Abstract:
Devices and methods are provided for temporarily inducing cardio-plegia arrest in the heart of a patient, and for establishing cardiopulmonary bypass in order to facilitate surgical procedures onthe heart and its related blood vessels. Specifically, a catheterbased system is provided for isolating the heart and coronary blood vessels of a patient from the remainder of the arterial system(850), and for infusing a cardio-plegia agent into the patient's coronary arteries to induce cardio-plegia arrest in the heart. The system includes an endo-aortic partitioning catheter (10) having an expandable balloon (11, 161) at its distal end, which is expanded within the ascending aorta (12, 157) to occlude the aortic lumen between the coronary ostia and the brachio-cephalic artery. Means for centering the catheter tip (330) within the ascending aorta include specially curved shaft configurations (1600), eccentric (710) or shaped (792) occlusion balloons (161, 350), and a steerable catheter tip (145) which may be used separately or in combination. The shaft of the catheter may have a coaxial (106) or multilumen (602) construction.
Abstract:
A catheter system is provided for accessing the coronary ostia (176, 180) transluminal from a peripheral arterial access site, such as the femoral artery, and for inducing cardioplegia arrest by direct infusion of cardioplegia solution into the coronary arteries. In a first embodiment, the catheter system is in the form of a single perfusion catheter (20) with multiple distal branches (24, 26, 28) for engaging the coronary ostia (176, 180). In a second embodiment, multiple perfusion catheters (82, 84) are delivered to the coronary ostia (176, 180) through a single arterial cannula (104). In a third embodiment, multiple perfusion catheters (112, 114, 116) are delivered to the coronary ostia (176, 180) through a single guiding catheter (126). In a fourth embodiment, multiple catheters (140, 142, 144) are delivered to the coronary ostia (176, 180) through a single guiding catheter (130) which has distal exit ports (134, 136, 138) that are arranged to direct the perfusion catheters into the coronary ostia (176, 180). In each embodiment, the catheters (20) are equipped with an occlusion means (30, 50) at the distal end of the catheter (20) for closing the coronary ostia (176, 180), and isolating the coronary arteries from the systemic blood flow.
Abstract:
Devices, systems, and methods are provided for accessing the interior of the heart, and performing procedures therein while the heart is beating. A tubular access device (22) is positioned through an intercostal space and through a muscular wall of the heart. The access device (22) includes a balloon or flange for sealing (32) the penetration to prevent leakage of blood. An obturator (52) is positionable in the access device, and includes cutting means (60) located at its distal end. Elongated instruments are introduced through the access device to perform surgical procedures including septal device repair, ablation, and electrophysiological mapping.
Abstract:
A flexible, length-adjustable suture organizer coupled to a retractor having a number of flexible straps. The straps are tensioned to retract tissue while the suture organizer is used to retain sutures extending through an opening created by the retractor. The retractor includes a holder which retains the suture organizer.
Abstract:
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 (24) within the heart (H) 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 (56) in the patient's chest. At least, one needle (26) having a suture (24) is then directed into the annulus while visualizing through the port placement (56) of the needle into the annulus. The needle (26) is then passed through the annulus.
Abstract:
Systems and methods are disclosed for performing less invasive surgical procedures within the heart. A method for less invasive repair or replacement of a cardiac valve (216) comprises placing an instrument (290) through an intercostal access port (212) and through a penetration in a wall of a vessel in communication with the heart, advancing the instrument (290) into the heart, using the instrument (290) to perform a surgical intervention on a cardiac valve (216) in the heart under visualization through an intercostal access port. The surgeons hands are kept outside of the chest during each step. The surgical intervention may comprise replacing the cardiac valve with a prosthetic valve, wherein the native valve is removed using a tissue removal instrument (206), the native valve annulus is sized with a specialized sizing device (216), a prosthetic valve is introduced through an intercostal access port (212) and through the penetration in the vessel, and the prosthetic valve is secured at the native valve position, all using instruments positioned through intercostal access ports without placing the hands inside the chest. Systems and devices for performing these procedures are also disclosed.
Abstract:
This invention is a system for inducing cardio-plegia arrest and performing an endovascular procedure within the heart or blood vessels of a patient. An endo-aortic partitioning catheter (10) has an inflatable balloon (11) which occludes the ascending aorta (12) when inflated. Cardio-plegia fluid may be infused through a lumen of the endo-aortic partitioning catheter (39) to stop the heart while the patient's circulatory system is supported on cardiopulmonary bypass. One or more endovascular devices (500) are introduced through an internal lumen (40) of the endo-aortic partitioning catheter (30) to perform a diagnostic or therapeutic endovascular procedure within the heart or blood vessels of the patient. Surgical procedures such as coronary artery bypass surgery or heart valve replacement may be performed in conjunction with the endovascular procedure while the heart is stopped. Embodiments of the system are described for performing, e.g., fiberoptic angioscopy of structures within the heart and its blood vessels, and valvuloplasty for correction of valvular stenosis.