Thoracoscopic devices and methods for arresting the heart

• US 5,425,705 A
• Filed: 12/27/1993
• Issued: 06/20/1995
• Est. Priority Date: 02/22/1993
• Status: Expired due to Term

• Current Assignee: Edwards Lifesciences LLC (Edwards Lifesciences Corporation)
• Original Assignee: Stanford Surgical Technologies, Inc.
• Inventors: Grainger, Jeffry J., Machold, Timothy R., Gifford, Hanson S. III, Roth, Alex T., Evard, Philip C., Sterman, Wesley D., Siegel, Lawrence C.
• Primary Examiner(s): Rosenbaum, C. Fred
• Assistant Examiner(s): VANOVER, PERRY
• Application Number:
  US08/173,899
• Time in Patent Office: 540 Days
• Field of Search: 606/205-211, 604/19, 604/27-28, 604/36, 604/93, 604/115-117, 604/164, 604/51-53, 604/56, 604/44, 604/4
• US Class Current: 604/28
• CPC Class Codes: A61B 17/00234 for minimally invasive surgery A61B17/0218, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/0057 Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect sutures A61B17/04; closing rectum or urethra near body surface A61F2/0009
• CPC Class Codes: A61B 17/0218 for minimally invasive surgery A61B17/0281, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/0467 Instruments for cutting sutures surgical cutting instruments A61B17/32
• CPC Class Codes: A61B 17/0469 Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 17/06061 Holders for needles or sutures, e.g. racks, stands hand-held holding instruments A61B17/0483; holders for articles A61B50/20; racks for syringes or for hypodermic or infusion needles A61M5/008
• CPC Class Codes: A61B 17/064 Surgical staples, i.e. penetrating the tissue
• CPC Class Codes: A61B 17/068 Surgical staplers , e.g. containing multiple staples or clampsstaplers containing only one staple A61B17/10; magazines or containers for staples A61B17/105; for performing anastomosis A61B17/115; staplers in general B25C5/00
• CPC Class Codes: A61B 17/12013 for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 17/122 Clamps or clips , e.g. for the umbilical cord for the vas deferens A61F6/206
• CPC Class Codes: A61B 17/1227 Spring clips
• CPC Class Codes: A61B 17/1285 for minimally invasive surgery
• CPC Class Codes: A61B 17/29 Forceps for use in minimally invasive surgery
• CPC Class Codes: A61B 17/2909 Handles
• CPC Class Codes: A61B 17/295 combined with cutting implements
• CPC Class Codes: A61B 17/30 Surgical pincettes without pivotal connectionsfor holding suture needles or materials A61B17/0483; wound clamps A61B17/08 ; hand-held gripping tools without pivotal connections in general B25B9/02
• CPC Class Codes: A61B 17/34 Trocars; Puncturing needles pointed biopsy instruments A61B10/0233; devices for piercing the ear-lobes A44C7/001; seals or hemostasis valves A61M39/06
• CPC Class Codes: A61B 17/3403 Needle locating or guiding means guides for suture needles A61B17/0482; guiding or tracking by nuclear magnetic resonance G01R33/285
• CPC Class Codes: A61B 18/1442 Probes having pivoting end effectors, e.g. forceps
• CPC Class Codes: A61B 18/1492 having a flexible, catheter-like structure, e.g. for heart ablation A61B18/1477 takes precedence
• CPC Class Codes: A61B 2017/00243 : cardiac
• CPC Class Codes: A61B 2017/00247 : Making holes in the wall of the heart, e.g. laser Myocardial revascularization
• CPC Class Codes: A61B 2017/00353 : one mechanical instrument performing multiple functions, e.g. cutting and grasping channel for multiple instruments A61B2017/3445; instrument channel A61B2017/22072; replaceable heads A61B2017/2931; suction A61M1/00
• CPC Class Codes: A61B 2017/00544 : pneumatically
