Less-invasive devices and methods for cardiac valve surgery

Abstract

Systems and methods are disclosed for performing less-invasive surgical procedures within the heart. A method for less-invasive repair or replacement of a cardiac valve comprises placing an instrument through an intercostal access port and through a penetration in a wall of a vessel in communication with the heart, advancing the instrument into the heart, and using the instrument to perform a surgical intervention on a cardiac valve in the heart under visualization through an intercostal access port The surgeons hands are kept outside of the chest during each step. The surgical intervention may comprise replacing the cardiac valve with a prosthetic valve, wherein the native valve is removed using a tissue removal instrument, the native valve annulus is sized with a specialized sizing device, a prosthetic valve is introduced through an intercostal access port and through the penetration in the vessel, and the prosthetic valve is secured at the native valve position, all using instruments positioned through intercostal access ports without placing the hands inside the chest. Systems and devices for performing these procedures are also disclosed.

What is claimed is:  
     
         1 . A method of accessing an internal chamber of the heart through a vessel having a lumen in fluid communication with the chamber, the heart and the vessel being within a patient's chest defined by a plurality of ribs connected to a sternum, the method comprising: 
 positioning an instrument into an inner lumen of the vessel through a penetration in a wall thereof, a proximal end of the instrument extending out of the patient's chest through a percutaneous access port between two adjacent ribs; and    manipulating the proximal end of the instrument to advance a distal end of the instrument through the vessel and into the internal chamber of the heart;    wherein all manipulations of the instrument are performed outside of the patient's chest.    
     
     
         2 . The method of  claim 1  wherein the vessel comprises an aorta and the internal chamber comprises a left ventricle, the step of manipulating comprising passing the distal end of the instrument through an aortic valve disposed in an aortic position between the aorta and the left ventricle.  
     
     
         3 . The method of  claim 2  further comprising attaching a valve prosthesis at the aortic position.  
     
     
         4 . The method of  claim 3  wherein the instrument comprises a suturing instrument, further comprising applying sutures to an annulus of the aortic valve using the suturing instrument.  
     
     
         5 . The method of  claim 3  wherein the step of attaching a valve prosthesis comprises positioning the valve prosthesis through a percutaneous access port between two adjacent ribs.  
     
     
         6 . The method of  claim 3  wherein the valve prosthesis is positioned at the aortic position using a delivery handle removably coupled to the valve prosthesis, the delivery handle being manipulated at a proximal end thereof which extends out of the patient's chest through a percutaneous access port between two adjacent ribs.  
     
     
         7 . The method of  claim 3  further comprising positioning the valve prosthesis through a percutaneous access port in a first orientation and re-orienting the valve prosthesis within the patient's chest into a second orientation before attachment at the aortic position.  
     
     
         8 . The method of  claim 7  wherein the step of re-orienting comprises manipulating from outside of the patient's chest an actuator on a delivery handle releasably coupled to the valve prosthesis.  
     
     
         9 . The method of  claim 7  wherein the second orientation is approximately perpendicular to the first orientation.  
     
     
         10 . The method of  claim 1  wherein all steps are performed without cutting or removing the ribs or sternum.  
     
     
         11 . The method of  claim 1  further comprising visualizing the vessel through a visualization device positioned in a percutaneous access port between two adjacent ribs.  
     
     
         12 . The method of claim I further comprising forming an incision in the vessel using a cutting tool manipulated from outside of the patient's chest.  
     
     
         13 . The method of  claim 12  further comprising retracting the incision open before positioning the instrument in the vessel lumen.  
     
     
         14 . The method of  claim 2  wherein the percutaneous access port is positioned in an intercostal space selected from the first, second, third, or fourth intercostal space on an anterior side of the patient's chest.  
     
     
         15 . The method of  claim 1  wherein the percutaneous access port comprises a cannula having a proximal end outside of the patient's chest, a distal end within th patient's chest exterior to the vessel, and a passage therebetween through which the instrument is positioned.  
     
     
         16 . In a valve replacement procedure, a method of positioning a replacement valve in a patient's heart within a patient's chest, the chest being defined by a plurality of ribs, the method comprising: 
 positioning an access device in the chest between two adjacent ribs, the access device defining an opening into the chest between the ribs and having and an illuminating device mounted adjacent to the opening;    illuminating the interior of the chest with the illuminating the device; and    introducing the replacement valve into the patient's chest through the opening.    
     
     
         17 . In a valve replacement procedure, a method of positioning a replacement valve in a patient's heart within a patient's chest, the chest being defined by a plurality of ribs, the method comprising: 
 positioning the distal end of an illuminating device within the chest through a percutaneous access port between two adjacent ribs;    illuminating the interior of the chest with the illuminating the device; and    introducing the replacement valve into the patient's chest through a percutaneous access port between two adjacent ribs while illuminating the interior of the chest with the illuminating device.    
     
     
         18 . An access device for providing a percutaneous passage into a chest cavity through which a replacement cardiac valve may be positioned, the access device comprising: 
 a device body having proximal and distal ends, the distal end being positionable between two adjacent ribs into the chest, the device body being configured to displace tissue between the ribs so as to define an opening into the chest through which the replacement valve may be positioned without interference; and    an illumination device mounted to the device body so as to illuminate the interior of the chest.    
     
     
         19 . An access cannula for providing a percutaneous passage into a chest cavity through which a replacement cardiac valve may be positioned the access cannula comprising: 
 a cannula body having proximal and distal ends, the distal end being positionable between two adjacent ribs into the chest, and having a lumen between the proximal and distal ends through which the replacement valve may be positioned into the chest; and    a light-conducting element mounted to the cannula body and extending from outside the chest to the distal end of the cannula body for illuminating the interior of the chest.    
     
     
         20 . In a valve replacement procedure, a method of positioning a replacement valve in an aortic position of a patient's heart within a patient's chest, the aortic position being disposed between a left ventricle of the heart and an aorta leading away from the heart, the chest being defined by a plurality of ribs connected to a sternum, the method comprising: 
 introducing the replacement valve into the patient's chest through a percutaneous access port between two adjacent ribs; and    positioning the replacement valve through a penetration in the aorta and into the aortic position by manipulating a valve-positioning instrument which engages the replacement valve, wherein all manipulation of the valve-engaging instrument is performed outside of the chest.