PROSTHESIS FOR ANNULOPLASTY COMPRISING A PERFORATED ELEMENT
A prosthesis for annuloplasty comprising a laminar or tubular element having a plurality of apertures along at least one portion. Preferably, the shape, dimensions, and arrangements of the apertures in this prosthesis are chosen in such a way as to give the prosthesis a differentiated flexibility in dependence on the location and direction of application of an external stress.
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The present application is a continuation of U.S. patent application Ser. No. 10/393,448, entitled “PROSTHESIS FOR ANNULOPLASTY COMPRISING A PERFORATED ELEMENT” filed Mar. 20, 2003 by Pietro Arru et al., which claims the benefit of European Patent Application No. 02425190.2 filed Mar. 27, 2002. Each of the foregoing U.S. and European patent applications is incorporated herein by reference in its entirety. Any disclaimer of claim scope that may have occurred during the prosecution of the above-referenced application(s) is hereby expressly rescinded.
TECHNICAL FIELDThe present invention relates in general to a device for cardiac valve repair operations and, in particular, to a prosthesis for annuloplasty.
BACKGROUNDThe human heart has four cardiac valves: the mitral valve, the tricuspid valve, the pulmonary valve and the aortic valve. The mitral valve is situated in the left atrio-ventricular ostium and regulates the unidirectionally of the flow of blood from the atrium to the ventricle. It opens in the diastole and closes in the systole, preventing blood from flowing back from the ventricle to the atrium. The annulus of a normally functioning mitral valve is characterized by shape, dimensions and flexibility such as to allow a correct closure of the valve lips during the systolic phase. For example, the mitral annulus has a characteristic “kidney” shape (of “D” shape), and is more flexible in the portion corresponding to the posteria lip of the valve. Illnesses or genetic defects can cause deformations or dilatations of the annulus of the mitral valve, resulting in an incomplete closure thereof with consequent regurgitation of blood. The same phenomena can occur in the tricuspid valve, situated between the right atrium and right ventricle.
A frequently used method for eliminating some pathological alterations of the mitral and tricuspid valves is that of reinstating the correct shape and dimensions of the valve annulus by means of surgical procedures known as annuloplasty. Annuloplasty comprises surgically implanting a supporting prosthesis on the dilated or deformed annulus for the purpose of reinstating its dimensions and/or physiological shape in such a way as to allow the cardiac valve to function correctly.
Support prostheses utilized in valve repair operations are called annuloplasty prostheses. In the majority of cases such prostheses are constituted by a closed or open ring structure comprising an inner core and an outer cladding of biocompatible material which allows surgical suture.
Annuloplasty prostheses of various types have been described in the prior art. Initially, the prostheses proposed were predominantly of the rigid type for the purpose of drastically reducing the dilatation of the valve annulus. Such prostheses are generally constituted by a metal core (for example, a titanium alloy), an optional sheath of cladding around the core, and an outer cladding of textile for suturing. Rigid annuloplasty prostheses are described, for example, in U.S. Pat. No. 4,055,861 by Carpentier et al., issued Nov. 1, 1977, and U.S. Pat. No. 3,656,185 by Carpentier et al., issued Apr. 18, 1972.
Rigid prostheses, although satisfactory as far as reinstatement of the shape and dimensions of the valve annulus are concerned, do not allow the annulus of the valve to flex along the base of the posterior cuspid in such a way as to assist the cardiac muscle movements. Consequently, significant stress is imposed on the suture points subjected to torsion and traction, which prevents natural behavior of the valve.
Subsequently, semi-rigid or completely flexible prosthesis models were proposed. Completely flexible annuloplasty prostheses are described, for example, in U.S. Pat. No. 5,041,130 by Carpentier et al., issued Aug. 20, 1991, U.S. Pat. No. 5,716,397 by Myers et al. issued Feb. 10, 1998, U.S. Pat. No. 6,102,945 by Campbell et al., issued Aug. 15, 2000, and U.S. Pat. No. 5,064,431 by Gilbertson et al., issued Nov. 12, 1991. The completely flexible prostheses follow the movements of the annulus during the cardiac cycle in an optimal manner. However, they have the disadvantage of not allowing the shape to be reconstructed in an optimal manner.
Semi-rigid prostheses seek to unite the advantages of the rigid type with those of the completely flexible type while avoiding the disadvantages of each. Semi-rigid annuloplasty prostheses are described, for example, in U.S. Pat. No. 5,061,277 by Carpentier et al., issued Oct. 29, 1991, U.S. Pat. No. 5,104,407 by Lam et al., issued Apr. 14, 1992, U.S. Pat. No. 5,674,279 by Wright et al., issued Oct. 7, 1997, U.S. Pat. No. 5,824,066 by Gross et al., issued Oct. 20, 1998, U.S. Pat. No. 5,607,471 by Seguin et al., issued Mar. 4, 1997, and U.S. Pat. No. 6,143,024 by Campbell et al., issued Nov. 7, 2000.
