Lateral- and posterior-aspect method for laser-assisted transmyocardial revascularization and other surgical applications

• US 6,036,685 A
• Filed: 02/18/1998
• Issued: 03/14/2000
• Est. Priority Date: 03/29/1996
• Status: Expired due to Fees

• Current Assignee: Eclipse Surgical Technologies, Inc. (Cryolife Incorporated)
• Original Assignee: Eclipse Surgical Technologies, Inc. (Cryolife Incorporated)
• Inventors: Mueller, Richard L.
• Primary Examiner(s): Dvorak, Linda C. M.
• Assistant Examiner(s): YARNELL, BRYAN KEITH
• Application Number:
  US09/025,644
• Time in Patent Office: 755 Days
• Field of Search: 606/2, 606/3, 606/7, 606/13, 606/14, 606/15, 606/16, 606/17, 128/898, 600/104, 600/108, 600/160
• US Class Current: 606/15
• CPC Class Codes: A61B 1/00098 Deflecting means for inserted tools
• CPC Class Codes: A61B 1/00154 using guiding arrangements for insertion
• CPC Class Codes: A61B 1/018 for receiving instruments
• CPC Class Codes: A61B 1/267 for the respiratory tract, e.g. laryngoscopes, bronchoscopes
• CPC Class Codes: A61B 1/3132 for laparoscopy
• CPC Class Codes: A61B 18/24 with a catheter A61B18/26, A61B18/28 take precedence
• CPC Class Codes: A61B 2017/00247 Making holes in the wall of the heart, e.g. laser Myocardial revascularization
• CPC Class Codes: A61B 2017/306 holding by means of suction
• CPC Class Codes: A61B 2018/00291 using suction
• CPC Class Codes: A61B 2018/00392 Transmyocardial revascularisation
• CPC Class Codes: A61B 90/37 Surgical systems with images on a monitor during operation
• CPC Class Codes: A61B 90/39 Markers, e.g. radio-opaque or breast lesions markers

Abstract

A method of visualizing and treating the heart by providing a balloon end contact scope with a main lumen, an essentially transparent contact viewing portion, and integral laser delivery means or other equipment channel suitable for viewing the heart; precisely positioning the contact viewing portion in contact with a portion of the heart adjacent the position to be viewed; and visualizing the heart. The scope may have a gripping surface particularly suitable for percutaneous use. For MIS use, the scope tents the pericardial sac. The method can be used to place a guide wire or tether to the heart to locate a fluoroscopic or other visualization means or to perform additional visualization, fluoroscopic marking or other interventional procedures. The method also comprises the step of delivering laser energy to a portion of the heart to effect transmyocardial revascularization. The method can be performed either by surgically or minimally invasively introducing a balloon end viewing scope into the chest cavity of a patient and through the pericardial sac of the heart to a position between the pericardial sac and the epicardial surface of the heart or by introducing a balloon end viewing scope into the vasculature of a patient, for example at a point on the femoral artery, and into an internal chamber of the heart.

Claims

1. A method of performing laser-assisted transmyocardial revascularization (TMR), the method comprising the steps of:

(a) providing a viewing scope having a laser delivery device for delivering laser energy to surfaces being visualized;

(b) introducing the viewing scope into the chest cavity of a patient and through a heart'"'"'s pericardial sac to a position between the pericardial sac and the heart'"'"'s epicardial surface;

(c) positioning the viewing scope adjacent an area of the epicardial surface and emplacing thereon so that the viewing scope tents the pericardial sac away from the epicardial surface;

(d) positioning a distal end of the laser delivery device adjacent the area of the epicardial surface; and

(e) irradiating the epicardial surface by the laser delivery device, thereby creating a TMR channel extending into the heart'"'"'s myocardium.

2. The method of claim 1 wherein the step (c) occurs at the heart'"'"'s lateral surface.

3. The method of claim 1 wherein the step (c) occurs at the heart'"'"'s posterior surface.

4. The method of claim 1 wherein the viewing scope of step (a) further includes means for gripping tissue, thereby a) stabilizing the viewing scope on the surface of a heart and b) resisting contractual forces caused by motions of the heart.

5. The method of claim 4 wherein step (c) further includes attaching the means for gripping prior to emplacing the viewing scope device on the heart wherein the means for gripping is a tether with a clip.

6. The method of claim 4 wherein the means for gripping tissue is selected from the group consisting of a suction means for drawing the viewing scope'"'"'s distal end against tissue or a textured frictional surface on the viewing scope'"'"'s transparent viewing distal end.

7. The method of claim 1 wherein prior to the step (b), the method further includes a step of forming at least one port in a patient'"'"'s chest cavity for introducing the viewing scope.

8. The method of claim 1 wherein the step (c) occurs at the heart'"'"'s posterior surface.

9. A method of performing laser-assisted myocardial revascularization from the endocardial surface of the heart, the method comprising the following steps:

(a) providing a viewing scope with proximal and distal ends, the distal end having a generally transparent inflatable balloon with a tissue gripping surface, the viewing scope further having at least one lumen, a visualization device and a laser delivery device extendable through the lumen and through the inflatable balloon;

(b) introducing the viewing scope through the vasculature of a patient and into an internal chamber of the heart;

(c) inflating the balloon and precisely positioning the viewing scope adjacent an area of the endocardium from which revascularization is to be initiated, the precise positioning achieved through the use of the visualization device disposed within the viewing scope, the visualization device visualizing through the generally transparent wall of the balloon against the endocardium;

(d) using the gripping surface of the balloon to stabilize the viewing scope on the endocardium while positioning a distal end of the laser delivery device through the at least one lumen adjacent the area of the endocardium from which revascularization is to be initiated; and

(e) delivering a controlled amount of laser energy to the endocardium to create a channel extending therethrough into myocardium.

10. A method of performing minimally invasive surgical procedures on a heart, the method comprising the steps of:

(a) providing a viewing scope having an interventional means for treating an epicardial surface being visualized;

(b) forming a single portal through a chest cavity of a patient and subsequently introducing the viewing scope into the patient'"'"'s chest cavity and through a heart'"'"'s pericardial sac to a position between the pericardial sac and the epicardial surface;

(c) positioning the viewing scope adjacent an area of the epicardial surface and using the viewing scope to tent the pericardium away from the epicardial surface;

(d) positioning a distal end of the interventional means adjacent the area of the epicardial surface;

(e) and treating the epicardial surface by the interventional means.

11. The method of claim 10 wherein the step (c) occurs at the heart'"'"'s lateral surface.

12. A method of performing minimally invasive surgical transmyocardial revascularization (TMR), the method comprising the steps of:

(a) providing a viewing scope including a laser delivery device for delivering laser energy to surfaces being visualized;

(b) forming a single portal through a patient'"'"'s chest cavity and subsequently introducing the viewing scope into the patients chest cavity and through a pericardium to the heart'"'"'s surface;

(c) positioning the viewing scope adjacent the heart and emplacing thereon while using the viewing scope device to tent the pericardium away from the heart'"'"'s surface;

(d) positioning a distal end of the laser delivery means adjacent the heart surface; and

(e) irradiating the heart surface by the laser delivery means, thereby creating a TMR channel extending into the heart'"'"'s myocardium.

13. The method of claim 12 wherein the step (c) occurs at the heart'"'"'s lateral surface.

14. The method of claim 12 wherein the step (c) occurs at the heart'"'"'s posterior surface.