WO1999004708A1 - Apparatus and method for transmyocardial revascularization by laser ablation - Google Patents
Apparatus and method for transmyocardial revascularization by laser ablation Download PDFInfo
- Publication number
- WO1999004708A1 WO1999004708A1 PCT/US1998/015139 US9815139W WO9904708A1 WO 1999004708 A1 WO1999004708 A1 WO 1999004708A1 US 9815139 W US9815139 W US 9815139W WO 9904708 A1 WO9904708 A1 WO 9904708A1
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- WO
- WIPO (PCT)
- Prior art keywords
- laser ablation
- channel
- ablation member
- fiber
- laser
- Prior art date
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Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
- A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
- A61B18/22—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00238—Type of minimally invasive operation
- A61B2017/00243—Type of minimally invasive operation cardiac
- A61B2017/00247—Making holes in the wall of the heart, e.g. laser Myocardial revascularization
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
- A61B2018/00345—Vascular system
- A61B2018/00351—Heart
- A61B2018/00392—Transmyocardial revascularisation
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/03—Automatic limiting or abutting means, e.g. for safety
- A61B2090/033—Abutting means, stops, e.g. abutting on tissue or skin
Definitions
- the present disclosure relates to improved apparatus and methods for transmyocardial revascularization (TMR) by laser ablation with a lasing device.
- TMR transmyocardial revascularization
- TMR is a procedure for treating heart disease, wherein multiple channels of small diameter are created in the heart wall, extending into the ventricle. Such channels facilitate delivery of blood directly from the ventricle to oxygen starved areas of the heart .
- TMR is typically used on patients with ischemic heart disease, particularly those who are not candidates for coronary artery bypass or percutaneous transluminal angioplasty.
- each channel is of sufficiently small diameter such that the end portions of the channels at the epicardium can be closed by blood clotting.
- the channels can be created by employing either a mechanical coring apparatus or a lasing device. With either technique, an objective is to produce channels that remain internally patent in the long term and which do not close up due to fibrosis and/or scarring.
- a CO2 laser was used to produce holes in the heart wall by transmitting laser energy from the laser to the heart wall.
- Typical CO2 lasers used for TMR are externally located and have an articulated support arm for aiming and directing laser energy through a series of mirrors that reflect the energy onto the heart wall.
- some surgical opening of the chest wall is required to access the heart muscle.
- the entrance wound in the heart can be closed by relatively brief external pressure while the endocardial and myocardial layers remain open to permit blood flow from the ventricle to the heart muscle .
- the intravascular method involves the direction of laser energy from inside the heart to form a bore in the heart wall while the other method involves introduction of the lasing apparatus through a relatively small iincision in the patient's chest to access the outer wall of the heart .
- U.S. Patent No. 4,658,817 to Hardy discloses a method and apparatus for TMR using a laser wherein a hollow needle having a sharp distal tip is inserted into the epicardium and a laser beam is focussed through the needle to create channels. It is stated in the Hardy patent that this technique eliminates surface bleeding and the need for suture. However, there is no laser ablation member (e.g., optical fiber) that advances through the needle and into the myocardium contemporaneously with laser energy being generated.
- laser ablation member e.g., optical fiber
- the technique for stopping the bleeding from each channel at the epicardium after channel formation typically entails applying pressure to the opening of the just-formed channel. Pressure is typically applied by the finger of the surgeon or assistant during open heart surgery, or with a laparoscopic instrument when the procedure is performed laparoscopically . In either case, because pressure is applied to each channel opening for at least several seconds, and it is impractical to begin forming another channel until the bleeding is stopped from the previous channel, the overall TMR procedure can be undesirably prolonged by the time expended on applying pressure to each channel.
- the present disclosure is directed to methods for performing transmyocardial revascularization employing a laser device having a laser ablation member, e.g., one or more optical fibers.
