Abstract
The invention comprises a method for performing a coronary artery bypass graft on a beating heart under thoracoscopic visualization without opening the chest wall. At least one small opening is formed in the patient's chest, a target artery for an arterial blood supply is located, instruments are introduced through one or more small openings formed in the patient's chest to prepare the target artery for fluid connection to the coronary artery, and instruments are introduced through one or more small openings formed in the patient's chest to connect the target artery to the coronary artery distal from a stenosis. In a preferred embodiment, a minimal left anterior intercostal thoracotomy provides access to form an anastomosis between the left internal mammary artery (LIMA) and the left anterior descending artery (LAD) while thoracoscopic viewing facilitates harvesting the LIMA. In other embodiments, access to the patient's heart may be obtained through a trocar sheath or other...
Patent number: 5888247Filing date: Apr 10, 1995
Issue date: Mar 30, 1999
Inventor: Frederico J. Benetti
Assignee: Cardiothoracic Systems, Inc
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What is claimed is:
1. A method for performing a coronary artery bypass graft procedure on the beating heart of a human patient comprising:
- forming a thoracotomy in the chest of the human patient to provide access to the beating heart,
- locating a target artery having an arterial blood supply,
- introducing a retractor into said thoracotomy, followed by manipulating said retractor to spread the chest both horizontally and vertically,
- forming an arteriotomy distal to a stenosis in a coronary artery of said beating heart, and
- bypassing said stenosis in said coronary artery using said arterial blood supply of said target artery to establish arterial blood flow distal to said stenosis.
2. The method of claim 1 wherein the thoracotomy is a minimal thoracotomy having a size of incision which is not substantially greater than 12 cm.
3. The method of claim 1 or 2 further comprising the step of stabilizing said beating heart.
4. The method of claim 3 wherein said coronary artery of said beating heart is stabilized by a method selected from the group consisting of contacting tissue proximate to said artery with forcep means, and tensioning ligatures about said coronary artery.
5. The method of claim 3 wherein said beating heart is stabilized by forcep means engaging tissue proximate to said coronary artery on either side of said arteriotomy.
6. The method of claim 1 wherein said coronary artery is selected from the group consisting of the left anterior descending, diagonal, circumflex, obtuse marginal, ramus intermedius, right coronary and posterior descending artery.
7. The method of claim 1 wherein said target artery is selected from the group consisting of the gastroepiploic artery, the right internal mammary artery, and the left internal mammary artery.
8. The method of claim 7 further comprising the step of separating said target artery from its support using instruments introduced through said thoracotomy.
9. The method of claim 7 further comprising the step of separating said target artery from its support, wherein said separation is visualized by a thoracoscope.
10. The method of claim 2 wherein said minimal thoracotomy is intercostal and in the left anterior chest, and wherein said target artery is the left internal mammary artery and said coronary artery is selected from the group consisting of the left anterior descending artery, a diagonal artery, and the circumflex artery.
11. The method of claim 1 wherein the formation of said arteriotomy is visualized by a thoracoscope.
12. The method of claim 1 wherein completion of said anastomosis is visualized by a thoracoscope.
13. The method of claim 1 wherein said anastomosis is completed using a graft selected from the group consisting of a harvested artery, a harvested vein, and a synthetic graft.
14. The method of claim 1 wherein said anastomosis is between the aorta and said coronary artery and is completed using a graft selected from the group consisting of a harvested artery, a harvested vein, and a synthetic graft.
15. A method for performing a coronary artery bypass graft procedure on the beating heart of a human patient comprising:
- forming an intercostal minimal thoracotomy in the left anterior chest of the human patient to provide access to the left internal mammary artery and a coronary artery selected from the group consisting of the left anterior descending artery, a diagonal artery, and the circumflex artery of the beating heart,
- introducing a retractor into said intercostal minimal thoracotomy, followed by providing access to said left internal mammary artery by manipulating said retractor to spread the chest both horizontally and vertically,
- locating the left internal mammary artery to provide an arterial blood supply by a method selected from the group consisting of direct vision of said left internal mammary artery and insertion of a thoracoscope into the left anterior chest,
- separating said left internal mammary artery from its support using instruments introduced through said intercostal minimal thoracotomy,
- stabilizing said coronary artery of said beating heart,
- forming an arteriotomy in said coronary artery of said beating heart wherein said arteriotomy is distal to a stenosis in said coronary artery, and
- completing an anastomosis of said left internal mammary artery to said coronary artery to establish arterial blood flow distal to said stenosis.
16. The method of claim 15 wherein said intercostal minimal thoracotomy has a size of incision which is not substantially greater than 12 cm.
17. The method of claim 15 wherein said coronary artery of said beating heart is stabilized by a method selected from the group consisting of contacting tissue proximate to said coronary artery with forcep means, and tensioning ligatures about said coronary artery.
18. The method of claim 15 wherein said beating heart is stabilized by forcep means engaging tissue proximate to said coronary artery on either side of said arteriotomy.
19. The method of claim 15 wherein said separation of said left internal mammary artery from its support base is visualized by a thoracoscope.
20. The method of claim 15 wherein the formation of said arteriotomy in said coronary artery is visualized by a thoracoscope.
21. The method of claim 15 wherein the completion of said anastomosis is visualized by a thoracoscope.
22. The method of claim 15 wherein said anastomosis is completed using a graft selected from the group consisting of a harvested artery, a harvested vein, and a synthetic graft.