Device to permit offpump beating heart coronary bypass surgery

Abstract

Mechanical elements and/or adhesive is used in conjunction with or in place of suction to releasably attach elements of a system for manipulating a heart during cardiac surgery to the heart. The elements of the heart manipulation system are disclosed in the application Ser. No. 09/087,511 filed on May 29, 1998 and in the patent application Ser. No. 08/936,184 filed on Sept. 17, 1997. One form of the system can be used in minimally invasive surgery.

We claim:  
     
         1 . A manipulation system for cardiac surgery comprising: 
 a gross support means for engaging a beating heart and supporting the heart when the heart is located and oriented for surgery, said gross support means being located at the base of the heart and including a head which is sized and shaped to cradle the myocardium of the left ventricle along the arterialventricular groove;    a suspension head for lifting the heart and which is located near the apical region of the heart and at least partially overlying the right ventricle; and    means for releasably attaching said suspension head to the heart.    
     
     
         2 . In a manipulation system for cardiac surgery which includes means for engaging a selected section of the heart to immobilize that selected section as a surgery target while permitting non-engaged sections of the heart to move in a manner whereby essentially unabated cardiac output is maintained while the heart is regionally immobilized, wherein the improvement comprises: 
 a suspension head means releasably attached to the surface of the beating heart to lift the heart and which is located near the apical region of the heart, said suspension head including a head abutting the surface of the beating heart, said head having means for accommodating multiplanar surface movement of the beating heart while remaining attached to the surface of the beating heart, said suspension head further including means for accommodating multiplanar movement of the beating heart.    
     
     
         3 . The improvement defined in  claim 1  wherein said gross support means is located adjacent to the left atrium.  
     
     
         4 . A heart manipulation system for use in cardiac surgery comprising: 
 a frame that is located inside a patient during beating heart surgery and which includes means for engaging the pericardial cavity of the patient for mounting said frame on the patient to move with the patient if the patient is moved or reoriented during surgery;    a suspension head movably mounted on said frame for lifting the heart and which is located near the apical region of the right ventricle to prevent collapse of the right ventricle during manipulation of the heart and at least partially overlying the right ventricle and which includes a flexible means for permitting multiplanar relative movement between the beating heart and means mounting the suspension head on said frame means, said suspension head including a flexible rim engaging the myocardium of the heart and being flexible in a plurality of planes so multiplanar movement of the myocardium during operation of the heart will be accommodated by said flexible rim;    means for releasably attaching said suspension head to the heart;    a means for locally engaging a selected section of the heart and locally immobilizing the heart adjacent to a surgery target so the heart is supported and free to operate during surgery while it is also locally immobilized at the surgery target with non-engaged sections of the heart free to move in a manner whereby essentially unabated cardiac output is maintained while the heart is locally immobilized, and further including a flexible rim engaging the myocardium of the heart and being flexible in a plurality of planes so multiplanar movement of the myocardium during operation of the heart will be accommodated by the flexible rim of said means for locally engaging a selected section of the heart;    a gross support means movably mounted on said frame for engaging the heart to support the heart when the heart is oriented for surgery and which is located at the base of the heart and which cradles the myocardium of the left ventricle along the arterialventricular groove and which includes means for movably connecting said gross support means to said frame, the gross support means supporting the mitral valve annulus to maintain competent mitral valve function and is placed beneath an infolded section of myocardium, said gross support means including a handle which extends outside of the patient during surgery for adjusting the location of said gross support means, and further including a head having a malleable rod means for connecting said head to said means for mounting said gross support means on said frame, said head including a plurality of sections which are movable relative to each other and means for maintaining said sections in a selected relative orientation; and    means for releasably attaching said gross support means to the heart.    
     
     
         5 . A heart manipulation system for use in cardiac surgery comprising: 
 a frame which is located inside a patient during beating heart surgery and which is mounted on the patient to move with the patient;    a suspension head mounted on said frame for lifting the beating heart and which includes a flexible head, said flexible head including a flexible rim, said flexible rim being flexible in a plurality of planes to accommodate multiplanar movement of the surface of the beating heart, and means for accommodating multiplanar movement of the beating heart during beating heart surgery;    means for releasably attaching said suspension head to the heart; and    means for engaging a selected section of the heart to immobilize that selected section as a surgery target while permitting non-engaged sections of the heart to move in a manner whereby essentially unabated cardiac output is maintained while the heart is locally immobilized.    
     
     
         6 . The improvement defined in  claim 1  wherein the improvement further includes means for engaging a selected section of the heart to immobilize that selected section as a surgery target while permitting non-engaged sections of the heart to move in a manner whereby essentially unabated cardiac output is maintained while the heart is regionally immobilized.  
     
     
         7 . A manipulation system for use in cardiac surgery comprising: 
 a gross support means for engaging and supporting a beating heart when the heart is located and oriented for surgery and which is located at the base of the heart and engages the beating heart at a location that supports the mitral valve annulus and which includes a flexible head which is sized and shaped to extend along the arterialventricular groove-of the heart;    means for immobilizing the heart adjacent to a surgery target so the heart is supported and free to operate during surgery while it is also locally immobilized at the surgery target;    means for releasably attaching said gross support means to the heart; and    a suspension head for lifting the heart and which is located near the apex of the heart and which includes a flexible head.    
     
     
         8 . The manipulation system defined in  claim 1  wherein said means for releasably attaching at least one of the suspension head or the gross support means to the heart includes sutures.  
     
     
         9 . The manipulation system defined in  claim 1  wherein said means for releasably attaching at least one of the suspension head or the gross support means to the heart includes adhesive.  
     
     
         10 . The manipulation system defined in  claim 1  wherein said means for releasably attaching at least one of the suspension head or the gross support means to the heart includes staples.  
     
     
         11 . The heart manipulation system defined in  claim 4  wherein said means for releasably attaching at least one of the suspension head or the gross support means to the heart includes sutures.  
     
     
         12 . The heart manipulation system defined in  claim 4  wherein said means for releasably attaching at least one of the suspension head or the gross support means to the heart includes adhesive.  
     
     
         13 . The heart manipulation system defined in  claim 4  wherein said means for releasably attaching at least one of the suspension head or the gross support means to the heart includes staples.  
     
     
         14 . The heart manipulation system defined in  claim 11  further including an extension on a rim of the suspension head to which said sutures are attached.  
     
     
         15 . The manipulation system defined in  claim 1  wherein said means for releasably attaching at least one of the suspension head or the gross support means to the heart includes suture needles.  
     
     
         16 . The heart manipulation system defined in  claim 4  wherein said means for releasably attaching at least one of the suspension head or the gross support means to the heart includes suture needles.  
     
     
         17 . The manipulation system defined in  claim 1  wherein said means for releasably attaching at least one of the suspension head or the gross support means to the heart includes mechanical elements.  
     
     
         18 . The heart manipulation system defined in  claim 4  wherein said means for releasably attaching at least one of the suspension head or the gross support means to the heart includes mechanical elements.  
     
     
         19 . The manipulation system defined in  claim 1  further including a flexible means for permitting said suspension head to move in a plurality of planes to accommodate movement of the heart during beating of the heart to maintain cardiac output.