Abstract: Described here are devices, systems and methods for forming a fistula between two blood vessels. Generally, the systems may comprise a first catheter which may comprise a fistula-forming element. The fistula-forming element may comprise one or more electrodes, mechanical cutting elements, laser sources, or combinations thereof, and may be used to assist in fistula formation. In some instances, a system may comprise a second catheter, which may comprise a fistula-forming element. One or more of the catheters may comprise one or more markers, magnetic alignment elements, and/or one shape-changing elements.

Abstract: A surgical fastener clip for proximating tissue, the clip providing an undeflected state in which the clip comprises a center portion, a first leg, and a second leg. The center portion has a perimeter defining a circle-like shape. The legs project outwardly relative to the perimeter from a point of departure to a tip. Extension of each of the legs relative to the perimeter defines an identical wind direction that is either clockwise or counterclockwise. The clip optionally includes a linear cross-member extending across the perimeter. The surgical clip can be formed by a wire that is partially wound onto itself in a spiral-like fashion, with the center portion and the legs being co-planar in the undeflected state. During use, the clip is rotated, drawing tissue into the center portion. Systems incorporating the clip are also provided.

Abstract: Described here are devices, systems and methods for forming a fistula between two blood vessels. Generally, the systems may comprise a first catheter which may comprise a fistula-forming element. The fistula-forming element may comprise one or more electrodes, mechanical cutting elements, laser sources, or combinations thereof, and may be used to assist in fistula formation. In some instances, a system may comprise a second catheter, which may comprise a fistula-forming element. One or more of the catheters may comprise one or more markers, magnetic alignment elements, and/or one shape-changing elements.

Abstract: A method for closing an opening at a target site including bodily tissue including embedding a plurality of self-closing clips into the target site in a spaced apart manner about a perimeter of the opening. Each of the clips has opposing clip ends and an intermediate segment. A flexible tether is coupled to the embedded clips to form a loop about the opening perimeter. A pulling force is applied onto at least one of the loop ends, thereby drawing the perimeter of the opening onto itself to completely close the opening. The loop ends are secured to maintain the target site in a closed state. In some embodiments, the target site is apical cardiac tissue, and the method is performed as part of a trans-apical access procedure.

Abstract: Described here are devices and methods for forming a fistula between two vessels. In some instances, the fistula may be formed between a proximal ulnar artery and a deep ulnar vein. The fistula may be formed using an electrode, and may be formed with a first catheter placed in a first blood vessel and a second catheter placed in a second blood vessel. In some instances, access to the proximal ulnar artery may be achieved through a brachial artery, and access to the deep ulnar vein may be achieved through a brachial vein.

Abstract: A delivery system for delivery of a radially expandable device to an implantation site in a patient, the delivery system including an elongated tubular member comprising a distal tip and an outer surface, first and second balloon portions spaced proximally from each other and the distal tip along a length of the tubular member, an annular space between the first and second balloon portions, a plurality of clip deployment tubes extendably moveable relative to the outer surface of the tubular member, and a plurality of clips, wherein each clip is moveable within a length of one of the clip deployment tubes between a retracted position and a deployed position.

Abstract: Device, system and method for drawing together patient tissue. A central hub has an axis. Several tines are coupled to the central hub. Each of the tines has a tip and is resiliently biased to form a coil. Each tip points radially outward from the axis, with an approximately common angle between adjacent ones of the tines.

Abstract: Described here are devices, systems and methods for forming a fistula between two blood vessels. Generally, the systems may comprise a first catheter which may comprise a fistula-forming element. The fistula-forming element may comprise one or more electrodes, mechanical cutting elements, laser sources, or combinations thereof, and may be used to assist in fistula formation. In some instances, a system may comprise a second catheter, which may comprise a fistula-forming element. One or more of the catheters may comprise one or more markers, magnetic alignment elements, and/or one shape-changing elements.

Abstract: An endovascular stapling apparatus for delivering a staple to a vessel of a patient, including a plurality of clips, a housing, and a rod. Each of the clips includes a bridge and legs that self-transition from a biased state to a natural state in which the legs each form a loop. The housing defines a channel and a window open to the channel. The clips are retained within the channel in the biased state. The rod is slidably disposed within the channel, selectively moves the clips toward and away from the window, and releases the clips from the window.

Abstract: A method for closing an opening at a target site including bodily tissue including embedding a plurality of self-closing clips into the target site in a spaced apart manner about a perimeter of the opening. Each of the clips has opposing clip ends and an intermediate segment. A flexible tether is coupled to the embedded clips to form a loop about the opening perimeter. A pulling force is applied onto at least one of the loop ends, thereby drawing the perimeter of the opening onto itself to completely close the opening. The loop ends are secured to maintain the target site in a closed state. In some embodiments, the target site is apical cardiac tissue, and the method is performed as part of a trans-apical access procedure.

Abstract: Device, system and method for drawing together patient tissue. A central hub has an axis. Several tines are coupled to the central hub. Each of the tines has a tip and is resiliently biased to for a coil. Each tip points radially outward from the axis, with an approximately common angle between adjacent ones of the tines.

