WO2000018303A1 - Technique de chirurgie cardiaque peu invasive - Google Patents

Technique de chirurgie cardiaque peu invasive Download PDF

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Publication number
WO2000018303A1
WO2000018303A1 PCT/US1999/022598 US9922598W WO0018303A1 WO 2000018303 A1 WO2000018303 A1 WO 2000018303A1 US 9922598 W US9922598 W US 9922598W WO 0018303 A1 WO0018303 A1 WO 0018303A1
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WO
WIPO (PCT)
Prior art keywords
patient
access hole
transsternal
access
ascending aorta
Prior art date
Application number
PCT/US1999/022598
Other languages
English (en)
Inventor
John A. Macoviak
Wilfred J. Samson
Original Assignee
Cardeon Corporation
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Cardeon Corporation filed Critical Cardeon Corporation
Priority to AU62752/99A priority Critical patent/AU6275299A/en
Publication of WO2000018303A1 publication Critical patent/WO2000018303A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00238—Type of minimally invasive operation
    • A61B2017/00243—Type of minimally invasive operation cardiac

Definitions

  • the present invention relates to methods and apparatus for transsternal surgical access to the aorta, the heart and the cardiovascular system of a patient and to methods and apparatus for performing surgical and interventional procedures through the transsternal access.
  • the present invention provides a method and apparatus for transsternal access to the ascending aorta and thereby to the heart and the rest of the cardiovascular system.
  • the transsternal access approach allows a variety of diagnostic, interventional and surgical procedures within the aorta, the heart and the cardiovascular system.
  • the transsternal approach has several advantages. In particular, the sternum is left largely intact, eliminating much of the pain, trauma and morbidity associated with a sternotomy, as well as the problem of dehiscence of the sternotomy.
  • the transsternal approach also spares both internal thoracic or internal mammary arteries (IMA), which is not true of the transverse sternotomy, or the L-shaped, C-shaped and Z-shaped partial sternotomies.
  • IMA internal mammary arteries
  • CABG coronary bypass graft surgery
  • transsection of the IMA may ruin the IMA for possible use as a graft vessel in the present or in a future surgery.
  • the transsternal approach also provides a possible path around or through scar tissue formations and adhesions from previous surgeries.
  • the transsternal approach provides an alternative approach into the aorta, the heart and the cardiovascular system when peripheral arterial access is complicated by peripheral vascular disease.
  • the method of the transsternal surgical access approach begins with a small skin incision inferior to the suprasternal notch and directly over the manubrium or the body of the sternum.
  • the skin is retracted to expose the sternum.
  • Tissue retraction and exposure of the sternum is relatively simple as there is very little tissue or muscle over the bone at this location.
  • a hole is drilled or punched through the sternum, preferably at a level between the first rib and the second intercostal space, which places the hole over the location of the ascending aorta.
  • a roadmap aortogram or a routine angiogram or ventriculogram will provide the surgeon with the necessary landmarks for placement of the transsternal hole.
  • the transsternal hole may be as small as a couple of millimeters or as large as a couple of centimeters in diameter.
  • a non-coring drill may be used to create the transsternal hole or a coring drill may used, particularly if the hole will be large.
  • the core removed by a coring drill may be saved and replaced in the transsternal hole at the end of the procedure. The anterior mediastinum is crossed and, if necessary, the lungs are retracted aside to extend the transsternal access channel and to expose the ascending aorta.
  • a transsternal aortic crossclamp is inserted through the transsternal access channel and used to occlude the ascending aorta for performing cardiopulmonary bypass with or without cardioplegic arrest.
  • an aortotomy incision is made and a catheter or cannula is inserted into the ascending aorta.
  • a transsternal aortic cannula is inserted to deliver oxygenated blood into the aorta, for example for cardiopulmonary bypass.
  • an intraluminal occlusion catheter is inserted to occlude the lumen of the ascending aorta.
  • the intraluminal occlusion catheter will have an expandable occlusion member that may be an inflatable balloon or an external catheter valve.
  • the intraluminal occlusion catheter may include a cardioplegia lumen having a port upstream of the expandable occlusion member and/or a perfusion lumen having a port downstream of the expandable occlusion member.
  • the intraluminal occlusion catheter may also include additional expandable occlusion members for further segmentation of the aorta and additional perfusion lumens for selective perfusion of the isolated segments of the vasculature.
  • interventional catheters or other surgical instruments may be inserted through the transsternal access channel for performing surgical repairs on the aorta, the heart valves, the coronary arteries, or other parts of the cardiovascular system.
