Abstract: In accordance with the present invention, there is disclosed surgical methods and apparatus for accessing and stabilizing the heart. The methods and apparatus facilitate access to an anastomosis site, allows various instruments or devices to be maneuvered and secured in place, and provide stabilization of the heart. The apparatus may involve a tissue stabilizer, and in particular a tissue stabilizer for use in immobilizing or stabilizing a portion of the beating heart using a compressive force delivered to the heart via the tissue stabilizer. The stabilizer may include a stabilizer base and a shaft. The shaft may be secured within an appropriate instrument mount preferably fixed to a retractor or other stable platform as disclosed herein. The stabilizers of the present invention provide improved access to a surgical site at a target vessel on the surface of the heart and may include features which facilitate optimal presentation of the target vessel.

Abstract: In accordance with the present invention, there is disclosed surgical methods and apparatus for accessing and stabilizing the heart. The methods and apparatus facilitate access to an anastomosis site, allows various instruments or devices to be maneuvered and secured in place, and provide stabilization of the heart. The apparatus may involve a tissue stabilizer, and in particular a tissue stabilizer for use in immobilizing or stabilizing a portion of the beating heart using a compressive force delivered to the heart via the tissue stabilizer. The stabilizer may include a stabilizer base and a shaft. The shaft may be secured within an appropriate instrument mount preferably fixed to a retractor or other stable platform as disclosed herein. The stabilizers of the present invention provide improved access to a surgical site at a target vessel on the surface of the heart and may include features which facilitate optimal presentation of the target vessel.

Abstract: An improved surgical clip and clip applicator for placing a surgical clip over a target structure. The surgical clip generally has a pair of opposing clamp arms, each having an associated clamping surface, and a connecting portion joining the clamp arms and biasing them to a normally closed position. The surgical clip may be opened and locked into the open position prior to being loaded into a clip applicator or the surgical clip may be opened by a clip applicator itself. The surgical clip and clip applicators require reduced actuation forces and simplified applicator mechanisms.

Abstract: A device for occlusion of a body passageway and subsequent perfusion of the body passageway with arterial return blood, cardioplegia and other fluid is disclosed. The device of the present invention is an expandable cannula comprising a flexible, expandable tubular elongate body having a first diameter and a second diameter, wherein the expandable cannula is inserted having a first diameter and then expanded to a second diameter to provide perfusion flow to the body passageway through at least one arterial return aperture provided on the distal end of the expandable tubular elongate body in fluid communication with a perfusion lumen provided within the cannula. The device may be further provided with one or more additional lumens for providing additional functions to the vessel lumen and may also include an expandable occluding member fixed at the distal end of the cannula for isolating the surgical area from the rest of the arterial system.

Abstract: The present invention relates to a vascular clamp assembly. The vascular clamp assembly includes at least one bendable elongated shaft with a proximal part and distal part. A pair of clamping members are located at the distal part of the shaft. The clamp includes means for moving the clamping members between an open position and a clamping position.

Abstract: A cannula for draining blood from a patient's heart during cardiac surgery including a main body and a pair of branches extending distally therefrom. The branches are biased to extend away from one another by pre-shaped stiffening elements, and have "D" shaped cross-sections defining flat surfaces oriented generally towards one another. The branches may be constrained in a retracted position, the flat surfaces abutting one another, and the resulting profile forming a substantially continuous extension of the main body. The branches have distal tips including drainage holes and occlusion balloons, and elbow portions including accordion-like ridges for preventing kinking. Grooves in the flat surfaces define a secondary lumen in the retracted position through which a cardioplegia delivery or an imaging device may be advanced. The cannula is directed into a trocar to constrain the branches in the retracted position, and the trocar is inserted into the right atrium.

Abstract: An improved method and apparatus for occluding a blood vessel is shown and described. A cannula adapted for insertion through a wall of a blood vessel is provided with an expandable member on a distal end which when expanded, substantially fills a cross-sectional annular area of the lumen of the blood vessel. An external clamp is coupled to the cannula and aligned with the expandable member, such that when the clamp is engaged, it moves the annular region of the blood vessel into contact with the inflatable member, the inflatable member and clamp thereby working in cooperation to occlude the blood vessel. The cannula may further be provided with a plurality of lumens extending through the cannula to corresponding openings in a distal end of the cannula, thereby allowing the perfusion of different fluids into the lumen of the blood vessel, both upstream and downstream of the internal occluding member, as well as the venting of fluid from the lumen of the blood vessel.

Abstract: The present invention relates to a vascular clamp assembly. The vascular clamp assembly includes at least one bendable elongated shaft with a proximal part and distal part. A pair of clamping members are located at the distal part of the shaft. The clamp includes means for moving the clamping members between an open position and a clamping position.

