# US 11,992,405 B2 · Percutaneous sling for papillary muscle approximation

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- Number: US 11,992,405 B2
- Document ID: US11992405B2
- Status: Granted
- Kind: B2
- Application number: 17/108,191
- Filed: 2020-12-01
- Published: 2021-06-03
- Granted: 2024-05-28
- Earliest claimed: 2019-12-03
- Assignees: Boston Scientific Scimed, Inc.
- Applicants: Boston Scientific Scimed, Inc.
- Inventors: Dongming Hou; Raffaele Cicerone; Bryan A. Clark; Aiden Flanagan; Tim O'Connor
- Web page: https://patentgrep.com/patent/US11992405B2

## CPC

- A61F 2/2457: {Chordae tendineae prostheses}
- A61B 17/0469: {Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery}
- A61F 2/2466: {Delivery devices therefor}
- A61B 2017/003: {Steerable}
- A61B 2017/00853: {low friction, hydrophobic and corrosion-resistant fluorocarbon resin coating (ptf, ptfe, polytetrafluoroethylene)}
- A61B 2017/0409: {Instruments for applying suture anchors}
- A61B 2017/0414: {having a suture-receiving opening, e.g. lateral opening}
- A61B 2017/0437: {the barbs being resilient or spring-like}
- A61B 2017/0443: {the shaft being resilient and having a coiled or helical shape in the released state}
- A61B 2017/0464: {for soft tissue}
- A61F 2220/0016: with sharp anchoring protrusions, e.g. barbs, pins, spikes
- A61F 2250/001: for adjusting a diameter
- 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 (dental prosthetics A61C)
- A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D)

## Abstract

An implant system and method of delivery includes a catheter system including a sling catheter having a plurality of distal openings and a delivery catheter, disposed within the sling catheter and having a distal port. Suture coupled anchors may be sequentially delivered by the delivery catheter to a cardiac treatment site by aligning the port of the delivery catheter with different openings of the sling catheter and pushing the anchor through the port and the sling catheter to embed the anchor into cardiac tissue such as tissue of a papillary muscle. Each anchor may have a linear configuration for translation within the delivery catheter and a biased configuration that inhibits its reentry into the sling catheter once deployed. Once all anchors are deployed, the suture may be tightened, the anchored portion of the sling catheter may be detached, and the catheter system withdrawn.

## Claims

### Claim 1

An implant comprising:
a cinchable sling catheter having a first opening and a second opening, the first opening and second opening extending through a wall of the cinchable sling catheter;
a first anchor configured to be disposed adjacent the first opening external to the sling catheter;
a second anchor configured to be disposed adjacent to the second opening external to the cinchable sling catheter; and
a cinchable suture carrying at least the first anchor and the second anchor, and configured to extend through a lumen of the cinchable sling catheter, and cinchable to cinch the cinchable sling catheter and to draw together the first anchor and the second anchor when the first anchor and the second anchor have been deployed with respect to tissue.

### Claim 2 (depends on 1)

The implant of claim 1, wherein the first opening and the second opening are two of a plurality of spaced apart openings of the cinchable sling catheter, wherein the spaced apart openings are evenly spaced or variably spaced.

### Claim 3 (depends on 1)

The implant of claim 1, wherein the cinchable sling catheter comprises a polytetrafluoroethylene tube.

### Claim 4 (depends on 1)

The implant of claim 1, wherein the cinchable sling catheter is configured for circumferential disposal about one or more papillary muscles, and at least one of the first opening or the second opening is orientated towards the one or more papillary muscles when circumferentially disposed.

### Claim 5 (depends on 1)

The implant of claim 1, wherein the first opening and the second opening are aligned along a common longitudinal axis of the cinchable sling catheter or are disposed along different longitudinal axes of the cinchable sling catheter.

### Claim 6 (depends on 1)

The implant of claim 1, wherein the first anchor and the second anchor are two of a plurality of anchors of the implant, and wherein each anchor is biased towards a configuration that inhibits return of the anchor into the cinchable sling catheter.

