Abstract
A heart retractor links lifting of the heart and regional immobilization which stops one part of the heart from moving to allow expeditious suturing while permitting other parts of the heart to continue to function whereby coronary surgery can be performed on a beating heart while maintaining cardiac output unabated and uninterrupted. Circumflex coronary artery surgery can be performed using the heart retractor of the present invention. The retractor includes a plurality of flexible arms and a plurality of rigid arms as well as a surgery target immobilizing element. One form of the retractor can be used in minimally invasive surgery, while other forms of the retractor can accommodate variations in heart size and paracardial spacing.
Filing date: Sep 17, 1997
Issue date: Feb 1, 2000
Inventors: Paul A. Spence, Warren Williamson, IV
Assignee: Guidant Corporation
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What is claimed is:
1. A retractor for use in heart surgery comprising:
- a rigid gross support means for engaging a heart to support the heart when the heart is oriented for surgery and including a multipositional support element fixed to a stationary support;
- means for immobilizing selected portions of the heart while permitting non-immobilized portions to move in a manner that continues heart operation; and
- a surgery target immobilizing means connected to said support element and engaging the heart adjacent to a surgery target for immobilizing the heart at and immediately adjacent to the surgery target
- whereby the heart is supported and free to operate during surgery while being locally immobilized at the surgery target.
2. The heart retractor defined in claim 1 wherein said gross support means includes a cup-shaped element for engaging and supporting the heart adjacent to the apex section of the heart.
3. The heart retractor defined in claim 2 wherein said support means further includes a plurality of rigid support arms each connected at one end thereof to said stationary support element and having a heart-attaching element thereon.
4. The heart retractor defined in claim 3 wherein said each heart-attaching element includes a suction attachment point.
5. The heart retractor defined in claim 3 wherein said support means further includes a vacuum source and means fluidically connecting said vacuum source to said cup-shaped element and further including means fluidically connecting said vacuum source to each heart-attaching element.
6. The heart retractor defined in claim 2 wherein said support means further includes a vacuum source and means fluidically connecting said vacuum source to said cup-shaped element.
7. The heart retractor defined in claim 1 wherein said target-immobilizing element includes a U-shaped target-defining element having two legs and means thereon for engaging the heart to position one leg on each side of the surgery target.
8. The heart retractor defined in claim 7 wherein said target-immobilizing element further includes a rigid arm attached to said U-shaped element and to said stationary support element.
9. The heart retractor defined in claim 1 wherein said means for immobilizing selected portions of the heart includes attachment means thereon for attaching to the surface of the heart.
10. A heart retractor for use in heart surgery comprising:
- support means for supporting the gross weight of a heart to support the heart when the heart is oriented for surgery and including a main support arm having means at one end thereof for mounting the support arm on a stationary support; and
- means for immobilizing selected portions of the heart and permitting other sections to move as required to continue heart operation during surgery, said immobilizing means including at least one rigid support arm connected at one end thereof to said support means and having means thereon for releasably attaching said rigid support arm to the heart, and at least one flexible support arm connected at one end thereof to said support means and having means on another end thereof for releasably attaching said flexible support arm to the heart.
11. The heart retractor defined in claim 10 wherein said means for immobilizing selected portions of the heart includes a plurality of flexible arms each connected at one end thereof to said support means and each having a heart-engaging member thereon.
12. The heart retractor defined in claim 11 wherein each heart-engaging member is a suction attachment point.
13. The heart retractor defined in claim 2 further including a surgery target immobilizing element having one end thereof connected to said support means and heart-engaging elements on another end thereof.
14. A retractor for use in minimally invasive heart surgery comprising:
- support means for engaging a heart to support the heart when the heart is oriented for surgery and including a handle having a distal end and a proximal end, said proximal end being located outside of a patient during surgery, a support element fixed to said distal end, and rigid elements fixed to said distal end and engaging and supporting chosen sections of the heart; and
- means for immobilizing selected portions of the heart while permitting non-immobilized portions to move in a manner that continues heart operation
- whereby the heart is supported and free to operate during minimally invasive surgery while being immobilized at selected locations.
15. The retractor defined in claim 14 wherein said means for immobilizing selected portions of the heart includes a plurality of flexible arms each connected to said handle.
16. The retractor defined in claim 15 wherein each rigid element includes a heart-engaging element and further includes a vacuum source fluidically connected to each heart-engaging element.
17. The retractor defined in claim 14 wherein said support means includes a cup-shaped element fixed to the distal end of said handle.
18. The retractor defined in claim 17 further including a vacuum source fluidically connected to said cup-shaped element.
19. A retractor for use in heart surgery comprising:
- support means for engaging a heart to support the heart when the heart is oriented for surgery and including a support element fixed to a stationary support and rigid elements engaging and supporting chosen sections of the heart;
- means for immobilizing selected portions of the heart while permitting non-immobilized portions to move in a manner that continues heart operation
- whereby the heart is supported and free to operate during surgery while being locally immobilized at the surgery target.
20. A heart positioning device for use in cardiac surgery comprising:
- support means for engaging a heart to support the heart when the heart has been oriented into an unnatural position or orientation for coronary surgery;
- means for attaching said support means to the heart so the heart operates with uncompromised ventricular function when the heart is oriented into an unnatural position or orientation for coronary surgery:
- means engaging sections of the heart to immobilize the sections engaged while permitting non-engaged sections of the heart to move in a manner whereby essentially unabated cardiac output is maintained during surgery while the heart is regionally immobilized.
