Abstract: Anastomotic stents for connecting a graft vessel to a target vessel, and methods of use thereof. The anastomotic stents of the invention are suitable for use in a variety of anastomosis procedures, including coronary artery bypass grafting. One embodiment of the invention comprises a large vessel anastomotic stent for use with large diameter target vessels such as the aorta or its major side branches. Another embodiment of the invention comprises a small vessel anastomotic stent for use on a target vessel which has a small diameter such as a coronary artery. Another aspect of the invention involves applicators for use with the stents of the invention.

Abstract: An anastomosis system and method uses an anvil to control and support a tissue site during an anastomosis procedure. The anvil is particularly useful for supporting a wall of a coronary artery during attachment of a graft vessel to the coronary artery because the wall of the coronary artery is very thin, difficult to grasp, and susceptible to tearing. In one method, the anvil is inserted into a pressurized or unpressurized target vessel and is pulled against an inner wall of the target vessel causing tenting of the thin tissue of the vessel wall. A graft vessel is then advanced to the anastomosis site and an end of the graft vessel is positioned adjacent and exterior of the target vessel. Staples are inserted through the tissue of the graft vessel and the target vessel by pivoting the arms of a staple holder towards the anvil. When the ends of the staples engage staple bending features on the anvil, the ends of the staples bend over securing the graft vessel and target vessel together.

Abstract: A device for everting an end of a hollow tissue structure may include a mandrel and a collar proximal to the mandrel. The mandrel may be elastomeric and deformable. At least one of the collar and the mandrel may be movable relative to the other. Deformation of the mandrel everts the end of the hollow tissue structure.

Abstract: The anastomosis device according to the present invention is a one piece device for connecting a graft vessel to a target vessel without the use of conventional sutures. The anastomosis device includes a frame for receiving and holding the end of a graft vessel in an everted position and first and second spreading members configured to be inserted into an opening in the target vessel. The first and second spreading members are arranged substantially in a plane for insertion into an opening in a target vessel, and are moved away from one another to capture the edges of the opening in the target vessel securing the graft vessel to the target vessel. One version of the anastomosis device includes a plurality of linkages arranged in two rows for grasping opposite sides of an opening in the target vessel. A portion of the linkages fold outward to trap vessel walls on opposite sides of the opening in the target vessel.

Abstract: An anastomosis device may include an outer loop and an inner loop connected to and substantially concentric with the inner loop. The outer loop and the inner loop may be connected by at least one hinge. At least one of the outer loop and the inner loop may be movable relative to the other along an axis defined by at least one hinge.

Abstract: An everter and threadthrough system useful for attaching a graft vessel to a anastomosis device which can be used to attach a graft vessel to a target vessel without the use of conventional sutures. The threadthrough system engages an end of the graft vessel and pulls the graft vessel through a deployment tool until a portion of the graft vessel extends beyond a distal end of the anastomosis device mounted on the deployment tool. The everter includes a spreading mechanism which expands the end of the graft vessel and folds the expanded end over the anastomosis device. In the case where the anastomosis device includes barbs, the everter can effect penetration of the graft vessel by the barbs. Once the graft vessel is everted over the anastomosis device, the deployment tool can be used to attach the graft vessel to a target vessel.

Abstract: A minimally-invasive coronary artery bypass graft procedure may be performed with a splittable proximal anastomosis tool. A distal anastomosis tool may be used as well, where that distal anastomosis tool may include a staple holder having two spaced-apart arms, staples detachably held by the staple holder, and an anvil connected to the staple holder.

Abstract: A tool used in the performance of an anastomosis procedure between a graft vessel and a target vessel, where that anastomosis procedure utilizes at least one surgical tool, may include an access system that has a port and a seal connected to the port. The seal may substantially prevent loss of fluid from the target vessel.

Abstract: A method for connecting a graft vessel to a target vessel, each vessel having a wall surrounding a lumen, may include providing a connector holder, associating an end of the graft vessel with the connector holder, positioning the connector holder outside of the lumen of the target vessel, outside the lumen of the graft vessel, and in proximity to the outer surface of the wall of the target vessel, and actuating the connector holder to secure the end of the graft vessel to the side of the target vessel.

