Abstract: A method and apparatus for facilitating coronary surgery on the beating heart wherein the vagus nerve is electrically stimulated to purposely temporarily stop or substantially reduce the beating of the heart under precisely controlled conditions. The apparatus controllably applies the electrical stimulus to preselected locations along the vagus nerve and thus to preselected nerve branches related to the heart. The apparatus includes several clip and probe configurations for establishing electrical contact with the vagus nerve. Such purposely caused temporary stoppage or substantial reduction of the beating of the heart facilitates procedures such as suturing of an anastomosis which would otherwise be more difficult because of the motion induced by the beating heart.

Abstract: Several embodiments of a clamping device are disclosed, for tightening and securing a purse string suture used to seal the tissue around a cannula or a catheter or the like placed in a heart, major vessel or other tissue structure. The clamping device includes a compressible sleeve means solidly secured at a proximal end to a compression-applying means such as a clamp mechanism. A suture-pulling needle is inserted through a common lumen, whereby the trailing ends of the suture thread which forms the purse string suture may be pulled through the compressible sleeve means and clamp mechanism. Application of a force to the clamp mechanism while it is not locked to the trailing ends compresses the compressible sleeve means. Release of the clamp mechanism locks the enclosed trailing ends of the suture thread. The compressed sleeve means applies constant and precalibrated tension on the purse string suture to continuously maintain the seal about the cannula.

Abstract: An automated stitching device having a "C"-shaped arcuate needle which is incrementally advanced in a circular path. A toggle and drive plate arrangement is used to drive the needle, and a one-way clutch mechanism is used to engage and permit incremental advancement of the needle along its circular path. The "C"-shaped arcuate needle is mounted and driven at the distal end of an elongated shaft. The stitching device is particularly suited for microsurgery, laparoscopic surgery, and various less invasive surgical procedures, and particularly for the suturing of blood vessels including during cardiac bypass surgery.

Abstract: The invention is devices and techniques which use a negative (suction) pressure or vacuum, applied through a surgical instrument, to fix the position of a portion of the surface of a beating heart so that a surgical procedure can be more easily performed. The devices apply a negative pressure at several points on the outer surface of the heart such that a portion of the heart is fixed in place by the suction imposed through the surgical instrument. Because the instrument fixes the position of the tissue, and because the instruments remain at a constant distance from the particular portion of the heart where the surgery is being performed, the device may also serve as a support or platform so that other surgical instruments or devices can be advantageously used at the site.

Abstract: The invention is methods and devices which a surgeon may use to stabilize the beating heart during a surgical procedure on the heart. Pursuant to the invention, a stabilizing device is introduced through an opening in the chest and brought into contact with the beating heart. By contacting the heart with the device and by exerting a stabilizing force on the device, the motion of the heart caused by the contraction of the heart muscles is effectively eliminated such that the heart is stabilized and the site of the surgery moves only minimally if at all. Typically, in separate steps, the surgeon contacts the heart with the stabilizing device, assesses the degree of movement of the anastomosis site, and exerts a force on the stabilizing device such that the contraction of the beating heart causes only minimal excess motion at the surgery site.

Abstract: Devices and methods for minimally invasive harvesting of a vessel, especially the internal mammary artery for coronary artery bypass grafting, are disclosed. Generally, an electrosurgical instrument is provided which has a scissors mechanism or other end effector for dissecting tissue. The instrument also has monopolar or bipolar capabilities. Bipolar blade configurations provide current flow between blades or within each blade of the scissors mechanism or both. The instrument includes at least one ergonomically positioned actuator for actuating movement of the blades or end effectors for cutting tissue, for actuating current flow for cauterizing tissue, or for simultaneously or sequentially actuating movement and current flow. In one embodiment, the actuator is operable by a fingertip. The instrument also has a shaft which extends between the scissor mechanism and a handle portion which may be selectively rotatable or malleable to optimize orientation of the scissor mechanism.

Abstract: The invention comprises a method for performing a coronary artery bypass graft on a beating heart under thoracoscopic visualization without opening the chest wall. At least one small opening is formed in the patient's chest, a target artery for an arterial blood supply is located, instruments are introduced through one or more small openings formed in the patient's chest to prepare the target artery for fluid connection to the coronary artery, and instruments are introduced through one or more small openings formed in the patient's chest to connect the target artery to the coronary artery distal from a stenosis. In a preferred embodiment, a minimal left anterior intercostal thoracotomy provides access to form an anastomosis between the left internal mammary artery (LIMA) and the left anterior descending artery (LAD) while thoracoscopic viewing facilitates harvesting the LIMA.

