公开(公告)号：US06913600B2

公开(公告)日：2005-07-05

申请号：US09161109

申请日：1998-09-25

申请人： Kirsten L. Valley ,  David W. Snow ,  Timothy C. Corvi ,  Brian S. Donlon ,  Stephen W. Boyd ,  Sylvia W. Fan ,  Alex T. Roth ,  William S. Peters ,  Richard J. Mueller, Jr. ,  Hanson S. Gifford, III

发明人： Kirsten L. Valley ,  David W. Snow ,  Timothy C. Corvi ,  Brian S. Donlon ,  Stephen W. Boyd ,  Sylvia W. Fan ,  Alex T. Roth ,  William S. Peters ,  Richard J. Mueller, Jr. ,  Hanson S. Gifford, III

IPC分类号： A61B17/00 ,  A61B17/02 ,  A61B17/04 ,  A61B17/06 ,  A61B17/28 ,  A61B17/30 ,  A61B17/34 ,  A61B18/14 ,  A61B19/00 ,  A61F2/24 ,  A61F2/958 ,  A61M1/00 ,  A61M1/36 ,  A61M25/00 ,  A61M25/01 ,  A61M25/06 ,  A61M29/02 ,  A61M31/00 ,  A61M29/00

CPC分类号： A61M25/0147 ,  A61B17/00234 ,  A61B17/0218 ,  A61B17/0467 ,  A61B17/0469 ,  A61B17/06061 ,  A61B17/2909 ,  A61B18/1492 ,  A61B90/50 ,  A61B2017/00243 ,  A61B2017/00247 ,  A61B2017/0243 ,  A61B2017/047 ,  A61B2017/0472 ,  A61B2017/0474 ,  A61B2017/0475 ,  A61B2017/2943 ,  A61B2017/306 ,  A61B2017/3405 ,  A61B2017/3492 ,  A61B2018/00214 ,  A61B2018/00232 ,  A61B2018/00261 ,  A61B2018/00291 ,  A61B2018/00363 ,  A61B2018/00392 ,  A61B2018/00577 ,  A61B2090/064 ,  A61B2090/306 ,  A61F2/2427 ,  A61M1/3621 ,  A61M1/3653 ,  A61M1/3659 ,  A61M25/0023 ,  A61M25/0028 ,  A61M25/0032 ,  A61M25/0041 ,  A61M25/0054 ,  A61M25/0125 ,  A61M25/0152 ,  A61M25/0155 ,  A61M25/0662 ,  A61M25/10 ,  A61M25/1002 ,  A61M25/1011 ,  A61M25/1029 ,  A61M25/1034 ,  A61M25/1038 ,  A61M39/0247 ,  A61M2025/0002 ,  A61M2025/0004 ,  A61M2025/0031 ,  A61M2025/0046 ,  A61M2025/0078 ,  A61M2025/015 ,  A61M2025/0161 ,  A61M2025/028 ,  A61M2025/1047 ,  A61M2025/105 ,  A61M2025/1052 ,  A61M2025/1059 ,  A61M2025/1077 ,  A61M2025/1095 ,  A61M2202/047 ,  A61M2205/11 ,  A61M2205/3344 ,  A61M2205/3355 ,  A61M2205/366 ,  A61M2210/125 ,  A61M2210/127

摘要： Devices and methods are provided for temporarily inducing cardioplegic arrest in the heart of a patient and for establishing cardiopulmonary bypass in order to facilitate surgical procedures on the heart and its related blood vessels. Specifically, a catheter based system is provided for isolating the heart and coronary blood vessels of a patient from the remainder of the arterial system and for infusing a cardioplegic agent into the patient's coronary arteries to induce cardioplegic arrest in the heart. The system includes an endoaortic partitioning catheter having an expandable balloon at its distal end which is expanded within the ascending aorta to occlude the aortic lumen between the coronary ostia and the brachiocephalic artery. Means for centering the catheter tip within the ascending aorta include specially curved shaft configurations, eccentric or shaped occlusion balloons and a steerable catheter tip, which may be used separately or in combination. The shaft of the catheter may have a coaxial or multilumen construction. The catheter may further include piezoelectric pressure transducers at the distal tip of the catheter and within the occlusion balloon. Means to facilitate nonfluoroscopic placement of the catheter include fiberoptic transillumination of the aorta and a secondary balloon at the distal tip of the catheter for atraumatically contacting the aortic valve. The system further includes a dual purpose arterial bypass cannula and introducer sheath for introducing the catheter into a peripheral artery of the patient.

