Catheter system and method for posterior epicardial revascularization and intracardiac surgery on a beating heart

Abstract

A catheter system and method of performing posterior epicardial revascularization and intracardiac surgery on a beating heart. Several catheter systems are provided to achieve a left ventricular isolation and a right ventricular isolation as required to facilitate surgery according to the methods of the present invention. Myocardial infusion is provided in either antegrade or retrograde flow to insure the myocardium meets its oxygen demand.

We claim:  
     
         1 . A catheter system for facilitating epicardial surgery and intracardiac surgery on a beating heart, comprising: 
 a first catheter having a shape and structure adapted to draw blood from a left ventricle of the beating heart;    a pump coupled to said first catheter; and    an aortic catheter coupled to said pump having a lumen and structure adapted to return said drawn blood to an aorta of the beating heart at a sufficient rate and pressure to perfuse the heart.    
     
     
         2 . The catheter system as specified in    claim 1    wherein said aortic catheter has a balloon having a diameter sufficient to occlude the aorta when inserted therein, wherein said lumen terminates at a distal end of said aortic catheter distal of said balloon.  
     
     
         3 . The catheter system as specified in    claim 1    wherein said first catheter has a shape and structure adapted to be inserted through an apex of the heart.  
     
     
         4 . The catheter system as specified in    claim 1    wherein said first catheter has a shape and structure adapted to be inserted through a pulmonary vein and a mitrial valve of the heart.  
     
     
         5 . The catheter system as specified in    claim 1    wherein said first catheter has a shape and structure adapted to be inserted through a left atrial appendage and a mitrial valve of the heart.  
     
     
         6 . The catheter system as specified in    claim 1    wherein said first catheter has a shape and structure adapted to be inserted through an aorta and an aortic valve of the heart.  
     
     
         7 . The catheter system as specified in    claim 1    wherein said aortic catheter further comprises perfusion means for sufficiently perfusing a myocardium of the beating heart.  
     
     
         8 . The catheter system as specified in    claim 7    wherein said perfusion means comprises structure to perfuse the myocardium via an aortic base of the heart in antegrade flow.  
     
     
         9 . The catheter system as specified in    claim 7    wherein said perfusion means comprises structure to perfuse a coronary sinus of the heart in retrograde flow.  
     
     
         10 . A catheter system for facilitating epicardial surgery and intracardiac surgery on a beating heart having pulmonary veins and an aorta, comprising: 
 a first catheter having a shape and structure adapted to draw blood from the pulmonary veins of a beating heart;    a pump coupled to said first catheter; and    an aortic catheter coupled to said pump having a lumen and structure adapted to return said drawn blood to the aorta of the beating heart at a sufficient rate and pressure to perfuse the body.    
     
     
         11 . The catheter system as specified in    claim 10    wherein said first catheter has two pairs of distal ends each adapted to be inserted into one of four pulmonary veins of the heart.  
     
     
         12 . The catheter system as specified in    claim 11    wherein said distal ends each have a balloon having a diameter sufficient to occlude one pulmonary vein when inserted therein and a lumen terminating distal of said balloon for drawing blood from said pulmonary veins.  
     
     
         13 . A catheter system for facilitating epicardial surgery and intracardiac surgery on a beating heart having a pulmonary artery, an inferior vena cava and a superior vena cava,. comprising: 
 a first venous return catheter having a shape and structure adapted to draw blood from the inferior vena cava and the superior vena cava;    a pump coupled to said first venous return catheter; and    a pulmonary artery catheter coupled to said pump having a lumen and structure adapted to return said drawn blood to the pulmonary artery of the beating heart at a sufficient rate and pressure to perfuse the body.    
     
     
         14 . The catheter system as specified in    claim 13    wherein said venous return catheter has a pair of balloons having a shape and size adapted to occlude the superior vena cava and the inferior vena cava.  
     
