APPARATUS, CONTROL DEVICE, KIT FOR SUPPORTING THE HEART ACTION, INSERTION SYSTEM, AND METHOD

Abstract

The present invention relates to an apparatus (500) for supporting the heart action, preferably by displacing the heart base (110) and/or the aortic root (201), comprising at least a first anchor (501) and a pulling device or guiding device (502, 503, 732, 732a, 732b) for moving the first anchor (501), wherein the first anchor (501) is provided and designed for implantation in or on the heart base (110), the heart skeleton (120), the aortic root (201) and/or a structure in local proximity to the aortic root (210), and/or comprising at least one lifting drive (502, 503). The present invention further relates to a control device (901), an insertion system, a kit and a method for supporting the heart action.

Claims

1. An apparatus for supporting the heart action, comprising at least a first anchor and a pulling device or guiding device for displacing the first anchor, wherein the first anchor is provided and configured for implantation in or on the heart base, the heart skeleton, the aortic root and/or a structure in local proximity to the aortic root, and/or said apparatus encompassing at least one lifting drive.

2. The apparatus according to claim 1, wherein the pulling device or guiding device is, or comprises a linear guiding device.

3. The apparatus according to claim 2, wherein the first anchor comprises a V- or U-shaped section and the first anchor is connected, with or by at least one linear guide sleeve, to at least one end of the first anchor, wherein the linear guide sleeve is designed to guide the linear guiding device.

4. The apparatus according to claim 2, wherein the linear guiding device comprises a piston.

5. The apparatus according to claim 2, wherein the linear guiding device is movable mechanically, hydraulically, pneumatically, electrically or magnetically.

6. The apparatus according to claim 3, wherein a tension or pulling spring in the linear guide sleeve is arranged between the linear guiding device and the first anchor.

7. The apparatus according to claim 3, wherein the connection between the first anchor and the linear guiding sleeve is, or comprises a plug connection, a clamp connection, a bayonet lock or another connection.

8. The apparatus according to claim 1, wherein the pulling device or guiding device comprises an elongated, flexible and tensile element.

9. The apparatus according to claim 1, wherein the apparatus comprises a second anchor for implantation in or on the heart apex, a ligament, a rib, a sternum and/or a structure with local proximity to the heart apex.

10. The apparatus according to claim 1, wherein the apparatus comprises a metal, a plastic and/or a composite material.

11. A control device comprising a mechanical, hydraulic, pneumatic, electric or magnetic drive system for driving a pulling or guiding device of the apparatus according to claim 1.

12. An insertion system comprising: an apparatus having a guiding device for displacing a first anchor; and at least one of an insertion catheter, a guiding catheter, a guidewire and at least one delivery or supply catheter.

13. A kit comprising: the apparatus according to claim 1, a control device comprising a mechanical, hydraulic, pneumatic, electric or magnetic drive system for driving a pulling or guiding device, and/or an insertion system having at least one of an insertion catheter, a guiding catheter, a guidewire and at least one delivery or supply catheter.

14. A method for supporting the heart action, said method comprising: providing the apparatus according to claim 1; implanting the first anchor in or on the heart base, the heart skeleton, the aortic root and/or a structure in local proximity to the aortic root; implanting the pulling or guidance device for moving the first anchor; and connecting the first anchor and the pulling or guiding device.

15. The method according to claim 14, further comprising: implanting the second anchor in or on the heart apex, a ligament, a rib, a sternum and/or a structure in local proximity to the heart apex; and connecting the first anchor and the second anchor.

16. The method according to claim 14, further comprising: providing a control device comprising a mechanical, hydraulic, pneumatic, electric or magnetic drive system for driving the pulling or guiding device of the apparatus according to claim 1; moving the pulling or guiding device using the control unit to support the heart action.

17. The apparatus of claim 3, wherein the first anchor is connected with or by at least two linear guide brushes to the at least one end of the first anchor.

