RU2216284C1 - Vacuum apparatus complex for temporary immobilization of myocardium local areas in operations without cardiac arrest and device for immobilization of myocardium local area - Google Patents

Abstract

FIELD: medical equipment; applicable in performance of full-scale slightly invasive operations without cardiac arrest. SUBSTANCE: complex has vacuum source and secured to retractor device for immobilization of myocardium local area with vacuum suckers holding myocardium local area. Vacuum source is made in form of autonomous vacuum unit provided with vacuum pump, collector, pipeline connecting collector with vacuum pump, pressure control valves in vacuum collector and control system of complex functioning. The latter includes vacuum level transducer in collector and electronic unit controlling immobilization of myocardium local area. Device for immobilization of myocardium local area has stabilizer of position of myocardium operated area secured to controlled supporting member. Myocardium stabilizer has load- carrying frame assembled of two hinged carrying clamps with two flanges limiting operation window. In this case, each carrying clamp has vacuum sucker having working cavity opened from end facing myocardium. Working cavity accommodates perforated inserts. EFFECT: provided high degree of immobilization of operated area and minimal injury to myocardium. 47 cl, 27 dwg

Description

 The invention relates to medicine and can be used in cardiac surgery when conducting full-scale and minimally invasive operations without cardiac arrest.

 Currently, a promising area of cardiac surgery are operations without cardiac arrest with the immobilization of the operated myocardial site, which can significantly reduce the traumatic effect on the patient. To perform such operations, vacuum apparatuses and devices are used to immobilize the local areas of the myocardium using vacuum suction cups. The main problems that have to be solved when developing vacuum hardware systems for cardiosurgical operations are to increase the reliability of temporary immobilization of the operated local myocardium, the limit is the complete exclusion of any movement of the surface of the operated myocardial site with minimal traumatic effect on the heart and maintaining normal working conditions as much as possible heart, as well as providing the surgeon with maximum opportunities to focus directly on the execution enii operations on myocardium with minimal distraction surgeon in preparation for surgery.

 A vacuum apparatus is known for temporarily immobilizing an organ, for example, a heart, comprising a device mounted on a power support for moving and holding the heart in the area of operation, having a power shoulder with a vacuum cup-shaped suction cup at the end of the shoulder. The vacuum cup-shaped suction cup coincides in shape with the apex of the heart and is connected using a suction flexible pipe to a vacuum source (see PCT application WO 01/17437 A2, A 61 B 17/02, 03/15/2001). During heart surgery, a cup-shaped suction cup is installed on top of the heart, a vacuum is created in the cavity of the vacuum suction cup, due to which the heart is fixed relative to the suction cup, but can continue to work. Then the heart is moved to the operating area, and the surgeon has the opportunity to carry out the operation in a more convenient area, including a working heart. The well-known vacuum apparatus for temporary immobilization of the heart involves a predetermined location of the cup-shaped suction cup on the heart, which limits the range of possible cardiosurgical operations without stopping the heart only to the area adjacent to the cup-shaped suction cup. The installation of a vacuum suction cup on the heart requires increased attention of the surgeon, since only his subjective sensations allow us to correctly assess the installation of a suction cup on the heart. In this vacuum hardware complex, as in all other known vacuum hardware complexes for cardiac surgery, a stationary vacuum system of the clinic is used as a vacuum source, the pressure in which is always maintained unchanged regardless of the requirements for a particular operation.

 Also known is a vacuum hardware complex for temporary immobilization of a local myocardial site during operations without cardiac arrest, described in PCT application WO 00/62680 A1, A 61 B 17/02, 10.26.2000. The known vacuum apparatus complex comprises a device mounted on a power support for immobilizing the operated myocardial site with an adjustable cantilever supporting element and covering the operated myocardial site with a single-cavity elastic vacuum suction cup having an annular or horseshoe-shaped shape, and a suction flexible pipe connecting the vacuum suction cup to a vacuum source, as which use the clinic's stationary vacuum system. A vacuum suction cup can be installed in any zone on the surface of the heart and allows you to immobilize the directly operated local area of the myocardium of the working heart, which greatly facilitates the work of the surgeon during cardiac surgery without stopping the heart. Like the previous invention, this vacuum apparatus complex uses a stationary clinic vacuum system as a vacuum source, the pressure in which is always maintained constant regardless of the requirements for a particular heart operation, which can lead to an increased traumatic effect on the myocardium. In addition, the known hardware complex is not protected from blood clots in the vacuum system in case of accidental suction of blood by a suction flexible pipe. The use of a single-cavity vacuum suction cup increases the area of the vacuum effect on the myocardium, which increases the risk of myocardial damage during surgery.

 Closest to the proposed vacuum hardware complex for temporary immobilization of the local myocardial region during operations without cardiac arrest according to the set of essential features is the invention described in PCT application WO 00/15119 A1, A 61 B 17/02, 23.03.2000. The vacuum hardware complex contains a vacuum source, a device for immobilizing the local myocardial site with two vacuum suction cups holding the operated myocardial site, and a suction flexible pipe connecting the vacuum suction cups to the vacuum source, mounted on the expander. The presence of two vacuum suction cups makes it possible to reduce the area of exposure to a rarefied effect on the myocardium and, thereby, reduce the traumatic effect of suction cups on the myocardium. However, as in all complexes with a stationary vacuum source, the known vacuum hardware complex does not allow you to choose the vacuum level in accordance with the specific conditions of the operation and does not allow you to control the current vacuum level, which increases the risk of traumatic myocardial damage during surgery. The need for a stationary vacuum source eliminates the possibility of using this invention in mobile cardiac complexes.

 A device for immobilizing a local area of the myocardium is described in PCT application WO 01/24709 A1, A 61 B 17/02, 04/12/2001. The known device contains an adjustable cantilever supporting element with a mount on the expander and attached to it by means of a spherical hinge stabilizer the position of the operated section of the myocardium clamping action, having a rigid frame that frames the surgical field. The rigid frame is assembled from two parts movably connected relative to each other, fixed in the assembled state by destructible jumpers. The frame is equipped with wedge-shaped clamps for turnstile threads for clamping the artery. Turnstile threads are passed through the operation window of the frame. This device has limited possibilities for immobilization of the operated area, which are entirely determined by the force of the tightened frame. Preloading the frame to the operated area of the myocardium also imposes restrictions on the functioning of the heart during surgery.

 Also known is a device for immobilizing a local myocardial site, described in PCT application WO 00/62680 A1, A 61 B 17/02, 10.26.2000. The known device contains an adjustable cantilever supporting element with a mount on the expander and attached to it a stabilizer of the position of the operated myocardial site. The stabilizer is mounted on a fork holder rigidly attached to an adjustable cantilever support element. The stabilizer has a single-cavity flexible vacuum suction cup of a ring or horseshoe shape in plan with a round operating window in the center of the suction cup, limited by cylindrical walls. The working cavity of the vacuum suction cup is made with the open end facing the myocardium. It is assumed that the surgical window has a diameter of 1 to 25 mm. This device has limited ability to immobilize the operated area. The use of a fork holder requires an enlarged open chest area. To organize a good suction of the suction cup to the myocardium, it is necessary that the body of the suction cup is continuous, which causes additional difficulties when removing the suction cup from the operated area, since it is necessary to cut its body. The execution of the body of the vacuum suction cup in the form of a horseshoe complicates the installation of a vacuum suction cup on the myocardium, since it is necessary to provide flexibility of both the annular and transverse walls of the vacuum suction cup.

