Abstract: Apparatus and methods for creating anastomoses are provided. An incision tool for creating an incision having a controlled length in a side wall of a patient's body tissue conduit is provided. A delivery device for inserting a hollow annular connector into an incision in a side wall of a patient's body tissue conduit is provided. The delivery device may include first and second anvil structures around which the connector may be disposed. By moving the first anvil structure away from the second anvil structure, the connector may expand to a desired configuration (e.g., non-round) within the aperture. In one example, the connector may be inserted into the aperture to hold the aperture open prior to attachment of a graft conduit to the aperture, thereby allowing a physician to inspect the aperture and the surrounding tissue.

Abstract: Methods and apparatus for making an anastomotic connection between a first aperture in a side wall of a graft conduit and a second aperture in a side wall of a body tissue conduit using a hollow self-expanding exterior connector are provided. The tissue about the first aperture is introduced into the hollow connector and is retained by first members of a distal portion of the connector. A delivery tool then collapses the distal perimeter defined by the first members by deforming the connector and delivers the first members into the lumen of the body tissue conduit via the second aperture. Upon inserting the first members into the body tissue conduit, the tool is disemployed and the connector reforms such that the first members and a more proximal portion of the connector external to the body tissue conduit press together the walls of the two conduits around the apertures.

Abstract: Plugs and methods for plugging septal defects and blood vessels are provided. Plugs are delivered via catheter to a septal defect or a location where it is desired to occlude blood flow in a blood vessel. The plugs are positioned and expanded at the treatment site. The expansion of the plugs can be accomplished passively by using a heat-treated elastic frame or actively by using a balloon to deform a plastically-deforming frame. Plugging structures mounted to the frame span the defect or lumen and prevent blood flow. The plugs described herein have small profiles, and are more reliable than preceding intraluminal transcatheter methods.

Abstract: A body tissue graft for use in a patient includes a frame structure made of a first elastic material, a covering of a second elastic material on the frame structure, the covering substantially filling openings in the frame structure, and a connector connected to the frame structure. Projections are secured to the connector structure. The projections facilitate attachment of the tubular graft in a patient by securing the graft to the body tissue with which the graft is employed. The connector selectively circumferentially expands and the projections selectively circumferentially expand. This may be done using an inflatable balloon to circumferentially expand the projections. A restraining member may be provided to restrain the projections in a cone shape so that an end of the graft may be used to open an aperture through a side wall of existing body organ tubing and a portion of the projections may enter the aperture.

Abstract: Instrumentation for facilitating cutting an opening in a side wall of a body conduit in a patient. A tubular structure defines a lumen and has a sharpened distal end portion configured to cut a section of the body conduit to create the opening. A tissue holding structure is provided which is axially movable within the lumen of the tubular structure. The tissue holding structure includes a piercing portion to permit passage of the tissue holding structure through the body conduit from an entrance side to an exit side thereof. The tissue holding structure also includes a retention member to secure the section of the body conduit to the tissue holding structure during movement of the tissue holding structure to approximate the entrance side of the body conduit with the sharpened distal portion of the tubular structure to enable the sharpened distal structure to cut the body conduit. A connector is also provided for attaching a new length of tubing to the body conduit at the opening made by the cutting.

Abstract: A medical graft connector for connecting an end of a tubular graft conduit to a side wall of a patient's existing tubular body conduit via an aperture in the side wall thereof has a first plurality of fingers configured to engage an interior surface of the side wall of the existing conduit. A second plurality of fingers is configured to engage an exterior surface of the side wall of the existing conduit. A third plurality of fingers is received in an interior lumen of the graft conduit, and a fourth plurality of fingers is configured to pierce the graft conduit. The connector is radially deformable between a first size and a second size.

