Sternum retractor for performing bypass surgery on a beating heart

Claims

We claim:

1. A tool for use in vascular surgery, comprising:

a member for placement against a part of the body to be immobilised;

said member having an arterial window defined therein of a size to give, in use, access therethrough to an artery of the body part;

said member having first and second body contact portions located adjacent to said arterial window for placement to either side of the artery; and

said member has a surgical wire attachment fitting mounted thereto, said fitting being mounted to extend, in use, away from the body part.

2. The tool of claim 1 wherein each of said body contact portions for placement against the body has a first surface for contacting the body, and a second surface for facing away from the body, said attachment fitting is mounted to one of said members and extends outwardly from the second surface thereof, and said fitting includes a slot for engaging a Silastic surgical wire.

3. The tool of claim 1 wherein each of said body contact portions has a medial portion having a concavity defined lengthwise therein, the concavity being directed, in use, toward the body part.

4. The tool of claim 1 wherein member said members for placement against the body has a first surface for contacting the body, and a second surface for facing away from the body, said attachment fitting is mounted to said members and extends outwardly from the second surface thereof, and said fitting includes a slot for engaging a surgical wire.

5. The tool of claim 4 wherein the surgical wire is composed of a material selected from the group comprising Silastic rubber, siliconized rubber, silicone rubber, silicone elastomer and elastic material.

6. A tool for use in vascular surgery, comprising:

a member for placement against a part of the body to be immobilised;

said member having an arterial window defined therein to give, in use, access therethrough to an artery of the body part upon which to perform a surgical operation;

said member having first and second body contact portions located to either side of said arterial window for placement against the body part along either side of the artery; and

each of said first and second portions having a surgical wire attachment fitting mounted thereto, said fittings being mounted to extend, in use, away from the body part.

7. The surgical tool of claim 6 wherein said tool further comprises a handle mounted to said member, and said handle extends away from said member in a direction leaving said arterial window free of obstruction.

8. The surgical tool of claim 6 wherein said tool further comprises a handle rigidly mounted to said member for positioning said member against the body part.

9. The surgical tool of claim 6 wherein said tool further comprises a rigid pull handle rigidly mounted to said member for positioning said member against the body part, said pull handle extending away from said member in a direction to press said contact portions against the body part under a pulling force applied to said handle.

10. The surgical tool of claim 6 wherein said member has a first side for facing, in use, away from the body part, and one of said attachment fittings is a post mounted to, and extending from, said exposed side, said post having a slot defined therein for receiving a Silastic surgical wire.

11. The surgical tool of claim 6 wherein said member has an exposed side for facing away from the body part in use, said attachment fittings are mounted to said exposed side, and said attachment fittings are angularly adjustable relative to said first and second body contact portions of said member.

12. The surgical tool of claim 6 wherein said tool has two of said attachment fittings on each of said first and second body contact portions whereby one surgical wire for engaging the artery can be anchored between one fitting on one body contact portion and one fitting one the other body contact portion, and another surgical wire for engaging the artery can be anchored between the other attachment fittings on each of said body contact portions.

13. The surgical tool of claim 6 wherein:

each of said body contact portions has a first surface for contacting the body part, and a second surface for facing away from the body part;

each of said body contact portions has a length measured in a direction alongside the artery and a width in a direction transverse to the artery;

each of said body contact portions has a pair of attachment fittings mounted thereto;

each of said attachment fittings is a post mounted to one of said second surfaces of said body contact portions;

each of said posts has a slot defined therein for receiving a Silastic wire; and

said slot is oriented at an oblique angle relative to said length and width.

14. The surgical tool of claim 6 wherein said member has a first side for facing, in use, away from the body part and one of said attachment fittings is a post mounted to, and extending from, said exposed side, said post having a slot defined therein for receiving a surgical wire.

15. The surgical tool of claim 14 wherein the surgical wire is composed of a material selected from the group comprising Silastic rubber, siliconized rubber, silicone rubber, silicone elastomer and elastic material.

16. The surgical tool of claim 15 wherein:

each of said body contact portions has a first surface for contacting the body part, and a second surface for facing away from the body part;

each of said body contact portions has a length measured in a direction alongside the artery and a width in a direction transverse to the artery;

each of said body contact portions has a pair of attachment fittings mounted thereto;

each of said attachment fittings is a post mounted to one of said second surfaces of said body contact portions;

each of said posts has a slot defined therein for receiving a surgical wire; and

said slot is oriented at an oblique angle relative to said length and width.

