WO1990001972A1 - Peripheral cardiopulmonary bypass and coronary reperfusion system - Google Patents

Peripheral cardiopulmonary bypass and coronary reperfusion system Download PDF

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Publication number
WO1990001972A1
WO1990001972A1 PCT/US1989/003759 US8903759W WO9001972A1 WO 1990001972 A1 WO1990001972 A1 WO 1990001972A1 US 8903759 W US8903759 W US 8903759W WO 9001972 A1 WO9001972 A1 WO 9001972A1
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WO
WIPO (PCT)
Prior art keywords
catheter
pump
patient
heart
blood
Prior art date
Application number
PCT/US1989/003759
Other languages
French (fr)
Inventor
Gerald D. Buckberg
James V. Maloney, Jr.
Kenneth A. Jones
Weldon D. West
Original Assignee
Shiley, Inc.
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Shiley, Inc. filed Critical Shiley, Inc.
Priority to JP1509840A priority Critical patent/JPH07114808B2/en
Publication of WO1990001972A1 publication Critical patent/WO1990001972A1/en

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Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M1/00Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
    • A61M1/36Other treatment of blood in a by-pass of the natural circulatory system, e.g. temperature adaptation, irradiation ; Extra-corporeal blood circuits
    • A61M1/3621Extra-corporeal blood circuits
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M1/00Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
    • A61M1/36Other treatment of blood in a by-pass of the natural circulatory system, e.g. temperature adaptation, irradiation ; Extra-corporeal blood circuits
    • A61M1/3613Reperfusion, e.g. of the coronary vessels, e.g. retroperfusion
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M1/00Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
    • A61M1/36Other treatment of blood in a by-pass of the natural circulatory system, e.g. temperature adaptation, irradiation ; Extra-corporeal blood circuits
    • A61M1/3621Extra-corporeal blood circuits
    • A61M1/3623Means for actively controlling temperature of blood
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M1/00Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
    • A61M1/36Other treatment of blood in a by-pass of the natural circulatory system, e.g. temperature adaptation, irradiation ; Extra-corporeal blood circuits
    • A61M1/3621Extra-corporeal blood circuits
    • A61M1/3643Priming, rinsing before or after use
    • A61M1/3644Mode of operation
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M1/00Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
    • A61M1/36Other treatment of blood in a by-pass of the natural circulatory system, e.g. temperature adaptation, irradiation ; Extra-corporeal blood circuits
    • A61M1/3621Extra-corporeal blood circuits
    • A61M1/3643Priming, rinsing before or after use
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M1/00Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
    • A61M1/36Other treatment of blood in a by-pass of the natural circulatory system, e.g. temperature adaptation, irradiation ; Extra-corporeal blood circuits
    • A61M1/3621Extra-corporeal blood circuits
    • A61M1/3664Extra-corporeal blood circuits for preparing cardioplegia solutions
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00Catheters; Hollow probes
    • A61M2025/0001Catheters; Hollow probes for pressure measurement
    • A61M2025/0003Catheters; Hollow probes for pressure measurement having an additional lumen transmitting fluid pressure to the outside for measurement
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2205/00General characteristics of the apparatus
    • A61M2205/33Controlling, regulating or measuring
    • A61M2205/3331Pressure; Flow
    • A61M2205/3344Measuring or controlling pressure at the body treatment site
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2205/00General characteristics of the apparatus
    • A61M2205/33Controlling, regulating or measuring
    • A61M2205/3331Pressure; Flow
    • A61M2205/3351Controlling upstream pump pressure
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2205/00General characteristics of the apparatus
    • A61M2205/33Controlling, regulating or measuring
    • A61M2205/3331Pressure; Flow
    • A61M2205/3355Controlling downstream pump pressure
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2205/00General characteristics of the apparatus
    • A61M2205/36General characteristics of the apparatus related to heating or cooling
    • A61M2205/366General characteristics of the apparatus related to heating or cooling by liquid heat exchangers

