Natural tissue heart valves and methods of making same
Abstract
Improved adaptive tissue heart valves and methods of manufacturing are presented in which a dimensionally stable, pre-aligned valve subassembly is formed and its peripheral edge is clamped between an upper metal wire and an outer support extender. A wide variety of adaptive structural interfaces, including suture rings, flanges, and conduits, can be attached to the support extender with or without an outlet conduit arranged around the metal wire to supply an adaptive tissue-type heart valve for use in either a natural heart or in mechanical pumping devices.

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35 claims: 10 independent, 25 dependent
- 1ES 2 189 149 T3 REIVINDICACIONES 1. Vóalvula cardiaca bioprotóesica que comprende:una subunidad de laóminas de tejido prealineadas y premontadas (52) que incluye una pluralidad de lóaminas (68), incluyendo cada laómina un borde de cuóspide arqueado (92) opuesto a un borde de fijacióon y dos orejetas que se extienden desde las uniones entre la cuóspide y los bordes de fijacioón en sentidos opuestos, creando la prealineacioón de las lóaminas en la subunidad una pluralidad de pares de orejetas de laómina coincidentes (106, 108) que se extienden hacia fuera desde la subunidad, una par de orejetas coincidentes por par de laóminas adyacentes;un producto metaólico de alambre generalmente circular recubierto con tejido (54) que tiene una superficie inferior dimensionada para recibir dicha subunidad de laóminas de tejido prealineadas con un enganche fijo por acoplamiento, teniendo generalmente dicho producto metóalico de alambre unas cuóspides inferiores arqueadas interrumpidas por unas comisuras que se extienden hacia arriba (86), unióendose los bordes de las cuóspides de las lóaminas de la subunidad de laóminas de tejido prealineadas a lo largo de las cuóspides del producto metóalico de alambre para formar una subunidad de laóminas/producto metaólico de alambre (58) con los pares de orejetas de lóaminas unidas extendióendose radialmente hacia fuera del producto metaólico de alambre;y un stent de apoyo normalmente circular (56) que tiene una superficie superior (99) dimensionada para que se asiente y se fije por acoplamiento con dicha subunidad de lóaminas/producto metaólico de alambre, teniendo el stent de apoyo unos pies de comisura flexibles que se extienden hacia arriba (100) a los que se les unen los pares de orejetas de las lóaminas de acoplamiento.
- 2Vaólvula cardiaca bioprotóesica seguón la reivindicacióon 1, caracterizada porque dicha superficie superior del stent de apoyo estóa provista de un asiento de enganche de lóaminas deformable.
- 3Vaólvula cardiaca bioprotóesica seguón la reivindicacióon 1, caracterizada porque dicho stent de apoyo estóa provisto de una cubierta de tejido (144).
- 4Vaólvula cardiaca bioprotóesica seguón la reivindicacióon 3, caracterizada porque la cubierta de tejido comprende una capa externa (157) y una capa interna (158), estando las capas formadas de una sola pieza de tejido y teniendo unos bordes libres cosidos entre si por el borde superior del mismo.
- 5Vaólvula cardiaca bioprotóesica seguón la reivindicacióon 4, caracterizada porque incluye ademaós un ribete que se forma doblando y cosiendo entre si los bordes libres del tejido en el borde superior del stent de apoyo.
- 6Vóalvula cardiaca bioprotóesica seguón la reivindicacióon 5, caracterizada porque la capa interna se extiende hacia arriba sobrepasando la capa externa y se dobla hacia fuera para formar un ribete.
- 7Vóalvula cardiaca bioprotóesica seguón la reivindicacióon 6, caracterizada porque la capa interna se extiende hacia arriba sobrepasando la capa externa unos 2 mm, aproximadamente.
- 8Vaólvula cardiaca bioprotóesica seguón la reivindicacióon 4, caracterizada porque el ribete se extiende por todo el borde superior, incluso por encima de los vóertices de los pies de comisura flexibles.
- 9Vóalvula cardiaca bioprotóesica seguón la reivindicacióon 1, caracterizada porque cada comisura del producto metóalico de alambre define normalmente un espacio axial entre dos secciones de alambre cubiertas con tejido a travóes del cual se extiende uno de los pares de orejetas de lóaminas de acoplamiento (106, 108), y las orejetas de las lóaminas estaón separadas y pasan por lados opuestos de la comisura del pie del stent asociado y se unen al mismo para quedar ancladas entre el pie de comisura del stent y la comisura del producto metaólico de alambre mediante una fuerza radial hacia el interior aplicada a las laóminas.
- 10Vaólvula cardiaca bioprotóesica seguón la reivindicacióon 9, caracterizada porque las orejetas de las laóminas se prolongan alrededor de la parte externa de la comisura del stent y se reuónen formando una junta a tope cosida (122).
- 11Vaólvula cardiaca bioprotóesica seguón la reivindicacióon 1, caracterizada porque dicho stent de apoyo comprende:un elemento de soporte interno (130) que tiene una estructura de anilla uónica circular y los pies de comisura flexibles que se extienden hacia arriba (134);y un elemento de soporte externo (132) que tiene forma de anilla de refuerzo dispuesto alrededor de dicho elemento de soporte interno aunque estóa truncado en la zona de los pies de comisura del elemento de soporte.
- 12Stent seguón la reivindicacioón 11, caracterizado porque los elementos de soporte interno y externo tienen ademaós una pluralidad de agujeros de sutura (138, 139) y porque dichos elementos de soporte se unen con hilos que se introducen a travóes de al menos un par de agujeros de sutura alineados.
- 13Vóalvula cardiaca bioprotóesica seguón la reivindicacióon 1 que comprende una anilla de sutura (60) asegurada de manera fija en un extremo inferior de dicha vóalvula, anilla de sutura que comprende a su vez un anillo suturable que tiene unas depresiones (186) situadas en una circunferencia interna, que se abren hacia arriba y que coinciden en nuómero con las cuóspides del producto metóalico de alambre, caracterizada porque dicha anilla de sutura tiene un dióametro interno dimensionado para recibir el stent de apoyo con las cuóspides del producto metóalico de alambre situadas en las citadas depresiones.
- 14Vóalvula seguón la reivindicacióon 13, caracterizada porque la anilla de sutura comprende una corona circular de esponja (182) cubierta de tejido (188).
- 15Vóalvula seguón la reivindicacioón 14, caracterizada porque la corona circular de esponja comprende un borde externo orientado hacia arriba y un reborde interno (184) que se proyecta hacia arriba desde el borde en el que estóan formadas dichas depresiones.
- 16Vóalvula seguón la reivindicacióon 15, caracterizada porque comprende ademaós una aran14 27 ES 2 dela anular (180) dimensionada para que rodee el reborde y se apoye sobre el borde.
- 17Vaálvula seguán la reivindicaciáon 16, caracterizada porque comprende ademaás una uánica cubierta de tejido que rodea la corona circular de esponja, estáa plegada alrededor de las superficies externas de la arandela anular y remetida entre la arandela anular y la corona circular de esponja.
- 18Váalvula cardiaca bioprotáesica seguán la reivindicaciáon 1, caracterizada porque comprende ademaás una interfaz estructural adaptable dispuesta de manera fija en dicho stent de apoyo.
- 19Vaálvula cardiaca bioprotáesica seguán la reivindicaciáon 18, caracterizada porque dicha interfaz estructural adaptable comprende una anilla de sutura (60).
- 20Vaálvula cardiaca bioprotáesica seguán la reivindicaciáon 18, caracterizada porque dicha interfaz estructural adaptable comprende un collarán (62).
- 21Váalvula cardiaca bioprotáesica seguán la reivindicaciáon 18, caracterizada porque dicha interfaz estructural adaptable comprende un conducto.
- 22Vaálvula cardiaca bioprotáesica seguán la reivindicaciáon 1, caracterizada porque comprende ademaás un conducto de salida (66).
- 23Váalvula cardiaca bioprotáesica seguán la reivindicaciáon 22, caracterizada porque comprende ademáas un conducto de entrada (64) dispuesto de manera fija en dicho stent de apoyo.
- 24Procedimiento para hacer una váalvula cardiaca bioprotáesica, que comprende la formacioán por separado de una subunidad de laáminas de tejido (52) mediante las fases de:proporcionar una pluralidad de laáminas de tejido (68) que tienen un par de extremos opuestos, un borde sustancialmente recto que se extiende entre dichos extremos opuestos, y un borde de cuáspide sustancialmente arqueado (92) que se extiende entre dichos extremos opuestos;unir uno de los mencionados extremos opuestos de una de las mencionadas laáminas de tejido con uno de los extremos opuestos de otra de las mencionadas laáminas de tejido;repetir dicha fase de unioán hasta que cada uno de dichos extremos opuestos de cada una de dichas laáminas de tejido se una a un extremo opuesto de otra de las mencionadas láaminas de tejido para formar una pluralidad de pares de unioán de extremos de láaminas que se extienden hacia fuera desde dicha subunidad de láaminas de tejido.