- One preferred method includes the steps of : advancing the laser ablation member a predetermined distance within the patien ' s heart tissue to mechanically pierce the epicardium; then outputting laser energy from the laser ablation member to ablate heart tissue and create a patent channel extending into the patient's ventricle; and, withdrawing the laser ablation member from the heart tissue, whereby epicardial tissue pushed aside during the initial advancing step substantially returns to a position coinciding with the channel and acts as a channel cap to reduce bleeding from the channel.
- the distal end of the laser fiber is advanced to or maintained at a position such that it extends distally from a laser handpiece held by the surgeon; the fiber is caused to press against the epicardium prior to laser firing, thereby causing the exterior tissue to "tent". The fiber is then advanced at a desired rate as the laser fires to form the channel.
- the laser fiber can be placed against the epicardium and initially advanced at a rate faster than the tissue ablation rate of the laser. In this method, the fiber during this stage, will mechanically pass through the heart tissue. After the fiber travels though at least a portion of the epicardium, the fiber advancement rate can be decreased to such a rate that the laser energy alone ablates the tissue to form the channel.
- the fiber can be advanced at a constant rate while the pulse rate of the laser is varied to allow mechanical passage of the fiber through at least a portion of the epicardium. More specifically, the amount of energy delivered by the laser fiber can be low, e.g., fewer pulses per second, while passing through a portion of the epicardium, and increased thereafter to complete the channel.
- the fiber creates a flap or "channel cap" in the epicardial surface.
- the interface between the channel cap and the adjacent epicardial/myocardial tissue defines a very narrow opening such that blood clotting can occur rapidly at the. interface.
- the present method may even allow the pressure-applying step to be eliminated entirely.
- the pressure of the channel cap may permit larger channels to be formed, as compared to channels without the cap, due to the channel cap's ability to moderate or prevent the flow of blood from the channel.
- FIG. 1 illustrates a laser ablation device used to create TMR channels
- FIG. 2 is a perspective view of the laser ablation device
- FIG. 3 is a perspective view of the hand piece of the laser ablation device;
- FIG. 4 is an exploded view showing the various components of the hand piece;
- FIG. 5 is a side view of the hand piece having a fiber extended in proximity to the epicardium
- FIG. 6 is a side view showing piercing of the epicardium
- FIG. 7 is a side view showing the fiber being advanced through the myocardium and endocardium;
- FIG. 8 is a side view showing withdrawal of the fiber from the heart tissue to reveal the channel created therein;
- FIG. 9A is a cross-sectional view of a completed transmyocardial channel
- FIG. 9B is an end view of the epicardium having a channel capped by a flap;
- FIGS. 10-13 illustrate an alternate method for performing TMR disclosed herein, where:
- FIG. 10 is a side view of the hand piece in proximity to the epicardium
- FIG. 11 is a side view showing piercing of the epicardium
- FIG. 12 is a side view showing the fiber being advanced through the myocardium and endocardium;
- FIG. 13 is a side view showing withdrawal of the fiber from the heart tissue to reveal the channel created therein;
- FIGS. 14-16 illustrate an alternative method for performing TMR disclosed herein; where:
- FIG. 14 is a side view showing piercing of the epicardium;
- FIG. 15 is a side view showing the fiber being advanced through the myocardium and endocardium;
- FIG. 16 is a side view showing withdrawal of the fiber from the heart tissue to reveal the channel created therein;
- FIGS. 17-19 illustrate an alternative method for performing TMR disclosed herein, where:
- FIG. 17 is a side view showing piercing of the epicardium
- FIG. 18 is a side view showing the fiber being advanced through the myocardium and endocardium; and FIG. 19 is a side view showing withdrawal of the fiber from the heart tissue to reveal the channel created therein.
- a laser ablation device designated generally as 10, is employed to practice a TMR procedure in accordance with the present disclosure.
- Device 10 is capable of advancing a laser ablation member 18 through heart tissue while concomitantly outputting laser energy, where the advancement rate is coordinated with the magnitude of laser energy generated and with the pulsing frequency of the laser source. This coordination enables highly patent and precise TMR channels to be created.