摘要翻译： 提供了设备和方法，用于临时诱导患者心脏中的心脏停搏停滞并建立心肺分流术，以便于心脏及其相关血管的外科手术。 特别地，提供一种基于导管的系统，用于将患者的心脏和冠状动脉血管与动脉系统的其余部分隔离，并将心脏停搏药物注入患者的冠状动脉以诱发心脏停搏。 该系统包括内主动脉分配导管，其在其远端具有可膨胀气囊，其在升主动脉内扩张以封闭冠状动脉口和头臂动脉之间的主动脉腔。 用于将导管末端定心在升主动脉内的装置包括特殊弯曲的轴构造，偏心或成形的闭塞气囊和可导向的导管尖端，其可以单独使用或组合使用。 导管的轴可以具有同轴或多腔结构。 该导管还可以包括位于导管的远侧末端处和闭塞气囊内的压电换能器。 促进导管的非荧光放置的手段包括主动脉的光纤透照和在导管的远端处的次级球囊，用于与主动脉瓣无创接触。 该系统还包括用于将导管引入患者的外周动脉的双用途动脉旁路插管和引导器护套。

公开(公告)号：US5814016A

公开(公告)日：1998-09-29

申请号：US797229

申请日：1997-02-07

申请人： Kirsten L. Valley ,  David W. Snow ,  Timothy C. Corvi ,  Brian S. Donlon ,  Stephen W. Boyd ,  Sylvia W. Fan ,  Alex T. Roth ,  William S. Peters ,  Richard J. Mueller, Jr. ,  Hanson S. Gifford, III

发明人： Kirsten L. Valley ,  David W. Snow ,  Timothy C. Corvi ,  Brian S. Donlon ,  Stephen W. Boyd ,  Sylvia W. Fan ,  Alex T. Roth ,  William S. Peters ,  Richard J. Mueller, Jr. ,  Hanson S. Gifford, III

IPC分类号： A61B17/00 ,  A61B17/02 ,  A61B17/04 ,  A61B17/06 ,  A61B17/28 ,  A61B17/30 ,  A61B17/34 ,  A61B18/14 ,  A61B19/00 ,  A61F2/24 ,  A61F2/958 ,  A61M1/00 ,  A61M1/36 ,  A61M25/00 ,  A61M25/01 ,  A61M25/06 ,  A61M29/02 ,  A61M29/00

CPC分类号： A61M25/0147 ,  A61B17/00234 ,  A61B17/0218 ,  A61B17/0469 ,  A61B17/06061 ,  A61B18/1492 ,  A61B90/50 ,  A61F2/2427 ,  A61M1/3653 ,  A61M1/3659 ,  A61M25/0028 ,  A61M25/0041 ,  A61M25/0152 ,  A61M25/0155 ,  A61M25/0662 ,  A61M25/10 ,  A61M25/1002 ,  A61M25/1011 ,  A61M25/1029 ,  A61M25/1038 ,  A61M39/0247 ,  A61B17/0467 ,  A61B17/2909 ,  A61B2017/00243 ,  A61B2017/00247 ,  A61B2017/0243 ,  A61B2017/047 ,  A61B2017/0472 ,  A61B2017/0474 ,  A61B2017/0475 ,  A61B2017/2943 ,  A61B2017/306 ,  A61B2017/3405 ,  A61B2017/3492 ,  A61B2018/00214 ,  A61B2018/00232 ,  A61B2018/00261 ,  A61B2018/00291 ,  A61B2018/00363 ,  A61B2018/00392 ,  A61B2018/00577 ,  A61B2090/064 ,  A61B2090/306 ,  A61M1/3621 ,  A61M2025/0002 ,  A61M2025/0004 ,  A61M2025/0031 ,  A61M2025/0046 ,  A61M2025/0078 ,  A61M2025/015 ,  A61M2025/0161 ,  A61M2025/028 ,  A61M2025/1047 ,  A61M2025/105 ,  A61M2025/1052 ,  A61M2025/1059 ,  A61M2025/1077 ,  A61M2025/1095 ,  A61M2202/047 ,  A61M2205/11 ,  A61M2205/3344 ,  A61M2205/3355 ,  A61M2205/366 ,  A61M2210/125 ,  A61M2210/127 ,  A61M25/0023 ,  A61M25/0032 ,  A61M25/0054 ,  A61M25/0125 ,  A61M25/1034

摘要： Devices and methods are provided for temporarily inducing cardioplegic arrest in the heart of a patient and for establishing cardiopulmonary bypass in order to facilitate surgical procedures on the heart and its related blood vessels. Specifically, a catheter based system is provided for isolating the heart and coronary blood vessels of a patient from the remainder of the arterial system and for infusing a cardioplegic agent into the patient's coronary arteries to induce cardioplegic arrest in the heart. The system includes an endoaortic partitioning catheter having an expandable balloon at its distal end which is expanded within the ascending aorta to occlude the aortic lumen between the coronary ostia and the brachiocephalic artery. Means for centering the catheter tip within the ascending aorta include specially curved shaft configurations, eccentric or shaped occlusion balloons and a steerable catheter tip, which may be used separately or in combination. The shaft of the catheter may have a coaxial or multilumen construction. The catheter may further include piezoelectric pressure transducers at the distal tip of the catheter and within the occlusion balloon. Means to facilitate nonfluoroscopic placement of the catheter include fiberoptic transillumination of the aorta and a secondary balloon at the distal tip of the catheter for atraumatically contacting the aortic valve. The system further includes a dual purpose arterial bypass cannula and introducer sheath for introducing the catheter into a peripheral artery of the patient.