Definitions

  • the subject invention relates to the treatment of hea attacks by placing the patient on a heart/lung machi without the necessity of a conventional open-che operation, and to the treatment of the heart attack by t infusion of a special solution directly into the corona arteries supplying the heart muscle.
  • a heart attack (acu myocardial infarction) due to the obstruction of a corona artery which supplies blood to the heart muscle. Of th number, a significant percentage die before reaching medic attention. Another group succumbs after reaching t hospital.
  • heart attacks are caused by close coronary arteries; opening an artery does not cure th heart attack; and controlling the conditions and compositio of the initial reperfusion of a blocked coronary artery doe permit salvage of the damaged myocardium beyond th obstruction.
  • the only accepted way to contro the conditions and composition of coronary reperfusion o individuals undergoing a heart attack is by open-ches surgical operation with direct decompression of the heart decompression of the left ventricle and direct infusion o the coronary arteries through surgically connected saphenou vein grafts.
  • the system should relieve th workload of the heart by supporting the body on a extracorporeal circulation to eliminate the flow work of th heart and relieve the left ventricle of all blood t eliminate pressure work of the heart. It is still another object to provide an improved tot extracorporeal circulation system for medical applications
  • the invention comprises a unique cardiopulmonary bypa apparatus and system.
  • an extracorporeal bypass apparatus having a veno catheter (10) for insertion into a femoral vein, su catheter being sufficiently long and flexible to reach t atrium area of a patient's heart and an arterial cannu (12) , characterized in that there is provided a single pu (18) connected between the venous catheter and the arteri cannula for withdrawing blood from a patient through sa venous catheter and pumping it into a patient through t arterial cannula; and a vent catheter (14) for inserti into an artery sufficiently long and flexible to reach t left ventricle of the heart, said vent catheter bei connected -in parallel with the venous catheter connected the pump in a manner such that the negative pressu developed by said pump is applied to the venous catheter a the vent catheter, said venous catheter and said pump bei constructed such that substantially all of the patient blood which would normally be returned to the heart bypassed through the venous catheter,
  • the venous catheter is of special design which, f the first time, permits the induction of percutaneous tot extracorporeal circulation, without producing dangero increases in negative pressure.
  • the hydrodynamics of t venous catheter system are selected so that they permit fu normal cardiac output of 5 to 7 liters per minute witho exceeding a maximum negative pressure, or suction, in t range of 140 to 200 mm Hg. This constraint minimizes blo damage and avoids creating bubbles in the blood.
  • a blood cardioplegia delivery syst further characterized by a cardioplegia delivery pump (2 having an inlet connected to the output of said arteri pump (18) ; a source of cardioplegic liquid (26) connected a an input to said cardioplegia pump; and a coronar reperfusion catheter assembly including a catheter (16 connected to the output of said cardioplegia pump, th coronary reperfusion catheter being sufficiently long an flexible to be adapted to be inserted through a patient' artery to reach an area of the heart that has been deprive of blood so that a cardioplegia solution can be applied t that area before resuming normal blood flow.
  • the system is useful for routine extracorporea circulation situations.
  • the system further advantageousl lends itself to electronic and mechanical control syste uniquely designed for performance of total extracorporea circulation and controlled coronary reperfusion.
  • Figure 1 is an overall schematic view of the system this invention
  • Figure 2 is a schematic, partial sectional view of t heart and venous and arterial passages to the heart.
  • Figure 3 is a partial sectional view of a portion of human heart with a vent catheter and a reperfusion cathet inserted into the heart;
  • Figure 4 is a perspective view of a portion of femoral venous catheter;
  • Figure 5 is a cross sectional view on line 5-5 Figure 4;
  • Figure 6 is a graph illustrating the fluid fl dynamics of the venous catheter and the vent catheter
  • Figure 7 is a perspective view of a portion of a ve catheter used in this invention.
  • Figure 8 is a cross section of the vent catheter line 8-8 of Figure 7;
  • Figure 9 is a schematic illustration cTf the use of alternate pumping arrangement;
  • Figure 10 is a schematic perspective view of arterial cannula assembly inserted in the femoral artery;
  • Figure 11 is a view similar to Figure 10, but with stylet of the cannula assembly partially withdrawn;
  • Figure 12 is a perspective view of the cannu assembly of Figures 10 and 11;
  • Figure 13 is a perspective view of the stylet of t assembly of Figure 12;
  • Figure 14 is a perspective view of an anti-backfl ring of the cannula assembly
  • Figure 15 is an enlarged, perspective, schematic vi of the cannula assembly inserted in a femoral artery
  • Figure 16 is a side elevational, partial sectionalized view of the assembly of Figure 12;
  • Figure 17 is a cross-sectional view of the cannu assembly with the stylet partially withdrawn and with t cannula clamped to prevent flow therethrough;
  • Figure 18 is a cross-sectional view on line 18-18 Figure 16; and Figure 19 is a perspective view of the detail end the reperfusion catheter assembly.
  • FIG. 1 A femoral-femoral bypass performed wherein a femoral venous catheter 10 allows rig heart access via the femoral vein 11.
  • a femoral arteri cannula 12 allows the return of oxygenated blood to t femoral artery, and is used in connection with the veno catheter 10 to achieve femoral-femoral total extracorpore circulation.
  • a left ventricular vent catheter 14 is used to ve the left heart during extracorporeal circulation with t introduction of the catheter 14 made at the femoral arte and passing transaortically into the left ventricle.
  • coronary reperfusion catheter 16 is inserted into, a transverses a stenosed vessel in order to reperfuse t heart region beyond the stenosis.
  • the venous catheter 10 and the vent catheter 14 are fluid communication with an arterial pump 18 which provid a negative pressure in order to draw venous blood into t arterial pump and to draw blood out of the left ventricl and maintain that portion of the heart in an at re condition.
  • the arterial pump 18 forces the blood throu an oxygenator/heat exchange 20 and an arterial filter 2
  • a heater/circulator 21 provides fluid flowing into the he exchanger contained within the oxygenator 20.
  • a bridging venous reservoir 25 is connected in flu communication with both the arterial pump 18 and t membrane oxygenator 20 in order to prime the system and maintain sufficient fluid for proper operation.
  • cardioplegia delivery pump 24 is in fluid communicati with the oxygenated blood after it leaves the arteri filter 22, and is also in fluid communication with cardioplegia source 26 so as to mix the oxygenated blo and cardioplegia before delivering it at a predetermin flow rate to the coronary reperfusion catheter 16.
  • the vent catheter 14 removes all residual blood fr the left ventricle and enables the heart to maintain at-rest condition while the reperfusion catheter 16 enabl reperfusion of the heart region beyond the stenosis wh precipitated the heart attack.
  • the femoral venous catheter 10 preferably made from ethylene-vinyl-acetate (EVA) tubi preferably having about 18% acetate.
  • EVA ethylene-vinyl-acetate
  • the tubing has constant inner diameter from the insertion tip up to proximal end.
  • the proximal end of the catheter 10 conne to a 3/8-inch connector which is in fluid communicat with the arterial pump.
  • the catheter 10 should be l enough to reach the right atrium from the femoral triang
  • the t wall and flexibility of the catheter allow for introduction percutaneously into the femoral vein of a w xange of patients, and resist the kinking that mig otherwise occur with other thin wall catheters as they a advanced through the iliac veins and across the curve the pelvis.
  • the distal end 27 of the venous catheter 10, as se in Figures 4 and 5, has a plurality of drainage holes which in a prototype product have a diameter of .165 wi 1/4-inch center to center spacing. These holes have smoo edges and are formed by a tubular cutter, with the cathet internally supported on a mandrel.
  • the holes are arrang in a spiral pattern so that if some holes are blocked vessel walls, others will be open. This arrangement al minimizes weakening of the catheter while providing t necessary hole area.
  • the holes extend sufficiently far fr the distal end of the catheter to span the area from whi blood is to be withdrawn.
  • the preferred technique f introducing this canula into the body is to use t Seldinger technique (percutaneous) or a cutdown procedu along with vessel dilation.
  • a radiopaque tip marker near the distal end enables the drainage holes to oriented in the superior vena cavae.
  • An elongated removab stylet 31 which receives a .045 inch guidewire (not show is used to introduce and guide the catheter into position.
  • the cross-sectional size and the material of t catheter 10 is particularly critical. Since a total bypa system is needed to accomplish the goals of the inventio it is necessary that the venous catheter fit within vario constraints. Bypassing the patient's total blood fl requires a capacity in the range of up to 5-7 liters p minute. An overall flow rate of 5 liters per minute expected in most patients. A thin-walled construction advantageously used to provide a larger blood flow with the size limitations that may be accommodated by hum veins.
  • the EVA material in connection with the thi walled construction, provides the needed flexibility to properly positioned, yet sufficient strength to preve kinking during normal handling. Moreover, t characteristics of the material are such that if the tubin is kinked and then released, it is self-restoring withou significant weakening.
  • French (O.D. - .341 inch, 8.66 mm) is suitable.
  • the catheter has an inner diameter of .277 inch (7.03 mm) thus making a wall thickness of .032 inch (.825 mm).
  • alternative approach is to use two smaller venous cathete that will carry the flow at the same negative pressure.
  • Figure 6 illustrates the constraints of the veno catheter construction graphically from test data. It c be seen that the fluid flow dynamics are such th significant negative pressure is needed to approach t required flow rates, but yet the increased flow fr increased suction diminishes quickly at higher level particularly for the smaller lumens. Within the acceptab pressure limit, it can be seen that inadequate flow obtained from a 22 F or 24 F (French) thin-walled lumen. 29 French thin-walled size provides adequate flow, but too large for the vein of some patients, and produc insufficient negative pressure to assist vent draina optimally (as discussed below) . Incidentally, the French lumen was made of polyethylene rather than EVA.
  • vent catheter 14 preferably a size 12.5 French (.164 inch, 4.166 mm O.D (.120 inch, 3.04 mm I.D.).
  • the catheter is preferably ma fro a flexible polyvinyl chloride (PVC) tubing.
  • the dist end 30 is formed in a loop providing a so-called "pigtail”
  • This loop when unstressed, has an outside diameter of abo 7/8-inch, and has a plurality of spaced apertures 32 whi are preferably about .050 inch in diameter and extend over vent length of about 4 cm.
  • a series of apertures 32 a located on opposite sides of the catheter.
  • the catheter 14 must be long enough to reach the le ventricle from the femoral triangle when passed retrogra through the arterial system.
  • a catheter with intravascular length of 100 cm, and an overall length about 112 cm is preferred.
  • the catheter 14 includes pressure monitoring lumen 41 which is integral with a formed in a wall of the vent catheter 14.
  • th lumen 41 has a diameter of about .030 inch.
  • the lumen extends from the proximal end of the catheter 14 to pressure inlet 41a which is spaced from the catheter tip distance further from the tip than the apertures 32.
  • T inlet 41a is positioned about 4 inches from the distal e of the catheter.
  • the inlet 41a is located on the same si of the catheter 14 as the pigtail to prevent obstruction the inlet 41a when the catheter contacts the ventricul wall.
  • the catheter 14 is extruded with the lum 41 extending throughout the length of the tubing.
  • the distal end of the tubing After t apertures 32 are formed, the distal end of the tubing heated and stretched to reduce its diameter and increa flexibility, and to form the pigtail into its curled shap In the stretching and heating operation, the lumen 41 closed on the distal end of the catheter.
  • the opening 4 is formed by cutting the tubing at the desired location spaced further from the tip than the apertures 32.
  • the exteri diameter of the catheter is decreased from .164 inch about .100 inch, and the interior diameter is decreased fr .120 inch to .062 inch.
  • the very tip of the catheter reduced a slight amount further. That is, the tip .030 in is tapered on its exterior and is reduced on its interi diameter to about .040 inch.
  • the preferred method of introducing the vent cathet 14 into the femoral artery is by using a sheath introduc procedure. After a tubular sheath (not shown) is position in the entrance to the artery, a guidewire 47 is introduc into a stiffening stylet (now shown) that is in the fl lumen of the catheter. The guidewire extends beyond t pigtail distal end 30 sufficiently to straighten it and permit insertion. The assembly is then inserted through t sheath into the artery. The guidewire and stylet a stopped when the wire approaches the aortic valve. T guide wire and the stylet are then withdrawn approximate 10 cm.
  • the curled distal e resiliently engages the aortic valve and passes through t valve without trauma when the valve opens.
  • the distal e then assumes the position illustrated in Figure 2 where the pressure lumen hole 41a in the distal end is shiel from the ventricle walls so as to prevent blockage w pressure is monitored through the catheter.
  • the flexibili of the catheter permits its presence in the ventricl across the aortic valve, without causing distortion of cusps of that valve and therefore avoids aort insufficiency.
  • a tube 40 is in fluid communication with the proxi end of the vent catheter via one aperture in a Wye connec 38 with the tube also communicating with the arterial p 18.
  • the catheter 14 is sized to allow transmission approximately up to 500 ml per minute of blood flow at same negative pressure at which the catheter 11 is opera by the arterial pump 18.
  • a pressure transducer is connec to a second aperture in the Wye connector 38 which in t is connected to the second lumen 41.
  • the lumen monitors the pressure in the left ventricle directly. the ventricle is being properly decompressed, the sens pressure should be about zero. Thus, there is a significa difference in pressure on the opposite sides of the aort valve.
  • the vent catheter is, as noted, necessary to ensu the left ventricle is completely decompressed, and does n fill with fluid and cause the heart to eject (pump) , ev though the heart is being bypassed.
  • the venous dra cannula 10 does not ensure continual left ventric decompression. Some coronary sinus return and/or bronchi flow will enter the left ventricle, distend it, allow wa tension to develop and result in occasional ejection despi apparent right heart decompression from the venous cathet 10.
  • the curve for the vent catheter shows vent flow capacity of about 100 ml/minute at a very flo negative pressure, and up to 500 ml/minute at about 17 negative pressure. This is a very satisfactory pressur limit for providing the desired vent flow capacity.
  • the suction provided by the venou catheter 10 and the ventricular vent catheter 14 are bot advantageously provided by the same arterial pump. Th diameter and flow resistance of the tubes 29, 40 and th catheters 10, 14 are selected with a diameter and length t provide a predetermined ratio of flow from each of th catheters for a given suction by the pump.
  • the amoun of suction provided to the left ventricle by the ven catheter 14 will vary in a predetermined relationship wit respect to the blood withdrawn from the femoral vein by th venous catheter.
  • a separate pump can be employed fo the vent catheter, as in the prior art, it is highl desirable that the single pump approach be employed. accomplish this, it is necessary to balance and coordina those two catheters. That is, it is necessary to utilize vent catheter that provides the needed flow within t pressure constraints required in connection with the veno flow.
  • the amount of suction provided to the le ventricle by the vent catheter will vary in a predetermin relationship with respect to the blood withdrawn from t femoral vein by the venous catheter.
  • the curve f the vent catheter is very similar to that for the 26 Fren venous catheter in the flow range desired.
  • the flow rate of the veno catheter 10 will be, in a preferred construction, about times greater than the flow capacity in the vent catheter for the same negative pressure, but may range from 10 to times greater for tubes of different sizes. If, in monitoring the pressure in the ventricle, it observed that the pressure is becoming too high, indicati an accumulation of blood, pump speed can be increased increase the flow through the vent catheter and the veno catheter, so long as the maximum negative pressure of 200 Hg is not exceeded.
  • ventric pressure should start to climb with vent flow at 360 ml a 5 venous flow at 51
  • pump speed can be increased to provi 500 ml of vent flow capacity, venous flow only increasing 7 liter a minute, and the negative pressure is at a sa 180.
  • a venous pressure transducer 42 monitors the pressu in the tubes 29 and 40 generated by the arterial pump 18.
  • a ventricular vent catheter of the type describ above is also useful for reducing volume of the ventricl in partial bypass situations, i.e., when not using a veno catheter and an oxygenator. In such situations a larg catheter is desired, such as 18 French.
  • the bridging reservoir 25 is connected in parallel wit
  • the arterial pump 18 with flow clamp 44 between th reservoir and the pump inlet, and a flow clamp 46 betwee the pump outlet and the reservoir.
  • the volu in the circuit can be controlled by temporarily opening on
  • th clamp 44 is briefly opened and then closed when the volu is at the desired level. Similarly, if less volume in t circuit is desired, the clamp 46 is briefly opened unti the desired volume is attained.
  • the system and method of this invention is a clos system; the chest is not opened to access the heart a there is no blood-to-air interface (other than in t oxygenator 20). Thus, whatever blood is taken out of t body must be returned to the body via catheter 12.
  • bridging reservoir 25 facilitates circulatory stabili during the initiation and conduct of the bypass by providi volume control. Maintaining a stable fluid flow in the bo - is especially important during the time immediatel following the initiation of extracorporeal circulation, a such instability can cause severe hypotension, possibl exacerbate the infarction, and cause secondary arrhythmia or cerebral symptoms.
  • the reservoir provides sufficien fluid to maintain circulatory-stability and has the capacit to allow fluid removal if the patient's blood volume i excessive due to heart failure. Further, the fluid in th reservoir can be used to prime the system. Arterial Pump. Oxv ⁇ enator. Filter. Bubble Detector
  • the arterial pump 18 withdraws blood from the bo under a negative pressure (suction) , along with t appropriate amount of fluid from the reservoir 25, if a is needed, and pumps the blood and fluid mixture out of t pump under a positive pressure.
  • the arterial pump 18 schematically illustrated in Figure 1 as a centrifug pump. Such a pump is known in the art and hence is n described in detail herein.
  • One suitable centrifugal pu is that provided by Biomedicus of Minneapolis, Minnesot
  • a primary advantage of a centrifugal pump is that it h
  • T pump is connected to an electronic controller to preve negative pressure from going above 200 mm Hg.
  • the blood is forced under pressu to the oxygenator 20 where the blood is oxygenated and t temperature of the blood is controlled.
  • the oxygenator and heater circulator are known in the art and are n described in detail herein.
  • the blood is preferab forced through an arterial filter 22, although a bypass provided.
  • the ma portion of the oxygenated and filtered blood is directed the arterial cannula 12 where it is returned to the femor artery of the body.
  • a bubble detector 50 and an arterial pressu transducer 52 may be located on the tube carrying the blo to the arterial cannula 12.
  • a positive displaceme pump may be attached to the venous line with an interpos compliance chamber (to dampen phasic pressure variation such that a servo based on negative pressure in the veno line achieves the desired flow.
  • an interpos compliance chamber to dampen phasic pressure variation such that a servo based on negative pressure in the veno line achieves the desired flow.
  • FIG. 9 A venous draina line 129, and a vent catheter line 140, comparable to t lines 29 and 40 in Fig. 1, are joined at a Y-connection a common line 141 leading to a compliance chamber 153 This chamber is in turn connected by tubing 145 to positive displacement pump 118 schematically illustrated a peristaltic pump.
  • a suitable example of a peristalti pump is made by Stockert/Shiley, in Kunststoff, Germany.
  • T pump 118 is controlled by an electronic controller 11 which receives pressure feedback from the compliance chambe through a suitable pressure transducer connection 121.
  • FIG. 9 The balance of the system of Fig. 9 is comparable that shown in Fig. 1.
  • a reservoir 125 with inlet and outl controls 144 and 146 bridges the pump 118 to provide fo volume adjustment.
  • the output of the pump is directe through an oxygenator 120, and optionally a filter 122 to line 123 leading to an arterial cannula.
  • a portion of t oxygenator output is directed through a line 128 to cardioplegia pump 124 and conducted through a line 125 to coronary artery by a suitable perfusion catheter.
  • cardioplegia supply 126 is connected by a line 127 to t pump 124.
  • the compliance chamber 143 includes a flexible bladd or reservoir 151, having an inlet connected on one end the venous drainage line 143 and an outlet connected on i other end to pump inlet tube 145.
  • a rigid outer housing 15 encloses the bladder 151. This housing is sealed around t bladder 151 so that the negative pressure applied to t bladder ⁇ 151 by the pump 118 is also applied to the spa within the housing 153 surrounding the bladder 151. Th negative pressure within the housing 153 is, as indicat above, sensed by a transducer 155 and fed back to t controller 119.
  • a valved outlet 157 from the housing 153 opened to atmosphere during priming to allow the bladder initially expand due to the head pressure of the fluid the system. The valve is then closed so that any changes the size of the bladder are then reflected in pressu changes in housing.
  • the peristaltic pump 118 is desirable in that t pumping mechanism does not actually contact the blood, th eliminating a source of contamination and allowing reuse the pump. Its shortcoming, however, is that if the blo supply falls, the pump can quickly increase the negati pressure applied on the venous drainage line to unsa levels, even with a pressure sensor in the line to send signal to a controller, the negative pressure can r undesirably before the pump speed reacts to reduce pressu
  • the compliance chamber 143 in combination with a sensor the pump controller solves this problem.
  • the press within the rigid housing 153 being the same as that wit the flexible bladder 151, is continually sensed and fed b to the pump controller.
  • the housing 153 can be configured replace the bridging reservoir 125, including being provi with the necessary inlet and outlet valves or clam Similarly, venous return can be augmented by negat pressure applied to the space between the housing 153 . the reservoir 151. Cardioplegia Pump
  • a portion of the oxygenated blood through the arter filter 22 is directed to the cardioplegia delivery pump
  • a normal body temperature of 37* Celsius believed suitable for the reperfused solution.
  • a suitab cardioplegia solution is believed to be an aspartat glutamate-enriched, hypocalcemia, buffered, hypersomol blood solution, as discussed more particularly in t above-mentioned Journal, Thoracic Cardiovascular Surger September 1986. Controls
  • a reperfusion pressure transducer 54 and monitor/pu feedback helps regulate the pressure with which t cardioplegia solution is provided to the catheter 16.
  • flow rate of 50 ml/ in or that rate obtained with 50 mm over the pressure drop in the system, whichever is greate is believed suitable for the reperfusion.
  • flow reduced if the pressure exceeds 50 mm Hg, but the rate best at 50 ml/min if the pressure drops below 50 mm H
  • reperfusion flow rate may found in Article XVI in the above-mentioned journal.
  • the femoral arterial cannula 12 is, as shown in Figu 12, a component of a cannula assembly 65.
  • the assemb further includes a stylet 66, which is slidably receiv within the cannula, a fitting 68 secured to the proxim end of the cannula, a stopcock 70 on the fitting, and clamp 71.
  • the cannula 12 which is disclosed in detail Figures 10-18 and below is separately claimed in a copendi application since it is useful in systems other than th illustrated in Figure 1.
  • the cannula 12 comprises an elongated -tubular body 72 preferably made from a medical-grade silicone rubber or a polyvinyl chloride material.
  • the body 72 has three principal sections including a distal tip section 72a for insertio into the femoral artery, an intermediate section 72b adapte to extend from the artery to a raised suture stabilizin ring 72c to be located near the exterior skin of the leg, and an exterior section 72d extending from the suture rin
  • the tip of section 72a is tapered to facilitat insertion into an artery.
  • the exterior diameter of the tip section 72 is 6.68 mm or 20 French, and the interior diameter i
  • the intravascular length of the tip section 72 in a preproduction version is 5.88 cm, which is a desirabl length to ensure adequate seating within the artery.
  • the intermediate section 72b has a length of abou
  • the section 72 is about 19 cm in length, making the overall length of t cannula about 33 cm.
  • the interior and exterior diamete are constant with the end of section 72b.
  • a pair of suture wings or flaps 74 are formed integr with and extend outwardly from the cannula exterior secti 72d.
  • the wings have a lower surface which is approximate tangent with the exterior of the section 72d.
  • the sutu wings in a prototype are positioned about 5 cm from t suture ring 72c.
  • the stylet 66 is elongated flexible tubular element preferably made polyvinyl chloride. The stylet 66 is slightly longer th the cannula 12 having a tapered tip 66a on one end whi extends beyond the tip of the cannula when the stylet fully inserted therein.
  • a knob 76 on the other end of the stylet extends beyond t fitting 68 and is useful for installing and removing t stylet from the cannula.
  • the diameter of the stylet slightly smaller than the inner diameter of the tip of t cannula.
  • a small diameter lumen 77 is formed througho the length of the stylet and is adapted to receive a sma diameter guidewire.
  • Included on the stylet 66 is cylindrical stop 66b having an exterior diameter which sized to slide relatively easily within the cannula, b nevertheless there is resistance to movement caused by t stop 76b engaging the interior of the cannula.
  • the st 76b is spaced from the tip end of the stylet about 15 and has a length of about 4 cm. This means that the end the stop 76b closest to the tip 66a of the stylet is locat at the suture ring of the cannula when the stylet is ful inserted in the cannula, as seen in Figure 16.
  • an ant backflow ring 80 preferably made of medical-grade silico rubber.
  • the ring has a short barrel-like tubular sha with two axially spaced outwardly extending annular ri 80a and 80b.
  • the ribs are dimensioned such that th snugly engage the interior wall of the fitting 68 cannula 12 and the exterior of the stylet to form a liqu inner and outer seal.
  • the adjustable medic clamp 71 Mounted on the exterior of the cannula between t suture wings and the fitting 68 is the adjustable medic clamp 71.
  • the clamp is of standard construction, adapt to be manually set to pinch the cannula closed when t stylet is removed.
  • the guidewire is inserted into the femo artery followed by the cannula and stylet with the styl fully inserted, as shown in Figures 10, 11 and 15.
  • cannula is preferably introduced by use of the Seldin technique, or a cutdown procedure along with ves dilation.
  • the assembly guided by the guidewire, inserted to the point where the cannula angled shoulder 7 engages the exterior of an artery 82 with the cannula section 72a extending into the artery, together with tip of the stylet, as illustrated in Figure 15. It can seen from that figure that the angled shoulder 72e enga the artery in a manner such that the artery substantia conforms to the shoulder with the exterior of the artery form a seal, and limits insertion. With the cannula positioned, it is sutured to the leg by means of the win as shown in Figure 15.
  • the stylet 66 is partially withdr by pulling on the knob 76 to the position shown in Fig
  • the clamp 71 With t stylet stop engaging the ring 80, the clamp 71 is squeez onto the cannula section 72d at a location between the t 66a of the stylet and the suture ring 72c, as seen in Figu 17.
  • the clamp close to the tip 66a of t stylet, there is only a small quantity of blood between t clamp and the stylet stop.
  • the stylet can be withdra completely with a pulling force greater than that previously move the stylet, such that the ring 80 in the e of the fitting is also withdrawn.
  • the ring 80 remai captured on the stylet 66.
  • the reperfusion catheter 16 is preferably made fr flexible polyvinylchloride (PVC) tubing, preferably in t range of 3.5 to 5 French.
  • the catheter 16 include a fema luer lock fitting (not shown) at the proximal en
  • the PVC tubing is barium impregnated incorporates two radiopaque bands for locating purpose one of such bands being located at 61 in Figure 19.
  • T reperfusion catheter 16 has a distal end 58 which contai a plurality of apertures 60 oriented in a spiral along t longitudinal axis of the catheter 16.
  • the holes are abo .030 inch (.762 mm) and extend for a tip length of abo 2 cm.
  • the tip of the catheter 16 tapers to a reduced si of about 3 French (.039 inch, .91 mm).
  • a flexible guidewire 34 such .018 inch diameter, which is capable of being insert through the occlusion in the heart.
  • a guiding catheter is inserted onto the guidewire 34 to a point just short the coronary ostiu .
  • the catheter 16 is inserted onto t guidewire 34 and into the guide catheter 62. Once t smaller reperfusion catheter 16 is positioned with i distal end 58 beyond the occlusion, the guidewire 34 withdrawn, and the reperfusion solution can be pass through the catheter 16 to exit through the apertures 6
  • the tapered tip of the catheter facilitates penetration the blockage and forms a seal with the blockage to prev blood flow through the occlusion.
  • a heart att victim has a heart/lung bypass initiated by cannulating femoral artery by arterial cannula 12 for arterial infl and by cannulating the femoral vein by the venous cathe 10 and advancing it under fluoroscopic control into right atrium for venous return.
  • the femoral-femoral byp is sustained by the above-identified apparatus.
  • the left ventricular vent catheter 14 is inser through the femoral artery through the aortic valve, into the left ventricle to provide left ventricu decompression.
  • the vent catheter 14 maintains the heart an at-rest condition by removing all blood flowing into left ventricle.
  • the process of the heart attack has b slowed markedly by placing the heart in such at-r condition.
  • the reperfusion catheter 16 is inserted as outli above to administer a regional blood cardioplegia distal the site of the occlusion which precipitated the he attack. After reperfusion therapy, the occlusion wh caused the heart attack is then dissolved by thrombolyt agents or by balloon angioplasty.
  • the reperfusion cathet 16 or the guide catheter 62 may advantageously be used f these methods of removing the occlusion.
  • the guidewire, angioplasty catheter are removed an after an additional 30 minutes on total bypass the cathet 14 is withdrawn.
  • the catheters 14, 16 are withdrawn a blood is allowed to enter the left ventricle.
  • the patie can then be taken off the heart bypass system. If t closed artery cannot be penetrated, the patient can transported to the operating room for coronary bypa grafting around the blockage.
  • the apparatus and procedure thus offer the possibili of allowing greatly improved, if not complete, recovery heart attack victims who would otherwise suffer from reduc heart function and shortened life span because a portion the myocardium necrosed from the prolonged absence of bloo
  • Another advantage is provided by the use of one pu for both the venous catheter 10 and the vent catheter 1
  • the single pump greatly simplifies the system operatio and requires less personnel, with less training, to mainta the appropriate blood pressure in the heart attack victi while adequately venting the heart.
  • the system further advantageously lends itself electronic and mechanical control systems uniquely design for performance of total extracorporeal circulation a controlled coronary reperfusion.