 Closest to the proposed device for immobilizing a local area of the myocardium on the set of essential features is the device described in PCT application WO 00/15119 A1, A 61 B 17/02, 03/23/2000. The known device comprises an adjustable cantilever supporting element with a mounting unit on the retractor and a stabilizer of the position of the myocardial site being operated attached via a spherical hinge. The stabilizer has two parallel supporting blades, connected at one end by a jumper, forming a supporting fork. Each supporting spatula is equipped with a vacuum suction cup with a flat contact surface facing the myocardium. Vacuum suction cups are equipped with nipples for connecting their working cavities to a vacuum source. The immobilization device is supplied assembled with vacuum suction cups fixed to an adjustable cantilever support element. During the operation, vacuum suction cups are placed on both sides relative to the operation zone and, when a vacuum is created in their working cavities, the myocardial region located between them is immobilized without exerting any pressing force on the heart, and the heart can continue to work without experiencing additional load. The operating window has good access, which facilitates the work of the surgeon. This device does not solve the problem of complete immobilization of the operated area, since the vertical movements of the operated area are limited only on two sides and the possibility of fluctuations of the myocardial surface from the working heart or accidental heart fibrillation penetrating from the open ends of the fork is not ruled out. When using this device, the complete set of the device cannot be changed during surgery, which increases the risk of myocardial injury, since it is difficult to predict the condition of the myocardium of the operated heart in advance.

 The problem to which the present invention is directed, is to develop a vacuum hardware complex and device for temporarily immobilizing a local area of the myocardium during operations without cardiac arrest, providing minimal traumatic effect on the myocardium and allowing to take into account the condition of the operated heart in order to reduce the risk during surgery, as well as provide a high degree of immobilization of the operated area. Another objective of the invention is the development of a vacuum hardware complex and a device for temporary immobilization of the local myocardial site during operations without cardiac arrest, allowing during a specific operation to set the optimal functional characteristics of the complex, the most appropriate state of the operated heart. Another objective of the invention is the development of a vacuum hardware complex and a device for temporary immobilization of the local myocardial region during operations without cardiac arrest, which allows maintaining the optimal mode of immobilization of the operated myocardial region during the whole operation, in order to ensure the possibility of heart surgery not only in large specialized centers, but also in regional surgical clinics, as well as in mobile cardiac surgical complexes. An additional objective of the invention is the development of a vacuum hardware complex and device for temporary immobilization of the local myocardial site during operations without cardiac arrest, providing the surgeon with more comfortable conditions for the operation. An additional objective of the invention is to increase the reliability of an autonomous vacuum hardware complex for temporary immobilization of a local myocardial site during operations without cardiac arrest.

 The stated technical problems are solved as follows.

 In a vacuum apparatus for temporarily immobilizing local areas of the myocardium during operations without cardiac arrest, containing a vacuum source, a device for immobilizing the local area of the myocardium with vacuum suction cups holding the local area of the myocardium, and a suction flexible pipe connecting the vacuum suction cups to a vacuum source, according to According to the invention, the vacuum source is equipped with an autonomous vacuum unit equipped with at least one vacuum pump, a collector, a pipeline connecting the collector to a vacuum pump, an electrically controlled normally closed vacuum valve for regulating the vacuum level in the collector installed in the specified pipeline, a vacuum discharge pipe in the manifold, connecting the collector to the atmosphere, an electrically controlled normally closed vacuum valve in the collector installed in the pipeline vacuum relief, and a system for monitoring the functioning of the complex, which includes a vacuum sensor in the manifold and electronic Lok portion immobilization local control infarction, to which are connected vacuum level sensor in the reservoir, the drive of the vacuum pump, the vacuum level control valve and a vacuum relief valve.

 In this case, the electronic control unit for immobilization of the local myocardial region is equipped with a microprocessor, a multifunctional display indicator of the complex's operating modes, a keyboard for setting the functional characteristics of the complex, and a device for recording the functional characteristics of the complex during surgery.

 A vacuum source and an electronic immobilization control unit for a local myocardial site can be placed in a portable container that has a front panel with a multifunctional display indicator of the complex’s operating modes, a keyboard for setting the functional characteristics of the complex, and a device for recording the functional characteristics of the complex during surgery.

 In addition, a manual valve, a water separator and a filtering means are sequentially installed in the suction flex.

 At the same time, the moisture separator is equipped with a removable latch for mounting it on the container wall.

 In addition, a suction flexible pipe, a filtering device, a moisture separator, a retractor, a device for immobilizing the operated myocardial site and its removable elements are placed in sealed sterilized packages, and the container has a niche for accommodating these packages.

 In this case, the portable container is equipped with a hinged or removable lid that covers the front panel and the niche.

 In addition, the complex is additionally equipped with a device for reposition of the heart in the operation zone, mounted on a retractor, equipped with a flexible vacuum suction cup connected to a vacuum source using its own suction flexible pipe, in which a manual valve, a moisture separator and a filtering device are installed in series.

 It is advisable to equip the vacuum source with a backup vacuum pump connected to the collector through a backup pipeline, in which a backup electrically operated normally closed vacuum valve for regulating the vacuum level in the collector is connected to the control unit.

 In this case, the electronic control unit for the immobilization of the local myocardial region is equipped with a permanent storage device with a set of standard programs for the functional characteristics of the complex.

 In a device for immobilizing a local myocardial region, containing an adjustable cantilever supporting element with a mounting unit on the expander and a stabilizer of the position of the operated myocardial segment attached to it via a spherical hinge, equipped with vacuum suction cups placed on both sides of the operation area with nipples for connecting their working cavities to the source vacuum, according to the invention, the stabilizer position of the operated area of the myocardium is equipped with a power frame assembled from two pivotally connected load-bearing brackets with two shelves, limiting the operating window, while each load-bearing bracket is equipped with a vacuum suction cup having a working cavity open from the end facing the myocardium and replaceable perforated inserts installed therein.

 The working cavity can be made rectangular in plan with smooth conjugation of the corners of the rectangle or arcuate in plan with smooth conjugation of the ends of the arcs.

The contact surface of the end of the working cavity can be made flat, and the flat contact surface of the end of the working cavity is inclined at an angle of 4-15 ^o to the plane of the operating window.

 In addition, the end surface of the suction cup facing the myocardium can be made spherical.

 In this case, a replaceable perforated insert is mounted flush with the contact surface of the end face of the vacuum suction cup.

 In addition, each replaceable perforated insert is equipped with suction channels connecting the supporting surface of the insert adjacent to the myocardium with its opposite surface facing the working cavity of the vacuum suction cup.

 In this case, the suction channels are cylindrical and uniformly located in the body of the insert.

 In this case, the suction channels are cylindrical and uniformly located in the body of the insert.

 In this case, the cylindrical suction channels have a diameter of 2-5 mm.

 In this case, the suction channels are placed in one line.

 In this case, the cross section of the cylindrical suction channels is the same along the length of the insert or the cross section of the cylindrical suction channels is maximum in the middle of the insert and decreases to its ends.

 In this case, the suction channels are arranged in two parallel lines and can be made with a rectangular cross section, the cross section of the rectangular suction channels being the same along the length of the insert or the cross section of the rectangular suction channels as much as possible in the middle of the insert and decreasing towards the ends of the insert.

 In addition, a replaceable perforated insert can be made in the form of a lattice.

 In this case, the lattice is formed by intersecting longitudinal and transverse grooves, respectively made on the upper and lower surfaces of the insert.

 It is advisable to make the outer edges of the suction cup facing the myocardium, as well as the edges of the openings of the suction channels or lattice grooves, rounded.

 A closed groove can be made along the perimeter of the side wall of the working cavity of the vacuum suction cup, and a replaceable perforated insert is made in the form of an elastic perforated plate, the edges of which are introduced into the specified groove.

 In this case, the outer and inner edges of the vacuum suction cup facing the myocardium are expediently rounded.

 In addition, the stabilizer position of the operated area of the myocardium is equipped with devices for attaching the turnstile threads to pinch the artery, and these means of fastening the turnstile threads are placed on the shelves of the bearing brackets.

 Moreover, each device for attaching a turnstile thread for pinching the artery is made in the form of a fixed bracket of a turnstile fixed on a shelf and firmly attached to its surface with an elastic clamp of a turnstile thread, and the turnstile thread clamp is made in the form of a U-shaped elastic element made of wire, the ends of which are fixed in a shelf staples.

 In addition, each device for attaching a turnstile for clamping an artery can be made in the form of a rack fixed to a shelf of a supporting bracket with a turnstile lock.

 At the same time, two parallel holes are made in the rack, and the turnstile thread lock is made in the form of a U-shaped elastic element made of wire tightly attached to the surface of the shelf, the ends of which are passed through the holes in the rack.

