Method and system for delivery of vasoactive drugs to the heart prior to and during a medical procedure

• US 20040199209A1
• Filed: 09/08/2003
• Published: 10/07/2004
• Est. Priority Date: 04/07/2003
• Status: Abandoned Application

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Keogh, James R., Jahns, Scott E., Hill, Michael R.S.
• Application Number:
  US10/657,353
• Publication Number:
  US 20040199209A1
• Time in Patent Office: Days
• US Class Current: 607/3
• CPC Class Codes: A61N 1/36114 Cardiac control, e.g. by vagal stimulation stimulating the heart A61N1/362
• CPC Class Codes: A61N 1/385 Devices for inducing an abnormal cardiac function, e.g. fibrillation

Abstract

A method of performing a medical procedure, such as surgery, is provided. A first vasoactive substance is delivered to the site of a medical procedure. The procedure is then performed. A second vasoactive substance is then delivered to the site of the procedure.

Claims

1. A method of performing a medical procedure, comprising:

stimulating a nerve to adjust beating of a heart to a first condition;

delivering a first vasoactive substance to a site of the medical procedure while the beating of the heart is in the first condition;

performing the medical procedure; and

delivering a second vasoactive substance to the site while the beating of the heart is in the first condition.

2. The method of claim 1 further comprising:

stimulating the heart to adjust beating of the heart to a second condition.

3. The method of claim 2, wherein the second condition is a condition in which the heart is beating, further comprising:

delivering the second vasoactive substance to the site after the second condition is achieved.

4. The method of claim 1 wherein the first vasoactive substance is a vasodilator selected from the group consisting of:

an organic nitrate, isosorbide mononitrate, a mononitrate, isosorbide dinitrate, a dinitrate, nitroglycerin, a trinitrate, minoxidil, sodium nitroprusside, hydralazine hydrochloride, nitric oxide, nicardipine hydrochloride, fenoldopam mesylate, diazoxide, enalaprilat, epoprostenol sodium, a prostaglandin, milrinone lactate, a bipyridine, a dopamine D1-like receptor agonist, a dopamine D1-like receptor stimulant, and a dopamine D1-like receptor activator.

5. The method of claim 1 wherein the second vasoactive substance is a vasoconstrictor selected from the group consisting of:

a sympathomimetic, methoxamine hydrochloride, epinephrine, midodrine hydrochloride, desglymidodrine, an alpha-receptor agonist, an alpha-receptor stimulant, and an alpha-receptor activator.

6. The method of claim 1 further comprising:

delivering a systemic drug during the medical procedure,

7. The method of claim 6 wherein the systemic drug is selected from the group consisting of:

a beta-blocker, a cholinergic agent, a cholinesterase inhibitor, a calcium channel blocker, a sodium channel blocker, a potassium channel agent, adenosine, an adenosine receptor agonist, an adenosine deaminase inhibitor, dipyridamole, a monoamine oxidase inhibitor, digoxin, digitalis, lignocaine, a bradykinin agent, a serotoninergic agonist, an antiarrythmic agent, a cardiac glycoside, a local anesthetic, atropine, a calcium solution, an agent that promotes heart rate, an agent that promotes heart contractions, dopamine, a catecholamine, an inotrope glucagon, a hormone, forskolin, epinephrine, norepinephrine, thyroid hormone, a phosphodiesterase inhibitor, prostacyclin, prostaglandin and a methylxanthine.

8. The method of claim 1 wherein the medical procedure is selected from the group consisting of:

a fluoroscopic procedure, a cardiac procedure, a vascular procedure, a neurosurgical procedure, an electrophysiology procedure, an ablation procedure, an endovascular procedure, a pulmonary procedure, an aneurysm repair, an imaging procedure, a CAT scan procedure, a MRI procedure, a genetic therapy, a cellular therapy, a cancer therapy, a radiation therapy, a transplantation procedure, a coronary angioplasty procedure, a stent delivery procedure, an atherectomy procedure, a procedure that requires precise control of cardiac motion, a procedure that requires precise control of bleeding, a port-access procedure, an endoscopic procedure, a sternotomy procedure, a thoracotomy procedure and a robotic procedure.

9. The method of claim 1 further comprising:

re-stimulating the nerve to re-adjust beating of the heart to the first condition; and

continuing the medical procedure.

10. The method of claim 1 wherein the nerve is selected from the group consisting of:

a vagal nerve, a carotid sinus nerve, a fat pad.

11. A method of performing a medical procedure on a vessel, comprising:

stimulating a nerve to adjust beating of a heart to a still condition;

delivering a first vasoactive substance to the vessel;

performing the medical procedure on the vessel while the heart is in a still condition and after delivery of the first vasoactive substance to the vessel; and

;

delivering a second vasoactive substance to the vessel and reducing stimulation of the nerve to adjust beating of the heart to a beating condition after performing the medical procedure.

12. The method of claim 11 further comprising:

stimulating the heart to achieve the beating condition.

13. The method of claim 11 further comprising:

re-stimulating the nerve to re-adjust beating of the heart to the still condition; and

continuing the medical procedure on the vessel.

14. The method of claim 11 wherein the nerve is selected from the group consisting of:

a vagal nerve, a carotid sinus nerve, a fat pad.

15. The method of claim 11 wherein the first vasoactive substance is a vasodilator selected from the group consisting of:

an organic nitrate, isosorbide mononitrate, a mononitrate, isosorbide dinitrate, a dinitrate, nitroglycerin, a trinitrate, minoxidil, sodium nitroprusside, hydralazine hydrochloride, nitric oxide, nicardipine hydrochloride, fenoldopam mesylate, diazoxide, enalaprilat, epoprostenol sodium, a prostaglandin, milrinone lactate, a bipyridine, a dopamine D1-like receptor agonist, a dopamine D1-like receptor stimulant, and a dopamine D1-like receptor activator.

16. The method of claim 11 wherein the second vasoactive substance is a vasoconstrictor selected from the group consisting of:

a sympathomimetic, methoxamine hydrochloride, epinephrine, midodrine hydrochloride, desglymidodrine, an alpha-receptor agonist, an alpha-receptor stimulant, and an alpha-receptor activator.

17. A method of harvesting a vessel, comprising:

stimulating a nerve to adjust beating of a heart to a first condition;

delivering a vasodilative substance to the heart while the heart is in the first condition;

harvesting the vessel while the heart is in the first condition, and;

delivering a vasoconstrictive substance to the heart and

reducing stimulation of the nerve to adjust beating of the heart to a second condition after harvesting the vessel.

18. The method of claim 17, further comprising:

stimulating the heart to adjust beating of the heart to the second condition.

19. The method of claim 17 wherein the vasodilator is selected from the group consisting of:

an organic nitrate, isosorbide mononitrate, a mononitrate, isosorbide dinitrate, a dinitrate, nitroglycerin, a trinitrate, minoxidil, sodium nitroprusside, hydralazine hydrochloride, nitric oxide, nicardipine hydrochloride, fenoldopam mesylate, diazoxide, enalaprilat, epoprostenol sodium, a prostaglandin, milrinone lactate, a bipyridine, a dopamine D1-like receptor agonist, a dopamine D1-like receptor stimulant, and a dopamine D1-like receptor activator.

20. The method of claim 17 wherein the vasoconstrictor is selected from the group consisting of:

a sympathomimetic, methoxamine hydrochloride, epinephrine, midodrine hydrochloride, desglymidodrine, an alpha-receptor agonist, an alpha-receptor stimulant, and an alpha-receptor activator.