Abstract

An apparatus and system to arrest or reverse heart damage from myocardial infraction by using a peripheral, femoral-femoral full bypass along with the venting (10, 14) of the left ventricle wherein the rate at which blood is drawn from the femoral vein and the rate at which the left ventricle is vented are related in a predetermined manner. The damaged area is treated with a cardioplegic solution; the blockage causing the heart attack is then removed by a thrombolytic solution or by angioplasty, while blood is prevented from entering the ventricle and from reactivating the heart from its at-rest condition. Normal blood flow is then restored, and the various catheters and bypass mechanism removed. The system is also useful for peripheral cardiopulmonary bypass systems not involving the application of a cardioplegic solution. The catheters are specially designed for their function.

Description

PERIPHERAL CARDIOPOIJIOHARY BYPASS AND CORONARY REPERFUSION SYSTEM The subject invention relates to the treatment of hea attacks by placing the patient on a heart/lung machi without the necessity of a conventional open-che operation, and to the treatment of the heart attack by t infusion of a special solution directly into the corona arteries supplying the heart muscle. Each year numerous people suffer a heart attack (acu myocardial infarction) due to the obstruction of a corona artery which supplies blood to the heart muscle. Of th number, a significant percentage die before reaching medic attention. Another group succumbs after reaching t hospital. Of those which survive, more than half suff permanent loss of a portion of the heart muscle owing to t damage done during the period of a heart attack by the la of blood supply (ischemia) . This damage impairs the qualit of life, shortens life expectancy, and increases t probability of death with subsequent heart attacks.
Recent experimental studies have demonstrated tha controlled reperfusion, which can be achieved via surgica intervention, may facilitate recovery of the lef ventricular function after myocardial infarction to greater degree than can be achieved using conventiona pharmacologic or mechanical strategies. The September 198 issue of the Journal of Thoracic and Cardiovascular Surger entitled "Studies of Controlled Reperfusion After Ischemia, discloses 'results of laboratory experience supporting t conclusion that controlled reperfusion is necessary. Mo specifically, it has been determined that damage can avoided by administering a special blood cardiopleg reperfusate to the damaged area before normal blood flow resumed. It appears that the cardioplegia solution flush the damaged capillary bed of toxins that have accumulat during the infarct episode. This cleansing apparent facilitates the recovery of the heart tissue when normal blood flow is resumed.
The studies reported in the above-referenced Journal utilized open-chest techniques for the extracorporea circulation, with a secondary pump for the venting of th ventricle to obtain the desired decompression condition.
There have been some femoral-to-femoral bypass systems, such as in U.S. patent 4,540,399, but it is not clear tha total bypass is obtained, and there is no provision fo ventricular venting.
Summarizing some of the foregoing background, it ca be simply stated that: heart attacks are caused by close coronary arteries; opening an artery does not cure th heart attack; and controlling the conditions and compositio of the initial reperfusion of a blocked coronary artery doe permit salvage of the damaged myocardium beyond th obstruction. Heretofore, the only accepted way to contro the conditions and composition of coronary reperfusion o individuals undergoing a heart attack is by open-ches surgical operation with direct decompression of the heart decompression of the left ventricle and direct infusion o the coronary arteries through surgically connected saphenou vein grafts. Although the results of this approach hav been proven superior to results obtained by any of th current methods of treating acute myocardial infarction, th performance of a major operation has risks of mortality an morbidity, and a high level of expense.
It is an object of the present invention to provide a improved system which will minimize the damage to th myocardium following heart attacks. Such a system should b able to be applied quickly after the onset of symptoms.
It is another object that the system should relieve th workload of the heart by supporting the body on a extracorporeal circulation to eliminate the flow work of th heart and relieve the left ventricle of all blood t eliminate pressure work of the heart. It is still another object to provide an improved tot extracorporeal circulation system for medical applications
The invention comprises a unique cardiopulmonary bypa apparatus and system. According to the invention, there provided an extracorporeal bypass apparatus having a veno catheter (10) for insertion into a femoral vein, su catheter being sufficiently long and flexible to reach t atrium area of a patient's heart and an arterial cannu (12) , characterized in that there is provided a single pu (18) connected between the venous catheter and the arteri cannula for withdrawing blood from a patient through sa venous catheter and pumping it into a patient through t arterial cannula; and a vent catheter (14) for inserti into an artery sufficiently long and flexible to reach t left ventricle of the heart, said vent catheter bei connected -in parallel with the venous catheter connected the pump in a manner such that the negative pressu developed by said pump is applied to the venous catheter a the vent catheter, said venous catheter and said pump bei constructed such that substantially all of the patient blood which would normally be returned to the heart bypassed through the venous catheter, and the blood reachi the left ventricle of the heart is withdrawn through t vent catheter so that the ventricle is decompressed. The venous catheter is of special design which, f the first time, permits the induction of percutaneous tot extracorporeal circulation, without producing dangero increases in negative pressure. The hydrodynamics of t venous catheter system are selected so that they permit fu normal cardiac output of 5 to 7 liters per minute witho exceeding a maximum negative pressure, or suction, in t range of 140 to 200 mm Hg. This constraint minimizes blo damage and avoids creating bubbles in the blood.
For use of this system in a heart attack situatio there is provided a blood cardioplegia delivery syst further characterized by a cardioplegia delivery pump (2 having an inlet connected to the output of said arteri pump (18) ; a source of cardioplegic liquid (26) connected a an input to said cardioplegia pump; and a coronar reperfusion catheter assembly including a catheter (16 connected to the output of said cardioplegia pump, th coronary reperfusion catheter being sufficiently long an flexible to be adapted to be inserted through a patient' artery to reach an area of the heart that has been deprive of blood so that a cardioplegia solution can be applied t that area before resuming normal blood flow. The system is useful for routine extracorporea circulation situations. The system further advantageousl lends itself to electronic and mechanical control syste uniquely designed for performance of total extracorporea circulation and controlled coronary reperfusion. The objects and advantages of the invention will beco more apparent from the following description taken conjunction with the accompanying drawings wherein:
Figure 1 is an overall schematic view of the system this invention; Figure 2 is a schematic, partial sectional view of t heart and venous and arterial passages to the heart.
Figure 3 is a partial sectional view of a portion of human heart with a vent catheter and a reperfusion cathet inserted into the heart; Figure 4 is a perspective view of a portion of femoral venous catheter;
Figure 5 is a cross sectional view on line 5-5 Figure 4;
Figure 6 is a graph illustrating the fluid fl dynamics of the venous catheter and the vent catheter;
Figure 7 is a perspective view of a portion of a ve catheter used in this invention;
Figure 8 is a cross section of the vent catheter line 8-8 of Figure 7; Figure 9 is a schematic illustration cTf the use of alternate pumping arrangement; Figure 10 is a schematic perspective view of arterial cannula assembly inserted in the femoral artery;
Figure 11 is a view similar to Figure 10, but with stylet of the cannula assembly partially withdrawn; Figure 12 is a perspective view of the cannu assembly of Figures 10 and 11;
Figure 13 is a perspective view of the stylet of t assembly of Figure 12;
Figure 14 is a perspective view of an anti-backfl ring of the cannula assembly;
Figure 15 is an enlarged, perspective, schematic vi of the cannula assembly inserted in a femoral artery;
Figure 16 is a side elevational, partial sectionalized view of the assembly of Figure 12; Figure 17 is a cross-sectional view of the cannu assembly with the stylet partially withdrawn and with t cannula clamped to prevent flow therethrough;
Figure 18 is a cross-sectional view on line 18-18 Figure 16; and Figure 19 is a perspective view of the detail end the reperfusion catheter assembly.
By way of a brief overview the system will be describ in connection with Figures 1, 2 and 3, as applied to recent heart attack victim. A femoral-femoral bypass performed wherein a femoral venous catheter 10 allows rig heart access via the femoral vein 11. A femoral arteri cannula 12 allows the return of oxygenated blood to t femoral artery, and is used in connection with the veno catheter 10 to achieve femoral-femoral total extracorpore circulation.
A left ventricular vent catheter 14 is used to ve the left heart during extracorporeal circulation with t introduction of the catheter 14 made at the femoral arte and passing transaortically into the left ventricle. coronary reperfusion catheter 16 is inserted into, a transverses a stenosed vessel in order to reperfuse t heart region beyond the stenosis. The venous catheter 10 and the vent catheter 14 are fluid communication with an arterial pump 18 which provid a negative pressure in order to draw venous blood into t arterial pump and to draw blood out of the left ventricl and maintain that portion of the heart in an at re condition. The arterial pump 18 forces the blood throu an oxygenator/heat exchange 20 and an arterial filter 2 A heater/circulator 21 provides fluid flowing into the he exchanger contained within the oxygenator 20. A bridging venous reservoir 25 is connected in flu communication with both the arterial pump 18 and t membrane oxygenator 20 in order to prime the system and maintain sufficient fluid for proper operation. cardioplegia delivery pump 24 is in fluid communicati with the oxygenated blood after it leaves the arteri filter 22, and is also in fluid communication with cardioplegia source 26 so as to mix the oxygenated blo and cardioplegia before delivering it at a predetermin flow rate to the coronary reperfusion catheter 16. The vent catheter 14 removes all residual blood fr the left ventricle and enables the heart to maintain at-rest condition while the reperfusion catheter 16 enabl reperfusion of the heart region beyond the stenosis wh precipitated the heart attack. Venous Catheter
In more detail, the femoral venous catheter 10 preferably made from ethylene-vinyl-acetate (EVA) tubi preferably having about 18% acetate. The tubing has constant inner diameter from the insertion tip up to proximal end. The proximal end of the catheter 10 conne to a 3/8-inch connector which is in fluid communicat with the arterial pump. The catheter 10 should be l enough to reach the right atrium from the femoral triang
An intravascular length about 70 cm, and an overall len of about 85 cm, has been found to be suitable. The t wall and flexibility of the catheter allow for introduction percutaneously into the femoral vein of a w xange of patients, and resist the kinking that mig otherwise occur with other thin wall catheters as they a advanced through the iliac veins and across the curve the pelvis. The distal end 27 of the venous catheter 10, as se in Figures 4 and 5, has a plurality of drainage holes which in a prototype product have a diameter of .165 wi 1/4-inch center to center spacing. These holes have smoo edges and are formed by a tubular cutter, with the cathet internally supported on a mandrel. The holes are arrang in a spiral pattern so that if some holes are blocked vessel walls, others will be open. This arrangement al minimizes weakening of the catheter while providing t necessary hole area. The holes extend sufficiently far fr the distal end of the catheter to span the area from whi blood is to be withdrawn. The preferred technique f introducing this canula into the body is to use t Seldinger technique (percutaneous) or a cutdown procedu along with vessel dilation. A radiopaque tip marker near the distal end enables the drainage holes to oriented in the superior vena cavae. An elongated removab stylet 31 which receives a .045 inch guidewire (not show is used to introduce and guide the catheter into position.
The cross-sectional size and the material of t catheter 10 is particularly critical. Since a total bypa system is needed to accomplish the goals of the inventio it is necessary that the venous catheter fit within vario constraints. Bypassing the patient's total blood fl requires a capacity in the range of up to 5-7 liters p minute. An overall flow rate of 5 liters per minute expected in most patients. A thin-walled construction advantageously used to provide a larger blood flow with the size limitations that may be accommodated by hum veins. The EVA material, in connection with the thi walled construction, provides the needed flexibility to properly positioned, yet sufficient strength to preve kinking during normal handling. Moreover, t characteristics of the material are such that if the tubin is kinked and then released, it is self-restoring withou significant weakening.
It has been determined that a negative pressure 200 mm of mercury is an appropriate safe maximum. High levels of negative pressure, which could create great blood flow, run the increasing risk of creating bubbles the blood. Although a minimum wall thickness is desire the tubing must not collapse when subjected to such negati pressure. It has been determined that a catheter size of
French (O.D. - .341 inch, 8.66 mm) is suitable. Preferabl the catheter has an inner diameter of .277 inch (7.03 mm) thus making a wall thickness of .032 inch (.825 mm). alternative approach is to use two smaller venous cathete that will carry the flow at the same negative pressure.
Figure 6 illustrates the constraints of the veno catheter construction graphically from test data. It c be seen that the fluid flow dynamics are such th significant negative pressure is needed to approach t required flow rates, but yet the increased flow fr increased suction diminishes quickly at higher level particularly for the smaller lumens. Within the acceptab pressure limit, it can be seen that inadequate flow obtained from a 22 F or 24 F (French) thin-walled lumen. 29 French thin-walled size provides adequate flow, but too large for the vein of some patients, and produc insufficient negative pressure to assist vent draina optimally (as discussed below) . Incidentally, the French lumen was made of polyethylene rather than EVA. is believed that the flow curve would be similar for EV The 26 French size provides adequate flow within acceptable pressure range of about 100-200 mm Hg, and can be accommodated by the femoral vein of most adults. Vent Catheter Referring to Figures 7 and 8, the vent catheter 14 preferably a size 12.5 French (.164 inch, 4.166 mm O.D (.120 inch, 3.04 mm I.D.). The catheter is preferably ma fro a flexible polyvinyl chloride (PVC) tubing. The dist end 30 is formed in a loop providing a so-called "pigtail This loop, when unstressed, has an outside diameter of abo 7/8-inch, and has a plurality of spaced apertures 32 whi are preferably about .050 inch in diameter and extend over vent length of about 4 cm. A series of apertures 32 a located on opposite sides of the catheter.
The catheter 14 must be long enough to reach the le ventricle from the femoral triangle when passed retrogra through the arterial system. A catheter with intravascular length of 100 cm, and an overall length about 112 cm is preferred.
As seen from Figure 8, the catheter 14 includes pressure monitoring lumen 41 which is integral with a formed in a wall of the vent catheter 14. Preferably, th lumen 41 has a diameter of about .030 inch. The lumen extends from the proximal end of the catheter 14 to pressure inlet 41a which is spaced from the catheter tip distance further from the tip than the apertures 32. T inlet 41a is positioned about 4 inches from the distal e of the catheter. The inlet 41a is located on the same si of the catheter 14 as the pigtail to prevent obstruction the inlet 41a when the catheter contacts the ventricul wall. Preferably, the catheter 14 is extruded with the lum 41 extending throughout the length of the tubing. After t apertures 32 are formed, the distal end of the tubing heated and stretched to reduce its diameter and increa flexibility, and to form the pigtail into its curled shap In the stretching and heating operation, the lumen 41 closed on the distal end of the catheter. The opening 4 is formed by cutting the tubing at the desired locati spaced further from the tip than the apertures 32.
In the stretching of the distal end, the exteri diameter of the catheter is decreased from .164 inch about .100 inch, and the interior diameter is decreased fr .120 inch to .062 inch. The very tip of the catheter reduced a slight amount further. That is, the tip .030 in is tapered on its exterior and is reduced on its interi diameter to about .040 inch.
The preferred method of introducing the vent cathet 14 into the femoral artery is by using a sheath introduc procedure. After a tubular sheath (not shown) is position in the entrance to the artery, a guidewire 47 is introduc into a stiffening stylet (now shown) that is in the fl lumen of the catheter. The guidewire extends beyond t pigtail distal end 30 sufficiently to straighten it and permit insertion. The assembly is then inserted through t sheath into the artery. The guidewire and stylet a stopped when the wire approaches the aortic valve. T guide wire and the stylet are then withdrawn approximate 10 cm. As the guide wire and stylet are withdrawn past t distal tip, the pigtail recurls, due to its memory, into t position shown in Figure 7. Thus, the curled distal e resiliently engages the aortic valve and passes through t valve without trauma when the valve opens. The distal e then assumes the position illustrated in Figure 2 where the pressure lumen hole 41a in the distal end is shiel from the ventricle walls so as to prevent blockage w pressure is monitored through the catheter. The flexibili of the catheter permits its presence in the ventricl across the aortic valve, without causing distortion of cusps of that valve and therefore avoids aort insufficiency.
A tube 40 is in fluid communication with the proxi end of the vent catheter via one aperture in a Wye connec 38 with the tube also communicating with the arterial p 18. The catheter 14 is sized to allow transmission approximately up to 500 ml per minute of blood flow at same negative pressure at which the catheter 11 is opera by the arterial pump 18. A pressure transducer is connec to a second aperture in the Wye connector 38 which in t is connected to the second lumen 41. Thus, the lumen monitors the pressure in the left ventricle directly. the ventricle is being properly decompressed, the sens pressure should be about zero. Thus, there is a significa difference in pressure on the opposite sides of the aort valve. This can be observed on a pressure monitori instrument by moving the catheter so that the pressure lum inlet 41a is exposed to either ventricular pressure arterial pressure. The location of the inlet 41a important in that, if the pressure is at the ventricul levels, ejecting or decompressed, it is known that the ve apertures 32 are in the ventricle.
The vent catheter is, as noted, necessary to ensu the left ventricle is completely decompressed, and does n fill with fluid and cause the heart to eject (pump) , ev though the heart is being bypassed. The venous dra cannula 10 does not ensure continual left ventric decompression. Some coronary sinus return and/or bronchi flow will enter the left ventricle, distend it, allow wa tension to develop and result in occasional ejection despi apparent right heart decompression from the venous cathet 10. Thus, it is important that the catheter and i connecting tube 40 are sized to transmit the maxim anticipated flow from the left ventricle. This can ran from 50 to 500 ml. Further, it is necessary to restri negative pressure to the 200 mm Hg limitation mention above in connection with the venous catheter.
