Minimally invasive cardiac valve surgery procedure

• US 6,182,664 B1
• Filed: 02/18/1997
• Issued: 02/06/2001
• Est. Priority Date: 02/19/1996
• Status: Expired due to Term

• Current Assignee: Cleveland Clinic Foundation
• Original Assignee: Edwards Lifesciences Corporation
• Inventors: Cosgrove, Delos M.
• Primary Examiner(s): Millin, V.
• Assistant Examiner(s): O'Hara, Kelley
• Application Number:
  US08/801,494
• Time in Patent Office: 1,449 Days
• Field of Search: 607/122, 607/126, 128/898, 604/19, 604/28, 604/49, 623/1, 623/2, 623/3, 623/1.26, 623/2.1, 623/3.1, 623/902, 623/904, 623/915, 623/921, 623/922, 623/FOR.101
• 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 17/02 for holding wounds open; Tractors specula A61B1/32 ; drainage appliances for wounds A61M27/00
• 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 2017/00243 cardiac
• CPC Class Codes: A61F 2/2427 Devices for manipulating or deploying heart valves during implantation
• CPC Class Codes: A61F 2/2445 Annuloplasty rings in direct contact with the valve annulus
• CPC Class Codes: A61F 2/2466 Delivery devices therefor
• CPC Class Codes: Y10S 623/902 Method of implanting
• CPC Class Codes: Y10S 623/914 Bone
• CPC Class Codes: Y10S 623/918 Heart
• CPC Class Codes: Y10S 623/922 Heart

Abstract

A minimally invasive approach for surgery on portions of the heart and great vessels located between a point approximately three centimeters above supra annular ridge and the mid ventricular cavity. A parasternal incision is made extending across a predetermined number of costal cartilage, e.g., a right parasternal incision extending from the lower edge of the second costal cartilage to the superior edge of the fifth costal cartilage. One or more costal cartilages, e.g., the third and fourth, are then excised to provide access to the portion of the heart or great vessels of interest, and a desired procedure completed. The minimally invasive approach enables repair or replacement of the mitral or aortic valve.

Claims

1. A method of performing minimally invasive cardiac valve repair or replacement surgery on a patient comprising the steps of:

preparing the patient for surgery;

making an incision in the chest of the patient;

said incision being approximately 10 cm in length;

said incision being made within a region on the chest that enables direct access to a location in the heart approximately 3 cm above the supra annular ridge and in the mid-ventricular cavity;

establishing cardiopulmonary bypass using at least one blood conduit placed within the region;

exposing a surgical field within said area approximately 3 cm above the supra annular ridge and in the mid-ventricular cavity; and

,

performing a valve repair or replacement procedure within the surgical field.

2. The method of claim 1, wherein said step of establishing cardiopulmonary bypass comprises:

connecting an arterial return cannula to an appropriate vessel, connecting a venous drain cannula to an appropriate vessel, occluding the aorta, and introducing cardioplegia solution through a coronary ostia.

3. The method of claim 1, wherein said step of performing a valve repair or replacement procedure comprises implanting a prosthetic valve.

4. The method of claim 1, wherein the step of exposing comprises:

a) dividing the outer layer of muscle tissue below the skin;

b) exposing one or more costal cartilages;

c) resecting the exposed costal cartilages;

d) incising and retracting the pericardium; and

e) incising one of the atrial chambers of the heart or the ascending aorta to expose the surgical field.

5. The method of claim 4, wherein the valve to be repaired or replaced is the aortic valve, and step e) comprises incising the ascending aorta, wherein the surgical field is an area adjacent the aortic valve.

6. The method of claim 4, wherein the valve to be repaired or replaced is the mitral valve, and step e) comprises incising the right atrium and intra-atrial septum, wherein the surgical field is an area adjacent the mitral valve.

7. The method of claim 6, further comprising:

after step e) to expose the surgical field, providing downward traction on the left atrial wall using a deformable retractor.

8. The method of claim 6, further comprising:

after step e) to expose the surgical field, inserting a resilient ring member into the surgical field between the valve and the left atrial wall to facilitate lifting tissue away from the valve area needing repair.