  • the catheters and/or instruments are removed and any aortotomy that has been made is closed.
  • the core removed by a coring drill may be placed back in the transsternal hole and held in place with a biocompatible surgical adhesive or a surgical closure device. Then, the skin incision is closed using sutures, skin staples, adhesive strips or any other surgical closure device.
  • Apparatus includes a system of surgical and/or interventional instruments for creating the transsternal access channel and for performing the intended surgical and/or interventional procedures.
  • the instrument system typically will include a sternal drill or punch, which may be coring or non-coring, and at least one additional surgical and/or interventional instrument.
  • the additional instruments may include an aortic crossclamp, a sidebiting clamp, an aortic perfusion cannula, an aortic occlusion catheter, and devices for performing surgical and/or interventional procedures within the aorta, the heart or the cardiovascular system.
  • FIG 1 is an anterior view of a patient showing the access site for the transsternal access channel. The heart and the ascending aorta are shown in phantom in this view.
  • FIG 2 is a superior view of a horizontal cross section of the thorax of a patient showing the transsternal access channel through the sternum and into the ascending aorta.
  • FIG 3 is a left lateral view of a sagital cross section of the thorax of a patient showing the transsternal access channel through the sternum and into the ascending aorta.
  • FIG 4 is a left lateral view of a sagital cross section of the thorax of a patient showing an aortic crossclamp inserted via the transsternal access channel.
  • FIG 5 is a left lateral view of a sagital cross section of the thorax of a patient showing an aortic perfusion cannula inserted via the transsternal access into the ascending aorta.
  • FIG 6 is a left lateral view of a sagital cross section of the thorax of a patient showing an aortic occlusion and perfusion cannula inserted via the transsternal access into the ascending aorta.
  • FIG 7 is a left lateral view of a sagital cross section of the thorax of a patient showing a selective aortic perfusion catheter inserted via the transsternal access into the aorta.
  • FIG 8 is a left lateral view of a sagital cross section of the thorax of a patient showing a transsternal introducer sheath inserted via the transsternal access into the ascending aorta.
  • FIG 9 is a left lateral view of a sagital cross section of the thorax of a patient showing an interventional catheter inserted via the transsternal access into the ascending aorta.
  • FIG 1 is an anterior view of a patient showing the access site for the transsternal access channel.
  • the heart and the ascending aorta are shown in phantom in this view.
  • the method of the transsternal surgical access approach begins with a small skin incision 102 inferior to the suprasternal notch and directly over the manubrium or the upper end of the body of the sternum.
  • the skin around the incision 102 is retracted to expose the sternum. Tissue retraction and exposure of the sternum is relatively simple as there is very little tissue or muscle over the bone at this location.
  • a hole 100 is drilled or punched through the sternum.
  • the optimal location of the transsternal hole 100 may vary considerably depending on the patient's anatomy and the procedure to be performed, however, it is generally placed at a level between the first rib and the second intercostal space, preferably directly over the location of the ascending aorta.
  • the transsternal hole 100 may be placed centrally along the median line or it may be placed to the right or the left of the median line depending on the location of the patient's ascending aorta.
  • the transsternal hole 100 may be drilled perpendicular to the anterior surface of the sternum or it may be angulated in any chosen direction for better alignment with the ascending aorta for the purposes of the intended procedure.
  • a roadmap aortogram or a routine angiogram or ventriculogram will provide the surgeon with the necessary landmarks for placement of the transsternal hole 100.
  • Variations of the transsternal approach include a suprasternal approach and parasternal approach.
  • the position of the ascending aorta within the thorax will favor access via an incision and access hole 100' partially or completely above the sternum in the suprasternal notch.
  • Such a surgical access method may be termed a suprasternal approach.
  • some portion of the superior part of the sternum may be removed to achieve optimum position and angulation of the access channel to the ascending aorta.
  • the thoracic anatomy will favor access via an incision and access hole
  • a parasternal approach such as this may be made through an intercostal space or part of the sternum and/or costal cartilage may be removed to achieve optimum position and angulation of the access channel to the ascending aorta.
  • Other aspects that may affect the choice of using the transsternal, suprasternal and parasternal approaches are the anatomy of other organs within the thorax, the presence of scar tissue from previous surgeries or injuries and emergency conditions warranting rapid aortic access. The following detailed description applies equally to each of these three variations of the surgical approach.