With reference to Figure 6, the relationship betwe applied negative pressure (ordinate) and venous cannu flow (lower abscissa) and vent catheter flow (upp abscissa) is presented. Note: a) The venous flows of 5 7 LPM are achieved at negative pressures of less than 2 mm Hg only with EVA catheters #26 and #29 French. b) T 12.5 French vent catheter always drains 7 percent of veno flow, the maximum expected flow from the left ventricle venous flows of 5 to 7 LPM. Figure 6 also illustrates the constraints of tubi size and pressure for the vent catheter identified as 12. vent on the graph. The curve for the vent catheter shows vent flow capacity of about 100 ml/minute at a very flo negative pressure, and up to 500 ml/minute at about 17 negative pressure. This is a very satisfactory pressur limit for providing the desired vent flow capacity. A shown in Figure 1, the suction provided by the venou catheter 10 and the ventricular vent catheter 14 are bot advantageously provided by the same arterial pump. Th diameter and flow resistance of the tubes 29, 40 and th catheters 10, 14 are selected with a diameter and length t provide a predetermined ratio of flow from each of th catheters for a given suction by the pump. Thus, the amoun of suction provided to the left ventricle by the ven catheter 14 will vary in a predetermined relationship wit respect to the blood withdrawn from the femoral vein by th venous catheter. While a separate pump can be employed fo the vent catheter, as in the prior art, it is highl desirable that the single pump approach be employed. accomplish this, it is necessary to balance and coordina those two catheters. That is, it is necessary to utilize vent catheter that provides the needed flow within t pressure constraints required in connection with the veno flow. Thus, the amount of suction provided to the le ventricle by the vent catheter will vary in a predetermin relationship with respect to the blood withdrawn from t femoral vein by the venous catheter. As seen, the curve f the vent catheter is very similar to that for the 26 Fren venous catheter in the flow range desired. Thus, if the is a need for change of flow in either catheter, the fl through the other catheter will be satisfactory, with t above specified flow rates, the flow rate of the veno catheter 10 will be, in a preferred construction, about times greater than the flow capacity in the vent catheter for the same negative pressure, but may range from 10 to times greater for tubes of different sizes. If, in monitoring the pressure in the ventricle, it observed that the pressure is becoming too high, indicati an accumulation of blood, pump speed can be increased increase the flow through the vent catheter and the veno catheter, so long as the maximum negative pressure of 200 Hg is not exceeded. Thus, for example, if the ventric pressure should start to climb with vent flow at 360 ml a 5 venous flow at 51, pump speed can be increased to provi 500 ml of vent flow capacity, venous flow only increasing 7 liter a minute, and the negative pressure is at a sa 180. A venous pressure transducer 42 monitors the pressu in the tubes 29 and 40 generated by the arterial pump 18.
10 A ventricular vent catheter of the type describ above is also useful for reducing volume of the ventricl in partial bypass situations, i.e., when not using a veno catheter and an oxygenator. In such situations a larg catheter is desired, such as 18 French. The inlet holes 3
15 may also be enlarged to accommodate increased blood flo Possibly with a larger catheter yet, a 100% assist can attained. Bridσinσ Reservoir
The bridging reservoir 25 is connected in parallel wit
20. the arterial pump 18, with flow clamp 44 between th reservoir and the pump inlet, and a flow clamp 46 betwee the pump outlet and the reservoir. With this arrangemen wherein the flow is not through the reservoir, the volu in the circuit can be controlled by temporarily opening on
25 or the other of the clamps. If more volume is needed, th clamp 44 is briefly opened and then closed when the volu is at the desired level. Similarly, if less volume in t circuit is desired, the clamp 46 is briefly opened unti the desired volume is attained.
30 The system and method of this invention is a clos system; the chest is not opened to access the heart a there is no blood-to-air interface (other than in t oxygenator 20). Thus, whatever blood is taken out of t body must be returned to the body via catheter 12. T
35 bridging reservoir 25 facilitates circulatory stabili during the initiation and conduct of the bypass by providi volume control. Maintaining a stable fluid flow in the bo - is especially important during the time immediatel following the initiation of extracorporeal circulation, a such instability can cause severe hypotension, possibl exacerbate the infarction, and cause secondary arrhythmia or cerebral symptoms. The reservoir provides sufficien fluid to maintain circulatory-stability and has the capacit to allow fluid removal if the patient's blood volume i excessive due to heart failure. Further, the fluid in th reservoir can be used to prime the system. Arterial Pump. Oxvσenator. Filter. Bubble Detector
The arterial pump 18 withdraws blood from the bo under a negative pressure (suction) , along with t appropriate amount of fluid from the reservoir 25, if a is needed, and pumps the blood and fluid mixture out of t pump under a positive pressure. The arterial pump 18 schematically illustrated in Figure 1 as a centrifug pump. Such a pump is known in the art and hence is n described in detail herein. One suitable centrifugal pu is that provided by Biomedicus of Minneapolis, Minnesot A primary advantage of a centrifugal pump is that it h
"hydro-dynamic slippage" such that if the patient's blo volume falls, the blood flow diminishes without produci high negative pressures and creating nucleation ("boiling1 of gasses as might occur with a displacement pump. T pump is connected to an electronic controller to preve negative pressure from going above 200 mm Hg.
From the pump 18, the blood is forced under pressu to the oxygenator 20 where the blood is oxygenated and t temperature of the blood is controlled. The oxygenator and heater circulator are known in the art and are n described in detail herein.
From the blood oxygenator, the blood is preferab forced through an arterial filter 22, although a bypass provided. After leaving the arterial filter 22, the ma portion of the oxygenated and filtered blood is directed the arterial cannula 12 where it is returned to the femor artery of the body. A bubble detector 50 and an arterial pressu transducer 52 may be located on the tube carrying the blo to the arterial cannula 12.
In lieu of aspirating blood through the veno catheter with a centrifugal pump, a positive displaceme pump may be attached to the venous line with an interpos compliance chamber (to dampen phasic pressure variation such that a servo based on negative pressure in the veno line achieves the desired flow. Such a system schematically illustrated in Figure 9. A venous draina line 129, and a vent catheter line 140, comparable to t lines 29 and 40 in Fig. 1, are joined at a Y-connection a common line 141 leading to a compliance chamber 153 This chamber is in turn connected by tubing 145 to positive displacement pump 118 schematically illustrated a peristaltic pump. A suitable example of a peristalti pump is made by Stockert/Shiley, in Munich, Germany. T pump 118 is controlled by an electronic controller 11 which receives pressure feedback from the compliance chambe through a suitable pressure transducer connection 121.
The balance of the system of Fig. 9 is comparable that shown in Fig. 1. A reservoir 125 with inlet and outl controls 144 and 146 bridges the pump 118 to provide fo volume adjustment. The output of the pump is directe through an oxygenator 120, and optionally a filter 122 to line 123 leading to an arterial cannula. A portion of t oxygenator output is directed through a line 128 to cardioplegia pump 124 and conducted through a line 125 to coronary artery by a suitable perfusion catheter. cardioplegia supply 126 is connected by a line 127 to t pump 124.
The compliance chamber 143 includes a flexible bladd or reservoir 151, having an inlet connected on one end the venous drainage line 143 and an outlet connected on i other end to pump inlet tube 145. A rigid outer housing 15 encloses the bladder 151. This housing is sealed around t bladder 151 so that the negative pressure applied to t bladder■ 151 by the pump 118 is also applied to the spa within the housing 153 surrounding the bladder 151. Th negative pressure within the housing 153 is, as indicat above, sensed by a transducer 155 and fed back to t controller 119. A valved outlet 157 from the housing 153 opened to atmosphere during priming to allow the bladder initially expand due to the head pressure of the fluid the system. The valve is then closed so that any changes the size of the bladder are then reflected in pressu changes in housing.
The peristaltic pump 118 is desirable in that t pumping mechanism does not actually contact the blood, th eliminating a source of contamination and allowing reuse the pump. Its shortcoming, however, is that if the blo supply falls, the pump can quickly increase the negati pressure applied on the venous drainage line to unsa levels, even with a pressure sensor in the line to send signal to a controller, the negative pressure can r undesirably before the pump speed reacts to reduce pressu The compliance chamber 143 in combination with a sensor the pump controller solves this problem. The press within the rigid housing 153, being the same as that wit the flexible bladder 151, is continually sensed and fed b to the pump controller. Thus, if there is a sudden loss blood which would result in an increase in negat pressure, the bladder will contract to reduce the rate the negative pressure rise, giving the controller 119 the pump time to reduce the speed of the pump 118. another variation, the housing 153 can be configured replace the bridging reservoir 125, including being provi with the necessary inlet and outlet valves or clam Similarly, venous return can be augmented by negat pressure applied to the space between the housing 153 . the reservoir 151. Cardioplegia Pump
A portion of the oxygenated blood through the arter filter 22 is directed to the cardioplegia delivery pump A cardioplegia solution from a cardioplegia source 26 mixed with the blood and provided under a controll temperature and pressure to the coronary reperfusi catheter 16. A normal body temperature of 37* Celsius believed suitable for the reperfused solution. A suitab cardioplegia solution is believed to be an aspartat glutamate-enriched, hypocalcemia, buffered, hypersomol blood solution, as discussed more particularly in t above-mentioned Journal, Thoracic Cardiovascular Surger September 1986. Controls
A reperfusion pressure transducer 54 and monitor/pu feedback helps regulate the pressure with which t cardioplegia solution is provided to the catheter 16. flow rate of 50 ml/ in or that rate obtained with 50 mm over the pressure drop in the system, whichever is greate is believed suitable for the reperfusion. Thus, flow reduced if the pressure exceeds 50 mm Hg, but the rate best at 50 ml/min if the pressure drops below 50 mm H Further information regarding reperfusion flow rate may found in Article XVI in the above-mentioned journal. T various pressure transducers 42, 52, 54 and the bubb detector 50 all electronically communicate with a syst controller 56, which in turn monitors the vital signs the heart attack victim and regulates the amount of flu withdrawn from, and reintroduced to, the victim. Arterial Cannula
The femoral arterial cannula 12 is, as shown in Figu 12, a component of a cannula assembly 65. The assemb further includes a stylet 66, which is slidably receiv within the cannula, a fitting 68 secured to the proxim end of the cannula, a stopcock 70 on the fitting, and clamp 71. The cannula 12 which is disclosed in detail Figures 10-18 and below is separately claimed in a copendi application since it is useful in systems other than th illustrated in Figure 1. The cannula 12 comprises an elongated -tubular body 72 preferably made from a medical-grade silicone rubber or a polyvinyl chloride material. The body 72 has three primar sections including a distal tip section 72a for insertio into the femoral artery, an intermediate section 72b adapte to extend from the artery to a raised suture stabilizin ring 72c to be located near the exterior skin of the leg, and an exterior section 72d extending from the suture rin
72c to the fitting 68. The tip of section 72a is tapered to facilitat insertion into an artery. In a preproduc ion version o the cannula, the exterior diameter of the tip section 72 is 6.68 mm or 20 French, and the interior diameter i
5.08 mm. The intravascular length of the tip section 72 in a preproduction version is 5.88 cm, which is a desirabl length to ensure adequate seating within the artery.
The intermediate section 72b has a length of abou
5 cm, with an interior diameter that tapers to abou
9.27 mm, and with an exterior diameter which tapers fro the tip end of about 8.4 mm and increases to about 12-13 cm
Thus, it can be seen that there is a significant exterio diameter change from the tip section 72a to the tip end o the intermediate section 72b. This diameter change forms a annular shoulder 72e adapted to engage the exterior of a artery. That shoulder is formed at an angle o approximately 45* with respect to a diametrical plan through the cannula. It has been found that this angle i particularly desirable for sealing with the exterior of th femoral artery when the cannula is inserted in the directio towards the heart.
Due to the angled shoulder and the angle at which th cannula tip is inserted in the femoral artery, it i important the cannula be rotationally oriented properly Thus, for orientation purposes, there is formed an elongate orientation rib 72g on the exterior of sections 72b and 72 extending from the suture ring 72c to the proximal end o the body which mates with the fitting 68. The section 72 is about 19 cm in length, making the overall length of t cannula about 33 cm. The interior and exterior diamete are constant with the end of section 72b.
A pair of suture wings or flaps 74 are formed integr with and extend outwardly from the cannula exterior secti 72d. The wings have a lower surface which is approximate tangent with the exterior of the section 72d. The sutu wings in a prototype are positioned about 5 cm from t suture ring 72c. Referring to Figures 12 and 13, the stylet 66 is elongated flexible tubular element preferably made polyvinyl chloride. The stylet 66 is slightly longer th the cannula 12 having a tapered tip 66a on one end whi extends beyond the tip of the cannula when the stylet fully inserted therein. The overall length is about 42 c A knob 76 on the other end of the stylet extends beyond t fitting 68 and is useful for installing and removing t stylet from the cannula. The diameter of the stylet slightly smaller than the inner diameter of the tip of t cannula. A small diameter lumen 77 is formed througho the length of the stylet and is adapted to receive a sma diameter guidewire. Included on the stylet 66 is cylindrical stop 66b having an exterior diameter which sized to slide relatively easily within the cannula, b nevertheless there is resistance to movement caused by t stop 76b engaging the interior of the cannula. The st 76b is spaced from the tip end of the stylet about 15 and has a length of about 4 cm. This means that the end the stop 76b closest to the tip 66a of the stylet is locat at the suture ring of the cannula when the stylet is ful inserted in the cannula, as seen in Figure 16.
Also included in the cannula assembly is an ant backflow ring 80 preferably made of medical-grade silico rubber. The ring has a short barrel-like tubular sha with two axially spaced outwardly extending annular ri 80a and 80b. The ribs are dimensioned such that th snugly engage the interior wall of the fitting 68 cannula 12 and the exterior of the stylet to form a liqu inner and outer seal.
Mounted on the exterior of the cannula between t suture wings and the fitting 68 is the adjustable medic clamp 71. The clamp is of standard construction, adapt to be manually set to pinch the cannula closed when t stylet is removed.
In use, the guidewire is inserted into the femo artery followed by the cannula and stylet with the styl fully inserted, as shown in Figures 10, 11 and 15. cannula is preferably introduced by use of the Seldin technique, or a cutdown procedure along with ves dilation. The assembly, guided by the guidewire, inserted to the point where the cannula angled shoulder 7 engages the exterior of an artery 82 with the cannula section 72a extending into the artery, together with tip of the stylet, as illustrated in Figure 15. It can seen from that figure that the angled shoulder 72e enga the artery in a manner such that the artery substantia conforms to the shoulder with the exterior of the artery form a seal, and limits insertion. With the cannula positioned, it is sutured to the leg by means of the win as shown in Figure 15.
With the cannula so positioned, there is little bl leakage through the hole in the artery as a result of seal with the shoulder 72e. Also, the backflow ring prevents leakage through the annular passage between stylet and the cannula, as seen in Figure 10. With forward portion of the cannula relatively firmly positio on the patient's leg, the other end of the cannula is f to be raised or manipulated, as may be appreciated f Figures 10 and 11.
When it is desirable to connect the cannula to extracorporeal circuit, the stylet 66 is partially withdr by pulling on the knob 76 to the position shown in Fig
17, wherein the stop 66b on the stylet engages anti-backf ring 80 in the fitting. There is firm resistance w thdrawing the ring 80 out of the cannula so that operator recognizes that that is the point to stop. The t 66a of the stylet is spaced considerably from the sutu ring since the length of the stylet from the stop 66b to i tip 66a is somewhat less than the length of the cannula fr its fitting end to the suture ring 72c. As the stylet 66 withdrawn, a small quantity of blood enters the cannul limited by the volume displaced by the stylet. With t stylet stop engaging the ring 80, the clamp 71 is squeez onto the cannula section 72d at a location between the t 66a of the stylet and the suture ring 72c, as seen in Figu 17. By locating the clamp close to the tip 66a of t stylet, there is only a small quantity of blood between t clamp and the stylet stop. Once the clamp has be positioned, and closed, the stylet can be withdra completely with a pulling force greater than that previously move the stylet, such that the ring 80 in the e of the fitting is also withdrawn. The ring 80 remai captured on the stylet 66. At this stage, there is only small quantity of blood in the open end of the cannula, a it is not under pressure. Because of this and the sutu wings, the end of the cannula can be easily handled f making connections to the pump and priming this cannul without loss of blood. Reperfusion Catheter
The reperfusion catheter 16 is preferably made fr flexible polyvinylchloride (PVC) tubing, preferably in t range of 3.5 to 5 French. The catheter 16 include a fema luer lock fitting (not shown) at the proximal en Preferably, the PVC tubing is barium impregnated incorporates two radiopaque bands for locating purpose one of such bands being located at 61 in Figure 19. T reperfusion catheter 16 has a distal end 58 which contai a plurality of apertures 60 oriented in a spiral along t longitudinal axis of the catheter 16. The holes are abo .030 inch (.762 mm) and extend for a tip length of abo 2 cm. The tip of the catheter 16 tapers to a reduced si of about 3 French (.039 inch, .91 mm).
In installing the coronary reperfusion catheter 1 there is first inserted a flexible guidewire 34, such .018 inch diameter, which is capable of being insert through the occlusion in the heart. A guiding catheter is inserted onto the guidewire 34 to a point just short the coronary ostiu . The catheter 16 is inserted onto t guidewire 34 and into the guide catheter 62. Once t smaller reperfusion catheter 16 is positioned with i distal end 58 beyond the occlusion, the guidewire 34 withdrawn, and the reperfusion solution can be pass through the catheter 16 to exit through the apertures 6
The tapered tip of the catheter facilitates penetration the blockage and forms a seal with the blockage to prev blood flow through the occlusion.
System Operation
The application of the above system and method w now be described with respect to Figure 1. A heart att victim has a heart/lung bypass initiated by cannulating femoral artery by arterial cannula 12 for arterial infl and by cannulating the femoral vein by the venous cathe 10 and advancing it under fluoroscopic control into right atrium for venous return. The femoral-femoral byp is sustained by the above-identified apparatus.
The left ventricular vent catheter 14 is inser through the femoral artery through the aortic valve, into the left ventricle to provide left ventricu decompression. The vent catheter 14 maintains the heart an at-rest condition by removing all blood flowing into left ventricle. The process of the heart attack has b slowed markedly by placing the heart in such at-r condition.
The reperfusion catheter 16 is inserted as outli above to administer a regional blood cardioplegia distal the site of the occlusion which precipitated the he attack. After reperfusion therapy, the occlusion wh caused the heart attack is then dissolved by thrombolyt agents or by balloon angioplasty. The reperfusion cathet 16 or the guide catheter 62 may advantageously be used f these methods of removing the occlusion. Once t reperfusion is completed, a guidewire is reinserted throu it and the reperfusion catheter 16 is removed. angioplasty catheter is then advanced in the guide cathet and conventional angioplasty is performed to relieve t stenosis in the coronary artery which caused a clot form. The guidewire, angioplasty catheter are removed an after an additional 30 minutes on total bypass the cathet 14 is withdrawn. The catheters 14, 16 are withdrawn a blood is allowed to enter the left ventricle. The patie can then be taken off the heart bypass system. If t closed artery cannot be penetrated, the patient can transported to the operating room for coronary bypa grafting around the blockage.
The above procedure, whereby normal blood is exclud from the area of the injured myocardium until after a peri of reperfusion, has been shown in animal tests to lead the consistent recovery of 40-100% of the muscle functi when the treatment is given within four to six hours of t occlusion.
The apparatus and procedure thus offer the possibili of allowing greatly improved, if not complete, recovery heart attack victims who would otherwise suffer from reduc heart function and shortened life span because a portion the myocardium necrosed from the prolonged absence of bloo
Another advantage is provided by the use of one pu for both the venous catheter 10 and the vent catheter 1 The single pump greatly simplifies the system operatio and requires less personnel, with less training, to mainta the appropriate blood pressure in the heart attack victi while adequately venting the heart. The system further advantageously lends itself electronic and mechanical control systems uniquely design for performance of total extracorporeal circulation a controlled coronary reperfusion.
While the above description is of the preferr embodiment, the disclosure will suggest or render appare various modifications and variations to those skilled the art which are within the spirit and scope of the subje invention.

