Surgical instruments and procedures for stabilizing the beating heart during coronary artery bypass graft surgery

• US 6,394,951 B1
• Filed: 03/13/2000
• Issued: 05/28/2002
• Est. Priority Date: 02/20/1996
• Status: Expired due to Fees

• Current Assignee: Maquet Cardiovascular LLC (Getinge AB)
• Original Assignee: Cardiothoracic Systems, Inc. (Boston Scientific Corporation)
• Inventors: Sherman, Benjamin, Taylor, Charles S., Morejohn, Dwight P., Weller, Gary B., Adair, Caralin R., Witt, William Friederich
• Primary Examiner(s): Smith, Jeffrey A.
• Application Number:
  US09/525,774
• Time in Patent Office: 806 Days
• Field of Search: 600/235,210,201,215,227,228,229,231,232,233,37
• US Class Current: 600/210
• 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 17/0206 with antagonistic arms as supports for retractor elements
• 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 17/0642 for bones, e.g. for osteosynthesis or connecting tendon to bone
• CPC Class Codes: A61B 17/12 for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord specially adapted for vas deferens or fallopian tubes A61F6/20; materials for ligaturing blood vessels A61L17/00
• CPC Class Codes: A61B 17/3421 Cannulas
• CPC Class Codes: A61B 17/3423 Access ports, e.g. toroid shape introducers for instruments or hands access sites for liquids A61M39/0247
• CPC Class Codes: A61B 17/8076 for the ribs or the sternum
• CPC Class Codes: A61B 2017/00243 cardiac
• CPC Class Codes: A61B 2017/00539 hydraulically
• CPC Class Codes: A61B 2017/00703 correcting for movement of heart, e.g. ECG-triggered
• CPC Class Codes: A61B 2017/00858 high friction or non-slip
• CPC Class Codes: A61B 2017/00991 Telescopic means
• CPC Class Codes: A61B 2017/0243 for immobilizing local areas of the heart, e.g. while it beats
• CPC Class Codes: A61B 2017/0648 threaded, e.g. tacks with a screw thread
• CPC Class Codes: A61B 2017/1139 Side-to-side connections, e.g. shunt or X-connections
• CPC Class Codes: A61B 2017/2825 Inserts of different material in jaws
• CPC Class Codes: A61B 2017/2913 cams or guiding means
• CPC Class Codes: A61B 2017/2929 with a head rotatable about the longitudinal axis of the shaft
• CPC Class Codes: A61B 2017/306 : holding by means of suction
• CPC Class Codes: A61B 2017/349 : Trocar with thread on outside
• CPC Class Codes: A61B 90/00 : Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges protective face masks A41D13/11; surgeon's or patient's gowns or dresses A41D13/12; devices for carrying-off, for treatment of, or for carrying-over, body liquids A61M1/00

Abstract

The invention is methods and devices which a surgeon may use to stabilize the beating heart during a surgical procedure on the heart. Pursuant to the invention, a stabilizing device is introduced through an opening in the chest and brought into contact with the beating heart. By contacting the heart with the device and by exerting a stabilizing force on the device, the motion of the heart caused by the contraction of the heart muscles is effectively eliminated such that the heart is stabilized and the site of the surgery moves only minimally if at all. Typically, in separate steps, the surgeon contacts the heart with the stabilizing device, assesses the degree of movement of the anastomosis site, and exerts a force on the stabilizing device such that the contraction of the beating heart causes only minimal excess motion at the surgery site. By fixing the position of the stabilizing device in a configuration where the motion of the beating heart is effectively eliminated, the surgeon is able to stabilize the beating heart for the duration of the procedure. The stabilizing device may be attached to a rigid support or may be attached to a semi-rigid support which is rendered motionless mechanically, chemically, or by human intervention. In certain preferred embodiments, the stabilizing device is affixed to a semi-rigid support which is caused to become rigid, by any of a variety of techniques, such that the position of the stabilizing device becomes fixed by the support, and the heart remains substantially motionless for the duration of the procedure.

Claims

1. A device for performing a surgical procedure on a beating heart, comprising:

a pair of contact members each having a longitudinal axis, said contact members being adapted to contact a surface of the beating heart on opposite sides of a target artery; and

an interconnecting member connected to each of said pair of contact members, wherein at least a portion of each said contact member is rotatable about said longitudinal axis of the respective contact member, with respect to said interconnecting member, and independently of the other of said contact members.

2. The device of claim 1, wherein said contact members are substantially longitudinally parallel to each other.

3. The device of claim 1, wherein said contact members comprise rollers.

4. The device of claim 1, wherein said contact members comprise cylindrical rollers oriented longitudinally parallel to the target artery.

5. The device of claim 1, wherein said contact members comprise pivoting surfaces.

6. The device of claim 1, wherein said contact members comprise belts.

7. The device of claim 1, wherein said contact members each comprise a contact surface which is rotatable about said longitudinal axis.

8. The device of claim 1, wherein said contact members are connected to form a substantially “

V”

shape.

9. The device of claim 1, further comprising a shaft means connected to and extending away from said interconnecting member.

10. The device of claim 9, wherein said shaft means comprises a substantially rigid elongated shaft.

11. The device of claim 9, wherein said shaft means comprises at least two tubular members which telescope to adjust the length of said shaft means.