公开(公告)号：US5766151A

公开(公告)日：1998-06-16

申请号：US486216

申请日：1995-06-07

申请人： Kirsten L. Valley ,  David W. Snow ,  William S. Peters

发明人： Kirsten L. Valley ,  David W. Snow ,  William S. Peters

IPC分类号： A61B17/00 ,  A61B17/02 ,  A61B17/04 ,  A61B17/06 ,  A61B17/28 ,  A61B17/30 ,  A61B17/34 ,  A61B18/14 ,  A61B19/00 ,  A61F2/24 ,  A61F2/958 ,  A61M1/00 ,  A61M1/36 ,  A61M25/00 ,  A61M25/01 ,  A61M25/06 ,  A61M29/02 ,  A61M29/00

CPC分类号： A61M25/0147 ,  A61B17/00234 ,  A61B17/0218 ,  A61B17/0469 ,  A61B17/06061 ,  A61B18/1492 ,  A61B90/50 ,  A61F2/2427 ,  A61M1/3653 ,  A61M1/3659 ,  A61M25/0028 ,  A61M25/0041 ,  A61M25/0152 ,  A61M25/0155 ,  A61M25/0662 ,  A61M25/10 ,  A61M25/1002 ,  A61M25/1011 ,  A61M25/1029 ,  A61M25/1038 ,  A61M39/0247 ,  A61B17/0467 ,  A61B17/2909 ,  A61B2017/00243 ,  A61B2017/00247 ,  A61B2017/0243 ,  A61B2017/047 ,  A61B2017/0472 ,  A61B2017/0474 ,  A61B2017/0475 ,  A61B2017/2943 ,  A61B2017/306 ,  A61B2017/3405 ,  A61B2017/3492 ,  A61B2018/00214 ,  A61B2018/00232 ,  A61B2018/00261 ,  A61B2018/00291 ,  A61B2018/00363 ,  A61B2018/00392 ,  A61B2018/00577 ,  A61B2090/064 ,  A61B2090/306 ,  A61M1/3621 ,  A61M2025/0002 ,  A61M2025/0004 ,  A61M2025/0031 ,  A61M2025/0046 ,  A61M2025/0078 ,  A61M2025/015 ,  A61M2025/0161 ,  A61M2025/028 ,  A61M2025/1047 ,  A61M2025/105 ,  A61M2025/1052 ,  A61M2025/1059 ,  A61M2025/1077 ,  A61M2025/1095 ,  A61M2202/047 ,  A61M2205/11 ,  A61M2205/3344 ,  A61M2205/3355 ,  A61M2205/366 ,  A61M2210/125 ,  A61M2210/127 ,  A61M25/0023 ,  A61M25/0032 ,  A61M25/0054 ,  A61M25/0125 ,  A61M25/1034

摘要： Devices and methods are provided for temporarily inducing cardioplegic arrest in the heart of a patient and for establishing cardiopulmonary bypass in order to facilitate surgical procedures on the heart and its related blood vessels. Specifically, a catheter based system is provided for isolating the heart and coronary blood vessels of a patient from the remainder of the arterial system and for infusing a cardioplegic agent into the patient's coronary arteries to induce cardioplegic arrest in the heart. The system includes an endoaortic partitioning catheter having an expandable balloon at its distal end which is expanded within the ascending aorta to occlude the aortic lumen between the coronary ostia and the brachiocephalic artery. Means for centering the catheter tip within the ascending aorta include specially curved shaft configurations, eccentric or shaped occlusion balloons and a steerable catheter tip, which may be used separately or in combination. The shaft of the catheter may have a coaxial or multilumen construction. The catheter may further include piezoelectric pressure transducers at the distal tip of the catheter and within the occlusion balloon. Means to facilitate nonfluoroscopic placement of the catheter include fiberoptic transillumination of the aorta and a secondary balloon at the distal tip of the catheter for atraumatically contacting the aortic valve. The system further includes a dual purpose arterial bypass cannula and introducer sheath for introducing the catheter into a peripheral artery of the patient.

摘要翻译： 提供了设备和方法，用于临时诱导患者心脏中的心脏停搏停滞并建立心肺分流术，以便于心脏及其相关血管的外科手术。 特别地，提供一种基于导管的系统，用于将患者的心脏和冠状动脉血管与动脉系统的其余部分隔离，并将心脏停搏药物注入患者的冠状动脉以诱发心脏停搏。 该系统包括内主动脉分配导管，其在其远端具有可膨胀气囊，其在升主动脉内扩张以封闭冠状动脉口和头臂动脉之间的主动脉腔。 用于将导管末端定心在升主动脉内的装置包括特殊弯曲的轴构造，偏心或成形的闭塞气囊和可导向的导管尖端，其可以单独使用或组合使用。 导管的轴可以具有同轴或多腔结构。 该导管还可以包括位于导管的远侧末端处和闭塞气囊内的压电换能器。 促进导管的非荧光放置的手段包括主动脉的光纤透照和在导管的远端处的次级球囊，用于与主动脉瓣无创接触。 该系统还包括用于将导管引入患者的外周动脉的双用途动脉旁路插管和引导器护套。

公开(公告)号：US06899704B2

公开(公告)日：2005-05-31

申请号：US09902523

申请日：2001-07-10

申请人： Wesley D. Sterman ,  Michi E. Garrison ,  Hanson S. Gifford, III ,  John H. Stevens ,  William S. Peters

发明人： Wesley D. Sterman ,  Michi E. Garrison ,  Hanson S. Gifford, III ,  John H. Stevens ,  William S. Peters

