Methods, systems, and apparatus for performing minimally invasive coronary artery bypass graft surgery

Abstract

A system for performing vascular surgery includes a first retractor blade and a second retractor blade and a fulcrum device. The first retractor blade includes a first grasping bar, and the second retractor blade comprises a second grasping bar. The first retractor blade and the second retractor blade are adapted to engage opposing edges of a subcostal incision in a patient. The fulcrum device includes a first fulcrum slot and a second fulcrum slot formed through opposing edges of the fulcrum device. The first fulcrum slot is adapted to receive the first grasping bar and the second fulcrum slot is adapted to receive the second grasping bar, such that the fulcrum device is adapted to apply leverage from the first retractor blade and the second retractor blade to spread the edges of the incision and to allow access to a chest cavity of the patient.

We claim: 
     
         1 . A conduit coupling device comprising:
 a first coupler comprising a first saddle, a first channel, a first tissue clamp, and a first flange projecting from the first channel and surrounding the first channel adjacent to an end of the first channel opposite the first saddle, said first flange including a first mating surface;   a second coupler comprising a second saddle, a second channel, a second tissue clamp, and a second flange projecting from the second channel and surrounding the second channel adjacent to an end of the second channel opposite the second saddle, said second flange including a second mating surface;   a clamping ring for securing said first flange and said second flange together,   wherein said first mating surface is configured to engage said second mating surface when said first flange and said second flange are secured together.   
     
     
         2 . The conduit coupling device of  claim 1 , wherein said first channel and said second channel have substantially constant cross-sectional area. 
     
     
         3 . The conduit coupling device of  claim 1 , wherein said first channel and said second channel have varying cross-sectional areas. 
     
     
         4 . The conduit coupling device of  claim 1 , wherein said first tissue clamp and said second tissue clamp comprise a shape-memory alloy. 
     
     
         5 . The conduit coupling device of  claim 1 , wherein each of said first tissue clamp and said second tissue clamp comprise a plurality of dimpled holes formed therethrough. 
     
     
         6 . The conduit coupling device of  claim 1 , wherein said first tissue clamp and said second tissue clamp comprise a plurality of teeth positioned along a periphery of said first tissue clamp and said second tissue clamp. 
     
     
         7 . The conduit coupling device of  claim 1 , wherein said first channel comprises a first end of substantially elliptical cross-section connected to said first saddle and a second end of substantially circular cross-section adjacent to said first flange. 
     
     
         8 . The conduit coupling device of  claim 1 , wherein said second channel comprises a first end of substantially elliptical cross-section connected to said second saddle and a second end of substantially circular cross-section adjacent to said second flange. 
     
     
         9 . The conduit coupling device of  claim 1 , wherein said first coupler may be positioned at varying positions relative to said second coupler, so that said first saddle and said second saddle may be positioned at varying positions relative to one another. 
     
     
         10 . The conduit coupling device of  claim 1 , wherein said first channel comprises a first end of substantially circular cross-section connected to said first saddle and a second end of substantially circular cross-section adjacent to said first flange. 
     
     
         11 . A coupler holder and delivery device for holding and delivering a coupler into a blood vessel, said coupler comprising a saddle; a channel, wherein said channel comprises a first end connected to said saddle and a second end; a tissue clamp positioned around said channel; and a flange formed adjacent to said second end of said channel, said coupler holder and delivery device comprising:
 an outer tube surrounding an inner shaft, such that said outer tube is slidable on said inner shaft and independently of said inner shaft;   a coupler conforming end, which is mounted on a first end of said inner shaft and is adapted to engage said second end of said channel of said coupler; and   a pair of opposing, tissue clamp receiving flanges mounted on opposite sides of a first end of said outer tube and adapted to engage said tissue clamp bend said tissue clamp away from said saddle, wherein said outer tube is slidable toward said first end of said inner shaft to engage said flanges to said tissue clamp, and wherein said outer tube is slidable away from said first end of said inner shaft to release said tissue clamp from said flanges.   
     
     
         12 . A method of performing vascular surgery, comprising the processes of:
 making a subcostal incision in a patient;   engaging opposing edges of said incision with a first retractor blade and a second retractor blade;   mounting a fulcrum device on said first retractor blade and said second retractor blade;   retracting said incision to provide access to the patient's chest cavity through which to operate;   placing a heart blade through said fulcrum device;   inserting an endoscope through said fulcrum device to locate damage in a coronary vessel;   positioning the heart with said heart blade to expose said damaged coronary vessel and a branch of the Internal Mammary Artery (“IMA”);   inserting a cannula through said fulcrum device into the apex of the patient's heart to place the patient on cardiopulmonary bypass;   making a vessel incision in said coronary vessel downstream from said located damage in said coronary vessel and inserting a first conduit coupler into said vessel incision;   making an IMA incision in said IMA and inserting a second conduit coupler into said IMA incision;   connecting said first conduit coupler to said second conduit coupler;   removing said cannula from the patient's heart; and   supplying blood to tissue downstream of said located damage via said first conduit coupler and said second conduit coupler.