Abstract: Methodology and related medical devices for effectively bypassing a blocked or partially blocked coronary artery and providing oxygenated blood to the myocardium. A coronary artery bypass method utilizes a shunt member. An upstream end portion of the shunt member is disposed in the myocardium of a patient's heart so that the upstream end portion communicates with the left ventricle of the patient's heart. An opposite or downstream end portion of the shunt member is placed in communication with a coronary artery of the patient downstream of a blockage in the coronary artery. The shunt member extends into the coronary artery from the myocardium either directly or indirectly with an intermediate or middle portion of the shunt member being disposed in an intrapericardial space of the patient, outside of the myocardium and outside of the coronary artery.

Abstract: A conduit is provided to provide a bypass around a blockage in the coronary artery. The conduit is adapted to be positioned in the myocardium or heart wall to provide a passage for blood to flow between a chamber of the heart such as the left ventricle and the coronary artery, distal to the blockage. The stent is self-expanding or uses a balloon to expand the stent in the heart wall. Various attachment means are provided to anchor the stent and prevent its migration.

Abstract: A coil is screwed into the heart wall HW between the left ventricle and coronary artery, followed by forming of a channel with laser, plasma, electrical, or mechanical device therethrough.

Abstract: Disclosed is a conduit that provides a bypass around a stenosis or occlusion in a coronary artery. The conduit is adapted to be positioned in the myocardium to provide a passage for blood to flow from a heart chamber to a coronary artery, at a site distal to the blockage or stenosis in the coronary artery. The conduit has a one-way valve positioned therein to prevent the backflow of blood from the coronary artery into the heart chamber.

Abstract: Cardiac implants include a conduit or scaffold having a first therapeutic agent in at least partial covering relation to at least a first portion of the scaffold, and a second therapeutic agent, different from the first therapeutic agent, in at least partial covering relation to at least a second portion of the scaffold. The first therapeutic agent and second therapeutic agent may include one of: antithrombotic agents, anti-inflammatory agents, antiproliferative agents, antibiotic agents, angiogenic agents, antiplatelet agents, anticoagulant agents, rhestenosis preventing agents, hormones and combinations thereof. Methods for making cardiac implants include providing a scaffold, covering at least a first portion of the scaffold with a first therapeutic agent, and covering at least a second portion of the scaffold, different from the first portion, with a second therapeutic agent different from the first therapeutic agent.

Abstract: A method for performing a bypass procedure utilizes the patient's vascular system for accessing or reaching a desired location within the patient's body. The method may also provide a direct flow path from a heart chamber to a coronary vessel via a septal passageway.

Abstract: Conduits are provided to direct blood flow from the left ventricle to a coronary artery at a location distal to a blockage in the coronary artery. Threaded and nonthreaded conduits are delivered using a guidewire delivered through the posterior and anterior walls of a coronary artery and into the heart wall. A dilator may be provided over the guidewire into the heart wall, and the conduit delivered over the dilator. An introducer sleeve may be provided over the dilator into the heart wall, the dilator removed, and the conduit delivered through the introducer sleeve. A hollow needle also may be inserted into the posterior and anterior walls of the coronary artery prior to inserting the guidewire. A depth measuring tool may determine the appropriate length of the conduit prior to delivery.

Abstract: A conduit is provided to provide a bypass around a blockage in the coronary artery. The conduit is adapted to be positioned in the myocardium or heart wall to provide a passage for blood to flow between a chamber of the heart such as the left ventricle and the coronary artery, distal to the blockage. The stent is self-expanding or uses a balloon to expand the stent in the heart wall. Various attachment means are provided to anchor the stent and prevent its migration.

Abstract: A stent suitable for implantation in myocardial tissue to enhance perfusion therein may include a tubular member having first and second ends and a lumen. The first end of the stent may be configured to pierce myocardial tissue and the lumen may be configured to be placed in flow communication with a coronary vessel. The stent may further include a means for retaining the tubular member within the myocardial tissue. A method for implanting the stent may include positioning the first end of the stent at a desired implantation site and applying force to the second end of the stent to implant the stent within the myocardial tissue. The method may further include engaging the means for retaining with the myocardial tissue to retain the stent in position.

Abstract: A vascular implant includes a scaffold and a tubing in covering relating to the scaffold. Preferably, the tubing completely covers or encases the scaffold interior surface and exterior surface to leave no portion of the scaffold exposed. Methods for constructing includes pulling tubing through a scaffold and folding at least a portion of the tubing over at least one of the ends of the scaffold. Methods for using an implant include performing coronary vessel bypass procedures or forming blood flow paths in a blood vessel utilizing constructions described herein.

Abstract: A method of treating a heart may include providing an implant having a first end and a second end, placing the implant in a heart wall between a heart chamber and a blood vessel such that the first end of the implant is in flow communication with at least one of the geart chamber and the blood vessel, and delivering an angiogenesis factor in a time-relaease mannor to the heart wall proximate the implant.