 In addition, in each shelf of the bearing brackets, tapering slots are made from the outside to accommodate turnstile threads in them for pinching the artery.

 The position stabilizer of the operated section of the myocardium can be equipped with removable vacuum suction cups.

 In addition, each bearing bracket has a U-shaped recess and is equipped with elements for fixing removable vacuum suction cups located on the edge of the U-shaped recess, and the fixing elements of the removable vacuum suction cup are made in the form of beads on the edge of the recess of the bearing bracket.

 In addition, each removable vacuum suction cup is equipped with a housing that repeats in plan the shape of the recess of the bearing bracket, while this housing is equipped with elements for fixing it in a U-shaped recess of the bearing bracket, and the fixing elements of the housing of the removable vacuum suction cup are placed on its side surface and are made in the form grooves covering the shoulders on the edge of the recess of the bearing bracket.

 The stabilizer of the position of the operated myocardial site can be equipped with a support rack, adjacent to the cantilever support element adjacent shelves of the bearing brackets are equipped with cantilevered protrusions with flat shelves pivotally connected to each other, a spherical hinge head is placed at one end of the support rack, and its second end is connected to the power frame while the distant adjacent shelves of the bearing brackets are interconnected by retainers, protecting them from vertical and horizontal lateral displacements.

 At the same time, through holes are made in the shelves of the cantilevered protrusions, and a cylindrical shank is made at the second end of the supporting rack, passed through these holes and articulated between the shelves of the load-bearing brackets of the power frame.

 In addition, the clamp from vertical lateral displacement can be placed on adjacent to each other edges of distant adjacent shelves.

 In this case, the clamp from horizontal lateral displacements represents two cantilevered protrusions of a L-shaped shape located on adjacent shelves and a thread covering these protrusions.

 Bearing staples of the stabilizer, it is advisable to perform with curved in terms of external edges.

 The essence of the invention is that by controlling the characteristics of the vacuum system, in particular the level of vacuum in the vacuum suction cup, and having an appropriately designed contact surface of the vacuum suction cup with the myocardium, to guarantee the minimum traumatic effect of the vacuum suction cup on the myocardium, while ensuring reliable immobilization the operated myocardial site and easy access to it by the surgeon.

 Equipping a vacuum source with an autonomous vacuum pump, a collector, a pipeline connecting the collector to a vacuum pump, an electrically controlled normally closed rarefaction level control valve in the collector installed in the specified pipeline, a vacuum discharge pipe in the manifold connecting the collector cavity to the atmosphere, and electrically controlled normally closed a vacuum relief valve in the collector installed in the vacuum discharge pipe forms an autonomous vacuum system of the apparatus This complex for temporary immobilization of local areas of the myocardium with a direct connection of the vacuum suction cup to the device for immobilizing the operated myocardial site allows you to create in the vacuum system those modes that are necessary for only this vacuum suction cup, and maintain the specified modes for the entire duration of the suction cup, at the same time, the presence of an electronic control unit allows you to set the optimal functional characteristics of the complex, laying its main parameters in the control unit meters, for example, the vacuum level in vacuum suction cups, the suction rate in vacuum suction cups and the vacuum discharge rate at the end of the operation, and the presence of a vacuum gauge in the collector allows you to compare the current parameters of the complex with the built-in control program and, if necessary, automatically adjust the functional characteristics of the complex using electrically controlled a pressure regulation valve and a vacuum relief valve, which reduces the traumatic effect on the myocardium and responsibly reduces the risk of the operation. The presence of an electronic control unit allows you to check before the start of the operation the correct functioning of the vacuum hardware complex, including the operability of the vacuum pump. Objective monitoring of the preparation of the vacuum hardware complex for the operation and automatic monitoring of its functioning during the operation allow the surgeon to fully concentrate on their immediate actions during the cardiac surgery.

 Equipping the electronic control unit for immobilization of the local myocardial region with a microprocessor, a multifunctional display indicator of the complex’s operating modes and a keypad for setting the functional characteristics of the complex allows you to select the optimal functional characteristics of the vacuum hardware complex that are most appropriate for the state of the heart of the patient being operated on and make sure that they are set correctly, which reduces the traumatic effect vacuum suction cup on the myocardium and reduces the risk when n the operation. The presence of a device for recording the functional characteristics of the complex makes it possible to record and record its operating parameters in order to use them when analyzing the results of the operation.

 Placing a vacuum source and an electronic control unit for immobilizing a local myocardial site in a portable container allows you to place it in any convenient place in the operating room, as well as use it in mobile cardiosurgical complexes. Equipping a portable container with a front panel with a multifunctional display indicator of the operating modes of the complex, a keyboard for setting the functional characteristics of the complex and a device for recording the functional characteristics of the complex during the operation provides comfortable conditions for the operator and surgeon when using the portable container, and the presence of a lid prevents damage to those placed on the front panel devices.

 Equipping the suction flexible pipeline with a manual valve, as well as installing filtering equipment and a moisture separator in it, increases the reliability of the vacuum equipment complex, as accidental suction of blood does not lead to the failure of the complex, and also makes it possible to quickly turn it off and simplifies the procedure of postoperative sterilization.

 Equipping the dehumidifier with a removable lock for hanging it on the container wall simplifies the deployment of the complex to the operating position.

 The presence of sealed sterilized packages for a suction flexible pipe, a filter device, a moisture separator, a retractor, a device for immobilizing the operated myocardial site and its removable elements and equipping the container with a niche to accommodate these packages increases the autonomy of the vacuum apparatus complex, which makes it possible to use it in mobile cardiology complexes.

 The presence of a hinged or removable cover covering the front panel and the niche prevents accidental damage to the front panel and equipment located in the niche.

 Providing the vacuum hardware complex with a device fixed to the retractor for moving the heart into the operation area, equipped with a flexible vacuum suction cup connected to a vacuum source using its own suction flexible pipe, in which a manual valve, a moisture separator and a filtering device are installed in series, makes it possible to establish the operated myocardial zone in the most convenient position for the surgeon and conduct cardiological operations in any, including inaccessible, areas of the heart a.

 Equipping a vacuum source with a backup vacuum pump connected to the manifold through a backup pipe in which a backup electrically operated normally closed vacuum regulating valve of the vacuum level in the manifold is connected to the control unit increases the reliability of the vacuum hardware complex, since the backup vacuum pump can be maintained in the " hot "reserve and, if necessary, quickly connect it to the collector while shutting down the main vacuum pump.

 The inclusion in the electronic control unit for immobilization of the local myocardial region of a permanent storage device with a set of standard programs of functional characteristics of the complex in it, corresponding to the characteristic cardiosurgical operations and the type of vacuum suction cups used in them, simplifies the preparation of the vacuum hardware complex for a specific cardiosurgical operation and, accordingly, reduces the load to the surgeon.

 Fixing the stabilizer of the position of the operated myocardial site using a spherical hinge on an adjustable cantilever supporting element ensures accurate installation of the stabilizer on the operated heart, and the presence of a vacuum suction cup with nipples on it to attach their working cavities to the vacuum source ensures the immobilization of the operated myocardial site during surgery. Equipping the stabilizer of the position of the operated myocardial site with a power frame assembled from two pivotally connected load-bearing brackets with two shelves, limiting the operating window, while each load-bearing bracket is equipped with a vacuum suction cup, contributes to better immobilization of the operated local myocardial site by compressing it to the power frame around the circuit , and the presence of a swivel provides easy removal of the stabilizer at the end of the operation. The presence in the vacuum suction cup of the working cavity open from the end of the myocardium and the installation of replaceable perforated inserts in it makes it possible, by selecting a replaceable perforated insert having an appropriately designed contact surface with the myocardium, to guarantee the minimum traumatic effect of the vacuum suction cup on the myocardium, while ensuring time reliable immobilization of the operated area of the myocardium along the entire contour of the operated area.