• CPC Class Codes: A61B 2017/00637 : for sealing trocar wounds through abdominal wall
• CPC Class Codes: A61B 2017/00663 : the implement being a suture
• CPC Class Codes: A61B 2017/0243 : for immobilizing local areas of the heart, e.g. while it beats trocars attached to inner organs or inner body tissue A61B2017/3488
• CPC Class Codes: A61B 2017/047 : having at least one proximally pointing needle located at the distal end of the instrument, e.g. for suturing trocar puncture wounds starting from inside the body J-shaped suture needles A61B2017/0608
• CPC Class Codes: A61B 2017/0472 : Multiple-needled, e.g. double-needled, instruments
• CPC Class Codes: A61B 2017/0474 : Knot pushers
• CPC Class Codes: A61B 2017/0475 : using sutures having a slip knot
• CPC Class Codes: A61B 2017/2905 : flexible
• CPC Class Codes: A61B 2017/2933 : camming or guiding means
• CPC Class Codes: A61B 2017/2943 : Toothed members, e.g. rack and pinion
• CPC Class Codes: A61B 2017/2945 : Curved jaws
• CPC Class Codes: A61B 2017/2946 : Locking means
• CPC Class Codes: A61B 2017/306 : holding by means of suction
• CPC Class Codes: A61B 2017/3405 : using mechanical guide means
• CPC Class Codes: A61B 2017/3427 : for intercostal space
• CPC Class Codes: A61B 2017/3445 : used as instrument channel for multiple instruments catheters A61B2017/22072
• CPC Class Codes: A61B 2017/3492 : against the outside of the body
• CPC Class Codes: A61B 2018/00214 : Expandable means emitting energy, e.g. by elements carried thereon
• CPC Class Codes: A61B 2018/00232 : having an irregular shape
• CPC Class Codes: A61B 2018/00261 : arranged in a line
• CPC Class Codes: A61B 2018/00291 : using suction
• CPC Class Codes: A61B 2018/00363 : Epicardium
• CPC Class Codes: A61B 2018/00392 : Transmyocardial revascularisation
• CPC Class Codes: A61B 2018/00577 : Ablation
• CPC Class Codes: A61B 2018/1432 : curved
• CPC Class Codes: A61B 2090/064 : for measuring force, pressure or mechanical tension
• CPC Class Codes: A61B 90/50 : Supports for surgical instruments, e.g. articulated arms
• CPC Class Codes: A61F 2/2427 : Devices for manipulating or deploying heart valves during implantation
• CPC Class Codes: A61M 2025/0003 : having an additional lumen transmitting fluid pressure to the outside for measurement
• CPC Class Codes: A61M 2025/0089 : Single injection needle protruding axially, i.e. along the longitudinal axis of the catheter, from the distal tip
• CPC Class Codes: A61M 2025/028 : having a mainly rigid support structure
• CPC Class Codes: A61M 2039/0279 : for introducing medical instruments into the body, e.g. endoscope, surgical tools
• CPC Class Codes: A61M 2202/047 : cardioplegic
• CPC Class Codes: A61M 2205/3344 : Measuring or controlling pressure at the body treatment site
• CPC Class Codes: A61M 2205/3355 : Controlling downstream pump pressure
• CPC Class Codes: A61M 2205/366 : by liquid heat exchangers
• CPC Class Codes: A61M 2210/127 : Aorta
• CPC Class Codes: A61M 2230/005 : Parameter used as control input for the apparatus
• CPC Class Codes: A61M 25/01 : Introducing, guiding, advancing, emplacing or holding catheters A61M25/10 takes precedence
• CPC Class Codes: A61M 25/1011 : Multiple balloon catheters
• CPC Class Codes: A61M 39/0247 : Semi-permanent or permanent transcutaneous or percutaneous access sites to the inside of the body peritoneal dialysis catheters A61M1/285; tracheostomy devices A61M16/0465; measuring pressure within the body A61B5/03; colostomy devices A61F5/445; gastrotomy feeding tubes A61J15/0015; means for fixing a feeding tube outside of the body A61J15/0053
• CPC Class Codes: Y10S 128/26 : Cannula supporters

