regions to reduce wall stress and improve pumping efficiency. The inventive methods and related devices include splinting of the chamber wall proximal the infarcted region and various other devices and methods including suture and patch techniques.

1 - 77 . (canceled)  
     
     
         78 . A method of direct localized therapeutic treatment of a heart, the method comprising: 
 identifying a target region of the myocardium of the heart; and    applying a self-anchoring mechanical device directly to a portion of the myocardial tissue of the identified target region,    whereby motion of the myocardial tissue of the identified target region is at least one of: restricted and limited.    
     
     
         79 - 83 . (canceled)  
     
     
         84 . A method of treating a heart having experienced a myocardial infarction, the method comprising: 
 identifying and locating at least one of: non-ischemic tissue, infarcted tissue, peri-infarcted tissue and ischemic tissue in the myocardium of the heart; and    placing a self-anchoring mechanical device in at least one of the non-ischemic tissue, infarcted tissue, peri-infarcted tissue and ischemic tissue to restrict or limit motion in at least one of the infarcted tissue, peri-infarcted tissue and ischemic tissue.    
     
     
         85 - 98 . (canceled)  
     
     
         99 . A method of treating a heart with abnormal heart wall motion, the method comprising: 
 identifying and locating at least one of: non-ischemic tissue, infarcted tissue, peri-infarcted tissue and ischemic tissue in the myocardium of the heart; and    placing a self-anchoring mechanical device in at least one of the non-ischemic tissue, infarcted tissue, peri-infarcted tissue and ischemic tissue to restrict or limit motion in at least one of the infarcted tissue, peri-infarcted tissue and ischemic tissue.    
     
     
         100 - 101 . (canceled)  
     
     
         102 . A device for placement in a myocardium of a heart, the device comprising: 
 means for attaching to the myocardium at two or more attachment locations; and    means for restricting, to substantially a predetermined value, a distance between at least two attachment locations.    
     
     
         103 - 109 . (canceled)  
     
     
         110 . A device for reducing stress in myocardial tissue, comprising: 
 a substantially tubular body having proximal and distal portions;    a first expanding anchor located at the proximal portion; and    a second expanding anchor located at the distal portion, wherein the tubular body comprises a lumen having a proximal opening in the proximal portion and a distal opening in the distal portion.    
     
     
         111 - 121 . (canceled)  
     
     
         122 . A method of direct localized therapeutic treatment of a heart, the method comprising: 
 identifying a target region of the myocardium of the heart; and    applying a self-anchoring mechanical device directly to a portion of the myocardial tissue of the identified target region to limit substantial lengthening of myocytes in the target region.    
     
     
         123 - 126 . (canceled)  
     
     
         127 . A method of treating mitral valvular regurgitation in a human heart, the method comprising: 
 providing a self-anchoring mechanical device;    identifying a target region of a myocardium of the heart; and    positioning the self-anchoring mechanical device within a portion of the identified target region so as to adjust a position of a base of at least one papillary muscle coupled to a mitral valve.    
     
     
         128 - 138 . (canceled)  
     
     
         139 . A method of treating mitral valvular regurgitation, the method comprising: 
 providing a restraining device having a distal anchor and a proximal anchor;    embedding the distal anchor of the device in heart tissue; and    embedding the proximal anchor in the heart tissue, wherein the restraining device is substantially positioned in a mid-wall of the heart and oriented to adjust a position of a base of at least one papillary muscle coupled to a mitral valve.    
     
     
         140 - 145 . (canceled)  
     
     
         146 . A method of treating a heart, the method comprising: 
 providing a restraining device having a distal anchor and a proximal anchor;    embedding the distal anchor of the device in heart tissue; and    embedding the proximal anchor in the heart tissue, wherein the restraining device is substantially positioned in a mid-wall of the heart.    
     
     
         147 - 153 . (canceled)  
     
     
         154 . A method for direct localized therapeutic treatment of myocardial tissue in heart having a pathological condition comprising the steps of: 
 a. identifying a target region of the myocardium;    b. applying a device to at least a portion of the myocardial tissue of the target region substantially identified in step (a) to physically modify the mechanical properties of said tissue and limit motion in the peri-infarct or infarct region.    
     
     
         155 . The method of  claim 154 , wherein geometry and wall stress of the infarct or peri-infarct tissue is altered.  
     
     
         156 . The method of  claim 155 , wherein the infarct region is excluded or shrunk.  
     
     
         157 . The method of  claim 156 , wherein expansion of the infarct or peri-infarct tissue during systole is limited.  
     
     
         158 . The method of  claim 154 , wherein the infarct or peri-infarct tissue is physically modified by at least one of stiffening, restraining, or constraining.  
     
     
         159 . The method of  claim 154 , wherein a device is placed through the myocardium to restrict motion in the peri-infarct or infarct regions.  
     
     
         160 . The method of  claim 154 , wherein the modified mechanical properties include an increase in systolic performance.  
     
     
         161 . The method of  claim 160 , wherein the modified mechanical properties includes substantially no decrease in global diastolic performance.  
     
     
         162 . The method of  claim 154 , wherein the device is utilized without external stimulation.  
     
     
         163 . The method of  claim 154 , wherein the target region includes a myocardial infarct.  
     
     
         164 . The method of  claim 154 , wherein the target region at least in part underlies the papillary muscles associated with a cardiac valve.  
     
     
         165 . The method of  claim 164 , wherein said cardiac valve is the mitral valve.  
     
     
         166 . The method of  claim 154 , wherein the device is a tubular structure positioned between at least first and second anchors.  
     
     
         167 . The method of  claim 166 , wherein the tubular structure includes slots configured to provide lateral flexibility.  
     
     
         168 . The method of  claim 167 , wherein the tubular structure is configured to provide lateral and longitudinal flexibility.  
     
     
         169 . The method of  claim 168 , wherein the tubular structure is configured to provide lateral shortening and limited lateral lengthening.  
     
     
         170 . The method of  claim 166 , wherein the at least first and second anchors are end portions of the tubular structure.  
     
     
         171 . The method of  claim 154 , wherein said applying step includes employing a guide catheter.  
     
     
         172 . The method of  claim 171 , wherein the guide catheter is inserted through the femoral artery, threaded through the aorta and inserted retrograde through the aortic valve into the left ventricle.  
     
     
         173 . The method of  claim 172 , wherein the guide catheter is placed against the endocardial surface of the left ventricle.  
     
     
         174 . The method of  claim 173 , further comprising: 
 placing a puncture device through the guide catheter to make a puncture into the endocardium.    
     
     
         175 . The method of  claim 174 , further comprising: 
 inserting a guidewire until it is located distal to the myocardial infarct and the distal peri-infarct region.    
     
     
         176 . The method of  claim 175 , further comprising: 
 introducing the delivery device over the guidewire to the desired location in the myocardium.    
     
     
         177 . The method of  claim 171 , wherein said catheter is employed percutaneously.  
     
     
         178 . The method of  claim 154 , wherein said applying step is preceded by performing a minithoractomy.  
     
     
         179 . The method of  claim 154 , wherein said applying step includes applying material intramyocardially.