9. A method of performing minimally invasive cardiac valve repair or replacement surgery on a patient comprising the steps of:

preparing the patient for surgery;

making an incision in the chest of the patient;

said incision being approximately 10 cm in length;

said incision being confined to a substantially rectangular area on the chest;

said rectangular area extending approximately two inches on either side of the sternum and from no higher than the first intercostal space at the top to the sixth intercostal space at the bottom;

establishing cardiopulmonary bypass using at least one blood conduit placed within the rectangular area;

exposing a surgical field below said incision; and

performing a valve repair or replacement procedure within the surgical field.

10. The method of claim 9, wherein said step of establishing cardiopulmonary bypass comprises:

connecting an arterial return cannula to an appropriate vessel, connecting a venous drain cannula to an appropriate vessel, occluding the aorta, and introducing cardioplegia solution through a coronary ostia.

11. The method of claim 9, wherein said step of performing a valve repair or replacement procedure comprises implanting a prosthetic valve.

12. The method of claim 9, wherein the step of exposing comprises:

a) dividing the outer layer of muscle tissue below the skin;

b) exposing one or more costal cartilages;

c) resecting the exposed costal cartilages;

d) incising and retracting the pericardium; and

e) incising one of the atrial chambers of the heart or the ascending aorta to expose the surgical field.

13. The method of claim 12, wherein the valve to be repaired or replaced is the aortic valve, and step e) comprises incising the ascending aorta, wherein the surgical field is an area adjacent the aortic valve.

14. The method of claim 12, wherein the valve to be repaired or replaced is the mitral valve, and step e) comprises incising the right atrium and intra-atrial septum, wherein the surgical field is an area adjacent the mitral valve.

15. The method of claim 14, further comprising:

after step e) to expose the surgical field, providing downward traction on the left atrial wall using a deformable retractor.

16. The method of claim 14, further comprising:

after step e) to expose the surgical field, inserting a resilient ring member into the surgical field between the valve and the left atrial wall to facilitate lifting tissue away from the valve area needing repair.

17. A method of performing minimally invasive cardiac valve repair or replacement surgery on a patient comprising the steps of:

preparing the patient for surgery;

making a straight incision of approximately 10 cm in length in the chest of the patient;

establishing cardiopulmonary bypass using at least one blood conduit placed in a region near said incision;

incising and retracting tissue in the area beneath the incision so as to expose a portion of the heart where surgery is required; and

performing a valve repair or replacement procedure on the exposed portion of the heart including establishing cardiopulmonary bypass.

18. The method of claim 17, wherein said step of establishing cardiopulmonary bypass comprises:

connecting an arterial return cannula to an appropriate vessel, connecting a venous drain cannula to an appropriate vessel, occluding the aorta, and introducing cardioplegia solution through a coronary ostia.

19. The method of claim 17, wherein said step of performing a valve repair or replacement procedure comprises implanting a prosthetic valve.

20. The method of claim 17, wherein the step of incising and retracting comprises:

a) dividing the outer layer of muscle tissue below the skin;

b) exposing one or more costal cartilages;

c) resecting the exposed costal cartilages;

d) incising and retracting the pericardium; and

e) incising one of the atrial chambers of the heart or the ascending aorta to expose the portion of the heart where surgery is required.

21. The method of claim 20, wherein the valve to be repaired or replaced is the aortic valve, and step e) comprises incising the ascending aorta, wherein the surgical field is an area adjacent the aortic valve.

22. The method of claim 20, wherein the valve to be repaired or replaced is the mitral valve, and step e) comprises incising the right atrium and intra-atrial septum, wherein the surgical field is an area adjacent the mitral valve.

23. The method of claim 22, further comprising:

after step e) to expose the surgical field, providing downward traction on the left atrial wall using a deformable retractor.

24. The method of claim 22, further comprising:

after step e) to expose the surgical field, inserting a resilient ring member into the surgical field between the valve and the left atrial wall to facilitate lifting tissue away from the valve area needing repair.