18. The apparatus according to claim 8, wherein the elongated, flexible and tensile element is a rope or a belt.

19. The method of claim 14, further comprising an insertion system—having at least one of an insertion catheter, a guiding catheter, a guidewire and at least one delivery or supply catheter, wherein the insertion system is used during the implanting of the first anchor, the implanting of the pulling or guidance device for moving the first anchor, and the connecting of the first anchor and the pulling or guiding device.

20. The method of claim 15, wherein the insertion system is used during the connecting of the first anchor and the second anchor.

Description

[0144] In the following, the apparatus according to the invention is described on the basis of preferred embodiments thereof with reference to the attached drawings. However, the invention is not limited to these embodiments. In the drawings:

[0145] FIG. 1 shows a representation of a heart with the four ventricles, heart base and heart skeleton;

[0146] FIG. 2 shows a representation of the pumping function of the heart;

[0147] FIG. 3 shows a representation of the suspension of the heart sac (or pericardium) in the chest (or thorax);

[0148] FIG. 4 shows a schematic representation of the pumping function of the left ventricle;

[0149] FIG. 5 shows an embodiment of the apparatus according to the present invention for supporting the aortic stroke;

[0150] FIG. 6 shows a schematic representation of the function of an embodiment of the apparatus according to the present invention for supporting the aortic stroke;

[0151] FIG. 7 shows the apparatus according to the present invention in an embodiment;

[0152] FIG. 8 shows a second anchor of an embodiment of the apparatus according to the present invention which is connected to a rib; and

[0153] FIG. 9 shows the apparatus according to the present invention in the implanted state in the thorax with a control device according to the present invention.

[0154] FIG. 1 shows a sectional view of a human heart 100 with the four ventricles (ventricle or atrium) 101, 102, 103, 104 and the heart base 110. FIG. 1A shows the left ventricle 101 (left lower heart chamber 101) and the left atrium 102 (left upper heart chamber 101) with the intermediate mitral valve 111 disposed in between, the right ventricle 103 (right lower heart chamber 103) and the right atrium 104 (right upper heart chamber 104) with the intermediate tricuspid valve 112 disposed in between. The interatrial septum 124 is disposed between the two atria 102, 104, and the interventricular septum 125 is disposed between the two ventricles 101 and 103.

[0155] In FIG. 1B, the heart base 110 is shown. The heart base 110 is a comparatively flat anatomical structure of the heart 100, on which the two atrioventricular valves, namely the mitral valve 111 and tricuspid valve 112, and the two pocket valves, namely the aortic valve 113 and the pulmonary valve 114, are disposed. The aortic valve 113 is enclosed by the aortic valve ring 130 or fixed in the aortic valve ring 130. The heart skeleton 120 consists of cartilaginous tissue and is the only rigid structure of the heart 100. The heart skeleton 120 completely encompasses the aortic root 201 and the central parts of the mitral valve ring 131 and the tricuspid valve ring 132. The most vigorously formed portions of the heart skeleton 120 are the left fibrous trigone 121 and the right fibrous trigone 122. On the right fibrous trigone 122, the mitral valve 111 and the tricuspid valve 112 adjoin each other. The heart muscle 123 of the interventricular septum 125 is connected to the heart skeleton 120 in the area of the right fibrous trigon 122 between the mitral valve 111 and the tricuspid valve 112. At this point, the contraction of the heart muscle 123 of the interventricular septum 125 leads to a pull or traction on the heart skeleton 120 and the therewith associated aortic valve 113 towards the heart apex.

[0156] The mitral valve 111 and tricuspid valve 112 close at the end of the diastole and ensure that when the ventricles 101 and 103 contract, the blood does not flow back into the atria 102 and 104 but is pumped forward and, on the right side, into the lungs and, on the left side, into the body's circuit. The aortic valve 113 and the pulmonary valve 114 close at the end of systole and ensure that, after the contraction of the two ventricles 101 and 103, the blood does not flow back into the ventricles 101 and 103, but rather that the diastolic blood pressure is maintained in the pulmonary artery and lungs on the right side and that the diastolic pressure is maintained in the aorta and the body's circuit on the left side.

