Abstract: Methods, devices and systems for forming magnetic anastomoses between two blood vessels. A first anastomotic component is removably supported by the distal end of a delivery device for attachment to a first vessel. The delivery device also supports a second anastomotic component that has been secured to a second blood vessel. The device is operated to secure the first component to the first vessel, couple the second component to the first component, and then release the components to complete the anastomosis. A robotic anastomosis system includes several robotic instruments that may be positioned through ports in a patient, used to secure an anastomotic component to a vessel, and then used to magnetically couple the components. Delivery devices for deploying magnetic anastomotic components include an actuator that uses magnetic repulsion to move the components into engagement with the inner and outer surfaces of the vessel wall.

Abstract: Tissue connector assemblies having at least two piercing members, each releaseably coupled to a surgical fastener such as a surgical clip. A flexible member such as a suture may be used to couple one or both piercing members to respective ends of the fastener.

Abstract: Surgical connection apparatus comprises a support having a proximal portion with a distal end and a proximal portion. The support forms a pathway between the proximal and distal portions. A plurality of self-closing clips are slidably disposed in the pathway and a pusher is arranged to slidably move in the pathway and push the clips in a distal direction. The apparatus facilitates partial ejection of a clip after which the remainder of the clip is withdrawn therefrom. In one embodiment, the support comprises a tubular needle with the distal end being pointed. The needle can be used to penetrate the tissue or material to be joined and to manipulate or approximate tissue or material to be joined before the clip is partially ejected.

Abstract: System, device and method for ablating target tissue adjacent pulmonary veins of a patient through an incision. An ablation device can include a hinge including a cam assembly, a moving arm, a floating jaw, and a lower jaw. Fingers can engage the floating jaw to hold the floating jaw in a first position with respect to the moving arm. Some embodiments of the invention can provide an ablation device including a central support, an upper four-bar linkage coupled to the central support, an upper jaw coupled to the upper linkage, a lower four-bar linkage coupled to the central support, and a lower jaw coupled to the lower linkage. Some embodiments of the invention can provide an ablation device having an upper jaw including a first cannula connection and a lower jaw including a second cannula connection. The system can include a first catheter coupled to the first cannula connection and a second catheter coupled to the second cannula connection.

Abstract: Methods and devices for perfusing a blood vessel during the entire course of an end-to-side or end-to-end anastomosis procedure. One method can be used to form an end-to-side anastomosis of a saphenous vein graft to a coronary artery during an off-pump, beating heart, coronary artery bypass graft. In this example, the distal end of an elongate tube carrying a saphenous vein graft is advanced into an arteriotomy distal to an occlusion in the coronary artery. Perfusing blood flow is provided through the tube to the coronary artery, the vein graft is advanced over the tube to the arteriotomy and sutured completely to the coronary artery. The elongate tube can be retracted through the now secured vein graft, and the coronary artery supplied again from the proximal end of the vein graft. Some tubular devices include a reversibly expandable distal region, to form a seal between the inserted tube and the coronary artery being perfused, to prevent blood flow into the surgical field.

Abstract: Methods and devices for forming a lesion in a target tissue having a cavity within. A first RF electrode and a second RF electrode can be coupled to opposite poles of an RF current source. The second electrode can be inserted into the tissue cavity and expanded to contact the target tissue from within. The first electrode can be externally disposed against the target tissue while applying RF current between the first and second electrodes to ablate the target tissue. Some methods are directed to ablating tribiculated atrial wall tissue to treat atrial fibrillation. The second electrode can contact the tribiculated tissue directly from within to provide a direct path between the two electrodes. In some methods, the second electrode is inserted through an incision made to remove an atrial appendage. The methods can provide deeper, narrower lesions relative to those made using remote, indifferent electrodes.

Abstract: A valve holder for a prosthetic valve having a stent with a stent base and multiple commissure posts projecting from the stent base, the valve holder including a central base portion, a plurality of legs radially extending from the central base portion, each leg comprising a first prong portion spaced from a second prong portion by a gap distance, a plurality of commissure post engaging members, wherein one commissure post engaging member is slideably engaged with each of the plurality of legs, and a handle extending from the central base portion.

Abstract: An anatomic space of the body, particularly the pericardial space, is accessed in a minimally invasive manner from a skin incision by an access instrument to facilitate visualization and introduction of devices or drugs or other materials, performance of medical and surgical procedures, and introducing and fixating a cardiac lead electrode to the heart. An elongated access instrument body preferentially bends in one direction and resists bending in a transverse direction, whereby the access instrument body distal end can be directed through a path around body structures to the anatomic site by manipulation of the access instrument body proximal end portion. A distal header formed at the access instrument body distal end extends outward of the access instrument body in the transverse direction and supports an inflatable balloon surrounding a working lumen exit port that is directed toward an anatomic surface when the balloon is inflated by inflation media introduced through an inflation lumen.

Abstract: A folding device used to fold a cardiac valve is disclosed. Also shown are methods and system for holding and delivering a cardiac valve during implantation. The folding device facilitates folding either a stented or unstented prosthetic valve prior to insertion into a valve annulus. A delivery system is provided to allow a user to measure the patient annulus to select the prosthetic valve size and insert a folded prosthetic valve into a target site. Methods for using the folding device and delivery system are also disclosed.

Abstract: A disposable, integrated extracorporeal blood circuit employed during cardiopulmonary bypass surgery performs gas exchange, heat transfer, and microemboli filtering functions in a way as to conserve volume, to reduce setup and change out times, to eliminate a venous blood reservoir, and to substantially reduce blood-air interface. Blood from the patient or prime solution is routed through an air removal device that is equipped with air sensors for detection of air. An active air removal controller removes detected air from blood in the air removal device. A disposable circuit support module is used to mount the components of the disposable, integrated extracorporeal blood circuit in close proximity and in a desirable spatial relationship to optimize priming and use of the disposable, integrated extracorporeal blood circuit. A reusable circuit holder supports the disposable circuit support module in relation to a prime solution source, the active air removal controller and other components.