21. The heart retractor defined in claim 20 wherein said support means includes a means for engaging the heart sufficiently to support the heart during coronary surgery.
22. The heart retractor defined in claim 20 wherein said support means includes arms which have locking elements for permitting the arms to be moved into position and then locked in position.
23. The heart retractor defined in claim 20 further including a surgery target immobilizing element connected to said support means and engaging the heart adjacent to a surgery target for immobilizing the heart at and immediately adjacent to the surgery target.
24. A heart retractor for use in heart surgery comprising:
- support means for engaging an apex portion of a heart to support the heart when the heart is lifted for surgery and including a main support arm having means at one end thereof for mounting the support arm on a stationary support; and
- means for immobilizing selected portions of the heart and permitting other sections to move as required to continue heart operation during surgery, said immobilizing means including at least one rigid support arm connected at one end thereof to said support means and having means on another end thereof for releasably attaching said rigid support arm to the heart, at least one flexible support arm connected at one end thereof to said support means and having means thereon for releasably attaching said flexible support art to the heart.
25. The heart retractor defined in claim 24 further including a surgery target immobilizing element having one end thereof connected to said support means and heart-engaging elements thereon.
26. A retractor for use in heart surgery comprising:
- a main support;
- a gross support means for engaging a heart and supporting the heart when the heart is oriented for surgery, said gross support means being attached to said main support;
- a fine support means for supporting portions of the heart during surgery, said fine support means being attached to said gross support means with non-supported portions of the heart moving in a manner whereby essentially unabated cardiac output is maintained during surgery while the heart is regionally immobilized at supported portions and including rigid elements engaging and supporting chosen sections of the heart.
27. A retractor for use in heart surgery comprising:
- a main support;
- a gross support means for engaging a heart and supporting the heart when the heart is oriented for surgery, said gross support means being attached to said main support and including means for adjusting the shape of said gross support means;
- a fine support means for supporting portions of the heart during surgery, said fine support means being attached to said gross support means with non-supported portions of the heart moving in a manner whereby essentially unabated cardiac output is maintained during surgery while the heart is regionally immobilized at supported portions and including rigid elements engaging and supporting chosen sections of the heart.
28. The retractor defined in claim 27 wherein said means for adjusting the shape of said gross support means includes a fastener attaching two arms together, with said two arms engaging the heart to support the gross weight of the heart.
29. The retractor defined in claim 27 further including attachment means on said fine support means for contacting the heart.
30. The retractor defined in claim 29 wherein said attachment means include suction points.
31. The retractor defined in claim 27 further including a support arm and a surgery target immobilizing element attached to said support arm.
32. A heart positioning device for use in cardiac surgery comprising:
- a stationary support;
- a rigid arm connected to said stationary support;
- a flexible element connected to said rigid arm;
- means on said flexible element for releasably attaching said flexible element to a heart to orient the heart into an unnatural position or orientation for coronary surgery and so the heart operates with uncompromised ventricular function when oriented into the unnatural position or orientation during coronary surgery.
33. The heart positioning device defined in claim 32 further including a second flexible element connected to said rigid arm.
34. The heart positioning device defined in claim 32 wherein said rigid arm is multipositional.
35. A heart positioning device for use in cardiac surgery comprising:
- a stationary support for orienting the heart into an unnatural position or orientation for coronary surgery;
- a flexible element connected to said stationary support for supporting the heart in a manner so the heart operates with uncompromised ventricular function when the heart is oriented into the unnatural position during coronary surgery; and
- means on said flexible element for releasably attaching said flexible element to the heart.
36. A heart positioning device for use in cardiac surgery comprising:
- a stationary support for orienting the heart into an unnatural position or orientation for coronary surgery;
- a rigid arm connected to said stationary support;
- a flexible element connected to said stationary support;
- means on said flexible element for releasably attaching said flexible element to a heart in a manner so the heart operates with uncompromised ventricular function when the heart is oriented into the unnatural position during coronary surgery.
37. The heart positioning device defined in claim 36 further including a second flexible element connected to said rigid arm.
38. The heart positioning device defined in claim 36 wherein said stationary support is multipositional.
39. A heart positioning device for use in cardiac surgery comprising:
- a frame;
- a stationary support attached to said frame for orienting the heart into an unnatural position or orientation for coronary surgery;
- a flexible element connected to said stationary support for supporting the heart in a manner so the heart operates with uncompromised ventricular function when the heart is oriented into the unnatural position during coronary surgery; and
- means on said flexible element for releasably attaching said flexible element to the heart.
40. The heart positioning device defined in claim 39 further including a second flexible element connected to said stationary support.
41. A heart positioning device for use in cardiac surgery comprising:
- a stationary support;
- a flexible element connected to said stationary support for supporting a heart in a manner so the heart operates with uncompromised ventricular function when the heart is oriented into an unnatural position or orientation during coronary surgery; and
- means on said flexible element for releasably attaching said flexible element to the heart.
42. The device defined in claim 41 wherein said stationary support is multipositional for allowing the stationary support to move in a plurality of orientations and positions.