Method of retracting heart tissue in closed-chest heart surgery using endo-scopic retraction

• US 5,613,937 A
• Filed: 08/23/1994
• Issued: 03/25/1997
• Est. Priority Date: 02/22/1993
• Status: Expired due to Term

• Current Assignee: Edwards Lifesciences LLC (Edwards Lifesciences Corporation)
• Original Assignee: Heartport, Inc. (Johnson & Johnson)
• Inventors: Daniel, Sean C., Garrison, Michi E.
• Primary Examiner(s): Apley, Richard J.
• Assistant Examiner(s): FLANAGAN, BEVERLY MEINDL
• Application Number:
  US08/294,454
• Time in Patent Office: 945 Days
• Field of Search: 600/201, 600/204, 600/208, 600/213, 600/215, 600/219, 600/226, 128/898, 604/49, 604/142, 606/46, 623/2
• US Class Current: 600/201
• 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 17/2909 Handles
• CPC Class Codes: A61B 17/320016 Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes A61B10/0233, A61B17/29, A61B17/3207 take precedence
• CPC Class Codes: A61B 17/3211 Surgical scalpels, knives; Accessories therefor
• CPC Class Codes: A61B 17/3417 Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating syringe needles A61M5/32; dilators A61M29/00
• CPC Class Codes: A61B 17/3468 for implanting or removing devices, e.g. prostheses, implants, seeds, wires devices for implanting seeds A61M37/0069
• 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 2017/00349 Needle-like instruments having hook or barb-like gripping means, e.g. for grasping suture or tissue A61B17/06066 takes precedence
• CPC Class Codes: A61B 2017/00575 for closure at remote site, e.g. closing atrial septum defects
• CPC Class Codes: A61B 2017/0243 for immobilizing local areas of the heart, e.g. while it beats
• 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
• 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 2017/2943 : 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 2017/3486 : Balloon
• 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 2018/1465 : Deformable electrodes
• CPC Class Codes: A61B 90/37 : Surgical systems with images on a monitor during operation
• 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 2025/028 : having a mainly rigid support structure
• CPC Class Codes: A61M 2039/027 : having a particular valve, seal or septum
• CPC Class Codes: A61M 2039/0279 : for introducing medical instruments into the body, e.g. endoscope, surgical tools
• 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 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

Abstract

The invention provides a system and method for manipulating a tissue structure within a body cavity. In a preferred embodiment, the invention provides a system and method for retracting and supporting the heart wall to provide access into the heart during a cardiac surgical procedure. The system comprises a tissue supporting member (500) positionable through a first percutaneous intercostal penetration into the thoracic cavity. The tissue supporting member has a contact surface (502) configured for supporting a portion of the heart wall. A retractor (40a) includes a shaft (400) with a proximal end, a distal end configured for introduction through a second percutaneous penetration and a diameter less than the width and length of the contact surface. A hook (428) is slidably coupled to the distal end of the shaft for releasably holding the tissue supporting member such that the contact surface is arranged transversely to the longitudinal axis of the shaft. With this configuration, the shaft and tissue supporting member can be introduced through two separate percutaneous penetrations and connected together within the thoracic cavity for retraction of the heart wall.

Claims

1. A method of retracting an incised opening in a wall of a chamber in a patient'"'"'s heart, the method comprising the steps of:

introducing a tissue supporting member, releasably connected directly to an introducer, into the patient'"'"'s thoracic cavity through a first percutaneous intercostal penetration, within a first intercostal space between two adjacent ribs, the tissue supporting member having a contact surface with a first length and a first width;

introducing a shaft having a longitudinal axis through a second percutaneous intercostal penetration, within a second intercostal space between two adjacent ribs, the shaft having a diameter smaller than the first width and the first length;

coupling the tissue supporting member to the shaft within the patient'"'"'s thoracic cavity while holding the tissue supporting member with the introducer;

positioning the tissue supporting member within an incised opening in a chamber wall of the patient'"'"'s heart;

manipulating said shaft from outside the patient'"'"'s chest to position the contact surface of the tissue support member into supportive contact with the chamber wall; and

applying a force to the shaft to retract the chamber wall thereby enlarging the opening.

2. The method of claim 1 wherein the tissue supporting member introducing step is carried out with the first percutaneous intercostal penetration being created in a right lateral side of the patient'"'"'s chest.

3. The method of claim 1 wherein the shaft introducing step is carried out with the second percutaneous intercostal penetration being created in an anterior portion of the patient'"'"'s chest.

4. The method of claim 1 wherein the applying step is carried out with the chamber wall being retracted anteriorly.

5. The method of claim 1 wherein the tissue supporting member introducing step is carried out with the tissue supporting member being introduced through a cannula positioned in the first percutaneous intercostal penetration.

6. The method of claim 1 further comprising the step of viewing the patient'"'"'s heart through a scope extending through a third percutaneous intercostal penetration in the patient'"'"'s chest.

7. The method of claim 1 further comprising the step of:

introducing an instrument through the first percutaneous intercostal penetration and through the opening; and

performing a procedure on the patient'"'"'s heart with the instrument.

8. The method of claim 7 wherein the performing step is a valve replacement.

9. The method of claim 8 wherein the performing step is a mitral valve replacement.

10. The method of claim 7 wherein the opening is in a left atrium of the patient'"'"'s heart.

11. The method of claim 10 wherein the tissue supporting member introducing step is carried out with the supporting member having said first length of sufficient length to extend into the left atrium to engage the interatrial septum.

12. The method of claim 1 wherein the tissue supporting member introducing step is carried out with the tissue supporting member being introduced through the first percutaneous penetration by a second shaft, the second shaft having means at a distal end for releasably holding the tissue supporting member.

13. The method of claim 12 further comprising the step of:

releasing the tissue supporting member from the second shaft after connecting the tissue supporting member to the first shaft.

14. The method of claim 1 further including the step of, before the tissue supporting member introducing step, arresting the heart.

15. The method of claim 14 further including the step of, before the arresting step, establishing cardiopulmonary bypass.

16. The method of claim 1 wherein said contact surface of said tissue support member generally extends in a direction away from the longitudinal axis of said shaft.

17. The method of claim 16 wherein said coupling step is accomplished by connecting said shaft to one end of said tissue support member.

18. The method of claim 17 wherein said positioning step includes the step of inserting an opposite second end of said tissue support member into the incised opening of the left atrium until a first lip portion thereof, extending rearwardly from said contact surface, supportably engages the interatrial septum.

19. The method of claim 18 wherein the contact surface of the tissue support member extends continuously between said first end and said second end.

20. The method of claim 19 wherein the contact surface has a curvature selected to conform to the inner surface of the incised opening.

21. The method of claim 1 wherein the tissue support member introducing step and the shaft introducing step are performed at generally right angles relative one another.