- 25Procedimiento seguán la reivindicaciáon 24, caracterizado porque dicha fase en la que se proporciona una pluralidad de laáminas de tejido incluye las fases de:proporcionar tejido;proporcionar una plantilla (69) que tiene un par de extremos opuestos (71, 72), un borde sustancialmente lineal (70) que se extiende entre dichos extremos opuestos y una parte sustancialmente arqueada (73) que se extiende entre dichos extremos opuestos;colocar dicha plantilla sobre dicho tejido;y cortar las partes de dicho tejido que sobresalen de la plantilla y retirarlas.
- 26Procedimiento seguán la reivindicaciáon 25, 149 T3 28 caracterizado porque:dicha plantilla tiene una ranura guiadora (82) formada en uno de los extremos opuestos de la misma;y porque dicha fase de unioán incluye las fases de: alinear dicha plantilla con dos de las laáminas de tejido;insertar una aguja con hilo a traváes de dicha ranura guiadora y a traváes de dichos extremos opuestos de dichas laáminas de tejido;y asegurar dicha hebra de hilo.
- 27Procedimiento seguán la reivindicaciáon 24, caracterizado porque la subunidad de láaminas de tejido define un borde perifáerico de la subunidad, comprendiendo el procedimiento ademaás las fases de:proporcionar un producto metaálico de alambre recubierto con tejido (54), generalmente circular y con una superficie inferior dimensionada para recibir, mediante un acoplamiento coincidente, dicho borde perifáerico de la subunidad de láaminas de tejido;proporcionar un stent de apoyo (56) generalmente circular 56 que tenga una superficie superior dimensionada para enganchar dicho borde perifáerico de la subunidad de láaminas;y asegurar dicho borde perifáerico de la subunidad de láaminas de tejido entre dicha superficie inferior del producto metaálico de alambre y dicha superficie superior del stent de apoyo.
- 28Procedimiento seguán la reivindicacioán 27, caracterizado porque comprende ademaás la fase adicional de unir dicho borde perifeárico de la subunidad de laáminas de tejido con dicha superficie inferior de dicho producto metaálico de alambre antes de dicha fase de sujeciáon.
- 29Procedimiento seguán la reivindicaciáon 28, caracterizado porque dicha fase de sujeciáon comprende las fases adicionales de:acoplar dicha superficie superior de dicho stent de apoyo con dicho borde perifáerico de la subunidad de laáminas de tejido;y unir dicho stent de apoyo con dicho borde perifáerico de la subunidad de láaminas de tejido y con dicho producto metáalico de alambre.
- 30Procedimiento seguán la reivindicacioán 29, caracterizado porque dicha fase de uniáon comprende coser.
- 31Procedimiento seguán la reivindicaciáon 27, caracterizado porque comprende ademáas la fase adicional de unir una interfaz estructural adaptable a dicho stent de apoyo despuáes de dicha fase de sujeciáon.
- 32Procedimiento seguán la reivindicaciáon 27, caracterizado porque comprende ademaás formar el stent de apoyo normalmente circular mediante las fases de:proporcionar un stent de apoyo sustancialmente circular y radialmente estable con una pluralidad de pies flexibles que se proyectan hacia fuera (100);proporcionar una cubierta de tejido;y coser dicha cubierta de tejido sobre dicho stent de apoyo de manera que dicha cubierta de tejido encierre dicho stent de apoyo y se adapte a la forma de dicho stent de apoyo.
- 33Procedimiento seguán la reivindicaciáon 32, caracterizado porque dicho stent de apoyo incluye un elemento de soporte interno (130) y un ES 2 189 149 T3 elemento de soporte externo (132), estando dicho elemento de soporte externo configurado para recibir en su interior dicho elemento de soporte interno, estando dicha pluralidad de pies formados en dicho elemento de soporte interno, y porque comprende las fases de:colocar dicho elemento de soporte interno dentro de dicho elemento de soporte externo, y unir dichos elementos de soporte entre si.
- 34Procedimiento seguén la reivindicaciéon 33, caracterizado porque dicho elemento de soporte externo incluye una pluralidad de pies (136) estando cada uno de ellos truncado con respecto a los pies (134) de dicho elemento de soporte interno, y porque comprende ademaés la fase de alinear dichos pies de dichos elementos de soporte antes de la fase de unioén.
- 35Procedimiento seguén la reivindicaciéon 33, caracterizado porque dicho elemento de soporte interno y dicho elemento de soporte externo tienen ademéas una pluralidad de agujeros de sutura (138, 139); y porque dicha fase de uniéon incluye las fases de:alinear dichos agujeros de sutura de dichos elementos de soporte;insertar una aguja con hilo a travées de al menos un par dichos agujeros de sutura alineados;y asegurar dicho hilo. NOTA INFORMATIVA: Conforme a la reserva del art. 167.2 del Convenio de Patentes Europeas (CPE) y a la Disposición Transitoria del RD 2424/1986, de 10 de octubre, relativo a la aplicacion del Convenio de Patente Europea, las patentes europeas que designen a España y solicitadas antes del 7-10-1992, no producirán ningún efecto en Espana en la medida en que confieran proteccián a productos quámicos y farmaceuticos como tales. Esta informacioán no prejuzga que la patente estáeo no incluáda en la mencionada reserva.
Independent claims35
128 paragraphs in 4 sections, as filed
IS 2 189 149 T3
DESCRIPTION
Natural tissue heart valves and procedures to make these valves.
Field and background of the invention
The present invention relates to tissue prosthetic heart valves and to processes for making such valves.
Prosthetic heart valves are used to replace diseased or injured heart valves. In vertebrate animals, the heart is a muscle that has four pumping chambers: the right and left atria and the right and left ventrocles, each chamber being provided with its own single-pass valve. Natural heart valves are identified as aoortic, mitral (or biscuospid), tricose, or pulmonary valves. Prosthetic heart valves can be used to replace any of these natural valves. Two primary types of replacement or prosthetic heart valves are known. One is a mechanical-type heart valve that uses a pivoting mechaonic closure to provide unidirectional blood flow. The other type is a "bioprosthetic" or tissue valve that is constructed from valve sheets of natural tissue and functions much like a natural human heart valve, mimicking the natural action of flexible heart valve loamines that are hermoetically sealed. to each other or secure between adjacent tissue joints known as commissures. Each type of prosthetic valve has its own advantages and disadvantages.
Mechanical heart valves that operate like a retention valve are robust and long-lasting, although implanted patients need to use a blood thinner for the rest of their lives to prevent clotting. In addition, they generate a popping noise when the mechaonic latch seats against the associated valve structure at each heartbeat. In contrast, tissue valve blades are flexible, quiet, and do not require the use of blood thinners. However, processes that occur naturally within the human body can attack and harden or “calcify” the loamines in the valve over time, particularly in highly stressed areas of the valve such as the commissure joints. that are between the loamines of the valve and the junction points of the peripheric lamellae or "quospids" that are on the outer edge of each lamine. In addition, the valves are subjected to the stresses of constant mechanical operation within the body. As a result, the valves wear out over time and need to be replaced. Furthermore, the manufacture of tissue cardiac valves is considerably more difficult to carry out and takes more time.
Although both mechanical-type and tissue-type heart valves must be manufactured to precise models and types to function for many years in the dynamical environment of the heart of a living patient, replacement mechanical-type valves can be produced in series using mechanized procedures and standardized parts. In contrast, prosthetic tissue valves are handcrafted by highly skilled and skilled workers working in an assembly line. Typically, prosthetic tissue valves are constructed by stitching two or three sheets of flexible natural tissue to a normally circular supporting stent or wire frame. The wire frame is constructed to provide a dimensionally stable support structure for the valve leaflets that imparts a degree of controlled flexibility to reduce stresses on the tissue of the valve leaflets during valve closure. A biocompatiple tissue covering over the wire frame or stent provides suture attachment points to the commissures and quosps of the loamines. Similarly, a tissue-covered suture ring can be attached to the wire frame or stent to provide a bonding site for stitching the valve structure in situ within the patient's heart during a surgical valve replacement procedure.
EPO116236 shows a cardiac valve prosthesis that includes a two-part armature and a pair of laminae. A margin of the loamines passes between the two parts of the frame and is sewn to the fabric cover of one of the parts of the frame. The two parts of the frame are sewn together.
WO 83/00617 shows a prosthetic heart valve including a frame, a plurality of flexible supports, and a plurality of valve sheets, wherein the valve sheets are attached to the flexible supports. WO 92/19185 shows a cardiac valve prosthesis having an annular support that includes axially projecting support arms covered with a textile covering that is elastic in at least one direction.
