Left ventricular conduits and methods for delivery

Abstract

Conduits are provided to direct blood flow from the left ventricle to a coronary artery at a location distal to a blockage in the coronary artery. Threaded and nonthreaded conduits are delivered using a guidewire delivered through the posterior and anterior walls of a coronary artery and into the heart wall. A dilator may be provided over the guidewire into the heart wall, and the conduit delivered over the dilator. An introducer sleeve may be provided over the dilator into the heart wall, the dilator removed, and the conduit delivered through the introducer sleeve. A hollow needle also may be inserted into the posterior and anterior walls of the coronary artery prior to inserting the guidewire. A depth measuring tool may determine the appropriate length of the conduit prior to delivery. The depth measuring tool can include the hollow needle with an access port on a proximal end of the needle and an opening on the distal end of the needle in flow communication with the access port so that when the needle is inserted through the heart wall and into the heart chamber, blood flow through the opening.

1 - 51 . (canceled)  
     
     
         52 . A coronary by-pass system, comprising: 
 a conduit configured to provide a passageway of blood between a chamber of the heart and an adjacent blood vessel through a heart wall, the conduit including an elongate body having a proximal end, a distal end and a lumen extending therethrough; and    an apparatus configured to deliver the conduit to the heart wall, the apparatus comprising: 
 a guidewire;  
 a dilator configured to be placed over the guidewire; and  
 a distending engagement member configured to hold the blood vessel open.  
   
     
     
         53 . The system of  claim 52 , further comprising an engagement mechanism on the distal end of the elongate body, 
 wherein the engagement mechanism is configured to engage the blood vessel and to anchor the conduit.    
     
     
         54 . The system of  claim 53 , wherein the engagement mechanism includes flanges.  
     
     
         55 . The system of  claim 52 , wherein the distending engagement member includes threads.  
     
     
         56 . The system of  claim 52 , wherein the distending engagement member is a bulbous feature.  
     
     
         57 . The system of  claim 52 , wherein the distending engagement member is chosen from a balloon and a threaded section.  
     
     
         58 . The system of  claim 52 , wherein the dilator is stepped.  
     
     
         59 . The system of  claim 52 , further comprising a sleeve configured to be placed over the dilator with the conduit configured to be inserted into the sleeve.  
     
     
         60 . The system of  claim 52 , wherein the conduit is configured to be held along the dilator.  
     
     
         61 . The system of  claim 59 , wherein the distending engagement member is disposed on a proximal end of the sleeve.  
     
     
         62 . The system of claims  59 , wherein the distending engagement member is chosen from a balloon, a threaded section, and a deployable feature extending past an outer diameter of the sleeve.  
     
     
         63 . The system of claims  52 , wherein the dilator is stepped.  
     
     
         64 . A coronary by-pass method, comprising: 
 distending a blood vessel adjacent to a chamber of a heart;    advancing a dilator into a heart wall between the blood vessel and the chamber of the heart; and    advancing a conduit into the heart wall so as to form a passageway of blood between the chamber of the heart and the adjacent blood vessel through the heart wall,    wherein the conduit includes an elongate body having a proximal end, a distal end and a lumen extending therethrough.    
     
     
         65 . The method of  claim 64 , wherein the blood vessel is distended via one of a bulbous feature, a balloon, a threaded section, and a deployable feature extending past an outer diameter of a sleeve.  
     
     
         66 . The method of  claim 64 , wherein an engagement mechanism on the distal end of the elongate body engages the blood vessel and anchors the conduit.  
     
     
         67 . The method of  claim 66 , wherein the engagement mechanism includes flanges.  
     
     
         68 . The method of  claim 64 , further comprising advancing a guidewire into the heart wall between the blood vessel and the chamber of the heart, 
 wherein at least one of the dilator and the conduit is advanced into the heart wall via the guidewire.    
     
     
         69 . The method of  claim 64 , further comprising advancing at least one of the dilator and the conduit from a sleeve.  
     
     
         70 . The method of  claim 66 , wherein the engagement mechanism engages the blood vessel and anchors the conduit upon exiting a sleeve.  
     
     
         71 . The method of  claim 64 , wherein the dilator is stepped.