  • the transsternal hole 100 may be as small as a couple of millimeters or as large as a couple of centimeters in diameter.
  • a non-coring drill may be used to create the transsternal hole or a coring drill or hole saw may used, particularly if the hole 100 will be large.
  • the core removed by a coring drill may be saved and replaced in the transsternal hole 100 at the end of the procedure.
  • FIG 2 is a superior view of a horizontal cross section of the thorax of a patient, taken along the line 2-2 in FIG 1 , showing the transsternal hole 100 and the transsternal access channel 104 through the sternum and into the ascending aorta.
  • FIG 3 is a left lateral view of a sagital cross section of the thorax of a patient, taken along the line 3-3 in FIG 2, showing the transsternal hole 100 and the transsternal access channel 104 through the sternum and into the ascending aorta.
  • Apparatus includes a system of surgical and/or interventional instruments for creating the transsternal access channel and for performing the intended surgical and/or interventional procedures.
  • the instrument system typically will include a sternal drill or punch, which may be coring or non-coring, and at least one additional surgical and/or interventional instrument.
  • the additional instruments may include an aortic crossclamp, a sidebiting clamp, an aortic perfusion cannula, an aortic occlusion catheter, and devices for performing surgical and/or interventional procedures within the aorta, the heart or the cardiovascular system.
  • FIG 4 is a left lateral view of a sagital cross section of the thorax of a patient showing a transsternal aortic crossclamp 108 inserted through the transsternal hole 100 and the transsternal access channel 104 and used to occlude the ascending aorta for performing cardiopulmonary bypass with or without cardioplegic arrest.
  • a sidebiting aortic clamp may be inserted through the transsternal access channel 104 and used to isolate a portion of the aortic wall for performing an aortic anastomosis of a coronary bypass graft or the like.
  • the aorta downstream of the transsternal aortic crossclamp 108 may be perfused with oxygenated blood supplied through an aortic perfusion cannula (described in more detail below) placed in the aortic arch via the transsternal access channel 104.
  • an aortic perfusion cannula may be placed by another method or the patient may be perfused through a peripheral perfusion cannula placed in a peripheral artery, such as the femoral, subclavian or axillary artery.
  • a cardioplegia cannula (not shown) may be placed in the ascending aorta upstream of the transsternal aortic crossclamp 108 via the transsternal access channel 104 for infusion of a cardioplegic agent to arrest the heart.
  • FIG 5 is a left lateral view of a sagital cross section of the thorax of a patient showing an aortic perfusion cannula 110 inserted via the transsternal hole 100 and the transsternal access channel 104 and through an aortotomy incision 106 into the ascending aorta.
  • An aortotomy incision 106 is made in the ascending aorta and the aortic perfusion cannula 110 is inserted through the ascending aorta and into the aortic arch.
  • a cardiopulmonary bypass pump, or the like perfuses oxygenated blood through the aortic perfusion cannula 110 into the aorta.
  • FIG 6 is a left lateral view of a sagital cross section of the thorax of a patient showing an intraluminal aortic occlusion and perfusion catheter or cannula 120 inserted via the transsternal hole 100 and the transsternal access channel 104 and through an aortotomy incision 106 into the ascending aorta.
  • the intraluminal occlusion catheter 120 will have an expandable occlusion member 122, which may be an inflatable balloon as shown, for occluding the ascending aorta between the coronary arteries and the brachiocephalic artery.
  • the expandable occlusion member 122 may be an external catheter valve.
  • the intraluminal occlusion catheter 120 includes a cardioplegia lumen 124 having a cardioplegia port 126 upstream of the expandable occlusion member 122 and a perfusion lumen 128 having a perfusion port 130 downstream of the expandable occlusion member 122.
  • the intraluminal occlusion catheter 120 includes a balloon inflation or actuation lumen 132 for inflating or otherwise deploying the expandable occlusion member 122 to occlude the ascending aorta.
  • the intraluminal occlusion catheter 120 may also include additional expandable occlusion members for further segmentation of the aorta and additional perfusion lumens for selective perfusion of the isolated segments of the vasculature.
  • FIG 7 is a left lateral view of a sagital cross section of the thorax of a patient showing a selective aortic perfusion catheter 140 inserted via the transsternal hole 100 and the transsternal access channel 104 and through an aortotomy incision 106 into the ascending aorta.
  • the selective aortic perfusion catheter 140 will have a first expandable occlusion member 144 for occluding the ascending aorta between the coronary arteries and the brachiocephalic artery and a second expandable occlusion member 142 for occluding the descending aorta downstream of the arch vessels.