Claims

1. An extracorporeal bypass apparatus having a ve catheter (10) for insertion into a femoral vein, s catheter being sufficiently long and flexible to reach atrium area of a patient's heart and an arterial cann (12) , characterized in that there is provided a single p (18) connected between the venous catheter and the arte cannula for withdrawing blood from a patient through s venous catheter and pumping it into a patient through arterial cannula; and a vent catheter (14) for insert into an artery sufficiently long and flexible to reach left ventricle of the heart, said vent catheter be connected in parallel with the venous catheter connected the pump in a manner such that the negative press developed by said pump is applied to the venous catheter the vent catheter, said venous catheter and said pump be constructed such that substantially all of the patien blood which would normally be returned to the heart bypassed through the venous catheter, and the blood reach the left ventricle of the heart is withdrawn through vent catheter so that the ventricle is decompressed.
2. The apparatus of Claim 1, wherein the negat pressure applied by said pump (18) to the venous cathe (10) and the vent catheter (14) is no greater than 200 Hg and said venous catheter can withdraw up to approximat 7 liters per minute of blood.
3. The apparatus of Claim 1, wherein the f capacity through the venous catheter (10) is about 15 ti greater than that of the vent catheter (14) .
4. The apparatus of Claim 1 wherein said v catheter (14) is a thin-walled flexible tube which ha coiled distal end (30) , which is adapted to conform t guidewire used in inserting the vent catheter, and plurality of apertures (32) in the side wall of its dis end, and said catheter includes a pressure lumen ( extending from the proximal end of the catheter to an in (41a) adjacent said apertures, the apertures being bet the tip of the catheter and the inlet to the pressur lumen.
5. The apparatus of Claim 1, including a reservoi (25) having an inlet in communication with the output o said pump (18) and having an outlet in communication wit the connection between said venous catheter (10) and sai pump, and including means (44, 46) for adjusting the flow o liquid into and out of said reservoir.
6. The apparatus of Claim 1, including a bloo cardioplegia delivery system, further characterized by cardioplegia delivery pump (24) having an inlet connected t the output of said arterial pump (18) ; a source cardioplegic liquid (26) connected as an input to sai cardioplegia pump; and a coronary reperfusion cathet assembly including a catheter (16) connected to the outp of said cardioplegia pump, the coronary reperfusion cathet being sufficiently long and flexible to be adapted to inserted through a patient's artery to reach an area of t heart that has been deprived of blood so that a cardiopleg solution can be applied to that area before resuming norm blood flow.
7. The apparatus of Claim 6, wherein sa reperfusion catheter assembly includes a guidewire (3 adapted to guide the reperfusion catheter through said are and a guide catheter (62) through which said reperfusi catheter is inserted in reaching a point just short of sa area.
8. The apparatus of Claim 1, wherein said veno catheter is made of ethylene-vinyl-acetate material with thin-walled construction that resists kinking.
9. A percutaneous cardiopulmonary bypass apparatu characterized in that there is provided a venous cathet (10) for insertion into a femoral vein; an arterial cannu (12) for insertion into an artery; an oxygenator (20) ; pump (18) connected between the venous catheter and t oxygenator for withdrawing blood from a patient through sa venous catheter and pumping it through the oxygenator a the arterial cannula into a pat ent; br dging non-dynam reservoir (25) having an inlet connected to the output said pumps and an outlet connected to the inlet of sa pump; said catheter being sufficiently long and flexible reach the atrium area of a patient's heart, said cathet having an interior diameter large enough to permit blo flow of 7 liters per minute with a negative pressu provided by said pump being no greater than 200 mm Hg, a said catheter being thin-walled, but non-kinkable wi normal handling.
10. The apparatus of Claim 9, wherein said cathet (10)is made of ethylene-vinyl-acetate, is a French 26 siz has an inner diameter of about than 7 mm and has plurality of holes (28) in its side wall extending from t distal end of the tip (27) far enough to not only draw blo from the atrium area of the heart, but to also draw blo from the portion of the vein draining the lower portion the body.
11. A catheter (14) for use in decompressing patient's heart in a peripheral system, said cathet characterized by a thin-walled, elongated tube to inserted into the patient's artery and fed into t patient's heart, the distal end (30) of said tube bei sufficiently flexible to permit its presence in t ventricle across the patient's aortic valve without causi distortion of the valve cusps and therefore avoiding val insufficiency, said distal end having a plurality openings (32) formed therein to conduct blood out of t patient's ventricle in response to a negative pressure bei applied to the proximal end of the catheter, said openin being located in the side walls of said distal end in pattern to insure that one or more holes will not be block by the walls of the ventricle when negative pressure applied to the catheter.
12. The catheter of Claim 11, including an elongat pressure lumen (41) formed in a wall of said tube, sa lumen having an inlet (41a) sufficiently close to the dist end (30) of the tube so as to be positioned within t patient's ventricle and extending to the proximal end of t tube with said openings located between said pressure lum inlet and the distal tip of the catheter.
13. The catheter of Claim 12, wherein said pressu lumen inlet (41a) is about four inches from the tip of t tube, and wherein said tube is approximately size 15 Fren with an overall length of about 112 cm, .and the interior said tube is approximately .120 inch, and said openings (3 are approximately .050 inch in diameter and extend over tube length of about an inch and a half.
14. Apparatus for withdrawing blood from a patient a peripheral cardiopulmonary bypass system, characterized that there is provided: a venous catheter (10) being sufficiently long a flexible to be inserted into a patient's femoral ve and fed through the venous system to the right atri area of a patient's heart, said catheter having plurality of openings (28) in its distal end to perm blood to be withdrawn into the catheter, and sa catheter having a proximal end adapted to positioned outside of the patient's body; a vent catheter (14) which is sufficiently lo and flexible to be inserted through the patient vascular system with the distal end (30) of the ve catheter being positioned in the left ventricle of t patient's heart and with the vent catheter having proximal end located outside of the patient's bod said vent catheter having a plurality of openings (3 in its distal end for permitting blood in the ventric to be withdrawn through the vent catheter; and tubing including an inlet (29) for connection the proximal end of said venous catheter, a separ inlet (40) for connection to the proximal end of s vent catheter, and a single outlet in communicat with said tubing inlets (29, 40) for connection to inlet of a pump (18) adapted to apply negative pressur to said catheters.
15. The apparatus of Claim 14, wherein said ven catheter (14) includes a pressure lumen (41) formed in th wall of the vent catheter, with the distal end (41a) of th lumen being adapted to sense pressure within the patient' ventricle when in the ventricle, and the proximal end of th pressure lumen is adapted to be connected to a pressur indicator (39) to monitor the ventricle pressure and t provide an indication of any undesirable pressure build-u within the ventricle.
16. The apparatus of Claim 14, including a reservoi (25) having an outlet adapted to be connected to said tubin between said tubing outlet and said tubing inlets (29, 40) said reservoir having an inlet adapted to be connected t the outlet side of said pump (18) .
17. The apparatus of Claim 16, including a flo control (44) on the outlet of said reservoir and a flo control (46) on the inlet to said reservoir.
18. A coronary reperfusion catheter (16) for use i providing cardioplegia to a patient's heart when used i connection with a peripheral cardiopulmonary bypass system said catheter including a tube sufficiently long an flexible to be adapted to be inserted through an occlusio in the patient's artery to reach an area of the heart tha has been deprived of blood so that a cardioplegic solutio can be applied to that area before resuming normal bloo flow, said tube having a tapered distal end (58) whic permits insertion to said area and seals with the occlusion and said tube having a plurality of holes (60) in sai tapered end to permit cardioplegia to be applied to sai area, the portion of the tube walls extending between sai holes and the proximal end of the tube being imperforate.
19. The catheter of Claim 18, wherein said cathete (16) is about a 4.5 French size and the distal end (58) i of a reduced size of about 3 French, and wherein said hole are about .030 inch in diameter and are arranged in a spir and extend about an inch from the tip of the catheter.
20. An extracorporeal heart bypass apparat comprising a venous catheter (29) , an arterial cannula (12 and a positive displacement pump (118) connected to app negative pressure to said catheter to withdraw blood from patient, characterized in that there is provided compliance chamber (143) connected between said pimp a said catheter to reduce the rate of change of negati pressure applied by said pump on said catheter; and controller (119) to control the speed of said pump, sa controller being responsive to the pressure in sa compliance chamber so as to decrease pump speed with increase in negative pressure in the compliance chamber.
21. The apparatus of Claim 20, wherein sa compliance chamber (143) comprises the space between expandable reservoir (151) connected between said pump (11 and said catheter (129), and a closed housing (15 surrounding said reservoir wherein the pressure in t chamber being related to the pressure in the reservoir, sa controller (119) being responsive to the pressure in sa space.
22. The apparatus of Claim 20, including a press transducer sensing the pressure in said space, with transducer (155) connected to provide its press information to said controller.
23. The apparatus of Claim 20, including a v catheter (140) connected in parallel to said venous cathe (129) such that the negative pressure provided by said p (118) is also applied to the vent catheter.
24. The apparatus of Claim 20, including a reserv (125) bridging said pump (118) with said bridging reserv having controls (144, 146) for increasing or decreasing volume of fluid in the system, with said arterial cann (123) for conducting the output of said pump to a patien artery.
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Cited By (9)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5478309A (en) * 1994-05-27 1995-12-26 William P. Sweezer, Jr. Catheter system and method for providing cardiopulmonary bypass pump support during heart surgery
US5523016A (en) * 1991-05-29 1996-06-04 Henkel Kommanditgesellschaft Auf Aktien Liquid pourable and pumpable surfactant preparation
US6217546B1 (en) 1997-05-19 2001-04-17 United States Surgical Corporation Catheter system
US6913601B2 (en) 1994-12-07 2005-07-05 Heartport, Inc. Method for delivering a fluid to the coronary ostia
US10881770B2 (en) 2018-01-10 2021-01-05 Magenta Medical Ltd. Impeller for blood pump
US11191944B2 (en) 2019-01-24 2021-12-07 Magenta Medical Ltd. Distal tip element for a ventricular assist device
US11260212B2 (en) 2016-10-25 2022-03-01 Magenta Medical Ltd. Ventricular assist device
US11291826B2 (en) 2018-01-10 2022-04-05 Magenta Medical Ltd. Axially-elongatable frame and impeller
KR20230039256A (en) * 2021-09-14 2023-03-21 박현수 arterial catheter

