Abstract: An apparatus for performing transmyocardial revascularization provides a closed-chest formation of a channel in a wall of a heart. An articulating scope in one embodiment includes a flexible distal portion which provides for a coupling of a surface of the heart to the distal portion. The articulating distal portion is coupled to a control member to provide articulation. Movement of the control member causes deflection, including articulation, of the generally flexible working end of the scope. The coupler may be a two way valve to provide both vacuum and flushing solutions. The articulating scope can be supported by a scope holder that is table mounted or mounted to the patient. An access port provides for the introduction of tools and instruments. An adaptor couples the access port with a handle. The handle provides a working channel for the introduction of an energy delivery device.

Abstract: A TMR energy delivery device is introduced through a first minimally invasive penetration of a patient's chest. Sufficient energy if delivered from the wave guide to the wall of the heart to form a channel through at least a portion of the wall. The device includes a visualization device or camera with a rigid portion and a distal end portion that is flexible, a cup member coupled to a distal end of the flexible distal portion, and a vacuum source coupled to the cup member for providing mechanical stability against the heart wall.