IPC分类号： A61B17/00 ,  A61B17/02 ,  A61B17/04 ,  A61B17/06 ,  A61B17/28 ,  A61B17/30 ,  A61B17/34 ,  A61B18/14 ,  A61B19/00 ,  A61F2/24 ,  A61F2/958 ,  A61M1/00 ,  A61M1/36 ,  A61M25/00 ,  A61B18/18 ,  A61B37/00

CPC分类号： A61B17/00234 ,  A61B17/0057 ,  A61B17/0218 ,  A61B17/0467 ,  A61B17/0469 ,  A61B17/06061 ,  A61B17/064 ,  A61B17/068 ,  A61B17/12013 ,  A61B17/122 ,  A61B17/1227 ,  A61B17/1285 ,  A61B17/29 ,  A61B17/2909 ,  A61B17/30 ,  A61B17/3403 ,  A61B18/1442 ,  A61B18/1492 ,  A61B90/50 ,  A61B2017/00243 ,  A61B2017/00247 ,  A61B2017/00637 ,  A61B2017/00663 ,  A61B2017/0243 ,  A61B2017/047 ,  A61B2017/0472 ,  A61B2017/0474 ,  A61B2017/0475 ,  A61B2017/2943 ,  A61B2017/306 ,  A61B2017/3405 ,  A61B2017/3427 ,  A61B2017/3492 ,  A61B2018/00214 ,  A61B2018/00232 ,  A61B2018/00261 ,  A61B2018/00291 ,  A61B2018/00363 ,  A61B2018/00392 ,  A61B2018/00577 ,  A61B2090/064 ,  A61F2/2427 ,  A61F2/2496 ,  A61M1/3664 ,  A61M25/0023 ,  A61M25/0032 ,  A61M25/1011 ,  A61M39/0247 ,  A61M2025/0003 ,  A61M2025/028 ,  A61M2025/1052 ,  A61M2039/027 ,  A61M2039/0279 ,  A61M2202/047 ,  A61M2205/3344 ,  A61M2205/3355 ,  A61M2205/366 ,  A61M2210/127 ,  A61M2230/005

摘要： The invention provides devices and methods for performing less-invasive surgical procedures within an organ or vessel. In an exemplary embodiment, the invention provides a method of closed-chest surgical intervention within an internal cavity of a patient's heart or great vessel. According to the method, the patient's heart is arrested and cardiopulmonary bypass is established. A scope extending through a percutaneous intercostal penetration in the patient's chest is used to view an internal portion of the patient's chest. An internal penetration is formed in a wall of the heart or great vessel using cutting means introduced through a percutaneous penetration in an intercostal space in the patient's chest. An interventional tool is then introduced, usually through a cannula positioned in a percutaneous intercostal penetration. The interventional tool is inserted through the internal penetration in the heart or great vessel to perform a surgical procedure within the internal cavity under visualization by means of the scope. In a preferred embodiment, a cutting tool is introduced into the patient's left atrium from a right portion of the patient's chest to remove the patient's mitral valve. A replacement valve is then introduced through an intercostal space in the right portion of the chest and through the internal penetration in the heart, and the replacement valve is attached in the mitral valve position.

摘要翻译： 本发明提供了用于在器官或血管内执行较少侵入性外科手术的装置和方法。 在一个示例性实施例中，本发明提供了一种在患者心脏或大血管的内腔内进行闭胸手术干预的方法。 根据该方法，患者的心脏被停止并建立了体外循环。 使用延伸穿过患者胸部经皮肋间穿透的范围来观察患者胸部的内部部分。 使用通过在患者胸部的肋间空间经皮渗透引入的切割装置在心脏或大容器的壁上形成内部穿透。 然后引入介入工具，通常通过定位在经皮肋间穿透中的套管。 介入工具通过心脏或大容器中的内部穿透插入，通过范围在可视化的内部空腔内执行外科手术。 在优选实施例中，切割工具从患者胸部的右侧部分引入患者的左心房以移除患者的二尖瓣。 然后将置换瓣膜通过胸部右侧部分的肋间空间并通过心脏内部穿透引入，置换瓣膜连接于二尖瓣位置。

公开(公告)号：US06478029B1

公开(公告)日：2002-11-12

申请号：US09634608

申请日：2000-08-05

申请人： Stephen W. Boyd ,  Alan R. Rapacki ,  Matthias Vaska ,  Brian S. Donlon ,  William S. Peters

发明人： Stephen W. Boyd ,  Alan R. Rapacki ,  Matthias Vaska ,  Brian S. Donlon ,  William S. Peters