Families Citing this family (246)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5270004A (en) 1989-10-01 1993-12-14 Minntech Corporation Cylindrical blood heater/oxygenator
DE4003425A1 (en) * 1990-02-06 1991-08-08 Beyersdorf Friedhelm Dr Med REPERFUSION DEVICE
US5186713A (en) * 1990-11-01 1993-02-16 Baxter International Inc. Extracorporeal blood oxygenation system and method for providing hemoperfusion during transluminal balloon angioplasty procedures
US5308320A (en) * 1990-12-28 1994-05-03 University Of Pittsburgh Of The Commonwealth System Of Higher Education Portable and modular cardiopulmonary bypass apparatus and associated aortic balloon catheter and associated method
US5221257A (en) * 1991-04-26 1993-06-22 Research Industries Corporation Apparatus and method for femoral venous cannulation
US20060161173A1 (en) * 1991-07-03 2006-07-20 Maginot Thomas J Endoscopic bypass grafting method utilizing an inguinal approach
US5304220A (en) 1991-07-03 1994-04-19 Maginot Thomas J Method and apparatus for implanting a graft prosthesis in the body of a patient
US7597697B1 (en) 1991-07-03 2009-10-06 Boston Scientific Scimed, Inc. Bypass grafting method
US7033383B1 (en) 1991-07-03 2006-04-25 Cardiothoracic Systems, Inc. Endoscopic bypass grafting method utilizing an inguinal approach
US5879499A (en) * 1996-06-17 1999-03-09 Heartport, Inc. Method of manufacture of a multi-lumen catheter
US6482171B1 (en) 1991-07-16 2002-11-19 Heartport, Inc. Multi-lumen catheter
US5769812A (en) 1991-07-16 1998-06-23 Heartport, Inc. System for cardiac procedures
US5452733A (en) * 1993-02-22 1995-09-26 Stanford Surgical Technologies, Inc. Methods for performing thoracoscopic coronary artery bypass
US5558644A (en) * 1991-07-16 1996-09-24 Heartport, Inc. Retrograde delivery catheter and method for inducing cardioplegic arrest
US5433700A (en) * 1992-12-03 1995-07-18 Stanford Surgical Technologies, Inc. Method for intraluminally inducing cardioplegic arrest and catheter for use therein
US5458574A (en) * 1994-03-16 1995-10-17 Heartport, Inc. System for performing a cardiac procedure
US5735290A (en) * 1993-02-22 1998-04-07 Heartport, Inc. Methods and systems for performing thoracoscopic coronary bypass and other procedures
US6029671A (en) * 1991-07-16 2000-02-29 Heartport, Inc. System and methods for performing endovascular procedures
US5584803A (en) * 1991-07-16 1996-12-17 Heartport, Inc. System for cardiac procedures
US6866650B2 (en) * 1991-07-16 2005-03-15 Heartport, Inc. System for cardiac procedures
US5795325A (en) * 1991-07-16 1998-08-18 Heartport, Inc. Methods and apparatus for anchoring an occluding member
US5766151A (en) * 1991-07-16 1998-06-16 Heartport, Inc. Endovascular system for arresting the heart
EP0529902B1 (en) * 1991-08-21 1999-02-10 Smith & Nephew, Inc. Fluid management system
US5269752A (en) * 1991-09-12 1993-12-14 Bennett Laurence M Method of extracorporeal treatment using a kink resistant catheter
US5449342A (en) * 1991-09-30 1995-09-12 Nippon Zeon Co., Ltd. Apparatus for assisting blood circulation
EP0665025B1 (en) * 1991-10-23 2002-02-27 Terumo Kabushiki Kaisha Medical pump driving device
US6224619B1 (en) 1991-12-17 2001-05-01 Heartport, Inc. Blood vessel occlusion trocar having size and shape varying insertion body
WO1994003266A1 (en) * 1992-08-03 1994-02-17 Maloney James V Jr Improved mass and thermal transfer means for use in heart lung machines, dialyzers, and other applications
US5718725A (en) * 1992-12-03 1998-02-17 Heartport, Inc. Devices and methods for intracardiac procedures
US6325067B1 (en) * 1992-12-03 2001-12-04 Wesley D. Sterman Methods and systems for performing thoracoscopic coronary bypass and other procedures
US5814097A (en) * 1992-12-03 1998-09-29 Heartport, Inc. Devices and methods for intracardiac procedures
US6283127B1 (en) 1992-12-03 2001-09-04 Wesley D. Sterman Devices and methods for intracardiac procedures
US5728151A (en) * 1993-02-22 1998-03-17 Heartport, Inc. Intercostal access devices for less-invasive cardiovascular surgery
US6494211B1 (en) 1993-02-22 2002-12-17 Hearport, Inc. Device and methods for port-access multivessel coronary artery bypass surgery
US5425705A (en) * 1993-02-22 1995-06-20 Stanford Surgical Technologies, Inc. Thoracoscopic devices and methods for arresting the heart
US5799661A (en) * 1993-02-22 1998-09-01 Heartport, Inc. Devices and methods for port-access multivessel coronary artery bypass surgery
US7213601B2 (en) 1993-02-22 2007-05-08 Heartport, Inc Minimally-invasive devices and methods for treatment of congestive heart failure
US5980455A (en) 1993-02-22 1999-11-09 Heartport, Inc. Method for manipulating a tissue structure within a thoracic cavity
US6010531A (en) * 1993-02-22 2000-01-04 Heartport, Inc. Less-invasive devices and methods for cardiac valve surgery
US6125852A (en) * 1993-02-22 2000-10-03 Heartport, Inc. Minimally-invasive devices and methods for treatment of congestive heart failure
US6346074B1 (en) * 1993-02-22 2002-02-12 Heartport, Inc. Devices for less invasive intracardiac interventions
US5462524A (en) * 1993-07-08 1995-10-31 Research Corporation Technologies Methods for improving recovery of heart function from open heart surgery
US5540841A (en) * 1993-07-26 1996-07-30 Pall Corporation Cardioplegia filter and method for processing cardioplegia fluid
US5409461A (en) * 1993-09-28 1995-04-25 Becton Dickinson And Company Catheter introducer assembly with needle shielding device
US5759170A (en) * 1993-11-30 1998-06-02 Heartport, Inc. Method for intraluminally inducing cardioplegic arrest and catheter for use therein
EP1129744B2 (en) * 1993-12-03 2014-05-07 Edwards Lifesciences AG Cardiopulmonary bypass system for closed-chest intervention
AU740743B2 (en) * 1993-12-03 2001-11-15 Edwards Lifesciences Ag Cardiopulmonary bypass system for closed-chest intervention
CA2181045C (en) * 1993-12-17 2004-08-31 John H. Stevens System for cardiac procedures
AU714807B2 (en) * 1993-12-17 2000-01-13 Heartport, Inc. System for cardiac procedures
US5466216A (en) * 1994-04-11 1995-11-14 Gish Biomedical, Inc. Antegrade/retrograde cardioplegia method and system
US5451207A (en) * 1994-04-25 1995-09-19 The Regents Of The University Of California Method of coronary plaque removal with bypass and perfusion
US5605545A (en) * 1994-05-05 1997-02-25 Northgate Technologies Incorporated Tubing system for delivering fluid to a surgical site
US5597377A (en) * 1994-05-06 1997-01-28 Trustees Of Boston University Coronary sinus reperfusion catheter
US5807243A (en) 1994-08-31 1998-09-15 Heartport, Inc. Method for isolating a surgical site
US5702358A (en) * 1995-02-23 1997-12-30 Sorin Biomedical Inc. Cardioplegia delivery apparatus and method of use
US5904697A (en) 1995-02-24 1999-05-18 Heartport, Inc. Devices and methods for performing a vascular anastomosis
DE69626105T2 (en) * 1995-03-30 2003-10-23 Heartport Inc ENDOVASCULAR CATHETER FOR LEADING FROM THE HEART
CA2215970A1 (en) * 1995-03-30 1996-10-03 Heartport, Inc. System and methods for performing endovascular procedures
AU1952100A (en) * 1995-03-30 2000-05-25 Heartport, Inc. Endovascular cardiac venting catheter and method
US5888247A (en) * 1995-04-10 1999-03-30 Cardiothoracic Systems, Inc Method for coronary artery bypass
DE19514638C2 (en) 1995-04-20 1998-06-04 Peter Dr Med Boekstegers Device for the selective suction and retroinfusion of a fluid from or into body veins controlled by venous pressure
US5863366A (en) * 1995-06-07 1999-01-26 Heartport, Inc. Method of manufacture of a cannula for a medical device
US5836311A (en) * 1995-09-20 1998-11-17 Medtronic, Inc. Method and apparatus for temporarily immobilizing a local area of tissue
US7445594B1 (en) 1995-09-20 2008-11-04 Medtronic, Inc. Method and apparatus for temporarily immobilizing a local area of tissue
US6290644B1 (en) 1996-02-20 2001-09-18 Cardiothoracic Systems, Inc. Surgical instruments and procedures for stabilizing a localized portion of a beating heart
CA2197614C (en) 1996-02-20 2002-07-02 Charles S. Taylor Surgical instruments and procedures for stabilizing the beating heart during coronary artery bypass graft surgery
US5894843A (en) * 1996-02-20 1999-04-20 Cardiothoracic Systems, Inc. Surgical method for stabilizing the beating heart during coronary artery bypass graft surgery
US6852075B1 (en) * 1996-02-20 2005-02-08 Cardiothoracic Systems, Inc. Surgical devices for imposing a negative pressure to stabilize cardiac tissue during surgery
US5980503A (en) * 1996-04-08 1999-11-09 Guidant Corporation Endoscopic cardioplegia infusion cannula and method of use
US6821265B1 (en) 1996-04-10 2004-11-23 Endoscopic Technologies, Inc. Multichannel catheter
US5868703A (en) * 1996-04-10 1999-02-09 Endoscopic Technologies, Inc. Multichannel catheter
US5746709A (en) * 1996-04-25 1998-05-05 Medtronic, Inc. Intravascular pump and bypass assembly and method for using the same
US5916191A (en) * 1996-04-30 1999-06-29 Medtronic, Inc. Pulsatile flow generation in heart-lung machines
US5843024A (en) * 1996-05-17 1998-12-01 Breonics, Inc. Solution and process for resuscitation and preparation of ischemically damaged tissue
US6022336A (en) * 1996-05-20 2000-02-08 Percusurge, Inc. Catheter system for emboli containment
US6270477B1 (en) * 1996-05-20 2001-08-07 Percusurge, Inc. Catheter for emboli containment
US6544276B1 (en) * 1996-05-20 2003-04-08 Medtronic Ave. Inc. Exchange method for emboli containment
ES2323866T3 (en) * 1996-10-04 2009-07-27 United States Surgical Corporation CIRCULATORY SUPPORT SYSTEM.
US5772625A (en) * 1996-11-19 1998-06-30 Heyer-Schulte Neurocare, Inc. External drainage shunt
US5879321A (en) * 1997-01-22 1999-03-09 The University Of Kentucky Research Foundation Portocaval-right atrial shunt
US5957879A (en) * 1997-01-24 1999-09-28 Heartport, Inc. Methods and devices for maintaining cardiopulmonary bypass and arresting a patient's heart
US6106497A (en) * 1997-01-31 2000-08-22 Medical Instrument Development Laboratories System and method for preventing an air embolism in a surgical procedure
JP3036686B2 (en) 1997-02-27 2000-04-24 政夫 高橋 Hemostatic holding device for vascular anastomosis used for coronary artery bypass surgery
US6035856A (en) * 1997-03-06 2000-03-14 Scimed Life Systems Percutaneous bypass with branching vessel
US6155264A (en) * 1997-03-06 2000-12-05 Scimed Life Systems, Inc. Percutaneous bypass by tunneling through vessel wall
US6026814A (en) * 1997-03-06 2000-02-22 Scimed Life Systems, Inc. System and method for percutaneous coronary artery bypass
US5755687A (en) 1997-04-01 1998-05-26 Heartport, Inc. Methods and devices for occluding a patient's ascending aorta
US6217826B1 (en) 1997-04-11 2001-04-17 University Of Pittsburgh Membrane apparatus with enhanced mass transfer, heat transfer and pumping capabilities via active mixing
US6106776A (en) 1997-04-11 2000-08-22 University Of Pittsburgh Membrane apparatus with enhanced mass transfer via active mixing
US6723284B1 (en) 1997-04-11 2004-04-20 University Of Pittsburgh Membrane apparatus with enhanced mass transfer, heat transfer and pumping capabilities via active mixing
US6090096A (en) 1997-04-23 2000-07-18 Heartport, Inc. Antegrade cardioplegia catheter and method
US6068608A (en) * 1997-05-01 2000-05-30 Chase Medical, Inc. Method of using integral aortic arch infusion clamp
US6132397A (en) * 1997-05-01 2000-10-17 Chase Medical Inc. Integral aortic arch infusion clamp catheter
US6092526A (en) * 1997-06-19 2000-07-25 Scimed Life Systems, Inc. Percutaneous chamber-to-artery bypass
US6213126B1 (en) 1997-06-19 2001-04-10 Scimed Life Systems, Inc. Percutaneous artery to artery bypass using heart tissue as a portion of a bypass conduit
US6443158B1 (en) 1997-06-19 2002-09-03 Scimed Life Systems, Inc. Percutaneous coronary artery bypass through a venous vessel
US6241699B1 (en) 1998-07-22 2001-06-05 Chase Medical, Inc. Catheter system and method for posterior epicardial revascularization and intracardiac surgery on a beating heart
EP1024852A2 (en) * 1997-07-22 2000-08-09 Chase Medical Inc. Catheter having a lumen occluding balloon and method of use thereof
US6017493A (en) 1997-09-26 2000-01-25 Baxter International Inc. Vacuum-assisted venous drainage reservoir for CPB systems
US6315751B1 (en) * 1997-08-15 2001-11-13 Cleveland Clinic Foundation Cardiopulmonary bypass system using vacuum assisted venous drainage
US6338712B2 (en) 1997-09-17 2002-01-15 Origin Medsystems, Inc. Device to permit offpump beating heart coronary bypass surgery
US6969349B1 (en) * 1997-09-17 2005-11-29 Origin Medsystem, Inc. Device to permit offpump beating heart coronary bypass surgery
US6390976B1 (en) * 1997-09-17 2002-05-21 Origin Medsystems, Inc. System to permit offpump beating heart coronary bypass surgery
US6889082B2 (en) 1997-10-09 2005-05-03 Orqis Medical Corporation Implantable heart assist system and method of applying same
US6610004B2 (en) * 1997-10-09 2003-08-26 Orqis Medical Corporation Implantable heart assist system and method of applying same
US6110139A (en) * 1997-10-21 2000-08-29 Loubser; Paul Gerhard Retrograde perfusion monitoring and control system
US6231585B1 (en) 1997-11-20 2001-05-15 Medivas, Llc Device for stabilizing a treatment site and method of use
US5957137A (en) * 1997-12-23 1999-09-28 Cobe Cardiovascular Operating Co., Inc. Controlled dilution controlled concentration cardioplegia solution administration
US6533770B1 (en) * 1998-01-21 2003-03-18 Heartport, Inc. Cannula and method of manufacture and use
US6159178A (en) * 1998-01-23 2000-12-12 Heartport, Inc. Methods and devices for occluding the ascending aorta and maintaining circulation of oxygenated blood in the patient when the patient's heart is arrested
US6295990B1 (en) 1998-02-03 2001-10-02 Salient Interventional Systems, Inc. Methods and systems for treating ischemia
US6622367B1 (en) 1998-02-03 2003-09-23 Salient Interventional Systems, Inc. Intravascular device and method of manufacture and use
US7879022B2 (en) 1998-02-06 2011-02-01 Medrad, Inc. Rapid exchange fluid jet thrombectomy device and method
US9586023B2 (en) 1998-02-06 2017-03-07 Boston Scientific Limited Direct stream hydrodynamic catheter system
US6736790B2 (en) 1998-02-25 2004-05-18 Denise R. Barbut Method and system for selective or isolated integrate cerebral perfusion and cooling
US6053896A (en) * 1998-05-01 2000-04-25 Cobe Cardiovascular Operating Co., Inc. Left ventricle valve
WO2000009200A1 (en) 1998-08-12 2000-02-24 Coaxia, Inc. Intravascular methods and apparatus for isolation and selective cooling of the cerebral vasculature during surgical procedures
US6325813B1 (en) 1998-08-18 2001-12-04 Scimed Life Systems, Inc. Method and apparatus for stabilizing vascular wall
BR9913759A (en) * 1998-09-15 2001-06-12 Medtronic Inc System to temporarily immobilize an area of tissue, and system to stabilize tissue
US6632189B1 (en) 1998-09-18 2003-10-14 Edwards Lifesciences Corporation Support device for surgical systems
WO2000043055A1 (en) * 1999-01-21 2000-07-27 Edwards Lifesciences Corporation Low-prime cardiopulmonary bypass circuit
US6245007B1 (en) 1999-01-28 2001-06-12 Terumo Cardiovascular Systems Corporation Blood pump
US6283912B1 (en) * 1999-05-04 2001-09-04 Cardiothoracic Systems, Inc. Surgical retractor platform blade apparatus