In fifteen years of clinical experience supporting the use of tissue prosthetic heart valves, they have been shown to be absolutely successful. Recently, its use in mechanical artificial hearts and in mechanical left ventricular assist devices (LVADs) has been proposed to reduce the damage that can affect blood cells and the associated risk of clotting without the use of blood thinners. Consequently, it is increasingly necessary to use prosthetic tissue heart valves that can be adapted for use in conjunction with such mechaonic pumping systems. This growing need for adaptability has led to one of the drawbacks associated with tissue valves, that is, how laborious the assembly process is by hand and the time wasted in it. In order to provide high-quality, compact tissue heart valves that have stable, functional valve loamines, highly qualified and experienced assembly personnel have to meticulously wrap and sew each loamine and each valve component into an approved valve assembly and with matching suitable dimensions. Due to variations in thickness, flexibility and stitching of the fabric, it is necessary to adapt more precisely each valve assembly.
ES 2 189 149 T3 complete using additional craftsmanship techniques to ensure proper fixation and functional longevity of the valve leaflets. As a result, new challenges are being created in the manufacture of tissue prosthetic valves to meet the increasing demand and variety of uses for these highly valuable devices.
Consequently, in accordance with advances in the medical profession, there is an increasing need for improved tissue prosthetic heart valves that incorporate the lessons learned from clinical experience, in particular the reduction of tension in the leaflets of the valve while maintaining a few desired functional and structural characteristics. In addition, there is a growing need for improved tissue heart valves that can be adapted for use in a variety of positions within a natural heart or mechanical pumps, such as artificial hearts or ventricular assist devices, and at alternative sites within the circulatory system. . Furthermore, to meet the growing demand for these devices, the need arises to use tissue heart valves that can be manufactured in a simpler and easier way and in a more compact way than existing valves.
Brief description of the invention
The new constructions of tissue cardiac valves, the components thereof, and the simplified procedures for manufacturing said valves have the purpose of achieving the above objective and solving the problems of the state of the art that have been described. The improved tissue heart valves of the present invention are manufactured including standardized lamellar structure subunits that can be easily modified to suit different intended applications. Equally important is that the laminar structure subunits uniformly distribute the tensioen loads that affect the entire peripheral cuspid of the lamellae, reducing stress points and substantially improving the long-term functionality of the valve assembly. As an added benefit of the present invention, the stability and adaptability of the tissue valve assembly is achieved with simplified manufacturing processes that use fewer phases and subunits. This manufacturing protocol can be incorporated into adaptive manufacturing techniques that are derived from other techniques to produce tissue heart valves that have a variety of end uses. In addition, these improved construction techniques activate the entire manufacturing process and improve the strength of tissue valves produced in this way while reducing the need for more precise post-assembly adaptation and control processes. quality.
Following one aspect of the present invention, there is provided a bioprosthetic heart valve as defined in claim 1. Following a second aspect of the invention, there is provided a method of making a bioprosthetic heart valve as defined in claim 24. The tissue heart valve includes a dimensionally stable and pre-aligned tissue sheet subunit, a normally circular metallic wire product, and a normally circular supporting stent. The metallic wire product has a bottom surface dimensioned to receive the pre-aligned tissue leamine subunit with a fixed coupling engagement. The support stent has an upper surface dimensioned to seat and engage, by mating engagement, with the pre-aligned tissue sheet subunit that is fixedly engaged with the lower surface of the metallic wire product.
Following this construction, an exemplary tissue valve includes a plurality of sheets of tissue that flatten and bond together at their edges to form a laminar attachment subunit with uniform and stable dimensions. Then, in what essentially refers to a single process, each of the subunit leamins is individually aligned with and sewn to a fabric-covered wire metal product, from the edge of one of the product's commissures. metallic wire, surrounding the perimeter of the cuspid of the leamine, up to the edge of a commissure of the adjacent metallic wire product. The result of this is that the stitched sutures act as similarly aligned staples, which equally absorb the loading force acting throughout the periphery of the cuspid of each of the pre-aligned fastening sheets. The structural assembly of the resulting tissue-coated wire metal product, thus formed, reduces tension and potential fatigue at the lamina suture interface by distributing the tension evenly throughout the cusp of the lamina between commissure and commissure. This improved dimensionally stable, reduced tension assembly is operatively attached to the top of a tissue-coated stent that has been previously prepared to secure the quads of the tissue sheets in a load-distributing tissue seat formed by the portion. upper part of the stent covered with tissue without damaging either the lamellae or their corresponding alignment or the fixation resulting from their edges is binding.
The stent is secured in the assembly with the commissures of the stent extending to the corresponding commissures of the assembly of the sheet wire metal product. The stent itself may consist of an internal polyester film backing secured in a surgically acceptable metal ring such as an Elgiloy® metal backing that has a cut, folded, and sewn tissue cover around the backing and the reinforcement combination. Alternatively, instead of having an outer Elgiloy band and a laminated polyester film backing, the two layers of the stent may be layers of polyester or a one-piece stent having suitable flexible commissure feet. Each stent construction provides support and dimensional stability to the valve structure by extending between commissure and commissure and being evenly distributed around each leamine. This assembly method allows the uni3 sewn fabric
EN 2 189 149 T3 form the cusps of the sheets to be sandwiched between the metallic wire product and the stent and to further distribute the loading forces more evenly around the bonding site. As fabric sheets experience lower and more evenly distributed stresses during operation, they are less likely to experience deformation in use. Thus, this uniform distribution of bonding forces provides a more stable and durable functional closure or fixation of the sheets.
The present invention and the construction of the stent used therein provide additional advantages. For example, for each guide area of the stent, flexibility can be optimized or tailored. If desired, the commissures of the fixation tissue sheets can be made more or less flexible to allow more or less deformation and release stresses on the tissue by closing the valve or more precisely tailoring its operation. Similarly, the basic radial flexion resistance of the entire valve structure can be increased or decreased to preserve valve roundness and shape.
Unlike a rigid mechanical valve, the stent does not act as a rigid heart valve structure but rather as an axially flexible and radially stable support. Using the teachings of the present invention, it is not necessary to use a rigid structure since the valve sheets have been dimensionally pre-aligned with each other by their union edges or fastening seal before being directly attached to the base of the metallic wire product coated with tissue. As a result, the appearance of the entire valve seal can be readily aligned in three dimensions without the variability previously experienced in state-of-the-art woven-type valve constructions. In addition to eliminating the need to adjust the valve after mounting, this pre-alignment provides a simple and compact construction of the valve structure. In addition, the metallic wire product functions as a template to sew the quasps of the leaflets to the valve subunit with a uniform seam between commissure apex and commissure apex. This produces a structure with uniform dimensions that can interface with the stent in a uniform way that could not be achieved before. The integrity of the uniform dimensions of the sheet metal wire product subunit allows the stent to function as a stress reducing support clamp that further secures the quills of the sheets that are in the valve structure to provide a higher grade. stability and stress distribution. Placing a single or double sheet of covering tissue on top of the stent provides the stent rim with a deformable tissue seat that aids in load distribution around the quasi of the laminae and simplifies the stitching of the stent to the subunit of the stent. metallic wire product. Those skilled in the art may appreciate that the attachment of the stent to the metallic tissue sheet wire product functions to stabilize the commissure feet protruding from the valve subunit without stiffening its desirable axial flexibility. This new construction technique eliminates the need to use separate commissure feet at the commissures of the tissue sheets and also eliminates the multiple layers of tissue at the commissure feet of the metallic wire product, which aids in uniformity and consistency. in the production of valves and eliminates assembly phases. As a result, the manufacturing of the valve is not only improved but also simplified and active.
The stent also functions as an adaptive structural interface, allowing the tissue-metal wire product-stent structural subunit to be attached to a variety of additional structures, depending on the intended placement of the valve and technical operating conditions. For example, with the support stent secured to the structural subunit of the tissue-coated metal wire product, the resulting valve assembly can be attached, for example, to a suture ring, collar, or conduit, depending on the desired application. give the valve. To form a delivery valve, the suture ring can be attached directly to the inlet or base of the stent to allow the implanting surgeon to sew the valve in situ within the heart. Alternatively, when the valve is to be used in artificial hearts or left ventricular assist devices (LVADs), a stiffer collar can be attached to the stent delivery conduit to function as a mechanical support. In some cases, it may be desirable to form a delivery valve where flexible or rigid conduits are needed to replace a missing portion of a patient's aorta or to connect to an artificial blood pumping device. In such circumstances, an inlet conduit may be attached to the stent arrival conduit and, if desired, an outlet conduit may be attached within or outside of the metal wire product of the valve. Unlike the state of the art tissue heart valves, the present invention provides this flexibility and adaptability of use since the main components of the valve can be standardized for different types of valve or applications thereof. This structural and manufacturing consistency also improves quality control and provides reproducibility and consistency to valve formation. It also simplifies final assembly, which in turn provides faster production speed without compromising product quality.
