Surgery – Miscellaneous – Methods
Utility Patent
1999-06-28
2001-01-02
Isabella, David J (Department: 3738)
Surgery
Miscellaneous
Methods
Utility Patent
active
06167889
ABSTRACT:
BACKGROUND OF THE INVENTION
This invention is directed to a method for performing a minimally invasive coronary artery bypass graft. More particularly, the method permits a thoracoscopic procedure without the need for extracorporeal circulation or other cardiopulmonary bypass.
A coronary artery bypass graft (CABG) involves performing an anastomosis on a diseased coronary artery to reestablish blood flow to an ischemic portion of the heart muscle. Improved long-term survival has been demonstrated bypassing the left anterior descending artery (LAD) with a left internal mammary artery (LIMA). Loop, F. D., Lytle, B. W., Cosgrove, D. M., et al. “Influence of the Internal Mammary Artery on 10 Years Survival and Other Cardiac Events,”
N. Eng. J. Med
., 1986; 314:1-6. This has encouraged surgeons to extend revascularization with arterial grafts to all coronary arteries. In multiple-vessel disease, other arteries have then to be used, such as: the right internal mammary artery (RIMA), the right gastroepiploic artery, the inferior epigastric artery and the radial artery. At the same time, other techniques are also being used: arterial sequential anastomosis and/or graft elongated and/or Y-or T-grafts. Calafiore, A. M., DiGianmarco, G., Luciani, N., et al. “Composite Arterial Conduits for a Wider Arterial Myocardial Revascularization.”
Ann Thorac. Surg
., 1994:58:185-191 and Tector, A. J., Amundson, S., Schmahl, T. M., et al. “Total Revasculization With T-Grafts”.
Ann Thorac. Surg
., 1994:57:33-39.
Traditionally, bypass graft procedures have required opening the chest wall via a stemotomy, stopping the heart and supporting the patient with a cardiopulmonary bypass system. These requirements are extremely invasive, pose significant risks, require lengthy hospitalization and are expensive. In hope of overcoming these and other problems, physicians have developed a number of alternatives such as percutaneous transluminal coronary angioplasty (PTCA), atherectomy, placement of stents and pharmacological treatments. The most common of these is PTCA which offers relatively short hospitalization periods and is relatively inexpensive. However, these benefits are mitigated by a significant restenosis rate. Similarly, the other alternatives suffer from their own drawbacks.
For these and other reasons, providing an anastomosis between an internal mammary artery and the LAD may be the best therapeutic option for severe proximal lesions. Benetti, F. J., Rizzardi, J. L., Naselli, G., et al., “Anastomosis Manerio Coronaria Sin Circulation Extracorporeal,”
Prense Medica Argentina
, 1985; 73:213. Accordingly, there is a need for improved CABG procedures that simplify surgical techniques and diminish hospital stays and costs.
SUMMARY OF THE INVENTION
The invention comprises a method for performing CABG procedures without the need for opening the chest wall, stopping the heart or providing cardiopulmonary bypass. Generally, at least one small opening is formed in the patient's chest, a target artery for an arterial blood supply is located through an opening in the patient's. Chest, instruments are introduced through one or more small openings formed in the patient's chest to separate the target artery from its support base; and instruments are introduced through one or more small openings formed in the patient's chest to connect the target artery to a portion of a coronary artery distal from a stenosis in fluid communication therewith to supply arterial blood from the target artery thereto. In a preferred embodiment, a minimal left anterior intercostal thoracotomy provides access to form the 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. Depending on the type of access, thoracoscopic visualization is used to locate the arterial blood supply, the location of the coronary artery to be bypassed or the location of the occlusion in the artery. In other embodiments, the diagonal (Dx) or circumflex (Cx) arteries may be bypassed.
REFERENCES:
patent: Re. 34150 (1992-12-01), Santilli et al.
patent: 4726356 (1988-02-01), Santilli et al.
patent: 4852552 (1989-08-01), Chaux
patent: 5025779 (1991-06-01), Bugge
patent: 5429144 (1995-07-01), Wilk
patent: 5452733 (1995-09-01), Sterman et al.
patent: 5888247 (1999-03-01), Bemetto
patent: 5947125 (1999-09-01), Benetti
patent: 2 267 827A (1993-12-01), None
“Mammary Artery-Coronary Artery Anastomosis as Method of Treatment for Angina Pectoris,” V.I. Kolessov, M.D.Thoracic and Cardiovascular Surgery, vol. 54, No. 4, Oct., 1967, pp. 535-544.