US6685632B1 (en) * 1999-05-04 2004-02-03 Cardiothoracic Systems, Inc. Surgical instruments for accessing and stabilizing a localized portion of a beating heart
US6626830B1 (en) 1999-05-04 2003-09-30 Cardiothoracic Systems, Inc. Methods and devices for improved tissue stabilization
US6231506B1 (en) 1999-05-04 2001-05-15 Cardiothoracic Systems, Inc. Method and apparatus for creating a working opening through an incision
US6315768B1 (en) * 1999-06-08 2001-11-13 Richard K. Wallace Perfusion procedure and apparatus for preventing necrosis following failed balloon angioplasty
US6511416B1 (en) * 1999-08-03 2003-01-28 Cardiothoracic Systems, Inc. Tissue stabilizer and methods of use
US6406424B1 (en) * 1999-09-16 2002-06-18 Williamson, Iv Warren P. Tissue stabilizer having an articulating lift element
US7338434B1 (en) 2002-08-21 2008-03-04 Medtronic, Inc. Method and system for organ positioning and stabilization
US6769434B2 (en) * 2000-06-30 2004-08-03 Viacor, Inc. Method and apparatus for performing a procedure on a cardiac valve
US6712856B1 (en) * 2000-03-17 2004-03-30 Kinamed, Inc. Custom replacement device for resurfacing a femur and method of making the same
US6454697B1 (en) * 2000-07-18 2002-09-24 Dai-Yuan Wang Cardiac support device and method
US6488662B2 (en) * 2000-12-19 2002-12-03 Laksen Sirimanne Percutaneous catheter assembly
US6676597B2 (en) 2001-01-13 2004-01-13 Medtronic, Inc. Method and device for organ positioning
US6758808B2 (en) 2001-01-24 2004-07-06 Cardiothoracic System, Inc. Surgical instruments for stabilizing a localized portion of a beating heart
US6773670B2 (en) * 2001-02-09 2004-08-10 Cardiovention, Inc. C/O The Brenner Group, Inc. Blood filter having a sensor for active gas removal and methods of use
US6730267B2 (en) * 2001-02-09 2004-05-04 Cardiovention, Inc. Integrated blood handling system having active gas removal system and methods of use
US7063714B2 (en) * 2001-08-22 2006-06-20 Gore Enterprise Holdings, Inc. Apparatus and methods for treating stroke and controlling cerebral flow characteristics
US6902540B2 (en) * 2001-08-22 2005-06-07 Gerald Dorros Apparatus and methods for treating stroke and controlling cerebral flow characteristics
US6929634B2 (en) * 2001-08-22 2005-08-16 Gore Enterprise Holdings, Inc. Apparatus and methods for treating stroke and controlling cerebral flow characteristics
US20070160645A1 (en) * 2001-10-25 2007-07-12 Jakob Vinten-Johansen PostConditioning System And Method For The Reduction Of Ischemic-Reperfusion Injury In The Heart And Other Organs
EP1438085B1 (en) 2001-10-25 2008-10-15 Emory University Catheter for modified perfusion
US8328877B2 (en) * 2002-03-19 2012-12-11 Boston Scientific Scimed, Inc. Stent retention element and related methods
US7527608B2 (en) * 2002-08-12 2009-05-05 Lma North America, Inc. Medication infusion and aspiration system and method
US7494460B2 (en) * 2002-08-21 2009-02-24 Medtronic, Inc. Methods and apparatus providing suction-assisted tissue engagement through a minimally invasive incision
US7371223B2 (en) * 2002-10-02 2008-05-13 Boston Scientific Scimed, Inc. Electroactive polymer actuated heart-lung bypass pumps
US7931590B2 (en) 2002-10-29 2011-04-26 Maquet Cardiovascular Llc Tissue stabilizer and methods of using the same
US20040111079A1 (en) * 2002-12-03 2004-06-10 Richard Hayes Targeted sanguinous drug solution delivery to a targeted organ
US20030130610A1 (en) * 2002-12-09 2003-07-10 Mager Larry F. Aortic balloon catheter with improved positioning and balloon stability
US7189352B2 (en) * 2003-01-14 2007-03-13 Medtronic, Inc. Extracorporeal blood circuit priming system and method
US7198751B2 (en) * 2003-01-14 2007-04-03 Medtronic, Inc. Disposable, integrated, extracorporeal blood circuit
US7201870B2 (en) * 2003-01-14 2007-04-10 Medtronic, Inc. Active air removal system operating modes of an extracorporeal blood circuit
US7204958B2 (en) * 2003-01-14 2007-04-17 Medtronic, Inc. Extracorporeal blood circuit air removal system and method
US7335334B2 (en) * 2003-01-14 2008-02-26 Medtronic, Inc. Active air removal from an extracorporeal blood circuit
US7022099B2 (en) * 2003-03-17 2006-04-04 Cardiovention, Inc. Extracorporeal blood handling system with automatic flow control and methods of use
US20050085762A1 (en) * 2003-03-31 2005-04-21 Venkataramana Vijay Perfusion circuit for cardiopulmonary bypass with air removal system
US6946099B2 (en) * 2003-03-31 2005-09-20 Venkataramana Vijay Methods of using condensed perfusion circuit for cardiopulmonary bypass and cardioplegia
US20060129091A1 (en) 2004-12-10 2006-06-15 Possis Medical, Inc. Enhanced cross stream mechanical thrombectomy catheter with backloading manifold
US7479104B2 (en) 2003-07-08 2009-01-20 Maquet Cardiovascular, Llc Organ manipulator apparatus
DE10336902C5 (en) * 2003-08-08 2019-04-25 Abiomed Europe Gmbh Intracardiac pumping device
US20050085683A1 (en) * 2003-10-15 2005-04-21 Bolling Steven F. Implantable heart assist system and method of applying same
US7455812B2 (en) * 2003-10-16 2008-11-25 Rheoxtech, Llc Method and apparatus for controlled reoxygenation
AU2004286782B2 (en) * 2003-11-07 2010-08-26 Gambro Lundia Ab Fluid distribution module and extracorporeal blood circuit including such a module
US7326195B2 (en) * 2003-11-18 2008-02-05 Boston Scientific Scimed, Inc. Targeted cooling of tissue within a body
US7179224B2 (en) * 2003-12-30 2007-02-20 Cardiothoracic Systems, Inc. Organ manipulator and positioner and methods of using the same
US20050148824A1 (en) * 2003-12-30 2005-07-07 Morejohn Dwight P. Transabdominal surgery system
US7399272B2 (en) 2004-03-24 2008-07-15 Medtronic, Inc. Methods and apparatus providing suction-assisted tissue engagement
US20060129087A1 (en) * 2004-03-31 2006-06-15 Takefumi Uesugi Method and apparatus for supplying predetermined gas into body cavities of a patient
US7445592B2 (en) * 2004-06-10 2008-11-04 Orqis Medical Corporation Cannulae having reduced flow resistance
US20050277870A1 (en) * 2004-06-10 2005-12-15 Robert Pecor Cannula having reduced flow resistance
US20060025840A1 (en) * 2004-08-02 2006-02-02 Martin Willard Cooling tissue inside the body
US7458952B2 (en) * 2004-11-18 2008-12-02 Venkataramana Vijay Integrated cardiopulmonary bypass system for open and closed bypass circuits
AU2005319144A1 (en) * 2004-12-22 2006-06-29 Emory University Therapeutic adjuncts to enhance the organ protective effects of postconditioning
US7947030B2 (en) * 2004-12-30 2011-05-24 Reynaldo Calderon Retrograde perfusion of tumor sites
US20060184199A1 (en) * 2005-02-14 2006-08-17 O'leary Shawn Apparatus and methods for reducing bleeding from a cannulation site
CA2601479A1 (en) * 2005-03-07 2006-09-14 Transonic Systems, Inc. System and method for determining cardiac output
US20060224110A1 (en) * 2005-03-17 2006-10-05 Scott Michael J Methods for minimally invasive vascular access
US7833268B2 (en) * 2005-04-29 2010-11-16 Delgado Iii Reynolds M Method and apparatus for implanting an aortic valve prosthesis
US8083664B2 (en) 2005-05-25 2011-12-27 Maquet Cardiovascular Llc Surgical stabilizers and methods for use in reduced-access surgical sites
US9283314B2 (en) * 2005-09-21 2016-03-15 Abiomed, Inc. Cannula systems
US8012117B2 (en) * 2007-02-06 2011-09-06 Medrad, Inc. Miniature flexible thrombectomy catheter
US20080188793A1 (en) * 2007-02-06 2008-08-07 Possis Medical, Inc. Miniature flexible thrombectomy catheter
US8162878B2 (en) * 2005-12-05 2012-04-24 Medrad, Inc. Exhaust-pressure-operated balloon catheter system
US8303569B2 (en) * 2006-04-19 2012-11-06 Medtronic Vascular, Inc. Composite laminated catheter with flexible segment and method of making same
US8308712B2 (en) * 2006-04-19 2012-11-13 Medronic Vascular, Inc. Composite laminated catheter with flexible segment and method of making same
US7794387B2 (en) 2006-04-26 2010-09-14 Medtronic, Inc. Methods and devices for stabilizing tissue
FR2901480A1 (en) * 2006-05-24 2007-11-30 Hemocare Sa Hydraulic circuit for intra-peritoneal or intrathoracic hyperthermal chemotherapy process implementing device, has discharging circuit connected to one of ends of exchanger and including discharge end in cavity of peritoneum of patient
US10772600B2 (en) 2015-09-25 2020-09-15 Perceptive Navigation Llc Image guided catheters and methods of use
US9855021B2 (en) 2006-10-12 2018-01-02 Perceptive Navigation, LLC Image guided catheters and methods of use
US8403858B2 (en) * 2006-10-12 2013-03-26 Perceptive Navigation Llc Image guided catheters and methods of use
US7867266B2 (en) * 2006-11-13 2011-01-11 Zoll Circulation, Inc. Temperature management system with assist mode for use with heart-lung machine
US8974418B2 (en) * 2007-06-12 2015-03-10 Boston Scientific Limited Forwardly directed fluid jet crossing catheter
US20080319386A1 (en) * 2007-06-20 2008-12-25 Possis Medical, Inc. Forwardly directable fluid jet crossing catheter
US8489190B2 (en) 2007-10-08 2013-07-16 Ais Gmbh Aachen Innovative Solutions Catheter device
US8439859B2 (en) 2007-10-08 2013-05-14 Ais Gmbh Aachen Innovative Solutions Catheter device
WO2009079539A1 (en) * 2007-12-17 2009-06-25 Medrad, Inc. Rheolytic thrombectomy catheter with self-inflation distal balloon
US8353907B2 (en) 2007-12-21 2013-01-15 Atricure, Inc. Ablation device with internally cooled electrodes
US8998892B2 (en) 2007-12-21 2015-04-07 Atricure, Inc. Ablation device with cooled electrodes and methods of use
US8439878B2 (en) * 2007-12-26 2013-05-14 Medrad, Inc. Rheolytic thrombectomy catheter with self-inflating proximal balloon with drug infusion capabilities
US8647294B2 (en) 2008-03-20 2014-02-11 Medrad, Inc. Direct stream hydrodynamic catheter system
EP2313126A4 (en) 2008-07-17 2018-03-28 Rheoxtech, LLC Method and apparatus for mitigating acute reoxygenation injury during percutaneous coronary intervention
US20100094074A1 (en) * 2008-10-10 2010-04-15 Hologic Inc. Brachytherapy apparatus and methods employing expandable medical devices comprising fixation elements
EP2194278A1 (en) 2008-12-05 2010-06-09 ECP Entwicklungsgesellschaft mbH Fluid pump with a rotor
EP2216059A1 (en) 2009-02-04 2010-08-11 ECP Entwicklungsgesellschaft mbH Catheter device with a catheter and an actuation device
EP2229965A1 (en) 2009-03-18 2010-09-22 ECP Entwicklungsgesellschaft mbH Fluid pump with particular form of a rotor blade
EP2246078A1 (en) 2009-04-29 2010-11-03 ECP Entwicklungsgesellschaft mbH Shaft assembly with a shaft which moves within a fluid-filled casing
EP2248544A1 (en) 2009-05-05 2010-11-10 ECP Entwicklungsgesellschaft mbH Fluid pump with variable circumference, particularly for medical use
EP2266640A1 (en) 2009-06-25 2010-12-29 ECP Entwicklungsgesellschaft mbH Compressible and expandable turbine blade for a fluid pump
EP2282070B1 (en) 2009-08-06 2012-10-17 ECP Entwicklungsgesellschaft mbH Catheter device with a coupling device for a drive device
EP2299119B1 (en) 2009-09-22 2018-11-07 ECP Entwicklungsgesellschaft mbH Inflatable rotor for a fluid pump
EP2298373A1 (en) 2009-09-22 2011-03-23 ECP Entwicklungsgesellschaft mbH Fluid pump with at least one turbine blade and a seating device
EP2298371A1 (en) 2009-09-22 2011-03-23 ECP Entwicklungsgesellschaft mbH Function element, in particular fluid pump with a housing and a transport element
EP2298372A1 (en) 2009-09-22 2011-03-23 ECP Entwicklungsgesellschaft mbH Rotor for an axial pump for transporting a fluid
DE102009045589A1 (en) * 2009-10-12 2011-04-14 Universitätsklinikum Freiburg Apparatus for treating an individual with cardiac output, cardiac arrest or stroke
US8888737B2 (en) 2009-10-20 2014-11-18 Rheoxtech, Llc Method and apparatus for cardiac tissue monitoring and catheter-based perfusion for mitigating acute reoxygenation injury
EP2314330A1 (en) 2009-10-23 2011-04-27 ECP Entwicklungsgesellschaft mbH Flexible shaft arrangement
EP2314331B1 (en) 2009-10-23 2013-12-11 ECP Entwicklungsgesellschaft mbH Catheter pump arrangement and flexible shaft arrangement with a cable core
US20110152741A1 (en) * 2009-12-21 2011-06-23 Michael Banchieri Cannula system
US9339599B2 (en) 2009-12-21 2016-05-17 Sorin Group Usa, Inc. Self-dilating cannula
EP2338539A1 (en) 2009-12-23 2011-06-29 ECP Entwicklungsgesellschaft mbH Pump device with a detection device
EP2338540A1 (en) 2009-12-23 2011-06-29 ECP Entwicklungsgesellschaft mbH Delivery blade for a compressible rotor
EP2338541A1 (en) 2009-12-23 2011-06-29 ECP Entwicklungsgesellschaft mbH Radial compressible and expandable rotor for a fluid pump
EP2347778A1 (en) 2010-01-25 2011-07-27 ECP Entwicklungsgesellschaft mbH Fluid pump with a radially compressible rotor
US9022998B2 (en) 2010-02-26 2015-05-05 Maquet Cardiovascular Llc Blower instrument, apparatus and methods of using
EP2363157A1 (en) 2010-03-05 2011-09-07 ECP Entwicklungsgesellschaft mbH Device for exerting mechanical force on a medium, in particular fluid pump
EP2388029A1 (en) 2010-05-17 2011-11-23 ECP Entwicklungsgesellschaft mbH Pump array
AU2011268433A1 (en) 2010-06-14 2013-01-10 Maquet Cardiovascular Llc Surgical instruments, systems and methods of use
EP2399639A1 (en) 2010-06-25 2011-12-28 ECP Entwicklungsgesellschaft mbH System for introducing a pump
EP2407185A1 (en) 2010-07-15 2012-01-18 ECP Entwicklungsgesellschaft mbH Radial compressible and expandable rotor for a pump with a turbine blade
EP2407187A3 (en) 2010-07-15 2012-06-20 ECP Entwicklungsgesellschaft mbH Blood pump for invasive application within the body of a patient
EP2407186A1 (en) 2010-07-15 2012-01-18 ECP Entwicklungsgesellschaft mbH Rotor for a pump, produced with an initial elastic material
EP2422735A1 (en) 2010-08-27 2012-02-29 ECP Entwicklungsgesellschaft mbH Implantable blood transportation device, manipulation device and coupling device
EP2497521A1 (en) 2011-03-10 2012-09-12 ECP Entwicklungsgesellschaft mbH Push device for axial insertion of a string-shaped, flexible body
US8795253B2 (en) 2011-04-05 2014-08-05 Sorin Group Italia S.R.L. Bi-directional perfusion cannula
EP2564771A1 (en) 2011-09-05 2013-03-06 ECP Entwicklungsgesellschaft mbH Medicinal product with a functional element for invasive use in the body of a patient
US8926492B2 (en) 2011-10-11 2015-01-06 Ecp Entwicklungsgesellschaft Mbh Housing for a functional element
EP2606920A1 (en) 2011-12-22 2013-06-26 ECP Entwicklungsgesellschaft mbH Sluice device for inserting a catheter
EP2606919A1 (en) 2011-12-22 2013-06-26 ECP Entwicklungsgesellschaft mbH Sluice device for inserting a catheter
EP2745869A1 (en) 2012-12-21 2014-06-25 ECP Entwicklungsgesellschaft mbH Sluice assembly for the introduction of a cord-like body, in particular of a catheter, into a patient
US9629981B2 (en) * 2013-12-13 2017-04-25 Dolcera Information Technology Services Private Limited Drainage catheter
DE102015000771A1 (en) * 2015-01-26 2016-07-28 Xenios Ag Arrangement with a suction line, a pressure line and a pump
CN104841029A (en) * 2015-03-20 2015-08-19 陈明龙 External cardio pump
WO2017075528A1 (en) 2015-10-30 2017-05-04 ECMOtek, LLC Devices for endovascular access through extracorporeal life support circuits
US20190000558A1 (en) 2017-06-28 2019-01-03 Theodore P. Abraham Devices and methods for image-guided percutaneous cardiac valve implantation and repair
US20210085955A1 (en) * 2018-04-06 2021-03-25 Kanha Vijay SINGRU Ventricular decompression and assisting apparatus

