U.S. patent application number 09/759727 was filed with the patent office on 2001-06-14 for catheter system and method for posterior epicardial revascularization and intracardiac surgery on a beating heart.
Invention is credited to Davis, Albert, Suresh, Mitta.
Application Number | 20010003795 09/759727 |
Document ID | / |
Family ID | 22394887 |
Filed Date | 2001-06-14 |
United States Patent
Application |
20010003795 |
Kind Code |
A1 |
Suresh, Mitta ; et
al. |
June 14, 2001 |
Catheter system and method for posterior epicardial
revascularization and intracardiac surgery on a beating heart
Abstract
A catheter system and method of performing posterior epicardial
revascularization and intracardiac surgery on a beating heart.
Several catheter systems are provided to achieve a left ventricular
isolation and a right ventricular isolation as required to
facilitate surgery according to the methods of the present
invention. Myocardial infusion is provided in either antegrade or
retrograde flow to insure the myocardium meets its oxygen
demand.
Inventors: |
Suresh, Mitta; (Richardson,
TX) ; Davis, Albert; (Richardson, TX) |
Correspondence
Address: |
Bill R. Naifeh
Haynes and Boone, LLP
Suite 3100
901 Main Street
Dallas
TX
75202
US
|
Family ID: |
22394887 |
Appl. No.: |
09/759727 |
Filed: |
January 12, 2001 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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09759727 |
Jan 12, 2001 |
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09121151 |
Jul 22, 1998 |
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60053416 |
Jul 22, 1997 |
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Current U.S.
Class: |
604/96.01 ;
604/101.03 |
Current CPC
Class: |
A61M 1/3666 20130101;
A61M 25/1011 20130101; A61M 25/0075 20130101; A61M 2025/1097
20130101; A61M 60/00 20210101; A61M 1/3653 20130101; A61M 60/135
20210101; A61M 60/833 20210101; A61M 1/3659 20140204; A61M 60/531
20210101; A61M 2210/127 20130101; A61M 60/122 20210101; A61M 60/295
20210101; A61M 25/10 20130101; A61M 60/497 20210101; A61M 60/143
20210101; A61M 1/3613 20140204; A61M 60/554 20210101; A61M 60/857
20210101; A61M 25/1002 20130101; A61M 60/40 20210101; A61M 60/892
20210101; A61M 2025/1052 20130101; A61M 60/50 20210101 |
Class at
Publication: |
604/96.01 ;
604/101.03 |
International
Class: |
A61M 029/00 |
Claims
We claim:
1. A catheter system for facilitating epicardial surgery and
intracardiac surgery on a beating heart, comprising: a first
catheter having a shape and structure adapted to draw blood from a
left ventricle of the beating heart; a pump coupled to said first
catheter; and an aortic catheter coupled to said pump having a
lumen and structure adapted to return said drawn blood to an aorta
of the beating heart at a sufficient rate and pressure to perfuse
the heart.
2. The catheter system as specified in claim 1 wherein said aortic
catheter has a balloon having a diameter sufficient to occlude the
aorta when inserted therein, wherein said lumen terminates at a
distal end of said aortic catheter distal of said balloon.
3. The catheter system as specified in claim 1 wherein said first
catheter has a shape and structure adapted to be inserted through
an apex of the heart.
4. The catheter system as specified in claim 1 wherein said first
catheter has a shape and structure adapted to be inserted through a
pulmonary vein and a mitrial valve of the heart.
5. The catheter system as specified in claim 1 wherein said first
catheter has a shape and structure adapted to be inserted through a
left atrial appendage and a mitrial valve of the heart.
6. The catheter system as specified in claim 1 wherein said first
catheter has a shape and structure adapted to be inserted through
an aorta and an aortic valve of the heart.
7. The catheter system as specified in claim 1 wherein said aortic
catheter further comprises perfusion means for sufficiently
perfusing a myocardium of the beating heart.
8. The catheter system as specified in claim 7 wherein said
perfusion means comprises structure to perfuse the myocardium via
an aortic base of the heart in antegrade flow.
