WO2022013857A1 - Dispositifs destinés à la séparation de valve - Google Patents

Dispositifs destinés à la séparation de valve Download PDF

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Publication number
WO2022013857A1
WO2022013857A1 PCT/IL2021/050844 IL2021050844W WO2022013857A1 WO 2022013857 A1 WO2022013857 A1 WO 2022013857A1 IL 2021050844 W IL2021050844 W IL 2021050844W WO 2022013857 A1 WO2022013857 A1 WO 2022013857A1
Authority
WO
WIPO (PCT)
Prior art keywords
splitter
cusp
cutter
valve
over
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/IL2021/050844
Other languages
English (en)
Inventor
Yair Feld
Arthur KERNER
Alexander Treystman
Gdaliahu ALMUZNINO
Issac TSEFADIA
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Rambam Med Tech Ltd
Original Assignee
Rambam Med Tech Ltd
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Rambam Med Tech Ltd filed Critical Rambam Med Tech Ltd
Publication of WO2022013857A1 publication Critical patent/WO2022013857A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/32—Surgical cutting instruments
    • A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/32—Surgical cutting instruments
    • A61B17/3201—Scissors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1492—Probes or electrodes therefor having a flexible, catheter-like structure, e.g. for heart ablation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/00234—Surgical instruments, devices or methods for minimally invasive surgery
    • A61B2017/00292—Surgical instruments, devices or methods for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00743—Type of operation; Specification of treatment sites
    • A61B2017/00778—Operations on blood vessels
    • A61B2017/00783—Valvuloplasty
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/22—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22038—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for with a guide wire
    • A61B2017/22039—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for with a guide wire eccentric
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00601—Cutting
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B2018/1405—Electrodes having a specific shape
    • A61B2018/144—Wire
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/24—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body
    • A61F2/2412—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body with soft flexible valve members, e.g. tissue valves shaped like natural valves