     
         15 . A method of performing epicardial revascularization and intracardiac surgery on a beating heart, the heart having an aorta, an aortic base, aortic valve, left ventricle, right pulmonary vein, left atrial apendage, inferior vena cava, superior vena cava, main pulmonary artery, mitrial valve, and coronary sinus, comprising the steps of: 
 a) drawing blood from the left ventricle using a pump and a first catheter while said heart is beating to obtain a left ventricular isolation; and    b) returning a majority of said drawn blood via said pump to the ascending aorta using an aortic catheter.    
     
     
         16 . The method as specified in    claim 15    wherein a portion of said drawn blood in said step b) is infused into the myocardium to provide myocardial infusion.  
     
     
         17 . The method as specified in    claim 16    wherein said portion of said drawn blood is infused into the aortic base to provide antegrade myocardial infusion.  
     
     
         18 . The method as specified in    claim 16    wherein said portion of said drawn blood is infused into the coronary sinus to provide retrograde myocardial infusion.  
     
     
         19 . The method as specified in    claim 16    wherein a volume and pressure of said drawn blood is selectively controlled during said myocardial infusion.  
     
     
         20 . The method as specified in    claim 16    wherein said aortic catheter also infuses said drawn blood into the myocardium.  
     
     
         21 . The method as specified in    claim 15    wherein said first catheter is inserted into the left ventricle through the apex of the heart.  
     
     
         22 . The method as specified in    claim 15    wherein said first catheter is inserted into the left ventricle via the pulmonary vein and through the mitrial valve.  
     
     
         23 . The method as specified in    claim 15    wherein said first catheter is inserted into the left ventricle via the left atrial appendage and through the mitrial valve.  
     
     
         24 . The method as specified in    claim 15    wherein said first catheter is inserted into the left ventricle via the aorta and through the aortic valve.  
     
     
         25 . The method as specified in    claim 15    further comprising the step of repairing the mitrial valve.  
     
     
         26 . A method of performing epicardial revascularization and intracardiac surgery on a beating heart, the heart having an aorta, an aortic base, aortic valve, left ventricle, right pulmonary vein, left atrial apendage, inferior vena cava, superior vena cava, main pulmonary artery, mitrial valve, and coronary sinus, comprising the steps of: 
 a) drawing blood from the main pulmonary veins using a first catheter and a pump while said heart is beating to obtain a left ventricular isolation; and    b) returning a majority of said drawn blood via said pump to the ascending aorta using an aortic catheter.    
     
     
         27 . The method as specified in    claim 26    wherein a portion of said drawn blood in said step b) is infused into the myocardium to provide myocardial infusion.  
     
     
         28 . The method as specified in    claim 26    wherein said portion of said drawn blood is infused into the aortic base to provide antegrade myocardial infusion.  
     
     
         29 . The method as specified in    claim 27    wherein said portion of said drawn blood is infused into the coronary sinus to provide retrograde myocardial infusion.  
     
     
         30 . The method as specified in    claim 27    wherein a volume and pressure of said drawn blood is selectively controlled during said myocardial infusion.  
     
     
         31 . The method as specified in    claim 27    wherein said aortic catheter also infuses said drawn blood into the myocardium.  
     
     
         32 . A method of performing epicardial revascularization and intracardiac surgery on a beating heart, the heart having an aorta, an aortic base, aortic valve, left ventricle, right pulmonary vein, left atrial apendage, inferior vena cava, superior vena cava, main pulmonary artery, mitrial valve, tricuspid valve, pulmonic valve, and coronary sinus, comprising the steps of: 
 a) drawing blood from the inferior vena cava and the superior vena cava using a pump and a first catheter while said heart is beating to create a bloodless right side of the heart; and    b) returning said drawn blood via said pump to the pulmonary artery using a second catheter.    
     
     
         33 . The method as specified in    claim 32    further comprising the step of repairing the tricuspid valve.  
     
     
         34 . The method as specified in    claim 32    further comprising the step of repairing the pulmonic valve.