IPC分类号： A61B1900

CPC分类号： A61B17/29 ,  A61B17/00234 ,  A61B17/0218 ,  A61B17/2909 ,  A61B18/1492 ,  A61B90/36 ,  A61B2017/00243 ,  A61B2017/00247 ,  A61B2017/0237 ,  A61B2017/0243 ,  A61B2017/047 ,  A61B2017/0472 ,  A61B2017/2901 ,  A61B2017/2905 ,  A61B2017/2912 ,  A61B2017/2927 ,  A61B2017/2932 ,  A61B2017/306 ,  A61B2017/308 ,  A61B2017/3405 ,  A61B2017/3492 ,  A61B2018/00214 ,  A61B2018/00232 ,  A61B2018/00261 ,  A61B2018/00291 ,  A61B2018/00363 ,  A61B2018/00392 ,  A61B2018/00577 ,  A61B2090/306 ,  A61F2/2427 ,  A61F7/10 ,  A61F2007/0001 ,  A61F2007/0054 ,  A61F2007/101 ,  A61M25/1011 ,  A61M39/0247 ,  A61M2025/028 ,  A61M2039/0279 ,  A61M2205/3344 ,  A61M2205/3355 ,  A61M2205/366

摘要： Surgical methods and instruments are disclosed for performing port-access or closed-chest coronary artery bypass (CABG) surgery in multivessel coronary artery disease. In contrast to standard open-chest CABG surgery, which requires a median sternotomy or other gross thoracotomy to expose the patient's heart, post-access CABG surgery is performed through small incisions or access ports made through the intercostal spaces between the patient's ribs, resulting in greatly reduced pain and morbidity to the patient. In situ arterial bypass grafts, such as the internal mammary arteries and/or the right gastroepiploic artery, are prepared for grafting by thoracoscopic or laparoscopic takedown techniques. Free grafts, such as a saphenous vein graft or a free arterial graft, can be used to augment the in situ arterial grafts. The graft vessels are anastomosed to the coronary arteries under direct visualization through a cardioscopic microscope inserted through an intercostal access port. Retraction instruments are provided to manipulate the heart within the closed chest of the patient to expose each of the coronary arteries for visualization and anastomosis. Disclosed are a tunneler and an articulated tunneling grasper for rerouting the graft vessels, and a finger-like retractor, a suction cup retractor, a snare retractor and a loop retractor for manipulating the heart. Also disclosed is a port-access topical cooling device for improving myocardial protection during the port-access CABG procedure. An alternate surgical approach using an anterior mediastinotomy is also described.

摘要翻译： 公开了手术方法和手段，用于在多支冠状动脉疾病中进行门禁或封闭式冠状动脉旁路（CABG）手术。 与标准的胸腔CABG手术相比，其需要中位胸骨切开术或其他大胸廓切开术来暴露患者的心脏，通过穿过患者肋骨之间的肋间空间形成的小切口或进入口进行后访问CABG手术，导致 大大减轻患者的疼痛和发病率。 通过胸腔镜或腹腔镜移植技术准备原位动脉旁路移植物，例如乳内动脉和/或右胃腹动脉，用于移植。 可以使用游离移植物，例如隐静脉移植物或自由动脉移植物来增加原位动脉移植物。 通过插入通过肋间进入口的心脏显微镜，直接观察移植血管与冠状动脉吻合。 提供收缩器械以操纵患者的封闭胸部内的心脏以暴露每个冠状动脉以进行可视化和吻合。 公开了一种用于重新路由移植血管的隧道器和铰接隧道抓紧器，以及用于操纵心脏的手指状牵开器，吸盘牵开器，圈套牵开器和回卷器。 还公开了一种用于在端口访问CABG过程期间改善心肌保护的端口访问局部冷却装置。 还描述了使用前纵隔切开术的替代手术方法。

公开(公告)号：US5797960A

公开(公告)日：1998-08-25

申请号：US425179

申请日：1995-04-20

申请人： John H. Stevens ,  Bruce A. Reitz ,  Alex T. Roth ,  William S. Peters ,  Hanson S. Gifford

发明人： John H. Stevens ,  Bruce A. Reitz ,  Alex T. Roth ,  William S. Peters ,  Hanson S. Gifford

IPC分类号： A61B5/0444 ,  A61B1/00 ,  A61B5/0402 ,  A61B17/00 ,  A61B17/02 ,  A61B17/04 ,  A61B17/06 ,  A61B17/28 ,  A61B17/30 ,  A61B17/32 ,  A61B17/34 ,  A61B18/00 ,  A61B18/14 ,  A61B19/00 ,  A61F2/24 ,  A61F2/958 ,  A61M1/00 ,  A61M29/00

CPC分类号： A61B17/00234 ,  A61B17/0057 ,  A61B17/0218 ,  A61B17/0469 ,  A61B17/06061 ,  A61B17/320016 ,  A61B17/3468 ,  A61B18/1482 ,  A61B18/1492 ,  A61B90/50 ,  A61F2/2427 ,  A61M25/1011 ,  A61M39/0247 ,  A61B17/0467 ,  A61B17/2909 ,  A61B17/3211 ,  A61B17/3417 ,  A61B18/1442 ,  A61B2017/00053 ,  A61B2017/00243 ,  A61B2017/00247 ,  A61B2017/00349 ,  A61B2017/00575 ,  A61B2017/00579 ,  A61B2017/00592 ,  A61B2017/00597 ,  A61B2017/00606 ,  A61B2017/00619 ,  A61B2017/00623 ,  A61B2017/00867 ,  A61B2017/00907 ,  A61B2017/0243 ,  A61B2017/047 ,  A61B2017/0472 ,  A61B2017/0474 ,  A61B2017/0475 ,  A61B2017/2943 ,  A61B2017/2946 ,  A61B2017/306 ,  A61B2017/3405 ,  A61B2017/3486 ,  A61B2017/3492 ,  A61B2018/00214 ,  A61B2018/00232 ,  A61B2018/00261 ,  A61B2018/00291 ,  A61B2018/00363 ,  A61B2018/00392 ,  A61B2018/00577 ,  A61B2018/00898 ,  A61B2018/00982 ,  A61B2018/1465 ,  A61B90/37 ,  A61M2025/028 ,  A61M2039/0279 ,  A61M2039/0297 ,  A61M2205/3344 ,  A61M2205/3355 ,  A61M2205/366 ,  Y10S623/904