Performing a working cavity of a rectangular shape in plan with smooth conjugation of the corners of a rectangle or performing its arcuate shape in plan with smooth conjugation of the ends of arcs with each other, as well as making the contact surface of the end face of the working cavity flat, including tilting the flat contact surface of the end of the working cavity at an angle 4-15 ^o to the plane of the operating window, provides the ability to conduct operations in any area of the heart, taking into account the curvature of its surface in the area of the operation.

 The execution of the end surface of the suction cup spherical facing the myocardium allows operations with the least traumatic effect on the myocardium.

 The presence of a replaceable perforated insert mounted flush with the contact surface of the end face of the vacuum suction cup allows reducing the traumatic effect of the stabilizer on the myocardium, since the contact surfaces of the replaceable insert and suction cup form a single smooth surface for any contact surface design.

 The proposed embodiments of a replaceable perforated insert provide the surgeon with a wide range of insert options in order to select an insert with a contact surface that most closely matches the condition of the myocardium of the operated heart.

 The execution of the outer edge of the vacuum suction cup facing the myocardium, as well as the rounded edges of the openings of the suction channels or lattice grooves, reduces their traumatic effect on the myocardium.

 Performing a closed groove along the perimeter of the side wall of the working cavity of the vacuum suction cup in the presence of a replaceable perforated insert in the form of an elastic perforated plate, the edges of which are inserted into the specified groove, is an alternative form of stabilizer that has the same properties as a stabilizer with a replaceable perforated insert, directly in contact with the surface of the myocardium.

 The execution of the outer and inner edges of the vacuum suction cup facing the myocardium rounded reduces their traumatic effect on the myocardium.

 Equipping the stabilizer of the position of the operated myocardial section with devices for attaching turnstile threads to pinch the artery with placing them on the shelves of the bearing brackets creates more comfortable conditions for the surgeon to work, and also reduces the risk during the operation, since the artery is pressed to the lower surface of the shelf, which provides a sufficiently large the contact surface and the force of the pinched artery is less dependent on the magnitude of the tension of the turnstile, which also reduces the risk of damage to the artery and guide her muscles.

 The proposed versions of the device for attaching the turnstile thread for pinching the artery allow the surgeon to simply fix the ends of the turnstile thread by inserting them under flat elastic clips. The reliability of the fixation of the ends of the turnstile thread guarantees the force of pressing the flat elastic element to the surface of the shelf of the supporting bracket, and the execution of the elastic element from the wire reduces the cost of production, which allows the use of disposable clamps and to exclude sterilization of these elements after the operation.

 The execution of narrowing slots in each shelf of the bearing brackets on the outside for placement of turnstile threads for clamping the artery simplifies the surgeon's work with the position stabilizer of the operated myocardial section, since the ends of the turnstile threads can be brought in from the outside of the stabilizer.

 Equipping the position stabilizer of the operated myocardial site with removable vacuum suction cups makes it possible to unify the stabilizer design and makes it more technologically advanced, and also makes it possible to use various sterilization modes for various elements of the stabilizer. The proposed form of the housing of the removable vacuum suction cup and its fixing elements in the carrier bracket provides quick installation and removal of the removable vacuum suction cup from the carrier bracket.

 An improvement in the position stabilizer of the operated myocardial site, namely, that it is equipped with a support rack, adjacent to the console support element adjacent shelves of the bearing brackets are equipped with cantilevered protrusions with flat shelves pivotally connected to each other, a spherical hinge head is placed at one end of the support rack, and the second end is connected to the power frame, while the distant adjacent shelves of the bearing brackets are interconnected by clips that protect them from vertical and horizontal Ontal lateral displacements, allows you to quickly prepare the stabilizer for operation.

 The proposed design of the mount of the stabilizer to an adjustable cantilever supporting element, characterized in that through holes are made in the flanges of the cantilevered protrusions, and a cylindrical shank is made at the second end of the supporting strut, passed through these holes and articulated between the shelves of the load-bearing staples of the power frame, smaller stabilizer, as it combines the articulation of brackets and the stabilizer on an adjustable Aulnay supporting member.

 The placement of the clamp from the vertical lateral displacement on adjacent edges of the distant adjacent shelves and the implementation of the clamp from the horizontal lateral displacements in the form of two cantilevered protrusions of the L-shaped form, placed on adjacent shelves, and covering the said protrusions of the thread, ensures the dimensional stability of the surgical field.

 The implementation of the stabilizer bearing brackets with curved outer edges provides higher ergonomic characteristics, since the arched shape is more convenient for the stabilizer to be held by the surgeon's hand, which simplifies the stabilizer coordination with respect to the operated artery.

 The invention is illustrated by drawings. In FIG. 1 is a structural diagram of the proposed portable vacuum hardware complex with a device for immobilizing a local portion of the myocardium; figure 2 - portable container, which houses a vacuum hardware complex; figure 3 is a structural diagram of a second embodiment of a vacuum hardware complex with a device for immobilizing a local area of the myocardium; figure 4 is a General view of a device for immobilizing a local site of the myocardium assembly; figure 5 is a view of the myocardial stabilizer in arrow A; figure 6 is a view of B in figure 5; Fig.7 is a section bb In Fig.6; on Fig-12 shows an end view of replaceable perforated inserts with various forms of execution of the suction channels; in FIG. 13 is an end view of an alternative embodiment of a replaceable perforated insert in the form of a lattice; on Fig - section GG in Fig. thirteen; in FIG. 15 - section DD in figure 3 (rotated); in Fig.16-20 shows another embodiment of the stabilizer (Fig.16 is a top view; Fig.17 is a section EE in Fig.16; Fig.18 is a section FJ in Fig.16; Fig.19 is a section II in Fig. 16; Fig. 20 is a plan view of a supporting bracket); on Fig.21-23 presents another embodiment of the stabilizer (Fig. 21 is a top view; Fig.22 is a section KK in Fig.21; Fig.23 is a view L in Fig.22 on the lower surface of the carrier bracket); in FIG. 24 is a diagram of the indicated hardware complex in operating position; on Fig is a diagram of the hardware complex in the working position with the simultaneous use of a device for immobilizing a local area of the myocardium and a device for moving the heart to the operated area; in Fig.26 - zone of operation using the proposed stabilizer; in FIG. 27 is a diagram of the clamping of an artery. The invention is presented schematically without respecting the proportions between the individual elements.

 The vacuum apparatus complex for temporary immobilization of local areas of the myocardium during operations without cardiac arrest contains a device 2 for immobilizing the local area of the myocardium with a stabilizer 3 holding the operated myocardial site 3 with two vacuum suction cups 4. The complex has a vacuum source 5 equipped with an autonomous vacuum pump 6 , collector 7, pipe 8 connecting the collector to a vacuum pump, electrically controlled by a normally closed control valve 9 I the vacuum level in the collector installed in the specified pipeline, the vacuum discharge pipe 10 in the collector connecting the collector to the atmosphere, electrically controlled by a normally closed valve 11 for vacuum relief in the collector installed in the vacuum discharge pipe, and a system for monitoring the functioning of the complex, including a sensor 12 levels of rarefaction in the collector and an electronic unit 13 for controlling the immobilization of a local myocardial site.

 The electronic unit 13 is equipped with a microprocessor 14, a multifunction display indicator (MFI) 15 modes of operation of the complex, a keyboard 16 for setting the functional characteristics of the complex, and a printer 17 for recording the functional characteristics of the complex during the operation. The microprocessor 14 through the corresponding interfaces and data bus connected to the MFI 15, the keyboard 16, the sensor 12 of the vacuum level in the collector. The microprocessor control signals are transmitted through the corresponding interfaces to the electrically controlled normally closed valve 9 for regulating the vacuum level in the collector and the valve 11 for vacuum relief in the collector and to the electric actuator 18 of the vacuum pump 6.

 The vacuum source 5 is connected to the vacuum suction cups 4 by a suction flexible pipe 19, in which filtering means 20, a water separator 21 and a manual valve 22 are installed in series. The outlet of the valve 22 is connected to the vacuum suction cups 4 through a tee 23.

 MFI 15 is a flat display on liquid crystals, the screen of which displays text and numerical information characterizing the set or current characteristics of the vacuum hardware complex. The information presented at MFI 15 contains the date and time of the start-up of the vacuum hardware complex, the number of the working pump, the set and current vacuum (in kPa), and the current operating time.

