Device to permit offpump beating heart coronary bypass surgery

• US 7,195,591 B2
• Filed: 02/23/2005
• Issued: 03/27/2007
• Est. Priority Date: 09/17/1997
• Status: Expired due to Fees

• Current Assignee: Maquet Cardiovascular LLC (Getinge AB)
• Original Assignee: Origin Medsystems Inc. (Eli Lilly and Company)
• Inventors: Williamson, Warren P. IV, Spence, Paul A.
• Primary Examiner(s): WEHNER, CARY ELLEN
• Application Number:
  US11/063,478
• Publication Number:
  US 20050148825A1
• Time in Patent Office: 762 Days
• Field of Search: 623/201, 623/215, 623/227, 623/228, 623/231, 623/233, 600/201, 600/215, 600/227, 600/228, 600/231, 600/233
• US Class Current: 600/210
• 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 2017/0243 for immobilizing local areas of the heart, e.g. while it beats
• CPC Class Codes: A61B 2017/306 holding by means of suction
• CPC Class Codes: A61B 2017/308 with suction cups

Abstract

A heart retractor links lifting of the heart and regional immobilization which stops one part of the heart from moving to allow expeditious suturing while permitting other parts of the heart to continue to function whereby coronary surgery can be performed on a beating heart while maintaining cardiac output unabated and uninterrupted. Circumflex coronary artery surgery can be performed using the heart retractor of the present invention. The retractor includes a plurality of flexible arms and a plurality of rigid arms as well as a surgery target immobilizing element. One form of the retractor can be used in minimally invasive surgery, while other forms of the retractor can accommodate variations in heart size and paracardial spacing.

Claims

1. A surgical system for facilitating a surgical procedure on a heart, said system comprising:

a sternal retractor;

a target immobilizing device mounted to said sternal retractor and adapted to contact a portion of the heart in a target area where the surgical procedure is to be performed, thereby stabilizing the target area; and

a heart retractor mounted to said sternal retractor and adapted to position the heart to allow access to multiple surgical target sites while cardiac output is maintained;

wherein said heart retractor comprises a suction element that is free to move relative to a remainder of said heart retractor.

2. The surgical system of claim 1, wherein said heart retractor comprises a suction head at a distal end portion thereof.

3. The surgical system of claim 1, wherein said heart retractor comprises an arm that is flexible in an unlocked condition and rigid in a locked condition, and wherein said suction element is connected to a distal end portion of said arm, wherein said suction element is free to move relative to said arm, even when said arm is in said locked condition.

4. The surgical system of claim 1, wherein said target immobilizing device comprises a heart engaging element at a distal end portion thereof.

5. The surgical system of claim 4, wherein said heart engaging element is U-shaped.

6. The surgical system of claim 1, wherein said heart retractor is adjustable in size to be sized to account for variations in heart size.

7. The surgical system of claim 1, wherein said heart retractor is adjustable in shape to be shaped to account for variations in heart shape.

8. The surgical system of claim 1, wherein said heart retractor is adjustable in shape to be shaped to account for variations in paracardial spacings.

9. A heart positioning device for use in cardiac surgery on a beating heart, comprising:

a suction head adapted to positively engage the beating heart said suction head including at least one suction element adapted to engage the surface of the heart by suction;

an arm supporting said suction head, said arm being flexible in an unlocked condition and rigid in a locked condition; and

a suspension mechanism connecting said at least one suction element to said arm;

;

wherein said at least one suction element is free to move, relative to said arm via said suspension mechanism, even when said arm is in said locked condition.

10. The heart positioning device of claim 9, wherein said arm is adapted to be fixed to a relatively stationary object.

11. The heart positioning device of claim 10, wherein said suspension mechanism permits movement of the heart in at least one plane when said suction head is engaged with the heart, said arm is fixed to the relatively stationary object, and said arm is in said locked condition.

12. The heart positioning device of claim 9, wherein said suction head further comprises a central portion adapted to engage and support an apex portion of the heart.

13. The heart positioning device of claim 12, further comprising at least one vacuum opening adapted to apply negative pressure through the central portion to the apex portion of the heart to engage the central portion through vacuum.

14. The heart positioning device of claim 12, wherein said central portion is adjustable in size to account for variations in size between various hearts.

15. The heart positioning device of claim 9, further comprising a surgery target immobilizing element connected to said support arm and configured to engage the heart adjacent to a surgery target and immobilize the heart immediately adjacent to the surgery target through said contact.

16. The heart positioning device of claim 15, wherein said surgery target immobilizing device comprises a target defining element adapted to engage the surface of the heart adjacent to the surgery target and an arm interconnecting said target defining element with said arm being flexible in an unlocked condition and rigid in a locked condition.

17. The heart positioning device of claim 16, wherein said target defining element is U-shaped.

18. The heart positioning device of claim 16, wherein said arm interconnecting said target defining element with said arm being flexible in an unlocked condition and rigid in a locked condition is rigid.

19. A device adapted to be inserted through a minimally invasive opening in a patient and adapted to support the weight of a beating heart and maintain cardiac output substantially unabated even though the heart is maintained in an unnatural position or orientation, said device comprising:

an arm having proximal and distal end portions;

a support member connected to said distal end portion, said support member adapted to positively engage the beating heart and including at least one suction element adapted to engage the surface of the heart by suction; and

a suspension mechanism connecting at least one of said at least one suction element to said arm;

wherein said at least one of said at least one suction element is free to move, relative to said arm via said suspension mechanism.

20. The device of claim 19, wherein said arm is substantially rigid.

21. The device of claim 19, further comprising a hand grip connected to said proximal portion of said arm.

22. The device of claim 19, wherein said suspension mechanism permits movement of the heart in at least one plane when said support member is engaged with the heart and said arm is maintained relatively motionless.

23. The device of claim 19, wherein said support member further comprises a central portion adapted to engage and support an apex portion of the heart.

24. The device of claim 23, further comprising at least one vacuum opening adapted to apply negative pressure through the central portion to the apex portion of the heart to engage the central portion through vacuum.

25. The device of claim 23, wherein said central portion comprises a flexible element and said arm comprises a hollow tubular portion, wherein said central portion is retractable into said hollow tubular portion to temporarily reduce the size of said central portion during insertion through the minimally invasive opening.

26. The device of claim 25, wherein said central portion is cup-shaped.

27. The device of claim 25, further comprising a rod passing through said arm and connected to said central portion;

said rod being movable in proximal and distal directions with respect to said arm to retract said central portion into said hollow tubular portion and eject said central portion from said hollow tubular portion, respectively.

28. The device of claim 19, further comprising a suction conduit passing through at least a portion of a length of said arm, said suction conduit connected to said at least one suction element and adapted, at a proximal end thereof, to be connected to a source of vacuum located externally of said device.

29. The device of claim 19, wherein at least one of said at least one suction elements comprises screen mesh to prevent entrapment of tissue in a suction pathway of said suction element.

30. The device of claim 19, further comprising a surgery target immobilizing element connected to said arm and configured to engage the heart adjacent to a surgery target and immobilize the heart immediately adjacent to the surgery target through said contact.

31. The device of claim 19, wherein the minimally invasive opening is defined between ribs of the patient.

32. The device of claim 19, further comprising at least one suction element rigidly connected to said arm.