摘要： Devices, systems, and methods are provided for accessing the interior of the heart and performing procedures therein while the heart is beating. In one embodiment, a tubular access device having an inner lumen is provided for positioning through a penetration in a muscular wall of the heart, the access device having a means for sealing within the penetration to inhibit leakage of blood through the penetration. The sealing means may comprise a balloon or flange on the access device, or a suture placed in the heart wall to gather the heart tissue against the access device. An obturator is removably positionable in the inner lumen of the access device, the obturator having a cutting means at its distal end for penetrating the muscular wall of the heart. The access device is preferably positioned through an intercostal space and through the muscular wall of the heart. Elongated instruments may be introduced through the tubular access device into an interior chamber of the heart to perform procedures such as septal defect repair and electrophysiological mapping and ablation. A method of septal defect repair includes positioning a tubular access device percutaneously through an intercostal space and through a penetration in a muscular wall of the heart, passing one or more instruments through an inner lumen of the tubular access device into an interior chamber of the heart, and using the instruments to close the septal defect. Devices and methods for closing the septal defect with either sutures or with patch-type devices are disclosed.

公开(公告)号：US06613069B2

公开(公告)日：2003-09-02

申请号：US09982504

申请日：2001-10-19

申请人： Stephen W. Boyd ,  Alan R. Rapacki ,  Matthias Vaska ,  Brian S. Donlon ,  William S. Peters ,  John H. Stevens

发明人： Stephen W. Boyd ,  Alan R. Rapacki ,  Matthias Vaska ,  Brian S. Donlon ,  William S. Peters ,  John H. Stevens

IPC分类号： A61B1744

CPC分类号： A61F7/10 ,  A61B17/00234 ,  A61B17/0057 ,  A61B17/0218 ,  A61B17/0467 ,  A61B17/0469 ,  A61B17/06061 ,  A61B17/064 ,  A61B17/068 ,  A61B17/12013 ,  A61B17/122 ,  A61B17/1227 ,  A61B17/1285 ,  A61B17/29 ,  A61B17/2909 ,  A61B17/30 ,  A61B17/3403 ,  A61B18/1442 ,  A61B18/1492 ,  A61B90/36 ,  A61B90/50 ,  A61B2017/00243 ,  A61B2017/00247 ,  A61B2017/00637 ,  A61B2017/00663 ,  A61B2017/0225 ,  A61B2017/0237 ,  A61B2017/0243 ,  A61B2017/047 ,  A61B2017/0472 ,  A61B2017/0474 ,  A61B2017/0475 ,  A61B2017/2912 ,  A61B2017/2927 ,  A61B2017/2932 ,  A61B2017/2943 ,  A61B2017/306 ,  A61B2017/308 ,  A61B2017/3405 ,  A61B2017/3427 ,  A61B2017/3492 ,  A61B2018/00214 ,  A61B2018/00232 ,  A61B2018/00261 ,  A61B2018/00291 ,  A61B2018/00363 ,  A61B2018/00392 ,  A61B2018/00577 ,  A61B2090/064 ,  A61B2090/306 ,  A61F2/2427 ,  A61F2007/0001 ,  A61F2007/0054 ,  A61F2007/101 ,  A61M25/0023 ,  A61M25/0032 ,  A61M25/1011 ,  A61M39/0247 ,  A61M2025/0003 ,  A61M2025/0031 ,  A61M2025/028 ,  A61M2025/1052 ,  A61M2039/0279 ,  A61M2202/047 ,  A61M2205/3344 ,  A61M2205/3355 ,  A61M2205/366 ,  A61M2210/127 ,  A61M2230/005

摘要： Surgical methods and instruments are disclosed for performing port-access or closed-chest coronary artery bypass (CABG) surgery in multivessel coronary artery disease. In contrast to standard open-chest CABG surgery, which requires a median sternotomy or other gross thoracotomy to expose the patient's heart, port-access CABG surgery is performed through small incisions or access ports made through the intercostal spaces between the patient's ribs, resulting in greatly reduced pain and morbidity to the patient. In situ arterial bypass grafts, such as the internal mammary arteries and/or the right gastroepiploic artery, are prepared for grafting by thoracoscopic or laparoscopic takedown techniques. Free grafts, such as a saphenous vein graft or a free arterial graft, can be used to augment the in situ arterial grafts. The graft vessels are anastomosed to the coronary arteries under direct visualization through a cardioscopic microscope inserted through an intercostal access port. Retraction instruments are provided to manipulate the heart within the closed chest of the patient to expose each of the coronary arteries for visualization and anastomosis. Disclosed are a tunneler and an articulated tunneling grasper for rerouting the graft vessels, and a finger-like retractor, a suction cup retractor, a snare retractor and a loop retractor for manipulating the heart. Also disclosed is a port-access topical cooling device for improving myocardial protection during the port-access CABG procedure. An alternate surgical approach using an anterior mediastinotomy is also described.