In particular, U.S. Pat. No. 5,104,407 describes a ring prosthesis comprising an annular support element which is substantially more rigid in one part than in the remainder. This more rigid part projects transversely with respect to the general plane in which the remaining part of the support element lies. On the other hand, U.S. Pat. No. 5,607,471 describes a ring prosthesis having variable transverse sections, and therefore differentiated rigidity along its circumferential extent.
All these known prostheses have, however, limitations in relation to the possibility of exhibiting a variable rigidity in dependence on the point and/or mode of application of the stresses. For example, U.S. Pat. No. 5,104,407 provides a structure with variable rigidity in the plane of the ring, but with a limited possibility of flexure outside this plane. On the other hand, U.S. Pat. No. 5,607,471 describes technical arrangements able to guarantee an improved flexibility out of the plane of the annulus. However, the possibility of effectively obtaining characteristics of variable rigidity of the prosthesis, for example, in its localised portions as well, appears significantly limited by the necessity to vary the area of the entire resistant section of the internal element. Moreover, the technical arrangements described in U.S. Pat. No. 5,607,471 do not allow an optimal behavior of the prosthesis in response to stresses in a tangential direction to be obtained (that is to say stresses directed along its longitudinal axis, which is usually closed in a ring), the rigidity in response to traction and compression at the same point of the internal element being substantially undifferentiated.
SUMMARYThe present invention provides a prosthesis for annuloplasty, the rigidity of which can be made variable in a described manner in dependence on the point, direction and mode (traction, compression, flexion, torsion) of application of the stresses. According to the invention, this is achieved thanks to a prosthesis for annuloplasty comprising a laminar or tubular element having a plurality of apertures in at least one portion. This element can then be defined hereinafter in the present description as “perforated.” In the perforated element, the apertures can be formed substantially according to any arrangement and with any shape and dimensions, so as to obtain the desired rigidity variation. For example, a prosthesis provided with such a perforated element can have markedly different rigidity whilst having a constant transverse section, so as to satisfy possible requirements of uniformity of dimensions.
The perforated element can be formed in its laminar form both with a flat development and with various three-dimensional shapes. Preferably, however, the perforated element is made in a tubular shape because this shape allows a more flexible and efficient arrangement of the apertures for the purpose of influencing the properties of rigidity of prosthesis. As a matter of fact, the transverse section of the perforated tubular element can be of any shape. A circular transverse section is preferred for reasons of practicality and simplicity of production.
The prostheses of the invention have the additional advantage of an easier suturability since the apertures formed in the perforated element can constitute, if necessary, preferential transit ways for the passage of a suture needle.
There are no particular limitations in relation to the material usable for the production of the perforated element. The perforated element can be produced in metal, polymeric, or composite material. For their part, the apertures can be formed in the perforated element with any conventional technology. For example, if the perforated element is made of metal, the apertures can be formed by piercing a pre-formed tube by a laser, electroerosion, or cutting. If the perforated element were formed of polymeric material, it could be directly formed into its definitive shape by moulding technologies. Overall, therefore, the production of the prosthesis of the invention is simple and economical.
Further advantages and characteristics of the invention will become apparent from the following detailed description provided purely by way of non-limitative example, with reference to the attached drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
FIGS. 3 to 6 are perspective views of respective alternative embodiments of the tubular element of
The reference 10 indicates in
The surface of the tubular element 18 and/or of the sheath 16 can be clad partially or totally with a thin layer of hemocompatible carbon, for example turbostratic carbon. The procedure for the production of such a cladding is, for example, described in U.S. Pat. Nos. 5,084,151, 5,387,247, 5,370,684, 5,133,845 and 5,423,886, the contents of each of which are hereby incorporated herein by reference. This cladding contributes to an improved hemocompatibility of the prosthesis 10 and to a controlled tissue growth of the receiving organism.
The desired characteristics of variation in flexibility can also be obtained with a suitable variation of the dimensions of the apertures 20 of the element 18, as illustrated for example in
It goes without saying that the arrangements of the apertures 20 previously illustrated and/or described can be combined in any way in different portions of the same perforated element 18 so as to regulate the rigidity of the prosthesis 10 in a desired manner in dependence on the point and direction of application of the stresses. Equally it is also possible, in embodiments of the perforated element 18 not illustrated, to arrange the apertures in an irregular manner rather than in a regularly repeating pattern.
