Apparatus and Methods for Occluding a Hallow Anatomical Structure

Abstract

A clamp ( 10 ) having at least first and second elongate clamping portions ( 2, 4 ) adapted to be placed on opposite sides of the hollow anatomical structure ( 40 ). The first and second elongate clamping portions ( 2, 4 ) respectively include ends coupled together with respective resilient urging members ( 6, 8 ) configured to urge at least one of the first and second elongate clamping portions ( 2, 4 ) toward the other of the first and second elongate clamping portions ( 2, 4 ) from an open position into a clamping position to occlude the hollow anatomical structure ( 40 ). The clamp ( 10 ) is shaped annularly such that it may surround the hollow anatomical structure ( 40 ) in the open position and reorient into a flattened shape in the clamping position to occlude the hollow interior of the hollow anatomical structure ( 40 ). Apparatus of the invention further include clamp delivery and actuation devices ( 80, 200 ) adapted to deploy the clamp ( 10 ).

1 . A device for occluding a hollow anatomical structure, the device comprising:
 a clamp having at least first and second elongate clamping portions adapted to be placed on opposite sides of the hollow anatomical structure, said first and second elongate clamping portions respectively having ends coupled together with respective resilient urging members configured to urge at least one of said first and second elongate clamping portions toward the other of said first and second elongate clamping portions from an open position into a clamping position to occlude the hollow anatomical structure,   said clamp comprising an annular shape configured to surround the hollow anatomical structure in the open position and a flattened shape in the clamping position configured to occlude the hollow interior of the hollow anatomical structure.   
   
   
       2 . The device of  claim 1 , wherein said resilient urging members normally spring bias at least one of said first and second elongate clamping portions toward the other of said first and second elongate clamping portions when said first and second elongate clamping portions are in the open position. 
   
   
       3 . The device of  claim 1 , wherein said first and second elongate clamping portions have tissue engaging surfaces for engaging the hollow anatomical structure in the clamping position, at least one of said tissue engaging surfaces adapted to promote tissue ingrowth. 
   
   
       4 . The device of  claim 3 , wherein said at least one tissue engaging surface includes pores sized from about 200 to about 400 microns. 
   
   
       5 . The device of  claim 1 , further comprising a fabric covering on at least one of said first and second elongate clamping portions. 
   
   
       6 . The device of  claim 1 , wherein said first and second elongate clamping portions each includes a tissue contacting surface for preventing line contact with the hollow anatomical structure thereby spreading a load force exerted by said first and second elongate clamping portions. 
   
   
       7 . The device of  claim 1 , wherein said first and second elongate clamping portions have complementary shapes in cross section such that said complementary shapes fit together in the clamping position. 
   
   
       8 . The device of  claim 1 , wherein at least one of said first and second elongate clamping portions is convexly curved toward the other of said first and second elongate clamping portions in cross section. 
   
   
       9 . The device of  claim 1 , further comprising projections on at least one of said first and second elongate clamping portions configured to engage the hollow anatomical structure when said clamp is in the clamping position. 
   
   
       10 . The device of  claim 1 , wherein said first and second elongate clamping portions and said resilient urging members are formed from at least one wire member. 
   
   
       11 . The device of  claim 10 , wherein said wire member is formed from a material having superelastic properties. 
   
   
       12 . The device of  claim 11 , wherein said wire member is formed from a nickel-titanium alloy. 
   
   
       13 . The device of  claim 10 , wherein said wire member is formed from steel. 
   
   
       14 . The device of  claim 10 , further comprising first and second tubular shaped members covering said wire member respectively on said first and second elongate clamping portions. 
   
   
       15 . The device of  claim 10 , wherein said resilient urging members each further comprise at least one generally U-shaped curved section in said wire member. 
   
   
       16 . The device of  claim 1 , wherein said first and second elongate clamping portions further comprise elongate generally parallel members capable of reorienting into a nonparallel relationship in the clamping position. 
   
   
       17 . The device of  claim 1 , further comprising tissue blocking members positioned at opposite ends of said elongate clamping portions and configured to present outward egress of clamped tissue beyond the respective ends of said elongate clamping portions. 
   
   
       18 . The device of  claim 17 , wherein the tissue blocking members are formed at least partially from a material that promotes tissue ingrowth. 
   
   
       19 . Apparatus for occluding a hollow anatomical structure, the device comprising:
 a clamp delivery and actuation device including first and second jaws, at least one of said first and second jaws configured to move toward and away from the other of said first and second jaws, and   a clamp configured for attachment to said first and second jaws and having at least first and second elongate clamping portions adapted to be placed on opposite sides of the hollow anatomical structure, said first and second elongate clamping portions respectively having ends coupled together with respective resilient urging members configured to urge at least one of said first and second elongate clamping portions toward the other of said first and second elongate clamping portions from an open position into a clamping position to occlude the hollow anatomical structure,   said clamp comprising an annular shape configured to surround the hollow anatomical structure in the open position and a flattened shape in the clamping position configured to occlude the hollow interior of the hollow anatomical structure.   
   
   
       20 . The apparatus of  claim 19 , wherein said first and second jaws and said clamp are configured to enable repeated movement of the clamp between the open and closed positions. 
   
   
       21 . The apparatus of  claim 19 , wherein said clamp is releasably held to said first and second jaws by suture. 
   
   
       22 . The apparatus of  claim 19 , wherein the clamp delivery and actuation device further comprises an endoscopic device. 
   
   
       23 . A method of occluding a hollow anatomical structure with an annular clamp having at least first and second elongate clamping portions with opposite ends coupled together by respective resilient urging members, the method comprising:
 holding the first and second elongate clamping portions a spaced apart orientation against a bias applied by the resilient urging members,   surrounding the hollow anatomical structure with the annular clamp, and   releasing the elongate clamping portions to move the first and second elongate clamping portions together against opposite sides of the hollow anatomical structure under the bias applied by the resilient urging members.   
   
   
       24 . The method of  claim 23 , wherein the hollow anatomical structure is the left atrial appendage of a heart. 
   
   
       25 . The method of  claim 23 , wherein the method further comprises:
 accessing the left atrial appendage of the heart through an intercostal space.   
   
   
       26 . The method of  claim 23 , wherein at least one of said elongate clamping portions further includes a fabric covering, and the method further comprises engaging the fabric covering with the hollow anatomical structure. 
   
   
       27 . The method of  claim 23 , further comprising:
 moving at least one of the first and second elongate clamping portions away from the other of the first and second elongate clamping portions;   repositioning the annular clamp on the hollow anatomical structure; and   moving at least one of the first and second elongate clamping portions toward the other of the first and second elongate clamping portions to occlude the hollow anatomical structure.   
   
   
       28 . A device for occluding a hollow anatomical structure, the device comprising:
 a clamp having at least first and second elongate clamping portions adapted to be placed on opposite sides of the hollow anatomical structure, said first and second elongate clamping portions respectively having ends coupled together in a manner allowing at least one of said first and second elongate clamping portions to move toward the other of said first and second elongate clamping portions from an open position into a clamping position to occlude the hollow anatomical structure,   said clamp comprising an annular shape configured to surround the hollow anatomical structure in the open position and a flattened shape in the clamping position configured to occlude the hollow interior of the hollow anatomical structure, and said elongate clamping portions further comprising generally parallel members capable of reorienting into at least first and second nonparallel relationships in the clamping position, said first nonparallel relationship comprising said elongate clamping portions converging toward one end of said clamp and said second nonparallel relationship comprising said elongate clamping portions converging toward an opposite end of said clamp.