  • the expandable occlusion members 142, 144 may be external catheter valves as shown. Alternatively, the expandable occlusion members 142, 144 may be inflatable balloons, as in the previously described embodiment.
  • the first expandable occlusion member 144 is an antegrade external catheter valve that allows antegrade blood flow past the occlusion member 144, but which hinders retrograde blood flow past the occlusion member 144
  • the second expandable occlusion member 142 is a retrograde external catheter valve that allows retrograde blood flow past the occlusion member 142, but which hinders antegrade blood flow past the occlusion member 142.
  • the selective aortic perfusion catheter 140 includes a cardioplegia lumen 146 having a cardioplegia port 148 upstream of the expandable occlusion members 142, 144, an arch perfusion lumen 150 having an arch perfusion port 152 between the expandable occlusion members 142, 144, and a corporeal perfusion lumen 154 having a corporeal perfusion port 156 downstream of the expandable occlusion members 142, 144.
  • the selective aortic perfusion catheter 140 includes an actuation lumen 158 for deploying the expandable occlusion members 142, 144 to segment the aorta.
  • the selective aortic perfusion catheter 140 may also include additional expandable occlusion members for further segmentation of the aorta and additional perfusion lumens for selective perfusion of the isolated segments of the vasculature.
  • FIG 8 is a left lateral view of a sagital cross section of the thorax of a patient showing a transsternal introducer sheath 160 inserted via the transsternal hole 100 and the transsternal access channel 104 and through an aortotomy incision 106 into the ascending aorta.
  • the transsternal introducer sheath 160 has a tubular body 162 with an internal lumen for inserting interventional catheters or other surgical instruments into the patient's aorta.
  • the transsternal introducer sheath 160 may include a trocar (not shown) insertable through the tubular body 162 for making the aortotomy incision 106.
  • the transsternal introducer sheath 160 has, at the proximal end of the tubular body 162, a hemostasis valve 164 or the like for sealing around instruments inserted through the transsternal introducer sheath 160 and a side flush port 166 for infusing fluids through the lumen of the tubular body 162.
  • the transsternal introducer sheath 160 may also include, at the distal end of the tubular body 162, an inner expandable sealing member 168 and an outer expandable sealing member 170.
  • the inner and outer expandable sealing members 168, 170 are expandable and retractable by means of an actuator 172 on the proximal end of the tubular body 162.
  • the inner and outer expandable sealing members 168, 170 are retracted and collapsed against the tubular body 162 for insertion into the transsternal hole 100 and through the transsternal access channel 104.
  • the inner and outer expandable sealing members 168, 170 are expanded to anchor the transsternal introducer sheath 160 and to seal the aortotomy incision 106.
  • Interventional catheters or other surgical instruments may be inserted through the transsternal introducer sheath 160 for performing surgical repairs on the aorta, the heart valves, the coronary arteries, or other parts of the cardiovascular system.
  • FIG 9 is a left lateral view of a sagital cross section of the thorax of a patient showing an interventional catheter 180 inserted via the transsternal hole 100 and the transsternal access channel 104 and through an aortotomy incision 106 into the ascending aorta.
  • the interventional catheter 180 may be inserted into the ascending aorta using the transsternal introducer sheath 160, described above in connection with FIG 8.
  • some interventional catheters and surgical instruments may be inserted directly through the transsternal hole 100 and the transsternal access channel 104 without an introducer.
  • the interventional catheter 180 is in the form of a coronary stent delivery catheter system.
  • a guiding catheter 182 is inserted into the ascending aorta via the transsternal introducer sheath 160 with the aid of a guidewire (not shown) and maneuvered to engage one of the patient's coronary arteries.
  • a stent delivery catheter 184 is inserted through the guiding catheter 182 and maneuvered across a stenosis or other lesion in the coronary artery with the aid of a steerable guidewire 186.
  • an expandable balloon 188 mounted at the distal end of the stent delivery catheter 184 is inflated to expand the stent 190 in the lesion.
  • the balloon 188 is deflated and the stent delivery catheter 184 and the guiding catheter 182 are withdrawn, leaving the expanded stent 190 in place.
  • interventional catheters or surgical instruments may be inserted through the transsternal introducer sheath 160 or directly through the transsternal access channel 104 for performing surgical repairs on the aorta, the heart valves, the coronary arteries, or other parts of the cardiovascular system.
  • the catheters and/or instruments are removed and any aortotomy incision 106 that has been made is closed.
  • the core removed by a coring drill may be placed back in the transsternal hole 100 and held in place with a biocompatible surgical adhesive or a surgical closure device. Then, the skin incision is closed using sutures, skin staples, adhesive strips or any other surgical closure device.

