1. A method of delivering and mounting a cardiac harness onto the heart, comprising:
releasably connecting at least first and second longitudinally spaced locations of a cardiac harness to a cardiac harness delivery device;
forming a small incision in a pericardium of a patient;
inserting a distal end of the cardiac harness delivery device through the small incision in the pericardium;
expanding the distal end of the delivery device thereby creating a space between the pericardium and an epicardial surface of the heart; and
advancing the cardiac harness through the small incision and the space and onto the epicardial surface of the heart.
2. The method of claim 1, wherein the distal end of the delivery device includes an introducer sleeve having a contracted diameter and an expanded diameter, the introducer sleeve being sized for insertion through the small incision in the pericardium.
3. The method of claim 2, wherein after the introducer sleeve is inserted through the small incision in the pericardium, expanding the introducer sleeve from the contracted diameter to the expanded diameter thereby creating the space.
4. The method of claim 3, wherein the small incision in the pericardium takes the shape of the expanded introducer sleeve.
5. The method of claim 4, wherein the expanded introducer sleeve functions as a lock to resist pulling the introducer sleeve out of the small incision in the pericardium.
6. The method of claim 5, wherein the expanded introducer sleeve is effectively locked in place between the epicardial surface of the heart and the pericardium.
7. The method of claim 5, wherein the expanded size of the introducer sleeve is greater than the size of the small incision in the pericardium.
8. The method of claim 7, wherein the space created by the expanded introducer sleeve provides an access pathway for the cardiac harness to slide onto the heart.
9. The method of claim 2, wherein the introducer sleeve is expanded from the contracted diameter to the expanded diameter, the expanded diameter being greater than a diameter of a small incision in the pericardium.
10. The method of claim 9, wherein as the introducer sleeve expands from the contracted diameter to the expanded diameter, the introducer sleeve presses upon and opens the small incision in the pericardium.
11. The method of claim 1, wherein before forming the small incision in the pericardium, forming a minimally invasive access site sized for receiving the delivery device.
12. The method of claim 1, wherein the small incision formed in the pericardium is adjacent to the apex of the heart.
13. The method of claim 1, wherein the distal end of the delivery device has an outer diameter of less than about 2.0 inches (5.08 cm).
14. The method of claim 1, wherein the distal end of the delivery device has an outer diameter of less than about 1.5 inches (3.81 cm).
15. The method of claim 1, wherein after the distal end of the delivery device is inserted through the small incision in the pericardium, the delivery device is releaseably attached to the heart.
16. The method of claim 15, wherein a vacuum is applied to the delivery device to releasably attach the delivery device to the heart.
17. A method of delivering and mounting a cardiac harness onto the heart, comprising:
releasably connecting at least first and second longitudinally spaced locations of a cardiac harness to a cardiac harness delivery device;
forming a minimally invasive access site in a patient;
forming a small incision in the pericardium;
providing a cardiac harness delivery device having an introducer sleeve with a flared portion;
inserting the flared portion through the small incision in the pericardium;
expanding the flared portion thereby creating a space between the heart and at least part of the pericardium; and
advancing the cardiac harness out of the delivery device and through the space so that the harness slides onto the heart.
18. The method of claim 17, wherein the flared portion has a contracted diameter for insertion through the small incision, and an expanded diameter for pressing open the small incision.
19. The method of claim 18, wherein the expanded diameter of the flared portion is greater than the size of the small incision in the pericardium.
20. The method of claim 19, wherein the space created by the expanded flared portion provides an access pathway for the cardiac harness to slide onto the heart.
21. The method of claim 17, wherein the expanded flared portion is effectively locked in place between the heart and the pericardium.
22. The method of claim 17, wherein as the flared portion is expanded, the flared portion presses upon and opens the small incision and the surrounding portion of the pericardium to create the space between at least part of the pericardium and the heart.
23. A method for mounting a cardiac harness on a heart, comprising:
forming a small incision in a pericardium;
providing a tubular member having a flared portion;
inserting the flared portion through the small incision;
expanding the flared portion to press upon and open the small incision and the surrounding pericardium to create a space between at least a portion of the pericardium and the heart;
locking the flared portion in place between the heart and the pericardium;
mounting a cardiac harness onto the heart by advancing the harness through the space and sliding the harness onto the heart; and
contracting the flared portion and withdrawing the flared portion from the small incision.
The claims below are in addition to those above.
All refrences to claim(s) which appear below refer to the numbering after this setence.
1. A pneumatic tire comprising a tread portion provided with
a pair of shoulder main grooves extending continuously in the tire circumferential direction so as to define a pair of shoulder land regions axially outside the respective shoulder main grooves,
axially inner shoulder sipes circumferentially arranged in each shoulder land region,
axially outer shoulder sipes circumferentially arranged in each shoulder land region so as to position axially outside the axially inner shoulder sipes,
wherein
in each shoulder land region, each axially inner shoulder sipe extends from the shoulder main groove toward the tread edge, and has an axially outer end within the shoulder land region, and
each axially outer shoulder sipe extends toward the tread edge from its axially inner end which is positioned substantially on an axially outward extension of one of the axially inner shoulder sipes.
2. The pneumatic tire according to claim 1, wherein
said each axially outer shoulder sipe extends on the axially outward extension.
