Devices and methods for ligating anatomical structures

Abstract

Devices and methods for ligating anatomical structures are provided herein. In particular, the devices and methods provided herein can be used to ligate the left atrial appendage. The ligating devices ( 10, 110, 210, 310, 410 ) comprise a ligating element ( 30, 130, 230, 330, 430 ) and a control element ( 40, 140, 240, 340, 430 ) which controls the opening of the ligating element in a loop or lariat shape. Some embodiments comprise also a positioning element ( 50, 150 ) which help position the ligating element. In some embodiments a conduit ( 250 ) is provided for displaying the ligating element by inflating control.

1 - 30 . (canceled) 
     
     
         31 . A ligating device comprising:
 a catheter comprising a proximal end and a distal end;   a ligating element located within the catheter, wherein the ligating element comprises a lumen and a first end and a second end, wherein the first end and the second protrude from the proximal end of the catheter;   a control element located within the lumen of the ligating element, the control element comprising a first end that protrudes from the ligating element and a second end located in the lumen of the ligating element, wherein a distal portion of the control element forms an open loop upon exit from the distal end of the catheter, wherein the open loop is compressed when the distal portion of the control element is located within the catheter, wherein the control element forces the ligating element to adopt a lariat configuration when the distal portion of the control element forming the open loop extends out of the distal end of the catheter; and   a knot formed in a portion of the ligating element, wherein the knot is located in the catheter proximal of the lariat configuration of the ligating element when the distal portion of the control element forming the open loop extends out of the distal end of the catheter, and wherein the knot is located in the catheter between the first end of control element and the distal end of the catheter when the distal portion of the control element forming the open loop extends out of the distal end of the catheter, and wherein the knot is located in the catheter between the second end of control element and the distal end of the catheter when the distal portion of the control element forming the open loop extends out of the distal end of the catheter.   
     
     
         32 . A ligating device according to  claim 31 , wherein the control element is removable, such that the control element can be pulled out of the lumen of the ligating element. 
     
     
         33 . A ligating device according to  claim 31 , wherein the control element extends through the portion of the ligating element that comprises the knot. 
     
     
         34 . A ligating device according to  claim 31 , wherein the control element comprises a distal portion and a proximal portion, and further wherein the distal portion is thinner than the proximal portion. 
     
     
         35 . A ligating device according to  claim 31 , wherein the ligating element comprises a hollow suture and the control element comprises shape memory material. 
     
     
         36 . A ligating device according to  claim 31 , further comprising a grasping element configured to advance to a position distal of the distal end of the catheter. 
     
     
         37 . A ligating device according to  claim 36 , wherein the grasping element is configured to extend through the lariat configuration of the ligating element when the distal portion of the control element forming the open loop extends out of the distal end of the catheter. 
     
     
         38 . A ligating device according to  claim 31 , wherein the catheter is located within a sheath and further wherein a grasping element is configured to advance through the sheath to a position distal of the distal end of the catheter, wherein the grasping element is configured to grasp a left atrial appendage for placement of the ligating element over the left atrial appendage when the ligating element forms a lariat configuration when the distal portion of the control element forming the open loop extends out of the distal end of the catheter. 
     
     
         39 . A ligating device comprising:
 a catheter comprising a proximal end and a distal end;   a ligating element located within the catheter, wherein the ligating element comprises a lumen and a first end and a second end, wherein the first end and the second protrude from the proximal end of the catheter;   a control element located within the lumen of the ligating element, the control element comprising a first end that protrudes from the ligating element and a second end located in the lumen of the ligating element, wherein a distal portion of the control element forms an open loop upon exit from the distal end of the catheter, wherein the open loop is compressed when the distal portion of the control element is located within the catheter, wherein the control element forces the ligating element to adopt a lariat configuration when the distal portion of the control element forming the open loop extends out of the distal end of the catheter; and   retention means for tightening and retaining the ligating element in position around a left atrial appendage, wherein the retention means is located in the catheter proximal of the lariat configuration of the ligating element when the distal portion of the control element forming the open loop extends out of the distal end of the catheter, and wherein the retention means is located in the catheter between the first end of control element and the distal end of the catheter when the distal portion of the control element forming the open loop extends out of the distal end of the catheter, and wherein the retention means is located in the catheter between the second end of control element and the distal end of the catheter when the distal portion of the control element forming the open loop extends out of the distal end of the catheter.   
     
     
         40 . A ligating device according to  claim 39 , wherein the retention means comprises a knot formed in the ligating element. 
     
     
         41 . A ligating device according to  claim 40 , wherein the control element extends through the portion of the ligating element that comprises the knot. 
     
     
         42 . A ligating device according to  claim 39 , wherein the retention means comprises a clip. 
     
     
         43 . A ligating device according to  claim 39 , wherein the control element is removable, such that the control element can be pulled out of the lumen of the ligating element. 
     
     
         44 . A ligating device according to  claim 39 , wherein the control element comprises a distal portion and a proximal portion, and further wherein the distal portion is thinner than the proximal portion. 
     
     
         45 . A ligating device according to  claim 39 , wherein the ligating element comprises a hollow suture and the control element comprises shape memory material. 
     
     
         46 . A ligating device according to  claim 39 , further comprising a grasping element configured to advance to a position distal of the distal end of the catheter. 
     
     
         47 . A ligating device according to  claim 46 , wherein the grasping element is configured to extend through the lariat configuration of the ligating element when the distal portion of the control element forming the open loop extends out of the distal end of the catheter. 
     
     
         48 . A ligating device according to  claim 46 , wherein the grasping element is configured to advance through the catheter such that the grasping element extends out of the distal end of the catheter. 
     
     
         49 . A ligating device according to  claim 39 , wherein the catheter is located within a sheath and further wherein a grasping element is configured to advance through the sheath to a position distal of the distal end of the catheter, wherein the grasping element is configured to grasp a left atrial appendage for placement of the ligating element over the left atrial appendage when the ligating element forms a lariat configuration when the distal portion of the control element forming the open loop extends out of the distal end of the catheter. 
     
     
         50 . A ligating device according to  claim 38 , wherein the grasping element is configured to extend through the lariat configuration of the ligating element when the distal portion of the control element forming the open loop extends out of the distal end of the catheter.