Method for coronary artery bypass

Abstract

The invention comprises a method for performing a coronary artery bypass graft on a beating heart under thoracoscopic visualization without opening the chest wall. At least one small opening is formed in the patient's chest, a target artery for an arterial blood supply is located, instruments are introduced through one or more small openings formed in the patient's chest to prepare the target artery for fluid connection to the coronary artery, and instruments are introduced through one or more small openings formed in the patient's chest to connect the target artery to the coronary artery distal from a stenosis. In a preferred embodiment, a minimal left anterior intercostal thoracotomy provides access to form an anastomosis between the left internal mammary artery (LIMA) and the left anterior descending artery (LAD) while thoracoscopic viewing facilitates harvesting the LIMA. In other embodiments, access to the patient's heart may be obtained through a trocar sheath or other means for providing percutaneous access to the patient's thoracic cavity without opening the chest wall. Thoracoscopic visualization, depending on the procedure, is used to locate the arterial blood supply, the location of the coronary artery to be bypassed and the location of the occlusion in the artery. In other embodiments, the diagonal (Dx) or circumflex (Cx) arteries may be bypassed.

1 - 4 . (canceled)  
   
   
       5 . A method for forming an anastomosis in a coronary artery of a patient's heart while the patient's heart continues to beat, said method comprising the steps of: 
 inserting at least one trocar into a chest cavity in which the beating heart is contained;    locating a target artery to be used as an arterial blood supply;    separating the target artery from a support base using at least one instrument inserted through the at least one trocar; and    connecting the target artery in fluid communication with the coronary artery to supply blood from the target artery to the coronary artery.    
   
   
       6 . The method of  claim 5 , wherein the target artery is located by viewing through a thoracoscope inserted through one of said at least one trocar.  
   
   
       7 . The method of  claim 5 , wherein said inserting at least one trocar comprises inserting at least two trocars into the chest cavity, and wherein said separating the target artery from a support base comprises inserting at least two instruments through at least two of said at least two trocars to perform said separating.  
   
   
       8 . The method of  claim 5 , wherein said inserting at least one trocar comprises inserting at least two trocars into the chest cavity, and wherein instruments are inserted through at least two of said at least two trocars to perform said connecting the target artery in fluid communication with the coronary artery.  
   
   
       9 . The method of  claim 5 , wherein said inserting at least one trocar comprises inserting at least three trocars into the chest cavity, wherein instruments are inserted through at least two of said at least three trocars to perform at least one of said separating and connecting steps, and wherein a scope is inserted through one of said at least three trocars for viewing within the chest cavity.  
   
   
       10 . The method of  claim 5 , further comprising stabilizing the coronary artery during said connecting step.  
   
   
       11 . The method of  claim 5 , wherein said connecting comprises performing an anastomosis at a location distal to a stenosis in the coronary artery.  
   
   
       12 . A kit for performing a coronary artery bypass graft procedure through at least one small opening in the chest of a patient while the heart remains beating, said kit comprising: 
 means for providing at least one small opening through the chest for access to the heart and chest cavity;    viewing means adapted to be percutaneously introduced through one of said at least one small openings to provide a view inside the chest cavity to a user outside of the chest cavity;    an instrument for performing an anastomosis; and    a stabilizer adapted to stabilize a vessel during performance of the anastomosis while the heart continues to beat.    
   
   
       13 . The kit of  claim 12 , further comprising at least one cutting instrument adapted to dissect a target artery.  
   
   
       14 . The kit of  claim 13 , wherein said cutting instrument is selected from the group consisting of scissors, clip appliers and electrocauteries.  
   
   
       15 . The kit of  claim 12 , further comprising a cutting instrument adapted to form an arteriotomy in a coronary artery downstream of a stenosis.  
   
   
       16 . The kit of  claim 15 , wherein said cutting instrument comprises a scalpel.  
   
   
       17 . The kit of  claim 12 , wherein said means for providing at least one small opening comprises a retractor adapted to be intercostally applied to spread ribs against which it is applied.  
   
   
       18 . The kit of  claim 17 , wherein said retractor is adapted to spread the chest both horizontally and vertically.  
   
   
       19 . The kit of  claim 12 , wherein said means for providing at least one small opening comprises at least one trocar.  
   
   
       20 . A kit for performing a coronary artery bypass graft procedure through at least one small opening in the chest of a patient while the heart remains beating, said kit comprising: 
 a retractor for expanding at least one small opening through the chest for access to the heart and chest cavity;    a thoracoscope adapted to be percutaneously introduced through one of said at least one small openings to provide a view inside the chest cavity to a user outside of the chest cavity;    an instrument for performing an anastomosis; and    a stabilizer adapted to stabilize a vessel during performance of the anastomosis while the heart continues to beat.    
   
   
       21 . A kit for performing a coronary artery bypass graft procedure through at least one small opening in the chest of a patient while the heart remains beating, said kit comprising: 
 at least one trocar for providing access to the heart and chest cavity;    an instrument insertion through one of said trocars and for performing an anastomosis; and    a stabilizer adapted for insertion through one of said trocars and for stabilizing a vessel during performance of the anastomosis while the heart continues to beat.    
   
   
       22 . The kit of  claim 21 , further comprising viewing means adapted to be percutaneously introduced through one of said at least one trocars to provide a view inside the chest cavity to a user outside of the chest cavity.