[0157] FIG. 2 shows a schematic representation of the heart. FIG. 2A shows the heart base 110 schematically. FIG. 2B shows the heart 100 in the diastole with relaxed heart muscle 123. The longitudinal axis 220 is longest here in the contraction cycle and the circumference of the ventricles 210 and the orthogonal diameter are largest. The two ventricles 101 and 103 are filled; the mitral valve 111 and tricuspid valve 112 are open to allow blood inflow into the ventricles. The aortic valve 113 is closed and thus prevents the backflow of blood from the body's circuit into the left ventricle 101 and maintains the diastolic blood pressure in the body. The aortic root 201 is maximally contracted or shortened at the end of the diastole.

[0158] FIG. 2C schematically shows the contraction of heart 100 in the systole with a normally elastic aortic root 201. The heart muscle 123 is contracted, the heart 100 has the smallest circumference 210 and the smallest orthogonal diameter in the heart cycle. The heart apex 105 remains stationary, the heart base 110 has shifted to the heart apex 105, and the longitudinal axis 220 is the shortest. The atrioventricular valves 111 and 112 are closed in order to prevent a back flow of blood into the two atria 102 and 104. The aortic valve 113 is open to allow ejection of blood into the body's circuit. The aortic root 201 is maximally stretched.

[0159] FIG. 2D schematically shows the contraction of the heart 100 in the systole as well, but with a stiff, non-elastic aortic root 201. The heart muscle 123 is contracted, and the heart has the smallest circumference 210 and the smallest orthogonal diameter with regard to the heart cycle. The heart apex 105 remains stationary, the position of the heart base 110 has not changed in relation to the diastole, since the stiff aortic root 201 cannot be stretched and so the heart base 110 cannot be drawn towards the heart apex 105. The longitudinal axis 220 is as long as in the relaxed heart 100 in diastole in FIG. 2B. However, due to muscle contraction, the circumference 210 and the orthogonal diameter are the smallest with regard to the heart cycle. The atrioventricular valves 111 and 112 are closed to prevent a backflow of blood into the two atria 102 and 104. The aortic valve 113 is open to allow ejection of blood into the body's circuit.

[0160] FIG. 3 shows a schematic representation of the chest of a person. The pericardium 300 (heart sac) rests on the diaphragm 302 and is stretched between the aortic root 201 with the mediastinum 306 and the sterno-pericardial ligament 301. The sterno-pericardial ligament 301 extends from the pericardium 300 in the area of the heart apex 105 to a rib 305 and to the manubrium sterni at the end of the sternum 303.

[0161] As the heart contracts, the pericardium 300 may follow the reduction in heart circumference 210 during the systole. Since the closed pericardium is stretched between the relatively immobile sternum 303 and the mediastinum 306 via the sterno-pericardial ligament 301, the heart apex 105 cannot move away from the sternum 303 in the direction of the heart base 110. For this reason, contraction of the heart and shortening of the longitudinal axis 220 of the heart results in traction on the heart base 110 and the elastic aortic root 201, which is thus stretched in the systole and the heart base 101 with the aortic root 201 is pulled toward the heart apex 105.

[0162] FIG. 4 shows a schematic representation of the pumping function of a ventricle 101 as depending on the elasticity of the aortic root 201.

[0163] FIG. 4A schematically shows a left ventricle 101 in diastole. The heart muscle 123 is relaxed, the longitudinal axis 220 is the longest, the circumference of the ventricle 210 and the orthogonal diameter are the largest in the heart cycle. The ventricle 101 is filled and the mitral valve 111 is open to allow the inflow of blood 401 into the ventricle. The aortic valve 113 is closed and thus prevents the backflow of blood from the body's circuit into the left ventricle and maintains the diastolic blood pressure in the body. The aortic root 201 is maximally contracted at the end of the diastole.

