Methods and Devices for Endoscopic Access to the Heart

Abstract

Disclosed are devices for cardioscopic and pericardioscopic access to the heart, including direct access to the left atrium. In certain embodiments, the device may comprise an atrial portal having a configuration such that the distal end of the atrial portal can access the atrium while the proximal end of the portal can extend to outside of the subject. The devices and methods may also include a pericardioscopic portal for emplacement of the atrial portal. Also, methods for using such atrial portals and pericardial portals to perform surgery on the heart, and in some cases to directly access the left atrium, and systems (e.g., kits) comprising these portals in combination with other therapeutic devices are disclosed.

1 . A device for accessing an atrium of a heart in a subject so as to perform a surgical procedure upon the atrium, the device comprising an atrial portal having a configuration such that the distal end of the atrial portal can provide cardioscopic access the atrium while the proximal end of the atrial portal can extend to outside of the subject. 
     
     
         2 . The device of  claim 1 , wherein the cardioscopic access is via an incision in the diaphragm and via the pericardial space. 
     
     
         3 . The device of  claim 1 , wherein the atrium is the left atrium. 
     
     
         4 . The device of  claim 1 , further comprising a pericardial portal into which the atrial portal is inserted, the pericardial portal having a configuration such that the distal end of the atrial portal can access the atrium while the proximal end of the atrial portal can extend to outside of the subject. 
     
     
         5 . The device of  claim 1 , further comprising an imaging device to provide an image of body structures present near the distal end of the atrial portal. 
     
     
         6 . The device of  claim 1 , further comprising a tool configured for emplacing sutures in the atrial wall to secure the atrial portal in the atrium wall. 
     
     
         7 . The device of  claim 6 , wherein the sutures are of a configuration so as to surround the atrial portal upon insertion of the atrial portal in the atrium such that tightening the sutures around the atrial portal secures the atrial portal in the atrium. 
     
     
         8 . The device of  claim 6 , further comprising a tourniquet configured to tighten the sutures around the atrial portal. 
     
     
         9 . The device of  claim 1 , wherein the atrial portal further comprises a needle within the lumen of the atrial portal, wherein the needle is configured to puncture the atrium so as to provide an opening for insertion of the portal into the atrium. 
     
     
         10 . The device of  claim 1 , wherein the atrial portal further comprises a guide wire, wherein the guide wire is configured to provide a path for insertion of the atrial portal into the atrium by threading the atrial portal over the guide wire and into the atrium. 
     
     
         11 . The device of  claim 1 , wherein the distal end of the atrial portal comprises a dilating introducer, wherein the dilating introducer is configured so as to be inserted in an opening in the atrial wall so as to enlarge the opening of the atrial wall for insertion of the atrial portal into the atrium. 
     
     
         12 . The device of  claim 1 , wherein the distal end of the atrial portal comprises a cap configured to secure the distal end of the atrial portal in the atrial wall. 
     
     
         13 . The device of  claim 12 , wherein at least a portion of the cap can be expanded laterally away from the central longitudinal axis of the atrial portal. 
     
     
         14 . The device of  claim 1 , further comprising at least one tool for performing procedures on the atrium or a region of the heart accessible via the atrium. 
     
     
         15 . The device of  claim 14 , wherein the tool is configured to be threaded over a guide wire that extends from the proximal end of the atrial portal to the distal end of the atrial portal. 
     
     
         16 . The device of  claim 14 , wherein the tool comprises at least one of an ablation element, an electrode, a stent, a valve, an expandable member, a debris capture device, or a barbed needle. 
     
     
         17 . A method to access the atrium of a heart in a subject so as to perform surgical procedures upon the atrium, the method comprising:
 (a) inserting the distal end of an atrial portal into the pericardium of the subject;   (b) manipulating the proximal end of the atrial portal to position the distal end of the atrial portal at the surface of the atrium;   (c) determining an entry location for the atrial portal to be inserted into the atrium;   (d) inserting the atrial portal into the atrium; and   (e) securing the position of the atrial portal in the atrium.   
     
     
         18 . The method of  claim 17 , further comprising inserting the atrial portal into a pericardial portal and positioning the distal end of the pericardial portal at the surface of the atrium. 
     
     
         19 . The method of  claim 17 , wherein the atrium is the left atrium. 
     
     
         20 . The method of  claim 17 , further comprising using an imaging device positioned at the distal end of the atrial portal to provides an image of body structures present near the distal end of the atrial portal. 
     
     
         21 . The method of  claim 17 , further comprising providing sutures in the surface of the atrium that surround the entry location for the atrial portal and tightening the sutures around the atrial portal upon insertion of the atrial portal in the atrium to secure the atrial portal in the atrium. 
     
     
         22 . The method of  claim 17 , wherein the step of inserting the atrial portal into the atrium comprises using a needle contained within the atrial portal to puncture the atrium wall. 
     
     
         23 . The method of  claim 17 , wherein the step of inserting the atrial portal into the atrium comprises inserting a guide wire through the needle, and withdrawing the needle such that the guide wire is inserted into the atrium at the entry location for the atrial portal, and then threading the atrial portal over the guide wire and into the atrium. 
     
     
         24 . The method of  claim 17 , wherein the step of inserting the atrial portal into the atrium comprises inserting a dilating introducer positioned at the distal end of the atrial portal into the entry location and advancing the introducer distally into the atrium wall to enlarge the opening at the entry location. 
     
     
         25 . The method of  claim 17 , further comprising using a flexible cap positioned on the distal end of the atrial portal to secure the distal end of the atrial portal in the atrial wall. 
     
     
         26 . The method of  claim 17 , wherein at least a portion of the cap can be expanded laterally away from the central longitudinal axis of the atrial portal. 
     
     
         27 . The method of  claim 17 , further comprising inserting a tool in the atrium using the atrial portal. 
     
     
         28 . The method of  claim 27 , wherein the tool comprises at least one of an ablation element, an electrode, a stent, a valve, an expandable, a debris capture device or a barbed needle. 
     
     
         29 . The method of  claim 27 , wherein the cardioscopic access is via an incision in the diaphragm and via the pericardial space 
     
     
         30 . A system for accessing an atrium of a heart in a subject so as to perform a surgical procedure upon the atrium, the system comprising an atrial portal having a configuration such that the distal end of the atrial portal can provide cardioscopic access the atrium while the proximal end of the atrial portal can extend to outside of the subject. 
     
     
         31 . The system of  claim 30 , further comprising a pericardial portal into which the atrial portal is inserted, the pericardial portal having a configuration such that the distal end of the atrial portal can access the atrium while the proximal end of the atrial portal can extend to outside of the subject. 
     
     
         32 . The system of  claim 30 , further comprising at least one tool for performing procedures on the atrium or a region of the heart accessible via the atrium. 
     
     
         33 . The system of  claim 32 , wherein the tool comprises at least one of an ablation element, an electrode, a stent, a valve, an expandable member, a debris capture device, or a barbed needle.