Abstract

La présente invention concerne une technique et un dispositif permettant un accès transsternal (100) à l'aorte ascendante, au coeur et au système cardio-vasculaire à des fins de diagnostic ou en vue d'interventions chirurgicales. Après réalisation d'une petite incision (102) sur le sternum, on perce un trou (100) au moyen d'une mèche à noyau ou non, en général entre la première côte et le deuxième espace intercostal, le trou se trouvant ainsi au-dessus de l'emplacement de l'aorte ascendante. L'accès chirurgical (100) peut également se faire par l'échancrure suprasternale ou dans la région parasternale. On croise le médiastin antérieur croisé et l'on repousse les poumons latéralement pour élargir l'accès transsternal et exposer l'aorte ascendante. On peut insérer une pince transversale aortique par le passage transternal pour bloquer l'aorte ascendante en prévision d'une circulation extracorporelle et d'un arrêt cardioplégique.
PCT/US1999/022598 1998-10-01 1999-09-29 Technique de chirurgie cardiaque peu invasive WO2000018303A1 (fr)

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Application Number Priority Date Filing Date Title
AU62752/99A AU6275299A (en) 1998-10-01 1999-09-29 Minimally invasive cardiac surgery procedure

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US10272898P 1998-10-01 1998-10-01
US60/102,728 1998-10-01

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Cited By (22)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6443970B1 (en) 2001-01-24 2002-09-03 Ethicon, Inc. Surgical instrument with a dissecting tip
US6458128B1 (en) 2001-01-24 2002-10-01 Ethicon, Inc. Electrosurgical instrument with a longitudinal element for conducting RF energy and moving a cutting element
US6464702B2 (en) 2001-01-24 2002-10-15 Ethicon, Inc. Electrosurgical instrument with closing tube for conducting RF energy and moving jaws
US6554829B2 (en) 2001-01-24 2003-04-29 Ethicon, Inc. Electrosurgical instrument with minimally invasive jaws
US6620161B2 (en) 2001-01-24 2003-09-16 Ethicon, Inc. Electrosurgical instrument with an operational sequencing element
US6652521B2 (en) 2001-01-24 2003-11-25 Ethicon, Inc. Surgical instrument with a bi-directional cutting element
EP2033581A1 (fr) * 2007-09-07 2009-03-11 Sorin Biomedica Cardio S.R.L. Systèmes de mise en place de soupapes prothétiques y compris par l'approche rétrograde/antérograde
US7993392B2 (en) 2006-12-19 2011-08-09 Sorin Biomedica Cardio S.R.L. Instrument and method for in situ deployment of cardiac valve prostheses
US8057539B2 (en) 2006-12-19 2011-11-15 Sorin Biomedica Cardio S.R.L. System for in situ positioning of cardiac valve prostheses without occluding blood flow
US8114154B2 (en) 2007-09-07 2012-02-14 Sorin Biomedica Cardio S.R.L. Fluid-filled delivery system for in situ deployment of cardiac valve prostheses
US8262681B1 (en) 2007-11-23 2012-09-11 Rabin Gerrah Device and method for performing endoluminal proximal anastomosis
US8353953B2 (en) 2009-05-13 2013-01-15 Sorin Biomedica Cardio, S.R.L. Device for the in situ delivery of heart valves
US8403982B2 (en) 2009-05-13 2013-03-26 Sorin Group Italia S.R.L. Device for the in situ delivery of heart valves
US8808367B2 (en) 2007-09-07 2014-08-19 Sorin Group Italia S.R.L. Prosthetic valve delivery system including retrograde/antegrade approach
US9168105B2 (en) 2009-05-13 2015-10-27 Sorin Group Italia S.R.L. Device for surgical interventions
US9707076B2 (en) 2012-08-23 2017-07-18 Minimally Invasive Surgical Access Limited Direct aortic access system for transcatheter aortic valve procedures
US10058313B2 (en) 2011-05-24 2018-08-28 Sorin Group Italia S.R.L. Transapical valve replacement
WO2019014643A1 (fr) * 2017-07-13 2019-01-17 Mitrx, Inc. Dispositifs et procédés pour accéder à l'oreillette gauche pour procédures cardiaques
WO2020146889A1 (fr) * 2019-01-11 2020-07-16 Mitrx, Inc. Dispositifs et procédés pour interventions cardiaques basées sur un cathéter
US11406375B2 (en) 2018-01-05 2022-08-09 Mitrx, Inc. Pursestring suture retractor and method of use
US11504231B2 (en) 2018-05-23 2022-11-22 Corcym S.R.L. Cardiac valve prosthesis
US11969341B2 (en) 2022-11-18 2024-04-30 Corcym S.R.L. Cardiac valve prosthesis

Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
FR2596271A3 (fr) * 1986-03-25 1987-10-02 Ispytatelny Inst Med Dispositif pour la tunnellisation de l'espace retrosternal
US5618307A (en) * 1995-04-03 1997-04-08 Heartport, Inc. Clamp assembly and method of use
WO1997029711A1 (fr) * 1996-02-19 1997-08-21 The Cleveland Clinic Foundation Procedure invasive minimale pour chirurgie cardiaque
WO1997042879A1 (fr) * 1996-05-14 1997-11-20 Embol-X, Inc. Dispositif d'occlusion aortique a filtre associe et son procede d'utilisation au cours d'une intervention chirurgicale
US5716370A (en) * 1996-02-23 1998-02-10 Williamson, Iv; Warren Means for replacing a heart valve in a minimally invasive manner
US5797960A (en) * 1993-02-22 1998-08-25 Stevens; John H. Method and apparatus for thoracoscopic intracardiac procedures

Patent Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
FR2596271A3 (fr) * 1986-03-25 1987-10-02 Ispytatelny Inst Med Dispositif pour la tunnellisation de l'espace retrosternal
US5797960A (en) * 1993-02-22 1998-08-25 Stevens; John H. Method and apparatus for thoracoscopic intracardiac procedures
US5618307A (en) * 1995-04-03 1997-04-08 Heartport, Inc. Clamp assembly and method of use
WO1997029711A1 (fr) * 1996-02-19 1997-08-21 The Cleveland Clinic Foundation Procedure invasive minimale pour chirurgie cardiaque
US5716370A (en) * 1996-02-23 1998-02-10 Williamson, Iv; Warren Means for replacing a heart valve in a minimally invasive manner
WO1997042879A1 (fr) * 1996-05-14 1997-11-20 Embol-X, Inc. Dispositif d'occlusion aortique a filtre associe et son procede d'utilisation au cours d'une intervention chirurgicale