9. The catheter system as specified in claim 7 wherein said
perfusion means comprises structure to perfuse a coronary sinus of
the heart in retrograde flow.
10. A catheter system for facilitating epicardial surgery and
intracardiac surgery on a beating heart having pulmonary veins and
an aorta, comprising: a first catheter having a shape and structure
adapted to draw blood from the pulmonary veins of a beating heart;
a pump coupled to said first catheter; and an aortic catheter
coupled to said pump having a lumen and structure adapted to return
said drawn blood to the aorta of the beating heart at a sufficient
rate and pressure to perfuse the body.
11. The catheter system as specified in claim 10 wherein said first
catheter has two pairs of distal ends each adapted to be inserted
into one of four pulmonary veins of the heart.
12. The catheter system as specified in claim 11 wherein said
distal ends each have a balloon having a diameter sufficient to
occlude one pulmonary vein when inserted therein and a lumen
terminating distal of said balloon for drawing blood from said
pulmonary veins.
13. A catheter system for facilitating epicardial surgery and
intracardiac surgery on a beating heart having a pulmonary artery,
an inferior vena cava and a superior vena cava,. comprising: a
first venous return catheter having a shape and structure adapted
to draw blood from the inferior vena cava and the superior vena
cava; a pump coupled to said first venous return catheter; and a
pulmonary artery catheter coupled to said pump having a lumen and
structure adapted to return said drawn blood to the pulmonary
artery of the beating heart at a sufficient rate and pressure to
perfuse the body.
14. The catheter system as specified in claim 13 wherein said
venous return catheter has a pair of balloons having a shape and
size adapted to occlude the superior vena cava and the inferior
vena cava.
15. A method of performing epicardial revascularization and
intracardiac surgery on a beating heart, the heart having an aorta,
an aortic base, aortic valve, left ventricle, right pulmonary vein,
left atrial apendage, inferior vena cava, superior vena cava, main
pulmonary artery, mitrial valve, and coronary sinus, comprising the
steps of: a) drawing blood from the left ventricle using a pump and
a first catheter while said heart is beating to obtain a left
ventricular isolation; and b) returning a majority of said drawn
blood via said pump to the ascending aorta using an aortic
catheter.
16. The method as specified in claim 15 wherein a portion of said
drawn blood in said step b) is infused into the myocardium to
provide myocardial infusion.
17. The method as specified in claim 16 wherein said portion of
said drawn blood is infused into the aortic base to provide
antegrade myocardial infusion.
18. The method as specified in claim 16 wherein said portion of
said drawn blood is infused into the coronary sinus to provide
retrograde myocardial infusion.
19. The method as specified in claim 16 wherein a volume and
pressure of said drawn blood is selectively controlled during said
myocardial infusion.
20. The method as specified in claim 16 wherein said aortic
catheter also infuses said drawn blood into the myocardium.
21. The method as specified in claim 15 wherein said first catheter
is inserted into the left ventricle through the apex of the
heart.
22. The method as specified in claim 15 wherein said first catheter
is inserted into the left ventricle via the pulmonary vein and
through the mitrial valve.
23. The method as specified in claim 15 wherein said first catheter
is inserted into the left ventricle via the left atrial appendage
and through the mitrial valve.
24. The method as specified in claim 15 wherein said first catheter
is inserted into the left ventricle via the aorta and through the
aortic valve.
25. The method as specified in claim 15 further comprising the step
of repairing the mitrial valve.
26. A method of performing epicardial revascularization and
intracardiac surgery on a beating heart, the heart having an aorta,
an aortic base, aortic valve, left ventricle, right pulmonary vein,
left atrial apendage, inferior vena cava, superior vena cava, main
pulmonary artery, mitrial valve, and coronary sinus, comprising the
steps of: a) drawing blood from the main pulmonary veins using a
first catheter and a pump while said heart is beating to obtain a
left ventricular isolation; and b) returning a majority of said
drawn blood via said pump to the ascending aorta using an aortic
catheter.