17. The surgical tool of claim 16 wherein the surgical wire is composed of a material selected from the group comprising Silastic rubber, siliconized rubber, silicone rubber, silicone elastomer and elastic material.

18. A surgical apparatus for use in coronary artery surgery, comprising:

a hand having a pair of fingers for placement alongside either side of a coronary artery, said fingers defining an arterial window therebetween;

each of said fingers having a contacting surface for contacting the heart, and an exposed surface for facing away from the heart;

each of said fingers having a wire attachment fitting mounted to said exposed surface thereof and standing outwardly in a direction away from said heart contacting surface;

whereby, in use, said wire attachment fittings stand on opposite sides of the arterial window from each other.

19. The surgical apparatus of claim 18 wherein said surgical apparatus has two pairs of said wire attachment fittings, said pairs being spaced apart, and one of each pair being mounted to each of said fingers.

20. The surgical apparatus of claim 18 wherein said attachment fittings include lugs mounted to extend away from said exposed surfaces of said fingers, and each of said lugs has a slot defined therein for receiving a Silastic surgical wire.

21. The surgical apparatus of claim 18 wherein said hand has a rigid handle rigidly mounted thereto by which said hand can be positioned relative to the heart.

22. The surgical apparatus of claim 18 wherein said hand has a rigid pull handle rigidly mounted thereto, said arterial window being free of obstruction by said handle.

23. The surgical apparatus of claim 18 wherein said fingers each have a longitudinal direction and a width direction, said wire attachment fittings have slotted walls for receiving Silastic surgical wire, and said attachment fittings are angularly adjustable relative to said longitudinal and width directions.

24. The surgical apparatus of claim 18 wherein:

each said finger has a proximal end region, a medial portion, and a distal end region terminating at a distal tip;

said hand has a yoke connected to said proximal end regions of said fingers;

said tool has a rigid handle, rigidly mounted to said yoke for positioning said hand against the heart;

each of said fingers has a longitudinal dimension measured from said proximal end to said distal tip;

each of said medial portions includes said contacting surface, and has a longitudinal concavity, the concavity being oriented in the heartward direction in use;

each of said distal end regions is bent relative to said medial portion in a direction such that said tip stands away from the heart in use;

and said proximal ends of said fingers are bent to extend away from the heart in use.

25. The surgical apparatus of claim 24 wherein said medial portions of said fingers have a tread for engaging the surface of the heart.

26. The surgical apparatus of claim 24 wherein said handle is a rigid pull handle.

27. The surgical apparatus of claim 18 wherein said attachment fittings include lugs mounted to extend away from said exposed surfaces of said fingers, and each of said lugs has a slot defined therein for receiving a surgical wire.

28. The surgical apparatus of claim 27 wherein the surgical wire is composed of a material selected from the group comprising Silastic rubber, siliconized rubber, silicone rubber, silicone elastomer and elastic material.

29. The surgical apparatus of claim 18 wherein said fingers each have a longitudinal direction and a width direction, said wire attachment fittings have slotted walls for receiving surgical wire, and said attachment fittings are angularly adjustable relative to said longitudinal and width directions.

30. The surgical apparatus of claim 29 wherein the surgical wire is composed of a material selected from the group comprising Silastic rubber, siliconized rubber, silicone rubber, silicone elastomer and elastic material.

FIELD OF THE INVENTION

The present invention relates to the field of cardiac surgery instrumentation and more specifically to the surgical method and apparatus optimized for coronary bypass operations.

BACKGROUND OF THE INVENTION

Direct coronary artery revascularization on a beating heart was conducted, both experimentally and clinically, in the 1950's and the 1960's, without stabilization.

Challenges associated with this surgical technique are as follows:

complete anastomosis is very difficult to achieve due to the motion of the beating heart;

the technique is limited to vessels of a minimum diameter--again due to difficulty in the anastomosis technique on a beating heart;

lifting of the heart for revascularization of posterior arteries results in a precipitous drop in arterial pressure;

the learning curve for surgeons performing this technique is very high; negotiating the learning curve may represent significant surgical morbidity and mortality.

The development of the cardio-pulmonary machine for extracorporeal circulation (ECC) enables coronary operations on an arrested heart. This allows the surgeon to operate on a perfectly still heart and to manipulate the heart to expose the target artery.