 The keyboard includes five 24-28 keys. Keys 24 "More" and 25 "Less" are designed to set or adjust the numerical functional characteristics of the complex, in particular, the level of vacuum in the collector 7, the current operating time, the duration of the operation, etc. Key 26 "Start" is designed to move the cursor on the MFI 15 change the information panel and control the operating modes of the complex. Key 27 "Stop" is designed to disable the complex equipment at the end of the operation. Key 28 "Pump" is intended for manual control of vacuum pumps. The electronic control unit may also have an indicator 29 of the operational status of the complex, connected to the microprocessor 14.

 The vacuum source 5 and the electronic unit 13 for controlling the immobilization of the local myocardial region are mounted in a portable container 30 and closed by the front panel 31. On the front panel there are MFIs 15, keys 24-28 of the device for setting the functional characteristics of the complex, an indicator 29 and a printer 17 for recording the functional characteristics of the complex during operation time. In the front of the container 30, there is a niche 32. During transportation, the sections of the suction flexible pipe 19, filter device 20, moisture separator 21, manual valve 22, tee 23, expander 1, device 2 for immobilization of the local area are placed in sealed sterilized packages 33 in the sealed sterilized packages 33. myocardium and its removable elements, in particular stabilizer 3 with vacuum suction cups, and other elements. Other elements necessary for servicing the vacuum hardware complex can also be located in the niche. The dehumidifier 21 is equipped with a removable latch 34 for hanging it on the side wall of the container 30. On the inner wall of the niche there is a nipple 35 for connecting a flexible suction pipe 19 to a vacuum source 5, a connector 36 for connecting the power cord of the vacuum apparatus complex, a network toggle switch 37 and a toggle switch 38 printer 17. During transportation, the removable latch 34 and the power cord are located in the niche 32. The portable container 30 has a hinged lid 39 that covers the front panel 31 and the niche 32.

 In the second embodiment of the vacuum hardware complex (Fig. 3), the vacuum source 5 is equipped with a backup vacuum pump 40 connected to the manifold 7 through a backup pipe 41, in which a backup electrically operated normally closed normally closed vacuum valve 42 for regulating the vacuum level in the collector is connected to the microprocessor 14 an electronic unit 13 for controlling the immobilization of a local myocardial site. The electronic unit 13 is equipped with read-only memory device 43 with a set of standard programs of functional characteristics of the complex embedded in it, connected through a corresponding interface to the microprocessor 14.

 In the working position, the expander 1 is installed on the opened chest of the patient. All equipment of the vacuum source 5, in any case, is located in a portable container 30.

 The device 2 used in the above-described vacuum hardware complex for temporary immobilization of the local myocardial region contains an adjustable cantilever support element 44 with a mounting unit 45, which makes it possible to change the angular position of the cantilever supporting element 44. The unit 45 is equipped with a clip 46 for attaching it to the conservator 1. At the end the cantilever support element 44 is a clip 47. The stabilizer 48 of the position of the operated section of the myocardium is equipped with a spherical joint, the head 49 of which is fi is clamped in the clamp 47. The cantilever support element 44 is controlled using the rotary knob 50. The design of the adjustable cantilever support element 44 is not considered within the framework of this application, since similar designs are already described in the literature, in particular, in PCT applications WO 00/15119 or WO 00/42921.

 The stabilizer 48 of the position of the operated section of the myocardium is equipped with a power frame 51, assembled from two pivotally connected supporting brackets 52 and 53, limiting the surgical window 54 with a size of 24 • 12 mm for applying an anastomosis. Each bearing bracket has a proximal shelf 55 and a distant shelf 56 and is equipped with a vacuum suction cup 57 having a working cavity 58 open from the end facing the myocardium and a replaceable perforated insert 59 installed therein. Each working cavity 58 is made rectangular in plan with smooth conjugation of the corners of the rectangle (shown by a dotted line in Fig. 5) and is connected by the suction channel 60 to the nipple 61. The stabilizer 48 has two nipples 61 to which the end sections of the suction flexible pipe 19 connecting the working floor are connected spacers 58 vacuum suction cups 57 with a vacuum source 5.

 The replaceable perforated insert 59 is mounted flush with the contact surface of the end face of the vacuum suction cup 57. The end surfaces 62 and 63 of the vacuum suction cup and the replaceable perforated insert facing the myocardium are made spherical with the same sphere radius equal to 40-50 mm, which in the best way ensures a uniform fit of the surface of the vacuum suction cup to the myocardium. Each replaceable perforated insert 59 is equipped with suction channels 64 connecting the supporting end surface 62 of the insert 59 adjacent to the myocardium with its opposite surface 65 facing the working cavity 58 of the suction cup.

 Vacuum suction cup 57 may be equipped with various interchangeable perforated inserts 59 shown in Fig.8-14.

 In the embodiment of the insert 59 shown in Fig. 8, the suction channels 64 are made cylindrical with the same channel diameter equal to 3 mm and are uniformly located in the body of the insert in one line.

 In the execution of the insert 59, shown in Fig.9, the suction channels 64 are cylindrical, arranged in a line along the length of the insert and have a maximum channel diameter of 5 mm in the middle of the insert. The diameter of the channels 64 decreases along the length of the insert and the end channel has a diameter of 2 mm

 In the embodiment of the insert 59 shown in FIG. 10, the suction channels 64 with a diameter of 2 mm each are placed in two parallel lines.

 In the execution of the insert 59 shown in Figs. 11 and 12, the suction channels 64 are made with a rectangular cross section and have either the same cross section along the length of the insert (Fig. 11) or the cross section of the rectangular suction channels as much as possible in the middle of the insert and decreases towards it ends (Fig.12).

 In the embodiment shown in FIGS. 13 and 14, the replaceable perforated insert 59 is made in the form of a lattice formed by mutually intersecting longitudinal 65 and transverse 66 grooves made respectively on the lower 67 and upper 68 surfaces of the insert. The lower surface 67 of the lattice is a supporting end surface adjacent to the myocardium and processed on a sphere.

 The outer edges of the suction cup 57 facing the myocardium, as well as the edges of the openings 64 of the suction channels or grooves 65 of the grill, are rounded.

 The stabilizer 48 position of the operated section of the myocardium is equipped with four devices 69 for fastening the turnstile threads for clamping the artery, placed on the shelves 55 and 56 of the bearing brackets 52 and 53. The device 69 for fastening the turnstile thread is an elastic bracket fixed to the shelf and tightly attached to its surface turnstile thread lock in the form of a U-shaped elastic element 70 of wire. The ends of the elastic element 70 are passed through the holes 71 in the bracket of the bracket and fixed on it. In each shelf of bearing brackets, tapering slots 72 are made on the outside for placement of turnstile threads in them for pinching the artery.

 The stabilizer 48 is equipped with a support rack 73. Adjacent shelves 55 of the supporting brackets 52 and 53 closest to the cantilever support element are equipped with cantilevered protrusions 74 and 75 with flat shelves 76 and 77 in which through holes 78 are made. A spherical head 49 is placed at one end of the support rack 73. hinge, and at its second end is a cylindrical shank 79, passed through the holes 78 and pivotally connecting the shelves 76 and 77 of the supporting brackets 52 and 53 of the power frame 51.

 On adjacent edges of the distant adjacent shelves 56 there is a latch that protects the supporting brackets 52 and 53 from vertical lateral displacement, made in the form of a tongue-and-groove joint 80.

 The distant shelves 56 are also equipped with a latch that protects the bearing brackets 52 and 53 from horizontal lateral displacements, which are two L-shaped cantilevered protrusions 81 placed on the shelves 56 and the thread 82 covering them.

 Another embodiment of the stabilizer 48 is shown in Fig.16-20.

