Device to permit offpump beating heart coronary bypass surgery

• US 7,476,199 B2
• Filed: 03/24/2003
• Issued: 01/13/2009
• Est. Priority Date: 09/17/1997
• Status: Expired due to Fees

• Current Assignee: Maquet Cardiovascular LLC (Getinge AB)
• Original Assignee: Maquet Cardiovascular LLC (Getinge AB)
• Inventors: Ortiz, Mark, Williamson, Warren P. IV, Spence, Paul A.
• Primary Examiner(s): Robert; Eduardo C
• Assistant Examiner(s): Swiger, III; James L
• Application Number:
  US10/395,797
• Publication Number:
  US 20030187333A1
• Time in Patent Office: 2,122 Days
• Field of Search: 600/201, 600204-206, 600/208, 600/210, 600/214, 600227-229, 600/231, 600/233, 600/235, 600/237
• US Class Current: 600/210
• CPC Class Codes: A61B 17/00491 Surgical glue applicators surgical adhesives A61L24/00; two-component delivery syringes A61M5/19
• 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 17/0293 with ring member to support retractor elements
• CPC Class Codes: A61B 17/04 for suturing wounds; Holders or packages for needles or suture materials suture materials A61L17/00
• CPC Class Codes: A61B 17/064 Surgical staples, i.e. penetrating the tissue
• CPC Class Codes: A61B 17/068 Surgical staplers , e.g. containing multiple staples or clampsstaplers containing only one staple A61B17/10; magazines or containers for staples A61B17/105; for performing anastomosis A61B17/115; staplers in general B25C5/00
• CPC Class Codes: A61B 17/29 Forceps for use in minimally invasive surgery
• CPC Class Codes: A61B 2017/00305 Constructional details of the flexible means
• CPC Class Codes: A61B 2017/00309 Cut-outs or slits
• CPC Class Codes: A61B 2017/0243 for immobilizing local areas of the heart, e.g. while it beats trocars attached to inner organs or inner body tissue A61B2017/3488
• CPC Class Codes: A61B 2017/308 with suction cups

Abstract

A system for manipulating a heart during cardiac surgery permits coronary surgery on a beating heart while maintaining cardiac output unabated and uninterrupted. Circumflex coronary artery surgery can be performed using the system. A component of the system engages the heart with a head of a heart positioning device, repositions the heart into a displaced position and maintains it in the displaced position while the heart continues to beat with substantially unabated and uninterrupted cardiac output. A select portion of the heart in the vicinity of a target area is immobilized to facilitate a surgical procedure to be performed at the target area. One form of the system can be used in minimally invasive surgery.

Claims

1. A method of positioning a beating heart and stabilizing a portion thereof in preparation for performing cardiac surgery while the heart continues to beat, said method comprising the steps of:

engaging the heart with a head of a heart positioning device;

repositioning the heart into a displaced position;

suspending the heart in the displaced position, while maintaining cardiac output substantially unabated and uninterrupted by fixing the heart positioning device with respect to a stationary object, wherein at least a portion of the head of the heart positioning device moves with natural movements of the beating heart even after said fixing the heart positioning device; and

immobilizing a select portion of the heart in the vicinity of a target area in which the surgical procedure is to be performed.

2. The method of claim 1, wherein the cardiac surgery is coronary bypass surgery.

3. The method of claim 1, wherein said immobilizing step comprises contacting an end of a target-immobilizing element with the select portion of the heart and fixing the target-immobilizing element with respect to a stationary object, which may be the same stationary object to which the heart positioning device is fixed, or a different stationary object.

4. The method of claim 3, wherein the heart positioning device is fixed to a sternal retractor and the target-immobilizing device is fixed to the sternal retractor.

5. The method of claim 3, wherein said contacting the end of the target-immobilizing element comprises mechanically applying immobilizing contact with the select portion of the heart.

6. The method of claim 3, wherein said contacting the end of the target-immobilizing element comprises applying suction to immobilize the select portion of the heart.

7. The method of claim 1, wherein the heart positioning device includes an arm and a suspension link interconnecting the arm with the head, and wherein said fixing comprises fixing the arm to the stationary object, thereby fixing the arm while the suspension link allows the head and the heart to move with respect to the fixed arm while the heart continues to beat.

8. The method of claim 7, wherein said fixing comprises fixing the arm to a sternal retractor.

9. The method of claim 1, wherein said repositioning comprises lifting the heart to an elevated position.

10. The method of claim 1, wherein said engaging comprises applying suction to the surface of the heart via the head.

11. The method of claim 1, wherein said head comprises a cup like element, said heart positioning device comprising flexible means that permit said element to move to accommodate multiplanar movement of the beating heart.

