Abstract: A retractor and a surgical tool are positioned within a cannula, and a dissection cradle of the retractor is positioned at the distal end of the cannula. The retractor includes a first portion with an axis approximately parallel to the axis of the cannula and a second portion with an axis skewed relative to the axis of the cannula. The dissection cradle is located at the distal end of the second portion of the retractor, and may include two substantially parallel, spaced legs with the retractor shaped in a loop between and in a plane skewed relative to the axes of the legs, and with the loop directed away from the surgical tool. Thus, in operation, when the surgeon locates a vessel and side branch of interest, the surgeon extends the retractor to cradle the vessel in the dissection cradle. Once cradled, the retractor may be fully extended to urge the vessel away from the axis of the cannula to isolate the side branch for exposure to the surgical tool.

Abstract: Endoscopic subxiphoid surgical procedures and instruments facilitate translumination of tissue through the pericardium, and promote encircling an intrapericardial region with one or more tissue-ablating probes for ablating cardiac tissue substantially encircling the left and right pulmonary veins as a treatment for chronic atrial fibrillation. Such endoscopic subxiphoid surgical procedures and instruments also facilitate placement of epicardial tacks about the annulus of the mitral valve for supporting a tensioned suture or band that decreases the size of the mitral annulus to repair a regurgitant valve. Suction-oriented instruments facilitate temporary attachment to an organ to establish precise positioning on the organ during a surgical procedure.

Abstract: Apparatus and method for performing surgical procedures within the mediastinum and within the pericardium include an endoscopic cannula having at least one lumen, a transparent tip, and an endoscope for introduction into the mediastinum and optionally into the pericardium via a single subxiphoid incision. A cavity may be initially dilated for advancing the endoscopic cannula using a dilating tool have an inner cannula and an outer expansible sheath that exerts a lateral-expansive, tissue-dilating force against the surrounding tissue cavity to allow the larger endoscopic cannula to be introduced into the mediastinum. Other surgical instruments, including a pericardial entry instrument are positioned through a lumen of the endoscopic cannula to cut a flap of the pericardium and create a small opening through which other surgical instruments such as an ablation probe or a restraining jacket may be introduced.

Abstract: A method of providing access to tissue for a surgical instrument through a body wall is provided. The method includes providing an expandable retractor having a flexible sheath, the retractor being in a collapsed state; introducing the retractor into the body and placing the retractor adjacent the tissue; expanding the retractor; deploying the flexible sheath by engaging the flexible sheath with a tool and driving the flexible sheath through the body wall with the tool; and inserting the surgical instrument from outside the body through the flexible sheath to provide access to the tissue by the surgical instrument.

Abstract: A flexible locking arm for use in an organ manipulator apparatus. The flexible locking arm has a flexible state, used to position the organ manipulator as needed, and a fixed state for mounting the manipulator in a desired orientation. Even in the fixed state, the organ manipulator maintains a limited freedom of movement, to allow the organ held to continue to move substantially according to its natural motion during functioning. For example, in an embodiment where a suction member exerts suction to retract a beating heart and suspend it in a retracted position during surgery by setting the flexible arm to the fixed state, as the retracted heart beats, a complaint joint allows it to expand and contract freely (and otherwise move naturally) at least in the vertical direction so that hemodynamic function is not substantially compromised.

Abstract: Apparatus and method for dilation of tissue utilize a tissue expansion device positioned on an inner cannula with an outer overlying expansive sheath that expands upon translation of the tissue expansion device therethrough. The tissue expansion device may be an olive or wedge formed near the tip of the cannula, and the expansible sheath includes two elongated shells that are fixably attached near proximal ends, and that are resiliently connected near distal ends. Translating the tissue expansion device through the expansible sheath expands the dimension of the shells to provide even dilation of surrounding tissue. Additionally, tissue dilation is performed in one continuous motion of retracting the inner cannula through the expansible sheath or pushing the tissue expansion device through the expansible sheath. The outer expansible sheath may be removed from the inner cannula to provide a dissection instrument having minimal outer diameter.