“Direct Coronary Surgery with Saphenous Vein Bypass Without Either Cardiopulmonary Bypass or Cardiac Arrest,” F.J. BenettiThe Journal of Cardiovascular Surgery, vol. 26, No. 3, May-Jun., 1985, pp. 217-222.
“Direct Myocardial Revascularization Without Cardiopulmonary Bypass,” E. Buffolo; J.C.S. Andrade; J.Succi; L.E.V. Leao, and C. GallucciThoac. Cardiovasc. Surgeon, 33 (1985) pp. 26-29.
“Coronary Artery Revascularization Without Cardiopulmonary Bypass,” R. Archer, D.O.; D.A. Ott, M.D.; R. Parravicini, M.D.; D.A. Cooley, M.D.; G.J. Reul, M.D.; O.H. Frazier, M.D.; J.M. Duncan, M.D.; J.J. Livesay, M.D., and W.E. Walker, M.D.Texas Heart Institute Journal, vol. 11, No. 1, Mar. 1984, pp. 52-57.
“Direct Myocardial Revascularization Without Extracorporeal Circulation,” F.J. Benetti, M.D.; G. Naselli, M.D.; M. Wood, M.D.; and L. Geffner, M.D.Chest, vol. 100, No. 2, Aug., 1991, pp. 312-316.
“Reoperative Coronary Artery Bypass Grafting Without Cardiopulmonary Bypass,” W.J. Fanning, MD; G.S. Kakos, MD; and T.E. Williams, Jr., MD, PhDThe Annals of Thoracic Surgery, vol. 55, No. 2, Feb. 1993, pp. 486-489.
“Coronary Artery Bypass Without Cardiopulmonary Bypass,” A.J. Pfister, MD; M.S. Zaki, MD; J.M. Garcia, MD; L.A. Mispireta, MD; P.J. Corso, MD; A.G. Qazi, MD; S.W. Boyce, MD; T.R. Coughlin, Jr., MD; and P. Gurny, MDThe Annals of Thoracic Surgery, vol. 54, No. 6, Dec. 1992, pp. 1085-1092.
“To Use or Not To Use the Pump Oxygenator in Coronary Bypass Operations,” Drs. W.G. Trapp and R. BisaryaThe Annals of Thoracic Surgery, vol. 19, No. 1, Jan., 1975, pp. 108-109.
“Direct Myocardial Revascularization by Saphenous Vein Graft,” R.G. Favaloro, M.D.; D.B. Effler, M.D.; L.K. Groves, M.D.; W.G. Sheldon, M.D.; and F.M. Sones, Jr., M.D.The Annals of Thoracic Surgery, vol. 10, No. 2, Aug., 1970, pp. 97-111.
“Preservation of Interventricular Septal Function in Patients Having Coronary Artery Bypass Grafts Without Cardiopulmonary Bypass,” C.W. Akins, M.D.; C.A. Boucher, M.D., and G.M. Pohost, M.D.American Heart Journal, vol. 107, No. 2, Feb., 1984, pp. 304-309.
“Left Thoracotomy Reoperation for Coronary Artery Disease,” Grosner, G, Lajos TZ, Schimertz G, Bergsland J.Journal of Cardiac Surgery, 1990, vol. 5, pp. 304-308.
“Left Thoracotomy for Reoperation for Coronary Revascularation,” Faro RS, Javid H, Najafi H., C. SerryThe Journal of Thoracic and Cardiovascular Surgery, 1982, vol. 84, pp. 453-455.
“An Alternative Approach to Isolated Circumflex Coronary Bypas Reoperations,” Cheung D, Flemma RJ, Mullen DC, Lepley D, Jr.The Annals of Thoracic Surgery, 1982, vol. 33, pp. 302-303.
“Left Thoracotomy for Reoperative Coronary Bypass,” Burlingame, MW, Bonchek, LI, and Vazales, BE.Journal of Thoracic Cardiovascular Surgery, 1988, vol. 95, pp. 508-510.
“Left Thoracotomy for Reoperative Coronary Artery Bypass Procedures,” Ungerleider, RM, Mills NL, Wechsler, AS.The Annals of Thoracic Surgery, 1985, vol. 40, pp. 11-15.
“Leftsided Thoracotomy for Coronary Artery Reoperation,” Borst HG.Thoraxchirurgie Vaskulare Chirurgie, 1978, vol. 26, pp. 95-97.
“Avoidance of Patent Anterior Grafts at Revisional Coronary Artery Surgery: Use of a Lateral Thoracotomy Approach,” Walker, WS, Sang CTM.Thorax, 1986, vol. 41, pp. 692-695.
“Left Tho
Bozicevic Field & Francis LLP.
Cannon Alan W.
Cardiothoracic Systems, Inc.
Isabella David J
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