Devices and methods for accessing the left atrium for cardiac procedures

Abstract

Systems, devices, and methods for providing access to the heart. The system includes an intracardiac access device comprising an elongate member having a channel extending between a distal end and a proximal end thereof. The intracardiac access device is configured to be advanced through an extrapericardial penetration in the left atrial wall without penetrating the pericardium of the heart. An optional procedural device is configured to be advanced through the channel of the intracardiac access device into an internal chamber of the heart and configured to perform a surgical procedure in the internal chamber of the heart. A working channel of an optional suprasternal access device is configured to facilitate access of the intracardiac access device into the body of the patient by providing a path from a suprasternal opening to a position adjacent the roof of the left atrium.

1 .- 49 . (canceled) 
     
     
         50 . A surgical instrument, comprising:
 an elongate member having a distal portion configured to be inserted into a body of a patient and a proximal portion configured to remain outside the body of the patient when the distal portion is inserted into the body of the patient, the elongate member comprising an inner wall defining a channel therein, the channel extending between a distal end and a proximal end of the elongate member and being configured to receive a procedural instrument for performing a surgical procedure,   wherein the distal portion of the elongate member is configured to extend from a suprasternal notch of the patient and through an extrapericardial penetration through a cardiac wall at a first location on a dome of a left atrium of the patient to access an internal chamber of the heart, the first location being outside a pericardium of the heart.   
     
     
         51 . (canceled) 
     
     
         52 . (canceled) 
     
     
         53 . (canceled) 
     
     
         54 . (canceled) 
     
     
         55 . (canceled) 
     
     
         56 . The surgical instrument of claim  2 , wherein the elongate member comprises a cannula, a sheath, a tube, or a hollow shell. 
     
     
         57 . The surgical instrument of claim  2 , wherein the elongate member has an outer diameter within a range of about 5 mm to about 30 mm. 
     
     
         58 . The surgical instrument of claim  2 , wherein the elongate member has a length within a range of about 5 cm to about 32 cm from the proximal end to the distal end. 
     
     
         59 . The surgical instrument of claim  2 , wherein the elongate member is rigid. 
     
     
         60 . The surgical instrument of claim  2 , wherein at least a portion of the elongate member is flexible or articulated. 
     
     
         61 . (canceled) 
     
     
         62 . The surgical instrument of claim  2 , wherein the channel is substantially straight from the proximal portion to the distal portion. 
     
     
         63 . The surgical instrument of claim  2 , wherein the elongate member is configured to fit within a working channel of a mediastinoscope. 
     
     
         64 . (canceled) 
     
     
         65 . (canceled) 
     
     
         66 . (canceled) 
     
     
         67 . The surgical instrument of claim  2 , wherein the distal portion of the elongate member is configured to be advanced through the extrapericardial penetration without penetrating the pericardium of the heart. 
     
     
         68 . The surgical instrument of claim  2 , wherein the distal portion of the elongate member is configured to contact the cardiac wall on the dome of the left atrium with the proximal portion extending out of the opening. 
     
     
         69 . The surgical instrument of claim  2 , further comprising a retention element coupled to the distal portion of the elongate member, wherein the retention element has an undeployed configuration and a deployed configuration, and wherein the retention element is configured to resist inadvertent removal of the elongate member from a cardiac wall of the patient. 
     
     
         70 . (canceled) 
     
     
         71 . (canceled) 
     
     
         72 . The surgical instrument of claim  2 , wherein the elongate member comprises an external cannula and an internal cannula disposed therein, and wherein the inner wall defining the channel comprises an inner wall of the internal cannula. 
     
     
         73 . The surgical instrument of  claim 72 , wherein a distal portion of the internal cannula is configured to be advanced from a distal end of the external cannula through the extrapericardial penetration and wherein the distal end of the external cannula is configured to remain in contact the cardiac wall outside the extrapericardial penetration. 
     
     
         74 . (canceled) 
     
     
         75 . The surgical instrument of  claim 73 , further comprising a retention element coupled to the distal portion of the elongate member, wherein the retention element has an undeployed configuration and a deployed configuration, wherein the retention element is configured to resist inadvertent removal of the elongate member from a cardiac wall of the patient, and wherein the retention element comprises a suction port in the external cannula configured to seal a distal end of the external cannula against the cardiac wall when negative pressure is applied to the cardiac wall via the suction port orb) a balloon on the distal portion of the internal cannula configured to engage an internal portion of the cardiac wall. 
     
     
         76 . (canceled) 
     
     
         77 . (canceled) 
     
     
         78 . (canceled) 
     
     
         79 . The surgical instrument of claim  2 , further comprising a sealing element coupled to the distal end of the elongate member, the sealing element being configured to be actuated from an undeployed configuration to a deployed configuration to form a hemostatic seal around the distal portion of the elongate member when the elongate member is advanced through the extrapericardial penetration into the internal chamber of the heart. 
     
     
         80 . (canceled) 
     
     
         81 . (canceled) 
     
     
         82 . (canceled) 
     
     
         83 . The surgical instrument of claim  2 , further comprising an anchoring element coupled to the proximal portion of the elongate member. 
     
     
         84 . The surgical instrument of claim  2 , further comprising a visualization element coupled to the elongate member. 
     
     
         85 . The surgical instrument of  claim 84 , wherein the visualization element comprises an optical channel extending through the elongate member and a lens aligned with the optical channel. 
     
     
         86 . (canceled) 
     
     
         87 . (canceled) 
     
     
         88 . (canceled) 
     
     
         89 . (canceled) 
     
     
         90 . (canceled) 
     
     
         91 . A system comprising:
 the surgical instrument of claim  2 ; and   a visualization device or procedural instrument configured for insertion into the internal chamber of the heart through the channel of the elongate member.   
     
     
         92 . The system of  claim 91 , wherein the visualization device comprises a mediastinoscope or an endoscope. 
     
     
         93 .- 146 . (canceled)