Methods for performing heart surgery

• US 5,855,210 A
• Filed: 11/06/1996
• Issued: 01/05/1999
• 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: Machold, Timothy R., Stevens, John H., Sterman, Wesley D., Siegel, Lawrence C., Curtis, Patricia E.
• Primary Examiner(s): Isabella, David J.
• Application Number:
  US08/749,384
• Time in Patent Office: 790 Days
• Field of Search: 128/897, 128/898, 604/4, 604/96, 604/49, 604/51-53, 606/128, 606/127, 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 2017/0243 : 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 2017/306 : holding by means of suction
• 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 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 2025/0003 : having an additional lumen transmitting fluid pressure to the outside for measurement
• CPC Class Codes: A61M 2025/028 : having a mainly rigid support structure
• CPC Class Codes: A61M 2039/0273 : for introducing catheters into the body
• 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 25/1011 : 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 closed-chest cardiac surgical intervention, said method comprising:

forming at least one percutaneous penetration in the patient'"'"'s chest;

creating an opening in an artery;

endovascularly advancing a distal end of a catheter through the opening to a location within the ascending aorta;

expanding an occluding element on the catheter at said location to inhibit the flow of blood and other fluids past said location;

establishing cardiopulmonary bypass by removing blood through a first catheter lumen positioned in a vein, oxygenating the blood, and returning the blood downstream of said location through a second catheter lumen positioned in an artery;

stopping heart contraction by introducing a cardioplegic agent to the patient'"'"'s heart through the catheter;

viewing the heart through a viewing device placed in one of the at least one percutaneous penetrations; and

performing a surgical procedure on the stopped heart using tools introduced through one of the at least one percutaneous penetrations.

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

viewing the heart through a viewing scope disposed through another percutaneous intercostal penetration in the patient, the viewing scope being introduced through a trocar sheath disposed in the another percutaneous intercostal penetration.

3. A method as in claim 1, wherein cardiopulmonary bypass is established from a femoral vein to a femoral artery.

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

positioning at least one access device between two ribs in a patient'"'"'s chest thereby forming a percutaneous penetration;

cutting the mammary artery using a tool introduced through the access device thereby forming an end;

creating an opening in an artery;

endovascularly advancing a catheter having an occluding member through the opening to a location within the ascending aorta between the brachiocephalic artery and the coronary ostia;

expanding the occluding member at the location to occlude the patient'"'"'s ascending aorta;

establishing cardiopulmonary bypass by removing blood through a first catheter lumen positioned in a vein, oxygenating the blood, and returning the blood downstream of said location through a second catheter lumen positioned in an artery;

stopping heart contraction by introducing a cardioplegic agent to the patient'"'"'s heart through the catheter;

forming an incision in the coronary artery using a cutting tool while the heart is stopped;

connecting the end of the internal mammary artery to the incision in the coronary artery; and

viewing the mammary artery through a viewing device placed in a percutaneous penetration during at least one of the cutting, forming and connecting steps.

5. A method as in claim 4, wherein at least three trocar sheaths are positioned on the lateral chest, each of the at least three trocar sheaths being positioned between adjacent ribs.

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

transecting the mammary artery using an electrosurgical cutting tool to dissect the mammary artery from the thoracic wall.

7. A method as in claim 4, wherein cardiopulmonary bypass is established from the femoral vein to the femoral artery.

8. A method as in claim 6, wherein the heart is stopped by the anterograde introduction of cardioplegic fluid through the catheter.

9. A method as in claim 4, wherein the incision in the coronary artery is formed using a scalpel.

10. A method as in claim 4, wherein the internal mammary artery and the coronary artery are connected using a suture.

11. A method as in claim 6, wherein the left ventricle is vented through the catheter.

12. A method as in claim 4, wherein the stopped heart is repositioned to better expose a region of the coronary artery which is a target for the incision.

13. A method as in claim 12, wherein the stopped heart is repositioned using at least two graspers positioned on opposite sides of the heart.

14. The method of claim 4, wherein:

the viewing step is carried out with the viewing device being a scope positioned in a percutaneous penetration.

15. A method of less-invasive cardiac surgical intervention, the method comprising:

forming at least one percutaneous penetration in the patient'"'"'s chest;

creating an opening in an artery;

positioning a distal end of an occlusion device through the opening to a location within the ascending aorta;

expanding an occluding element on the occlusion device at said location to inhibit the flow of blood and other fluids past said location;

maintaining circulation of blood in the patient'"'"'s arterial system downstream of the occluding element by removing blood through a first catheter lumen positioned in a vein, oxygenating the blood, and returning the blood downstream of said location through a second catheter lumen positioned in an artery;

stopping heart contractions by introducing a cardioplegic agent to the patient'"'"'s heart;

positioning a device for viewing the heart in one of the at least one percutaneous penetrations;

viewing the heart through the device; and

performing a surgical procedure on the stopped heart using tools introduced through one of the at least one percutaneous penetrations.

16. The method of claim 15 wherein the step of positioning comprises positioning a trocar sleeve in the percutaneous penetration, the step of viewing being carried out through the trocar sleeve.

17. The method of claim 16 wherein the device for viewing the heart comprises a thoracoscope positionable through the trocar sleeve, the step of viewing comprising visualizing the heart using the thoracoscope.

18. The method of claim 15 wherein the procedure comprises connecting an arterial blood source to a coronary artery on the patient'"'"'s heart.

19. The method of claim 15 wherein the occlusion device comprises a catheter, the method further comprising introducing the catheter into a peripheral artery and endovascularly advancing the catheter into the ascending aorta.

20. The method of claim 15 wherein the step of maintaining circulation comprises removing blood from a peripheral vein, oxygenating the blood, and returning the blood to a peripheral artery.