Method and system for organ positioning and stabilization

• US 7,507,235 B2
• Filed: 05/28/2002
• Issued: 03/24/2009
• Est. Priority Date: 01/13/2001
• Status: Expired due to Fees

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Olig, Christopher, Colson, Michael A., Jahns, Scott E, Jolly, Katherine, Montpetit, Karen, Guenst, Gary W., Keogh, James R., O'Neill, William G., Gubbin, Douglas H., Daigle, Thomas, Pignato, Paul A.
• Primary Examiner(s): Johnson, III; Henry M
• Application Number:
  US10/156,315
• Publication Number:
  US 20020138109A1
• Time in Patent Office: 2,492 Days
• Field of Search: 128/898, 600/37
• US Class Current: 606/32
• CPC Class Codes: A61B 17/0206 with antagonistic arms as supports for retractor elements
• CPC Class Codes: A61B 17/22004 using mechanical vibrations, e.g. ultrasonic shock waves A61B17/225 takes precedence
• 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 2017/2905 flexible
• CPC Class Codes: A61B 2017/308 with suction cups
• CPC Class Codes: A61N 1/36114 Cardiac control, e.g. by vagal stimulation stimulating the heart A61N1/362

Abstract

This invention provides a system and method for positioning, manipulating, holding, grasping, immobilizing and/or stabilizing a heart including one or more tissue-engaging devices, one or more suction sources, one or more fluid sources, one or more energy sources, one or more sensors and one or more processors. The system and method may include an indifferent electrode, a drug delivery device and an illumination device. The system'"'"'s tissue-engaging device may comprise a tissue-engaging head, a support apparatus and a clamping mechanism for attaching the tissue-engaging device to a stable object. The system may be used during various medical procedures including the deployment of an anastomotic device, intermittently stopping and starting of the heart, ablation of cardiac tissues and the placement of cardiac leads.

Claims

1. A method of performing an electrode placement procedure on a patient'"'"'s heart, comprising:

providing a first tissue contact device comprising;

a rigid tissue contact member sized and shaped to fit through a small incision in a region of the patient'"'"'s chest;

an illumination device coupled to the rigid tissue contact member;

a maneuvering apparatus having a rigid shaft and a handle; and

a remotely actuatable joint moveably coupling the tissue contact member to the maneuvering apparatus;

introducing the rigid contact member of the first tissue contact device to the patient'"'"'s thoracic cavity through a small incision in the patient'"'"'s chest;

providing illumination;

actuating the joint remotely from outside the thoracic cavity of the patient;

maneuvering the tissue contact member of the first tissue contact device to position pericardium away from a surface of the heart to create space between the surface of the heart and the pericardium using the first tissue contact device, the space providing exposure of the heart;

providing a second tissue contact device comprising;

a rigid tissue contact member having an ablation electrode; and

a maneuvering apparatus having a shaft and a handle coupled to the rigid contact member;

introducing the rigid contact member of the second tissue contact device into the thoracic cavity of the patient through an incision in the region of the patient'"'"'s chest; and

placing the ablation electrode on or within the exposed heart.

2. The method of claim 1 further comprising:

stimulating the heart in order to adjust the beating of the heart.

3. The method of claim 2 wherein the heart is stimulated by pacing.

4. The method of claim 2 wherein the heart is stimulated by defibrillation.

5. The method of claim 1 further comprising:

sensing the electrical signals of the heart.

6. The method of claim 1 further comprising:

administering at least one drug to the heart.

7. The method of claim 6 wherein the drug is selected from the group consisting of:

a beta-blocker, a cholinergic agent, a cholinesterase inhibitor, a calcium channel blocker, a sodium channel blocker, a potassium channel agent, adenosine, an adenosine receptor agonist, an adenosine deaminase inhibitor, dipyridaniole, a monoamine oxidase inhibitor, digoxin, digitalis, lignocaine, a bradykinin agent, a serotoninergic agonist, an antiarrythmic agent, a cardiac glycoside, a local anesthetic, atropine, a calcium solution, an agent that promotes heart rate, an agent that promotes heart contractions, dopamine, a catecholamine, an inotrope glucagon, a hormone, forskolin, epinephrine, norepinephrine, thyroid hormone, a phosphodiesterase inhibitor, prostacyclin, prostaglandin and a methylxanthine.

8. The method of claim 1 further comprising:

delivering one or more fluids to the heart.

9. The method of claim 8 wherein the one or more fluids comprises at least one diagnostic agent, therapeutic agent or biological agent.

10. The method of claim 1 further comprising:

evaluating the hemodynamic condition of the heart with a sensor.

11. The method of claim 1, further comprising:

providing at least one fluid adjacent the electrode.

12. The method of claim 1 further comprising:

stimulating a nerve to adjust the beating of the heart to a first condition.