 The stabilizer 48 differs from the previously described in that the suction cups 57 are removable. Each bearing bracket has a U-shaped recess 83 and is equipped with shoulders 84 for fixing removable vacuum suction cups located on the edge of the U-shaped recess. Each removable vacuum suction cup has its own housing 85, repeating in terms of the shape of the recess 83 of the bearing bracket. Each housing 85 has a working cavity 58 open from the end of the myocardium and a replaceable perforated insert 59 installed therein. The working cavity 58 of each replaceable vacuum suction cup is connected by the suction channel 86 to the nipple 87. The stabilizer 48 has two nipples 87 to which the ends of the suction are connected. a flexible conduit 19 connecting the working cavities of the suction cups to the vacuum source 5. On the side surface of the housing 85, grooves 88 are made covering the shoulder 84 of the carrier bracket.

 The stabilizer 48 has four devices 89 for fastening the turnstile threads for pinching the artery, each of which is a rack 90 with a turnstile lock secured to one of the shelves of the supporting bracket. The latch is made in the form of a U-shaped elastic element 91 made of wire tightly attached to the surface of the shelf, the ends of which are passed through holes 92 in the rack 90.

 The stabilizer 48 is equipped with a support rack 73, the fastening of which to the supporting brackets is similar to the previously described option. The distant shelves 56 are equipped with a latch that protects the supporting brackets 52 and 53 from horizontal lateral displacements and is made similar to the previously described embodiment. On adjacent edges of the distant adjacent shelves 56 there is a latch that protects the bearing brackets 52 and 53 from vertical lateral displacement and consists of jaws 93 rigidly fixed to the edge of the flange of one carrier bracket 52, and a response element 94 included in the gap between the jaws on the edge shelves of another supporting bracket 53.

 Another embodiment of the stabilizer 48 is shown in Fig.21-23.

The stabilizer 48 differs from the form of execution of the vacuum suction cups described above. Vacuum suction cups 57 are placed directly in brackets 52 and 53 on two sides of the operating window 54. The working cavity 58 of the vacuum suction cup is made in an arcuate shape in plan with smooth conjugation of the ends of the arcs between them in semicircles. The contact surface 95 of the vacuum suction cup 57 is made flat and inclined at an angle of 10 ^o to the plane of the operating window 54. A closed groove 97 is made along the perimeter of the side wall 96 of the working cavity of the vacuum suction cup. The replaceable perforated insert is made in the form of an elastic perforated plate 98, the edges of which are brought into the specified groove. The external and internal edges of the suction cup facing the myocardium are rounded. Each working cavity 58 is connected by a suction channel 60 with a nipple 61. The stabilizer supporting brackets are made with external edges 99 arched in plan.

 The stabilizer 48 is equipped with a support rack 73, the fastening of which to the supporting brackets is similar to the previously described option. The distant shelves 56 are equipped with clamps that protect the supporting brackets 52 and 53 from horizontal and vertical lateral displacements and are made similar to the previously described options. The stabilizer is equipped with devices for attaching turnstile threads for pinching the artery, similar to those described in the first embodiment, which does not exclude the use of other versions.

 In the expanded state, the removable elements of the vacuum hardware complex are removed from the sealed packages and attached to each other. The stabilizer 48 is mounted on an adjustable cantilever support element 44, which in turn is fixed in a node 45 mounted on the conservator 1. The vacuum suction cups of the stabilizer 48 are connected via a flexible suction pipe 19 through a tee 23 with a manual valve 22 and then through a water separator 21 and a filter a device 20 with a nipple 35 on the side wall of a niche 32 of the container 30, which is the outlet of the vacuum source 5. The moisture separator 21 is installed in the latch 34 on the side wall of the container.

 In an expanded embodiment, the vacuum hardware complex is additionally equipped with a device 100 for moving the heart to the operation zone, mounted on the conservator 1, equipped with a flexible vacuum suction cup 101 connected to a vacuum source 5 using its own suction flexible pipe 102, in which a manual valve 103, a moisture separator, are installed in series 104 and filtering means 105. A dehumidifier 104 is fixed to the wall of the container niche in the same way as the dehumidifier 21. A flexible conduit 102 is connected I'm going to the vacuum source 5 through my own nipple 106.

 It is possible to connect the flexible conduits 19 and 102 to one nipple 35 through the corresponding tee. The specific choice of connection option is determined by the characteristics of the vacuum source.

 The operation of the complex is explained below.

 The portable container 30 with the equipment of the vacuum hardware complex is transported packed in a polymer bag and removed from it immediately in front of the operating room. The container 30 is installed at a distance of 2-3 m from the operating table and through the connector 36 is connected to the network. Packages 33 with portable equipment of the vacuum hardware complex are removed from the niche 32 and the complex is deployed in the working position. The retractor 1 is installed in the surgical field. On the retractor in a position convenient for the surgeon, device 2 is fixed for immobilization of the local myocardial site. Before fixing device 2, one of the replaceable perforated inserts 59, which are most appropriate for the upcoming operation, is installed in each vacuum suction cup 57, the distant shelves 56 of the supporting brackets are closed together and the cantilevered protrusions 81 are connected with the thread 82, preparing the stabilizer 48 of the position of the operated myocardial site for operation. Mount the suction flexible pipe 19, sequentially connecting the filter device 20, the moisture separator 21, the manual valve 22 and the tee 23, connect the pipe 19 on the one hand to the nipple 35 of the vacuum source 5, and on the other hand to the vacuum suction cups of the stabilizer 48 and begin preparation vacuum hardware complex for operation.

Manual valve 22 is placed in the "Closed" position. Turn on the toggle switches 37 and 38 and supply voltage to the units of the vacuum source 5, the electronic control unit 13 and the printer 17. The message appears on the MFI 15:
VACUUM DEVICE
After 4 seconds, the message is displayed on the MFI 15, including the current date and time, and the cursor mark on the first digit of the message in the leftmost position:
02/15/02 Fri 15:33
02/15/03
Set time
If the information that appears coincides with the real value of the time, continue to prepare the vacuum hardware complex for the operation. For this, by successively pressing the “Start” key 26, the cursor is moved to the far right position. Pressing the “Start” key once will shift the cursor by one position. Press the "Start" button again and start the test procedure for the vacuum source.

 If the information that appears does not match the real time, set the real current time on the MFI 15 by moving the cursor using the 26 "Start" key to the number that needs to be changed. Using the 24 "More" or 25 "Less" keys, set the desired value and press the 26 "Start" key to enter the adjusted value into the microprocessor 14. In this case, the cursor moves to the next position. After setting the real current time, the Start button starts the test procedure for the vacuum source.

With the correct tight assembly of the suction flexible pipe 19 and the normal operation of the vacuum pumps 6 and 40, a message appears after 1-2 minutes:
02/15/02 Fri 15:36
Block check
Pump 1 - Normal
Pump 2 - Normal
After successful testing at MFI 15, a message is displayed on the functional characteristics of the vacuum source:
02/15/02 Fri 15:38
Pump 1
Ass.R-40 Tech.-00
Work - 00:00:00
where "Pump 1" is the number of the working vacuum pump;
"Assigned p. -40" - the depression set by the surgeon during the operation (the figure indicates the amount of depression at the previous start);
"Tek.r.-00" - the current vacuum measured in the reservoir;
"Work - 00:00:00" - the current duration of operation of the vacuum pump 1 in operational mode at this turn on (hour: min: sec).

 To increase the life of pumps 6 and 40, the electronic control unit 13 alternately selects one of two vacuum pumps for operation each time it is connected to the network; while the second pump is in standby mode. If necessary, you can manually switch to work with another vacuum pump by pressing key 28 "Pump".

 Use the 24 "More" and 25 "Less" keys to set the value of the specified vacuum (in the range of 8-48 kPa) and use the 26 "Start" button to set the vacuum source 5 to automatically maintain the specified vacuum level. When operating in this mode, the MFI 15 constantly displays the current vacuum in the collector 7 - "Tech.-R-XX", and the current operating time of the unit from the moment the "Start" key is pressed.

 If the vacuum in the vacuum line of 60 kPa is exceeded, a message about the failure appears on the MFI 15 and the device automatically turns off.

Simultaneously with testing the vacuum source 5, testing of the registration system is started and at the exit from the printer 17 a ribbon appears with the message:
TEST BCM-1
Date: 15 Feb. 2002 15:38
Pump 1 - NORMAL
Pump 2 - NORMAL
IB
F .......