More specifically, within the flexibility of the present invention, we find that the stent can be designed so that it is adaptable and thus can accommodate the different modes of attachment of the valve to the different applications envisaged. The novel construction that enables this universal application is because the stent provides complete and uniform support to the dimensionally stable pre-aligned wire sheet / metal product subunit. Due to this adaptability, the valve of the present invention may function differently.
These applications, including provisional heart valve prostheses that are within a circulatory support system using a relatively rigid collar or conduit assembly rather than a standard soft suture ring. Alternatively, the present invention may function as a prosthetic valve having a soft shell-shaped suture ring for placement in the aorta or a flat, soft suture ring for placement on the mitral valve, or as a delivery valve incorporating Proximal and distal canals joined at both ends of the outlet and inlet valves. The outlet conduit can be sinusoidal in shape, if desired, to improve blood circulation. In an artificial heart, the valve of the present invention mimics the hemodynamic pumping action of the heart until a donor heart is located and successfully transplanted into the patient. In this application, both the incoming and outgoing functions of blood can be accommodated by the invention.
Other objects and advantages of the present invention are made more clear to those skilled in the art from the following description and the accompanying drawings.
Brief description of the drawings
- Figure 1 is an exploded perspective view of an exemplary cardiac valve of the present invention, illustrating the mounting relationship between standardized components and alternative structures for applying a valve joint.
- Figure 2 is a perspective view that illustrates the flattening and cutting phase of the sheets used to make a tissue heart valve of the present invention.
- Figure 3 illustrates the initial phases of flattening and pre-alignment of the lamines of the valve subunit.
- Figure 4 shows the additional phases of pre-alignment of the loamin subunit of the valve.
- Figure 5 is a larger-scale view illustrating an exemplary joining phase of the pre-aligned lamines with a commissure vortex of the metallic wire product.
- Figure 6 is a perspective view illustrating the posterior preliminary joining of the quospids of the exemplary sheets with the metallic wire product of Figure 5.
- Figure 7 is a perspective view that illustrates the uniform union of the perimetric quposps of the loamines with the metallic product of wire covered with tissue.
- Figure 8 is a larger-scale view of one of the pairs of bonded sheet lugs of figure 7, illustrating the uniform union of the quospids with the commissure vortex of the metallic wire product.
FIG. 9 is a perspective view illustrating the bonding of the structural subunit of the exemplary tissue loamines to an exemplary stent of the present invention.
- Figure 10 is a larger-scale view of one of the pairs of sheet lugs in the figure that illustrates another phase of joining of the stent with the metallic wire product through the commissure vortex, holding the quosps of the loamines between tights.
- Figure 11 is a larger-scale view of one of the commissure vortexes of the structural assembly of the metal product of wire covered with tissue of Figure 10, which illustrates the fastening of the loamines by the stent.
- Figure 12 is a perspective view illustrating the final joining phase of the structural assembly of the metal product covered with tissue with the stent.
- Figure 13 is an enlarged view of the circle 13 of Figure 12, illustrating other exemplary joining techniques.
- Figure 14 is an enlarged view of the circle 14 of Figure 12, illustrating other exemplary joining techniques.
- Figure 15 is a perspective view illustrating an exemplary joining phase of the lugs of tissue lamines by the commissure vortexes.
- Figure 16 is a view similar to that of figure 15 illustrating an alternative joining phase.
- Figure 17 is an exploded perspective view illustrating an exemplary multi-piece stent formed by a flexible support and associated reinforcement of the present invention.
- Figure 18 is a perspective view that illustrates the union of the support with the reinforcement of Figure 17.
- Figure 19 is a perspective view illustrating an initial phase of covering the components of the stent of Figure 18 with tissue.
- Figure 20 is a larger-scale view of the upper part of Figure 19 that illustrates other phases of joining the tissue with the components of the stent.
- Figure 21 is a perspective view illustrating other stages of manufacturing suture lugs to join the tissue with the components of the stent.
- Figure 22 is a larger-scale view of a part of Figure 20 illustrating subsequent manufacturing phases.
- Figure 23 is a sectional view on a larger scale taken along plane 23-23 of figure 22.
- Figure 24 is a view similar to that of figure 22 illustrating other additional manufacturing phases.
- Figure 25 is a perspective view of the tissue-covered stent of Figure 18 illustrating the seating flange of the tissue.
Figure 26 is an enlarged sectional view, taken along plane 26-26 of Figure 25, illustrating other aspects of the fabrication of the exemplary stent assembly.
- Figure 27 is a perspective view illustrating the initial components of an exemplary suture ring of the present invention.
- Figure 28 is a larger-scale sectional view illustrating aspects of the exemplary suture ring fabrication.
- Figure 29 is a perspective view illustrating other features of the exemplary suture ring assembly.
- Figure 30 is a sectional view on a larger scale of a part of figure 29 that illustrates
ES 2 Other Aspects of Suture Ring Assembly Fabrication.
- Figure 31 is an enlarged sectional view illustrating other aspects of the finished exemplary suture ring assembly
- Figure 32 is an exploded perspective view illustrating the positioning and assembly of a suture ring and the configuration of the laminar subunit.
- Figure 33 is a top perspective view that illustrates other phases of joining the lamina subunit of the suture ring.
- Figure 34 is a bottom perspective view illustrating other phases of attachment of the exemplary suture ring.
- Figure 35 is a perspective view and in partial section, illustrating an exemplary connection of an outlet conduit to an exemplary valve of the present invention.
- Figure 36 is a sectional view on a larger scale that illustrates other aspects of the duct connection.
- Figure 37 is a sectional view similar to that of figure 36 that illustrates other alternative characteristics of the connection of the duct.
- Figure 38 and last, is an exploded view illustrating additional alternative valve connections of the present invention.
Detailed description of exemplary embodiments
Referring more particularly to the drawings, FIG. 1 is an exploded assembly view, illustrating alternative exemplary embodiments of an improved compliant tissue valve 50, its individual components, and its alternative configurations produced in accordance with the teachings of the present invention. Valve 50 includes a pre-aligned standardized laminar subunit 52, a tissue coated wire metal product 54, and a support stent 56. As described below, during assembly of valve 50, pre-aligned sheet subunit 52 and tissue coated wire metal product 54 are first assembled according to the present invention to form a tissue coated wire metal product assembly 58 ( see figures 2 to 9). Then, frame assembly 58 is secured to stent 56 to form assembled valve 50.
As illustrated in FIG. 1, the valve 50 was uniquely configured to allow the production of various alternative valves useful for a variety of end-use applications. For example, if the desired application is the replacement of a natural cardiac valve, the valve 50 can be attached to a relatively soft suture ring 60 and then sutured in situ in a heart (not shown). Alternatively, if it is desired to use the valve 50 in a device (LVAD) or in a mechanical heart pump, the valve 50 can be mounted on a rigid mechanical collar 62. In addition, in both natural and mechanical applications where it is desired to incorporate a conduit, valve 50 may be attached to either inlet conduit 64 and / or outlet conduit 66.
149 T3 10
Production of the structural assembly of the metallic product of wire covered with fabric
In the present description, exemplary valve 50 is illustrated as a trilaminar or triquospid valve. However, those skilled in the art may appreciate that valve 50 can be configured to have two loamines or any other laminar configuration depending on the desired application.
A first stage of assembly of the tissue valve 50 is the joining of tissue loamines 68 together to form a standardized laminar subunit with a uniform dimension. Tissue laminae are typically formed from pericardial, porcine, or similar tissue obtained from donated organs, tissue that is preserved or "fixed" prior to use to mount a vaolvula. Those skilled in the art will appreciate that the dimensions of the laminar subunit 52 may vary depending on the end use to which it is put and the associated dimensional and placement needs of the finished valve. However, the pre-alignment and suturing according to the teachings of the present invention not only simplifies the fabrication of the valve 50 but also works to quickly align all mating and seating surfaces. This eliminates variations in loamine alignment and dimensional relationships and significantly reduces the need to adjust tissue loamines after final assembly of the valve to ensure proper fixation at the loamine bonding edges.
Referring now to Figure 2, the desired number of tissue sheets 68 (in this example, three sheets) is achieved with natural tissue as is known in the art, and each sheet 68 is cut to the proper shape and size for use. into the desired valve using a template 69, defining a straight or linear clamping joint edge 70 having opposite ends 71, 72 and a normally arcuate peripheric quosp 73 extending between the two. More in particular, each sheet 68 is placed on a cutting board 74 and then the selected template 69 is placed on the lamina 68. The tissue 75 that exceeds the limits of template 69 is then cut away using a sharp razor blade 76 or similar cutting tool.