13. The method of claim 12 wherein the first condition is a stopped condition.

14. The method of claim 12 wherein the first condition is a slowed condition.

15. The method of claim 12 further comprising:

adjusting stimulation of the nerve to adjust the beating of the heart to a second condition.

16. The method of claim 15 further comprising:

stimulating the nerve a subsequent time in order to re-adjust the beating of the heart to the first condition.

17. The method of claim 15 wherein the stimulation is stopped to achieve the second condition.

18. The method of claim 15 wherein the second condition is a beating condition.

19. The method of claim 15 further comprising:

stimulating the heart in order to adjust the beating of the heart to the second condition.

20. The method of claim 19 wherein the heart is stimulated by pacing.

21. The method of claim 12 wherein the nerve is a vagal nerve.

22. The method of claim 1 wherein the second tissue contact device is a suction assisted device.

23. The method of claim 1 further comprising:

providing at least one fluid adjacent the second tissue contact device.

24. The method of claim 23 wherein the fluid is provided adjacent the ablation electrode.

25. The method of claim 1 wherein the tissue contact member of the first or second tissue contact device comprises one or more hooks.

26. The method of claim 1 wherein the tissue contact member of the first or second tissue contact device comprises one or more clamps.

27. The method of claim 1 wherein the tissue contact member of the first or second tissue contact device comprises one or more barbs.

28. The method of claim 1 wherein the tissue contact member of the first or second tissue contact device comprises a magnet.

29. The method of claim 1 wherein the joint is a pivot that allows the tissue contact member of the first tissue contact device to rotate relative to the rigid shaft.

30. The method of claim 1 wherein the joint is a hinge.

31. The method of claim 1 wherein the tissue contact member of the first or second tissue contact device is shaped to conform to a surface of tissue.

32. The method of claim 1 wherein the tissue contact member of the first or second tissue contact device is shapeable to conform to a surface of tissue.

33. The method of claim 1 wherein the illumination device includes a light source.

34. The method of claim 1 wherein the illumination device includes an illuminating material.

35. The method of claim 1 wherein the illumination device includes a fiber optic conduit.

36. The method of claim 1 wherein the illumination device includes a light pipe.

37. The method of claim 1 wherein the illumination device includes a battery.

38. The method of claim 1 wherein the illumination device provides UV light.

39. The method of claim 1 wherein the illumination device provides IR light.

40. The method of claim 1 wherein the illumination device provides visible light.

41. The method of claim 1 wherein the illumination device includes a laser.

42. The method of claim 1 wherein the illumination device includes a switch.

43. The method of claim 1 wherein the first tissue contact device includes a LED.

44. The method of claim 1 wherein the first or second tissue contact device is removably coupled to a flexible hose during the procedure.

45. The method of claim 1 wherein the first or second tissue contact device is removably coupled to a flexible tube during the procedure.

46. The method of claim 1 wherein the first or second tissue contact device is removably coupled to a flexible catheter during the procedure.

47. The method of claim 1 wherein the first or second tissue contact member is guided into a desired position.

48. The method of claim 1 wherein the first or second tissue contact member comprises one or more sensors.

49. The method of claim 1 further comprising ablating a tissue of the heart to perform at least a portion of a MAZE procedure.

50. The method of claim 1 wherein the step of placing the ablation electrode on the heart includes placing the ablation electrode on epicardial tissue of the heart.

51. The method of claim 1 further comprising the step of guiding the first or second tissue contact device into a desired position using a guidance technique.

52. The method of claim 51 wherein the guidance technique is a flouroscopic guidance technique.

53. A method of performing an electrode placement procedure on a patient'"'"'s heart, comprising:

providing a first tissue contact device comprising;

a rigid tissue contact member sized and shaped to fit through a small incision in a region of the patient'"'"'s chest;

an illumination device coupled to the rigid tissue contact member;

a maneuvering apparatus having a rigid shaft and a handle; and

a remotely actuatable joint moveably coupling the tissue contact member to the maneuvering apparatus;

introducing the rigid contact member of the first tissue contact device to the patient'"'"'s thoracic cavity through a small incision in the patient'"'"'s chest;

providing illumination;

actuating the joint remotely from outside the thoracic cavity of the patient;

maneuvering the tissue contact member of the first tissue contact device to position pericardium away from a surface of the heart to create space between the surface of the heart and the pericardium using the first tissue contact device, the space providing exposure of the heart;

providing a second tissue contact device comprising;

a rigid tissue contact member having an energy transfer electrode; and

a maneuvering apparatus having a shaft and a handle coupled to the rigid contact member;

introducing the rigid contact member of the second tissue contact device into the thoracic cavity of the patient through an incision in the region of the patient'"'"'s chest; and

placing the electrode on or within the exposed heart.

