Delivering a conduit into a heart wall to place a coronary vessel in communication with a heart chamber and removing tissue from the vessel or heart wall to facilitate such communication

Abstract

Devices and methods for delivering conduits into the wall of a patient's heart to communicate a coronary vessel with a heart chamber. The devices are passed through the coronary vessel and the heart wall to place the conduit and establish a blood flow path between the vessel and the heart chamber. Additional devices and methods are provided for removing tissue from a coronary vessel or the heart wall to establish a flow path between the coronary vessel in communication with the heart chamber.

1 . A device for delivering a conduit into the wall of a patient's heart to place the conduit in communication with a heart chamber, the device comprising:
 a support member having a length, a proximal end and a distal end;   a conduit supported by the support member;   a sheath overlying at least a portion of the conduit, the sheath being movable to selectively expose the portion of the conduit covered by the sheath, wherein the sheath is moved to expose said portion of the conduit upon positioning the support member and conduit at a desired location within the wall of the heart; and   a positioning member that provides a visual indication of the position of the conduit with respect to the heart wall, wherein the positioning member is configured to engage a tissue surface and is supported adjacent the distal end of the shaft, the positioning member being movable between collapsed and expanded orientations.   
     
     
         2 . The device of  claim 1 , wherein the positioning member is configured to engage a surface of the heart wall and is supported by the sheath. 
     
     
         3 . The device of  claim 2 , wherein the sheath has a large diameter section that comprises the positioning member. 
     
     
         4 . The device of  claim 1 , wherein the conduit comprises an expandable tubular element and the sheath comprises a retractable sleeve that overlies the tubular element. 
     
     
         5 . The device of  claim 4 , wherein the expandable tubular element comprises a stent and the support member comprises a shaft on which the stent is mounted, and the shaft includes an expansion mechanism for expanding the stent. 
     
     
         6 . A device for delivering a conduit through the wall of a patient's heart and the wall of a coronary vessel to communicate a heart chamber with the coronary vessel, the device comprising:
 a support member configured for placement through the wall of a hear so that a portion of the support member extends into a heart chamber;   an expandable conduit sized and configured for placement in the heart wall so as to communicate the heart chamber with a coronary vessel, wherein the conduit is supported on the support member in a collapsed orientation and is expanded to an expanded orientation for placement in the heart wall; and   wherein the support member has an expansion mechanism that engages the conduit and is actuated to move the conduit from the collapsed orientation to the expanded orientation to securely position the conduit in the heart wall.   
     
     
         7 . The device of  claim 6 , wherein the distal end of the support member is sharpened for forming an opening in the wall of the heart, and the support member has a section that is tapered for dilating the opening formed by the distal end. 
     
     
         8 . The device of  claim 6 , wherein the support member comprises a hollow member that removably receives a dilator having a sharpened tip for forming an opening in the heart wall. 
     
     
         9 . The device of  claim 6 , further comprising a positioning member for engaging tissue to control the position of the conduit with respect to the heart wall. 
     
     
         10 . The device of  claim 9 , further comprising a sheath disposed over the conduit so as to substantially cover the exterior of the conduit. 
     
     
         11 . The device of  claim 10 , wherein the sheath is a retractable sleeve and the positioning member is supported by the sheath. 
     
     
         12 . A method for placing and expanding a conduit in the wall of a patient's heart, the method comprising steps of:
 (a) providing a support member and a conduit, the conduit being supported in a collapsed orientation and movable to an expanded orientation;   (b) placing the support member and the conduit in a wall of a patient's heart;   (c) positioning the conduit within the wall of the heart;   (d) expanding the conduit to the expanded orientation; and   (e) removing the support member and leaving the conduit in the wall of the heart.   
     
     
         13 . The method of  claim 12 , wherein the conduit is passed through a wall of a coronary vessel and through the wall of the heart into a heart chamber containing oxygenated blood, the conduit placing the heart chamber in communication with the interior of the coronary vessel. 
     
     
         14 . The method of  claim 13 , wherein the coronary vessel is a coronary artery and the heart chamber is the left ventricle. 
     
     
         15 . The method of  claim 13 , wherein the conduit is positioned in the wall of the heart so that one end of the conduit extends partially into the heart chamber. 
     
     
         16 . The method of  claim 12 , further comprising a positioning member for engaging the heart wall to control the position of the conduit with respect to the heart wall.