27. The method as specified in claim 26 wherein a portion of said
drawn blood in said step b) is infused into the myocardium to
provide myocardial infusion.
28. The method as specified in claim 26 wherein said portion of
said drawn blood is infused into the aortic base to provide
antegrade myocardial infusion.
29. The method as specified in claim 27 wherein said portion of
said drawn blood is infused into the coronary sinus to provide
retrograde myocardial infusion.
30. The method as specified in claim 27 wherein a volume and
pressure of said drawn blood is selectively controlled during said
myocardial infusion.
31. The method as specified in claim 27 wherein said aortic
catheter also infuses said drawn blood into the myocardium.
32. A method of performing epicardial revascularization and
intracardiac surgery on a beating heart, the heart having an aorta,
an aortic base, aortic valve, left ventricle, right pulmonary vein,
left atrial apendage, inferior vena cava, superior vena cava, main
pulmonary artery, mitrial valve, tricuspid valve, pulmonic valve,
and coronary sinus, comprising the steps of: a) drawing blood from
the inferior vena cava and the superior vena cava using a pump and
a first catheter while said heart is beating to create a bloodless
right side of the heart; and b) returning said drawn blood via said
pump to the pulmonary artery using a second catheter.
33. The method as specified in claim 32 further comprising the step
of repairing the tricuspid valve.
34. The method as specified in claim 32 further comprising the step
of repairing the pulmonic valve.
Description
CROSS REFERENCE TO RELATED APPLICATIONS
[0001] Cross reference is made to the following commonly assigned
patent applications, the teachings of which are incorporated herein
by reference:
1 SERIAL NUMBER TITLE FILING DATE 08/846,666 Integral Aortic Arch
Infusion May 1, 1997 Clamp Catheter 09/070,696 Integral Aortic Arch
Infusion April 30, 1998 Clamp Having Pressure Ports 08/838,802
Venous Return Catheter April 10, 1997 having Integral Support
Member Attorney's Docket # Catheter Having A Lumen July 22, 1998
1050-2013 Occluding Balloon and Method of Use Thereof
FIELD OF THE INVENTION
[0002] The present invention is generally related to cardiac
catheter systems including venous perfusion and arterial perfusion
cardiac catheters for providing cardiopulmonary bypass support and
isolation of a heart during heart surgery, and more particularly to
a system and method facilitating intracardiac surgery including
valvular repair and/or replacement on a beating heart.
BACKGROUND OF THE INVENTION
[0003] Use of catheters to administer fluids to and draw fluids out
of the body has been a standard practice in medical procedures for
years. Multiple catheters may be used to connect an extracorporeal
circuit to the body during open-heart procedures. The various
catheters are simultaneously or sequentially used to provide
different functions, for instance, one catheter for delivering a
cardioplegia solution to arrest the heart, with another catheter
being inserted into the heart to infuse oxygenated blood to the
ascending aorta.
[0004] One of the developing technologies in medicine at this time
is least invasive cardiac surgery. Currently, the two popular
methods of least invasive surgery is either on a beating heart, or
on a stable heart. The beating heart surgery is typically limited
to anterior epicardial revascularization. Specifically, this
surgery includes procedures including anastomosis of the left
internal mammary artery (LIMA) to the left anterior descending
(LAD) artery.
[0005] Left ventricular decompression (LVD) and right ventricular
decompression (RVD) are popularly used as assist devices, wherein a
pump is used to drain the blood from the left ventricle or the
right ventricle and delivered into the aorta or pulmonary artery,
respectively, so that the myocardium is rested and can recover over
a period of time. Assist devices are popularly used as bridges to
heart transplants. In some cases, assist devices are used
post-operatively to help the myocardium to recover from the shock
of myocardial infarction in combination with the stress of
open-heart surgery.
[0006] The present invention is directed to a catheter system and
method for facilitating intracardiac surgery including valvular
repair and/or replacement on a beating heart. It is desirable to
keep a heart beating where possible to reduce trauma to the heart.