54. The method of claim 53 further comprising stimulating the heart in order to adjust the beating of the heart.

55. The method of claim 53 wherein the heart is stimulated by pacing.

56. The method of claim 53 wherein the heart is stimulated by defibrillation.

57. The method of claim 53 further comprising sensing the electrical signals of the heart.

58. The method of claim 53 further comprising administering at least one drug to the heart.

59. The method of claim 58 wherein the drug is a beta-blocker, a cholinergic agent, a cholinesterase inhibitor, a calcium channel blocker, a sodium channel blocker, a potassium channel agent, adenosine, an adenosine receptor agonist, an adenosine deaminase inhibitor, dipyridamole, a monoamine oxidase inhibitor, digoxin, digitalis, lignocaine, a bradykinin agent, a serotoninergic agonist, an antiarrythmic agent, a cardiac glycoside, a local anesthetic, atropine, a calcium solution, an agent that promotes heart rate, an agent that promotes heart contractions, dopamine, a catecholamine, an inotrope glucagon, a hormone, forskolin, epinephrine, norepinephrine, thyroid hormone, a phosphodiesterase inhibitor, prostacyclin, prostaglandin or a methylxanthine.

60. The method of claim 53 further comprising delivering one or more fluids to the heart.

61. The method of claim 60 wherein the fluid comprises a diagnostic agent, a therapeutic agent, a biological agent, or a combination thereof.

62. The method of claim 53 further comprising evaluating the hemodynamic condition of the heart with a sensor.

63. The method of claim 53, further comprising providing at least one fluid adjacent the electrode.

64. The method of claim 53 further comprising stimulating a nerve to adjust the beating of the heart to a first condition.

65. The method of claim 64 wherein the first condition is a stopped condition.

66. The method of claim 64 wherein the first condition is a slowed condition.

67. The method of claim 64 further comprising adjusting stimulation of the nerve to adjust the beating of the heart to a second condition.

68. The method of claim 67 further comprising stimulating the nerve a subsequent time in order to re-adjust the beating of the heart to the first condition.

69. The method of claim 67 wherein the stimulation is stopped to achieve the second condition.

70. The method of claim 67 wherein the second condition is a beating condition.

71. The method of claim 67 further comprising stimulating the heart in order to adjust the beating of the heart to the second condition.

72. The method of claim 71 wherein the heart is stimulated by pacing.

73. The method of claim 64 wherein the nerve is a vagal nerve.

74. The method of claim 53 wherein the second tissue contact device is a suction assisted device.

75. The method of claim 53 further comprising providing at least one fluid adjacent the second tissue contact device.

76. The method of claim 75 wherein the fluid is provided adjacent the ablation electrode.

77. The method of claim 53 wherein the tissue contact member of the first or second tissue contact device comprises one or more hooks.

78. The method of claim 53 wherein the tissue contact member of the first or second tissue contact device comprises one or more clamps.

79. The method of claim 53 wherein the tissue contact member of the first or second tissue contact device comprises one or more barbs.

80. The method of claim 53 wherein the tissue contact member of the first or second tissue contact device comprises a magnet.

81. The method of claim 53 wherein the joint is a pivot that allows the tissue contact member of the first tissue contact device to rotate relative to the rigid shaft.

82. The method of claim 53 wherein the joint is a hinge.

83. The method of claim 53 wherein the tissue contact member of the first or second tissue contact device is shaped to conform to a surface of tissue.

84. The method of claim 53 wherein the tissue contact member of the first or second tissue contact device is shapeable to conform to a surface of tissue.

85. The method of claim 53 wherein the illumination device includes a light source.

86. The method of claim 53 wherein the illumination device includes an illuminating material.

87. The method of claim 53 wherein the illumination device includes a fiber optic conduit.

88. The method of claim 53 wherein the illumination device includes a light pipe.

89. The method of claim 53 wherein the illumination device includes a battery.

90. The method of claim 53 wherein the illumination device provides UV light.

91. The method of claim 53 wherein the illumination device provides IR light.

92. The method of claim 53 wherein the illumination device provides visible light.

93. The method of claim 53 wherein the illumination device includes a laser.

94. The method of claim 53 wherein the illumination device includes a switch.

95. The method of claim 53 wherein the first tissue contact device includes a LED.

96. The method of claim 53 wherein the first or second tissue contact device is removably coupled to a flexible hose during the procedure.

97. The method of claim 53 wherein the first or second tissue contact device is removably coupled to a flexible tube during the procedure.

98. The method of claim 53 wherein the first or second tissue contact device is removably coupled to a flexible catheter during the procedure.

99. The method of claim 53 wherein the first or second tissue contact member is guided into a desired position.

100. The method of claim 53 wherein the first or second tissue contact member comprises one or more sensors.

101. The method of claim 100 further comprising ablating a tissue of the heart to perform at least a portion of a MAZE procedure.

102. The method of claim 53 wherein the step of placing the electrode on the heart includes placing the electrode on epicardial tissue of the heart.

103. The method of claim 53 further comprising the step of guiding the first or second tissue contact device into a desired position using a guidance technique.

104. The method of claim 103 wherein the guidance technique comprises flouroscopy.