Abstract: This invention is methods and devices for stabilizing the beating heart during a surgical procedure on the heart. Pursuant to the invention, a stabilizing device is introduced through an opening in the chest and brought into contact with the beating heart. By contacting the heart with the device and by exerting a stabilizing force on the device, the motion of the heart caused by the contraction of the heart muscles is effectively eliminated such that the heart is stabilized and the site of the surgery moves only minimally if at all. Typically, in separate steps, the surgeon contacts the heart with the stabilizing device, assesses the degree of movement of the anastomosis site, and exerts a force on the stabilizing device such that the contraction of the beating heart causes only minimal excess motion at the surgery site.

Abstract: Devices and methods for minimally invasive harvesting of a vessel, especially the saphenous vein for coronary artery bypass grafting, are disclosed which facilitate a minimally invasive vessel harvesting procedure. Generally, an instrument is provided which facilitates introduction of vessel harvesting tools through a minimally invasive incision, and provides the capability to separate the vessel from surrounding tissue while minimizing trauma to the patient and preserving the patency of the vessel. The instrument includes a mechanism for separating the vessel from surrounding tissue and may also include mechanisms for severing side branches from the vessel during the harvesting procedure. In one embodiment, an integrated vessel harvesting assembly is provided which may rotate around a vessel and provides a unitary mechanism for separating the vessel from surrounding tissue and for severing the side branches.

Abstract: A low profile unobtrusive occluder device is disclosed which is particularly applicable for occluding blood vessels in minimally invasive beating heart CABG surgical procedures, wherein relatively small surgical openings are provided. At least one flexible member is provided on the occluder, which is placed against the vessel. A suture thread is passed under the vessel to encompass the vessel between the occluder and suture thread. The suture thread is selectively attached to the occluder such that the flexible member, when deformed, applies continuous selected tension on the suture thread to apply a corresponding compression on the vessel which occludes the flow of blood. An applicator is attached to the occluder to enable installation thereof, but is detachable after installation such that only the low profile occluder remains on the heart surface during surgery. The applicator is re-attached to the occluder to facilitate removal of the latter.

Abstract: An access platform having a first and a second blade interconnected to a spreader member that laterally drives the blades apart or together and a sternal pad interconnected to a blade. The superior blade is pivotally coupled to the spreader member such that it naturally rises as the blades are separated. Alternatively, a vertical displacement member is operably interconnected to a blade and the spreader member and is used to vertically displace the interconnected superior blade and, thus, increase a surgeon's working space and visual access for the dissection of an internal mammary artery. A tissue retractor is interconnected to the blades to draw the soft tissue around an incision away from the surgeon's working area.

Abstract: The present invention relates to an integrated cannula and vascular clamp assembly. The integrated cannula and vascular clamp assembly includes a pair of clamping members made of a physiologically acceptable material that are pivotally coupled to a cannula for movement between an open position for at least partially surrounding a portion of a blood vessel section to be occluded and a clamping position for compressing the blood vessel with pressure sufficient to occlude blood flow through the section.

Abstract: A method and apparatus for facilitating coronary surgery on the beating heart wherein the vagus nerve is electrically stimulated to purposely temporarily stop or substantially reduce the beating of the heart under precisely controlled conditions. The apparatus controllably applies the electrical stimulus to preselected locations along the vagus nerve and thus to preselected nerve branches related to the heart. The apparatus includes several clip and probe configurations for establishing electrical contact with the vagus nerve. Such purposely caused temporary stoppage or substantial reduction of the beating of the heart facilitates procedures such as suturing of an anastomosis which would otherwise be more difficult because of the motion induced by the beating heart.

Abstract: Several embodiments of a clamping device are disclosed, for tightening and securing a purse string suture used to seal the tissue around a cannula or a catheter or the like placed in a heart, major vessel or other tissue structure. The clamping device includes a compressible sleeve means solidly secured at a proximal end to a compression-applying means such as a clamp mechanism. A suture-pulling needle is inserted through a common lumen, whereby the trailing ends of the suture thread which forms the purse string suture may be pulled through the compressible sleeve means and clamp mechanism. Application of a force to the clamp mechanism while it is not locked to the trailing ends compresses the compressible sleeve means. Release of the clamp mechanism locks the enclosed trailing ends of the suture thread. The compressed sleeve means applies constant and precalibrated tension on the purse string suture to continuously maintain the seal about the cannula.

Abstract: An automatic purse string suture device is disclosed that enables a surgeon to install a purse string suture in tissue structures, particularly for sealing the tissue about a cannula. The device is particularly suited for minimally invasive cardiothoracic procedures and is comprised of an applicator having an elongated structure with protrusions extending from the distal edge thereof. Also provided are means for advancing a needle through a passage to pass a suture through tissue that has been conformed to the distal edge of the device. Various means for conforming the tissue to the distal edge are disclosed as are methods for using the device to facilitate cardiothoracic surgery.