Abstract: Methods and devices for revascularization of a patient's coronary artery system which obviate the need to place the patient on cardiopulmonary bypass. A method is provided for revascularizing a patient while the-heart is beating, and includes performing at least one minimally invasive coronary artery bypass graft procedure, or other cardiac surgical procedure, and contemporaneously performing at least one catheter-based procedure in at least one coronary artery. The catheter-based procedure(s) may be either therapeutic or diagnostic or both, and may involve delivering at least one catheter to a coronary artery via a surgical or percutaneous opening in the thoracic cavity or via a percutaneous opening at a location peripheral to the thoracic cavity. The catheter-based procedure or procedures is performed contemporaneously with the bypass graft procedure, and specifically prior to, during, or after anesthetizing the patient for purposes of the bypass graft procedure.

Abstract: A surgical instrument is configured to aid in performing a procedure of detaching an internal mammary artery (IMA) and the like, from the connecting tissues and side branch vessels which surround the artery in its native location, wherein the detaching procedure is preliminary to the performing of a coronary artery bypass grafting procedure and wherein the IMA is detached via a minimally invasive thoracotomy. To this end, an elongated slender rod includes a handle at its proximal end and an artery engaging loop, arc, fork configuration, or hook at its distal working end. Embodiments may incorporate electrosurgical capability or electrical insulation. A surgeon thus has means for harvesting an intact and undamaged graft vessel from its native location through a minimally invasive incision with enhanced speed, visibility, and freedom of motion.

Abstract: Surgical instruments and methods for making substantially linear incisions, especially through the wall of vessels, such as arteries, specifically designed for coronary artery bypass graft procedures (CABG) on the beating heart. The invention is particularly useful to create the incision in the artery to which a bypass graft is sewn, typically the left anterior descending artery (LAD). The instruments allow incisions to be rapidly made, precisely measured, and cleanly formed so that a bypass graft can be rapidly sewn in place, without undue trauma to surrounding tissue and excessive loss of blood. In one embodiment, a hand-held instrument has a cutting edge formed on the interior edge of a curved blade fixed near the end of the instrument. The tip of the blade has a point for penetrating the vessel wall which may have several alternate shapes to facilitate penetration of the vessel wall while minimizing trauma to the surrounding tissue.

Abstract: A plurality of embodiments of a distal perfusion device are disclosed, which device facilitates anastomosis constructions by maintaining a dry anastomosis site while simultaneously maintaining blood flow distally in the blood vessel to prevent ischemia and reduce overall patient trauma. The perfusion device is configured for installation into a blood vessel such as a left anterior descending coronary artery through an incision therein, to which is to be grafted a distal end of a blood vessel such as an internal mammary artery. The device includes a central member of selected configuration and material, terminating at either end thereof in respective selectively tapered end members. A lumen extending through the central member and end members, and selected perforations in the end members, maintain blood flow through the perfusion device.

Abstract: An access platform having a first and a second blade interconnected to a spreader member that laterally drives the blades apart or together and support pads interconnected to the first blade. A torsional member is operably interconnected to the first blade and the spreader member and is used to vertically displace the first blade in either direction and, thus, increase a surgeon's working space and visual access for the dissection of an internal mammary artery. A tissue retractor interconnected to the blades is used to draw the soft tissue around an incision away from the surgeon's working area.

Abstract: The invention is devices and techniques which use a negative (suction) pressure or vacuum, applied through a surgical instrument, to fix the position of a portion of the surface of a beating heart so that a surgical procedure can be more easily performed. The devices apply a negative pressure at several points on the outer surface of the heart such that a portion of the heart is fixed in place by the suction imposed through the surgical instrument. Because the instrument fixes the position of the tissue, and because the instruments remain at a constant distance from the particular portion of the heart where the surgery is being performed, the device may also serve as a support or platform so that other surgical instruments or devices can be advantageously used at the site.

Abstract: An automated stitching device having a "C"-shaped arcuate needle which is incrementally advanced in a circular path. A toggle and drive plate arrangement is used to drive the needle, and a one-way clutch mechanism is used to engage and permit incremental advancement of the needle along its circular path. The "C"-shaped arcuate needle is mounted and driven at the distal end of an elongated shaft. The stitching device is particularly suited for microsurgery, laparoscopic surgery, and various less invasive surgical procedures, and particularly for the suturing of blood vessels including during cardiac bypass surgery.

Abstract: The invention comprises a method for facilitating coronary surgery on the beating heart wherein the vagal nerve is electrically stimulated to temporarily stop or substantially reduce the beating of the heart. Such temporary stoppage or substantial reduction of the beating of the heart facilitates procedures such as suturing of an anastomosis which would otherwise be more difficult because of the motion induced by the beating heart.