Local cardiac immobilization surgical device

Abstract

A device and method for temporarily immobilizing a small segment of the surface of the heart during coronary artery bypass grafting for obviating the necessity for placing the patient on cardiopulmonary bypass are disclosed.

1. In a surgical method comprising making an incision through the thoracic wall of a patient, and performing a surgical procedure proximate the surface of the heart, the improvement comprising immobilizing a portion of the surface of the heart upon which surgery is to be performed by temporarily securing to the surface of the heart a cardiac immobilizing member that at least partially surrounds the portion of the surface of the heart upon which the surgery is to be performed thereby substantially fixing the position of the cardiac immobilizing device, the step of securing the immobilizing member comprising applying a partial vacuum to the surface of the heart. 
     
     
       2. The method of  claim 1  wherein the step of securing the cardiac immobilizing member to the heart further comprises applying a layer of physiologically compatible adhesive between the cardiac immobilizing member and the surface tissue of the heart. 
     
     
       3. In a surgical method comprising making an incision through the thoracic wall of a patient, and performing a surgical procedure proximate the surface of the heart, the improvement comprising immobilizing a portion of the surface of the heart upon which surgery is to be performed by placing a cardiac immobilizing member that defines at least one partial chamber in substantially fluid tight sealed relationship with the surface of the heart at least partially surrounding the portion of the surface of the heart upon which the surgery is to be performed to define at least one vacuum chamber and partially evacuating said vacuum chamber to secure the cardiac immobilizing device in sealed relationship to the heart and fixing the position of the cardiac immobilizing device. 
     
     
       4. The method of  claim 3  the incision through the thoracic wall is substantially surrounded by the cardiac immobilizing member. 
     
     
       5. Apparatus constructed and adapted to immobilize a surface portion of the heart of a patient to enable a surgical procedure to be performed on the heart while the heart is beating comprising:
 a cardiac immobilizing member comprising structure defining a partial chamber having edges, the edges being so constructed and configured to form a substantially fluid-tight seal with the surface of the heart, said member being so constructed and configured to at least partially surround that portion of the heart upon which the surgical procedure is to be performed and when in sealed relationship with the heart to define with the heart a vacuum chamber;    means for partially evacuating the vacuum chamber for securing said cardiac immobilizing member to the heart; and    means for fixing the position of the cardiac immobilizing member;    said cardiac immobilizing member, evacuating means and fixing means being constructed, configured and adapted to be attachable to the heart by reason of a partial vacuum in the partial chamber defined by the cardiac immobilizing member and substantially immobilizing that portion of the heart surface at least partially surrounded by the cardiac immobilizing member.    
     
     
       6. The apparatus of  claim 5  wherein the cardiac immobilizing member generally defines an annulus. 
     
     
       7. The apparatus of  claim 6  wherein the cardiac immobilizing member has a minor diameter and a major diameter and the minor diameter is about one inch and the major diameter is about one and one-half inches. 
     
     
       8. The apparatus of  claim 5  wherein the cardiac immobilizing member comprises walls at least partially formed of soft resiliently deformable polymeric material. 
     
     
       9. The apparatus of  claim 5  wherein the cardiac immobilizing member defines a plurality of chambers. 
     
     
       10. The apparatus of  claim 9  wherein the cardiac immobilizing member comprises walls at least partially formed of soft cushion seal resiliently deformable polymeric material. 
     
     
       11. Apparatus constructed and adapted to immobilize a surface portion of the heart of a patient to enable a surgical procedure to be performed on the heart while the heart is beating comprising:
 a cardiac immobilizing member comprising structure defining an elongate surface configured and constructed to lie in intimate contact with the surface of the heart of the patient and being so constructed and configured to at least partially surround that portion of the heart upon which the surgical procedure is to be performed;  
 a layer of physiologically compatible adhesive for bonding the elongate surface temporarily to the surface tissue of the heart; and  
 means for fixing the position of the cardiac immobilizing member;  
 said cardiac immobilizing member and fixing means being constructed, configured and adapted to be attachable to the heart by the adhesive thereby substantially immobilizing that portion of the heart surface at least partially surrounded by the cardiac immobilizing member.  
 
