Medical closure device
A medical closure device (1; 20) comprising an inner member (2; 23), which is adapted to be positioned against an inner surface of a tissue wall, and a retaining member (3; 13; 21), which is attached to the inner member, wherein the retaining member is in the form of a loop made up by multiple coils of at least one filament, the coils lying side-by-side one another such that when increasing tension is applied in the loop, at least one of the at least one filament breaks apart before side-by-side portions of the at least one filament slide readily with respect to one another.
The present invention relates generally to the field of sealing or closure devices for, e.g., the sealing of a percutaneous puncture in a vessel wall, and in particular to the class of sealing devices that comprises an intra-arterial member, which is held in place by a retaining member, and more particular to the special characteristics of this retaining member.BACKGROUND OF THE INVENTION
In U.S. Pat. No. 6,508,828, which is assigned to the present assignee and whose entire contents are incorporated herein by reference for the sealing devices and methods disclosed therein, a sealing device is disclosed for sealing a puncture hole in a vessel wall. This sealing device comprises an inner sealing member, an outer locking member, and a retaining member. The inner sealing member is adapted to be positioned at an inner surface of the vessel wall, while the outer member is adapted to be positioned at an outer surface of the vessel wall. In use, the inner and outer members sandwich the vessel wall, and are held together by the retaining member, to thereby seal the puncture hole in the vessel wall. Other examples of sealing devices that comprise an inner member and an outer member, which are held together by an elongated retaining member, can be found in, for example, U.S. Pat. Nos. 5,593,422 and 5,620,461.
The retaining member can be provided in the form of a loop, which has been made from a thread, suture, monofilament, multifilament, or some other thread-like structure, the ends of which have been joined together by means of a knot. As an alternative, the ends of the thread-like element can be glued together to thereby form a loop.
In the U.S. Patent Application Publications Nos. 2005/0137625 and 2007/0239209, whose entire contents are incorporated herein by reference for the sealing devices and methods disclosed therein, the drawbacks with knotting and gluing are discussed, and an alternative approach is presented, wherein the ends of, for example, a suture are joined together by embedding one portion of the suture within another portion of the same suture, such that as tension in the suture increases, the different suture portions are held together by the friction then acting between these suture portions.
The present invention is therefore directed to an improved method of joining an elongated, thread-like element into a loop suitable for holding at least an inner member being part of a sealing device in place, and a general object of the invention is to provide a sealing device comprising an inner member which is attached to a loop, which is manufactured by this improved method.SUMMARY OF THE INVENTION
The above-mentioned object is achieved with a medical sealing device comprising an inner member which is attached to a retaining member described herein.
As was stated above, in a medical sealing or closure device it is generally known to hold an inner member thereof by means of a retaining member, which can be provided in the form of a suture or filament. The sealing device is usually delivered into a puncture hole by some kind of insertion and positioning assembly, and to arrange the retaining member in the form of a loop provides thereby certain advantages, because a loop can easily be attached to and handled by the other elements of the insertion and positioning assembly. For this reason it is less favorable to produce a loop from a thread whose ends are tied together, because there is a risk that the resulting knot gets stuck in the insertion and positioning assembly during the delivery procedure. To create a loop by gluing together the ends of a thread is also less practical, because, for example, glue has to harden, and care must be taken to ensure that there is no excess glue that can contaminate the other parts of the insertion and positioning assembly and thereby jeopardize its proper functioning. The most elegant way of creating a loop is perhaps to thread one portion of, for example, a suture into another portion of the same suture, such that when the suture is subjected to tension, friction between the suture portions increases and holds the loop intact. The threading of one portion of a suture into another portion of the suture is, however, a rather time-consuming procedure, and requires a considerable amount of manual dexterity to manufacture, and is less suited for large-scale production.
In contrast, the present invention introduces a novel technique for providing a retaining member in the form of a loop made from a thread-like structure. Herein the term “filament” will be used as a common term for all kinds of thread-like structures, including but not limited to threads, sutures, fibers, monofilaments, multifilaments, etc. According to one embodiment of the invention, a loop is created by winding up a single filament multiple times, to thereby create a knotless loop, which holds together purely due to the friction acting between the individual filament coils. It has been found that the winding preferably should be performed at least ten (10), and more preferably at least twenty (20) times, to thereby create a loop comprising at least ten and more preferably at least twenty turns or coils, all made up from the same filament.
In another embodiment of the invention, several individual filaments are (preferably simultaneously) wound multiple times into one common loop comprising several coils of each individual filament. In this embodiment, the preferred number of windings can be somewhat smaller, but at least five (5), and more preferably at least ten (10), windings should be performed, such that in the loop an individual filament is represented by at least five and more preferably by at least ten turns or coils. Another way of expressing this feature of a knotless loop according to the present invention is to say that in a cross-section of the loop there are at least five, and more preferably at least ten, smaller cross-sections present, which all originate from the same filament. The number of windings (coils) could, however, be much larger, and for a thin monofilament, the number of coils could exceed one hundred, or even be in excess of two or three hundred, depending on, in particular, the surface characteristics of the filament used.
