Methods and systems for performing thoracoscopic coronary bypass and other procedures

• US 5,735,290 A
• Filed: 07/28/1994
• Issued: 04/07/1998
• Est. Priority Date: 02/22/1993
• Status: Expired due to Term

• Current Assignee: Heartport, Inc. (Johnson & Johnson)
• Original Assignee: Heartport, Inc. (Johnson & Johnson)
• Inventors: Stevens, John H., MacHold, Timothy R., Sterman, Wesley D., Siegel, Lawrence C., Curtis, Patricia E.
• Primary Examiner(s): Weiss, John G.
• Assistant Examiner(s): Polutta, Mark O.
• Application Number:
  US08/281,891
• Time in Patent Office: 1,349 Days
• Field of Search: 604/49, 604/264, 128/898, 606/7, 606/8, 623/2, 623/66
• 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 17/0057 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 17/30 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 17/3403 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 2017/00637 : for sealing trocar wounds through abdominal wall
• CPC Class Codes: A61B 2017/00663 : the implement being a suture
• CPC Class Codes: A61B 2017/0225 : flexible, e.g. fabrics, meshes, or membranes
• CPC Class Codes: A61B 2017/0237 : for heart surgery endoscopic heart surgery A61B2017/00243; endoscopic access devices, i.e. trocars, A61B17/34
• 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 2017/2912 : transmission of forces to actuating rod or piston
• CPC Class Codes: A61B 2017/2927 : the angular position of the head being adjustable with respect to the shaft
• CPC Class Codes: A61B 2017/2932 : Transmission of forces to jaw members
• CPC Class Codes: A61B 2017/2943 : Toothed members, e.g. rack and pinion
• CPC Class Codes: A61B 2017/306 : holding by means of suction
• CPC Class Codes: A61B 2017/308 : with suction cups
• CPC Class Codes: A61B 2017/3405 : using mechanical guide means
• CPC Class Codes: A61B 2017/3427 : for intercostal space
• 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 2090/064 : for measuring force, pressure or mechanical tension
• CPC Class Codes: A61B 2090/306 : using optical fibres
• CPC Class Codes: A61B 90/36 : Image-producing devices or illumination devices not otherwise provided for
• 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 2007/0001 : Body part
• CPC Class Codes: A61F 2007/0054 : with a closed fluid circuit, e.g. hot water
• CPC Class Codes: A61F 2007/101 : for cooling organs in the body before or during surgery
• CPC Class Codes: A61F 7/10 : Cooling bags, e.g. ice-bags
• CPC Class Codes: A61M 2025/0003 : having an additional lumen transmitting fluid pressure to the outside for measurement
• CPC Class Codes: A61M 2025/0031 : characterized by lumina for withdrawing or delivering, i.e. used for extracorporeal circuit treatment
• CPC Class Codes: A61M 2025/028 : having a mainly rigid support structure
• CPC Class Codes: A61M 2025/1052 : for temporarily occluding a vessel for isolating a sector
• 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 25/0023 : by the form of the lumen, e.g. cross-section, variable diameter
• CPC Class Codes: A61M 25/0032 : characterized by at least one unconventionally shaped lumen, e.g. polygons, ellipsoids, wedges or shapes comprising concave and convex parts
• 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

A method for closed-chest cardiac surgical intervention relies on viewing the cardiac region through a thoracoscope or other viewing scope and endovascularly partitioning the patient'"'"'s arterial system at a location within the ascending aorta. The cardiopulmonary bypass and cardioplegia can be induced, and a variety of surgical procedures performed on the stopped heart using percutaneously introduced tools. The method of the present invention will be particularly suitable for forming coronary artery bypass grafts, where an arterial blood source is created using least invasive surgical techniques, and the arterial source is connected to a target location within a coronary artery while the patient is under cardiopulmonary bypass and cardioplegia.

Claims

1. A method for forming an anastomosis between a mammary artery and a coronary artery of a patient, said method comprising:

positioning at least one trocar sheath through the patient'"'"'s chest;

introducing a viewing scope into the patient'"'"'s chest;

transecting the patient'"'"'s mammary artery using a tool introduced through the at least one trocar sheath while viewing the artery using the viewing scope;

establishing cardiopulmonary bypass;

stopping heart contraction;

forming an incision in a coronary artery using a cutting tool introduced through a trocar sheath; and

connecting the internal mammary artery to the incision in the coronary artery using an anastomosis tool.

