Abstract: Surgical methods and instruments are disclosed for performing port-access or closed-chest coronary artery bypass (CABG) surgery in multivessel coronary artery disease. In contrast to standard open-chest CABG surgery, which requires a median sternotomy or other gross thoracotomy to expose the patient's heart, port-access CABG surgery is performed through small incisions or access ports made through the intercostal spaces between the patient's ribs, resulting in greatly reduced pain and morbidity to the patient. In situ arterial bypass grafts, such as the internal mammary arteries and/or the right gastroepiploic artery, are prepared for grafting by thoracoscopic or laparoscopic takedown techniques. Free grafts, such as a saphenous vein graft or a free arterial graft, can be used to augment the in situ arterial grafts. The graft vessels are anastomosed to the coronary arteries under direct visualization through a cardioscopic microscope inserted through an intercostal access port.

Abstract: A method of treatment of congestive heart failure comprises the steps of introducing an aortic occlusion catheter through a patient's peripheral artery, the aortic occlusion catheter having an occluding member movable from a collapsed position to an expanded position; positioning the occluding member in the patient's ascending aorta; moving the occluding member from the collapsed shape to the expanded shape after the positioning step; introducing cardioplegic fluid into the patient's coronary blood vessels to arrest the patient's heart; maintaining circulation of oxygenated blood through the patient's arterial system; and reshaping an outer wall of the patient's heart while the heart is arrested so as to reduce the transverse dimension of the left ventricle.

Abstract: An apparatus for minimizing the risk of air embolism includes an instrument delivery member 2 having a gas outlet 38 for delivering gas into a patient's thoracic cavity. The gas is directed across an opening 48 in the instrument delivery member 2 to help retain the gas in the patient's thoracic cavity. The gas is preferably carbon dioxide which is more soluble in blood than air which will thereby decrease the likelihood of the patient receiving an embolism due to trapped air in the patient's heart and great vessels after surgery.

Abstract: An apparatus for minimizing the risk of air embolism includes an instrument delivery member 2 having a gas outlet 38 for delivering gas into a patient's thoracic cavity. The gas is directed across an opening 48 in the instrument delivery member 2 to help retain the gas in the patient's thoracic cavity. The gas is preferably carbon dioxide which is more soluble in blood than air which will thereby decrease the likelihood of the patient receiving an embolism due to trapped air in the patient's heart and great vessels after surgery.

Abstract: Devices and methods are provided for temporarily inducing cardioplegic arrest in the heart of a patient and for establishing cardiopulmonary bypass in order to facilitate surgical procedures on the heart and its related blood vessels. Specifically, a catheter based system is provided for isolating the heart and coronary blood vessels of a patient from the remainder of the arterial system and for infusing a cardioplegic agent into the patient's coronary arteries to induce cardioplegic arrest in the heart. The system includes an endoaortic partitioning catheter having an expandable balloon at its distal end which is expanded within the ascending aorta to occlude the aortic lumen between the coronary ostia and the brachiocephalic artery. Means for centering the catheter tip within the ascending aorta include specially curved shaft configurations, eccentric or shaped occlusion balloons and a steerable catheter tip, which may be used separately or in combination.

Abstract: A device for minimizing displacements of the heart when performing a beating heart surgical procedure including two heart engaging members. The heart engaging members are slidably coupled to a retractor. The heart engaging members may be rotated and extended as necessary to reach the target site on the patient's heart. The heart engaging members have curved distal ends which are configured to engage a coronary shunt positioned in the coronary artery. A suture extends around the coronary and is coupled to the heart engaging members.

Abstract: A device for minimizing displacements of the heart when performing a beating heart surgical procedure including two heart engaging members. The heart engaging members are slidably coupled to a retractor. The heart engaging members may be rotated and extended as necessary to reach the target site on the patient's heart. The heart engaging members have curved distal ends which are configured to engage a coronary shunt positioned in the coronary artery. A suture extends around the coronary and is coupled to the heart engaging members.

Abstract: A method of treatment of congestive heart failure comprises the steps of introducing an aortic occlusion catheter through a patient's peripheral artery, the aortic occlusion catheter having an occluding member movable from a collapsed position to an expanded position; positioning the occluding member in the patient's ascending aorta; moving the occluding member from the collapsed shape to the expanded shape after the positioning step; introducing cardioplegic fluid into the patient's coronary blood vessels to arrest the patient's heart; maintaining circulation of oxygenated blood through the patient's arterial system; and reshaping an outer wall of the patient's heart while the heart is arrested so as to reduce the transverse dimension of the left ventricle.

Abstract: A device for minimizing displacements of the heart when performing a beating heart surgical procedure including two heart engaging members. The heart engaging members are slidably coupled to a retractor. The heart engaging members may be rotated and extended as necessary to reach the target site on the patient's heart. The heart engaging members have curved distal ends which are configured to engage a coronary shunt positioned in the coronary artery. A suture extends around the coronary and is coupled to the heart engaging members.

