Devices, systems, and methods for treating the left atrial appendage

Abstract

Disclosed are embodiments of a method for occluding a left atrial appendage (LAA) and other cavities or openings within a body. Some embodiments of the method can include an implant configured to be deployed within the LAA or other cavity, configured to be expanded or moved against a wall portion of the LAA or other cavity, and configured to twist at least a portion of the LAA or other cavity when the implant is rotated. Thereafter, one or more securing elements, staples, sutures, or other fasteners can be implanted in the gathered tissue to hold the tissue in the gathered state, thereby occluding the opening of the LAA or other cavity. In some embodiments, the opening of the LAA or other cavity can be occluded by elongating or otherwise reshaping the opening using an implant device, and securing the opening in the occluded state.

1 .- 20 . (canceled) 
     
     
         21 . An implant for a left atrial appendage; comprising:
 a frame that is expandable from a collapsed state to an expanded state, the frame comprising a wall having an elongated shape along an entire length of the frame in at least the expanded state;   wherein the frame defines a first width in a first direction from a first portion across the opening of the frame to a second portion that is greater than a second width in a second direction that is perpendicular to the first direction.   
     
     
         22 . The implant of  claim 21 , further comprising a first apex extension that extends away from the proximal end of the frame at the first portion of the wall, wherein the first apex extension is configured to prevent the frame from passing completely through an ostium of the left atrial appendage. 
     
     
         23 . The implant of  claim 21 , further comprising an opening extending through the frame in an axial direction from a proximal end to a distal end of the frame, the opening being surrounded by the wall. 
     
     
         24 . The implant of  claim 21  wherein the first width of the opening of the frame is at least two times the second width of the frame, but no more than ten times the second width of the opening of the frame, when the implant is in a naturally expanded state outside of the body. 
     
     
         25 . The implant of  claim 21 , wherein the first width of the opening of the frame is from two times to five times the second width of the opening of the frame when the implant is in a naturally expanded state outside of the body. 
     
     
         26 . The implant of  claim 21 , wherein a ratio of the first width of the opening of the frame of the frame to the second width of the opening of the frame when the implant is in a deployed state in the left atrial appendage is at least 5:1. 
     
     
         27 . The implant of  claim 21 , wherein a ratio of the first width of the frame to the second width of the frame when the implant is in a deployed state in the left atrial appendage is from 2:1 to 5:1. 
     
     
         28 . The implant of  claim 21 , wherein the implant is configured to change a shape of the ostium so that a first width of the ostium is at least two times the second width of the ostium, but no more than ten times the second width of the ostium, when the implant is in a deployed state in the left atrial appendage. 
     
     
         29 . The implant of  claim 21 , wherein the implant is configured to change a shape of the ostium so that a first width of the ostium is from two times to five times the second width of the ostium, when the implant is in a deployed state in the left atrial appendage. 
     
     
         30 . The implant of  claim 21 , wherein the frame comprises grip features on an outside surface of the frame at least at the first portion and the second portion of the frame configured to inhibit a movement of the frame relative to a tissue surface of the ostium of the left atrial appendage. 
     
     
         31 . The implant of  claim 21 , comprising a cover coupled with the frame, the cover at least partially covering the opening in the frame. 
     
     
         32 . The implant of  claim 21 , wherein the first and second end portions of the frame are configured to spread a first portion of an ostium of the left atrial appendage apart from a second portion of the ostium that is opposite to the first portion so as to elongate the ostium of the left atrial appendage in the first direction. 
     
     
         33 . The implant of  claim 21 , wherein a cross-sectional area of the opening of the implant is from 50% to 70% less than an opening of the LAA prior to deployment of the implant. 
     
     
         34 . A method of treating a left atrial appendage; comprising:
 advancing a delivery catheter having an implant therein into the heart;   advancing a distal tip of the delivery catheter near an ostium of the left atrial appendage;   elongating the left atrial appendage in a first direction by at least expanding the implant in the first direction so that a ratio of a size of the ostium of the left atrial appendage in the first direction relative to a size of the ostium of the left atrial appendage in a second direction that is perpendicular to the first direction is at least 2:1; and   withdrawing the delivery catheter with the implant positioned in the left atrial appendage.   
     
     
         35 . The method of  claim 34 , further comprising elongating the left atrial appendage in the first direction by at least expanding the implant in the first direction so that the ratio of the size of the ostium of the left atrial appendage in the first direction relative to the size of the ostium of the left atrial appendage in the second direction is from 2:1 to 5:1. 
     
     
         36 . The method of  claim 34 , further comprising elongating the left atrial appendage in the first direction by at least expanding the implant in the first direction so that the ratio of the size of the ostium of the left atrial appendage in the first direction relative to the size of the ostium of the left atrial appendage in the second direction is from 3:1 to 4:1. 
     
     
         37 . The method of  claim 34 , further comprising elongating the left atrial appendage in the first direction by at least expanding the implant in the first direction so that the ratio of the size of the ostium of the left atrial appendage in the first direction relative to the size of the ostium of the left atrial appendage in the second direction is 3.5:1. 
     
     
         38 . An implant for treating a left atrial appendage; comprising:
 a frame that is expandable from a first state to a second state, the frame having:   a middle portion;   a first end portion coupled with the middle portion, the first end portion being expandable in a first direction when the frame is expanded from the first state to the second state;   a second end portion coupled with the middle portion, the second end portion being expandable in a second direction when the frame is expanded from the first state to the second state, the second direction being opposite to the first direction;   a length in a lengthwise direction between the first end portion and the second end portion; and   a width in a widthwise direction that is perpendicular to the lengthwise direction;   wherein:   the frame is advanceable through a delivery catheter when the frame is in the first state; and   the length of the frame increases when the frame is expanded from the first state to the second state.   
     
     
         39 . The implant of  claim 38 , wherein the first and second end portions of the frame are configured to spread a first portion of an ostium of the left atrial appendage apart from a second portion of the ostium that is opposite to the first portion so as to elongate the ostium of the left atrial appendage in the lengthwise direction. 
     
     
         40 . The implant of  claim 38 , further comprising a clip configured to hold two or more portions of tissue of the left atrial appendage together. 
     
     
         41 . The implant of  claim 38 , wherein the frame is configured to increase in size in the lengthwise direction without increasing in size in any other direction 
     
     
         42 . The implant of  claim 38 , wherein the frame is self-expandable from the first state to the second state. 
     
     
         43 . The implant of  claim 38 , wherein the second stage portion comprises a hinge mechanism for constricting or closing the opening of the left atrial appendage. 
     
     
         44 . The implant of  claim 38 , wherein at least a portion of the frame is configured to be contractible in the lengthwise direction so as to decrease a length of the frame in the lengthwise direction. 
     
     
         45 . The implant of  claim 38 , wherein the frame comprises a length of wire having a U-shape configured to allow cantilever bending near the middle portion of the frame. 
     
     
         46 . The implant of  claim 38 , wherein the frame comprises multiple U-shape cantilever sections or torsion spring forms.