Abstract: A method for revascularizing a coronary vessel with a conduit through the heart wall having a diameter transition in the myocardial leg, wherein blood flow is in the direction of transition from larger to smaller diameter. A method for revascularizing a coronary vessel using an implant with a myocardial leg having a maximum cross-sectional area proximate a first end, and inserting the first end through the myocardium into a heart chamber so that the implant directs blood flow into the coronary vessel. A transmyocardial implant with a myocardial leg including point of minimum diameter and a first end with a larger diameter, and a vessel leg in fluid communication with the myocardial leg.

Abstract: A conduit is provided to provide a bypass around a blockage in the coronary artery. The conduit is adapted to be positioned in the myocardium or heart wall to provide a passage for blood to flow between a chamber of the heart such as the left ventricle and the coronary artery, distal to the blockage. The stent is self-expanding or uses a balloon to expand the stent in the heart wall. Various attachment means are provided to anchor the stent and prevent its migration. In one embodiment, a conduit is provided having a distal top which is more preferably a ball top, wire top, flare top or flip-down top. These top configurations anchor the shunt at one end in the coronary artery.

Abstract: A transmyocardial implant establishes a blood flow path through a heart wall between a heart chamber and a lumen of a coronary vessel on the heart wall. The implant includes a hollow conduit having an open first end and an open second end. The conduit is dimensioned so as to extend at least from the vessel through said heart wall and into said chamber. The conduit has a conduit wall defining a blood flow pathway within an interior of said conduit between the first and second ends. The first and second ends are mutually positioned for the first end to reside within the vessel and opposing a wall of the vessel when the conduit is placed within the heart wall with the second end protruding into the chamber. The conduit wall is formed of a material sufficiently rigid to resist deformation and closure of the pathway in response to contraction of the heart wall. A flow restriction is formed in the pathway for reducing a discharge velocity of blood flow discharged from the first end.

Abstract: A method for revascularizing a coronary vessel with a conduit through the heart wall having a diameter transition in the myocardial leg, wherein blood flow is in the direction of transition from larger to smaller diameter. A method for revascularizing a coronary vessel using an implant with a myocardial leg having a maximum cross-sectional area proximate a first end, and inserting the first end through the myocardium into a heart chamber so that the implant directs blood flow into the coronary vessel. A transmyocardial implant with a myocardial leg including point of minimum diameter and a first end with a larger diameter, and a vessel leg in fluid communication with the myocardial leg.

Abstract: A method of flowing blood from a heart chamber to a coronary vessel includes providing a conduit with a first end and second end, providing the conduit within a heart wall such that the first end of the conduit is open towards the heart chamber and the second end is open towards the blood vessel, and during diastole, restricting a flow of blood from the coronary vessel to the heart chamber via the natural valve.

Abstract: A method, and related tools for performing the method, of delivering a stent or other like device to the heart to connect the left ventricle to the coronary artery to thereby supply blood directly from the ventricle to the coronary artery may be used to bypass a total or partial occlusion of a coronary artery. The method may include placing a guide device and a dilation device through an anterior wall and a posterior wall of the coronary vessel and through a heart wall between the heart chamber and the coronary vessel. The dilation device may be used to form a passageway in the heart wall at a location defined by the guide device. The method may then include placing a stent within the passageway.

Abstract: An implant for use in direct left ventricle to coronary vessel revascularization is disclosed. The implant includes a sleeve sized to pass through a heart wall. The sleeve is sufficiently rigid to remain open during contraction of the heart. The implant also includes a plurality of conduits at least partially mounted in the sleeve.

Abstract: One aspect of the present invention relates to a method for passing a fluid through a shunt located in the wall of a heart, the shunt providing fluid communication between a heart chamber and a coronary artery, with a hollow catheter. Another aspect of the present invention relates to a method of inserting a wire through a shunt located in the wall of a heart with a hollow catheter. A further aspect of the present invention relates to passing fluid through a shunt located in the wall of a heart, the shunt providing fluid communication between a heart chamber and a coronary artery, by injecting fluid into the heart chamber. A further aspect of the present invention relates to a catheter with a flexible, hollow, inner member to which a self expanding basket is attached. A further aspect of the present invention relates to a method of passing a radio-opaque contrast fluid through a shunt located in a heart wall, the shunt providing fluid communication between a heart chamber and a coronary artery.

Abstract: Described herein are various methods and apparatuses for delivering stents and other devices into the myocardium of a patient. One preferred stent delivery system provides access to the insertion site in the myocardium by advancing a delivery catheter through a blockage in a coronary artery, or around the blockage through a coronary vein or through a channel or tunnel formed around the blockage. In one embodiment, once the distal end of the delivery catheter is adjacent the myocardium, an angled bend is created in the catheter by actuating expandable steering guides mounted to the catheter which cooperate with the walls of the blood vessel to cause the catheter to turn. Then, a guidewire is advanced through the delivery catheter and into the myocardium. In another embodiment, a tip-deflecting pull wire extends from the distal end of the delivery catheter which may be actuated to turn towards and then inserted into the myocardium.