 AND.......

 ABOUT.......

 which includes the number of the medical history (IB) and the surname, name, patronymic of the patient, completing the preparation of the vacuum hardware complex for heart surgery.

 During the operation, the printer 17 periodically prints the number of the running pump, the vacuum level in the collector and the current operation time.

 A pair of turnstile threads 107 is passed under the coronary artery 108 from two sides relative to the operated site. The stabilizer 48 is installed over the anastomotic zone between the turnstile threads. The stabilizer is applied to the operated area, orienting it along the artery 108, the manual valve 22 is opened and the stabilizer is slightly pressed to the surface of the myocardium, fixing the suction cups 57 on the myocardium from two sides relative to the operated area. The operated section of the myocardium is brought out to a position convenient for the surgeon to work, and by turning the handle 50, the stabilizer position is rigidly fixed. Turnstile threads 107 are passed through the narrowing slots 72, they are pulled up and the ends of the turnstile threads are fixed, passing them under the U-shaped elastic elements 70 of the turnstile clamps. When tensioned, the turnstile threads 107 press the artery 108 to the lower surface of the shelves of the stabilizer and pinch it, stopping the movement of blood through the artery. After that, anastomosis of the artery is directly performed.

 After the anastomosis has been performed, the turnstile threads 107 are removed from under the artery 108, the manual valve 22 is closed, the thread 82 is cut, covering the L-shaped cantilevered protrusions 81 and holding the supporting brackets 52 and 53 of the power frame 51 of the stabilizer 48 in the closed position. The bearing brackets 52 and 53 are disconnected and the stabilizer is removed from the operating area. Then remove the device 2 for immobilization of the local area of the myocardium from the conservator 1.

 After the operation is completed, the Stop key 27 is pressed, and the electrically operated normally closed normally closed vacuum relief valve 11 in the collector 7 is opened, installed in the vacuum discharge pipe 10, and the vacuum in the manifold 7 is reduced to zero. The following parameters are displayed on the printer 17: start and end time of the operation; number of the working pump; current dilution during surgery.

Procedure 1
Start - 16:01
Pump 1 Backflow = 35
Stop - 16:45
Remote equipment of the vacuum hardware complex is dismantled and sent for sterilization or disposal.

If a malfunction is detected when testing a vacuum hardware complex, then an encoded error message appears on the MFI 15, for example:
02/15/02 Fri 15:36
Pump 1 - Failure 1
Pump 2 - Normal
where after the word "failure" a fault code is issued. This information indicates a malfunction in the vacuum pump 1, which does not exclude the possibility of conducting an operation on one vacuum pump 2.

If when testing a vacuum hardware complex, a malfunction of both vacuum pumps is detected, then an encoded message appears on MFI 15:
05/15/02 Fri 15:36
Pump 1 - Failure 1
Pump 2 - Failure 2
Using this information, a leaky spot is identified and the fault is eliminated. If, after checking the installation of the vacuum system and retesting, a failure is detected on both pumps, then the use of this vacuum hardware complex becomes impossible and the complex requires a thorough check outside the operating room or replacement.

 The operation of the vacuum hardware complex in the expanded embodiment is basically the same as the example described above.

 When the complex is deployed on the retractor 1, the device 100 is initially attached for moving the heart into the area of operation with a flexible vacuum suction cup 101. The device 100 is attached to the retractor 1 similarly to the device 2 for immobilization of the local myocardium. To connect the flexible vacuum suction cup 101 to the vacuum source 5, its own suction flexible pipe 102 is mounted with the hand valve 103, the moisture separator 104 and the filtering means 105 connected in series. The moisture separator 104 is mounted on the wall of the niche 32 of the container in the same way as the moisture separator 21. The last section of the flexible pipeline 102 is connected to the vacuum source 5 through its own nipple 106, but, as already noted, other options for connecting the flexible pipe 102 to the vacuum source 5. Possible ue to the retractor device 2 for immobilizing a local area of the myocardium and preparation for the position of the operated portion 48 of the stabilizer infarction do not differ from the above example.

 The serviceability check of the mounted flexible suction pipelines 19 and 102 and the vacuum source units 5, as well as setting up the complex for the working conditions in the forthcoming operation, are carried out similarly to the previously described example with parameter monitoring at the MFI. As a rule, vacuum suction cups 57 and a flexible vacuum suction cup 101 operate with the same vacuum level, which simplifies the setup of the complex for the operation and the operation itself, but if necessary and appropriate selection of vacuum source units 5, the operation of vacuum suction cups 57 and 101 with different levels of vacuum is not ruled out . Upon completion of the test of the readiness of the vacuum complex for the operation, a flexible vacuum suction cup 101 is installed on the top of the heart and the manual valve 103 is opened. A suction is created in the suction cup 101 and it is firmly fixed on the top of the heart. Moving the suction cup 101, set the heart in a position convenient for the operation with good access to the localized area of the myocardium and fix the position of the suction cup 101 relative to the retractor 1. The flexible vacuum suction cup 101 does not interfere with the normal functioning of the heart.

 A pair of turnstile threads 107 is passed under the coronary artery 108 from two sides relative to the operated site. The stabilizer 48 is installed over the anastomotic zone between the turnstile threads. The stabilizer is applied to the operated area, orienting it along the artery 108, the manual valve 22 is opened, the stabilizer is slightly pressed to the surface of the myocardium, fixing the vacuum suction cups 57 on the myocardium from two sides relative to the operated area, and, rotating the handle 50, firmly fix the position of the stabilizer. The further course of the operation of the arterial anastomosis does not differ from the previously described example.

 After the anastomosis has been performed, the turnstile threads 107 are removed from under the artery 108, the manual valve 22 is closed, the thread 82 is cut, covering the L-shaped cantilevered protrusions 81 and holding the supporting brackets 52 and 53 of the power frame 51 of the stabilizer 48 in the closed position. The bearing brackets 52 and 53 are disconnected and the stabilizer is removed from the operating area. Then remove the device 2 for immobilization of the local portion of the myocardium from the conservator 1. After loosening the fixation of the flexible vacuum suction cup 101 on the conservator 1, return the heart to its original position, close the manual valve 103, disconnect the flexible vacuum suction cup 101 from the vacuum source 5 and remove it from the top of the heart .

 Bringing the complex to its initial state does not differ from the previously described example.

 The claimed vacuum hardware complex can be manufactured industrially using modern materials, electronic components and technologies. In particular, for completing the vacuum hardware complex, one can use the PIC 16F874-04 / SP microprocessor from the US Micro-chip company and the SVM-910-40 RF 230-A matrix printer from CITIZEN. When implementing the invention, various designs of the position stabilizer of the operated myocardial site can be used, different from those described in this application and shown in the drawings illustrating the invention, without departing from the spirit and scope of the present invention, determined by the scope of the claims set forth in the claims.

Claims (47)

