Surgical instruments and procedures for stabilizing a localized portion of a beating heart

• US 6,656,113 B2
• Filed: 05/25/2001
• Issued: 12/02/2003
• 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: Taylor, Charles S., Morejohn, Dwight P., Ferrari, Richard M., Weller, Gary B., Green, Harry Leonard II, Wallin, Joshua K.
• Primary Examiner(s): WEHNER, CARY ELLEN
• Application Number:
  US09/866,109
• Publication Number:
  US 20010025136A1
• Time in Patent Office: 921 Days
• Field of Search: 600/201, 600/213, 600/214, 600/215, 600/219, 600/222, 600/227, 600/231, 600/232, 600/233, 600/37, 600/235
• US Class Current: 600/235
• 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 17/0483 Hand-held instruments for holding sutures A61B17/0469 takes precedence; other holders for needles or sutures A61B17/06061; surgical forceps A61B17/28; surgical pincettes A61B17/30
• 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
• CPC Class Codes: A61B 90/50 : Supports for surgical instruments, e.g. articulated arms

Abstract

In accordance with the present invention, there is disclosed surgical methods and apparatus for accessing and stabilizing the heart. The methods and apparatus facilitate access to an anastomosis site, allows various instruments or devices to be maneuvered and secured in place, and provide stabilization of the heart. The apparatus may involve a tissue stabilizer, and in particular a tissue stabilizer for use in immobilizing or stabilizing a portion of the beating heart using a compressive force delivered to the heart via the tissue stabilizer. The stabilizer may include a stabilizer base and a shaft. The shaft may be secured within an appropriate instrument mount preferably fixed to a retractor or other stable platform as disclosed herein. The stabilizers of the present invention provide improved access to a surgical site at a target vessel on the surface of the heart and may include features which facilitate optimal presentation of the target vessel.

Claims

1. An apparatus for stabilizing a localized portion of a beating heart comprising:

a substantially rigid base member formed from a unitary piece of sheet material having a first side and a second side, said base member having a first section adapted to contact the surface of the beating heart and a second section at a fixed angle to said first section, said first section defining a first contact surface, a second contact surface, and an open space therebetween; and

a ball-shaped member connected to said second section at a location which is offset from said open space.

2. The apparatus of claim 1 further comprising a post having a first end and a second end, said first end attached to said second section at said location and said second end attached to said ball-shaped member.

3. The apparatus of claim 1 further including a shaft having a proximal end and a distal end having a socket operably engaged with said ball-shaped member.

4. The apparatus of claim 3 wherein said shaft is curved.

5. The apparatus of claim 3 wherein said shaft is substantially straight.

6. The apparatus of claim 1 wherein said angle is from about 75 degrees to about 105 degrees.

7. The apparatus of claim 6 wherein said angle is about 90 degrees.

8. The apparatus of claim 7 wherein said post extends from said first side.

9. The apparatus of claim 1 wherein said angle is more than about 120 degrees and said post extends from said second side.

10. An apparatus for stabilizing a localized portion of a beating heart, comprising:

a substantially rigid base member having at least one surface adapted to contact the surface of the heart,

a post having a first end moveably coupled to said base member and a second end having a ball-shaped member extending therefrom.

11. The apparatus of claim 10 further comprising a shaft having a proximal end and a distal end, said distal end having a socket operably engaged with said ball-shaped member.

12. The apparatus of claim 10 wherein said shaft is substantially rigid.

13. The apparatus of claim 10 wherein said base member has a first section having at least one surface for contacting the surface of a heart and a second section adjacent said first section, said post being moveably coupled to said second section.

14. The apparatus of claim 13 wherein said second section is at an angle relative to said first section.

15. The apparatus of claim 13 wherein said second section has a slot adapted to receive said first end of said post, said first end being moveably within said slot from a first position to a second position.

16. The apparatus of claim 10 wherein at least a portion of said base member has a curved outer profile and said post is mounted to a top member having an interior profile adapted to engage and concentrically rotate about said curved outer profile.

17. The apparatus of claim 16 wherein said base member has at least one elongate slot and said top member has at least one tab engaged within said at least one slot.

18. An apparatus for stabilizing a localized portion of a beating heart, comprising:

a base member having at least one surface adapted to contact the surface of the heart,

a link member pivotably coupled to said base member at a predetermined pivot point, said link member having a first link end spaced a distance away from said pivot point; and

a post having a first post end attached to said first link end and a second post end having at least a ball shaped member extending therefrom.

19. The apparatus of claim 18 further comprising a shaft having a proximal end and a distal end, said distal end having a socket operably engaged with said ball-shaped member.

20. The apparatus of claim 19 wherein said shaft is substantially rigid.

21. The apparatus of claim 18 wherein said link member has a second link end opposite said first link end, said second link end being releasably locked to said base member to substantially prevent relative movement of said link member relative to said base member.

22. The apparatus of claim 18 wherein said link member pivots about a pivot pin extending from said base member.

23. The apparatus of claim 22 wherein said base member has a first contact surface, a second contact surface, and an open space therebetween.

24. The apparatus of claim 23 wherein said link member has a first position wherein said post is offset from said open space in a first direction and a second position wherein said post is offset from said open space in a second direction.

25. An apparatus for stabilizing a localized portion of a beating heart, comprising:

a base member adapted to engage the surface of the beating heart at an anastomotic site; and

a shaft means having a distal end portion and a proximal end portion, said distal end portion being movably coupled to said base member, wherein said base member may be positioned about three degrees of freedom relative to said shaft means.

26. The apparatus of claim 25, wherein said distal end portion may be coupled to said base member in any one of at least two distinct coupling locations of said base member.

27. The apparatus of claim 25, wherein said shaft means is slidably coupled to said base member along a predefined sliding path, and wherein said shaft means may be positively locked in at least one position along said predefined sliding path.

28. The apparatus of claim 27, wherein said shaft means may be positively locked at two or more positions along said predefined sliding path.

29. The apparatus of claim 25, wherein said base member comprises three discrete coupling sites, any of which said distal end of said shaft means may be coupled with.

30. An apparatus for stabilizing a localized portion of a beating heart, comprising:

a base member having a first section adapted to contact a surface of the beating heart and a second section at a substantially right angle to said first section, said second section having a first side facing said first section and a second side facing away from said first section; and

a shaft means having a distal end portion and a proximal end portion, said distal end portion being coupled with said second section.

31. The apparatus of claim 30, wherein said shaft means extends substantially parallel to said first section.

32. The apparatus of claim 30, wherein said shaft means is coupled with said base member on said first side of said second section.

33. The apparatus of claim 32, wherein said shaft means extends substantially parallel to said first section.

34. The apparatus of claim 33, wherein said shaft means is substantially straight.

35. The apparatus of claim 30, further comprising a ball joint connector interconnecting said second section and said distal end portion, wherein said base member may be positioned about three degrees of freedom relative to said shaft means.