Definitions

  • TAVI Transcatheter Aortic Valve Implantation
  • TAVI A rare catastrophic complication of TAVI is coronary artery obstruction, specifically in the case of prosthetic valves ("Assessing the Risk for Coronary Obstruction After Transcatheter Aortic Valve Implantation and the Need to Perform BASILICA: The VIVID Classification," Gilbert H L Tang, Ikki Komatsu, Liron Tzemach, Matheus Simonato, Arik Wolak, Philipp Blanke, Danny Dvir Eurointervention. 2020 May 4) and TAVI-in-TAVI ("Feasibility of Repeat TAVR After SAPIEN 3 TAVR A Novel Classification Scheme and Pilot Angiographic Study," Gilbert H.L. Tang, Syed Zaid, Eisha Gupta, Hasan Ahmad, Asaad Khan, Jason C. Kovacic, Steven L. Lansman, George D. Dangas, Samin K. Sharma and Annapoorna Kini. JACC: Cardiovascular Interventions Volume 12, Issue 13, July 2019).
  • Some embodiments of the present invention provide a dedicated device for intentional splitting of a native or prosthetic valve cusp before performing TAVI, in order to prevent coronary artery obstruction.
  • a valve-splitting device for splitting a native or prosthetic valve cusp, the valve splitting device for use with a guidewire
  • the valve- splitting device including: a cover sheath; and a splitter, which is removably disposed inside the cover sheath, and which includes: a first over-the-wire cutter, which is shaped so as to define a guidewire lumen that is configured to accept and slide over the guidewire; and a second opposing cutter, wherein the splitter is configured, upon distal advancement of the splitter out of a distal end of the cover sheath, to be opened such that the first over-the-wire cutter and the second opposing cutter are separated from each other and are disposable on opposite sides of the cusp, such that closing the splitter by bringing the first over-the-wire cutter and the second opposing cutter together cuts the cusp.
  • At least one of the first over-the-wire cutter and the second opposing cutter includes one or more cutting protrusions, which are configured to cut the cusp by lacerating the cusp.
  • the second opposing cutter includes the one or more cutting protrusions.
  • At least one of first over-the-wire cutter and the second opposing cutter includes an elongate cutting blade, which is configured to cut the cusp by excising a piece of material of the cusp.
  • the second opposing cutter includes the elongate cutting blade.
  • the elongate cutting blade is located along at least a portion of an edge of the second opposing cutter.
  • the splitter further includes a cutting sleeve, which is configured to be distally advanced toward and then over the open splitter, thereby closing the splitter by bringing the first over-the-wire cutter and the second opposing cutter together, and cutting the cusp when the first over-the-wire cutter and the second opposing cutter are disposed on the opposite sides of the cusp.
  • a cutting sleeve which is configured to be distally advanced toward and then over the open splitter, thereby closing the splitter by bringing the first over-the-wire cutter and the second opposing cutter together, and cutting the cusp when the first over-the-wire cutter and the second opposing cutter are disposed on the opposite sides of the cusp.
  • the cutting sleeve is configured to be advanced out of the distal end of the cover sheath in order to reach the splitter.
  • the splitter further includes a spring that is configured to open the splitter by separating the first over-the-wire cutter and the second opposing cutter from each other.
  • the valve- splitting device is configured to apply energy during cutting.
  • a method for splitting a native or prosthetic valve cusp of a patient including: inserting a guidewire into a left ventricle of the patient; advancing a valve- splitting device over the guidewire to a location above an aortic root, while a splitter of the valve-splitting device is removably disposed inside a cover sheath of the valve- splitting device, while the guidewire slides through a guidewire lumen defined by a first over-the-wire cutter of the splitter, and while the splitter is closed; advancing the splitter out of a distal end of the cover sheath toward the native or prosthetic valve cusp; while the splitter is open such that the first over-the-wire cutter and a second opposing cutter of the splitter are separated from each other, disposing the first over-the- wire cutter and the second opposing cutter on opposite sides of the cusp; cutting the cusp by closing the splitter by bringing the first over-
  • cutting the cusp includes lacerating the cusp using one or more cutting protrusions of at least one of first over-the-wire cutter and the second opposing cutter.
  • the second opposing cutter includes the one or more cutting protrusions
  • cutting the cusp includes lacerating the cusp using the one or more cutting protrusions of the second opposing cutter.
  • cutting the cusp includes excising a piece of material of the cusp using an elongate cutting blade of at least one of first over-the-wire cutter and the second opposing cutter.
  • the second opposing cutter includes the elongate cutting blade
  • cutting the cusp includes excising the piece of material of the cusp using the elongate cutting blade of the second opposing cutter.
  • the elongate cutting blade is located along at least a portion of an edge of the second opposing cutter.
  • cutting the cusp includes distally advancing a cutting sleeve toward and then over the open splitter, thereby closing the splitter by bringing the first over- the-wire cutter and the second opposing cutter together.
  • distally advancing the cutting sleeve toward the open splitter includes distally advancing the cutting sleeve out of the distal end of the cover sheath toward the open splitter.
  • the splitter further includes a spring that is configured to open the splitter by separating the first over-the-wire cutter and the second opposing cutter from each other.
  • the method further includes subsequently implanting a prosthetic aortic valve.
  • cutting the cusp further includes applying energy during cutting.
  • Figs. 1A-F are schematic illustrations a method for splitting a native or prosthetic valve cusp before performing a Transcatheter Aortic Valve Implantation (TAVI), in accordance with an application of the present invention
  • Figs. 2A-B are schematic illustrations of the cusp after it has been lacerated using a valve-splitting device described with reference to Figs. 1A-F, in accordance with an application of the present invention
  • Figs. 3A-F are schematic illustrations another method for splitting a native or prosthetic valve cusp before performing TAVI, in accordance with an application of the present invention
  • Figs. 4A-B are schematic illustration of the cusp after a piece of material has been removed using a valve- splitting device described with reference to Figs. 3A-F, in accordance with an application of the present invention.
  • Fig. 5 is a schematic illustration of an operating handle positioned at a distal end of the valve- splitting device of Figs. 1A-F or Figs. 3A-F, in accordance with an application of the present invention.
  • FIGs. 1A-F are schematic illustrations a method for splitting a native or prosthetic valve cusp 4 before performing a Transcatheter Aortic Valve Implantation (TAVI), in accordance with an application of the present invention.
  • Figs. 1 A- F also show a valve-splitting device 20 used to perform the method.
  • Fig. 1A shows aortic valve cusp 4, a left coronary artery 5, and a right coronary artery 6.