 1. A vacuum apparatus for temporarily immobilizing local areas of the myocardium during operations without cardiac arrest, comprising a vacuum source, a device for immobilizing the local area of the myocardium with vacuum suction cups holding the local part of the myocardium, and a suction flexible pipe connecting the vacuum suction cups to a vacuum source, characterized in the fact that the vacuum source is made in the form of a stand-alone vacuum unit equipped with at least one vacuum pump, collector, pipeline connecting the collector to a vacuum pump, electrically controlled normally closed vacuum valve for regulating the vacuum level in the collector installed in the specified pipeline, vacuum discharge pipe in the collector connecting the collector to the atmosphere, electrically controlled normally closed vacuum relief valve in the collector installed in the vacuum discharge pipeline, and a system for monitoring the functioning of the complex, which includes a vacuum level sensor in the collector and electric ronny unit infarction local area immobilization control to which are connected vacuum level sensor in the reservoir, the drive of the vacuum pump, the vacuum level control valve and a vacuum relief valve.  2. The complex according to claim 1, characterized in that the electronic control unit for the immobilization of the local myocardial site is equipped with a microprocessor, a display indicator of the operating modes of the complex, a keyboard for setting the functional characteristics of the complex, and a device for recording the functional characteristics of the complex during surgery.  3. The complex according to claim 2, characterized in that the vacuum source and the electronic control unit for immobilization of the local myocardial site are located in a portable container that has a front panel with a display indicator of the complex’s operating modes, a keyboard for setting the functional characteristics of the complex and a device for recording functional characteristics complex during surgery.  4. The complex according to any one of paragraphs. 1-3, characterized in that a manual valve, a dehumidifier and a filtering means are sequentially installed in the suction flexible conduit.  5. The complex according to claim 4, characterized in that the dehumidifier is equipped with a removable latch for mounting it on the container wall.  6. The complex according to paragraphs. 4 and 5, characterized in that the suction flexible pipe, a filtering device, a moisture separator, a retractor, a device for immobilizing a local area of the myocardium and its removable elements are placed in sealed sterilized packages, and the container has a niche for accommodating these packages.  7. The complex according to claim 6, characterized in that the portable container is equipped with a hinged or removable lid that covers the front panel and the niche.  8. The complex according to any one of paragraphs. 1-7, characterized in that it is additionally equipped with a device mounted on the retractor for moving the heart into the operation area, equipped with a flexible vacuum suction cup connected to a vacuum source using its own suction flexible pipe, in which a manual valve, a moisture separator and a filtering device are installed in series.  9. The complex according to any one of paragraphs. 1-7, characterized in that the vacuum source is equipped with a backup vacuum pump connected to the collector through a backup pipe, in which a backup electrically operated normally closed normally closed vacuum valve for controlling the vacuum level in the collector is connected to the control unit.  10. A device for immobilizing a local myocardial region, comprising an adjustable cantilever supporting element with a mounting unit on the expander and a stabilizer of the position of the operated myocardial region attached to it via a spherical hinge, equipped with vacuum suction cups placed on both sides of the operation area with nipples for connecting their working cavities to a vacuum source, characterized in that the stabilizer of the position of the operated myocardial site is equipped with a power frame assembled of two pivotally connected load-bearing brackets with two shelves, limiting the operating window, while each load-bearing bracket is equipped with a vacuum suction cup having a working cavity open from the end and replaceable perforated inserts installed therein.  11. The device according to p. 10, characterized in that the working cavity is made rectangular in plan with smooth conjugation of the corners of the rectangle.  12. The device according to p. 10, characterized in that the working cavity is made arcuate in plan with smooth conjugation of the ends of the arcs between them.  13. The device according to any one of paragraphs. 10-12, characterized in that the contact surface of the end face of the working cavity is made flat. 14. The device according to p. 13, characterized in that the flat contact surface of the end of the working cavity is inclined at an angle of 4-15 ^o to the plane of the operating window.  15. The device according to p. 10, characterized in that the end surface of the vacuum suction cup facing the myocardium is made spherical.  16. The device according to any one of paragraphs. 10-15, characterized in that the replaceable perforated insert is mounted flush with the contact surface of the end face of the vacuum suction cup.  17. The device according to p. 16, characterized in that each replaceable perforated insert is equipped with suction channels connecting the supporting surface of the insert adjacent to the myocardium with its opposite surface facing the working cavity of the vacuum suction cup.  18. The device according to p. 16, characterized in that the suction channels are cylindrical and uniformly located in the body of the insert.  19. The device according to p. 18, characterized in that the cylindrical suction channels have a diameter of 2-5 mm  20. The device according to p. 19, characterized in that the suction channels are placed in one line.  21. The device according to p. 20, characterized in that the cross section of the cylindrical suction channels is the same along the length of the insert.  22. The device according to p. 20, characterized in that the cross-section of the cylindrical suction channels is maximally in the middle of the insert and decreases to its ends.  23. The device according to p. 19, characterized in that the suction channels are placed in two parallel lines.  24. The device according to p. 16, characterized in that the suction channels are made with a rectangular cross section.  25. The device according to p. 24, characterized in that the cross section of the rectangular suction channels is the same along the length of the insert.  26. The device according to p. 24, characterized in that the cross section of the rectangular suction channels is maximally in the middle of the insert and decreases towards the ends of the insert.  27. The device according to p. 16, characterized in that the replaceable perforated insert is made in the form of a lattice.  28. The device according to p. 27, characterized in that the lattice is formed by intersecting longitudinal and transverse grooves, respectively made on the upper and lower surfaces of the insert.  29. The device according to any one of paragraphs. 16-28, characterized in that the outer edges of the suction cup facing the myocardium, as well as the edges of the openings of the suction channels or lattice grooves are rounded.  30. The device according to any one of paragraphs. 10-15, characterized in that a closed groove is made along the perimeter of the side wall of the working cavity of the vacuum suction cup, and a replaceable perforated insert is made in the form of an elastic perforated plate, the edges of which are introduced into the specified groove.  31. The device according to p. 30, characterized in that the outer and inner edges of the vacuum suction cup facing the myocardium are rounded.  32. The device according to any one of paragraphs. 10-31, characterized in that the stabilizer position of the operated area of the myocardium is equipped with devices for attaching the turnstile threads for clamping the artery, while these means of fastening the turnstile threads are placed on the shelves of the bearing brackets.  33. The device according to p. 32, characterized in that each device for attaching the turnstile for clamping the artery is made in the form of a fixed bracket fixed to the shelf of the carrier and tightly attached to its surface with an elastic latch of the turnstile.  34. The device according to p. 33, characterized in that the latch of the turnstile thread is made in the form of a U-shaped elastic element made of wire, the ends of which are fixed in the shelf bracket.  35. The device according to p. 32, characterized in that each device for attaching a turnstile for clamping an artery is made in the form of a rack fixed to a shelf of a supporting bracket with a turnstile lock.  36. The device according to p. 35, characterized in that the rack has two parallel holes, and the turnstile thread lock is made in the form of a U-shaped elastic element made of wire tightly attached to the shelf surface, the ends of which are passed through the holes in the rack.  37. The device according to any one of paragraphs. 32-36, characterized in that in each shelf of the bearing brackets, tapering slots are made on the outside for placement of turnstile threads in them for pinching the artery.  38. The device according to any one of paragraphs. 10-37, characterized in that the stabilizer position of the operated area of the myocardium is equipped with removable vacuum suction cups.  39. The device according to p. 38, characterized in that each supporting bracket has a U-shaped recess and is equipped with elements for fixing removable vacuum suction cups located on the edge of the U-shaped recess.  40. The device according to p. 39, characterized in that the fixing elements of the removable vacuum suction cup are made in the form of beads on the edge of the recess of the bearing bracket.  41. The device according to p. 38, characterized in that each removable vacuum suction cup is equipped with a housing that repeats in plan the shape of the recess of the bearing bracket, while this housing is equipped with elements for fixing it in a U-shaped recess of the bearing bracket.  42. The device according to p. 41, characterized in that the fixing elements of the housing of the removable vacuum suction cup are placed on its side surface and made in the form of grooves covering the shoulders on the edge of the recess of the bearing bracket.  43. The device according to any one of paragraphs. 10-42, characterized in that the position stabilizer of the operated section of the myocardium is equipped with a supporting stand, adjacent to the cantilever supporting element adjacent shelves of the bearing brackets are equipped with cantilevered protrusions with flat shelves pivotally connected to each other, a spherical hinge head is placed at one end of the supporting stand the second end is connected to the power frame, while the distant adjacent shelves of the bearing brackets are interconnected by clamps that protect them from vertical and horizontal transverse escheny.  44. The device according to p. 43, characterized in that through-holes are made in the shelves of the cantilevered protrusions, and a cylindrical shank is made at the second end of the support column, passed through these holes and articulated between the shelves of the load-bearing brackets of the power frame.  45. The device according to p. 44, characterized in that the latch from the vertical lateral displacement is placed on adjacent edges of distant adjacent shelves.  46. The device according to p. 43, characterized in that the latch from horizontal lateral displacements is two cantilevered protrusions of an L-shaped shape located on adjacent shelves and spanning a thread over said protrusions.  47. The device according to any one of paragraphs. 10-46, characterized in that the bearing bracket of the stabilizer is made with curved in plan outer edges.

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