### Claim 7

A delivery system comprising:
a first catheter having a proximal end, a distal end and a lumen extending from the proximal end to the distal end, a portion of the distal end of the first catheter comprising a cinchable sling having a plurality of spaced apart openings extending through a first catheter wall;
a second catheter having a proximal end, a distal end, and a delivery lumen extending from the proximal end to the distal end, the distal end of the second catheter including a delivery port that extends through a second catheter wall, the second catheter translatably disposed within the lumen of the first catheter to enable alignment of the delivery port with one or more of the plurality of spaced apart openings of the cinchable sling;
a plurality of anchors carried by a suture; and
a push tube, translatably disposed within the delivery lumen and configured to advance at least one of the plurality of anchors through the delivery lumen and through the delivery port;
wherein the suture is cinchable to cinch the cinchable sling and to draw together the anchors when the anchors have been deployed with respect to tissue.

### Claim 8 (depends on 7)

The delivery system of claim 7, wherein the cinchable sling of the first catheter is formed of a polytetrafluoroethylene tube.

### Claim 9 (depends on 7)

The delivery system of claim 7, wherein the cinchable sling of the first catheter has a higher flexibility than the second catheter.

### Claim 10 (depends on 7)

The delivery system of claim 7, wherein an outer diameter of the cinchable sling is between 1 mm and 12 mm, a length of the cinchable sling is between 1 cm-35 cm and the plurality of spaced apart openings are spaced at least 2 mm apart.

### Claim 11 (depends on 7)

The delivery system of claim 7, wherein the plurality of anchors are coupled via one or more sutures.

### Claim 12 (depends on 11)

The delivery system of claim 11, further including a cinch mechanism configured to reduce spacing between the plurality of anchors.

### Claim 13 (depends on 12)

The delivery system of claim 12, wherein the cinch mechanism is configured to detach the cinchable sling from the first catheter.

### Claim 14 (depends on 12)

The delivery system of claim 12, wherein the cinch mechanism is configured to bind at least a portion of at least one of the one or more sutures to at least one of the plurality of anchors.

### Claim 15 (depends on 7)

The delivery system of claim 7, wherein each of the plurality of anchors has a first configuration enabling translation through the second catheter and delivery port, and a second configuration that inhibits translation through the delivery port and wherein the second catheter retains the plurality of anchors in the second configuration.

### Claim 16 (depends on 7)

The delivery system of claim 7, wherein the plurality of spaced apart openings of the cinchable sling are aligned along a common longitudinal axis of the first catheter or are disposed along different longitudinal axes of the first catheter.

### Claim 17 (depends on 7)

The delivery system of claim 7, wherein the plurality of spaced apart openings are evenly spaced or a spacing of plurality of spaced apart openings varies.

### Claim 18 (depends on 7)

The delivery system of claim 7, including a cinching mechanism for tightening the suture.

### Claim 19

A method of sub valvular repair, the method comprising:
advancing a catheter system to a left ventricle, the catheter system including a cinchable sling catheter having a plurality of openings extending through a distal wall of the sling catheter and a delivery catheter, translatably disposed within the cinchable sling catheter, the delivery catheter having a distal port extending through a wall of the delivery catheter;
orienting the plurality of openings towards papillary muscles;
advancing a first anchor, carried by a suture, towards the distal port of the delivery catheter, the first anchor having a linear configuration enabling translation of the first anchor through the delivery catheter;
aligning the distal port with a first opening of the cinchable sling catheter and pushing the first anchor through the distal port and the first opening into first papillary tissue, the first anchor assuming a biased configuration that inhibits return of the first anchor into the first opening when the first anchor is pushed from the delivery catheter;
advancing a second anchor, carried by the suture, towards the distal port of the delivery catheter, the second anchor comprising the linear configuration during translation through the delivery catheter;
aligning the distal port with a second opening of the cinchable sling catheter and pushing the second anchor through the distal port and the second opening into second papillary tissue, the second anchor assuming the biased configuration that inhibits return of the second anchor into the second opening when the second anchor is pushed from the delivery catheter; and
cinching the suture to cinch the cinchable sling catheter and to draw the first anchor and the second anchor together to adjust a spacing between the first papillary tissue and the second papillary tissue into which the first anchor and the second anchor have respectively been pushed.

### Claim 20 (depends on 19)

The method of claim 19, further including:
binding one or more portions of the suture to at least one anchor;
detaching at least a portion of the cinchable sling catheter; and
removing the catheter system from the left ventricle.