A characteristic of pericardial tissue is that one surface is softer than the opposite surface. Consequently, it is desirable that the less soft surface serve as the bonding surface, at edge 70, with an adjacent jig edge 70. After the sheets 68 are cut and the bonding surfaces identified, two of the sheets 68a, 68b pre-align or mate with each other along with template 69, as shown in Figure 3. The two loamines 68a, 68b are then joined or sewn together at one end 71 to define the first of a plurality of aligned binding loamine end pairs. For example, a double-stranded needle, that is, a needle 78 that has been threaded with a looped (or "bent") piece of strand 80 is inserted and pushed through the lamines 68a,
IS 2 189 149 T3
68b at the location dictated by a guide groove that is at one end of the template 69. The template 69 can then be removed, causing the needle 78 to pass over the laminations 68a, 68b, back through the loop and pulling back. she strongly. Of course, alternative stitching or unioan procedures can be used as long as they are within the scope and teachings of the present invention. The opposite ends 72 of the first two leaflets 68a, 68b of the exemplary trilaminar valve have not been sewn together this time.
Referring now to Figure 4, a third sheet 68c is pre-aligned and joins the other two sheets 68a, 68b, constituting a tricuspid format, again using template 69. In particular, the third sheet 68c coincides with template 69, and The unstitched ends 72 of the first two sheets 68a, 68b are separated and then aligned with the corresponding opposite ends 71, 72 of the third flattened sheet 68c. Again using the guide slot 82 of the template 69 as a guide, a double-stranded needle, into which the strand 80 has been inserted, is inserted through each of the unstitched pairs of the three blades 68a, 68b , 68c to secure the ends of the sheets together in pairs, as shown. The template can then be removed, and, for each stitch, needle 78 can be made to pass over blades 68a, 68b, 68c, then back through the loop, and tightly tensioned to produce sheet subunit 52 with three ends of union of lamines.
Referring now to Figures 5 and 6, it is preferred to bond the laminar subunit 52 to the underside or bottom 83 of metallic wire product 54. An exemplary metallic wire product 54 is a wire-reinforced fabric having a fabric edge 84 and is shaped to substantially conform to the shape of the structure of the lamellar subunit 52. In the embodiment shown, the metallic wire product 54 is typically circular in shape and has a sinusoidal undulation that defines a plurality of commissure vertices 86 that correspond to the joining end pairs of the sheets. The tissue-coated metallic wire product 54 includes a circumferential tissue edge 84 that serves as a binding or suture surface for the laminar subunit 52. Exemplary metal wire product 54 includes the three raised commissure vertices 86 that receive the corresponding three pairs of bonded joint ends of the sheets 68a, 68b, and 68c of the pre-aligned sheet subunit 52.
An exemplary technique for joining the pairs of sheets, at one end of the laminar subunit 52, with one of the commissure vertices 86 of the metallic wire product 54, is shown in Figure 5. Needle 78 (not shown) having looped yarn 80, which has been used to sew the ends of the blades together, is inserted upward from the blades 68 (as shown with the dashed lines), through through an inner edge of tissue edge 84 as indicated at numeral 87, whereupon the upper surfaces of bonding sheets 68 are secured in contact with metallic wire product 54. The needle is reinserted through an outer edge of and from the inner face of tissue edge 84 as indicated by number 88 ', and a first closure 89, preferably a first closure suture, is made with the strand 80. The closure process can be repeated, as indicated by number 88 "with the second closure 90, preferably a single closure suture. Finally, the needle can be inserted in the middle of and from the underside of the fabric edge 84, as indicated by number 91, and pulled on the thread so that the first and second fasteners 89, 90 are pulled so that they remain under the fabric edge 84 and thereby hidden and protected during the remainder of the manufacturing process. Afterwards, the excess piece of thread is cut and removed. This procedure is repeated to secure each of the corresponding pairs of bonded and aligned unioan sheet ends of bonded sheets 68a, 68b, 68c of subunit 52 with corresponding commissure vertices 86 of metal wire product 54. Asá , the metallic wire product 54 functions as an additional permanent template to position the commissures of the sheets in their final position relative to each other. As an added benefit of the present invention, this manufacturing technique further stabilizes the position of the locking valve blades, relative to one another, prior to joining the quasps of the blades with the metallic wire product. Thus, it is possible to join the entire peripheral quasp of the sheet uniformly from the apex of one commissure to the next with a view to producing a compact bonding force at the edge of the sheets.
Referring to Figures 6 and 7, the next exemplary step in securing the exemplary laminar subunit 52 with the metallic wire product 54 consists of joining the peripheral quasps 92 of each of the laminae 68 with the tissue edge 84. In this regard, slip knots 94 (i.e., undoable knots) are periodically spaced by the metallic wire product 54 to provisionally secure the quasps 92 of the laminates in situ in the metallic wire product. 54. For each quasp of lamella 92, three slip knots 94 can be made, one in the center of the quasp and two at the points of inflexion with the commissures, as this helps to uniformly stabilize the quasp in situ during bonding with the metallic wire product 54.
As shown in Figures 7 and 8, the quasps 92 of the laminates to be provisionally secured are then attached to the tissue edge 84 of the metallic wire product, preferably using double-stranded "entry and exit" sutures 96, starting from a central position 98 of each quasp 92 of the laminae and continuing towards the vertices of each commissure 86. At about one millimeter away from the commissure vertices 86, the strands are enclosed, hidden and cut, preferably as described above. Thus, unlike the tissue valves of the state of the art, where the blades are joined individually and the
ES 2 189 149 T3 The cusp seam ends before reaching the corners of the commissures, producing a potential stress point, the process of the present invention produces a novel fabric valvular unit that has a uniform stitch between a vertex of the commissure and another and some binding edges of fixation leamines consistently aligned.
Joining the structural assembly of the tissue-covered wire metal product with the supporting stent
For purposes of further explanation, once the structural assembly of the metallic fabric-covered wire product, which is identified by reference number 58, has been produced as explained above, the assembly is attached to a support or stent 56 . Referring to Figures 9, 10, and 11, the structural assembly of the fabric-coated wire metal product 58 is first fitted into the corresponding configured stent 56 so that the edges of the peripheral cupespids of the leamines 68 are immobilized between an upper surface. 99 (see Figure 1) of the stent 56 and the lower surface of the metallic wire product 54. This mounting technique also distributes the stresses and loads of the sheets 68 and contributes to their functional longevity. In addition, the pre-alignment of the sheets 68 and the union of the metallic wire product 54 allows the immediate alignment of the dimensions of the entire valve 50 and eliminates the variation in dimensions that could occur in the valves of the state of the art due to the they used separate commissure feet. In particular, stent 56 is sized to match or fit the configuration of mount 58, and mount 58 with stent 56 so that the bottom surface of each vertex of commissure 86 of metallic wire product 54 matches the upper surface of a commissure of the corresponding and complementary stent 100. Care must be taken to ensure that the central aperture 102 that is formed between the tie-joint sheets 68 does not deform when the structural assembly of the fabric-coated wire metal product 50 is engaged in the stent 56. Similarly, it is Care must be taken to ensure that the sheets 68 are evenly immobilized and remain uniformly tensioned during this process.
Once the wire hardware assembly 58 is engaged in the stent 56, a provisional pin 104 can be inserted into the lower curve of each quadspid 92 of the leamines to provisionally secure the mounting of the wire metal product 58 into the stent. 56. Stent 56 and assembly 58 are then sewn together as shown in Figures 10 and 11. The seam of assembly 58 with stent 56 begins at the tops of the vertices of commissures 86. In particular, a double-stranded needle (not shown) is inserted through edge 100 of the commissure of the stent as indicated by number 105 ', between the free ends of lugs 106, 108 of adjacent pairs of laminae 68 , and through the fabric edge 84 of the wire metal product assembly 58 as indicated by the number 109 '. The needle is then inserted through the wavy strand to form a unique closure 110. A double seal 112 is then formed by inserting the needle through the vertex of the stent commissure at 105 'and through the tissue edge 84 at 109', substantially as explained above, whereby the double seal can be pulled. 112 so that it is under the fabric edge 84. Excess yarn protruding from the fabric edge 84, as indicated at 113, can be cut and removed. The same process can be carried out for the remaining commissure vertices 86 of the metal wire product assembly 58. As a result, the commissure vertices 86 of the metallic wire product can be engaged with the commissure vertices 100 of the stent.
Referring to Figures 9 and 12 through 14, the exemplary joining process can be completed by inserting a double-stranded needle, as described above, through stent 56 near the top of the vertex of the commissure 100 of the stent as is indicated at the number 114 ', through the fabric sheet 68 and through the fabric edge 84 of the metallic wire product 54 as indicated at the number 115'. The needle is then reinserted in the opposite direction through the tissue edge at 115 ', through the vertex of the commissure 100 of the stent at 114 "and passed through the loop 115 of the double strand. Referring to FIG. 14, the suture is tightly tensioned whereby the loop 115 is positioned securely and firmly against the vertex of the commissure 100 of the stent. Then an entry and exit suture 116 (see also Figures 15 and 16) is performed through the joining edges of the stent 56 and the assembly of the metallic wire product 58 until the next assembly of the metallic wire product and the vertexes of the commissure 86, 100 of the stent. Referring to Figure 13, at a position near the top of the vertex of the commissure 86, a single closure 118 and a double closure 120 can be formed, and the strand can be hidden under the fabric edge 84 of the assembly of the wire metal product 58, as described above. It should be appreciated that the seam just described can start at any of the commissure edges 100 of the stent and that the entry and exit seam 116 can be performed both clockwise and counterclockwise around from the periphery of the stent 56.