There is a desire for procedures including, repair and/or
replacement of the mitrial valve located between the left atrium
and the left ventricle, and the aortic valve located at the aortic
base of the heart. There is also a desire to provide a procedure to
repair the tricuspid valve and the pulmonic valve in the right side
of the heart.
SUMMARY OF THE INVENTION
[0007] The present invention achieves technical advantages as a
catheter system and method facilitating intracardiac surgery on a
beating heart. The present invention comprises a catheter system
and method for obtaining a left ventricular isolation to drain the
left ventricle and facilitate valvular or posterior epicardial
surgery on a beating heart including replacement of the mitrial
valve and the aortic valve. The present invention also comprises a
catheter system and method for obtaining a right ventricular
isolation to drain the right atrium and facilitate intracardiac or
posterior epicardial surgery on a beating heart, such as to repair
the tricuspid valve and the pulmonic valve.
[0008] According to a first embodiment of the present invention, a
left ventricular isolation is obtained by draining oxygenated blood
from the left ventricle of the heart, or draining directly from the
pulmonary veins, using a catheter and a pump. The pump directs the
drained oxygenated blood to the ascending aorta to provide artrial
return. The left ventricle is accessed in one of several ways
including a) through the apex of the heart, b) via the pulmonary
vein and the mitrial valve, c) via the left atrial apendage and
through the mitrial valve, and d) through the aorta and through the
aortic valve.
[0009] According to a second embodiment of the present invention a
right ventricular isolation is obtained by draining the systemic
blood from the superior vena cava and the inferior vena cava to
provide a bloodless right side of the heart. The drained blood is
returned by a pump directly to the pulmonary artery to complete the
extracorporeal circuit.
[0010] Myocardial infusion is provided while performing the left
ventricular isolation and the right ventricular isolation by
perfusing the blood vessels of the beating heart in antegrade or
retrograde flow. In antegrade flow, a portion of the arterial
return blood is infused into the coronaries at the aortic base of
the aorta. In retrograde flow, a portion of the arterial return
blood is infused into the coronary sinus. In both the antegrade and
retrograde flow of myocardial infusion, the perfusion pressures and
flow rates are carefully maintained to adequately perfuse the heart
to meet the oxygen demand of the myocardium. The pressure and flow
rate of the myocardial infusion is carefully controlled to avoid
damage to the coronary sinus.
[0011] The catheter system of the present invention includes
several embodiments for effectively providing a bloodless portion
of the heart to facilitate intracardiac surgery on a beating heart.
To facilitate repair or replacement of the mitrial valve or aortic
valve, for example, several embodiments are provided for draining
the left ventricle of the heart. To facilitate repair or
replacement of the pulmonic valve and the tricuspid valve on a
beating heart, several embodiments are provided to drain the right
atrium of the heart.
BRIEF DESCRIPTION OF THE DRAWINGS
[0012] FIG. 1 is an illustration of a first catheter system
achieving an left ventricular isolation of the heart to facilitate
aortic valve repair/replacement and epicardial surgery whereby
blood is drained from the left ventricle via the apex of the heart
with retrograde myocardial infusion;
[0013] FIG. 2 is an illustration of the left ventricle access
cannula suited for use in FIG. 1;
[0014] FIG. 3 is a cross section of the aortic perfusion cannula of
FIG. 1 for providing arterial return of oxygenated blood as well as
retrograde myocardial infusion;
[0015] FIG. 4 is an illustration of a second catheter system and
method for draining the left ventricle of the heart using a
catheter inserted through the right pulmonary vein and the mitrial
valve for performing aortic valve replacement/repair and epicardial
surgery;
[0016] FIG. 5 is an illustration of a third catheter system and
method for draining blood from the left ventricle using a catheter
inserted through the left atrial apendage and the mitrial valve of
the heart for performing aortic valve replacement/repair and
epicardial surgery;
[0017] FIG. 6 is an illustration of a fourth catheter system and
method for draining the left ventricle of the heart using a
catheter inserted through the aorta and the aortic valve of the
heart for performing epicardial surgery;
[0018] FIG. 7 is an illustration of a fifth catheter system and