Abstract: An aortic occlusion catheter has a blood return lumen for returning oxygenated blood to a patient and an occluding member for occluding the patient's ascending aorta. The blood return lumen has openings on both sides of the occluding member for infusing oxygenated blood on both sides of the occluding member.

Abstract: Systems and methods are disclosed for performing less-invasive surgical procedures within the heart. A method for less-invasive repair or replacement of a cardiac valve comprises placing an instrument through an intercostal access port and through a penetration in a wall of a vessel in communication with the heart, advancing the instrument into the heart, and using the instrument to perform a surgical intervention on a cardiac valve in the heart under visualization through an intercostal access port. The surgeons hands are kept outside of the chest during each step.

Abstract: Devices and methods are provided for less-invasive surgical treatment of cardiac valves whereby the need for a gross thoracotomy or median sternotomy is eliminated. In one aspect of the invention, a delivery system for a cardiac valve prosthesis such as an annuloplasty ring or prosthetic valve includes an elongated handle configured to extend into the heart through an intercostal space from outside of the chest cavity, and a prosthesis holder attached to the handle for releasably holding a prosthesis. The prosthesis holder is attached to the handle in such a way that the holder, prosthesis and handle have a profile with a height smaller than the width of an intercostal space when the adjacent ribs are unretracted, preferably less than about 30 mm.

Abstract: A method and device for introduction of a catheter and/or delivering a fluid, such as oxygenated blood, to a patient's vascular system includes a cannula having an expandable portion. The expandable portion is movable from a collapsed position to an expanded position. The expandable portion is inserted into the patient in the collapsed position which facilitates introduction and advancement of the cannula through the patient's blood vessel. After introduction into the patient, the expandable portion is moved to the expanded position. The expandable portion protects the blood vessel against fluid forces when flowing a fluid through the cannula and protects the vessel from contact with the catheter advanced through the cannula.

Abstract: The invention provides devices and methods for suture placement while performing less invasive surgical procedures within a body cavity. In an exemplary embodiment, the invention provides for the placement of sutures within the heart or a great vessel that is accessed from outside the closed chest. According to one exemplary method, the patient's heart valve is accessed through an intercostal port in the patient's chest. At least one needle having a suture is then directed into the annulus while visualizing through the port placement of the needle into the annulus. The needle is then passed through the annulus.

Abstract: An apparatus for minimizing the risk of air embolism includes an instrument delivery member 2 having a gas outlet 38 for delivering gas into a patient's thoracic cavity. The gas is directed across an opening 48 in the instrument delivery member 2 to help retain the gas in the patient's thoracic cavity. The gas is preferably carbon dioxide which is more soluble in blood than air which will thereby decrease the likelihood of the patient receiving an embolism due to trapped air in the patient's heart and great vessels after surgery.

Abstract: Devices and methods are provided for temporarily inducing cardioplegic arrest in the heart of a patient and for establishing cardiopulmonary bypass in order to facilitate surgical procedures on the heart and its related blood vessels. Specifically, a catheter based system is provided for isolating the heart and coronary blood vessels of a patient from the remainder of the arterial system and for infusing a cardioplegic agent into the patient's coronary arteries to induce cardioplegic arrest in the heart. The system includes an endoaortic partitioning catheter having an expandable balloon at its distal end which is expanded within the ascending aorta to occlude the aortic lumen between the coronary ostia and the brachiocephalic artery. Means for centering the catheter tip within the ascending aorta include specially curved shaft configurations, eccentric or shaped occlusion balloons and a steerable catheter tip, which may be used separately or in combination.

Abstract: A coronary shunt for occluding both sides of an anastomosis site and providing a blood flow path across the anastomosis site. The shunt includes two occluding members sized and configured to occlude the coronary artery. A tether is attached to the coronary shunt and is used to remove the coronary shunt from the coronary artery before completing the anastomosis.

Abstract: An aortic occlusion catheter has a blood return lumen for returning oxygenated blood to a patient and an occluding member for occluding the patient's ascending aorta. The blood return lumen has openings on both sides of the occluding member for infusing oxygenated blood on both sides of the occluding member.

Abstract: A deployable clamp for clamping a patient's ascending aorta between the coronary arteries and the brachiocephalic artery. The clamp is detachably mounted to the distal end of an elongated clamp positioner and is manipulated and actuated from the proximal end of the clamp positioner at a location outside of the patient's thoracic cavity. When actuated, the clamp blocks blood flow through the ascending aorta.

Abstract: The invention provides a percutaneous visualization system for direct, stereoscopic visualization of a body cavity during minimally-invasive surgical procedures. The visualization system includes a cannula having a distal end, a proximal end, and a passage extending therebetween. The passage is configured to allow stereoscopic vision therethrough, and is preferably tapered from the proximal end to the distal end. A sleeve is positionable in the passage of the cannula, the sleeve having an optical passage also configured to allow stereoscopic vision, preferably by tapering. A lens may be disposed in the optical passage of the sleeve tier wide-angle viewing. Magnification means may be positioned in optical alignment with the optical passage to provide a magnified image of a surgical site.