Surgical instruments and procedures for stabilizing the beating heart during coronary artery bypass graft surgery

Abstract

The invention is methods and devices which a surgeon may use to stabilize 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 means, assesses the degree of movement of the anastomosis site, and exerts a force on the stabilizing means such that the contraction of the beating heart causes only minimal excess motion at the surgery site. By fixing the position of the stabilizing means in a configuration where the motion of the beating heart is effectively eliminated, the surgeon is able to stabilize the beating heart for the duration of the procedure. The stabilizing means may be attached to a rigid support or may be attached to a semi-rigid support which is rendered motionless mechanically, chemically, or by human intervention. In certain preferred embodiments, the stabilizing means is affixed to a semi-rigid support which is caused to become rigid, by any of a variety of techniques, such that the position of the stabilizing means becomes fixed by the support, and the heart remains substantially motionless for the duration of the procedure.

1 . A method to stabilize the beating heart comprising the steps of: 
 contacting at least one section of the beating heart with a stabilizing means, exerting a force on the stabilizing means.    
     
     
         2 . The method of  claim 1  wherein the at least one section of the beating heart is the target artery of an anastomosis.  
     
     
         3 . The method of  claim 1  wherein the stabilizing means is comprised of two substantially planar contact members.  
     
     
         4 . The method of  claim 2  wherein the contact members further comprise a friction means on a bottom surface of the contact member.  
     
     
         5 . The method of  claim 1  further comprises attaching the stabilizing means to a fixed support to maintain the stabilizing force while an anastomosis is completed.  
     
     
         6 . The method of  claim 5  wherein the stable support is a surgical rib retractor.  
     
     
         7 . A method to install a coronary artery bypass graft from a source artery to a target coronary artery while the heart is beating comprising the steps of: 
 1) providing an access space to the beating heart by a surgical procedure selected from the group consisting of a thoracotomy and a sternotomy,    2) introducing a stabilizing means through the access space,    3) contacting the surface of the beating heart proximate to the target artery at an anastomosis with a stabilizing means,    4) exerting a stabilizing force on the beating heart by positioning the stabilizing means,    5) restricting blood flow through the target artery while allowing the heart to continue to beat,    6) sewing an anastomosis to the target artery,    7) re-establishing blood flow through the target artery.    
     
     
         8 . A device for use in a cardiovascular surgery on the beating heart comprising: 
 a means for stabilizing the beating heart comprising contact members shaped to engage the surface of the beating heart, said contact members attached to a shaft means.    
     
     
         9 . The device of  claim 8  further comprising means for anchoring said shaft means to a stable support.  
     
     
         10 . The device of  claim 9  further comprising friction means on the bottom surface of said contact members.  
     
     
         11 . The device of  claim 10  wherein said shaft means is comprised of a rigid shaft having a push block affixed at the end thereof, wherein said push block engages a ball joint proximate to said contact members device.  
     
     
         12 . The device of  claim 11  wherein said rigid shaft is operably connected to a fixture at the proximal end of the device.  
     
     
         13 . The device of  claim 8  wherein said shaft means is further comprised at a telescope release mechanism surrounding a housing.  
     
     
         14 . The device of  claim 8  wherein said contact member has a frame, a spring mechanism, and a frame extension operably connected to said frame and said spring mechanism.  
     
     
         15 . The device of  claim 8  wherein said shaft means is connected to a single contact member.  
     
     
         16 . The device of  claim 8  comprising a pair of shaft means interconnected by a pivot at an intermediate point of said shaft means.  
     
     
         17 . The device of  claim 8  wherein said shaft means is adjustable along its length by continuous positioning of a first portion of said shaft means which engages a second portion and moves slidably in relation thereto.  
     
     
         18 . The device of  claim 17  wherein said shaft means is further comprised of a spring mechanism disposed between said first and second portions of said shaft means and wherein said spring mechanism surrounds a rigid shaft connected to one of said first and second shaft members.  
     
     
         19 . A device for use in cardiac surgery comprising: 
 means for stabilizing the beating heart comprising a sheath member having support attachments positioned along its length.    
     
     
         20 . The device of  claim 19  wherein the support attachments are inflatable.  
     
     
         21 . The device of  claim 20  wherein the sheath member has at least one lumen connected to said inflatable support attachments.  
     
     
         22 . The device of  claim 19  in combination with a rib retractor wherein a portion of said sheath member is attached to said retractor.