Methods and apparatus for transpericardial left atrial appendage closure

Abstract

Methods and apparatus for closing a left atrial appendage are described. The methods rely on introducing a closure tool from a location beneath the rib cage, over an epicardial surface, and to the exterior of the left atrial appendage. The closure device may then be used to close the left atrial appendage, preferably at its base, by any one of a variety of techniques. A specific technique using graspers and a closing loop is illustrated.

What is claimed is: 
     
         1 . A method for closing a left atrial appendage of a patient's heart, said method comprising:
 positioning a closure instrument through a percutaneous passage beneath the rib cage, over an epicardial surface, and adjacent to the left atrial appendage; and   closing the left atrial appendage using the closure instrument.   
     
     
         2 . A method as in  claim 1 , wherein positioning comprises advancing a distal end of the closure instrument through an access sheath, into the pericardial space, and over an epicardial surface to an atrioventricular groove of the heart. 
     
     
         3 . A method as in  claim 2 , wherein closing comprises looping, suturing, stapling, clipping, riveting, clamping, or fusing the left atrial appendage at a neck region thereof. 
     
     
         4 . A method as in  claim 3 , wherein closing further comprises grasping the left atrial appendage prior to closing the neck region thereof. 
     
     
         5 . A method as in  claim 1 , wherein the method is performed while the patient's heart is beating. 
     
     
         6 . A method as in  claim 5 , wherein the method is performed while both lungs of the patient remain inflated. 
     
     
         7 . A method as in  claim 6 , wherein the method is performed while the patient is under a local anesthetic. 
     
     
         8 . A kit comprising:
 a closure device; and   instructions for use setting forth a method as in  claim 1 .   
     
     
         9 . A method as in  claim 1 , further comprising separating a parietal pericardium from a visceral pericardium near left atrial appendage prior to closing the left atrial appendage to create a space over the atrial appendage. 
     
     
         10 . A method as in  claim 9 , further comprising viewing the atrial appendage through the space.