摘要翻译： 公开了手术方法和手段，用于在多支冠状动脉疾病中进行门禁或封闭式冠状动脉旁路（CABG）手术。 与标准的胸腔CABG手术相比，其需要中位胸骨切开术或其他大胸廓切开术来暴露患者的心脏，通过患者肋骨之间的肋间空间形成的小切口或进入端口进行口腔进入CABG手术，导致 大大减轻患者的疼痛和发病率。 通过胸腔镜或腹腔镜移植技术准备原位动脉旁路移植物，例如乳内动脉和/或右胃腹动脉，用于移植。 可以使用游离移植物，例如隐静脉移植物或自由动脉移植物来增加原位动脉移植物。 通过插入通过肋间进入口的心脏显微镜，直接观察移植血管与冠状动脉吻合。 提供收缩器械以操纵患者的封闭胸部内的心脏以暴露每个冠状动脉以进行可视化和吻合。 公开了一种用于重新路由移植血管的隧道器和铰接隧道抓紧器，以及用于操纵心脏的手指状牵开器，吸盘牵开器，圈套牵开器和回卷器。 还公开了一种用于在端口访问CABG过程期间改善心肌保护的端口访问局部冷却装置。 还描述了使用前纵隔切开术的替代手术方法。

公开(公告)号：US06401720B1

公开(公告)日：2002-06-11

申请号：US09411095

申请日：1999-10-04

申请人： John H. Stevens ,  Bruce A. Reitz ,  Alex T. Roth ,  William S. Peters ,  Hanson S. Gifford

发明人： John H. Stevens ,  Bruce A. Reitz ,  Alex T. Roth ,  William S. Peters ,  Hanson S. Gifford

IPC分类号： A61B1900

CPC分类号： A61B17/00234 ,  A61B17/0057 ,  A61B17/0218 ,  A61B17/0467 ,  A61B17/0469 ,  A61B17/06061 ,  A61B17/2909 ,  A61B17/320016 ,  A61B17/3211 ,  A61B17/3417 ,  A61B17/3468 ,  A61B18/1442 ,  A61B18/1482 ,  A61B18/1492 ,  A61B90/37 ,  A61B90/50 ,  A61B2017/00053 ,  A61B2017/00243 ,  A61B2017/00247 ,  A61B2017/00349 ,  A61B2017/00575 ,  A61B2017/00579 ,  A61B2017/00592 ,  A61B2017/00597 ,  A61B2017/00606 ,  A61B2017/00619 ,  A61B2017/00623 ,  A61B2017/00867 ,  A61B2017/00907 ,  A61B2017/0243 ,  A61B2017/047 ,  A61B2017/0472 ,  A61B2017/0474 ,  A61B2017/0475 ,  A61B2017/2943 ,  A61B2017/2946 ,  A61B2017/306 ,  A61B2017/3405 ,  A61B2017/3486 ,  A61B2017/3492 ,  A61B2018/00214 ,  A61B2018/00232 ,  A61B2018/00261 ,  A61B2018/00291 ,  A61B2018/00363 ,  A61B2018/00392 ,  A61B2018/00577 ,  A61B2018/00898 ,  A61B2018/00982 ,  A61B2018/1465 ,  A61F2/2427 ,  A61M25/1011 ,  A61M39/0247 ,  A61M2025/028 ,  A61M2039/0279 ,  A61M2039/0297 ,  A61M2205/3344 ,  A61M2205/3355 ,  A61M2205/366 ,  Y10S623/904

摘要： Devices, systems, and methods are provided for accessing the interior of the heart and performing procedures therein while the heart is beating. In one embodiment, a tubular access device having an inner lumen is provided for positioning through a penetration in a muscular wall of the heart, the access device having a means for sealing within the penetration to inhibit leakage of blood through the penetration. The sealing means may comprise a balloon or flange on the access device, or a suture placed in the heart wall to gather the heart tissue against the access device. An obturator is removably positionable in the inner lumen of the access device, the obturator having a cutting means at its distal end for penetrating the muscular wall of the heart. The access device is preferably positioned through an intercostal space and through the muscular wall of the heart. Elongated instruments may be introduced through the tubular access device into an interior chamber of the heart to perform procedures such as septal defect repair and electrophysiological mapping and ablation. A method of septal defect repair includes positioning a tubular access device percutaneously through an intercostal space and through a penetration in a muscular wall of the heart, passing one or more instruments through an inner lumen of the tubular access device into an interior chamber of the heart, and using the instruments to close the septal defect. Devices and methods for closing the septal defect with either sutures or with patch-type devices are disclosed.

