Method and apparatus for minimizing the risk of air embolism when performing a procedure in a patient's thoracic cavity

• US 5,849,005 A
• Filed: 01/16/1996
• Issued: 12/15/1998
• Est. Priority Date: 06/07/1995
• Status: Expired due to Term

• Current Assignee: Edwards Lifesciences LLC (Edwards Lifesciences Corporation)
• Original Assignee: Heartport, Inc. (Johnson & Johnson)
• Inventors: Garrison, Michi E., Mueller, Richard L. Jr., Donlon, Brian S.
• Primary Examiner(s): Bockelman, Mark
• Application Number:
  US08/585,871
• Time in Patent Office: 1,064 Days
• Field of Search: 604/23, 604/26, 604/48, 604/49, 604/43, 604/93, 604/104, 604/122, 604/264, 604/174, 128/207.14-16, 600/560, 606/1
• US Class Current: 606/1
• 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 17/0293 with ring member to support retractor elements
• CPC Class Codes: A61B 2017/00243 cardiac
• CPC Class Codes: A61B 2090/401 using air flow
• CPC Class Codes: A61B 90/40 Apparatus fixed or close to patients specially adapted for providing an aseptic surgical environment
• CPC Class Codes: A61F 2/2403 with pivoting rigid closure members check valves with hinged closure members in general F16K15/03
• CPC Class Codes: A61F 2/2427 Devices for manipulating or deploying heart valves during implantation
• CPC Class Codes: A61F 2/2448 D-shaped rings
• CPC Class Codes: A61F 2/2466 Delivery devices therefor
• 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 25/0041 pre-formed, e.g. specially adapted to fit with the anatomy of body channels urethral catheters A61F2/04
• CPC Class Codes: A61M 25/0133 Tip steering devices
• CPC Class Codes: A61M 25/1011 Multiple balloon catheters

Abstract

An apparatus for minimizing the risk of air embolism includes an instrument delivery member 2 having a gas outlet 38 for delivering gas into a patient'"'"'s thoracic cavity. The gas is directed across an opening 48 in the instrument delivery member 2 to help retain the gas in the patient'"'"'s thoracic cavity. The gas is preferably carbon dioxide which is more soluble in blood than air which will thereby decrease the likelihood of the patient receiving an embolism due to trapped air in the patient'"'"'s heart and great vessels after surgery.

Claims

1. A method of minimizing the risk of air emboli in a patient'"'"'s circulatory system when performing a procedure in the patient'"'"'s thoracic cavity, comprising the steps of:

inserting an instrument delivery member into a patient'"'"'s thoracic caviler thereby forming a first percutaneous penetration, the instrument delivery member having a throughhole sized to permit an instrument to pass therethrough;

coupling an outlet from a source of gas to the instrument delivery member;

injecting the gas from the source of gas into the patient'"'"'s thoracic cavity through the outlet coupled to the instrument delivery member, the injecting step being carried out with a plurality of outlets coupled to the instrument delivery member for passing the gas into the patient'"'"'s thoracic cavity, the injecting step being carried out so that the gas issuing from the plurality of outlets forms a gas shield across the throughhole.

2. The method of claim 1, further comprising the step of:

inserting an instrument for performing a procedure on the patient'"'"'s heart through the first instrument delivery member.

3. The method of claim 1, wherein:

the coupling step is carried out with the source of gas being a source of carbon dioxide.

4. The method of claim 1, further comprising the step of:

withdrawing the gas through an inlet of a vacuum line, the vacuum line being coupled to a vacuum pump.

5. The method of claim 1, further comprising the step of:

monitoring a gas concentration in the patient'"'"'s thoracic cavity;

the injecting step being carried out to maintain a minimum gas concentration in the patient'"'"'s thoracic cavity.

6. The method of claim 1, further comprising the step of:

humidifying the gas before the injecting step.

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

measuring a temperature in the patient'"'"'s thoracic cavity; and

changing the temperature of the gas injected into the patient in response to the temperature in the patient'"'"'s thoracic cavity measured during the measuring step.

8. The method of claim 1, further comprising the step of:

measuring the pressure in the patient'"'"'s thoracic cavity;

the injecting step being carried out so that a pressure in the patient'"'"'s thoracic cavity exceeds atmospheric pressure thereby resisting introduction of air into the patient'"'"'s thoracic cavity.

9. The method of claim 1, wherein:

the inserting step is carried out with the outlet being integrally formed with the instrument delivery member.

10. An instrument delivery member adapted to inject a gas into a patient'"'"'s thoracic cavity to minimize the risk of air embolism, comprising:

a sidewall forming a throughhole sized and configured to permit a medical instrument to pass therethrough, the sidewall having a proximal end, a distal end and a longitudinal axis, the throughhole having a cross-section in a direction perpendicular to the longitudinal axis, the cross-section having a width and a length, at least one of the width and length being at least 2 cm;

a gas inlet configured to be coupled to a source of gas;

a plurality of gas outlets coupled to the sidewall for injecting a gas into a patient'"'"'s thoracic cavity, the plurality of gas outlets being fluidly coupled to the gas inlet, the plurality of gas outlets being positioned and configured to direct a gas shield across substantially the entire throughhole so that gas losses through the throughhole are minimized.