Devices and methods for port-access multivessel coronary artery bypass surgery

• US 6,478,029 B1
• Filed: 08/05/2000
• Issued: 11/12/2002
• Est. Priority Date: 02/22/1993
• Status: Expired due to Term

• Current Assignee: Heartport, Inc. (Johnson & Johnson)
• Original Assignee: Heartport, Inc. (Johnson & Johnson)
• Inventors: Vaska, Matthias, Rapacki, Alan R., Peters, William S., Boyd, Stephen W., Donlon, Brian S.
• Primary Examiner(s): Isabella, David J.
• Application Number:
  US09/634,608
• Time in Patent Office: 829 Days
• Field of Search: 128/858, 600/204, 600/205, 600/201, 600/227, 600/228, 600/229, 600/231
• 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 17/0218 for minimally invasive surgery A61B17/0281, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/29 Forceps for use in minimally invasive surgery
• CPC Class Codes: A61B 17/2909 Handles
• 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 2017/0237 for heart surgery
• CPC Class Codes: A61B 2017/0243 for immobilizing local areas of the heart, e.g. while it beats
• 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
• CPC Class Codes: A61B 2017/0472 Multiple-needled, e.g. double-needled, instruments
• CPC Class Codes: A61B 2017/2901 Details of shaft
• CPC Class Codes: A61B 2017/2905 flexible
• CPC Class Codes: A61B 2017/2912 transmission of forces to actuating rod or piston
• CPC Class Codes: A61B 2017/2927 the angular position of the head being adjustable with respect to the shaft
• CPC Class Codes: A61B 2017/2932 Transmission of forces to jaw members
• CPC Class Codes: A61B 2017/306 holding by means of suction
• CPC Class Codes: A61B 2017/308 with suction cups
• CPC Class Codes: A61B 2017/3405 using mechanical guide means
• 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 2090/306 : using optical fibres
• CPC Class Codes: A61B 90/36 : Image-producing devices or illumination devices not otherwise provided for
• CPC Class Codes: A61F 2/2427 : Devices for manipulating or deploying heart valves during implantation
• CPC Class Codes: A61F 2007/0001 : Body part
• CPC Class Codes: A61F 2007/0054 : with a closed fluid circuit, e.g. hot water
• CPC Class Codes: A61F 2007/101 : for cooling organs in the body before or during surgery
• CPC Class Codes: A61F 7/10 : Cooling bags, e.g. ice-bags
• CPC Class Codes: A61M 2025/028 : having a mainly rigid support structure
• CPC Class Codes: A61M 2039/0279 : for introducing medical instruments into the body, e.g. endoscope, surgical tools
• 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 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

Surgical methods and instruments are disclosed for performing port-access or closed-chest coronary artery bypass (CABG) surgery in multivessel coronary artery disease. In contrast to standard open-chest CABG surgery, which requires a median sternotomy or other gross thoracotomy to expose the patient'"'"'s heart, post-access CABG surgery is performed through small incisions or access ports made through the intercostal spaces between the patient'"'"'s ribs, resulting in greatly reduced pain and morbidity to the patient. In situ arterial bypass grafts, such as the internal mammary arteries and/or the right gastroepiploic artery, are prepared for grafting by thoracoscopic or laparoscopic takedown techniques. Free grafts, such as a saphenous vein graft or a free arterial graft, can be used to augment the in situ arterial grafts. The graft vessels are anastomosed to the coronary arteries under direct visualization through a cardioscopic microscope inserted through an intercostal access port. Retraction instruments are provided to manipulate the heart within the closed chest of the patient to expose each of the coronary arteries for visualization and anastomosis. Disclosed are a tunneler and an articulated tunneling grasper for rerouting the graft vessels, and a finger-like retractor, a suction cup retractor, a snare retractor and a loop retractor for manipulating the heart. Also disclosed is a port-access topical cooling device for improving myocardial protection during the port-access CABG procedure. An alternate surgical approach using an anterior mediastinotomy is also described.

Claims

1. A method of contacting tissue during open or closed chest cardiac surgery comprising:

accessing a surface of the heart;

positioning a first member having at least one primary suction port on the surface of the heart;

coupling a first suction source to any of said at least one primary suction port of the first member;

creating a suction with the first suction source, the created suction then communicated to any primary suction port;

controlling the vacuum pressure of said first suction source by limiting the vacuum pressure to a pressure that avoids tissue damage;

grasping the surface of the heart with the suction in any primary suction port; and

fixing the first member to a stationary object.

2. The method of claim 1 in which the step of accessing a surface of the heart comprises providing access through an intercostal space.

3. The method of claim 1 in which the steps of accessing a surface of the heart comprises inserting an endoscope and a cutting instrument through the chest and cutting through the pericardium with the cutting instrument.

7. The method of claims 1 and 4 wherein said pressure has a maximum of 150 mmHg.

4. A method of contacting tissue during open or closed chest cardiac surgery comprising:

accessing a surface of the heart;

positioning a first member having at least one primary suction port along a first planar surface on the surface of the heart;

coupling first suction source to any of at least one primary suction port of the first member;

creating a suction with the first suction source, the created suction then communicated to at least one primary suction port;

controlling the vacuum pressure of said first suction source by limiting the vacuum pressure to a pressure that avoids tissue damage; and

fixing the first member to a stationary object.

5. The method of claim 4 in which the step of accessing a surface of the heart comprises providing access through an intercostal space.

6. The method of claim 4 in which the step of accessing a surface of the heart comprises inserting an endoscope and a cutting instrument through the chest and cutting through the pericardium with the cutting instrument.