Abstract: An apparatus for performing anastomosis between a graft vessel and a target vessel may include a trocar that may create an opening in the target vessel. At least part of the trocar may be expandable to allow an anastomosis device to pass through the distal end thereof. The apparatus may include a holder configured to hold the anastomosis device, and place and deploy the anastomosis device in the opening created by the trocar.

Abstract: A method of performing anastomosis includes securing an access port system to an exterior surface of the target vessel to assist in axial alignment, depth registration, and/or sealing when inserting instruments such as punching instruments and anastomosis instruments into the target vessel.

Abstract: An anastomosis tool may include a connector holder connected to an anvil. The connector holder may be bifurcated and configured to straddle the graft vessel. The connector holder may be generally U-shaped. The connector holder may be shaped to extend around more than half of the circumference of the graft vessel.

Abstract: A trocar useful for forming an incision in a target vessel for placement of an anastomosis device which may have an inner flange formed by radial expansion of the device and an outer flange formed by axial compression of the device. The trocar can have a smaller size during formation of the incision and a larger size when retracted over a deployment tool used to deploy the anastomosis device.

Abstract: A method for anastomosing a first vessel to a second vessel may include connecting an end of the first vessel to the side of the second vessel and creating an opening in the wall of the second vessel from within the lumen of the second vessel, where that opening allows fluid communication between the lumen of the first vessel and the lumen of the second vessel.

Abstract: A coronary artery bypass graft procedure is performed through one or more openings made in the patient to create a point of entry to the thoracic cavity. A vein measurement device measures the distance between the proximal and distal anastomotic sites for each graft. A proximal anastomosis tool splits to release a graft vessel after deploying an anastomosis device at the proximal anastomosis site. The tool may be articulated. An integrated stabilizer stabilizes one or more tools relative to the surface of the beating heart at a distal anastomotic site. A distal anastomotic tool may be provided as part of the integrated stabilizer, and connects one end of the graft vessel to a target vessel. An epicardial dissector may be provided as part of the integrated stabilizer, and dissects the epicardium from the target vessel at a distal anastomotic site, as needed.

Abstract: An anastomosis system for connecting a graft vessel to a target vessel includes spaced-apart arms, and an anvil connected to those arms, where that anvil has a blunt distal end. The anvil is insertable into the target vessel. One or more connectors, such as staples, may be deployed from each arm to connect the graft vessel to the target vessel.

Abstract: An apparatus for performing anastomosis between a graft vessel and a target vessel may include a connector holder having spaced-apart arms, and a member connected to the connector holder, where the member is insertable through an opening in a wall of the target vessel at least partially into the lumen of the target vessel. One or more connectors, such as staples, may be deployed from each arm to connect the graft vessel to the target vessel. One or more connectors may be deformable against the member.

Abstract: An anastomosis device may include a central region, and at least one projection connected to the distal end of the central region, where at least one projection is foldable in at least the proximal direction. An anastomosis device may include a central region, and an inner flange connected to the distal end of the central region, the inner flange deployable from a first position to an expanded position, where the inner flange includes at least one substantially triangular inner flange element.

Abstract: An anastomosis device may include at least one first element connectible to at least one second element, where at least one first element is frangible. At least one second element may include at least one opening therethrough, where each opening receives a corresponding first element. At least one deflectable tab may extend into at least one opening to engage a corresponding first element.

Abstract: An anastomosis device is a one piece device for connecting a graft vessel to a target vessel without the use of conventional sutures. The anastomosis device includes an expandable tube configured to have a graft vessel secured to the tube. The device has an expandable linkage positioned at one end of the device and expansion of this linkage causes a first radially extending flange to fold outward. This first flange abuts an interior wall of a target vessel and a second flange is formed which abuts an exterior wall of the target vessel trapping the target vessel between the two flanges and secures the end of the graft vessel into an opening in the wall of the target vessel. The device greatly increases the speed with which anastomosis can be performed over known suturing methods and allows anastomosis to be performed in tight spaces.