Devices and methods for port-access multivessel coronary artery bypass surgery
First Claim
1. A method of performing coronary artery bypass graft surgery at a surgical site on a heart within a chest of a patient, the chest having a sternum and a plurality of ribs, each rib being separated from an adjacent rib by an intercostal space, the method comprising the steps of:
- making first and second access ports into the chest through at least one intercostal space, the surgical site being on an aspect of the heart facing away from the first access port;
arresting the patient'"'"'s heart;
introducing a retraction instrument through the second access port;
manipulating the retraction instrument to reposition the heart within the chest into a retracted position wherein the aspect of the heart containing the surgical site is facing the first access port; and
anastomosing a vascular graft to a coronary artery at the surgical site using an anastomosing instrument introduced through the first access port;
wherein the ribs and sternum remain intact during each of said steps.
3 Assignments
0 Petitions
Accused Products
Abstract
Surgical methods and instruments are disclosed for performing port-access or closed-chest coronary artery bypass (CABG) surgery in multivessel coronary artery disease. In contrast to standard open-chest CABG surgery, which requires a median sternotomy or other gross thoracotomy to expose the patient'"'"'s heart, port-access CABG surgery is performed through small incisions or access ports made through the intercostal spaces between the patient'"'"'s ribs, resulting in greatly reduced pain and morbidity to the patient. In situ arterial bypass grafts, such as the internal mammary arteries and/or the right gastroepiploic artery, are prepared for grafting by thoracoscopic or laparoscopic takedown techniques. Free grafts, such as a saphenous vein graft or a free arterial graft, can be used to augment the in situ arterial grafts. The graft vessels are anastomosed to the coronary arteries under direct visualization through a cardioscopic microscope inserted through an intercostal access port. Retraction instruments are provided to manipulate the heart within the closed chest of the patient to expose each of the coronary arteries for visualization and anastomosis. Disclosed are a tunneler and an articulated tunneling grasper for rerouting the graft vessels, and a finger-like retractor, a suction cup retractor, a snare retractor and a loop retractor for manipulating the heart. Also disclosed is a port-access topical cooling device for improving myocardial protection during the port-access CABG procedure. An alternate surgical approach using an anterior mediastinotomy is also described.
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Citations
50 Claims
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1. A method of performing coronary artery bypass graft surgery at a surgical site on a heart within a chest of a patient, the chest having a sternum and a plurality of ribs, each rib being separated from an adjacent rib by an intercostal space, the method comprising the steps of:
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making first and second access ports into the chest through at least one intercostal space, the surgical site being on an aspect of the heart facing away from the first access port; arresting the patient'"'"'s heart; introducing a retraction instrument through the second access port; manipulating the retraction instrument to reposition the heart within the chest into a retracted position wherein the aspect of the heart containing the surgical site is facing the first access port; and anastomosing a vascular graft to a coronary artery at the surgical site using an anastomosing instrument introduced through the first access port; wherein the ribs and sternum remain intact during each of said steps. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41)
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42. A method of performing coronary artery bypass graft surgery at a surgical site on a heart within a chest of a patient, the chest having a sternum and a plurality of ribs, each rib being connected to the sternum by a costal cartilage, the method comprising the steps of:
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creating a mediastinotomy by a method selected from (i) making an intercostal incision between two ribs and (ii) cutting a costal cartilage to disconnect a rib from the sternum; introducing a retraction instrument through the mediastinotomy; arresting the patient'"'"'s heart; manipulating the retraction instrument to reposition the heart within the chest into a retracted position wherein an aspect of the heart containing the surgical site is visible through the mediastinotomy; and anastomosing a vascular graft to a coronary artery at the surgical site using an anastomosing instrument introduced through the mediastinotomy. - View Dependent Claims (43, 47)
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44. A method of performing coronary artery bypass graft surgery at a surgical site on a heart within a chest of a patient, the chest having a sternum and a plurality of ribs, each rib being separated from an adjacent rib by an intercostal space, the method comprising the steps of:
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placing a catheter in an ascending aorta leading away from the patient'"'"'s heart; arresting the patient'"'"'s heart; occluding the ascending aorta by means of an occluding member on the catheter; circulating oxygenated blood through the patient'"'"'s arterial system downstream of the occluding member; making at least one access port into the chest through at least one intercostal space, the surgical site being on an aspect of the heart facing away from the access port; introducing a retraction instrument through one of the at least one access ports; manipulating the retraction instrument to reposition the heart within the chest into a retracted position wherein the aspect of the heart containing the surgical site is visible through one of the at least one access ports; and anastomosing a vascular graft to a coronary artery at the surgical site using an anastomosing instrument introduced through one of the at least one access ports. - View Dependent Claims (48)
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45. A method of performing coronary artery bypass graft surgery at first and second surgical sites on a heart within a chest of a patient, the chest having a sternum and a plurality of ribs, each rib being separated from an adjacent rib by an intercostal space, the method comprising the steps of:
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making at least one access port into the chest through at least one intercostal space, the first surgical site being on a first aspect of the heart facing the access port; arresting the patient'"'"'s heart; anastomosing a first vascular graft to a first coronary artery at the first surgical site using an anastomosing instrument, the anastomosing instrument being manipulated from outside the chest by means of a handle extending out of the chest through one of the at least one access ports; introducing a retraction instrument through one of the at least one access ports, the retraction instrument having a proximal end extending out of the chest through one of the at least one access ports; manipulating the proximal end of the retraction instrument to reposition the heart within the chest into a retracted position wherein a second aspect of the heart containing a second surgical site is facing one of the at least one access ports; and anastomosing a second vascular graft to a second coronary artery at the second surgical site using an anastomosis instrument having an elongaged handle after the manipulating step, the anastomosis instrument being manipulated from outside the chest by means of the handle which extends out of the chest through one of the at least one access ports. - View Dependent Claims (49)
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46. A method of performing coronary artery bypass graft surgery at a surgical site on a heart within a chest of a patient, the chest having a sternum and a plurality of ribs, each rib being separated from an adjacent rib by an intercostal space, the method comprising the steps of:
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making at least one access port into the chest through at least one intercostal space, the surgical site being on an aspect of the heart facing away from the access port; arresting the patient'"'"'s heart; introducing a retraction instrument through one of the at least one access ports; manipulating the retraction instrument to reposition the heart within the chest into a retracted position wherein the aspect of the heart containing the surgical site is visible through one of the at least one access ports; and anastomosing a vascular graft to a coronary artery at the surgical site using an anastomosing instrument introduced through one of the at least one access ports, wherein the retraction instrument and the anastomosing instrument are manipulated substantially entirely from outside the chest. - View Dependent Claims (50)
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Specification