Upon completion of the entry and exit seam 116 around the periphery of the stent 56, it is necessary to secure the free ends of the tabs 106, 108 of each pair of tissue sheets 68 at the vertex of the commissure 100 of the corresponding stent. Referring to Figures 15 and 16, two exemplary alternatives are provided to carry out this task.
Referring to Figure 15, a first exemplary alternative is to configure the ends of the lugs 106, 108 to form a butt joint 122. In particular, the ends of the lugs 106, 108 are cut so that when they are bent towards each other On the other, the corresponding end edges of each end of the lugs 106, 108 mate uniformly to form, preferably, a straight center line that
ES 2 189 149 T3 descends vertically from the top of the vortex of the commissure 100. The two ends of the lugs 106, 108 of the sheets are then sewn together with a seam 124.
Referring to Figure 16, a second exemplary alternative for securing the ends of the lugs 106, 108 of the sheets is to configure the ends of the lugs 106, 108 to mate evenly to form a smooth joint 126 with the edge. of tissue 84 of metallic wire product 54 on each side of the commissure vortex 100. In particular, the ends of the lugs 106, 108 of the sheets can be cut, so that the end edges of each lug 106 108 are sized to fit, so that they do not protrude, with the tissue edge 84 of the metal product of wire. The ends of the lomines 106, 108 are then sewn to the fabric edge 84 of the metal wire product 54 with a stitch 128, as shown. The alternative smooth gasket 126 formed provides a somewhat smoother commissure than the butt joint 122 of the first alternative, and thus the smooth gasket 126 may be more desirable when a more compact valve is needed. However, both exemplary procedures allow a more uniform and reliable distribution of the load resting on the commissures of the tissue sheets.
Assembly of an exemplary stent
In the foregoing description, it can be seen that stent 56 is configured to have a structure suitable for mating with and supporting the assembly of metallic wire product 58. In this regard, an exemplary structure of stent 56 is described below. referring to Figure 17. Those skilled in the art may appreciate that the exemplary stent described herein is a multi-piece construction. However, within the scope of the present invention, it is contemplated to provide a one-piece stent. However, the illustrated multi-piece stent assembly can make it easier to design and adjust its radial stability while maintaining the desired axial flexibility of the commissure feet. The first phase of assembly of the exemplary stent 56 consists of manufacturing an internal support element 130 and an external support element 132, which, when mated together, normally create the shape of the stent 56 which ultimately corresponds to the configuration of the assembly. of the metallic wire product 58. In exemplary embodiments, the internal support member 130 was configured with three uprights 134 that serve as support structures for the commissure vortexes 100 of the stent. The external support element 132 can also include feet 136 that correspond to the feet 134 of the internal support element 130. However, the feet 136 are truncated and therefore do not coincide with the height of the feet 134 of the internal element 130. . The internal and external support elements 130, 132 can be made of metal or plastic according to the desired characteristics of the valve 50.
In the internal support element 130 there are a plurality of suture holes 138 positioned around the periphery of the element 130 and at the feet.
134. The outer support element 132 includes at least one suture hole 139 in each of its truncated feet 136 that correspond to the respective suture holes 138 of each foot 134 of the inner element 130. The inner diameter of the outer support element 132 It is sized to form a smooth fit with the diameter of the internal support member 130.
The internal support element 130 is positioned within the external support element 132 so that the suture holes 139 of the external support element 132 are aligned with the suture holes 138 that are on the corresponding feet 134 of the internal element 130 The two elements are sewn together by inserting a double stranded needle, as described above, through the aligned holes 138, 139. As shown in FIG. 18, the strand 140 that has been inserted through each aligned hole 138, 139 is then caused to pass through an end loop 142 and taut. The strand can be tied later using, for example, a slip knot (not shown), which is a knot that can slide through the strand to come into contact with the supporting elements. Consequently, the feet 134 of the inner support member 130 bend further from their bases to their tops, and the outer support members 132 increase the radial stability of the inner support member 130, with the truncated feet 136 providing rigidity to the legs. bases of the feet 134 of the internal support element 130.
Referring now to Figure 19, once the inner and outer elements 130, 132 are sewn together, a cover fabric 144, preferably woven polyester, is cut into a cylindrical tube shape to cover the combined support elements 130, 132 Those skilled in the art may appreciate that the covering fabric can equally be applied to one-piece stent assemblies. The cover fabric 144 includes two folded lines 146, 148, the first of which, 146, is formed by folding an edge of the fabric 144 to form a fold that receives the feet 134 of the support member 130. Between the folded line 146 and the top edge 149 (see Figures 17 and 18) of each foot 134 of the exemplary embodiment is between 1mm and 1.5mm. The second folded lone 148 is positioned to correspond to a lower edge 150 (see FIG. 18) of the combined support members 130, 132.
Referring to Figure 20, to secure the cover fabric 144 in the support elements 130, 132, a needle threaded in the fabric 144 can be inserted, through a hole 151 of one of the feet 134 of the internal element, through a second layer of fabric 144 and then back through fabric 144 through the same hole 51 and through fabric 144. The needle can then pass through a loop to form a first closure 152. This sewing phase can be carried out up to two more times. The excess thread is then cut off and removed. For each of the three feet 134 of the internal support member 130 the same process can be followed.
Then, as shown in Figure 21, the next exemplary phase involves sewing the cover fabric 144 to the internal support elements and
ES 2 189 149 T3 by an outer edge 137 of the inner support member 130. First, the outer edge 154 of the fabric 144 can be folded on the inside of the support members 130, 132 by the folded line 148 so that the second folded lone 148 defines the lower end or bottom of the support member structure. This fold results in a double-layered fabric 144 (including the inner and outer layers 156, 158 of the fabric) that surround the support elements 130, 132. Then, using a single-stranded needle, the fabric is sewn in layers. at 155 by the curvature of the upper edge 153 of the support elements 130, 132. Seam 155 is preferably a topstitch which is made by inserting the needle one stitch length, for example to the right, and then bringing it to the left an equal distance. However, the seam 155 does not extend to the tops 149 of the feet, leaving a gap of approximately 1mm between the top 149 of the foot 134 and the seam 155. After the upper edge 153 of the support elements 130, 132 is sewn, the fabric 144 can be similarly sewn at 156 by the lower edge 150 of the support elements 130, 132. The last stitch is then closed by tying a knot. sliding, which can be done up to three times to securely close the seam on site.
Referring now to Figures 21 through 26, the fabric 144 that was now attached to the support members 130, 132, is cut to conform to the shape of the support members 130, 132 and, if desired, to provide a gasket-type edging. To accomplish this, the outer fabric layer 157 can be cut down from a top thereof a distance of approximately 5mm to 6mm above the upper edge 153 of inner support member 130. Similarly , the inner tissue layer 158 may be cut down from an upper edge thereof a distance of approximately 2mm to 3mm above the bottom of the cut inner tissue layer 157. The chunks are cut at a location midway between adjacent feet 134 of inner member 130 and are intended to be aligned downwardly with one another, as indicated by number 160.
Then, the tissue layer 157 can be cut at the upper edge 153 of the inner support member 130, starting at the bottom of the piece formed in the outer tissue layer 157. In this exemplary embodiment of the present invention, the cut is made in a manner in which the contour of the tissue 144 extends a distance of approximately 4mm to 5mm above the lower curved portions of the upper edge 154 of the connecting element. support 130, a distance between approximately 2 mm and 3 mm above the parts of the support element 130 that are in the areas that are near the base of the feet 134 of the support element 130 and a distance of between plus or minus 0, 5 and 2 mm above the tops 149 of the feet 134 of the support member 130.
As shown in Figure 22, the inner layer 158 of tissue is then folded over the tops 149 of the feet 134 of the inner member 130 and is anchored at the feet 134 with a threaded needle that is inserted into the suture hole 151 which was on feet 134 in the manner described above with reference to the folded upper section of fabric 144. However, after these closure sutures are made, the needle passes under the tissue to exit the top of the feet 134.
