Methods and devices for minimally invasive cardiac surgery for atrial fibrillation

Abstract

Devices for enhancing minimally invasive cardiac surgery include a visualization device including an inflatable balloon at or near the distal end. Some visualization devices also include one or more lumens for allowing the introduction of one or more devices to a surgical site through the visualization device. Systems of the invention involve a visualization device which has at least one lumen for allowing introduction of an ablation device and/or other devices. A visualization device with an inflatable balloon may be positioned to create a space between a heart and pericardium when the balloon is inflated.

We claim: 
     
         1 . A method of reducing blood flow through a left atrial appendage of a heart of a patient, comprising:
 introducing an elongate visualization device into the patient;   introducing a left atrial appendage clip applier through a lumen of the elongate visualization device via a first incision; and   applying at least one clip to the left atrial appendage of the patient with the left atrial appendage clip applier.   
     
     
         2 . The method according to  claim 1 , wherein the clip applier comprises a clamp for applying a clip, a handle for operating the clamp, and an elongate shaft coupled with the clamp and the handle. 
     
     
         3 . The method according to  claim 1 , wherein actuating the clip applier to move first and second elongate applier members to compress first and second elongate segregation members such that the first and second elongate segregation members compress the left atrial appendage without severing the appendage. 
     
     
         4 . The method according to  claim 1 , wherein the clip applier carries an atrial segregation device separable from the clip applier, the clip applier having a first elongate applier member with a first applier distal end and a second elongate applier member with a second applier distal end, and the atrial segregation device having a first elongate segregation member and a second elongate segregation member, where the first elongate applier member is parallel to a middle portion of the first elongate segregation member and the second elongate applier member is parallel to a middle portion of the second elongate segregation member, wherein the first and second applier distal ends terminate along outer lateral sides of the first and second elongate segregation members and a distal portion of the clip applier co-terminates with a distal portion of the atrial segregation device. 
     
     
         5 . The method according to  claim 4 , wherein the clip applier holds the atrial segregation device as a U-shaped configuration. 
     
     
         6 . The method according to  claim 4 , wherein the atrial segregation device is disposed within the clip applier. 
     
     
         7 . The method according to  claim 4 , further comprising segregating the left atrial appendage by applying the atrial segregation device to the left atrial appendage of the heart with the clip applier such that the left atrial appendage is positioned between the first and second elongate applier members and between the first and second elongate segregation members. 
     
     
         8 . The method according to  claim 7 , further comprising separating the clip applier from the atrial segregation device after applying the atrial segregation device to the left atrial appendage. 
     
     
         9 . The method according to  claim 7 , further comprising leaving the atrial segregation device applied to the left atrial appendage while the first incision is closed. 
     
     
         10 . The method according to  claim 1 , further comprising introducing an insufflation device through the elongate visualization device, wherein the insufflation device is configured to provide insufflation from an insufflation source. 
     
     
         11 . The method according to  claim 1 , wherein the step of applying at least one clip to the left atrial appendage of the patient comprises segregating the left atrial appendage. 
     
     
         12 . The method according to  claim 1 , wherein the step of applying at least one clip to the left atrial appendage of the patient comprises segregating the left atrial appendage without severing the left atrial appendage. 
     
     
         13 . The method according to  claim 1 , further comprising introducing an ablation device through the lumen of the visualization device, wherein the ablation device is configured to ablate tissue. 
     
     
         14 . The method according to  claim 1 , further comprising visualizing a portion of the heart by introducing the visualization device into the patient via a second incision, where the second incision is one of a subxiphoid incision, a subcostal incision, and a thoracotomy. 
     
     
         15 . The method according to  claim 1 , further comprising clipping and excising the left atrial appendage. 
     
     
         16 . The method according to  claim 1 , further comprising contacting the left atrial appendage with the clip applier. 
     
     
         17 . The method according to  claim 1 , further comprising advancing the visualization device to position at least one inflatable balloon on the visualization device between the heart and a layer of pericardium adjacent the heart to position a visualization member of the visualization device between the heart and the layer of pericardium. 
     
     
         18 . The method according to  claim 17 , further comprising inflating the at least one inflatable balloon while the at least one inflatable balloon is disposed between the heart and the layer of pericardium to create a space between the heart and the layer of pericardium. 
     
     
         19 . The method according to  claim 18 , further comprising using the visualization member of the visualization device to visualize the heart during a surgical procedure while the visualization member is disposed in the space between the heart and the layer of pericardium created by the at least one inflatable balloon. 
     
     
         20 . The method according to  claim 18 , wherein the step of inflating the at least one inflatable balloon comprises inflating one balloon disposed around a circumference of the visualization device.