Abstract: Device, system and method for drawing together patient tissue. A bridge segment has an axis and a first end and a second end opposite the first end. A first tine is coupled to the first end and projects from the bridge segment in a first direction orthogonal to the bridge segment. A second tine is coupled to the first end and projects from the bridge segment in a second direction approximately opposite the first direction. A third tine is coupled to the second end and projects from the bridge segment approximately in the first direction. A fourth tine is coupled to the second end and projects from the bridge segment approximately in the second direction. The first, second, third and fourth tines are each resiliently biased to form a coil approximately parallel to a plane orthogonal to the axis of the bridge segment.

Abstract: An endovascular stapling apparatus for delivering a staple to a vessel of a patient, including a plurality of clips, a housing, and a rod. Each of the clips includes a bridge and legs that self-transition from a biased state to a natural state in which the legs each form a loop. The housing defines a channel and a window open to the channel. The clips are retained within the channel in the biased state. The rod is slidably disposed within the channel, selectively moves the clips toward and away from the window, and releases the clips from the window.

Abstract: An endostapler delivery system includes a biasing mechanism to offset or counter forces generated by a stapling device and therefore prevent the stapling device from moving during the firing of the staple. The delivery system includes a catheter having at least one lumen extending there through for receiving the stapling device. The biasing mechanism is an expandable biasing cage having a dome or semi-circular expanded shape provided at the distal portion of the catheter. When expanded, the biasing cage does not block or occlude a vessel, thereby allowing blood flow to continue during the stapling procedure. The endostapler delivery system further includes a steering wire that can be used to bend the catheter shaft.

Abstract: An endostapler delivery system includes a biasing mechanism to offset or counter forces generated by a stapling device and therefore prevent the stapling device from moving during the firing of the staple. The delivery system includes a catheter having at least one lumen extending there through for receiving the stapling device. The biasing mechanism is an expandable biasing cage having a dome or semi-circular expanded shape provided at the distal portion of the catheter. When expanded, the biasing cage does not block or occlude a vessel, thereby allowing blood flow to continue during the stapling procedure. The biasing cage may include a plurality of ribbons or strands that extend generally parallel to the blood flow when expanded in situ, a mesh or braided structure, or a plurality of ribbons or strands that extend generally parallel to the blood flow when expanded in situ and a mesh or braided structure placed over the plurality of ribbons.

Abstract: A surgical fastener clip for proximating tissue, the clip providing an undeflected state in which the clip comprises a center portion, a first leg, and a second leg. The center portion has a perimeter defining a circle-like shape. The legs project outwardly relative to the perimeter from a point of departure to a tip. Extension of each of the legs relative to the perimeter defines an identical wind direction that is either clockwise or counterclockwise. The clip optionally includes a linear cross-member extending across the perimeter. The surgical clip can be formed by a wire that is partially wound onto itself in a spiral-like fashion, with the center portion and the legs being co-planar in the undeflected state. During use, the clip is rotated, drawing tissue into the center portion. Systems incorporating the clip are also provided.

Abstract: A surgical apparatus for guiding the position of a medical device to a desired location includes an outer sleeve, a tether, and at least one elastic anchor hook engaged with the tether. The tether may be slideably moveable within the outer sleeve. Additionally, the anchor hook is configured to anchor into bone at the desired location. In certain embodiments, the anchor hook is elastically deformable from an unstressed curved shape to a deformed straightened shape. The anchor hook may be deformed to the straightened shape when positioned within the outer sleeve and may reform to the curved shape upon deployment from the outer sleeve. In certain embodiments, a rod surrounds part of the tether and is used for threading through medical devices to advance the medical devices to the desired location. Additionally, a deployment button may be used to deploy the anchor hooks from the outer sleeve.

Abstract: A surgical connection apparatus including a plurality of delivery assemblies, a housing assembly, and a drive mechanism. The delivery assemblies each include an outer member, an inner member, and optionally a retention member. The inner member is disposed within the outer member, terminates at a distal tip and forms an internal passage that is open at a window. The delivery assemblies releasably retain a self-closing clip. The housing assembly maintains the delivery assemblies in a generally circular arrangement. The drive mechanism operates to transition the delivery assembly in releasing a self-closing clip from the corresponding delivery assembly. With this construction, a plurality of self-closing clips can be simultaneously deployed in a manner effectuating, for example, an end-to-side anastomosis.

Abstract: A method and apparatus for forming a lesion in tissue along a desired ablation path with treating a body tissue in situ (e.g., an atrial tissue of a heart to treat) atrial fibrillation include a lesion formation tool including is positioned against the heart surface. The lesion formation tool includes a guide member having a tissue-opposing surface for placement against a heart surface. An ablation member is coupled to the guide member to move in a longitudinal path relative to the guide member. The guide member includes a track. A carriage is slidably received with the track. The ablation member is secured to the carriage for movement therewith. The guide member includes a visualization component.

Abstract: A method and apparatus for treating a body tissue in situ (e.g., an atrial tissue of a heart to treat) atrial fibrillation include a lesion formation tool is positioned against the heart surface. The lesion formation tool includes a guide member having a tissue-opposing surface for placement against a heart surface. An ablation member is coupled to the guide member to move in a longitudinal path relative to the guide member. The ablation member has an ablation element for directing ablation energy in an emitting direction away from the tissue-opposing surface. The guide member may be flexible to adjust a shape of the guide member for the longitudinal path to approximate the desired ablation path while maintaining the tissue-opposing surface against the heart surface. In one embodiment, the ablation member includes at least one radiation-emitting member disposed to travel in the longitudinal pathway.