     
     
       12. The apparatus of  claim 11  wherein the cardiac immobilizing member generally defines an annulus. 
     
     
       13. The apparatus of  claim 11  wherein the cardiac immobilizing member has a minor diameter and a major diameter and the minor diameter is about one inch and the major diameter is about one and one-half inches. 
     
     
       14. The apparatus of  claim 11  wherein the cardiac immobilizing member at least partially comprises resiliently deformable polymeric material. 
     
     
       15. In a surgical method comprising making an incision through the thoracic wall of a patient, and performing a surgical procedure proximate the surface of the heart, the improvement comprising:
   immobilizing a portion of the surface of the heart upon which surgery is to be performed by:      temporarily securing to the surface of the heart a cardiac immobilizing member than at least partially surrounds the portion of the surface of the heart upon which the surgery is to be performed; and        substantially fixing the position of the cardiac immobilizing member;          the steps of securing the immobilizing member comprising applying a partial vacuum to the surface of the heart and applying a layer of physiologically compatible adhesive between the cardiac immobilizing member and the surface tissue of the heart.     
     
     
       16. In a surgical method comprising making an incision through the thoracic wall of a patient, and performing a surgical procedure proximate the surface of the heart, the improvement comprising:
   immobilizing a portion of the surface of the heart upon which surgery is to be performed by:      placing a cardiac immobilizing member that defines at least one partial chamber comprising on a surface thereof a physiologically compatible adhesive in substantially fluid tight sealed relationship with the surface of the heart partially surrounding the portion of the surface of the heart upon which the surgery is to be performed, thereby forming a chamber comprising the partial chamber and the surface of the heart; and        creating a vacuum in said chamber to fix the position of the cardiac immobilizing member and at least partially immobilize the partially surrounded portion of the heart tissue.       
     
     
       17. In a surgical method comprising making an incision through the thoracic wall of a patient, and performing a surgical procedure proximate the surface of the heart, the improvement comprising:
   immobilizing a portion of the surface of the heart upon which surgery is to be performed by:      temporarily securing to the surface of the heart a U - shaped cardiac immobilizing member that at least partially surrounds the portion of the surface of the heart upon which the surgery is to be performed; and        substantially fixing the position of the cardiac immobilizing member;          the steps of securing the immobilizing member to the surface of the heart comprising applying a partial vacuum to the surface of the heart and applying a layer of physiologically compatible adhesive between the cardiac immobilizing member and the surface tissue of the heart.     
     
     
       18. In a surgical method comprising making an incision through the thoracic wall of a patient, and performing a surgical procedure proximate the surface of the heart, the improvement comprising:
   immobilizing a portion of the surface of the heart upon which surgery is to be performed by:      placing a U - shaped cardiac immobilizing member that defines at least one partial chamber comprising on a surface thereof a physiologically compatible adhesive in substantially fluid tight sealed relationship with the surface of the heart partially surrounding the portion of the surface of the heart upon which the surgery is to be performed, thereby forming a chamber comprising the partial chamber and the surface of the heart; and        creating a vacuum in said chamber to fix the position of the cardiac immobilizing member and at least partially immobilize the partially surrounded portion of the heart issue.       
     
     
       19. In a surgical method comprising making an incision through the thoracic wall of a patient, and performing a surgical procedure proximate the surface of the heart, the improvement comprising:
   immobilizing a portion of the surface of the heart upon which surgery is to be performed by:      temporarily securing to the surface of the heart an immobilizing member configured and constructed to define only one single chamber and to at least partially surround the portion of the surface of the heart upon which the surgery is to be performed; and substantially fixing the position of the cardiac immobilizing member;          the step of securing the immobilizing member comprising applying a partial vacuum through the cardiac immobilizing member to the surface of the heart.     
     
     
       20. In a surgical method comprising making an incision through the thoracic wall of a patient, and performing a surgical procedure proximate the surface of the heart, the improvement comprising:
   immobilizing a portion of the surface of the heart upon which surgery is to be performed by:      placing a U - shaped cardiac immobilizing member that defines only one partial chamber in substantially fluid tight sealed relationship with the surface of the heart partially surrounding the portion of the surface of the heart upon which the surgery is to be performed, thereby forming a chamber comprising the partial chamber and the surface of the heart; and        creating a vacuum in said chamber to fix the position of the cardiac immobilizing member and at least partially immobilize the partially surrounded portion of the heart tissue.       
     