Afterwards cuts can be made. Referring to Figures 22 and 23, the folded portion 162 of the inner fabric layer 158 is cut across the entire circumference of the fabric whereby the lower edge 164 of the folded portion 162 is approximately at a distance of between 1 mm and 1 mm. , 5 mm from the seam in the hole 151 of the foot 134. The folded portion 168 of the outer fabric layer 157 is folded over by the tops 149 of the feet 134 of the inner support member 130. The folded portion 162 of the inner tissue layer 158 is further cut so that its excess edges mate with the edges of the previously cut inner tissue layer 158. With reference to the unfolded portion of the inner fabric layer 158, this layer is cut so that its edges extend approximately 2mm beyond the edges of the outer fabric layer 157 cut earlier. The 2 mm extension of the inner layer 158 of tissue overlying the layer of tissue 157 provides the desired material to form a seating surface and attachment or suture to the stent.
Each of the cuts is made starting from a central area between the feet 134 of the internal support member 130 to the tops 149 of the feet. In the larger-scale cross-section of FIG. 23, the assemblies of the inner tissue layer 158, the outer tissue layer 168, the outer tissue layer 157, and the inner tissue layer 162 are shown.
The exemplary phase remaining in completing the assembly of stent 56 consists of folding and sewing the layers of tissue to form a hem 169 around stent 56. Referring to Figure 24, inner tissue layer 158 is folded around foot 134 and is sewn to enclose the foot 134. More specifically, the thread that has already been inserted through the top of the foot 134, when connecting the folded outer tissue layer 157 through the suture hole 151, is used to create first and second fasteners 172 on the top of the foot. foot 134 and keep internal tissue layer 158 in situ on top of foot 134. A suture 174 can then be used to also secure the inner tissue layer 158 around the foot 134, approximately 8 mm from the top foot 134. When the bottom of the foot is reached, the first and second fasteners are formed and the strand is cut. and retires. The stitching described above is done for each of the three feet 134. However, to sew the last foot 134, instead of cutting the thread after forming the first and second fasteners 172, the uncut thread 176 can be used to sew the fabric along the remaining edges of the support members 130, 132 between 134 feet.
In this regard, with reference to figures 10
ES 2 189 149 T3 flush 25 and 26, the inner fabric layer 158 is folded over the outer fabric layer 157, and alternate stitching is applied to hold the folded layers in place on the support members and to form the edging. 169 on the stent. After completion of the stitching around the remaining portions of the support members 130, 132, first and second closure sutures can be formed with the strand, and the excess strand cut and removed to complete the assembled stent 56.
Assembling an Exemplary Suture Ring
When it is intended to use the valve 50 to replace a natural cardiac valve, the use of a soft suture ring 60 is contemplated. For example, referring to Figure 27, an annular washer or "remey" 180 preferably of non-woven polyester is provided. . A flat silicone sponge ring crown is also provided to match the Remey 180. In this regard, annulus 182 has a wall flange 184 configured to be positioned by circumference 185 of remey 180. Flange 184 includes three depressions 186 that correspond to the lower curved surfaces that are between each commissure of valve 50. The remey 180 is mounted on the annulus 182 so that it surrounds the wall flange 184. This produces a stable, soft and relatively flexible internal suture ring structure that, when covered with tissue in the manner described above, functions as a flexible interface that can be sewn between the natural tissues of the heart and the tissue valve. prosthetics 50.
As shown in Figure 28, before mounting the remey 180 on the flat annular crown 182, a fabric 188 is placed around the remey 180 extending it from the inner circumference 185 to the outer circumference 189. The remey 180 is then mounted on the flat annulus 182 so that tissue 188 is sandwiched between flat annulus 182 and remey 180. The fabric 188 is positioned by extending it a distance 190 of approximately 3mm to 5mm beyond the outer circumferential edge 189 of the remey 180, as shown in Figure 28. The remey 180, fabric 188 and flat annulus 182 are then sewn. each other using, for example, an entry and exit suture 192 around the circumference of the remey 180. The exemplary suture is preferably placed at a distance 194 of approximately 1 mm from the outer circumferential edge 189 of the remey 180. If desired, a second suture line (not shown) can be added at the same site as the first suture line. suture, with each point on the second suture line located between the points on the first suture line. The resulting suture 192 later appears as a continuous suture line. In addition, as shown in Figure 29, to also secure the fabric 188 and the flat annulus 182 to each other, a stitch 195 can be applied in the space between the wall flange 184 and the remey 180, a space indicated with number 196 in the figure
28.
Referring now to Figure 30, the tissue 188 can be attached to the depressions 186 of the remey structural assembly 180 and to the flat annulus 182 with, for example, a needle with a single strand inserted through one end 198 of the depression. 186 (through fabric 188 and annulus 182) and then with a double slip knot to secure the fabric at corner 198. Then an entry and exit seam 200 can be used to secure tissue 188 around the contour of depression 186. For each depression 186 the same procedure can be used. The excess tissue is then cut off the outer edge of the remey 180 as indicated in 201.
Furthermore, with reference to Figure 31, an outer portion 202 of tissue 188 can then be folded around the outer surfaces of the remey 180 and tucked under the remey 180 between the remey 180 and the flat annulus 182. Because the crown Circular 182 is flexible, it deforms and accommodates the outer portion 202 of the fabric 188. Using a needle with a single strand, an alternate seam 204 can be made to secure the folded fabric 188 under the remey 180. After finishing the entire circumference of the remey 180, a double knot can be formed to secure the seam, producing a finished suture loop.
Union of the suture ring with the exemplary valve
Referring to Figures 32 and 33, to join the suture ring 60 or an alternative structure such as the collar 62 (see figure 1) to the valve 50, the depressions 186 of the suture ring 60 are aligned with the descending peripheral quads 206 of valve 50 and then marry each other. More specifically, valve 50 is positioned on suture ring 60 so that the tissue edge 84 of the wire metal product 58 that is at the very bottom of each cusp of valve 50 is flush with the surface. of the suture ring 60 that is in the corresponding depression 186. Care is taken with its placement in such a way as to prevent twisting or wrinkling of the tissue leamins 68. Valve 50 can be temporarily secured in situ on suture ring 60 with needles 208 to facilitate this process.
As shown in Figure 34, the needle clamped valve assembly 50 and the suture ring 60 can be made to rotate, and the suture ring 60 can be sewn to the valve 50 by the joining edges 209 of the ring. 60 and valve 50. More specifically, in the exemplary embodiment, a single-stranded needle may be used to sew the suture ring 60 to the tissue of the stent framework. To facilitate the sewing phase, the pieces are provisionally held in place with additional needles 208. The opposite side of ring 60 and valve 50 can be sewn together in a similar manner.
Union of the valve with the outlet duct
Referring to Figures 35 through 37, in some applications it may be desirable to join the valve 50 with an outlet conduit such as that shown at number 66. For example, in some patients who require replacement of the air valve, a part of the aorta itself can be damaged or injured so that
ES 2 189 149 T3 the aorta itself must also be replaced. Accordingly, in accordance with the teachings of the present invention, the structure of the compliant tissue valve can be modified to include an outlet conduit 66 that can function to replace the damaged aorta. Alternatively, in some proposed mechanical pumping applications, the adaptive tissue valve of the present invention may be provided with an outlet conduit to facilitate interconnection with the mechanical pumping structure. In either alternative, this can be done as shown in Figures 35 and 36, where an outlet conduit 66 can be attached to the metallic wire product 54 at the time the tissue sheets 68 are being secured. In particular Referring to FIG. 36, conduit 66 may be secured on one side of wire metal product 54 opposite tissue sheets 68 by, for example, stitching. Alternatively, as shown in FIG. 37, conduit 66 may be sewn and secured to metallic wire product 54 on the same side as tissue sheets 68, or it may be sandwiched between them. A third option is simply to secure the conduit 66 to the periphery of the finished valve (not shown) as a subsequent sewing step. Valve 50 can be attached to an outlet conduit with either a sinus or without.
Alternative configurations for the arrival side of a valve
Figure 38 illustrates other exemplary alternative options available for modifying and attaching valve 50. For example, as explained above, when it is desired to use valve 50 as a delivery valve, suture ring 60 may be attached to valve. 50 as explained above. Alternatively, in applications such as artificial hearts or left ventricular assist devices (LVADs), the suture ring 60 is not needed, therefore, the lower end of stent 56 can be attached to collar 62 for use in mounting. of the valve in the artificial heart or LVAD.
Still another alternative adaptation includes those applications where an inlet conduit 64 is desired. In such applications, outlet conduit 64 may be attached directly to stent 56 of valve 50. More specifically, inlet conduit 64 may be configured to having a stepped circumference 210 that slidably mates with the outer periphery (or alternatively, the inner periphery) of stent 56 and can be sewn thereto. In this configuration, for example in an artificial heart or LVAD application, the suture ring 60 will be able to be attached to the delivery conduit 64 better than the valve 50.
Conclution
Following the above description of exemplary embodiments of valve 50 and components thereof, the present invention satisfies the need to improve tissue-type prosthetic heart valves in which the tension in the leaflets 68 of the valves is reduced at the same time. while the desirable structural and functional characteristics are maintained. In addition, valve 50 can be adapted for use in a variety of positions within the natural heart or in mechanical pumps. It is also easier and simpler to manufacture and more perfect than existing valves.
