Apparatuses and methods for performing minimally invasive diagnostic and surgical procedures inside of a beating heart

Abstract

The present invention provides apparatuses and methods for performing minimally invasive diagnostic and surgical procedures inside of a beating heart. An assembly for use in performing such a medical procedure includes a port and a fluid transport device. The port has a housing configured for insertion through a chamber wall of a heart chamber, at least one valve disposed in the housing, and an inlet connected to the housing. The inlet has an inlet passage in fluid communication with a lumen of the housing. The fluid transport device has an end that attaches to the inlet of the port, another end that attaches to a fluid source, and a fluid channel therebetween to pass a fluid from the fluid source to the heart chamber. A method of preparing a beating heart for a diagnostic or medical procedure comprises the steps of inserting a cardiac port through a chamber wall of the beating heart and pressurizing the heart chamber with blood from the patient's artery. Repair of the heart's mitral valve can be effected by a stapled annuloplasty procedure. Where sutures are used in the diagnostic or surgical procedure, a suture cutting device for cutting a suture inside a beating heart can be used. The suture cutting device can include an elongated body having a lumen, a wall member extending into the lumen, and a knot-receiving chamber defined by a first area on a first side of the wall member. The wall member defines a channel therethrough dimensioned to permit passage of a suture and to prevent passage of a knot. A cutting implement is movably disposed in the lumen in a second area on a second side of the wall member opposite the first side. The cutting implement moves between a first position and second position to cut the suture. Movement of the cutting implement is limited to ensure that the cutting implement does not cut through the suture knot.

1 .- 29 . (canceled) 
   
   
       30 . A method of treatment, comprising:
 inserting a cardiac port into a heart chamber wall while the heart remains beating, wherein the port is comprised of a housing, a lumen, a first valve and a second valve in the lumen, and an inlet through the housing and entering the lumen between the first valve and the second valve;   positioning the housing so that the lumen allows access to an interior of the heart chamber via the lumen through the first valve and the second valve;   inserting a medical instrument into the heart chamber interior via the lumen; and   repairing a defect in the heart with the inserted medical instrument.   
   
   
       31 . The method of  claim 30 , wherein the repairing comprises performing a surgical technique selected from the group consisting of mitral valve repair, repair of atrial or ventricular septal defects, and endovascular aortic surgery. 
   
   
       32 . The method of  claim 30 , wherein the housing comprises a first portion and a second portion with a narrower circumference relative to the first portion, the second portion comprising a flange around a lower circumference, and wherein the inserting comprises positioning the heart chamber wall between the first portion and the flange on the second portion of the housing. 
   
   
       33 . The method of  claim 30 , further comprising:
 inserting a catheter into the inlet and into the lumen and into the heart chamber.   
   
   
       34 . A system for performing annuloplasty, said system comprising:
 a plurality of plication staples suitable for application to a mitral valve annulus; and   a suture or a band of material adapted to be stapled to the mitral valve annulus at fixed positions along the suture or band of material to plicate mitral valve annulus tissue and thereby reduce the length of the mitral valve annulus; wherein the staples and suture or band of material are adapted to be delivered to the mitral valve annulus of a heart while the heart is beating   
   
   
       35 . A system as in  claim 34 , further comprising an instrument for delivering the staples to the valve annulus and plicating valve annulus tissue while the heart is beating. 
   
   
       36 . A system, comprising:
 a port adapted to span a wall of an atrium and provide access therethrough   a plurality of plication staples adapted to pass through the port and suitable for application to a mitral valve annulus;   a suture or a band of material adapted to be stapled to the mitral valve annulus at fixed positions along the suture or band of material to plicate mitral valve annulus tissue and thereby reduce the length of the mitral valve annulus wherein the staples and suture or band of material are adapted to be delivered to the mitral valve annulus of a heart while the heart is beating; and   an instrument for delivering the staples to the valve annulus and plicating valve annulus tissue.   
   
   
       37 . The system of  claim 36 , wherein the port comprises:
 a housing having a first end, a second end, and a lumen therethrough;   at least one valve disposed in the housing to open and close the lumen; and   an inlet connected to the housing, the inlet having an inlet passage in fluid communication with the lumen of the housing, the inlet adapted to transmit a fluid between an exterior of the port and the lumen of the housing.   
   
   
       38 . The system according to  claim 37 , wherein the housing includes a first portion and a second portion, the second portion having a length substantially equal to a thickness of the wall of the atrium. 
   
   
       39 . The system according to  claim 38 , wherein the second portion is flexible relative to the first portion. 
   
   
       40 . The system according to  claim 38 , wherein the inlet connects to the housing adjacent a position of the at least one value. 
   
   
       41 . The system according to  claim 38 , wherein the housing has first and second retainer members to retain the wall of the atrium therebetween. 
   
   
       42 . The system according to  claim 41 , wherein the first and second retainer members are annular flanges that encircle the exterior surface of the housing. 
   
   
       43 . The system according to  claim 38 , wherein the housing includes a first portion having a first diameter and a second portion having a second diameter smaller than that of the first portion. 
   
   
       44 . The system according to  claim 43 , wherein the second portion has a length substantially equal to a thickness of the wall of the atrium. 
   
   
       45 . The system according to  claim 43 , wherein the second portion is flexible relative to the first portion. 
   
   
       46 . The system of  claim 36 , wherein the port comprises:
 a housing having a first end, a second end, and a lumen therethrough;   at least one valve disposed in the housing to open and close the lumen; and   first and second retainer members on the housing, the first retainer member being spaced from the second retainer member a predetermined distance to anchor the chamber wall between the first and second retainer members.   
   
   
       47 . The system according to  claim 46 , wherein the first and second retainer members comprise first and second flanges disposed on an exterior surface of the housing. 
   
   
       48 . The system according to  claim 47 , wherein a portion of the housing between the first flange and the second flange is flexible relative to a remaining portion of the housing. 
   
   
       49 . The system according to  claim 47 , further comprising an inlet connected to the housing, the inlet having an inlet passage in fluid communication with the lumen of the housing, the inlet passage adapted to transmit a fluid between an exterior of the port and the lumen of the housing. 
   
   
       50 . The system of  claim 36 , wherein the plurality of plication staples are inserted and folded in on themselves at fixed positions along the mitral valve annulus, thereby reducing the length of the mitral valve annulus. 
   
   
       51 . The system of  claim 50 , wherein the plurality of plication staples are attached to the suture or band of material. 
   
   
       52 . A cardiac port for insertion through a chamber wall of a heart chamber to perform a medical procedure inside of a beating heart, comprising:
 a housing having a first end, a second end, and a lumen therethrough the housing comprising a first portion and a second portion, the second portion having a length substantially equal to the thickness of the chamber wall;   a first valve disposed in the housing to open and close the lumen;   a second valve disposed in the house to open and close the lumen; and   an inlet connected to the housing between the first valve and the second valve, the inlet having an inlet passage in fluid communication with the lumen of the housing, the inlet adapted to transmit a fluid between an exterior of the port and the lumen of the housing.   
   
   
       53 . The cardiac port of  claim 52 , wherein the second portion is flexible relative to the first portion. 
   
   
       54 . The cardiac port of  claim 52 , wherein the housing comprises first and second retainer members to retain the chamber wall therebetween. 
   
   
       55 . The cardiac port of  claim 54 , wherein the first and second retainer members are annular flanges that encircle the exterior surface of the housing. 
   
   
       56 . The cardiac port of  claim 52 , wherein the first portion has a first diameter and the second portion has a second diameter smaller than that of the first portion.