At the present time, the standard coronary artery bypass graft (CABG) procedure typically requires a full median sternotomy and extracorporeal circulation through a cardio-pulmonary machine.

Even with the constant technological improvements achieved during the last twenty-five years, the advantages offered with ECC have been offset by morbidity and mortality related to the ECC itself. The inflammatory response, as well as systemic microembolisms generated by ECC, induce to some extent a dysfunctional state of the brain, lungs and kidneys, which tends to increase with the aging of the patient. Furthermore, evidence suggests that when ECC can be avoided, the left ventricular function is better preserved, thereby reducing risk of post-operative complications.

As a result, alternate CABG procedures that do not rely on the use of ECC offer distinct advantages.

Recently, minimally invasive surgery, involving a partial sternotomy or mini-thorocotomy, has generated much interest since it removes precisely the need for ECC. This surgery does, however, have its limitations. It is adequate for only one or two coronary bypass grafts. Moreover, it does not provide access to the posterior descending or circumflex arteries, and impairs both the anastomosis and the surgeon's vision due to the limited heart exposure.

These limitations may lead to future, more-invasive surgical interventions through partial or full sternotomy, if "blockages" progress in those arteries which were not accessible via minimally invasive procedures.

Therefore, partial revascularization may lead to re-intervention which not only represents a disadvantage to the patient but a financial burden to the health care system.

SUMMARY OF THE INVENTION

It is therefore an object of the present invention to provide a surgical apparatus allowing to perform coronary surgery, in particular coronary artery revascularization, without the need for extra-corporeal circulation.

It is a further object of the invention to provide a surgical apparatus to perform complete revascularization of coronary arteries without the need for extra-corporeal circulation.

It is a further object of the invention to provide a surgical apparatus for performing coronary surgery, in particular coronary artery revascularization, on a beating heart.

It is a further object of the invention to provide a surgical apparatus for performing coronary surgery, in particular coronary artery revascularization, enabling grafting on all arteries of the heart and their respective branches, most particularly the right coronary (RC), the posterior descending artery (PDA), the left anterior descending artery (LAD) and diagonals, the branches of the circumflex artery (Cx) namely the obtuse marginal (1 through 4) and the postero-lateral branches.

It is a further object of the invention to provide a surgical apparatus for performing coronary surgery, in particular coronary artery revascularization, provided with positioning means being capable of being mounted in a plurality of locations on a sternum retractor or any other adequate support.

It is a further object of the invention to provide a surgical apparatus for performing coronary surgery, in particular coronary artery revascularization, simplifying the grafting process.

It is a further object of the invention to provide a surgical apparatus for performing coronary surgery, in particular coronary artery revascularization, with reduced costs associated with shorter time of surgery, reduced costs of surgical equipment, reduced surgical staff, significantly reduced risk of medical complications, and shorter hospital recovery stay.

It is a further object of the invention to provide a surgical apparatus for performing coronary surgery, in particular coronary artery revascularization, that is easy to utilize for surgeons and representing an evolution of current proven practice without the need for long retraining period.

It is a further object of the invention to provide a surgical apparatus for performing coronary surgery, in particular coronary artery revascularization, enabling surgeons to operate on all patients, especially those not well suited to minimally invasive techniques or well suited to conventional coronary artery bypass grafting (CABG) with extra corporeal circulation (ECC).

It is a further object of the invention to provide a surgical apparatus for performing coronary surgery, in particular coronary artery revascularization, with a risk reduced procedure for the patient, a cost effective solution to reducing health care expenses, and an ergonomic layout enhancing the efficiency of surgeons.

It is a further object of the invention to provide a surgical apparatus for performing coronary surgery, in particular coronary artery revascularization, that is ergonomic, easy to deploy, easy to sterilize, and time efficient with respect to the multitude of attachments which might be needed during the course of open chest surgery.

It is a further object of the invention to provide a surgical apparatus for performing coronary surgery, in particular coronary artery revascularization, which optimizes accessibility to all different arteries requiring grafting irrespective of variations in personal physiology from one patient to another.

It is a further object of the invention to provide a surgical apparatus for performing coronary surgery, in particular coronary artery revascularization, that can be used with known types retractors, as a retrofit arrangement.

Another object of the invention is to provide positioning means for a surgical apparatus, in particular a heart stabilizer for performing

coronary surgery, particularly coronary artery revascularization, without the need for extra-corporeal circulation.

Another object of the invention is to provide contacting means for a surgical apparatu