method for draining the left ventricle of the heart and
facilitating epicardial surgery;
[0019] FIG. 8 is a cross section of the aortic perfusion catheter
of FIG. 7 for providing antegrade myocardial infusion;
[0020] FIG. 9 is an illustration of a sixth catheter system and
method for drawing blood from the pulmonary veins to provide a
bloodless left ventricle of the heart to facilitate repair or
replacement of the mitrial valve and the aortic valves and perform
epicardial surgery;
[0021] FIG. 10 is a partial cross section of one pulmonary vein
catheter of FIG. 9 illustrating a pair of distal ends each having a
balloon for occluding the respective pulmonary vein as shown in
FIG. 9;
[0022] FIG. 11 is an illustration of a seventh catheter system and
method providing a right ventricular isolation by draining systemic
blood from the superior vena cava and the inferior vena cava, with
return blood being directed to the pulmonary artery to facilitate
replacement or repair of the pulmonic valve and the tricuspid
valve;
[0023] FIG. 12 is a cross section of the pulmonary artery catheter
in FIG. 11 providing arterial return to the pulmonary artery;
and
[0024] FIG. 13 is a side view of the venous catheter of FIG. 11 for
drawing blood from the inferior vena cava and superior vena cava of
the heart.
DESCRIPTION OF THE PREFERRED EMBODIMENT
[0025] With reference to FIG. 1, there is shown the first preferred
catheter system and method of the present invention for
facilitating intracardiac surgery and posterior epicardial
revascularization on a beating heart. First, to provide a brief
overview of the heart to further understand the catheter system and
method of the present invention, a brief description of the heart's
features will be provided.
[0026] A human heart 10 is seen to include an aorta 12, a right
atrium shown at 16, with the inferior vena cava being shown at 18
and the superior vena cava being shown at 20. The Brachiocephalie
Artery is shown at 22. The aortic base is shown at 24 with the
aortic valve being shown at 26.
[0027] Referring now to the catheter system 30 shown in FIG. 1, to
facilitate repair or replacement of a aortic valve 26 located at
the aortic base 24, a left ventricular access cannula 32 is
inserted through the apex of the heart to drain oxygenated blood
from the left ventricle 34 of the heart to obtain a left
ventricular isolation. System 30 is seen to include a pump 36
coupled to the proximal end of catheter 32 via a flexible conduit
38 for draining the left ventricle. Pump 36 has a feedback
mechanism responsive to a sensor such as a pressure sensor (not
shown) located at the tip of the catheter 32 to ensure the pump
drains blood from the left ventricle at a sufficient rate to drain
the left ventricle without sucking air into the line. The pump 36
provides the drained blood via a conduit 40 to an aortic perfusion
cannula generally shown at 42. Catheter 42 infuses the returned
oxygenated blood into the ascending aorta 12 as shown. Returned
blood is infused out the distal end 44 of catheter 42 upwardly into
the ascending aorta to complete the bypass of the beating heart and
perfuse the body. Catheter 42 is further seen to include an
inflatable balloon 48 for selectively and effectively occluding the
ascending aorta to isolate the distal end of catheter 42 from the
aortic base 24. Catheter 42 is inserted into the ascending aorta
via an opening 50 created by the physician through the wall of the
aorta and is secured thereto using sutures or the like. Catheter 42
further includes a marker or indicia 52 for indicating a proper
insertion point of the catheter 42 into the aorta to further assist
the surgeon during the proper placement of the catheter distal end
within the ascending aorta 12.
[0028] The catheter 42 is further seen to include a myocardial
infusion catheter portion 60 for providing retrograde flow of
oxygenated blood to the coronary sinus 62. Catheter portion 60 has
a distal balloon 64 which is selectively and controllably inflated
by the physician to occlude the coronary sinus, whereby oxygenated
blood is provided in retrograde flow into the coronary sinus via
distal opening 66. A pressure and volume control 70 of catheter
portion 60 is selectively controlled by the physician to control
the volume and pressure of the retrograde infusion flow. For
instance, it is typically desired to maintain a volume flow of
about 500 milliliters per minute, and a pressure in the range of 40
mm Hg, which is typically not to exceed 60 mm Hg. Catheter portion
60 diverts a small portion of the returned arterial blood to the
coronary sinus to insure that the myocardium of the beating heart
is sufficiently perfused with oxygenated blood to meet its oxygen
demand.