To prevent any tendency of unwinding of the filament(s) in a loop, some adherent material or property can be provided to cause the filaments to adhere to one another. Such an adherent, which could be an adhesive or a tacky material, e.g. wax or grease, or a conventional suture coating material, can be applied either to the surface of the loop itself, or to the surface of the individual filaments constituting the loop. Herein, the term “adherent” is meant to encompass all such adherent materials. An adherent should, however, not be confused with an adhesive such as glue which is used as the actual means that holds the loop together. Herein, an adherent is mainly used to prevent the filaments of the loop from fraying, but such an adherent can also increase the friction between the surfaces of neighbouring filament coils in a loop.
In a particular embodiment of a loop according to the present invention, the loop can be provided with a thickened section created by winding at least one filament around a portion of the loop, i.e. this thickening winding is perpendicular to the coils making up the loop itself. Such a thickened section can, in a sealing device comprising an outer member, be used for friction locking of the outer member. A friction lock for an outer member is disclosed in, for example, the above-referenced U.S. Pat. No. 6,508,828, whose entire contents are incorporated herein by reference.
For ease of understanding, embodiments of the present invention will be described with reference to a sealing device adapted for the sealing of a percutaneous puncture in a vessel wall, such as an artery wall. The invention could, however, be applied to other types of medical sealing or closure devices, for example devices for the closing of an opening or defect in a patient's heart (e.g. a so-called patent foramen ovale).
A similar way of manufacture a loop comprising multiple coils of the same filaments is to wind a multifilament multiple times. A multifilament consists of several filaments, which, for example, have been braided or twined into a multifilament. Also in this case, the result of the winding process is that a cross-section of the loop comprises several individual filament cross-sections, i.e. very similar to the cross-section shown in
Table 1 shows the test results for a multifilament braided from twenty (20) filaments made from a segmented copolymer composed of L,L-lactide, trimethylene carbonate and ε-caprolactone with the weight percentage 88:8:4 and made by Poly-Med, Inc., South Carolina, U.S. The multifilament was wound into loops consisting of different numbers of coils. Each loop was then subjected to tension, and the maximum tension (in Newton) before failure as well as mode of failure were recorded. To prevent any unravelling tendencies of the loops, an adherent in the form of ordinary hair wax (Sportin' Waves® sold by Soft Sheen Products, Inc., Illinois, U.S.) was applied to the surface of the loops. As evident from Table 1, when the multifilament was wound only two (2) times, the mode of failure was sliding, whereas already four (4) windings produced a loop which instead broke. Herein, the failure mode “break” indicates that the filaments themselves break apart, while the failure mode “sliding” indicates that the filaments slide readily with respect to one another such that the loop unravels. The term “readily” is meant to distinguish this catastrophic unravelling of the filaments in a loop from a small and insignificant (initial) displacement or rearrangement of the filaments in a loop. Such a displacement or rearrangement can typically occur at the start of the tensioning of the loop in question.
The general purpose of a loop according to the invention is to function as a retaining member in a sealing device, wherein the retaining member holds an inner member. When the sealing device further comprises an outer member, which can slide along the retaining member until it is to be held in place by a friction lock created between the retaining member and a bore or hole in the outer member, a loop according to the invention can preferably be provided with a thickened portion. This thickened portion is advantageously also provided as a knotless portion in that one or several filaments are wound around a portion of a loop already created in accordance with the method described above. The windings of this thickened portion are thus directed perpendicular to the windings (or coils) of the basic loop. Alternatively, the transverse coils of a thickened portion can be made by winding of at least one filament which is not a continuous part of a filament forming the basic longitudinal loop.
Such a thickened portion is disclosed in
As with the first embodiment of the invention shown in
Although the present invention has been described with reference to specific embodiments, also shown in the appended drawings, it will be apparent to those skilled in the art that many variations and modifications can be done within the scope of the invention as described in the specification and defined with reference to the claims below. It is in particular contemplated that the number of windings and thereby the number of resulting coils of a loop can range from a rather small number, e.g. five or ten, to a rather large number like several hundreds, depending on the specifics of the filament(s) used and the final strength required. A suitable number can easily be determined by a few simple experiments.
1. A medical closure device (1; 20) comprising an inner member (2; 23), which is adapted to be positioned against an inner surface of a tissue wall, and a retaining member (3; 13; 21), which is attached to the inner member, wherein the retaining member is in the form of a loop made up by multiple coils of at least one filament, the coils lying side-by-side one another such that when increasing tension is applied in the loop, at least one of the at least one filament breaks apart before side-by-side portions of the at least one filament slide readily with respect to one another.
2. A medical closure device according to claim 1, wherein the closure device further comprises an outer member (24), which is adapted to be positioned against an outer surface of the tissue wall, wherein the retaining member is provided with a thickened portion (22) made by multiple winding of at least one filament around the circumference of a portion of the loop.
3. A medical closure device according to claim 1, wherein the loop is knotless.
4. A medical closure device according to claim 1, wherein the medical closure device is adapted for closing a puncture in a vessel wall.
5. A medical closure device according to claim 1, wherein the medical closure device is adapted for closing a septal defect in a heart.
International Classification: A61B 17/12 (20060101);