  • a guidewire 3 is inserted into the left ventricle, e.g., via the femoral artery.
  • Guidewire 3 is typically not an element of valve-splitting device 20.
  • a sheath may be inserted into the femoral artery.
  • the aortic valve may be crossed with a straight wire over a catheter (e.g., an AL1 catheter) and an exchange wire may be introduced to the left ventricle.
  • a pigtail catheter may be introduced, and the guidewire 3 is inserted to the apex of the left ventricle.
  • valve- splitting device 20 is then advanced over guidewire 3 to a location above the aortic root.
  • Valve- splitting device 20 typically comprises a cover sheath 22 and/or a nosecone 24.
  • cover sheath 22 is proximally retracted.
  • Valve- splitting device 20 further comprises a splitter 26, which is removably disposed inside cover sheath 22 at the stage of the procedure shown in Fig. IB.
  • Splitter 26 comprises a first over-the-wire cutter 30 and a second opposing cutter 32 that comprises one or more cutting protrusions 34 (e.g., a single cutting protrusion 34, as shown), such as one or more needles or spikes.
  • Splitter 26 is shaped so as to define a guidewire lumen 40, configured to accept and slide over guidewire 3.
  • first over-the-wire cutter 30 of splitter 26 is shaped to define guidewire lumen 40.
  • first over-the-wire cutter 30 comprises the one or more cutting protrusions 34
  • second opposing cutter 32 and first over-the-wire cutter 30 comprise respective one or more cutting protrusions 34 (configurations not shown).
  • both cutters 30 and 32 are considered cutters, because the cutter without cutting protrusions assists in the cutting by providing a surface against which the cutting protrusions press during cutting. Cutters 30 and 32 may also be considered jaws of splitter 26.
  • guidewire lumen 40 has a diameter of between 0.035' and 0.042', in order to accommodate a standard guidewire having a diameter of 0.035' - 0.038'.
  • splitter 26 is advanced out of a distal end of cover sheath 22 toward cusp 4 of the aortic valve.
  • the aortic valve is shown in the figures as a native aortic valve, the aortic valve may also be a prosthetic valve of a previously implanted prosthetic aortic valve, e.g., implanted in a TAVI procedure.
  • splitter 26 is opened by separating first over-the-wire cutter 30 and second opposing cutter 32 from each other.
  • splitter 26 comprises a spring 42 that is configured to separate the cutters 30 an d32 from each other (as shown, for example, in Fig. ID); alternatively, splitter 26 is opened using other techniques, such as using one or more control wires (configuration not shown).
  • Splitter 26 is oriented towards the cusp 4 that needs laceration.
  • splitter 26 is advanced into contact with cusp 4, such that cutters 30 and 32 are disposed on opposite surfaces of cusp 4.
  • first over-the-wire cutter 30 may be disposed on a ventricular side of cusp 4 and second opposing cutter 32 may be disposed on an aortic side of cusp 4, or vice versa.
  • a cutting sleeve 44 of valve-splitting device 20 is distally advanced toward and then over splitter 26, thereby closing splitter 26 by bringing first over- the-wire cutter 30 and second opposing cutter 32 together, and cutting cusp 4.
  • cutting sleeve 44 is advanced out of the distal end of cover sheath 22 in order to reach splitter 26.
  • splitter 26 is configured to cut cusp 4 by lacerating cusp 4, typically substantially without removing any material (e.g., tissue) of cusp 4.
  • heat is applied, such as by a diathermia device, for improving cutting efficiency.
  • energy such as RF ablation energy, is applied, for improving cutting efficiency.
  • splitter 26 and cutting sleeve 44 are proximally retracted from lacerated cusp 4 into cover sheath 22.
  • Cover sheath 22, including splitter 26 and cutting sleeve 44, is withdrawn from the patient's body.
  • a prosthetic aortic valve is implanted, such as in a TAVI procedure.
  • FIGs. 2A-B are schematic illustrations of cusp 4 after it has been lacerated using valve-splitting device 20 as described with reference to Figs. 1 A-F, in accordance with an application of the present invention.
  • the ostium of right coronary artery 6 is not obstructed when cusp 4 is pushed toward the aorta, such as during implantation of a prosthetic valve, e.g., during a TAVI procedure.
  • FIGs. 3A-F are schematic illustrations another method for splitting a native or prosthetic valve cusp 4 before performing TAVI, in accordance with an application of the present invention.
  • Figs. 3A-F also show a valve splitting device 120 used to perform the method. Other than as described below, the method is identical to the method described hereinabove with reference to Figs. 1A-F, and valve splitting device 120 is identical to valve- splitting device 20, described hereinabove with reference to Figs. 1A-F.
  • Valve- splitting device 120 comprises a splitter 126, which, other than as described hereinbelow, is generally similar to splitter 26 of valve-splitting device 20, described hereinabove with reference to Figs. 1A-F, and may implement any of the features of splitter 26, mutatis mutandis.
  • a second opposing cutter 132 of splitter 126 of valve- splitting device 120 comprises an elongate cutting blade 134, which is configured to cut cusp 4 by excising a piece of material of cusp 4, such as shown in the transition between Figs. 3D and 3E.
  • the excised piece of cusp material is trapped between first over-the-wire cutter 30 and second opposing cutter 132, and removed from the patient's body using splitter 126 as splitter 126 is proximally retracted into cover sheath 22, such as shown in Fig. 3F.
  • first over-the-wire cutter 30 comprises elongate cutting blade 134
  • second opposing cutter 132 and first over-the-wire cutter 30 comprise respective elongate cutting blades 134 (configurations not shown).
  • both cutters 30 and 132 are considered cutters, because the cutter without the elongate cutting blade assists in the cutting by providing a surface against which the elongate cutting blade presses during cutting. Cutters 30 and 132 may also be considered jaws of splitter 126.
  • elongate cutting blade 134 is generally U-shaped (as shown in Fig. 3D) or generally V-shaped (configuration not shown). Alternatively, elongate cutting blade 134 is shaped so as to form a closed loop (configuration not shown).
  • elongate cutting blade 134 is located along at least a portion of an edge of second opposing cutter 132.
  • FIGs. 4A-B are schematic illustration of cusp 4 after the piece of material has been removed using valve- splitting device 120 as described with reference to Figs. 3A-F, in accordance with an application of the present invention.
  • the ostium of right coronary artery 6 is not obstructed when cusp 4 is pushed toward the aorta, such as during implantation of a prosthetic valve, e.g., during a TAVI procedure.
  • FIG. 5 is a schematic illustration of an operating handle 212 positioned at a distal end of valve-splitting device 20 or valve- splitting device 120, in accordance with an application of the present invention.
  • operating handle 212 is shown in Fig. 5 as positioned at the distal end of valve- splitting device 20, the operating handle may also be positioned at the distal end of valve-splitting device 120, mutatis mutandis.
  • Operating handle 212 comprises one or more of the following elements: a knob 214 for retracting cover sheath 22, a port 216 for guidewire 3, a knob 218 for advancing cutting sleeve 44, a port 220 for diathermia input to cutting sleeve 44 and/or one or both of the splitter cutters, and/or a flushing port 222.