Abstract: A medical graft connector for connecting an end of a tubular graft conduit to a side wall of a patient's existing tubular body conduit via an aperture in the side wall thereof has a plurality of fingers configured to engage an interior surface of the side wall of the existing conduit. At least one of the plurality of fingers has an end portion configured to pierce the graft conduit. The plurality of fingers is substantially radially aligned with respect to a longitudinal axis and wherein the connector is radially enlargeable between a first size and a second size.

Abstract: Methods for making an anastomotic connection between a first conduit and a second conduit in a patient. The first conduit and a second conduit of the patient are placed relatively adjacent to each other at the operative site to make a side-to-side anastomosis connection. A region is created where the first conduit and the second conduit contact each other. An adhesive is placed in the region between the two conduits. An aperture is then created in the region with a cutting instrument. A ring of sutures or other fasteners may be used in place of or in addition to the adhesive. An end-to-side anastomosis may be used instead of a side-to-side anastomosis.

Abstract: A medical graft connector or plug is made, for example, by cutting end portions of a tube of highly elastic material axially at numerous locations spaced circumferentially around the tube to produce a plurality of fingers which extend axially from each end of an uncut medial portion of the tube. The fingers are deflected radially outwardly from the medial portion and set in that condition. For a graft connector, the medial portion is coaxially connected to an end portion of a tubular graft. The connector is then installed through an aperture in the side wall of a patient's tubular body conduit, for example, by using a delivery tube in which the fingers are elastically deflected back to approximately their initial positions. When the delivery conduit is withdrawn from the connector, the fingers spring out to engage the inner and outer surfaces of the body conduit wall.

Abstract: A catheter-based system for accessing specific body cavities percutaneously and minimizing patient trauma is provided. In the preferred embodiment, in order to create an aperture at an access site in a patient's existing tubular body organ structure, a delivery sheath is passed axially along the interior of a portion of the existing tubular body organ structure to place a distal end of the delivery sheath near the access site. A centering wire is passed axially along the interior of the delivery sheath, piercing through from inside to outside of the patient's existing tubular body organ structure at the access site by causing an end portion of the centering wire to emerge from the distal end of the delivery sheath. A cutting catheter is passed substantially coaxially over the centering wire and axially along the interior of the delivery sheath.

Abstract: Methods and apparatus for making an anastomotic connection between a first conduit and a second conduit. A connector structure having a first end portion and a second end portion is positioned about a balloon catheter, which when pressurized, expands to a significant extent at the distal end thereof. The balloon enlarges the connector structure when positioned at the distal end portion of the balloon to create the anastomosis, and at the same time reduces the axial length of the connector, thereby compressing the first conduit to the second conduit, creating a hemodynamic seal and a firm attachment of the two conduits. After enlargement, the connector structure remains in place and adds structure to the anastomosis. During introduction, the second end portion of the connector is covered by a nosecone assembly to prevent trauma to the second conduit while the apparatus is being introduced.

Abstract: A medical graft connector for connecting an end of a tubular graft conduit to a side wall of a patient's existing tubular body conduit via an aperture in the side wall thereof has a first plurality of fingers configured to engage an interior surface of the side wall of the existing conduit. A second plurality of fingers is configured to engage an exterior surface of the side wall of the existing conduit. A third plurality of fingers is received in an interior lumen of the graft conduit, and a fourth plurality of fingers is configured to pierce the graft conduit. The connector is radially deformable between a first size and a second size.

Abstract: Methods and apparatus for making an anastomotic connection between a first conduit and a second conduit. A connector structure having a first end portion and a second end portion is positioned about a balloon catheter, which when pressurized, expands to a significant extent at the distal end thereof. The balloon enlarges the connector structure when positioned at the distal end portion of the balloon to create the anastomosis, and at the same time reduces the axial length of the connector, thereby compressing the first conduit to the second conduit, creating a hemodynamic seal and a firm attachment of the two conduits. After enlargement, the connector structure remains in place and adds structure to the anastomosis. During introduction, the second end portion of the connector is covered by a nosecone assembly to prevent trauma to the second conduit while the apparatus is being introduced.

