Minimally invasive cardiac surgery procedure

Abstract

A minimally invasive approach for surgery on portions of the heart and great vessels. A parasternal incision is made extending across a predetermined number of costal cartilages, e.g., a right parasternal incision extending from the lower edge of the second costal cartilage to the superior edge of the fifth costal cartilage. One or more costal cartilages, e.g., the third and fourth, are then excised to provide access to the portion of the heart or great vessels of interest, for example between a point approximately three centimeters above supra annular ridge and the mid ventricular cavity, and a desired procedure completed. A minimally invasive procedure for repair or replacement of the aortic valve is disclosed that includes making a transverse incision of about 10 cm in length over the second or third intercostal space in the thorax of the patient, dividing the sternum transversely following the incision, retracting the transversely divided sternum, exposing the ascending aorta, and incising the ascending aorta to provide access to an area adjacent the aortic valve.

1 - 19 . (canceled)  
   
   
       20 . A surgical retractor for use in performing minimally invasive cardiac surgery through an incision approximately 5 to 10 cm in length, wherein said incision enables direct access to the heart and is confined to a substantially rectangular area on the chest and wherein said rectangular area extends approximately two inches on either side of the sternum and from no higher than the first intercostal space at the top to the sixth intercostal space at the bottom, said retractor comprising: 
 an elongated, malleable portion of material having a distal end, a middle portion and a proximal end;    said distal end configured to have an angled planar edge portion for holding heart tissue away form a surgical site in said incision and to thereby decrease any visual obstruction to the surgeon of said surgical site.    
   
   
       21 . A surgical retractor as set forth in  claim 20 , wherein said retractor is a hand held retractor.  
   
   
       22 . A surgical retractor as set forth in  claim 20 , wherein said retractor is attachable to a incision retracting platform.  
   
   
       23 . A surgical retractor as set forth in  claim 20 , wherein said distal end of said retractor is rounded so as to minimize trauma to tissue during use of said retractor.  
   
   
       24 . A surgical retractor as set forth in  claim 20 , wherein said middle portion is substantially perpendicular to said planar portion.  
   
   
       25 . A surgical retractor as set forth in  claim 24 , wherein said distal end is shorter in length than said middle portion.  
   
   
       26 . A surgical retractor for use in performing minimally invasive cardiac surgery through an incision approximately 5 to 10 cm in length, wherein said incision enables direct access to the heart and is confined to a substantially rectangular area on the chest and wherein said rectagular area extends approximately two inches on either side of the sternum and from no higher than the first intercostal space at the top to the sixth intercostal space at the bottom, said retractor comprising: 
 a substantially circular, radially compressible ring for placement in a chamber of the heart through said incision;    said ring having sufficient resiliency in the radial direction to hold resected tissue of a heart chamber away from a surgical site.    
   
   
       27 . A surgical retractor as set forth in  claim 26 , wherein said retractor has a substantially constant cross-sectional diameter.  
   
   
       28 . A surgical retractor as set forth in  claim 26 , wherein said retractor has a substantially constant diameter.  
   
   
       29 . A surgical retractor as set forth in  claim 26 , wherein said retractor is sized to be placed within a space between a mitral valve and a left atrial wall of a patient undergoing heart surgery.  
   
   
       30 . A kit of surgical instruments for use in performing minimally invasive cardiac surgery trough an incision approximately 5 to 10 cm in length, wherein said incision enables direct access to the heart and is confined to a substantially rectangular area on the chest and wherein said rectangular area extends approximately two inches on either side of the sternum and from no higher than the first intercostal space at the top to the sixth intercostal space at the bottom, said instrument comprising: 
 a retrograde cardioplegia cannula for introduction into the coronary sinus through a peripheral vein such that said cannula is not visible through said approximately 5 to 10 cm incision;    an aortic occluding balloon cannula for introduction through the sub-clavian artery such that said cannula is not visible through said approximately 5 to 10 cm incision;    an arterial return cannula and a venous return cannula for introduction intraluminally into the arterial and venous system, respectively, such that said cannulae are not visible through said approximately 5 to 10 cm incision;    a malleable elongated retractor for holding resected tissue away from a surgical site in said approximately 10 cm incision such that visual obstruction to the surgeon is minimized; and,    a substantially circular, radially compressible retractor insertable into said approximately 5 to 10 cm incision for holding resected tissue of a heart chamber.    
   
   
       31 . A kit set forth in  claim 30 , wherein said elongated retractor has a distal end, a middle portion and a proximal end.  
   
   
       32 . A kit as set forth in  claim 31 , wherein said distal end is configured to have an angled planar edge portion for holding heart tissue away from a surgical site in said incision and to thereby decrease any visual obstruction to the surgeon of said surgical site.  
   
   
       33 . A kit as set forth in  claim 31  wherein said distal end of said elongated retractor is rounded so as to minimize trauma to tissue during use of said retractor.  
   
   
       34 . A kit as set forth in  claim 32 , wherein said middle portion of said elongated retractor is substantially perpendicular to said planar portion.  
   
   
       35 . A kit as set forth in  claim 32 , wherein said distal end of said elongated retractor is shorter in length than said middle portion.  
   
   
       36 . A kit as set forth in  claim 30 , wherein said circular retractor has sufficient resiliency in the radial direction to hold resected tissue of a heart chamber allay from a surgical site.  
   
   
       37 . A kit as set forth in  claim 30 , wherein said circular reactor has a substantially constant cross-sectional diameter.  
   
   
       38 . A kit as set forth in  claim 30 , wherein said circular retractor has a substantially constant diameter.  
   
   
       39 . A kit as set forth in  claim 30 , wherein said retractor is sized to be placed within a space between a mitral valve and a left atrial wall of a patient undergoing heart surgery.