Abstract: A method of adjusting the stiffness and size of a guidewire without full withdrawal of the guidewire from a patient's vascular system comprising providing a guidewire system comprising an inner member having a first outer diameter and a first stiffness, an outer member having a third larger diameter and a third stiffness, and a stiffener positioned between the inner and outer members and having a second outer diameter larger than the first diameter and smaller than the third diameter. The method includes selectively changing the relative positions of the members to alter the pushability and stiffness of the guidewire system.

Abstract: A medical guidewire system comprising a first inner member having a first outer diameter, a second intermediate member having a second outer diameter larger than the first outer diameter, and a third outer member having a third diameter larger than the second outer diameter of the second member. The second member has a longitudinal extending opening to receive the first member for sliding movement with respect to the first member and the third outer member has a longitudinally extending opening to receive the second member for sliding movement with respect to the first and second member. The first member has a first stiffness, the third member has a third stiffness greater than the first stiffness, and the second member is movable to stiffen the guidewire system.

Abstract: The present invention provides a valve configured for insertion on the proximal and distal sides of a heart valve annulus to replace the heart valve of a patient. The valve comprises a first substantially annular portion adapted to be positioned on a proximal side of the annulus of a patient and a second substantially annular portion adapted to be positioned on a distal side of the annulus of a patient, wherein at least one of the first and second substantially annular portions is movable towards the other portion to a clamped position to clamp around the annulus. The second portion has a flow restricting portion extending therefrom and is movable between a first position to permit the flow of blood and a second position to restrict the flow of blood. In one embodiment, the valve has a suture joining the first and second portions to draw the first and second portions into closer proximity and a cinch member to secure the suture to maintain the first and second portions in the clamped position.

Abstract: A method of inserting a dialysis catheter into a patient comprising the steps of inserting a guidewire into the jugular vein of the patient through the superior vena cava and into the inferior vena cava, providing a trocar having a lumen and a dissecting tip, inserting the trocar to enter an incision in the patient and to create a subcutaneous tissue tunnel, threading the guidewire through the lumen of the trocar so the guidewire extends through the incision, providing a dialysis catheter having first and second lumens, removing the trocar, and inserting the dialysis catheter over the guidewire through the incision and through the jugular vein and superior vena cava into the right atrium.

Abstract: A surgical apparatus for delivering fluid to treat a lesion comprising an elongated member having a distal tip and a plurality of slots formed in a sidewall proximal of the distal tip, a plurality of fluid delivery members positioned in the elongated member and having a lumen and at least one opening communicating with the lumen for delivering fluid to the lesion, and an actuator actuable to a first position to move the plurality of fluid delivery members from a retracted position within the elongated member to a first deployed position extending radially with respect to the elongated member and actuable to a second position to move the plurality of fluid delivery members from the first position to a second deployed position extending further radially from the elongated member.

Abstract: A device for closing an aperture in a vessel wall comprising an elongated member positionable inside the vessel against an internal opening of the aperture and having a dimension exceeding a dimension of the internal opening of the aperture to prevent egress of fluid through the aperture, and at least two curved legs positionable outside the vessel to help retain the elongated member in position.

Abstract: A surgical apparatus for delivering fluid to treat a lesion comprising an elongated member having a distal tip and a plurality of slots formed in a sidewall proximal of the distal tip, a plurality of fluid delivery members positioned in the elongated member and having a lumen and at least one opening communicating with the lumen for delivering fluid to the lesion, and an actuator actuable to a first position to move the plurality of fluid delivery members from a retracted position within the elongated member to a first deployed position extending radially with respect to the elongated member and actuable to a second position to move the plurality of fluid delivery members from the first position to a second deployed position extending further radially from the elongated member.

Abstract: A minimally invasive surgical procedure is disclosed which includes the steps forming a fold of tissue, extending one or more needles through the fold of tissue, deploying a tissue fastener from an interior lumen of each of the needles, and retracting each of the needles from the fold of tissue such that the tissue fasteners remain deployed in the fold of tissue.

Abstract: An apparatus for passing a guidewire through a subcutaneous tissue tunnel to enable over-the wire insertion of a catheter through the tissue tunnel. The apparatus comprises an elongated member having a distal end portion having a tip configured to advance through the tissue tunnel and an opening extending longitudinally with respect to the apparatus and dimensioned to receive the guidewire. The guidewire is inserted through the opening to pass the guidewire through the tunnel to enable subsequent insertion of the catheter.

Abstract: A tissue retaining ring for use with a plurality of surgical fasteners mounted within a disposable loading unit utilized during a vascular anastomosis inlcudes a genrally circular, semi-pliable material having a series of alternating loops and arcuate portions. Each of the loops defines an aperture therein which is dimensioned to receive a distal end of one of the plurality of surgical fasteners. When the instrument is fired, the surgical fasteners are simultaneously deformed through the tissue ring and through the tissue. The tissue retaining ring holds the tissue in place along the surgical fastener and reduces the chances of tissue slippage after deformation.