     
       21. Apparatus constructed and adapted to immobilize a surface portion of the heart of the patient to enable a surgical procedure to be performed on the heart while the heart is beating comprising:
   a U - shaped cardiac immobilizing member defining only one U - shaped partial chamber configured and constructed to lie, when in use, in substantially fluid tight sealed relationship with the surface of the heart and to partially surround that portion of the heart upon which the surgical procedure is to be performed; and        means for producing a vacuum in said vacuum cup for fixing the position of the cardiac immobilizing member;        said cardiac immobilizing member being constructed, configured and adapted to be secured to the surface to the heart thereby substantially immobilizing that portion of the heart surface partially surrounded by the cardiac immobilizing member.     
     
     
       22. Apparatus constructed and adapted to immobilize a surface portion of the heart of the patient to enable a surgical procedure to be performed on the heart while the heart is beating comprising:
   a generally U - shaped cardiac immobilizing cup defining a partial chamber and a layer of physiologically compatible adhesive on the cup, said layer being configured and adapted to lie, in use, against the surface tissue of the heart, said chamber being configured and constructed to lie, when in use, in substantially fluid tight sealed relationship with the surface of the heart and to partially surround that portion of the heart upon which the surgical procedure is to be performed; and        means for producing a vacuum in said vacuum cup for fixing the position of the cardiac immobilizing member;        said cardiac immobilizing member being constructed, configured and adapted to be secured to the surface to the heart thereby substantially immobilizing that portion of the heart surface partially surrounded by the cardiac immobilizing member.     
     
     
       23. In a surgical method comprising making an incision through the thoracic wall of a patient, and performing a surgical procedure proximate the surface of the heart, the improvement comprising:
   immobilizing a portion of the surface of the heart upon which surgery is to be performed by:      temporarily securing to the surface of the heart a cardiac immobilizing member adjacent the portion of the surface of the heart upon which the surgery is to be performed and substantially fixing the position of the cardiac immobilizing member, said cardiac immobilizing member comprising structure that, in use, defines with the heart a closed chamber and enclosed in said chamber a member comprising open pore material;        the steps of temporarily securing said cardiac immobilizing member to the surface of the heart comprising applying a partial vacuum in said chamber to the surface of the heart with said open pore member in contact with the heart.       
     
     
       24. Apparatus constructed and adapted to immobilize a surface portion of the heart of the patient to enable a surgical procedure to be performed on the heart while the heart is beating comprising:
   a cardiac immobilizing member comprising structure defining at least one partial chamber having edges, the edges being so constructed and configured to form a substantially fluid - tight seal with the surface of the heart and, enclosed in said chamber, a member comprising an open pore material, said cardiac immobilizing member being so constructed and configured to contact a portion of the heart adjacent that portion of the heart upon which the surgical procedure is to be performed and, when in sealed relationship with the heart, to define with the heart a partial vacuum chamber with said open pore material in contact with the surface of the heart;        means for partially evacuating the vacuum chamber for securing said cardiac immobilizing member to the heart; and        means for fixing the position of the cardiac immobilizing member;        said cardiac immobilizing member, evacuating means and fixing means being constructed, configured and adapted to be attachable to the heart by reason of a partial vacuum in the partial chamber defined by the cardiac immobilizing member and to substantially immobilize that portion of the heart surface adjacent the cardiac immobilizing member.     
     
     
       25. Apparatus for immobilizing a surface portion of the heart of a patient to enable a surgical procedure to be performed on the heart while the heart is beating comprising:
   a cardiac immobilizing member comprising at least one partial chamber, each said partial chamber comprising walls terminating in edges, said walls at least partially formed of resiliently conformable material, each said partial chamber defining with the heart at least one vacuum chamber when said edges are in sealed relationship with the heart; and        means for communicating each partial chamber with a vacuum source.     
     
     
       26. The apparatus of  claim 25  wherein said resiliently conformable material is selected from the group consisting of natural rubber, synthetic rubber, silicone rubber, resilient polymer and deformable polymer. 
     