- Lasing device 10 is similar to lasing devices disclosed in copending, commonly assigned U.S. Patent Application Serial No. 08/648,638 to Pacala et al . , filed May 13, 1996, the subject matter of which is incorporated herein by reference.
- Laser ablation device 10 includes a hand piece 11, an optical fiber advancing mechanism 12, a laser generator 14, a foot operated actuator 16, and a control module 17.
- the optical fiber advancing mechanism 12 is of the type capable of precisely transmitting longitudinal motion to laser ablation member 18, e.g., an optical fiber, optical fiber bundle or other laser energy transmission mechanism.
- the controlled longitudinal motion can be provided by one or more motors and preferably by one or more commercially available stepper motors.
- the laser generator 14 may be either a continuous wave laser or a pulsed, high energy laser, such as, for example, an excimer, CO2 , Yag or an alexandrite laser.
- the optical fiber advancing mechanism 12 and the laser generator 14 are operably connected to foot actuator 16.
- foot actuator 16 By depressing foot actuator 16, laser energy is transmitted through the optical fiber 18 by laser generator 14 while fiber advancing mechanism 12 contemporaneously advances optical fiber 18 relative to hand piece 11.
- foot actuator 16 can cause at least partial advancement of the fiber without transmission of laser energy, as will be described in greater detail.
- An electrical signal from foot actuator 16 actuates control module 17 which communicates with fiber advancing mechanism 12.
- Control module 17 is programmable and controls the motors or other suitable advancing structure in advancing mechanism 12 upon actuation of foot actuator 16.
- Control module 17 is shown with a receptacle 19 adapted to engage a terminal of a programmable computer to interface control module 17 with the computer.
- a toggle switch 15 may be provided on the control module 17 to switch from an operation mode to a test mode. In a particular test mode, when the foot actuator 16 is acted upon, the flexible optical fiber is moved sequentially from a retracted position, to a predetermined extended position, and back to the retracted position.
- Fiber advancing mechanism 12 can be equipped with two internal limit switches (not shown) .
- the first limit switch is activated when the optical fiber 18 is at a desired retracted position (i.e., a "home” position), wherein the mechanism that is retracting the fiber is caused to stop.
- Optical fiber 18 is in the retracted position unless foot actuator 16 is depressed or the test mode is activated.
- the exact retracted position is selectable by means of selector 23, e.g., a rotatable knob.
- One way of implementing a TMR procedure in accordance with the present disclosure using laser ablation device 10 is to select the retracted position as a position in which the distal end of optical fiber 18 protrudes from the distal end of hand piece 11, the purpose of which is discussed in greater detail, below.
- the second limit switch within unit 12 limits/controls the maximum distance that the optical fiber can extend from hand piece 11.
- This limit switch is an indexer which includes external selector 21.
- Selector 21 is provided so that the operator can select the desired maximum extension of the distal end of the optical fiber from the handpiece .
- selector 21 can be in the form of a rotatable knob that can be set at selectable positions, wherein each position corresponds to a predetermined maximum longitudinal position of the optical fiber. When the fiber reaches the selected maximum position, a limit switch automatically terminates the fiber's advancement.
- FIG. 3 illustrates a perspective view of the hand piece 11 of laser ablation device 10.
- hand piece 11 includes housing 20 formed from molded housing half- sections 20a and 20b. Housing 20 has an elongated body 22 with a conically tapered section 24.
- Optional locator ring 26 is provided at the distal end of conically tapered section 24.
- the front surface 27 is positioned in abutting relation with the epicardium of a patient directly following the piercing of the epicardium with the tip of fiber 18 during a TMR procedure.
- Locator ring 26 facilitates proper orientation of the hand piece with respect to the heart tissue. However, locator ring may be eliminated if it is desired to improve visibility of the epicardium with some trade-off of stability.
- Locator ring 26 can be formed integrally with housing half -sections 20a and 20b or can be removably fastened to tapered section 24.
- a ridged surface 28 is formed on an outer wall of housing half -sections 20a and 20b to facilitate grasping of the device 10.