Naturally, the principle of the invention remaining the same, the details of construction and the embodiments can be widely varied with respect to what has been described purely by way of example, without by this departing from its ambit.
Claims
1. An annuloplasty prosthesis for repair of a cardiac valve annulus by affecting the dimensions or shape of the valve annulus, so as to improve performance of the cardiac valve, the prosthesis comprising:
- a ring element having a longitudinal axis, a curved portion, and a generally straight portion, the ring element configured to have a shape generally corresponding to a desired shape of a normal cardiac valve annulus; and
- a sheath covering at least a portion of the ring element;
- wherein the ring element defines a plurality of apertures each having a characteristic selected to effect the flexibility of the annuloplasty prosthesis.
2. The annuloplasty prosthesis of claim 1 wherein the characteristic includes one or more of a size, a shape, and a location along the longitudinal axis.
3. The annuloplasty prosthesis of claim 1 wherein the apertures are configured such that the curved portion is more flexible than at least the straight portion.
4. The annuloplasty prosthesis of claim 1 wherein the ring element is an open ring having a first end and a second end.
5. The annuloplasty prosthesis of claim 1 wherein the ring element has a tubular cross-section.
6. The annuloplasty prosthesis of claim 1 wherein the ring element has a laminar cross-section.
7. An annuloplasty prosthesis comprising a ring element having a size and a shape generally corresponding to a cardiac valve annulus, the ring element including a plurality of apertures for controlling the flexibility of the annuloplasty prosthesis.
8. The annuloplasty prosthesis of claim 7 wherein the apertures are disposed along at least a portion of the ring element and are configured such that the prosthesis has a desired non-uniform flexibility along its length.
9. The annuloplasty prosthesis of claim 7 wherein the apertures are configured such that the prosthesis has a differentiated flexibility depending on the location and direction of application of an external stress.
10. The annuloplasty prosthesis of claim 7 wherein the prosthesis is generally planar, and wherein the apertures are configured such that the prosthesis has a first flexibility in response to a first external stress acting in the general plane of the prosthesis and a second flexibility in response to a second external stress acting generally transverse to the general plane of the prosthesis.
11. The annuloplasty prosthesis of claim 7 wherein:
- the ring element has a first portion and a second portion; and
- at least one of a size, a shape, or a position of each aperture is selected such that the first portion is more flexible than at least a part of the second portion.
12. The annuloplasty prosthesis of claim 7 wherein the ring element has a curved portion and a straight portion, and wherein the apertures are configured such that the curved portion is more flexible than the straight portion.
13. The annuloplasty prosthesis of claim 12 wherein the curved portion includes first and second end regions and a center region therebetween, and wherein the apertures are configured such that the center region is more flexible than the first and second end regions.
14. The annuloplasty prosthesis of claim 7 wherein the ring element is an open ring having first and second ends.
15. A method of forming an annuloplasy prosthesis, the method comprising:
- forming a plurality of apertures in a laminar or tubular element, including configuring the apertures such that the laminar or tubular element has a desired non-uniform flexibility along its length; and
- forming the laminar or tubular element into a ring element having a shape generally corresponding to a shape of a natural cardiac valve annulus.
16. The method of claim 15 wherein forming the plurality of apertures includes selecting at least one of a size, a shape, and a location of each aperture such that the laminar or tubular element has a desired non-uniform flexibility along its length.
17. The method of claim 15 wherein forming the plurality of apertures includes configuring the apertures such that the prosthesis has a differentiated flexibility depending on the location and direction of application of an external stress.
18. The method of claim 15 wherein:
- forming the laminar or tubular element into a ring element includes forming a generally planar ring element; and
- forming the plurality of apertures includes configuring the apertures such that the annuloplasty prosthesis has a first flexibility in response to a first external stress acting in the general plane of the ring element and a second flexibility in response to a second external stress acting generally transverse to the general plane of the ring element.
19. The method of claim 15 wherein:
- forming the laminar or tubular element includes forming the laminar or tubular element into a ring element having a curved portion and a generally straight portion; and
- forming the plurality of apertures includes configuring the apertures such that the curved portion is more flexible than at least a part of the straight portion.
20. The method of claim 15 wherein forming the laminar or tubular element includes forming the laminar or tubular element into an open ring element having a center portion and first and second ends.
Type: Application
Filed: Apr 19, 2007
Publication Date: Aug 16, 2007
Applicant: Sorin Biomedica Cardio (Saluggia)
Inventors: Pietro Arru (Fraz. Vernone (Torino)), Giovanni Bergamasco (Torino), Carla Stacchino (Torino)
Application Number: 11/737,474
International Classification: A61F 2/24 (20060101);