[0164] FIG. 4B schematically shows the contraction of the heart with a normally elastic aortic root 201. The heart muscle 123 is contracted, the heart has the smallest circumference 210 or orthogonal diameter. The heart apex 105 remains stationary since the pericardium 300 is connected to the sternum 303 via the sterno-pericardial ligament 301. Due to the contraction of the heart muscle 123, the heart base 110 has shifted to the heart apex 105 and the longitudinal axis 220 is the shortest in the heart cycle. The mitral valve 111 is closed to prevent the backflow of blood into the atrium 102. The aortic valve 113 is open to allow ejection of blood 401 into the body's circuit. The aortic root 201 is maximally stretched. After the systole in FIG. 4B, the heart muscle 123 relaxes, the circumference of the heart 210 and its orthogonal diameter increases again, and the aortic root 201 pulls the heart base 110 away from the heart apex 105 (FIG. 4A). By this, blood present in the aortic root 201 is pumped into the body's circuit during the diastole.

[0165] FIG. 4C schematically shows contraction of the left ventricle 101 as well, but with a stiff, nonelastic aortic root 201. The heart muscle 123 is contracted. The heart apex 105 remains stationary since the pericardium 300 is connected to the sternum 303 via the sterno-pericardial ligament 301. The position of the heart base 110 has not changed since the stiff aortic root 201 cannot be stretched and thus the heart base cannot be drawn towards heart apex 105. The longitudinal axis 220 is as long as that in the relaxed heart in diastole in FIG. 4A. However, because of the muscle contraction, the circumference 210 and the orthogonal diameter are smallest in the heart cycle. The mitral valve 111 is closed in order to prevent backflow of blood into the left atrium 102. The aortic valve 113 is open to allow ejection of blood into the body's circuit.

[0166] After the systole FIG. 4C, the heart muscle relaxes again and the circumference 210 increases again (FIG. 4A). Since the heart base 110 remains stationary, there is no forward pumping of blood in the aortic root 201 with stiff aortic root 201 in FIG. 4C during the diastole compared to the situation with elastic aortic root in FIG. 4B.

[0167] FIG. 5 shows an exemplary embodiment of the apparatus 500 according to the present invention. In this, FIG. 5A shows a schematic representation of the apparatus 500 in the ventricles 101 and 103 and in the atria 102 and 104. The apparatus 500 comprises a first anchor 501, which can be referred to as bracket or connecting piece, and a guiding device 502, which can be referred to as a lifting drive, which is optionally arranged in the right ventricle 103, and a guiding device 503, which is optionally arranged in the left ventricle 101.

[0168] In several embodiments, the length of the apparatus 500 according to the present invention is preferably between 70 mm and 120 mm in the diastole, particularly preferably between 72 mm and 116 mm, and preferably between 60 mm and 115 mm in the systole, particularly preferably between 62 mm and 114 mm. The change in length of the apparatus 500 from diastole to systole is preferably a minimum of 0 mm and a maximum of 21 mm, particularly preferably a minimum of 10 mm and a maximum of 15 mm.

[0169] The first anchor 501 comprises two ends 513 and 514. A first end 513 is optionally arranged in the implanted state at the lower end of the right atrium 104 in the immediate vicinity of the base of the septal leaflet of the tricuspid valve 112. A second end 514 of the first anchor 501 is optionally arranged in the implanted state at the lower end of the left atrium 102 in the immediate vicinity of the base of the anterior leaflet of the mitral valve 111. The first anchor 501 optionally penetrates the atrial septum 124 at the lower end of the atrial septum 124 and, as shown in FIG. 5B, above the right fibrous trigone 122 where the mitral valve 111 and the tricuspid valve 112 adjoin each other.

[0170] The first anchor 501 is connected at its first end 513 (When referring to an end herein, this may optionally be understood as an end region. These two terms may optionally be interchanged.) in the right atrium 104 to the first end 511 of the guiding device 502. The first end 511 of the guiding device 502 penetrates the septal leaflet of the tricuspid valve 112 directly at the base of the valve leaflet. The guiding device 502 is located in the right ventricle 103, directly adjacent to the interventricular septum 125 and penetrates the heart apex 105 with its second end 512a. The second end 512a of the guiding device 502 is optionally connected to a rib 305 (see FIGS. 8 and 9); alternatively, the second end 512a may be anchored, for example, directly in heart apex 105 or on the sterno-pericardial ligament 301.