- FIG. 4 illustrates hand piece 11 with housing half-sections 20a and 20b and the internal components separated.
- Housing half-sections 20a and 20b define a central bore 30, a proximal recess 32, and a distal recess 34.
- the proximal recess 32 is configured to receive a swivel connector 36 which is fastened to the optical fiber casing 38.
- the swivel connector 36 has an annular flange 40 dimensioned to be received within an increased diameter section 42 of proximal recess 32 to permit rotation of housing 20 with respect to optical fiber casing 38.
- the locator ring 26 has a cylindrical body portion 44 having an annular flange 46 formed at its proximal end.
- the cylindrical body portion 44 includes a central bore 50 and is configured to be received within the distal recess 34 defined by housing half-sections 20a and 20b.
- Central bore 50 of cylindrical body portion 44 is aligned with a central opening 48 formed in the distal end of the housing 20 and the central bore 30 of housing 20.
- Locator ring 26 can either swivel, to allow independent rotation of the hand piece relative thereto, or be fixed in place.
- the optical fiber 18 is slidably positioned within central bores 30 and 50 such that it can be advanced through opening 48 in housing 20.
- Pins or screws 49 can be used to fasten the housing half -sections 20a and 20b together to secure the locator ring 26 and the swivel connector 36 to the housing 20. If locator ring 26 is eliminated, front surface 31 of tapered portion 29 can act as the stop which contacts the patient's outer epicardial surface to prevent initial penetration of fiber 18 beyond distance D_ . This surface 31 can be buttressed slightly whereby it would form a small diameter collar that is seated against the epicardium during the channel formation procedure.
- the distal end of hand piece 11 corresponds to the front surface 27 of locator ring 26. Allowing optical fiber 18 to protrude enables the surgeon to pierce the epicardium with the tip of fiber 18 without initially firing the laser, such that fiber 18 penetrates a predetermined distance into the outer heart wall. This initial penetration of the fiber is stopped at the predetermined distance by means of the surface 27 contacting the epicardial wall. The operator then depresses foot actuator 16 to cause laser energy to be generated and form the channel. By virtue of the initial penetration without laser energy output, the transmyocardial channel that is formed will be "capped" at the epicardium by the outer heart tissue which is not ablated. This will become more apparent below.
- the advancing mechanism 12 can be designed in conjunction with the control unit 17 to activate fiber 18 to automatically advance longitudinally by the desired predetermined initial distance without laser energy output .
- This initial distance will be designated hereafter as distance Dj_
- This automatic initial advancement can be implemented either by activating an additional switch (not shown) on unit 12 or 17, or it can advance automatically whenever actuator 16 is initially depressed. In either of these cases, the above-noted retracted position would preferably not be adjustable but rather, would be preset to approximately coincide with the distal surface 27.
- selector switch 23 would be designed in conjunction with advancing mechanism 12 to allow selection of the initial penetration distance D ⁇ _, not to select the retracted position.
- the operator/surgeon preferably selects the initial penetration distance Dj_ .
- this distance could be preset and not alterable by the operator
- a healthy heart has a wall thickness of 10 -15mm.
- a diseased heart may be as thick as 40mm (measured from the outer surface of the epicardium to the inner surface of the endocardium) .
- the initial penetration distance D- is typically selected in the range of about 1 to about 2 -5mm and preferably from about 2 to about 5mm so that the fiber 18 penetrates slightly into the myocardium.
- the diameter of the fiber (or fiber optic bundle) 18 is typically in the range of about 0.5 to about 2.5mm, and preferably about 1.4mm.
- the TMR channel to be formed has about the same size diameter as the fiber or fiber bundle
- the heart tissue may "tent” in response to the partially advanced fiber pressing against the epicardium. If this occurs, upon commencement of laser firing, the heart tissue will swiftly move towards the handpiece (the "tent” will collapse) . This movement of the tissue will cause the outer layers of the heart tissue to receive less laser energy, resulting in at least a partial channel cap to aid in closing the channel.