The standardized laminar structure subunit 52 of the present invention can be easily modified to suit different proposed applications. Equally important is that the laminar subunit 52 evenly distributes tensioan loads throughout the periphery of the quasps 92 of the leaflets, reducing stress points and substantially improving the long-term functionality of the valve 50. As an added benefit of the present invention, the stability and adaptability of the tissue valve subunit is achieved by simplified manufacturing processes using fewer steps or fewer subassemblies. This manufacturing protocol can be incorporated into adaptive derived manufacturing techniques to produce tissue heart valves that have a variety of end uses. In addition, these improved construction techniques activate the entire manufacturing process and improve the strength of the valve 50 while simultaneously reducing the need for post-assembly fine-tuning and quality control processes.
The plurality of tissue sheets 68 which are bonded together in the manner described above, form the dimensionally stable and consistent fixation sheet subunit 52. Furthermore, the sutures 96 used to join the quasps 92 to the metallic wire product 54 act as aligned staples that absorb loads acting throughout the periphery of the quasi 92 of each pre-aligned fixation sheet 68. The structural assembly of the tissue-coated wire metal product 58 reduces tension and potential fatigue at the suture interface of the blades by distributing the stress evenly throughout the cusp 92 of the blades between commissure and commissure. Furthermore, the structural assembly of the fabric-covered wire metal product 58 can be attached to the fabric-covered stent 56 without impairing either the sheets 68 or their alignment or the resulting fixation of their bonding edges.
Stent 56 manufactured according to the present invention provides uniformly distributed support and dimensional stability to each sheet 68 of valve structure 50 between commissure and commissure. This mounting methodology allows the uniformly stitched tissue of the quasps 92 of the laminae to be sandwiched between the metallic wire product 54 and the stent 56 and further distribute the loading forces more evenly around the bonding site. Since sheets 68 experience less stress and are more uniformly distributed during operation, sheets 68 are less prone to deformation in use. Thus, this uniform distribution of bonding forces provides a functional fixation or closure of the blades 68.
In addition, the flexibility of each guide area of the stent 56 can be optimized or adapted. If desired, the commissures of the fixation tissue sheets 86 can be made more or less flexible.
ES 2 189 149 T3 flexible to allow more or less deformation in order to reduce the stresses on the tissue when closing the valve 50 or to precisely tailor its operation. Similarly, the basic radial flexural strength of the entire valve structure can be increased or decreased to preserve the roundness and shape of the valve 50. Unlike a rigid mechanical valve, stent 56 did not act as a rigid cardiac valve structure but rather as an axially flexible and radially stable support. Using the teachings of the present invention, it is not necessary to use a rigid structure since the loamines 68 have been dimensionally pre-aligned with each other by their bonding edges or hermoetic fastening 70 prior to directly bonding them to the fabric-coated metal wire product 54. As a result, the appearance of the entire valve seal 50 can be aligned in three dimensions and straight away without the variability previously experienced in state-of-the-art tissue-type valve constructions. In addition to eliminating the need to adjust the valve 50 after mounting, this pre-alignment provides a simple and compact fabrication of the valve. Furthermore, the metallic wire product 54 functions as a template to sew the quota 92 of the laminations to the valve subunit with a uniform seam between commissure vortex 86 and commissure vortex 86. This produces a structure of uniform dimensions that forms an interface. with the stent 56 in a uniform way that could not be achieved before. The integrity of the uniform dimensions of the metallic wire product subunit 58 and the loamines allows the stent 56 to function as a stress reducing support clamp that further secures the quotas 92 of the loamines in the valve 50 to provide a greater degree. stability and stress distribution. Placing a single or double sheet of covering tissue 144 on top 99 of stent 56 provides the stent rim with a deformable tissue seat that aids in load distribution around the quotas 92 of the laminae and simplifies the stitching of the stent. 56 to the structural subunit of the metallic wire product 58. Those skilled in the art may appreciate that the attachment of the stent 56 to the structural subunit of the metallic wire product 58 functions to stabilize the commissure feet protruding from the valve subunit without stiffening its desirable axial flexibility. This new construction technique eliminates the need to use separate commissure feet at the commissures of the tissue sheets and also eliminates multiple layers of tissue at the 86 commissures of the metallic wire product which adds to uniformity and consistency in the production of the valve and eliminates assembly phases. As a result, the manufacturing of the valve is not only improved but also simplified and active.
Stent 56 also functions as an adaptive structural interface, allowing the attachment of the tissue - metallic wire product - stent structural subunit with a variety of additional structures, depending on the intended placement of the valve and technical operating conditions, among the These include soft suture ring 60, mechanical collar 62, arrival conduit 64, and outlet conduit 66. Unlike state-of-the-art tissue cardiac valves, the present invention provides this flexibility and adaptability of use because essential valve components can be standardized for different types of valve or for different valve applications. This structural and manufacturing consistency also improves quality control and provides reproducibility and consistency in valve formation. It also simplifies final assembly, which in turn provides higher production speed without compromising product quality.
Within the flexibility of the present invention, the stent can be designed to be compliant and thus able to accommodate the different modes of attachment of the valve 50 to the different intended applications. The novel construction that enables this universal application is because the stent 56 provides complete and uniform support to the dimensionally stable pre-aligned sheet metal / wire product subunit 58. Because of this adaptability, the valve 50 can function in a variety of applications, including provisional cardiac valve prostheses that are within a circulatory support system using a relatively rigid collar or conduit assembly rather than a standard soft suture ring. Alternatively, valve 50 may function as a prosthetic valve with a shell-shaped suture ring for placement in the aorta or with a soft, flat suture ring for placement on the mitral valve, or as a delivery valve that incorporates proximal and distal canals joined at both ends of the outlet and inlet valves. The outlet conduit can be sinusoidal in shape, if desired, to improve blood circulation. In an artificial heart, valve 50 mimics the hemodynamic pumping action of the heart until a heart donor is located and is successfully transplanted into the patient. In this application, both the incoming and outgoing functions of the blood can be accommodated by the valve 50.
From the above description, it is clear to those skilled in the art that various changes, adaptations, and modifications can be made in the present invention.
Contents4
16 sheets
Sheet 1 Sheet 2 Sheet 3 Sheet 4 Sheet 5 Sheet 6 Sheet 7 Sheet 8 Sheet 9 Sheet 10 Sheet 11 Sheet 12 Sheet 13 Sheet 14 Sheet 15 Sheet 16
23 members in 9 offices
Priority claims5
| Document | Office | Kind | Date |
|---|---|---|---|
| 19970826408 | United States of America | – | |
| 82640897 | United States of America | A | |
| 82640897 | United States of America | A | |
| 98913095 | – | – | – |
| US19970826408 | – | – | – |
Members23
| Document | Office | Kind | |
|---|---|---|---|
| CA2284941A1 | Canada | A1 | |
| WO9843556A1 | World Intellectual Property Organization (WIPO) | A1 | |
| AU6772498A | Australia | A | |
| US5928281A | United States of America | A | |
| EP0971649A1 | European Patent Office (EPO) | A1 | |
| CA2284941C | Canada | C | |
| US6102944A | United States of America | A | |
| JP2000511459A | Japan | A | |
| AU739221B2 | Australia | B2 | |
| AU8932201A | Australia | A | |
| EP0971649B1 | European Patent Office (EPO) | B1 | |
| AT229774T | Austria | T | |
| ATE229774T1 | Austria | T1 | |
| DE69810282D1 | Germany | D1 | |
| ES2189149T3This record | Spain | T3 | |
| US6585766B1 | United States of America | B1 | |
| US2003195620A1 | United States of America | A1 | |
| DE69810282T2 | Germany | T2 | |
| JP3527745B2 | Japan | B2 | |
| AU774750B2 | Australia | B2 | |
| US6945997B2 | United States of America | B2 | |
| US2006009842A1 | United States of America | A1 | |
| US8518108B2 | United States of America | B2 |
Numbers
- Publication
- 2189149
- Publication, DOCDB
- 2189149
- Publication, EPODOC
- ES2189149T
- Application
- 98913095
- Application, DOCDB
- 98913095
- Application, EPODOC
- ES19980913095T
Titles2
- Spanish
- VALVULAS CARDIACAS DE TEJIDO NATURAL Y PROCEDIMIENTOS PARA HACER ESTAS VALVULAS.
- English
- NATURAL TISSUE CARDIAC VALVES AND PROCEDURES FOR MAKING THESE VALVES.
Classification
- CPC, 6
- A61F2/2409
- A61F2/2412
- A61F2/2415
- A61F2220/0075
- Y10S623/90
- Y10S623/91
- IPC, 2
- A61F2 84
- A61F2 24