Abstract: A system and method for creating lesions and assessing their completeness or transmurality. Assessment of transmurality of a lesion is accomplished by monitoring the depolarization signal in a local electrogram taken using electrodes located adjacent the tissue to be ablated. Following onset of application of ablation energy to heart tissue, the local electrogram is measured with electrodes located adjacent tissue to be ablated so that the ablation energy to ablation elements can be selectively reduced or terminated when transmurality is detected.

Abstract: A suction assisted ablation device having a support surface, suction elements disposed adjacent the support surface, at least one electrode and at least one suction conduit is provided. The device may further include fluid openings, which allow fluid to irrigate target tissue and aid in ablation. A method for ablating tissue using suction is also provided.

Abstract: Tissue stabilizers including a clamp assembly, a turret assembly, an articulating arm having a tension element extending therethrough, a collet assembly and a head-link assembly are disclosed. Methods of stabilizing tissue are also disclosed.

Abstract: An electrocautery device is disclosed. In accordance with one aspect of the invention, the electrocautery electrode/tip is provided with a hollow, conductive tube terminating at its distal end in a ball point type tip. Fluid, preferably conductive fluid, is applied to the proximal end of the hollow electrode/tip, and expelled from the distal end thereof during electrocautery. The ball point distal tip allows the distal tip to be directly applied to the tissue and “rolled” or slid along the tissue. This allows the distal tip to be moved across the tissue without dragging or snagging on the tissue. In addition, the conductive fluid expelled from the distal tip further lubricates the distal tip as it moves across the tissue. If conductive fluid is used, the conductive fluid emanating from the electrode/tip conducts the RF electrocautery energy away from the distal tip so that it is primarily the fluid, rather than the distal tip that actually accomplishes the cauterizing of tissue.

Abstract: The present invention is an assembly comprising a prosthetic valve to be implanted; a radially expandable stent comprising at least one zone intended to be expanded to allow the stent, in the expanded state, to bear against the wall of the body duct to be fitted with the valve, this bearing making it possible to immobilize this stent with respect to this wall; and means for mounting the valve with respect to the stent, making it possible to connect the valve to the stent in such a way that the placement of the stent allows the valve to be mounted in the body duct, and expansion means such as a balloon catheter being provided to trigger expansion of the stent at the implantation site. According to the invention, the valve and the stent are designed in such a way that, at the moment when the stent is expanded, the valve is situated outside the zone or zones of the stent that are subjected to said expansion means.

Abstract: A fixation band has a tubular frame and a tube, wherein the tubular frame comprises longitudinally-extending members having a hook on its distal end and fixation means on its proximal end. The tubular frame preferably comprises a laterally-extending member for stabilization. The tube is positioned inside longitudinally-extending members and a sewing cuff is formed in the tube distal to the distalmost end of the longitudinally-extending members. A standard prosthetic valve can be secured to the fixation band by suturing the prosthetic valve's sewing cuff to the fixation band's sewing cuff and the prosthetic valve can be advanced to a valve seat. By pulling the tubular frame proximally, the hooks pass into surrounding tissue so that the fixation band and prosthetic valve are fixed against proximal movement. The fixation means then secure the fixation band to the surrounding tissue so that the prosthetic valve is fixed against distal movement.

Abstract: A tissue connector assembly comprising a clip movable between an open configuration and a closed configuration and a mechanical restraining device attached to the clip for restraining the clip in its open configuration. A needle may be releasably attached to the clip. A method for connecting tissues is also disclosed. The method includes inserting a clip through tissue with the clip being biased in an open position by a restraining device secured to the clip, and removing the restraining device from the clip.

Abstract: The invention provides a system and method for harvesting a vessel section. The system includes an endoscope, at least one harvesting tool, and an elongated instrument including a shaft and a housing. The shaft includes a viewable region along a length of the shaft and a lumen to slidably receive the endoscope. The housing is releasably engaged with the shaft and includes an elongated opening to provide a working area adjacent to a vessel for the harvesting tool. The method includes making an incision at a point corresponding to the proximal end of the vessel section to be harvested. A shaft is inserted through the incision and adjacent to the vessel section. A housing is slidably engaged with the inserted shaft. Harvesting operations are performed in a working area defined by sidewalls of the housing. The harvesting operations are visually monitored through the shaft.

Abstract: Method and apparatus for ablating target tissue adjacent pulmonary veins of a patient. A clamping ablation tool can include an upper arm having an upper neck, a link assembly, and an upper actuator. The link assembly can include a distal electrode and a proximal electrode. The clamping ablation tool can include a lower arm that mates with the upper arm. The lower arm can include a lower neck, a distal jaw, and a lower actuator. The distal jaw can include a jaw electrode, and the lower actuator can control movement of the distal jaw.

Abstract: Method and apparatus for ablating target tissue adjacent pulmonary veins of a patient. The ablation device can include a lower jaw assembly including a proximal jaw having a proximal electrode and a distal jaw having a distal electrode, and an upper jaw assembly including an upper jaw having an upper electrode. A proximal actuator can be movable between a first position in which the proximal jaw is open and a second position in which the proximal jaw is clamped with respect to the upper jaw. A distal actuator can be movable between a third position in which the distal jaw is open and a fourth position in which the distal jaw is clamped with respect to the upper jaw.