Pericardium management tool for intra-pericardial surgical procedures

Abstract

Tools for managing the pericardium during intra-pericardial procedures such as the delivery of cardiac support devices. One embodiment of the tool includes a tubular body of low friction material having a diameter, a fixed lip on an exterior end and an extendable lip on an interior end. The extendable lip moves with respect to the body between a retracted state and an expanded state. The tool is inserted through an incision in the pericardium and deployed by moving the lip to the expanded state. When deployed a barrier portion of the body engages the edges of the incision and the extendable lip lines the inside of the pericardium around the incision.

1 . A tool for managing a patient's pericardium during an intra-pericardial procedure, including:
 a tubular body having a diameter and first and second ends;   a lip on one or both of the first and second ends of the body, the lip extendable with respect to the body between a retracted state and an expanded state to form a lip extending from and having a diameter greater than the diameter of the body.   
   
   
       2 . The tool of  claim 1  and further including an actuating member attached to the lip for extending the lip between the retracted and expanded states. 
   
   
       3 . The tool of  claim 2  wherein the actuating member is a hand-actuated member. 
   
   
       4 . The tool of  claim 2  wherein the actuating member includes an elongated wire member attached to the lip and forming a hoop that is movable between a first diameter state and a second, enlarged diameter state, for moving the lip between the retracted and expanded states. 
   
   
       5 . The tool of  claim 4  wherein the actuating member causes the elongated wire to move in a generally lengthwise direction to move the hoop between the first and second diameter states. 
   
   
       6 . The tool of  claim 5  wherein the body and lip include flexible material, and wherein the elongated wire is attached to the flexible material at the lip. 
   
   
       7 . The tool of  claim 1  wherein the body and lip include flexible material. 
   
   
       8 . The tool of  claim 7  wherein the flexible material includes a plurality of strips of material. 
   
   
       9 . The tool of  claim 8  wherein portions of the strips of material overlap at a barrier portion when the lip is in the expanded state. 
   
   
       10 . The tool of  claim 8  wherein portions of the strips of material that form the body are positioned adjacent to one another at a barrier portion when the lip is in the expanded state. 
   
   
       11 . The tool of  claim 10  wherein portions of the strips of material that form the lip fan out from the portions forming the body. 
   
   
       12 . The tool of  claim 11  and further including a hoop on the ends of the strips of material for fanning the portions of the strips of material. 
   
   
       13 . The tool of  claim 12  wherein the lip formed by the hoop and fanned portions of the strips is an external end of the tool. 
   
   
       14 . The tool of  claim 13  and including a second lip on an internal end of the tool. 
   
   
       15 . The tool of  claim 7  wherein the body and lip include a single flexible piece of material. 
   
   
       16 . The tool of  claim 1  wherein the body and lip are formed of flexible material. 
   
   
       17 . The tool of  claim 16  wherein the body and lip are formed of elastic material. 
   
   
       18 . The tool of  claim 1  wherein the body has a relatively low friction interior surface. 
   
   
       19 . The tool of  claim 1  wherein the body and lip are formed of relatively low friction material. 
   
   
       20 . The tool of  claim 18  wherein the body and lip are formed of fluorinated polymer. 
   
   
       21 . The tool of  claim 1  wherein the body includes a plurality of strips of material having adjacent side edges. 
   
   
       22 . The tool of  claim 21  wherein the strips of material include engagement structure for engaging adjacent strips of material. 
   
   
       23 . The tool of clam  22  wherein the engagement structure includes adhesive. 
   
   
       24 . The tool of  claim 21  wherein the strips of material have non-linear side edges. 
   
   
       25 . The tool of  claim 24  wherein the strips of material have concave side edges. 
   
   
       26 . The tool of  claim 21  wherein the strips of material have at least portions that are flexible 
   
   
       27 . The tool of  claim 1  wherein the body includes a polymer member having a lubricious coating. 
   
   
       28 . A retractor for managing a patient's pericardium through an incision in the pericardium to provide access to a pericardial space, including:
 a pair of blades, each having an wall portion for engaging an edge of the pericardium and a lip extending from the wall for engaging the pericardium within the pericardial space; and   an actuating mechanism connected to the blades, for moving the blades between a closed position for insertion into the pericardial space through the incision and an open position into engagement with the pericardium to create an opening into the pericardial space.   
   
   
       29 . The retractor of  claim 28  wherein the wall portions of the blade have a convex surface for engaging the edge of the pericardium. 
   
   
       30 . The retractor of  claim 28  wherein the lips have a convex edge. 
   
   
       31 . The retractor of  claim 28  wherein:
 the wall portions of the blade have a convex surface for engaging the edge of the pericardium; and   the lips have a convex edge.   
   
   
       32 . The retractor of  claim 28  wherein the actuating mechanism includes a pair of handles pivotally connected to one another. 
   
   
       33 . The retractor of  claim 28  wherein the actuating mechanism includes:
 a handle, wherein one of the blades is fixedly mounted to the handle; and   an actuating member movably mounted to the handle, wherein another of the blades is mounted to the actuating mechanism.   
   
   
       34 . A kit for forming a tool to manage a patient's pericardium during intra-pericardial procedures, including a plurality of flexible, lubricious elements that can be inserted into an incision in the pericardium, spaced around an edge of the opening and extended under the pericardium to line the pericardium around the incision. 
   
   
       35 . The kit of  claim 34  wherein the elements are strips of flexible material. 
   
   
       36 . The kit of  claim 34  wherein the elements include structures for attaching adjacent elements to one another.