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Medical Informatics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Pathology (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Prostheses (AREA)

Abstract

L'invention concerne également un dispositif de séparation de valve (20, 120) destiné à séparer une cuspide de valve native ou prothétique (4). Le dispositif de séparation de valve (20, 120) comprend une gaine de recouvrement (22) et un séparateur (26, 126), qui est disposé de manière amovible à l'intérieur de la gaine de recouvrement (22). Le séparateur (26, 126) comprend un premier dispositif de coupe sur fil (30), qui est façonné de manière à définir une lumière de fil-guide (40) qui est conçue pour accepter et coulisser sur un fil-guide (3) ; et un second dispositif de coupe opposé (32, 132). Le séparateur (26, 126) est conçu, lors de l'avancement distal du séparateur (26, 126) hors d'une extrémité distale de la gaine de recouvrement (22), devant être ouverte de sorte que le premier dispositif de coupe à fil (30) et le second dispositif de coupe opposé (32, 132) sont séparés l'un de l'autre et sont jetables sur des côtés opposés de la cuspide (4), de sorte que la fermeture du séparateur (26, 126) par la mise en contact du premier dispositif de coupe à fil (30) et du second dispositif de coupe opposé (32, 132) coupe la cuspide conjointement (4). L'invention décrit également d'autres modes de réalisation.
PCT/IL2021/050844 2020-07-14 2021-07-11 Dispositifs destinés à la séparation de valve Ceased WO2022013857A1 (fr)

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US202063051479P 2020-07-14 2020-07-14
US63/051,479 2020-07-14

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Cited By (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2023139576A1 (fr) 2022-01-18 2023-07-27 Rambam Medtech Ltd. Dispositifs de sectionnement de valvule
US20240173065A1 (en) * 2022-11-28 2024-05-30 St. Jude Medical, Cardiology Division, Inc. Transcatheter Tools for Basilica or Lampoon Procedure and Methods of Using Same
WO2024157136A1 (fr) * 2023-01-27 2024-08-02 Medtronic, Inc. Dispositif de résection de feuillet orientable
WO2025003027A1 (fr) * 2023-06-28 2025-01-02 Koninklijke Philips N.V. Dispositif de saisie et de découpe de feuillet de valve cardiaque

Citations (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20200146690A1 (en) * 2018-11-14 2020-05-14 Medtronic, Inc. Devices and methods for preparing a valve for a transcatheter valve replacement procedure

Patent Citations (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20200146690A1 (en) * 2018-11-14 2020-05-14 Medtronic, Inc. Devices and methods for preparing a valve for a transcatheter valve replacement procedure

Cited By (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2023139576A1 (fr) 2022-01-18 2023-07-27 Rambam Medtech Ltd. Dispositifs de sectionnement de valvule
US20240173065A1 (en) * 2022-11-28 2024-05-30 St. Jude Medical, Cardiology Division, Inc. Transcatheter Tools for Basilica or Lampoon Procedure and Methods of Using Same
EP4389025A1 (fr) * 2022-11-28 2024-06-26 St. Jude Medical, Cardiology Division, Inc. Outils transcathéter pour procédure basilice ou laboon
WO2024157136A1 (fr) * 2023-01-27 2024-08-02 Medtronic, Inc. Dispositif de résection de feuillet orientable
WO2025003027A1 (fr) * 2023-06-28 2025-01-02 Koninklijke Philips N.V. Dispositif de saisie et de découpe de feuillet de valve cardiaque

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