Abstract: A method of cooling an organ. A portion of a body fluid bathing an organ is withdrawn while a cool fluid is infused. A separate portion of the body fluid can be cooled during the withdrawing. A volume of up to about 5% of the body fluid can be withdrawn. A catheter is provided with a cooling mechanism to contact and cool the body fluid. The catheter can have an inlet port to withdraw body fluid and an outlet port to allow infusion of a cool fluid. Additionally, an organ cooling pump assembly is provided including a pump and a catheter.

Abstract: An apparatus for tissue dissection and instrument anchoring, including a dissection balloon having a viewing window (preferably a rigid, transparent window) at its distal end, or including an anchoring or dissection balloon having nonuniform elasticity selected to achieve desired inflated shape and pressure characteristics, and methods for using such apparatus. The window, which can be a lens (such as a wide angle lens), is transparent and either rigid or non-rigid but sufficiently strong to retain a desired optical shape while (and after) being pushed against tissue layers by a rigid instrument deployed within the balloon. In preferred embodiments, the balloon is a long-necked dissection balloon deployed through a cannula.

Abstract: Apparatus and surgical methods establish temporary suction attachment to a target site on the surface of a bodily organ for enhancing accurate placement of a surgical instrument maintained in alignment with the suction attachment. A suction port on the distal end of a supporting cannula provides suction attachment to facilitate accurate positioning of a needle for injection penetration of tissue at the target site of for anchoring a cardiac electrode on the moving surface of a beating heart. Force applied via the suction attachment to the surface of the heart selectively distorts the surface of the myocardium for angularly orienting and accurately positioning a surgical instrument or cardiac electrode thereon.

Abstract: Apparatus and surgical methods establish temporary suction attachment to a target site on the surface of a bodily organ for enhancing accurate placement of a surgical instrument maintained in alignment with the suction attachment. A suction port on the distal end of a supporting cannula provides suction attachment to facilitate accurate positioning of a needle for injection penetration of tissue at the target site on the moving surface of a beating heart. Force applied via the suction attachment to the surface of the heart promotes perpendicular orientation of the surface of the myocardium for enhanced accuracy of placement of a surgical instrument thereon.

Abstract: A method of cooling an organ. A portion of a body fluid bathing an organ is withdrawn while a cool fluid is infused. A separate portion of the body fluid can be cooled during the withdrawing. A volume of up to about 5% of the body fluid can be withdrawn. A catheter is provided with a cooling mechanism to contact and cool the body fluid. The catheter can have an inlet port to withdraw body fluid and an outlet port to allow infusion of a cool fluid. Additionally, an organ cooling pump assembly is provided including a pump and a catheter.

Abstract: A valve assembly. The valve assembly can include valve members with passageways partially non-overlapping. A compression member can be, provided adjacent the valve members. The valve assembly can be incorporated into a medical access device.

Abstract: Apparatus and method for dilation of tissue utilize a tissue expansion device positioned on an inner cannula with an outer overlying expansive sheath that expands upon translation of the tissue expansion device therethrough. The tissue expansion device may be an olive or wedge formed near the tip of the cannula, and the expansible sheath includes two elongated shells that are fixably attached near proximal ends, and that are resiliently connected near distal ends. Translating the tissue expansion device through the expansible sheath expands the dimension of the shells to provide even dilation of surrounding tissue. Additionally, tissue dilation is performed in one continuous motion of retracting the inner cannula through the expansible sheath or pushing the tissue expansion device through the expansible sheath. The outer expansible sheath may be removed from the inner cannula to provide a dissection instrument having minimal outer diameter.

Abstract: A system for releasing a graft within vasculature that incorporates graft bindings severed by current-generated heat in a resistive wire element. In one aspect, the graft is held by bindings threaded through a resistive wire loop formed between conducting wires attached to opposite ends of a high resistive wire element. When an external current source is applied to the conducting wires, heat generated in the resistive wire element causes the bindings to sever, thereby allowing the graft to be released within vasculature.