Family Cites Families (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3513845A (en) * 1966-09-15 1970-05-26 United Aircraft Corp Bypass heart pump and oxygenator system
US3903895A (en) * 1973-01-05 1975-09-09 Sherwood Medical Ind Inc Cardiovascular catheter
JPS5491805U (en) * 1977-12-13 1979-06-29
US4196731A (en) * 1978-03-17 1980-04-08 Baxter Travenol Laboratories, Inc. Silicone-containing thermoplastic polymers for medical uses
US4540399A (en) * 1983-02-01 1985-09-10 Ken Litzie Emergency bypass system

Non-Patent Citations (1)

* Cited by examiner, † Cited by third party
Title
Journal of Thoracii and Cardiovascular Surgery Volume 92, Number 3 Part 2 published September, 1986, C.V. MOSBY Co., St. Louis, Mo., U.S., Regional Blood Cardiplegic Perfusion During Vented by without Thoracotomy: A new Concept, (Okamoto, M.D), see the entire article, page 553-563. *

Cited By (26)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5523016A (en) * 1991-05-29 1996-06-04 Henkel Kommanditgesellschaft Auf Aktien Liquid pourable and pumpable surfactant preparation
US5478309A (en) * 1994-05-27 1995-12-26 William P. Sweezer, Jr. Catheter system and method for providing cardiopulmonary bypass pump support during heart surgery
US6913601B2 (en) 1994-12-07 2005-07-05 Heartport, Inc. Method for delivering a fluid to the coronary ostia
US6217546B1 (en) 1997-05-19 2001-04-17 United States Surgical Corporation Catheter system
US11260212B2 (en) 2016-10-25 2022-03-01 Magenta Medical Ltd. Ventricular assist device
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US11291825B2 (en) 2016-10-25 2022-04-05 Magenta Medical Ltd. Ventricular assist device
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US11806116B2 (en) 2018-01-10 2023-11-07 Magenta Medical Ltd. Sensor for blood pump
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US11185680B2 (en) 2018-01-10 2021-11-30 Magenta Medical Ltd. Ventricular assist device
US11684275B2 (en) 2018-01-10 2023-06-27 Magenta Medical Ltd. Distal tip element for blood pump
US11666747B2 (en) 2019-01-24 2023-06-06 Magenta Medical Ltd. Manufacturing an impeller
US11484699B2 (en) 2019-01-24 2022-11-01 Magenta Medical Ltd. Welding overtube
US11471663B2 (en) 2019-01-24 2022-10-18 Magenta Medical Ltd. Frame for blood pump
US11298523B2 (en) 2019-01-24 2022-04-12 Magenta Medical Ltd. Impeller housing
US11285309B2 (en) 2019-01-24 2022-03-29 Magenta Medical Ltd. Ventricular assist device with stabilized impeller
US11191944B2 (en) 2019-01-24 2021-12-07 Magenta Medical Ltd. Distal tip element for a ventricular assist device
KR20230039256A (en) * 2021-09-14 2023-03-21 박현수 arterial catheter
KR102596967B1 (en) * 2021-09-14 2023-10-31 박현수 arterial catheter

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EP0431071A4 (en) 1992-03-11
AU4169693A (en) 1993-09-16
US5011469A (en) 1991-04-30
EP0431071A1 (en) 1991-06-12
AU4315789A (en) 1990-03-23
JPH07114808B2 (en) 1995-12-13
JPH04501220A (en) 1992-03-05
DE8990089U1 (en) 1991-08-22
CA1325754C (en) 1994-01-04
EP0357338A2 (en) 1990-03-07

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