12. A method of positioning a beating heart and stabilizing a portion thereof, for performing cardiac surgery while the heart continues to beat, said method comprising the steps of:

engaging the heart with a head of a heart positioning device;

lifting the heart into an elevated position;

suspending the heart in the elevated position by fixing an arm of the heart positioning device, wherein the head is movably connected to the arm, thereby permitting the head and heart to move with respect to the fixed arm as the heart continues to beat; and

immobilizing a select portion of the heart to facilitate performance of the cardiac surgery, while a remainder of the heart remains free to move to maintain substantially unabated cardiac output.

13. The method of claim 12, wherein the cardiac surgery is coronary bypass surgery.

14. The method of claim 12, wherein said immobilizing is accomplished by mechanical contact with a target immobilizing element.

15. The method of claim 14, further comprising fixing the target immobilizing element to a stationary object, which may be the same stationary object to which the heart positioning device is fixed, or a different stationary object.

16. The method of claim 15, wherein the heart positioning device is fixed to a sternal retractor and the target immobilizing element is fixed to the sternal retractor.

17. The method of claim 12, wherein said immobilizing comprises applying suction to the select portion of the heart through a target immobilizing element.

18. The method of claim 17, further comprising fixing the target immobilizing element to a stationary object, which may be the same stationary object to which the heart positioning device is fixed, or a different stationary object.

19. The method of claim 18, wherein the heart positioning device is fixed to a sternal retractor and the target immobilizing element is fixed to the sternal retractor.

20. A method of facilitating cardiac surgery on a patient while the patient'"'"'s heart continues to beat, said method comprising the steps of:

placing a retractor in a sternal incision so as to provide direct access to the beating heart;

engaging the heart with a head of a heart positioning device;

lifting the heart into an elevated position;

suspending the heart in the elevated position by fixing an arm of the heart positioning device to the sternal retractor, wherein the head continues to move with beating movements of the heart after said fixing; and

immobilizing a select portion of the heart by contacting the select portion with a surgery target immobilizing element and fixing the surgery target immobilizing element to the sternal retractor.

21. The method of claim 20, wherein the cardiac surgery is coronary bypass surgery.

22. The method of claim 20, wherein said contacting comprises mechanically contacting the select portion with the target immobilizing element.

23. The method of claim 20, wherein said contacting comprises applying suction to the select portion of the heart through the target immobilizing element.

24. The method of claim 20, wherein the heart positioning device includes an arm which is flexible in a first configuration and rigid in a second configuration, the head being movably connected to the arm in both first and second configurations, and wherein the arm is in said first configuration during said engaging, and in said second configuration during said suspending.

25. The method of claim 20, wherein said engaging comprises applying suction to the heart via the head.

26. A method of positioning a beating heart and stabilizing a portion thereof, for performing cardiac surgery while the heart continues to beat, said method comprising the steps of:

engaging the heart, using suction, with a head of a heart positioning device;

lifting the heart into an elevated position;

suspending the heart in the elevated position by fixing an arm of the heart positioning device, wherein the head is movably connected to the arm, thereby permitting the head and heart to move with respect to the fixed arm as the heart continues to beat; and

immobilizing a select portion of the heart to facilitate performance of the cardiac surgery, while a remainder of the heart remains free to move to maintain substantially unabated cardiac output.

27. The method of claim 26, wherein said immobilizing is accomplished by mechanical contact with a target immobilizing element.

28. The method of claim 26, further comprising fixing the target immobilizing element to a stationary object, which may be the same stationary object to which the heart positioning device is fixed, or a different stationary object.

29. The method of claim 26, wherein said immobilizing comprises applying suction to the select portion of the heart through a target immobilizing element.

30. A method of positioning a beating heart and stabilizing a portion thereof in preparation for performing cardiac surgery while the heart continues to beat, said method comprising the steps of:

engaging the heart with a head of a heart positioning device;

moving the heart in a direction toward the head, thereby moving the head along with the heart to a displaced position;

suspending the heart in the displaced position, while maintaining cardiac output substantially unabated and uninterrupted by fixing the heart positioning device with respect to a stationary object, wherein at least a portion of the head of the heart positioning device moves with natural movements of the beating heart even after said fixing the heart positioning device; and

immobilizing a select portion of the heart in the vicinity of a target area in which the surgical procedure is to be performed.