Abstract: A medical graft connector for connecting an end of a tubular graft conduit to a side wall of a patient's existing tubular body conduit via an aperture in the side wall thereof has a first plurality of fingers configured to engage an interior surface of the side wall of the existing conduit. A second plurality of fingers is configured to engage an exterior surface of the side wall of the existing conduit. A third plurality of fingers is received in an interior lumen of the graft conduit, and a fourth plurality of fingers is configured to pierce the graft conduit. The connector is radially deformable between a first size and a second size.

Abstract: Apparatus for securing an axial end portion of a tubular graft conduit in a lumen of a patient's existing tubular body organ structure via an aperture in a side wall thereof is disclosed. An anchor device is configured for attachment to the end portion of the tubular graft conduit. The anchor device defines a constant axial length and a cross-section radially expandable between a first diameter sized for insertion into the aperture in the side wall of the body conduit and a second diameter sized to secure the end portion of the tubular graft conduit coaxially between the anchor device and the lumen of the tubular body conduit. The anchor device defines a longitudinal axis that may change between a substantially straight configuration and a curvilinear configuration such that the cross-section remains substantially unchanged.

Abstract: Methods and apparatus for delivering and installing a new length of tubing between two sections of a patient's existing body organ tubing and at least partly outside of that existing structure. For example, the new length of tubing may be for the purpose of providing the patient with a coronary bypass. The new tubing may be an artificial graft, a natural graft (harvested elsewhere from the patient), or both. The new tubing is delivered to and installed at the operative site primarily by working through the patient's existing tubular body organ structure. This avoids the need for any significant surgery on the patient.

Abstract: Methods and apparatus for making an anastomotic connection between first and second tubular fluid conduits are provided. For example, a connector may be configured for attachment to the first and second tubular fluid conduits and have an interior thereof substantially accessible to the interior of the first tubular fluid conduit. The connector may be configured for annular enlargement. An expandable structure is provided having a first portion configured to annularly enlarge the connector by engaging the interior of the connector. A second portion may be configured to extend through an opening in the medial portion of the first tubular fluid conduit.

Abstract: A connector for use in providing an anastomotic connection between two tubular body fluid conduits in a patient. The connector is preferably a single, integral, plastically deformable structure that can be cut from a tube. The connector has axial spaced portions that include members that are radially outwardly deflectable from other portions of the connector. The connector is annularly enlargeable so that it can be initially delivered and installed in the patient in a relatively small annular size and then annularly enlarged to provide the completed anastomosis. The radially outwardly deflected members of the first and second portions respectively engage the two body fluid conduits connected at the anastomosis and hold those two conduits together in fluid-tight engagement. Apparatus for use in delivering and deploying a connector is also disclosed.

Abstract: A bypass graft conduit is installed in the circulatory system of a patient using apparatus which facilitates performing most or all of the necessary work intraluminally (i.e., via lumens of the patient's circulatory system). A guide structure such as a wire is installed in the patient via circulatory system lumens so that a portion of the guide structure extends along the desired path of the bypass conduit, which bypass conduit path is outside the circulatory system as it exists prior to installation of the bypass graft. The bypass graft is then introduced into the patient along the guide structure and connected at each of its ends to the circulatory system using connectors that form fluid-tight annular openings from the bypass graft lumen into the adjacent circulatory system lumens. The guide structure is then pulled out of the patient.

Abstract: Methods and apparatus for delivering and installing a new length of tubing between two sections of a patient's existing body organ tubing and at least partly outside of that existing structure. For example, the new length of tubing may be for the purpose of providing the patient with a coronary bypass. The new tubing may be an artificial graft, a natural graft (harvested elsewhere from the patient), or both. The new tubing is delivered to and installed at the operative site primarily by working through the patient's existing tubular body organ structure. This avoids the need for any significant surgery on the patient.