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 system for preparing a graft vessel for anastomosis includes one or more tools held within a functional package having at least one recess. An anastomosis tool or portion thereof may be held in at least one recess. An anastomosis device is connected to the anastomosis tool. At least one recess is shaped and sized to hold an amount of biocompatible fluid sufficient to immerse the anastomosis device.

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: An anastomosis device includes a deployable section that may be connected to a discard section. The deployable section may be configured to expand in two substantially orthogonal directions during deployment. The deployable section may include a ring that includes one or more expandable elements.

Abstract: A system for preparing a graft vessel for anastomosis includes one or more tools held within a functional package. The package includes a tray and tray top, either or both of which may include one or more features configured to hold the contents of the tray securely therein, and/or may include one or more registration features configured to register one or more items in a desired position in the tray. The package has multiple recesses for holding one or more tools for preparing a graft vessel for anastomosis, and can be sealed and sterilized along with its contents. One of these tools may be a poke-through tool that includes a plurality of membranes within a shell.

Abstract: A tool for removing at least one tissue plug from the wall of at least one tubular tissue structure may include a cutter and a piercing member positioned within the cutter, where the piercing member and cutter are configured to translate together, as well as an impulse source operationally connected to the cutter and the piercing member.

Abstract: An integrated anastomosis tool both creates an opening in a side wall of a target blood vessel and performs an anastomosis procedure to connect a graft vessel to a side of the target blood vessel with a single integrated tool. The integrated anastomosis tool includes a cutting device, a graft vessel attachment device, an introducer, and a tool body. In each of the embodiments of the anastomosis tool, the advancement paths of a cutting device and a graft vessel attachment device cross, intersect, or align so that both the cutting device and the graft vessel attachment device can be operated by a single tool at the same intended anastomosis site in a sequential manner. The anastomosis procedure can be performed on a pressurized vessel since there is no need to interchange tools during the procedure.

Abstract: An piercing member is axially fixed to and positioned within a cutter, both of which are components of a stand-alone tool for creating an opening in the wall of a tubular tissue structure. The stand-alone tool includes an impulse source connected to the piercing member and to the cutter. An actuator is operationally connected to the impulse source, where the actuator causes the impulse source to release energy to and provide an impulse to the piercing member and the cutter. The tool may be configured to make multiple openings in the tissue of the same patient. Where the tool is configured to make multiple openings in the tissue of the same patient, the tool allows the piercing member and cutter to be moved back to an initial pre-deployment position after each use.

Abstract: A tissue punch for creating a hole in the wall of a target blood vessel for receiving an anastomosis device includes a piercing element for penetrating the tissue and a cutting element for cutting a plug of tissue around the pierced hole. The tissue punch includes a trocar for inserting the piercing element. After punching is complete, the piercing element is removed from the trocar through a side wall of the trocar so that a medical device can be deployed through the trocar lumen. The tissue punch may also include a tissue trap for trapping the plug of tissue.

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 system for performing anastomosis between a graft vessel and a target vessel includes a tissue effector that may be configured to deploy a user-selectable number of connectors. The system includes an anvil that enters the wall of the target vessel through an entry hole that is spaced apart from the anastomosis site, and at least one anvil entry hole sealer may be utilized to substantially seal the anvil entry hole upon withdrawal of the anvil. The system may include a shield and a cutter, both of which are movable relative to the anvil, where the shield is configured to protect the graft vessel from the cutter. The cutter may include an incising element movable from a stowed position to an active position.

Abstract: An anastomosis system for connecting a graft vessel to a target vessel includes an elongated anvil arm for insertion into the target vessel. The anvil arm includes a contact surface that contacts the inner surface of the wall of the target vessel. The anvil arm includes a channel through which a cutting element translates, and a opening that extends between the channel and the contact surface of the anvil arm. The cutting element is translated along the channel, and is controlled to extend through the opening and make an incision in the wall of the target vessel at a selected location. The incision is made at a location spaced apart from the penetration site at which the anvil arm is inserted into the target vessel, resulting in a tissue bridge between the incision and the penetration site.

Abstract: A method for performing anastomosis between a graft vessel and a target vessel with an integrated anastomosis tool may include actuating at least one control on the integrated anastomosis tool to create an opening in the target vessel and complete an anastomosis with the target vessel. Another method for performing anastomosis may include creating an opening in intact tissue of the target vessel with an integrated anastomosis tool; and deploying an anastomosis device with the integrated anastomosis tool. The anastomosis may be performed with an anastomosis device, such as an anastomosis device having a deployable section detachable from a discard section.

Abstract: A tissue punch for creating a hole in the wall of a target blood vessel for receiving an anastomosis device includes a piercing element for penetrating the tissue and a cutting element for cutting a plug of tissue around the pierced hole. The tissue punch includes a trocar for inserting the piercing element. After punching is complete, the piercing element is removed from the trocar through a side wall of the trocar so that a medical device can be deployed through the trocar lumen. The tissue punch may also include a tissue trap for trapping the plug of tissue.

Abstract: A medical device which can be implanted at a target site in a living body. The device includes an inner flange formed by radial expansion of the device and an outer flange formed by axial compression of the device. The device can include an implant portion and a discard portion which separate from each other during formation of the outer flange. The separation can occur by fracturing a frangible linkage or by mechanically separating a portion of the outer flange from a deployment tool. The device can be a one piece anastomosis device for connecting a graft vessel to a target vessel without the use of conventional sutures. The inner and outer flanges capture the edges of an opening in a target vessel and secure the graft vessel to the opening in the target vessel. The device greatly increases the speed with which anastomosis can be performed over known suturing methods.

Abstract: A single integrated tool is used both to create an opening in a vessel wall and deploy an anastomosis device into that opening, thereby simplifying an anastomosis procedure such as a coronary artery bypass graft procedure. The creation of the opening and deployment of the anastomosis device may be actuated with a single control.

Abstract: A single integrated tool is used both to create an opening in a vessel wall and deploy an anastomosis device into that opening, thereby simplifying an anastomosis procedure such as a coronary artery bypass graft procedure. The creation of the opening and deployment of the anastomosis device may be actuated with a single control.

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 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 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.