12. The device of claim 9, wherein said shaft means comprises a curved tubular member.

13. The device of claim 9, wherein said shaft means comprises a malleable elongated member.

14. The device of claim 9, wherein said shaft means comprises an elongated member formed from a plurality of interconnecting link members.

15. The device of claim 14, wherein said interconnecting link members have a first free state and a second locked state wherein adjacent link members are relatively immobile relative to each other.

16. The device of claim 14, wherein said link members are interconnected by articulating joints.

17. The device of claim 16, wherein said articulating joints comprise spherical joints.

18. The device of claim 9, wherein said shaft means is connected to said interconnecting member by a ball and socket joint.

19. The device of claim 18, wherein said ball and socket joint comprises a locking ball and socket joint.

20. The device of claim 9, further comprising a connector on said shaft means, said connector being adapted to fix said shaft means to a substantially stable support.

21. The device of claim 20, wherein the relatively stable support is a sternal retractor.

22. The device of claim 1, further comprising at least one suction port formed in at least one of said interconnecting member and said pair of contact members.

23. The device of claim 22, wherein at least one said suction port is formed in each of said pair of contact members.

24. The device of claim 23, wherein each of said contact members has a plurality of said suction ports formed therein, each of said suction ports being fluidly connected with a lumen, said lumen being adapted for connection to a suction or positive pressure source.

25. A device for performing a surgical procedure on a beating heart, comprising:

a pair of contact members adapted to contact a surface of the beating heart; and

a shaft means operably connected to said contact members, wherein at least a portion of each said contact member is independently rotatable with respect to said shaft means.

26. The device of claim 25, wherein independent rotations of at least a portion of each said contact member are about respective axes which are substantially parallel to one another.

27. The device of claim 25, further comprising a joint interconnecting said shaft means to said contact members.

28. The device of claim 27, wherein said joint comprises a ball and socket joint having three degrees of freedom.

29. The device of claim 28, wherein said ball and socket joint comprises is lockable.

30. The device of claim 25, wherein said shaft means is connected to said contact members via an interconnecting member, at least a portion of said contact members being rotatable relative to said interconnecting member.

31. The device of claim 30, further comprising a joint interconnecting said shaft means and said interconnecting member.

32. The device of claim 31, wherein said joint comprises a ball and socket joint.

33. The device of claim 25, wherein said contact members comprise rotatable rollers adapted to frictionally engage the surface of the beating heart.

34. The device of claim 33, further comprising an interconnecting member operably connected to said shaft means, said interconnecting member having longitudinal support members extending therefrom, said rollers being configured to rotate about said longitudinal support members.

35. The device of claim 34, wherein said support members are substantially parallel to each other.

36. The device of claim 33, wherein said rollers include high friction surfaces.

37. The device of claim 33, wherein said rollers are textured.

38. The device of claim 25, wherein said contact members each comprise a contact surface which is rotatable about a longitudinal axis of said contact member.

39. The device of claim 25, wherein said shaft means comprises a shaft.

40. The device of claim 25, wherein said shaft means comprises a curved member.

41. The device of claim 25, wherein said shaft means comprises a malleable elongated member.

42. The device of claim 25, wherein said shaft means comprises a n elongated member formed from a plurality of interconnecting link members.

43. The device of claim 42, wherein said link members are interconnected by joints.

44. The device of claim 43, wherein said joints comprise spherical joints.

45. The device of claim 25, further comprising at least one suction port formed in at least one of said pair of contact members.

46. The device of claim 45, wherein at least one said suction port is formed in each of said pair of contact members.

47. The device of claim 46, wherein each of said contact members has a plurality of said suction ports formed therein, each of said suction ports being fluidly connected with a lumen, said lumen being adapted for connection to a suction or positive pressure source.

48. The device of claim 25, further comprising a connector on said shaft means, said connector being adapted to fix said shaft means to a relatively stable support.

49. The device of claim 48, wherein the relatively stable support is a retractor.

50. A method of stabilizing cardiac tissue to facilitate performing a surgical procedure in a vicinity of the cardiac tissue, said method comprising the steps of:

contacting the cardiac tissue with a pair of interconnected contact members, at least a portion of each of which is independently rotatable with respect to a member interconnecting the contact members; and

rotating at least one of said contact members relative to the other of said contact members.

51. The method of claim 50, wherein said rotating comprises rotating at least a portion of each contact member towards one another, thereby gathering cardiac tissue between said contact members.

52. The method of claim 50, wherein said rotating comprises rotating at least a portion of each contact member away from one another, thereby spreading cardiac tissue between said contact members.

53. The method of claim 50, wherein said pair of contact members comprises a pair of rollers and said rotating comprises rotating each of said rollers in opposite directions to one another while maintaining said interconnecting member in a stable position.

54. The method of claim 50, wherein the interconnecting member further connects the contact members to a shaft means, said method further comprising fixing the shaft means to a relatively stable support.

55. The method of claim 54, wherein said fixing the shaft means comprises fixing the shaft means to a retractor.

56. The method of claim 50, further comprising applying suction to the cardiac tissue through at least one port formed in at least one of the contact members.