[0171] The first anchor 501 is connected at its second end 514 in the left atrium 102 to the first end 511b of the second guiding device 503. For simplicity, the second guiding device 503 will also be referred to as guiding device hereinafter. The first end 511b of the guiding device 503 has penetrated the anterior leaflet of the mitral valve 111 directly at the base of the valve leaflet. The second guiding device 503 is located in the left ventricle 101, directly next to the interventricular septum 125 and penetrates with its second end 512b into the heart apex 105, preferably all the way through it. The second end 512b of the second guiding device 503 is optionally connected to a rib 305; alternatively, the second end 512b can be anchored directly in the heart apex 105 or on the sterno-pericardial ligament 301.

[0172] In several embodiments, the apparatus 500 according to the present invention may be implanted entirely surgically via open heart surgery. Alternatively, in several embodiments, the apparatus 500 according to the present invention may be implanted via a combination procedure using a catheter and surgical intervention. Alternatively, in several embodiments, the apparatus 500 according to the present invention may also be introduced completely by a catheter.

[0173] The complete surgical implantation is preferably carried out via a conventional heart operation.

[0174] Alternatively, in several embodiments, the implantation may be performed by performing or carrying out a combination procedure in which a catheter is used to introduce the first anchor 501 into the atrial septum via the vena cava and the right atrium 104. The chest is surgically opened over the heart apex 105, and the first two ends 511a and 511b of the guiding devices 502 and 503 are inserted over the apex 105 into the beating heart along the interventricular septum 125. In this case, the guiding devices 502 and 503 perforate the tricuspid valve 112 and mitral valve 111 from the ventricular side. The two first ends 511a, 511b of the guiding devices 502, 503 are then connected to the corresponding end 513 or 514, respectively, of the first anchor 501 under fluoroscopy at the beating heart. The second ends 512a, 512b of the guide devices 502, 503 are then openly surgically connected to a rib. Alternatively, the second ends 512a, 512b may be anchored directly in the heart apex 105 or the sterno-pericardial ligament 301.

[0175] In the fully catheter-based implantation, the guiding device 502 is inserted into the heart via the right atrium 104 and the septal leaflet of the tricuspid valve 112 is perforated with the second end 512a of the guiding device 502. The guiding device 502 is advanced into the heart apex 105 and is anchored there. Alternatively, the heart apex 105 can be perforated with the second end 512a of the guiding device 502 and then anchored in the sterno-pericardial ligament 301 or on the rib 305.

[0176] The second guiding device 503 is introduced into the heart via the right atrium 104 and advanced into the left atrium 102 via a perforation in the atrial septum 124. The anterior mitral valve leaflet 111 is perforated with the second end 512b of the guiding device 503. The second end 512b of the guiding device 503 is advanced into the heart apex 105 and anchored there. Alternatively, the heart apex 105 may be perforated with the second end 512a of the guiding device 502 and then anchored in the sterno-pericardial ligament 301 or on the rib 305.

[0177] The first anchor 501 is inserted into the heart via the right atrium 104, and the second end 514 is inserted into the left atrium 102 via a perforation in the interatrial septum 124. Under fluoroscopy, a closure system (not shown) is connected between the first end 514 of the connector 501 to the first end 511b of the guiding device 503 and between the second end 513 of the first anchor 501 to the first end 511a of the guiding device 502.

[0178] FIG. 6 schematically represents the function of the apparatus 500 according to the present invention, after it has been implanted in a heart, with a stiff aortic root 201 as has already been described in FIG. 4C. It is assumed that the heart's strength is insufficient to stretch the stiff aorta 201 and pull the heart base 110 toward the heart apex 105. In FIG. 4B, a normally elastic aorta 201 was described in which the heart base 110 may be pulled toward the heart apex 105.

[0179] FIG. 6A shows schematically the heart in the diastole with the implanted apparatus 500 according to the present invention.

[0180] The guiding devices 502 and 503 are stretched, the long axis of the heart 220 is longest in the heart cycle, the heart base 110 is farthest from the heart apex 105, and the aortic root 201 is correspondingly short.