Cited By (33)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6695840B2 (en) 2001-01-24 2004-02-24 Ethicon, Inc. Electrosurgical instrument with a longitudinal element for conducting RF energy and moving a cutting element
US6790217B2 (en) 2001-01-24 2004-09-14 Ethicon, Inc. Surgical instrument with a dissecting tip
US6464702B2 (en) 2001-01-24 2002-10-15 Ethicon, Inc. Electrosurgical instrument with closing tube for conducting RF energy and moving jaws
US6554829B2 (en) 2001-01-24 2003-04-29 Ethicon, Inc. Electrosurgical instrument with minimally invasive jaws
US6620161B2 (en) 2001-01-24 2003-09-16 Ethicon, Inc. Electrosurgical instrument with an operational sequencing element
US6652521B2 (en) 2001-01-24 2003-11-25 Ethicon, Inc. Surgical instrument with a bi-directional cutting element
US6458128B1 (en) 2001-01-24 2002-10-01 Ethicon, Inc. Electrosurgical instrument with a longitudinal element for conducting RF energy and moving a cutting element
US6773435B2 (en) 2001-01-24 2004-08-10 Ethicon, Inc. Electrosurgical instrument with closing tube for conducting RF energy and moving jaws
US6443970B1 (en) 2001-01-24 2002-09-03 Ethicon, Inc. Surgical instrument with a dissecting tip
US7063699B2 (en) 2001-01-24 2006-06-20 Ethicon, Inc. Electrosurgical instrument with minimally invasive jaws
US8470024B2 (en) 2006-12-19 2013-06-25 Sorin Group Italia S.R.L. Device for in situ positioning of cardiac valve prosthesis
US7993392B2 (en) 2006-12-19 2011-08-09 Sorin Biomedica Cardio S.R.L. Instrument and method for in situ deployment of cardiac valve prostheses
US8057539B2 (en) 2006-12-19 2011-11-15 Sorin Biomedica Cardio S.R.L. System for in situ positioning of cardiac valve prostheses without occluding blood flow
US8070799B2 (en) 2006-12-19 2011-12-06 Sorin Biomedica Cardio S.R.L. Instrument and method for in situ deployment of cardiac valve prostheses
US9056008B2 (en) 2006-12-19 2015-06-16 Sorin Group Italia S.R.L. Instrument and method for in situ development of cardiac valve prostheses
EP2033581A1 (fr) * 2007-09-07 2009-03-11 Sorin Biomedica Cardio S.R.L. Systèmes de mise en place de soupapes prothétiques y compris par l'approche rétrograde/antérograde
US8114154B2 (en) 2007-09-07 2012-02-14 Sorin Biomedica Cardio S.R.L. Fluid-filled delivery system for in situ deployment of cardiac valve prostheses
EP2399527A1 (fr) * 2007-09-07 2011-12-28 Sorin Biomedica Cardio S.r.l. Systèmes de mise en place de soupapes prothétiques y compris par l'approche rétrograde/antérograde
US8808367B2 (en) 2007-09-07 2014-08-19 Sorin Group Italia S.R.L. Prosthetic valve delivery system including retrograde/antegrade approach
US8486137B2 (en) 2007-09-07 2013-07-16 Sorin Group Italia S.R.L. Streamlined, apical delivery system for in situ deployment of cardiac valve prostheses
US8475521B2 (en) 2007-09-07 2013-07-02 Sorin Group Italia S.R.L. Streamlined delivery system for in situ deployment of cardiac valve prostheses
US8262681B1 (en) 2007-11-23 2012-09-11 Rabin Gerrah Device and method for performing endoluminal proximal anastomosis
US8403982B2 (en) 2009-05-13 2013-03-26 Sorin Group Italia S.R.L. Device for the in situ delivery of heart valves
US8353953B2 (en) 2009-05-13 2013-01-15 Sorin Biomedica Cardio, S.R.L. Device for the in situ delivery of heart valves
US9168105B2 (en) 2009-05-13 2015-10-27 Sorin Group Italia S.R.L. Device for surgical interventions
US10058313B2 (en) 2011-05-24 2018-08-28 Sorin Group Italia S.R.L. Transapical valve replacement
US9707076B2 (en) 2012-08-23 2017-07-18 Minimally Invasive Surgical Access Limited Direct aortic access system for transcatheter aortic valve procedures
WO2019014643A1 (fr) * 2017-07-13 2019-01-17 Mitrx, Inc. Dispositifs et procédés pour accéder à l'oreillette gauche pour procédures cardiaques
US11406375B2 (en) 2018-01-05 2022-08-09 Mitrx, Inc. Pursestring suture retractor and method of use
US11504231B2 (en) 2018-05-23 2022-11-22 Corcym S.R.L. Cardiac valve prosthesis
WO2020146889A1 (fr) * 2019-01-11 2020-07-16 Mitrx, Inc. Dispositifs et procédés pour interventions cardiaques basées sur un cathéter
EP3908230A4 (fr) * 2019-01-11 2022-09-28 MITRX, Inc. Dispositifs et procédés pour interventions cardiaques basées sur un cathéter
US11969341B2 (en) 2022-11-18 2024-04-30 Corcym S.R.L. Cardiac valve prosthesis

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