Abstract: An inflatable retraction apparatus is provided for retracing an organ inside a body to gain access to an adjacent tissue. The apparatus includes an able chamber formed from a single thin envelope, and capable of being collapsed for insertion through an incision and being expanded to a predetermined shape for retracing the organ. An inflation mechanism is adapted to selectively inflate the chamber to the predetermined shape. The inflation mechanism includes at least one inflation tube attached to the inflatable chamber in fluid communication theretween, and an inflatable maintaining lattice operatively enveloping the inflatable chamber and in operative association with the inflation mechanism.

Abstract: Forming a proximal anastomosis on an aortic wall includes method and instrumentation and apparatus for forming an aortic puncture and inserting a fluid-impervious sealing element with a lateral flange and central stem into the vessel through the puncture. An anastomosis of a graft vessel over the puncture is partially completed with the central stem of the sealing element protruding through the partial anastomosis. A removal instrument attaches to the central stem and retrieves the sealing element that disassembles in helical disassociation of the flange and stem into a continuous strand that is withdrawn from the partial anastomosis prior to completion of the procedure.

Abstract: Apparatus and methods for using the apparatus are disclosed for cardiac restraint. More specifically, the apparatus and methods are directed to accessing the pericardium, accessing the heart within the pericardium, and restraining the heart by at least partially enclosing the heart with the apparatus. An embodiment of a cardiac restraint apparatus according to the present invention comprises a jacket, the jacket having a rim which defines an opening for receiving a heart. The apparatus also comprises a knot pusher that has a hollow elongate body, as well as a strand that extends around the rim of the jacket and is tied into a slipknot. The strand is positioned such that at least one end portion of the strand extends through the knot pusher such that a distal end of the knot pusher can be moved into engagement with the slipknot, whereby pulling the end portion of the strand away from the heart while pushing the knot pusher against the slipknot and reducing the diameter of the opening defined by the rim.

Abstract: A retractor and a surgical tool are positioned within a cannula, and a dissection cradle of the retractor is positioned at the distal end of the cannula. The retractor includes a first portion with an axis approximately parallel to the axis of the cannula and a second portion with an axis skewed relative to the axis of the cannula. The dissection cradle is located at the distal end of the second portion of the retractor, and may include two substantially parallel, spaced legs with the retractor shaped in a loop between and in a plane skewed relative to the axes of the legs, and with the loop directed away from the surgical tool. Thus, in operation, when the surgeon locates a vessel and side branch of interest, the surgeon extends the retractor to cradle the vessel in the dissection cradle. Once cradled, the retractor may be fully extended to urge the vessel away from the axis of the cannula to isolate the side branch for exposure to the surgical tool.

Abstract: An organ manipulator including at least one suction member or adhesive disc mounted to a compliant joint, a flexible locking arm for mounting such suction member or compliant joint, and a method for retracting and suspending an organ in a retracted position using suction (or adhesive force) so that the organ is free to move normally (e.g., to beat or undergo other limited-amplitude motion) in at least the vertical direction during both steps. In preferred embodiments, a suction member exerts suction to retract a beating heart and suspend it in a retracted position during surgery. As the retracted heart beats, the compliant joint allows it to expand and contract freely (and otherwise move naturally) at least in the vertical direction so that hemodynamic function is not compromised. The suction member conforms or can be conformed to the organ anatomy, and its inner surface is preferably smooth and lined with absorbent material to improve traction without causing trauma to the organ.

Abstract: A cannula includes a tubular body having proximal closed end and distal blunt end, at least one lumen extending the length of the body, an endoscope having a lighted, viewing end disposed in the lumen near the distal end of the body, and a transparent, tissue separating member substantially covering the distal end of the body. The tissue separating member has a blunt tip disposed from and of the end distal to the body. A method of using such a cannula separates tissue to form an elongated cavity along the course of a small blood vessel and subsequently harvesting the blood vessel.