Abstract: An apparatus for passing a guidewire through a subcutaneous tissue tunnel to enable over-the wire insertion of a catheter through the tissue tunnel. The apparatus comprises an elongated member having a distal end portion having a tip configured to advance through the tissue tunnel and an opening extending longitudinally with respect to the apparatus and dimensioned to receive the guidewire. The guidewire is inserted through the opening to pass the guidewire through the tunnel to enable subsequent insertion of the catheter.

Abstract: A system for stapling tissue comprises a flexible endoscope and an operative head including a pair of opposed, curved tissue clamping jaws sized to pass through an esophagus, the jaws being moveable with respect to one another between an open tissue receiving configuration and a closed tissue clamping configuration, a first one of the curved jaws including a stapling mechanism and a second one of the jaws including a staple forming anvil surface, the stapling mechanism including staple slots through which staples are fired arranged in a row extending from a proximal end of the first jaw to a distal end thereof in combination with a control handle which, when the operative head is in an operative position within one of a patient's stomach and esophagus, remains outside the patient, the control handle including a first actuator for moving the jaws relative to one another and a second actuator for operating the stapling mechanism.

Abstract: A dialysis catheter comprising a first portion having a first diameter, an elongated distal portion having a second diameter smaller than the first diameter, and a transition region between the first portion and distal portion. A first longitudinally extending central lumen configured to deliver blood terminates in an opening in the distal portion. At least two independent longitudinally extending lumens are positioned radially of the first lumen, configured to withdraw blood from a patient, and terminate in a longitudinally directed opening in the transition portion.

Abstract: A dialysis catheter comprising a catheter body having a proximal portion, a distal portion, a first longitudinally extending central lumen configured to deliver blood, and at least three longitudinally extending lumens positioned radially of the central lumen and configured to withdraw blood from a patient. At least one blood delivery opening is formed in the distal portion of the catheter body and in fluid communication with the first lumen and configured for passage of blood therethrough. At least three blood withdrawal openings are formed in the outer wall of the catheter body, wherein each of the openings is in fluid communication with one of the at least three lumens and is configured for passage of blood from a patient.

Abstract: A catheter for delivering and withdrawing blood from a patient's body comprising a catheter body having a distal portion, a central return lumen extending from a proximal portion of the catheter body to the distal portion to allow blood passage therethrough, at least three longitudinally extending intake lumens independent of the return lumen and radially displaced with respect to the return lumen, and means for enabling simultaneous cut off of fluid flow to the at least three longitudinally extending lumens.

Abstract: A surgical apparatus for delivering fluid to treat a lesion comprising an elongated member having a distal tip and a first and second set of openings formed in a sidewall proximal of the distal tip. The second set of openings is positioned proximally of the first set of openings. First and second set of fluid delivery members are movably positioned in the elongated for delivering fluid to the lesion. An actuator moves the fluid delivery members from a retracted position within the elongated members to a first deployed position extending radially with respect to the elongated member and moves the fluid delivery members from the first deployed position to a second deployed position extending further radially from the elongated member. The fluid delivery members are retained in the first and second deployed positions by a retention member.

Abstract: A peritoneal dialysis catheter for insertion into the abdominal cavity of a patient for delivering and withdrawing fluid from a patient comprising a catheter body having a proximal portion, a distal tip portion and a first longitudinally extending lumen configured to deliver fluid into the abdominal cavity. First and second side openings are formed in an outer wall of the catheter body adjacent the distal tip portion and are in fluid communication with the first lumen and configured for passage of fluid therethrough. A stiffening insert is positioned in the distal tip portion and has a first stiffness greater than a second stiffness of the distal tip portion to facilitate entry into the abdominal cavity. The stiffening insert has a lumen therethrough communicating with the first lumen. A method for insertion of the dialysis catheter is also disclosed.

Abstract: The present invention provides a valve configured for insertion on the proximal and distal sides of a heart valve annulus to replace the heart valve of a patient. The valve comprises a first substantially annular portion adapted to be positioned on a proximal side of the annulus of a patient and a second substantially annular portion adapted to be positioned on a distal side of the annulus of a patient, wherein at least one of the first and second substantially annular portions is movable towards the other portion to a clamped position to clamp around the annulus. The second portion has a flow restricting portion extending therefrom and is movable between a first position to permit the flow of blood and a second position to restrict the flow of blood. In one embodiment, the valve has a suture joining the first and second portions to draw the first and second portions into closer proximity and a cinch member to secure the suture to maintain the first and second portions in the clamped position.

Abstract: A surgical biopsy apparatus for cutting tissue comprising a housing having a longitudinal axis, first and second members movable from a retracted position to an extended position with respect to the housing, a third member slidably positioned and extendable with respect to the first member, a fourth member slidably positioned and extendable with respect to the second member, and an electrocautery cutting wire slidable with respect to the third and fourth members to surround a region of tissue positioned between the third and fourth members to cut the tissue.

Abstract: A method of locating a vessel lumen to enable placement of a vascular hole closure device comprising the steps of providing a syringe containing a fluid therein, connecting the syringe to an elongated instrument, exerting a force on the syringe plunger as it is inserted through the tissue towards the vessel wall, and detecting movement of the syringe to eject the fluid to determine entry of the elongated instrument into the vessel lumen.