- FIGS. 5-8 a method for producing a TMR channel utilizing the laser ablation device 10 is illustrated.
- hand piece 11 is brought in proximity to the epicardium 52 of a heart patient.
- the tip of optic fiber 18 protrudes slightly from the locator ring 26 by distance Dj_, where O _ is measured from the distal surface 18a of fiber 18 to the front surface 27 of locator ring 26.
- the surface 18a may be flat as shown; however, it could alternatively be beveled to facilitate piercing of the epicardium and preliminary advancement into the epicardial/myocardial tissue.
- the distance Dj_ is selectable by means of select switch 23 (FIG. 1) discussed earlier.
- the fiber tip surface 18a With the tip of fiber 18 protruding in this manner (retracted position) , and without depressing the foot actuator 16 to output laser energy, the fiber tip surface 18a is brought into contact with epicardium 52 so as to mechanically pierce or "tent" the epicardial outer surface.
- the fiber tip initially advances through at least a portion of the epicardium 52 and myocardium 50 either without laser energy being generated or immediately after lasing begins.
- epicardial tissue and as shown, myocardial tissue, if desired
- Tissue 53 will substantially return to its natural position following channel formation and act as a cap to reduce bleeding from the channel as will become apparent below.
- initial penetration of the fiber occurs until the front surface 27 contacts the epicardium 52 (FIG. 6) .
- fiber 18 has penetrated approximately the distance Oj_ into the heart tissue.
- Locator ring 26 enhances the surgeon's ability to position and stabilize the laser device 10 with respect to the heart, which can be beating during the procedure.
- some embodiments may not utilize locator ring 26.
- the TMR channel is formed by transmitting laser energy from the tip of fiber 18 to ablate heart tissue while correspondingly advancing optical fiber 18. The fiber tip is advanced through the myocardium 50 and endocardium 54 until it reaches its maximum extended position corresponding to the distance D2 between fiber tip surface 18a and the surface 27 of locator ring 26.
- fiber 18 is preferably advanced at a rate that is coordinated with the power level and the frequency of pulsing of the laser generator.
- optical fiber 18 can be advanced at a rate of between about 0.125mm/sec (0.005 in/sec) to about 12.7mm/sec (0.5 in/sec) with a laser power level of about 10 mJ/mm2 to about 60 mJ/mm ⁇ and a pulsing frequency of about 5 Hz to about 400 Hz.
- the optical fiber is advanced at a rate of about 0.75mm/sec to about 2.0mm/sec with a laser power level of between about 30 mJ/mm ⁇ to about 40 mJ/mm ⁇ and a pulse frequency of about 20 to about 50 Hz.
- the rate of advancement of the optical fiber is no greater than the rate of ablation of tissue in order to minimize mechanical tearing by the fiber.
- the advancing mechanism can be set to advance the fiber at a rate greater than the ablation rate. Studies have shown that a xenon chloride excimer laser operating at a power level of about 35mJ/mm2 can ablate about 30-35 microns of animal heart tissue per pulse.
- the maximum extended position corresponding to the distance D2 is selectable by the surgeon by means of select switch 21. Once the maximum extended position is reached, wherein fiber 18 typically penetrates slightly into ventricle 56, output of laser energy is automatically suspended. At this point, the operator releases depression of foot actuator 16, causing fiber 18 to retract to the retracted position, as depicted in FIG. 8. The hand piece 11 is then drawn away from the heart wall whereby transmyocardial channel 60 is completed. The completed transmyocardial channel 60 is shown in cross-section in FIG. 9A, while FIG. 9B shows the end view of the epicardium 52.
- the epicardium/myocardial tissue 53 that was pushed aside without being ablated during the preliminary penetration of fiber 18, returns to its original location coinciding with channel 60 upon the fiber's withdrawal.
- This tissue 53 forms a flap that acts as a cap for the channel 60 to reduce bleeding from the channel at the epicardium 52.
- the interface 59 between the flap of tissue 53 and the adjacent tissue is generally an annular ring less than 360_ in extent.
