Compositions, apparatus and methods for facilitating surgical procedures

• US 6,087,394 A
• Filed: 08/23/1999
• Issued: 07/11/2000
• Est. Priority Date: 08/08/1997
• Status: Expired due to Term

• Current Assignee: Duke University
• Original Assignee: Duke University
• Inventors: Duhaylongsod, Francis G.
• Primary Examiner(s): KRASS, FREDERICK F
• Application Number:
  US09/379,381
• Time in Patent Office: 323 Days
• Field of Search: 514/478, 514/479, 514/922, 607/9, 607/10, 607/11, 607/16, 607/27, 607/28, 607/30, 600/16, 600/17, 600/18, 604/507, 604/508, 604/509, 604/510, 604/96, 604/272, 604/523, 604/532
• US Class Current: 514/478
• CPC Class Codes: A61K 2300/00 Mixtures or combinations of active ingredients, wherein at least one active ingredient is fully defined in groups A61K31/00 - A61K41/00
• CPC Class Codes: A61K 31/00 Medicinal preparations containing organic active ingredients
• CPC Class Codes: A61K 31/135 having aromatic rings , e.g. ketamine, nortriptyline methadone A61K31/137
• CPC Class Codes: A61K 31/22 of acyclic acids, e.g. pravastatin
• CPC Class Codes: A61K 31/27 of carbamic or thiocarbamic acids, meprobamate, carbachol, neostigmine
• CPC Class Codes: A61K 31/445 Non condensed piperidines, e.g. piperocaine
• CPC Class Codes: A61K 45/06 Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
• CPC Class Codes: A61M 2210/125 Heart
• CPC Class Codes: A61P 9/00 Drugs for disorders of the cardiovascular system
• CPC Class Codes: A61P 9/04 Inotropic agents, i.e. stimulants of cardiac contraction; Drugs for heart failure

Abstract

Methods are provided for conducting surgical procedures in a patient wherein, during the surgical procedure, autonomous ventricular electrical conductivity and escape beats are reversibly and transiently suppressed to facilitate the surgical procedure. Also provided are compositions which are capable of inducing ventricular asystole in a patient. The compositions may include an AV node blocker. In one embodiment, compositions including an atrioventricular (AV) node blocker and a β-blocker are provided, wherein the β-blocker is present in an amount sufficient to substantially reduce the amount of AV node blocker required to induce ventricular asystole in the patient. The compositions and methods may be used for inducing temporary ventricular asystole in a beating heart, and to facilitate the performance of a variety of surgical techniques, including minimally invasive microsurgical techniques. Methods for performing a surgical procedure on a human patient are provided wherein a composition capable of inducing transient reversible ventricular asystole is administered to the heart, for example by intracoronary injection. The heart then is electrically paced using an electrical pacing system, thereby to maintain the patient'"'"'s blood circulation. The electrical pacing then is selectively intermittently stopped to allow ventricular asystole to occur, and the steps of the surgical or therapeutic procedure, such as suturing, are conducted during the time that the electrical pacing is intermittently stopped. The methods and compositions advantageously may be used in a range of different surgical procedures including cardiac, vascular and neurosurgical procedures.

Claims

1. A method for conducting a surgical procedure on a human patient comprising:

placing at least a portion of a delivery device in a coronary vessel of the heart of the patient;

delivering an AV node blocker to the AV node of the patient via the coronary vessel with the device; and

inducing transient reversible ventricular asystole in the heart, while maintaining the ability of the heart to be electrically paced.

2. The method of claim 1 including selecting a catheter as the delivery device.

3. The method of claim 1 wherein the device is placed in the right coronary artery of the heart of the patient.

4. The method of claim 1 wherein the device is placed in the left coronary artery of the heart of the patient.

5. The method of claim 1 wherein the device includes an outlet and the outlet is placed in the right coronary artery of the heart of the patient and immediately proximal to the AV node artery.

6. The method of claim 1 wherein the device includes an outlet and the outlet is placed in the AV node artery.

7. The method of claim 1 wherein the device is placed in the middle cardiac vein of the heart of the patient.

8. The method of claim 1 wherein the device is placed into an ostium of a right or left coronary artery of the heart of the patient.

9. The method of claim 1 further including introducing the device through the femoral artery.

10. The method of claim 1 further including introducing the device through an incision in the aorta of the patient.

11. The method of claim 1, further comprising administering a beta-blocker to the heart.

12. The method of claim 11, wherein the beta-blocker is administered prior to the AV node blocker.

13. The method of claim 11, wherein the beta-blocker is propranolol.

14. The method of claim 11, wherein the beta-blocker is administered with said device.

15. The method of claim 1, wherein the AV node blocker is a cholinergic agent.

16. The method of claim 1, wherein the AV node blocker is carbachol.

17. The method of claim 1, wherein said procedure is a coronary artery bypass procedure.

18. The method of claim 1, wherein delivery of the AV node blocker is by needle injection.

20. The method of claim 1, further comprising electrically pacing the heart.

21. The method of claim 20, further comprising selectively, intermittently stopping the pacing to allow for ventricular asytole.

19. A method for conducting a surgical procedure on a human patient comprising delivering an AV node blocker to a coronary vessel of the patient by needle injection, and inducing transient reversible ventricular asystole in the heart, while maintaining the ability of the heart to be electrically paced.