[0181] FIG. 6B shows the heart at the end of the systole schematically. It is assumed that the heart's strength is insufficient to stretch the stiff aortic root 201. The guiding devices 502 and 503 have actively shortened and pulled the heart base 110 and thus also the stiff aortic root 201 to the heart apex 105. As a result, the longitudinal axis 220 is shortest in the heart cycle and the stiff aortic root 201 is actively stretched by the apparatus 500 according to the present invention.

[0182] On the way back from systole in FIG. 6B to the diastole in FIG. 6A, the aortic root 201 contracts again. As a result, the heart base 110 moves away from the heart apex 105 and the corresponding column of blood in the aortic root 201 is pumped into the body's circuit during the diastole.

[0183] FIG. 7 shows, schematically simplified, alternative embodiments of the apparatus 500 according to the present invention. In FIG. 7A, the guiding devices 502 and 503 are shortened by hydraulic force. The shortening occurs by moving the linear guiding devices 702a, 702b, optionally designed as pistons, relative to the linear guiding sleeves 701a, 701b, designed as cylinders. If it is shortened, the pistons are pushed into the cylinder; if it is lengthened, the pistons are pulled out of the cylinders. The second ends 512a, 512b of the pistons 702a, 702b may be anchored for example to the heart apex 105, to the sterno-pericardial ligament 301 or to the rib 305. By applying a negative pressure to the respective second end 512a, 512b of the pistons 702a, 702b, the first ends 710a, 710b of the cylinders 701a, 701b move towards the first ends 720a, 720b of the pistons 702a, 702b. This results in a shortening of the guiding devices 502 and 503 and the first anchor 501 is pulled towards the heart apex 105.

[0184] In FIG. 7B, the guiding devices 502 and 503 are shortened by a tension caused by a spring 731a, 731b. The second end of the piston 512 is anchored to the heart apex 105, to the sterno-pericardial ligament 301, or to the rib 305. In each of the guide devices 502 and 503 there is a spring 731a, 731b which connects the first end of the cylinder 710a, 710b to the first end 720a, 720b of the piston 702a, 702b. As a result of the retraction of the aortic root 201 in the diastole, the pistons 702a, 702b in the cylinders 701a, 701b are moved to the second end of the cylinder 711a, 711b and the springs 731a, 731b are tensioned. The springs 731a, 731b may be referred to as tension springs. During the systole, the springs 731a, 731b shorten and the first ends 710a, 710b of the cylinders 701a, 701b are drawn towards the first end of the pistons 720a, 720b. In this way, the increased force for stretching the stiff aorta 201 in the systole is at least partially compensated for by the tension of the springs 731a, 731b.

[0185] In FIG. 7C, the guiding devices 502 and 503 become shorter with the aid of a rope 732. The second ends 512a, 512b of the pistons 702a, 702b may be anchored to the heart apex 105, to the sterno-pericardial ligament 301, or to the rib 305. In the cylinders 701a, 701b, the rope 732a, 732b is attached to the first end of the cylinder 710a, 710b, respectively. The end of the rope 732a, 732b is redirected at a second anchor (not shown) in the vicinity of the heart apex 105, of the sterno-pericardial ligament 301 or of the rib 305.

[0186] By pulling on the ropes 732a, 732b, the cylinders 701a, 701b are pulled over the respective pistons 702a, 702b and the respective first end 710a, 710b of the cylinders 701a, 701b moves to the first ends 720a, 720b of the pistons 702a, 702b. This results in a shortening of the guiding devices 502 and 503 and the connecting piece 501 is pulled towards the heart apex 105.

[0187] In FIG. 7D, an apparatus 500 according to the present invention is shown, which consists only of a first anchor 501 designed as a hollow connecting piece 735 and a rope 732. The end of the rope 732 is redirected at a second anchor (not shown) at the heart apex 105, at the sterno-pericardial ligament 301, or at the rib 305. Pulling on one or both ends of the rope 732, results in the pulling of the connector 735 toward the heart apex 105.

[0188] In addition to the apparatuses 500 described, other active shortening mechanisms are also conceivable and encompassed by the invention, such as shortening by magnetic force, by a transplanted muscle, a bioengineered muscle, or an artificial muscle, each of which may be used to generate force.

