Abstract: Apparatus for performing a transgastric procedure includes an elongated tubular main access device having the first lumen with open proximal end and a side opening distal end, and a second lumen with open ends. A balloon having a wall on the outside of the device surrounds the distal end and a fluid conduit extends along the device for inflating the balloon so that when the device is inserted into a patient's esophagus and the balloon is inflated, the portion of the esophagus opposite the distal end is isolated from the remainder of the esophagus. The apparatus may also include a side access unit having an elongated flexible coaxial inner and outer tubes having proximal and distal ends and being movable relatively in the axial direction. First seals are mounted to the distal end of the outer tube, and second seals are mounted to the distal end of the inner tube, an actuator adjacent to the proxable ends of the tubes move the tubes relatively so as to vary the axial spacing the first and second seals.

Abstract: A minimally invasive approach implementing the concept of transesophageal access to the heart and surrounding structures is described which allows intra and extra cardiac procedures to be performed while the heart is beating. The technique creates a short, wide and almost straight tubular access to the posterior mediastinum, pericardial space and interior of the heart through a penetration in a segment in the GI tract preferably the esophagus in proximity to a cardiac chamber. The access device isolates the penetration site from the rest of the esophageal lumen and secures the penetration site in the esophageal wall. Other means are used to secure the penetration field in the esophageal wall and prevent micro leakage, including circumferential pressure isolation of the esophageal segment, continuous intra esophageal suction and irrigation, and vacuum negative pressure throughout the procedure.