Transapical valve replacement

Abstract

Techniques for reaching the interior of the heart, such as for aortic valve replacement, can combine elements of percutaneous implantation methods and elements of surgical implantation methods. In some instances, aortic valve replacement may include a dual transapical approach in which a transfemoral approach is used to reach the apex of the patient's heart from inside the left ventricle while a minimally invasive surgical procedure provides access to the exterior of the apex via an intercostal approach.

1 . A transapical method of gaining access to an interior of a patient's heart, the method comprising steps of:
 advancing a first guidewire through the ascending aorta and through the aortic valve to a location within the left ventricle;   advancing a guide catheter over the first guidewire to the location within the left ventricle;   advancing a cutting catheter over the first guidewire;   advancing a balloon catheter including an inflatable balloon over the first guide catheter;   inflating the inflatable balloon proximate the wall of the left ventricle;   penetrating the wall of the left ventricle using the cutting catheter;   accessing the interior of a patient's chest through an intercostal space that is disposed above the apex of the patient's heart;   advancing an S-shaped catheter through the intercostal space such that the S-shaped catheter has a distal end positioned proximate the patient's pericardial sac;   penetrating the pericardial sac using an instrument advanced through the S-shaped catheter;   connecting a distal end of the balloon catheter to the distal end of the S-shaped catheter; and   withdrawing the S-shaped catheter to lift the apex of the heart.   
     
     
         2 . The method of  claim 1 , wherein the first guidewire is advanced through the patient's vasculature from a femoral access point. 
     
     
         3 . The method of  claim 1 , wherein accessing the interior of a patient's chest comprises penetrating the chest wall through an intercostal space using a hollow needle. 
     
     
         4 . The method of  claim 1 , wherein the instrument used to penetrate the pericardial sac is a hollow needle. 
     
     
         5 . The method of  claim 1 , further comprising advancing a port over the balloon catheter. 
     
     
         6 . The method of  claim 5 , further comprising delivering a prosthetic valve through the port. 
     
     
         7 . A transapical method of gaining access to an interior of a patient's heart, the method comprising steps of:
 advancing a first hollow needle into a patient's chest through an intercostal space, the intercostal space being above the apex of the patient's heart;   advancing an S-shaped catheter through the first hollow needle such that the S-shaped catheter has a distal end positioned proximate the patient's pericardial sac;   advancing a guidewire through the S-shaped catheter;   advancing a second hollow needle over the guidewire to a position proximate the pericardial sac;   penetrating the pericardial sac with the second hollow needle;   advancing a catheter bearing a cutting blade through the second hollow needle and penetrating the heart wall;   advancing a catheter including an inflatable balloon on a distal region of the catheter;   inflating the inflatable balloon; and   partially withdrawing the catheter to lift the apex of the heart to a higher position proximate the intercostal space through which the first hollow needle was advanced.