System for performing extraluminal coronary bypass and method of operation thereof

Abstract

A system to perform a bypass procedure performed by an apparatus (100, 400, 600) comprising a steerable body portion (102, 450, 452) and at least one transducer (114, 414) controlled by at least one controller (610). The system may include one or more acts of transluminally detaching at least a portion of a first artery from connective tissue (423) of a chest wall (425) that is attached to the first artery by applying ultrasound signals of a first type emitted by the at least one transducer (114, 414) situated within the first artery; steering the detached portion of the first artery from a current location to a bypass location by applying a force from the steerable body portion, which is located outside of the first artery, to at least a portion of the detached portion of the first artery; and coupling the first artery to a target artery at the bypass location to establish flow communication between the first artery and the target artery.

1 . A method of operating a surgical apparatus to perform a bypass procedure, the surgical apparatus comprising a steerable body portion defining a plurality of channels configured to receive one or more instruments slidably deployable through corresponding channels of the plurality of channels, one of the instruments comprising an ultrasound transducer array having at least one transducer controlled by at least one controller, the method comprising:
 transluminally detaching at least a portion of a first artery from connective tissue of a chest wall that is attached to the first artery by applying ultrasound signals of a first type emitted by the at least one transducer situated within the first artery when extended from one of the plurality of channels of the steerable body portion;   steering the detached portion of the first artery from a current location to a bypass location by applying a force from the steerable body portion, which is located outside of the first artery, to at least a portion of the detached portion of the first artery; and coupling the first artery to a target artery at the bypass location to establish flow communication between the first artery and the target artery.   
     
     
         2 . The method of  claim 1 , further comprising an act of interrupting blood flow to the first artery by placing a clip about the first artery by the apparatus. 
     
     
         3 . The method of  claim 1 , further comprising an act of establishing a port in the target artery at the bypass location using one or more of an arterial puncture device and a laser arteriectomy device. 
     
     
         4 . The method of  claim 3 , wherein the act of coupling further comprises an act of inserting a graft stent at least partially through the port in the target artery. 
     
     
         5 . The method of  claim 1 , further comprising an act of transluminally cauterizing side branches of the first artery by applying ultrasound signals of a second type emitted by the at least one transducer that is situated within the first artery. 
     
     
         6 . The method of  claim 1 , wherein the ultrasound signals of the first type comprise histotripsy pulses and the ultrasound signals of the second type comprise high-intensity focused ultrasound (HIFU) pulses that are lower in intensity and longer in duration than the ultrasound signals of the first type. 
     
     
         7 . The method of  claim 1 , wherein the first artery is a left internal mammary artery (LIMA) and the target artery is a left anterior descending artery (LAD). 
     
     
         8 . A computer program stored on a non-transitory computer readable memory medium, the computer program configured to control an apparatus comprising a steerable body portion, defining a plurality of channels ( 126 ) configured to receive one or more instruments slidably extendable from and retractable into corresponding channels of the plurality of channels, one of the instruments comprising an ultrasound transducer array having at least one transducer controlled by at least one controller to perform a bypass procedure, the computer program comprising:
 a program portion configured to control the apparatus to enable:   transluminally detaching at least a portion of a first artery from connective tissue of a chest wall that is attached to the first artery by applying ultrasound signals of a first type emitted by the at least one transducer extended from one of the plurality of channels and situated within the first artery; and   steering the detached portion of the first artery from a current location to a bypass location by applying a force from the steerable body portion, which is located outside of the first artery, to at least a portion of the detached portion of the first artery; and   coupling the first artery to a target artery at the bypass location to establish flow communication between the first artery and the target artery.   
     
     
         9 . The computer program  claim 8 , wherein the program portion is further configured to enable interruption of blood flow to the first artery by placing a clip, deployable through another one of the plurality of channels, about the first artery by a gripping portion of the apparatus. 
     
     
         10 . The computer program  claim 8 , wherein the program portion is further configured to enable establishing a port in the target artery at the bypass location using at least one of an arterial puncture device and a laser arteriectomy device deployable through another one of the plurality of channels. 
     
     
         11 . The computer program  claim 8 , wherein the program portion is further configured to enable insertion of a graft stent, deployable through another one of the plurality of channels, at least partially through the port in the target artery. 
     
     
         12 . The computer program  claim 8 , wherein the program portion is further configured to enable transluminally cauterizing side branches of the first artery by applying ultrasound signals of a second type emitted by the at least one transducer. 
     
     
         13 . The computer program  claim 8 , wherein the ultrasound signals of the first type comprise histotripsy pulses and the ultrasound signals of the second type comprise high-intensity focused ultrasound (HIFU) pulses that are lower in intensity and longer in duration than the ultrasound signals of the first type.