Abstract

The invention provides devices and methods for thoracoscopically arresting the heart and establishing cardiopulmonary bypass, thus facilitating a variety of less-invasive surgical procedures on and within the heart and great vessels of the thorax. In one embodiment, the invention provides a thoracoscopic system for arresting a patient'"'"'s heart including a clamp configured for introduction into the patient'"'"'s thoracic cavity through a percutaneous intercostal penetration in the patient'"'"'s chest. The clamp is positionable about the patient'"'"'s ascending aorta between the coronary arteries and the brachiocephalic artery. The clamp is coupled to the distal end of an elongated handle means for manipulating the clamp from a location outside of the patient'"'"'s thoracic cavity. A means for actuating the clamp is coupled to the proximal end of the handle means. When actuated, the clamp blocks blood flow through the ascending aorta. A delivery cannula may be used to deliver cardioplegic fluid into the ascending aorta upstream from the clamp to arrest cardiac function.

Claims

1. A method of arresting a heart in a thoracic cavity of a patient, the method comprising:

viewing an interior portion of the patient'"'"'s thoracic cavity through a scope positioned in a percutaneous intercostal penetration in the patient'"'"'s chest;

introducing a clamp into the patient'"'"'s thoracic cavity through a percutaneous intercostal penetration in the patient'"'"'s chest;

positioning the clamp about an aorta between a coronary artery and a brachiocephalic artery, under visualization by means of the scope, the aorta having an aortic lumen through which blood flows from the heart;

actuating the clamp from a location outside of fire patient'"'"'s thoracic cavity so as to block blood flow through the aortic lumen; and

delivering cardioplegic fluid into the aortic lumen upstream of the clamp through a delivery lumen of a delivery cannula, the delivery cannula having a distal end disposed within the aortic lumen upstream of the clamp, and a proximal end disposed outside of the thoracic cavity.

2. The method of claim 1 wherein the delivery cannula extends through a percutaneous penetration in the patient'"'"'s chest.

3. The method of claim 2 wherein the delivery cannula is introduced into the aortic lumen by penetrating a wall of the aorta with a distal end of the delivery cannula.

4. The method of claim 3 further comprising guiding the delivery cannula so as to penetrate the wall of the aorta at a predetermined location relative to the clamp.

5. The method of claim 4 wherein the delivery cannula is guided by guide means coupled to the clamp.

6. The method of claim 1 wherein the delivery, cannula is introduced into a peripheral artery in the patient and transluminally positioned into the aortic lumen of the ascending aorta.

7. The method of claim 6 wherein the delivery cannula is introduced into a femoral artery.

8. The method of claim 6 wherein the delivery cannula is positioned in the ascending aorta before the clamp is actuated to block the aortic lumen.

9. The method of claim 1 wherein the clamp is fixed to a distal end of an elongated shaft positionable through an intercostal penetration in the patient'"'"'s chest.

10. The method of claim 9 wherein the clamp is actuated by means of an actuator coupled to the proximal end of the shaft.

11. The method of claim 3 further comprising, after delivering the cardioplegic fluid, closing the penetration in the wall of the aorta.

12. The method of claim 11 wherein the step of closing comprises applying a plug or patch to the penetration.

13. The method of claim 11 wherein the step of closing comprises suturing the penetration closed.

14. The method of claim 11 wherein the step of closing comprises applying a staple to the aortic wall.

15. The method of claim 11 wherein a means for closing the penetration is mounted to a device selected from the group including the clamp and the delivery cannula, the closing means being actuated from outside the thoracic cavity.

16. A method of infusing fluid into an aorta in a body cavity of a patient, a the method comprising:

introducing a clamp into the body cavity through a percutaneous penetration;

positioning the clamp about the aorta, the aorta having an inner lumen;

actuating the clamp from a location outside of the patient'"'"'s body cavity so as to block the inner lumen of the aorta; and

delivering the fluid into the inner lumen of the aorta through a delivery lumen of a delivery cannula extending through a percutaneous penetration into this body cavity the delivery cannula having a distal end disposed within the inner lumen, and a proximal end disposed outside of the body cavity.

17. The method of claim 16 wherein the fluid comprises cardioplegic fluid.

18. The method of claim 16 wherein the clamp is positioned about the aorta between a coronary artery and a brachiocephalic artery.

19. The method of claim 16 wherein the delivery cannula is coupled to the clamp.

20. The method of claim 16 wherein the delivery cannula is transluminally positioned from a peripheral artery into the inner lumen of the aorta.