Prosthesis (i.e. – artificial body members) – parts thereof – or ai – Arterial prosthesis – Stent structure
Patent
1997-03-26
1998-07-07
Brittingham, Debra S.
Prosthesis (i.e., artificial body members), parts thereof, or ai
Arterial prosthesis
Stent structure
623 2, 623 3, A61F 206, A61F 224, A61F 110
Patent
active
057761850
DESCRIPTION:
BRIEF SUMMARY
The present invention relates to prosthetic replacements designed for use in cardiovascular surgery or in vascular surgery in general.
Various serious pathologies dealt with by the cardiac surgeon involve dilatation or aneurysm of the ascending aorta associated with impaired function, or insufficiency, of the aortic valve.
The aim of surgical intervention is to replace the damaged anatomical structures, usually with prostheses.
A commonly used technique involves implantation of a prosthesis known as a composite graft or valved conduit consisting of a single structure that comprises a tubular portion, which replaces the ascending aorta, bearing at its proximal end an artificial cardiac valve, which replaces the aortic valve.
Composite grafts are commercially available in different sizes to allow them to be matched exactly to patients' anatomical structures.
A problem of fundamental importance for correct and complete execution of the surgical intervention arises from the concomitant re-establishment of coronary circulation to the heart, in that: oxygenation of the heart and hence its vitality.
The coronary arteries originate from the most proximal segment of the ascending aorta, through two openings, the coronary ostia, one right and the other left, situated in an anatomically well defined position on the aortic wall. The coronary arteries originate from the ascending segment of the aorta; since said segment is affected by the pathological process of aneurysm, and therefore is also subject to replacement, the need arises to reattach the coronary artery origins to the tubular portion of the composite graft.
Whilst there is almost unanimous agreement amongst specialists in the field on the use of and implantation technique for the aortic composite graft, the ideal method for coronary reattachment has not yet been developed. The currently employed techniques have given rise to controversy as regards their intraoperative reliability and late results.
In brief, two main approaches can be identified: valved conduit and the coronary ostia.
The following techniques belong to group A): coronary artery origins on to the valved conduit, using the residual aortic wall which is brought over, the prosthetic conduit (so-called wrapping). The problems related to this technique are intraoperative bleeding, coronary artery dehiscence and false aneurysms. arteries from their site and re-implantation of the coronary ostia on the valved conduit as separate buttons. The disadvantages of this technique are the risk of injury of the coronary vessels or the pulmonary artery during the isolation procedure; the inaccessibility of the left coronary artery anastomosis which makes it difficult to control bleeding, should it occur.
The Cabrol technique belongs to group B) and consists in the use of a commercially available tubular vascular graft made of woven material known by the name of Dacron.RTM.; this graft is sutured, at its the ends, to each coronary origin and connected to the valved conduit by suturing (side to side anastomosis). The result is a single orifice, instead of the original two, at the valved conduit that conveys the blood into the two branches of the graft destined for the respective coronary ostia.
The greatest problems with this technique are the possibility of kinking of the graft at the side to side anastomosis on the valved conduit and the possible formation of an angle with resulting occlusion of the right coronary branch of the graft.
Svensson's technique lies between group A) and group B) in that it uses the aortic button technique for the right coronary ostium and a modified Cabrol technique--only one graft branch--for the left coronary ostium.
WO 82/01644 describes a prosthetic conduit according to the preamble of appended claim 1. The parts of such conduit provide a fixed relation with respect to the conduit and therefore no orientation of the conduit is possible after assembling.
The aim of the invention is to overcome the drawbacks of the techniques described above and to create a prosthetic conduit espe
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Poletti Giuseppe
Verona Alessandro
Brittingham Debra S.
Verona Alessandro
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