- the cap 53 can consist of both epicardial and myocardial tissue, but could alternatively be just epicardial tissue.
- channel 60 fiber 18 can be moved to another location on the epicardium to begin forming another channel, without the necessity of applying extended pressure to the portion of the epicardium coinciding with just-formed channel 60.
- the overall procedure wherein dozens of channels 60 are typically formed can thus be performed much faster as compared to other methods .
- the distal end 18a of the laser fiber 18 is initially flush with the distal end of laser handpiece 11 (FIG. 10) .
- the fiber 18 is then caused to puncture the epicardium 52 prior to or upon commencement of laser firing (FIG. 11) by advancing the fiber a distance Di prior to firing.
- the fiber is then advanced at a specifically desired rate as the laser fires to form the channel 60 (FIG. 12) ; and is withdrawn upon completion of the channel 60 (FIG.13) .
- the laser fiber 18 can be placed against the epicardium 52 and initially advanced at a rate faster than the tissue ablation rate of the laser (FIG. 14) .
- the fiber 18 will mechanically pass through the heart tissue.
- the fiber advancement rate can be decreased to such a rate that the laser energy ablates the tissue to form the channel 60 (FIG. 15) .
- the fiber 18 is then withdrawn from the heart tissue (FIG. 16) .
- the fiber 18 pierces the heart tissue (FIG. 17) and is advanced at a constant rate while the firing rate of the laser energy is varied to allow mechanical passage of the fiber 18 through at least a portion of the epicardium 52 (FIG. 18) . More specifically, the amount of energy delivered by the laser fiber 18 can be low, e.g., fewer pulses per second, while passing through a portion of the epicardium 52, and increased thereafter to complete the channel 60. The fiber 18 is then withdrawn from the heart tissue (FIG. 19) .
Abstract
Description
Claims
Priority Applications (4)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
JP2000503775A JP2001510701A (en) | 1997-07-22 | 1998-07-22 | Apparatus and method for transmyocardial vascular regeneration by laser ablation |
EP98935909A EP0998231A4 (en) | 1997-07-22 | 1998-07-22 | Apparatus and method for transmyocardial revascularization by laser ablation |
CA002297295A CA2297295A1 (en) | 1997-07-22 | 1998-07-22 | Apparatus and method for transmyocardial revascularization by laser ablation |
AU85063/98A AU8506398A (en) | 1997-07-22 | 1998-07-22 | Apparatus and method for transmyocardial revascularization by laser ablation |
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US5336297P | 1997-07-22 | 1997-07-22 | |
US60/053,362 | 1997-07-22 |
Publications (1)
Publication Number | Publication Date |
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WO1999004708A1 true WO1999004708A1 (en) | 1999-02-04 |
Family
ID=21983697
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/US1998/015139 WO1999004708A1 (en) | 1997-07-22 | 1998-07-22 | Apparatus and method for transmyocardial revascularization by laser ablation |
Country Status (5)
Country | Link |
---|---|
EP (1) | EP0998231A4 (en) |
JP (1) | JP2001510701A (en) |
AU (1) | AU8506398A (en) |
CA (1) | CA2297295A1 (en) |
WO (1) | WO1999004708A1 (en) |
Cited By (5)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US6152918A (en) * | 1996-04-05 | 2000-11-28 | Eclipse Surgical Technologies, Inc. | Laser device with auto-piercing tip for myocardial revascularization procedures |
US6217575B1 (en) | 1999-02-24 | 2001-04-17 | Scimed Life Systems, Inc. | PMR catheter |
US6468271B1 (en) | 1999-02-24 | 2002-10-22 | Scimed Life Systems, Inc. | Device and method for percutaneous myocardial revascularization |
US6533779B2 (en) | 2001-01-16 | 2003-03-18 | Scimed Life Systems, Inc. | PMR catheter and associated methods |