公开(公告)号：US06325067B1

公开(公告)日：2001-12-04

申请号：US09482306

申请日：2000-01-12

申请人： Wesley D. Sterman ,  Lawrence C. Siegel ,  Patricia E. Curtis ,  John H. Stevens ,  William S. Peters ,  Timothy R. Machold

发明人： Wesley D. Sterman ,  Lawrence C. Siegel ,  Patricia E. Curtis ,  John H. Stevens ,  William S. Peters ,  Timothy R. Machold

IPC分类号： A61B1900

CPC分类号： A61B17/00234 ,  A61B17/0057 ,  A61B17/0218 ,  A61B17/0467 ,  A61B17/0469 ,  A61B17/06061 ,  A61B17/064 ,  A61B17/068 ,  A61B17/12013 ,  A61B17/122 ,  A61B17/1227 ,  A61B17/1285 ,  A61B17/29 ,  A61B17/2909 ,  A61B17/30 ,  A61B17/3403 ,  A61B18/1442 ,  A61B18/1492 ,  A61B90/50 ,  A61B2017/00053 ,  A61B2017/00243 ,  A61B2017/00247 ,  A61B2017/00575 ,  A61B2017/00637 ,  A61B2017/00663 ,  A61B2017/00867 ,  A61B2017/00907 ,  A61B2017/0243 ,  A61B2017/047 ,  A61B2017/0472 ,  A61B2017/0474 ,  A61B2017/0475 ,  A61B2017/2943 ,  A61B2017/306 ,  A61B2017/3405 ,  A61B2017/3427 ,  A61B2017/3492 ,  A61B2018/00214 ,  A61B2018/00232 ,  A61B2018/00261 ,  A61B2018/00291 ,  A61B2018/00363 ,  A61B2018/00392 ,  A61B2018/00577 ,  A61B2018/00982 ,  A61B2090/064 ,  A61F2/2427 ,  A61M25/0032 ,  A61M25/1011 ,  A61M39/0247 ,  A61M2025/0003 ,  A61M2025/0031 ,  A61M2025/028 ,  A61M2025/1052 ,  A61M2039/0258 ,  A61M2039/0273 ,  A61M2039/0279 ,  A61M2202/047 ,  A61M2205/3344 ,  A61M2205/3355 ,  A61M2205/366 ,  A61M2210/127 ,  A61M2230/005

摘要： A method for closed-chest cardiac surgical intervention relies on viewing the cardiac region through a thoracoscope or other viewing scope and endovascularly partitioning the patient's arterial system at a location within the ascending aorta. The cardiopulmonary bypass and cardioplegia can be induced, and a variety of surgical procedures performed on the stopped heart using percutaneously introduced tools. The method of the present invention will be particularly suitable for forming coronary artery bypass grafts, where an arterial blood source is created using least invasive surgical techniques, and the arterial source is connected to a target location within a coronary artery while the patient is under cardiopulmonary bypass and cardioplegia

摘要翻译： 闭胸心脏外科手术的方法依赖于通过胸腔镜或其他观察范围观察心脏区域，并在升主动脉内的位置血管内划分病人的动脉系统。 可以诱发心肺分流术和心脏停跳症，并使用经皮引入的工具对停止的心脏进行各种手术程序。 本发明的方法将特别适用于形成冠状动脉旁路移植物，其中使用最少侵入性手术技术产生动脉血源，并且当患者处于心肺时，动脉源连接到冠状动脉内的目标位置 旁路和心麻痹

公开(公告)号：US5860992A

公开(公告)日：1999-01-19

申请号：US594869

申请日：1996-01-31

申请人： Sean Christopher Daniel ,  Brian S. Donlon ,  Michi E. Garrison ,  Hanson S. Gifford, III ,  Daniel C. Rosenman ,  William S. Peters ,  Robert L. Lathrop, II ,  George Crothall ,  James B. Mullin ,  Gerald R. Anderson ,  Wiley A. Kittrell

发明人： Sean Christopher Daniel ,  Brian S. Donlon ,  Michi E. Garrison ,  Hanson S. Gifford, III ,  Daniel C. Rosenman ,  William S. Peters ,  Robert L. Lathrop, II ,  George Crothall ,  James B. Mullin ,  Gerald R. Anderson ,  Wiley A. Kittrell

IPC分类号： A61B17/04 ,  A61B17/06 ,  A61F2/24

CPC分类号： A61B17/0491 ,  A61B17/0469 ,  A61B17/062 ,  A61B17/0625 ,  A61B2017/047 ,  A61B2017/0472 ,  A61B2017/061 ,  A61F2/2409

摘要： The invention provides devices and methods for suture placement while performing less invasive surgical procedures within a body cavity. In an exemplary embodiment, the invention provides for the placement of sutures within the heart or a great vessel that is accessed from outside the closed chest. According to one exemplary method, the patient's heart valve is accessed through an intercostal port in the patient's chest. At least one needle having a suture is then directed into the annulus while visualizing through the port placement of the needle into the annulus. The needle is then passed through the annulus.

摘要翻译： 本发明提供了用于缝合放置的装置和方法，同时在体腔内执行较少侵入性的外科手术。 在一个示例性实施例中，本发明提供将缝合线放置在心脏内或从封闭胸部外部进入的大容器中。 根据一种示例性方法，患者的心脏瓣膜通过患者胸部的肋间端口进入。 至少一根具有缝合线的针头然后被引导到环形空间中，同时通过针头插入环形空间的端口可视化。 然后针穿过环。