3. The pneumatic tire according to claim 1, wherein
the tread portion is provided between the shoulder main grooves with at least one crown main groove extending continuously in the tire circumferential direction so as to define a pair of middle land regions between the shoulder main grooves and at least one crown main groove,
each middle land region is provided with
middle grooves each having an open end opened to the crown main groove and a terminal end terminated within the middle land region, and
middle grooves each having an open end opened to the shoulder main groove and a terminal end terminated within the middle land region, and
the width of each middle groove is gradually decreased from the open end toward the terminal end.
4. The pneumatic tire according to claim 3, wherein
each middle land region is provided with first middle sipes extending from the crown main groove to the shoulder main groove,
a block piece defined between each middle groove and the adjacent first middle ripe is provided at its edge on the middle groove’s open end side with a chamfered part.
5. The pneumatic tire according to claim 3, wherein
the middle land region is provided with second middle sipes each extending from the terminal end of one of the middle grooves to the opposite one of the crown main groove and the shoulder main groove.
6. The pneumatic tire according to claim 1, wherein
each shoulder land region is provided with
shoulder grooves extending axial inwardly from the tread edge and each having an axially inner end terminated within the shoulder land region, and
third shoulder sipes extending from the respective inner ends of the shoulder grooves to the shoulder main groove.
7. The pneumatic tire according to claim 1, wherein
the tread portion is provided between the shoulder main grooves with a pair of crown main grooves extending continuously in the tire circumferential direction so as to define a center land region between the crown main grooves,
the center land region is provided with center grooves each having an open end opened to the crown main groove and a terminal end terminated within the center land region, and
the width of the center groove is gradually decreased from the open end toward the terminal end.
8. The pneumatic tire according to claim 2, wherein
the tread portion is provided between the shoulder main grooves with at least one crown main groove extending continuously in the tire circumferential direction so as to define a pair of middle land regions between the shoulder main grooves and at least one crown main groove,
each middle land region is provided with
middle grooves each having an open end opened to the crown main groove and a terminal end terminated within the middle land region, and
middle grooves each having an open end opened to the shoulder main groove and a terminal end terminated within the middle land region, and
the width of each middle groove is gradually decreased from the open end toward the terminal end.
9. The pneumatic tire according to claim 4, wherein
the middle land region is provided with second middle sipes each extending from the terminal end of one of the middle grooves to the opposite one of the crown main groove and the shoulder main groove.
10. The pneumatic tire according to claim 2, wherein
each shoulder land region is provided with
shoulder grooves extending axial inwardly from the tread edge and each having an axially inner end terminated within the shoulder land region, and
third shoulder sipes extending from the respective inner ends of the shoulder grooves to the shoulder main groove.
11. The pneumatic tire according to claim 3, wherein
each shoulder land region is provided with
shoulder grooves extending axial inwardly from the tread edge and each having an axially inner end terminated within the shoulder land region, and
third shoulder sipes extending from the respective inner ends of the shoulder grooves to the shoulder main groove.
12. The pneumatic tire according to claim 4, wherein
each shoulder land region is provided with
shoulder grooves extending axial inwardly from the tread edge and each having an axially inner end terminated within the shoulder land region, and
third shoulder sipes extending from the respective inner ends of the shoulder grooves to the shoulder main groove.
13. The pneumatic tire according to claim 5, wherein
each shoulder land region is provided with
shoulder grooves extending axial inwardly from the tread edge and each having an axially inner end terminated within the shoulder land region, and
third shoulder sipes extending from the respective inner ends of the shoulder grooves to the shoulder main groove.
14. The pneumatic tire according to claim 2, wherein
the tread portion is provided between the shoulder main grooves with a pair of crown main grooves extending continuously in the tire circumferential direction so as to define a center land region between the crown main grooves,
the center land region is provided with center grooves each having an open end opened to the crown main groove and a terminal end terminated within the center land region, and
the width of the center groove is gradually decreased from the open end toward the terminal end.
15. The pneumatic tire according to claim 3, wherein
the tread portion is provided between the shoulder main grooves with a pair of crown main grooves extending continuously in the tire circumferential direction so as to define a center land region between the crown main grooves,
the center land region is provided with center grooves each having an open end opened to the crown main groove and a terminal end terminated within the center land region, and
the width of the center groove is gradually decreased from the open end toward the terminal end.
16. The pneumatic tire according to claim 4, wherein
the tread portion is provided between the shoulder main grooves with a pair of crown main grooves extending continuously in the tire circumferential direction so as to define a center land region between the crown main grooves,
the center land region is provided with center grooves each having an open end opened to the crown main groove and a terminal end terminated within the center land region, and
the width of the center groove is gradually decreased from the open end toward the terminal end.
17. The pneumatic tire according to claim 5, wherein
the tread portion is provided between the shoulder main grooves with a pair of crown main grooves extending continuously in the tire circumferential direction so as to define a center land region between the crown main grooves,
the center land region is provided with center grooves each having an open end opened to the crown main groove and a terminal end terminated within the center land region, and
the width of the center groove is gradually decreased from the open end toward the terminal end.
18. The pneumatic tire according to claim 6, wherein
the tread portion is provided between the shoulder main grooves with a pair of crown main grooves extending continuously in the tire circumferential direction so as to define a center land region between the crown main grooves,
the center land region is provided with center grooves each having an open end opened to the crown main groove and a terminal end terminated within the center land region, and
the width of the center groove is gradually decreased from the open end toward the terminal end.