US6544220B2 (en) | 2001-02-14 | 2003-04-08 | Scimed Life Systems, Inc. | Fluid jet PMR |
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US4658817A (en) * | 1985-04-01 | 1987-04-21 | Children's Hospital Medical Center | Method and apparatus for transmyocardial revascularization using a laser |
US5554152A (en) * | 1990-12-18 | 1996-09-10 | Cardiogenesis Corporation | Method for intra-operative myocardial revascularization |
US5703985A (en) * | 1996-04-29 | 1997-12-30 | Eclipse Surgical Technologies, Inc. | Optical fiber device and method for laser surgery procedures |
US5713894A (en) * | 1996-02-27 | 1998-02-03 | Murphy-Chutorian; Douglas | Combined mechanical/optical system for transmyocardial revascularization |
US5738680A (en) * | 1996-04-05 | 1998-04-14 | Eclipse Surgical Technologies, Inc. | Laser device with piercing tip for transmyocardial revascularization procedures |
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DE4032860A1 (en) * | 1990-10-12 | 1992-04-16 | Zeiss Carl Fa | POWER-CONTROLLED CONTACT APPLICATOR FOR LASER RADIATION |
NZ272209A (en) * | 1991-05-01 | 2001-02-23 | Univ Columbia | Myocardial revascularisation of the heart by a laser |
US5222953A (en) * | 1991-10-02 | 1993-06-29 | Kambiz Dowlatshahi | Apparatus for interstitial laser therapy having an improved temperature sensor for tissue being treated |
US5807383A (en) * | 1996-05-13 | 1998-09-15 | United States Surgical Corporation | Lasing device |
-
1998
- 1998-07-22 EP EP98935909A patent/EP0998231A4/en not_active Withdrawn
- 1998-07-22 JP JP2000503775A patent/JP2001510701A/en active Pending
- 1998-07-22 WO PCT/US1998/015139 patent/WO1999004708A1/en not_active Application Discontinuation
- 1998-07-22 CA CA002297295A patent/CA2297295A1/en not_active Abandoned
- 1998-07-22 AU AU85063/98A patent/AU8506398A/en not_active Abandoned
Patent Citations (5)
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US4658817A (en) * | 1985-04-01 | 1987-04-21 | Children's Hospital Medical Center | Method and apparatus for transmyocardial revascularization using a laser |
US5554152A (en) * | 1990-12-18 | 1996-09-10 | Cardiogenesis Corporation | Method for intra-operative myocardial revascularization |
US5713894A (en) * | 1996-02-27 | 1998-02-03 | Murphy-Chutorian; Douglas | Combined mechanical/optical system for transmyocardial revascularization |
US5738680A (en) * | 1996-04-05 | 1998-04-14 | Eclipse Surgical Technologies, Inc. | Laser device with piercing tip for transmyocardial revascularization procedures |
US5703985A (en) * | 1996-04-29 | 1997-12-30 | Eclipse Surgical Technologies, Inc. | Optical fiber device and method for laser surgery procedures |
Non-Patent Citations (1)
Title |
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See also references of EP0998231A4 * |
Cited By (5)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US6152918A (en) * | 1996-04-05 | 2000-11-28 | Eclipse Surgical Technologies, Inc. | Laser device with auto-piercing tip for myocardial revascularization procedures |
US6217575B1 (en) | 1999-02-24 | 2001-04-17 | Scimed Life Systems, Inc. | PMR catheter |
US6468271B1 (en) | 1999-02-24 | 2002-10-22 | Scimed Life Systems, Inc. | Device and method for percutaneous myocardial revascularization |
US6533779B2 (en) | 2001-01-16 | 2003-03-18 | Scimed Life Systems, Inc. | PMR catheter and associated methods |
US6544220B2 (en) | 2001-02-14 | 2003-04-08 | Scimed Life Systems, Inc. | Fluid jet PMR |
Also Published As
Publication number | Publication date |
---|---|
JP2001510701A (en) | 2001-08-07 |
EP0998231A1 (en) | 2000-05-10 |
EP0998231A4 (en) | 2001-02-28 |
AU8506398A (en) | 1999-02-16 |
CA2297295A1 (en) | 1999-02-04 |
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