Intercostal access devices for less-invasive cardiovascular surgery

• US 5,728,151 A
• Filed: 06/05/1995
• Issued: 03/17/1998
• 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: Garrison, Michi E., Stevens, John H.
• Primary Examiner(s): ISABELLA, DAVID J
• Application Number:
  US08/463,167
• Time in Patent Office: 1,016 Days
• Field of Search: 623/11, 623/12, 623/2, 623/66, 606/144, 606/148, 128/898
• US Class Current: 128/898
• 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 17/0218 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 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 2017/0243 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 2017/2943 Toothed members, e.g. rack and pinion
• CPC Class Codes: A61B 2017/2945 Curved jaws
• 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 2017/3492 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 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: A61F 2/2496 : Devices for determining the dimensions of the prosthetic valve to be implanted, e.g. templates, sizers
• 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 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
• CPC Class Codes: Y10S 623/904 : Heart

Abstract

The invention provides devices and methods for performing less-invasive surgical procedures within an organ or vessel. In an exemplary embodiment, the invention provides a method of closed-chest surgical intervention within an internal cavity of a patient'"'"'s heart or great vessel. According to the method, the patient'"'"'s heart is arrested and cardiopulmonary bypass is established. A scope extending through a percutaneous intercostal penetration in the patient'"'"'s chest is used to view an internal portion of the patient'"'"'s chest. An internal penetration is formed in a wall of the heart or great vessel using cutting means introduced through a percutaneous penetration in an intercostal space in the patient'"'"'s chest. An interventional tool is then introduced, usually through a cannula positioned in a percutaneous intercostal penetration. The interventional tool is inserted through the internal penetration in the heart or great vessel to perform a surgical procedure within the internal cavity under visualization by means of the scope. In a preferred embodiment, a cutting tool is introduced into the patient'"'"'s left atrium from a right portion of the patient'"'"'s chest to remove the patient'"'"'s mitral valve. A replacement valve is then introduced through an intercostal space in the right portion of the chest and through the internal penetration in the heart, and the replacement valve is attached in the mitral valve position.

Claims

1. A method of organizing sutures for securing a replacement cardiac valve in a heart within a patient'"'"'s chest, the chest being defined by a plurality of ribs, each rib being separated from an adjacent rib by an intercostal space, the method comprising:

placing an access device in a percutaneous penetration within an intercostal space, the access device forming an opening into the patient'"'"'s chest between the adjacent ribs;

passing a plurality of sutures through tissue of the patient'"'"'s heart, the sutures extending through the opening in the patient'"'"'s chest; and

organizing the sutures on a suture organizer mounted to the access device outside the chest, the suture organizer being positioned outside the patient'"'"'s chest.

2. The method of claim 1 wherein the step of organizing comprises placing each suture in a slot on the suture organizer configured to retain the suture therein.

3. The method of claim 1 wherein the access device comprises a cannula having a body with a distal end, a proximal end, and a passage therebetween in an axial direction, the suture organizer being mounted to the proximal end of the cannula.

4. The method of claim 3 wherein the suture organizer comprises a plurality of suture retention devices arranged around the passage of the cannula.

5. The method of claim 4 wherein the plurality of suture retention devices comprise a plurality of slots configured to releasably retain the sutures therein.

8. The method of claim 1 further comprising positioning a replacement cardiac valve through the opening into the chest and securing the replacement cardiac valve in the heart with the plurality of sutures.

9. The method of claim 8 wherein the sutures are passed through a sewing ring of the replacement cardiac valve outside the patient'"'"'s chest before the step of positioning.

6. A method of organizing sutures for securing a replacement cardiac valve in a heart within a patient'"'"'s chest, the chest being defined by a plurality of ribs, each rib being separated from an adjacent rib by an intercostal space, the method comprising:

placing an access device in a percutaneous penetration within an intercostal space, the access device forming an opening into the patient'"'"'s chest between the adjacent ribs, the access device including a cannula having a body with a distal end, a proximal end, and a passage therebetween in an axial direction;

passing a plurality of sutures through tissue of the patient'"'"'s heart, the sutures extending through the opening in the patient'"'"'s chest; and

organizing the sutures on a suture organizer mounted to the access device outside the chest, the suture organizer being positioned outside the patient'"'"'s chest, the suture organizer being mounted to the proximal end of the cannula;

wherein the passage of the cannula has a cross-sectional width and a cross-sectional height perpendicular to the axial direction, the cross-sectional height being substantially larger than the cross-sectional width.

7. The method of claim 6 wherein the passage has a cross-sectional shape selected from the group including rectangular, oval and elliptical.

10. A method of organizing sutures in a surgical procedure on a body structure within a body cavity, the method comprising:

positioning an access device in a percutaneous penetration, the access device forming a passage into the body cavity, the access device having a plurality of retention devices;

attaching a suture to the body structure using an instrument placed through the passage;

drawing an end of the suture out of the body cavity through the passage; and

placing the suture in one of the plurality of retention devices mounted to the access device outside the body cavity.

11. The method of claim 10 wherein the step of placing is carried out with the plurality of retention devices being a plurality of slots on the access device, the plurality of slots being configured to releasably retain the suture therein.

12. The method of claim 10 wherein the access device comprises a cannula having a distal end, a proximal end, and a lumen therebetween, the plurality of retention devices being mounted to a proximal end of the cannula.