[0189] FIG. 8 represents a second anchor 800 on the rib 305. The anchor 800 is attached with an abutment 801 on the outside of the rib 305, an abutment 802 on the inside of the rib 305, and with a central connection 803 through the rib 305. The second anchor 800 is secured in local proximity to the heart apex 105 in the rib 305. A ball joint 804 movably connects the second anchor 800 to the second end 512a, 512b of the guiding device 502, 503. Preferably, both guiding devices 502 and 503 are movably connected to the rib 305 with their second end 512a, 512b, by a second anchor 800, respectively.

[0190] In addition to the described second anchor 800 on the rib, other designs and anchor shapes are conceivable (e.g. also merely the use of a surgical thread), which are also encompassed by the present invention.

[0191] FIG. 9 represents a chest with an implanted apparatus 500 according to the invention. The two second ends 512a, 512b of the guiding devices 502 and 503 are each connected to the rib 305 by a second anchor 800. The respective guiding device 502 and 503 is connected to the control unit 901 and/or to the energy source 900 via the connections 902. Depending on the design, the required lifting force of the guiding device is transferred via the connections 902 as hydraulic force, tensile force, rotational force, electromagnetic force or in another form. The control unit 901 may be synchronized with natural heart activity via an ECG measurement or a pressure measurement. The control unit 901 may include an electric motor, linear motor, gears, pumps, or other devices necessary to generate and transmit the required force through the connections 902. The control unit 901 may include power sources such as batteries or rechargeable batteries that can be charged via an external charger. Other energy sources, such as nuclear energy, may also be conceivable to provide the necessary power and are encompassed by the present invention.

LIST OF REFERENCE NUMERALS

[0192] 100 heart [0193] 101 left ventricle, [0194] 102 left atrium [0195] 103 right ventricle, [0196] 104 right atrium [0197] 105 heart apex [0198] 110 heart base [0199] 111 mitral valve [0200] 112 tricuspid valve [0201] 113 Aortic valve [0202] 114 pulmonary valve [0203] 120 heart skeleton [0204] 121 left fibrous trigone [0205] 122 right fibrous trigone [0206] 123 heart muscle [0207] 124 interatrial septum [0208] 125 interventricular septum, ventricle septum [0209] 130 aortic valve ring [0210] 131 mitral valve ring [0211] 132 tricuspid valve ring [0212] 201 aortic root [0213] 210 circumference of the ventricles in the diastole, orthogonal diameter [0214] 220 longitudinal axis of the ventricles [0215] 300 pericardium, heart sac [0216] 301 sterno-pericardial ligament [0217] 302 diaphragm, midriff [0218] 303 sternum [0219] 304 xiphoid process [0220] 305 rib [0221] 306 mediastinum, mediastinal area [0222] 401 blood flow or influx [0223] 500 apparatus for supporting heart action [0224] 501 first anchor; bracket; connecting piece between the two guiding devices [0225] 502 guiding device; lifting drive [0226] 503 guiding device; second guiding device; [0227] 511a,b first end of the guiding device [0228] 512a,b second end of the guiding device [0229] 513 first end of connecting piece 501 in the right atrium [0230] 514 second end of the connecting piece 501 in the lift atrium [0231] 701a,b cylinder; linear guiding sleeve [0232] 702a,b piston; linear guiding device [0233] 710a,b first end of the cylinder [0234] 711a,b second end of the cylinder [0235] 720a,b first end of the piston [0236] 721a,b second end of the piston [0237] 731a,b spring [0238] 732 pulling device; rope [0239] 732a,b pulling device; rope [0240] 735 first anchor; connecting piece between the atria [0241] 800 second anchor; optionally arranged on the rib [0242] 801 abutment on the outer side of the rib [0243] 802 abutment on the inner side of the rib [0244] 803 connection of the abutment on the outer side of the rib with the abutment on the inner side of the rib [0245] 804 ball joint [0246] 900 energy source [0247] 901 control unit [0248] 902 connection of control unit with guiding device