2. A method as in claim 1, wherein at least three trocar sheaths are positioned on the lateral chest and between adjacent ribs.

3. A method as in claim 1, wherein the internal mammary artery is transected using an electrosurgical cutting tool to dissect the artery from the thoracic wall and a cutting tool to sever the proper length of the artery.

4. A method as in claim 1, further comprising the step of:

endovascularly partitioning the patient'"'"'s arterial system at a location within the ascending aorta between the brachiocephalic artery and the coronary ostia, the arterial system being partitioned by endovascularly advancing a distal end of a catheter to the ascending aorta, and expanding a blocking element on the catheter to inhibit the flow of blood and other fluids.

5. A method as in claim 1, further comprising the step of:

establishing cardiopulmonary bypass from a femoral vein to a femoral artery.

6. A method as in claim 4, further comprising the step of:

stopping heart contractions, the heart being stopped by the anterograde introduction of cardioplegic fluid through the catheter.

7. A method as in claim 1, wherein the incision in the coronary artery is formed using a scalpel.

8. A method as in claim 1, wherein the arteries are connected using suture.

9. A method as in claim 4, wherein the left ventricle is vented by applying a negative pressure through the catheter.

10. A method as in claim 1, wherein the stopped heart is repositioned to better expose the region of the coronary artery which is the target for the incision.

11. A method as in claim 10, wherein the stopped heart is repositioned using at least two graspers positioned on opposite sides of the heart.

12. A method of forming an anastomosis between a mammary artery and a coronary artery of a patient, the method comprising:

creating at least one opening between ribs in the patient'"'"'s chest;

dissecting a mammary artery from a wall of the patient'"'"'s chest using a dissection tool inserted through one of the at least one openings, the dissection tool being manipulated from outside the chest;

transecting the mammary artery to create a free end;

viewing the patient'"'"'s heart through one of the at least one openings to identify a coronary artery;

connecting the free end of the mammary artery to the coronary artery using an anastomosis tool inserted through one of the at least one openings, the anastomosis tool being manipulated from outside the chest;

stopping heart contractions; and

maintaining circulation of blood in the patient'"'"'s arterial system while heart contractions are stopped.

13. The method of claim 12 wherein the step of maintaining circulation comprises withdrawing blood from a femoral vein and returning oxygenated blood to a femoral artery.

14. The method of claim 12 wherein the step of stopping heart contractions comprises endovascularly positioning a catheter in the patient'"'"'s ascending aorta from a peripheral artery;

and

blocking blood flow through the ascending aorta with a blocking element mounted to the catheter.

15. The method of claim 14 further comprising delivering cardioplegic fluid into the coronary circulation.

16. The method of claim 15 wherein the cardioplegic fluid is delivered through a lumen in the catheter leading to a port upstream of the blocking element.

17. The method of claim 14 further comprising venting fluid from the aorta upstream of the blocking element through a lumen in the catheter.

18. A method of forming an anastomosis between a mammary artery and a coronary artery of a patient, the method comprising:

creating at least one opening between ribs in the patient'"'"'s chest, the creating step being carried out so that at least first and second openings are formed in the chest;

dissecting a mammary artery from a wall of the patient'"'"'s chest using a dissection tool inserted through one of the at least one openings, the dissection tool being manipulated from outside the chest, the dissection tool being inserted through the first opening and the anastomosis tool being inserted through the second opening;

transecting the mammary artery to create a free end;

viewing the patient'"'"'s heart through one of the at least one openings to identify a coronary artery; and

connecting the free end of the mammary artery to the coronary artery using an anastomosis tool inserted through one of the at least one openings, the anastomosis tool being manipulated from outside the chest.

19. The method of claim 18 wherein the first opening is in a lateral side of the chest and the second opening is in an anterior side of the chest.

20. A method of performing an anastomosis between a mammary artery and coronary artery in a chest of a patient, the chest having a sternum and a plurality of ribs, the improvement comprising forming the anastomosis using a tool inserted through at least one opening between the ribs without dividing the patient'"'"'s sternum, the tool being manipulated from outside the chest.