     
       27. The apparatus of  claim 25  further comprising a connector extending between a substantially stationary object and said cardiac immobilizing member. 
     
     
       28. The apparatus of  claim 25  wherein said connector is substantially rigid. 
     
     
       29. The apparatus of  claim 25  wherein said connector is an elongate rod. 
     
     
       30. The apparatus of  claim 25  wherein said substantially stationary object is a sternal retractor. 
     
     
       31. The apparatus of  claim 25  wherein said means for communicating each partial chamber with a vacuum source comprises a port. 
     
     
       32. The apparatus of  claim 25  further comprising open pore material enclosed in each said partial chamber. 
     
     
       33. The apparatus of  claim 32  wherein said open pore material at least partially fills each said partial chamber. 
     
     
       34. The apparatus of  claim 25  wherein said cardiac immobilizing member is so configured to at least partially surround that portion of the heart upon which the surgical procedure is to be performed. 
     
     
       35. The apparatus of  claim 34  wherein said cardiac immobilizing member surrounds on two opposing sides said portion of the heart upon which the surgical procedure is to be performed. 
     
     
       36. The apparatus of  claim 34  wherein said cardiac immobilizing member surrounds on three sides said portion of the heart upon which the surgical procedure is to be performed. 
     
     
       37. The apparatus of  claim 34  wherein said cardiac immobilizing member substantially surrounds said portion of the heart upon which the surgical procedure is to be performed. 
     
     
       38. The apparatus of  claim 25  wherein said cardiac immobilizing member is U- shaped.   
     
     
       39. The apparatus of  claim 25  wherein said cardiac immobilizing member is generally circular. 
     
     
       40. The apparatus of  claim 39  wherein said cardiac immobilizing member is a closed circle. 
     
     
       41. The apparatus of  claim 39  wherein said cardiac immobilizing member is an open circle. 
     
     
       42. The apparatus of  claim 25  wherein said cardiac immobilizing member is generally elliptical. 
     
     
       43. The apparatus of  claim 42  wherein said cardiac immobilizing member is a closed ellipse. 
     
     
       44. The apparatus of  claim 42  wherein said cardiac immobilizing member is an open ellipse. 
     
     
       45. Apparatus for immobilizing a surface portion of the heart of a patient to enable a surgical procedure to be performed on the heart while the heart is beating comprising:
   a cardiac immobilizing member comprising at least one partial chamber, each said partial chamber comprising a wall terminating in an edge, the edge being operably associated with a seal at least partially formed of resiliently conformable material, each said partial chamber defining with the heart a vacuum chamber when said seal is in sealed relationship with the heart; and        means for communicating each said partial chamber with a vacuum source.     
     
     
       46. Apparatus for immobilizing a surface portion of the heart of a patient to enable a surgical procedure to be performed on the heart while the heart is being comprising:
   a cardiac immobilizing member comprising at least one partial chamber, each said partial chamber comprising an upper face and downwardly - extending walls terminating in edges, the edges being operably associated with a seal at least partially formed of resiliently conformable material, each said partial chamber defining with the heart at least one vacuum chamber when said seals are in sealed relationship with the heart, said cardiac immobilizing member being so configured to at least partially surround that portion of the heart upon which the surgical procedure is to be performed; and        means for communicating each partial chamber with a vacuum source.     
     
     
       47. Apparatus for immobilizing a surface portion of the heart of a patient to enable a surgical procedure to be performed on the heart while the heart is beating comprising:
   a cardiac immobilizing member comprising at least one partial chamber, each said partial chamber comprising resiliently conformable edges, each said partial chamber defining with the heart at least one vacuum chamber when said edges are in sealed relationship with the heart; and means for communicating each partial chamber with a vacuum source.     
     
     
       48. In a surgical method comprising making an incision through the thoracic wall of a patient, and performing a surgical procedure proximate the surface of the heart, the improvement comprising:
   immobilizing a portion of the surface of the heart upon which surgery is to be performed by temporarily securing to the surface of the heart by application of a partial vacuum a cardiac immobilizing member and substantially fixing the position of the cardiac immobilizing member;        said cardiac immobilizing member comprising portions formed of resiliently deformable material for forming a seal with the heart tissue.