Device to permit offpump beating heart coronary bypass surgery

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.

Patent number: 6019722
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.

Method for coronary artery bypass

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: 5888247
Filing 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.

Cardiac sling for circumflex coronary artery surgery

Abstract
A cardiac sling for supporting the heart during surgery a support a polymeric film net of interconnecting ribs of polymeric material for applying, in use, sufficient pressure to the portions of the surface of the heart adjacent the ribs to prevent hemorrhage from the anastomotic site of bypass grafting is disclosed.

Patent number: 4973300
Filing date: Sep 22, 1989
Issue date: Nov 27, 1990
Inventor: John T. M. Wright
Assignee: Pioneering Technologies, Inc.
Primary Examiner: Kerry Owens

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What is claimed is:

1. A cardiac sling for supporting the heart during surgery comprising:

a support portion comprising a latticework of ribs surrounding a multiplicity of holes formed in an elastomeric film sheet, the lattice work being so constructed an configured such that the holes have a minimum diameter of from about 0.25 to about 0.75 inch and the ribs are from about 0.062 to about 0.312 inches wide as to apply, sufficient pressure to the portions of the surface of the heart adjacent there is to prevent hemorrhage from the anastomotic site by bypass grafting;

and means for securing the support portion under the heart.

2. The cardiac sling of claim 1 wherein the elastomeric film sheet is formed of transparent polymer lightly colored a color which contrasts with blood and tissue.

3. The cardiac sling of claim 1 wherein the elastomeric film sheet is formed of polymeric material between about 0.005 and about 0.030 inches in thickness.

4. The cardiac sling of claim 1 wherein the elastomeric film sheet is formed of soft, smooth, matt finish, tear resistant, blood impervious polyurethane.

5. The cardiac sling of claim 1 wherein the means for securing the support portion under the heart comprises at least a pair of tapes extending from the support portion, at the support portion and tapes being formed of one unitary sheet of said polymeric film.

6. A cardiac sling for supporting the heart during surgery comprising:

a support portion formed of soft, smooth, tear resistant, blood impervious transparent polyurethane colored with a color which contrasts with the color of tissue and blood having a matt finish between about 0.005 and about 0.030 inches in thickness, having a multiplicity of hexagonal holes having a diameter of from about 0.25 to about 0.75 inch as measured between opposed flat sides thereof separated by interconnecting ribs from about 0.062 to about 0.312 inches wide defining six sides thereof forming a net of said interconnecting ribs for applying, in use, sufficient pressure to the portions of the surface of the heart adjacent the ribs to prevent hemorrhage from the anastomotic site of bypass grafting;

and means for securing the support portion under the heart.

7. A cardiac sling for supporting the heart during surgery comprising:

a support portion formed of soft, smooth, tear resistant, blood impervious transparent polyurethane film colored with a color which contrasts with the color of tissue and blood and having a matt finish, thefilm being between about 0.005 and about 0.030 inches in thickness, having a multiplicity of hexagonal holes having a diameter of from about 0.25 to about 0.75 inch as measured between opposed flat sides thereof separated by interconnecting ribs from about 0.062 to about 0.312 inches wide defining six sides thereof forming a net of said interconnecting ribs for applying, in use, sufficient pressure to the portions of the surface of the heart adjacent the ribs to prevent hemorrhage from the anastomotic site of bypass grafting;

and at least a pair of tapes extending from the support portion for securing the support portion under the heart;

the support portion and tapes being formed of one unitary sheet of said polyurethane film.

Heart support for coronary artery surgery

Abstract

The heart support is formed of flat cloth tapes crossing each other at right angles and stitched together to provide a mesh with square openings. The support is heart shaped in outline with a transverse fixation tape having free ends extending laterally in opposite directions from the apex to secure the support to the heart of the patient. Each tape in the mesh is formed of a folded bias weave cloth capable of stretching to conform the support to the shape of the heart.

Patent number: 3983863
Filing date: Jun 2, 1975
Issue date: Oct 5, 1976
Inventors: Walter H. Janke, Milford Barron
Assignee: American Hospital Supply Corporation

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What is claimed is:

1. A heart support comprising a mesh of flat cloth tapes crossing each other at intervals to provide openings between said tapes, a marginal tape around the periphery of said mesh imparting a heart shaped outline to the support, said crossing tapes being stitched together at their crossing points and said marginal tape being stitched to the ends of said crossing tapes, and a fixation tape stitched to said crossing and marginal tapes at the apex of said heart shaped outline and having free ends extending laterally in opposite directions from said apex, said tapes being formed of bias weave material so as to be stretchable.

2. A heart support as defined in claim 1, said tapes being formed from strips of material folded longitudinally to multiple thickness.

3. A heart support as defined in claim 2, the ends of said crossing tapes being inserted in said fold of said marginal tape.

4. A heart support as defined in claim 2, said material having a middle fold and the edge portions being folded inward to provide quadruple thickness of material.

5. A heart support as defined in claim 4, said strips of material being approximately 2.5 cm wide, said tapes being approximately 6 mm wide, and said openings being approximately 1.5 cm on each side.

6. A heart support as defined in claim 2 including longitudinal stitching in certain of said tapes holding said material in folded condition and securing the tapes to each other at said crossing points.