[0029] According to the catheter system and method of FIG. 1,
posterior epicardial revascularization as well as intracardiac
surgery can be provided by the surgeon to repair or replace the
aortic valve. This surgery is possible since the heart can remain
beating with the left ventricle being isolated and free of blood,
and with the myocardium being sufficiently infused. Stabilization
platforms currently available in the market can be used to
stabilize the specific operational site. The aortic base is
rendered essentially bloodless by catheter 32 to facilitate a clear
working area for the surgeon while the returned arterial flow is
directed into the ascending aorta at a sufficient rate to perfuse
the human heart of the patient.
[0030] Turning now to FIG. 2, there is shown the left ventricular
catheter 32 of FIG. 1. Catheter 32 is seen to be elongated having
an inner continuous lumen 70 terminating at a plurality of openings
72 at the distal end thereof. Catheter 32 typically has a
continuous diameter along the length thereof to facilitate smooth
insertion into the left ventricle 34 of the heart, as shown in FIG.
1. Catheter 32 typically is comprised of a flexible material such
as silicone or polyvinylchloride (PVC) or the like. Catheter 32 is
further seen to include a transition area 74 in the distal body
portion 76 having a distal end 78 adapted to fluidly couple with
passageway 38 shown in FIG. 1.
[0031] Referring now to FIG. 3, there is shown a partial sectional
side view of the aortic perfusion catheter 42 as depicted in FIG.
1. Catheter 42 is seen to include a balloon inflation lumen 80
fluidly communicating with an interior cavity 82 of balloon 48.
Lumen 80 facilitates the selective inflation and deflation of
balloon 48 as controlled by the surgeon. Catheter 42 is further
seen to include a large main lumen 84 having a diameter sufficient
to provide adequate oxygenated blood flow at a sufficient pressure
to adequately perfuse the human body via distal opening 86 at
distal end 44. At the proximal end of catheter 42 is seen 2
passageway 90 extending through a diverter finger 92 for directing
a small portion of the blood flowing through main lumen 84 into the
pressure/volume control 70. The small portion of the blood flow
communicated via lumen 90 is controlled by control 70 to provide
oxygenated blood at a sufficient flow rate and pressure to the
distal end of catheter portion 60. The oxygenated blood is
dispensed via distal opening 66 for providing retrograde flow into
the coronary sinus as shown in FIG. 1. Balloon 64 is controllably
inflated by a balloon control 94 so as to properly occlude the
coronary sinus 62 without damage thereto. In summary, aortic
perfusion catheter 42 provides two functions. First, providing
arterial return of oxygenated blood to the ascending aorta 12 to
perfuse the body, and second, providing retrograde flow of
oxygenated blood to the coronary sinus to provide myocardial
infusion.
[0032] Turning now to FIG. 4, there is shown at 100 a catheter
system and method according to a second preferred embodiment of the
present invention. The left ventricle 34 is drained using a
catheter 102 inserted through the right pulmonary vein 104 and
through the mitrial valve to obtain an left ventricular isolation.
Catheter 102 is seen to have a plurality of openings 106 at the
distal end thereof for draining the left ventricle 34. Catheter 102
is sufficiently flexible to allow maneuvering through an incision
108 created in the right pulmonary vein and manipulation through
the nitrial valve into the left ventricle 34 with minimal trauma to
the heart. Oxygenated blood is drawn from the left ventricle 34 and
routed through passageway 110 to pump 36. The blood is provided by
pump 36 via the passageway 40 back through catheter 42 into the
ascending aorta to perfuse the body as previously described with
regards to FIG. 1, wherein like numerals refer to like
elements.
[0033] Catheter system 100 facilitates the repair of the aortic
valve on the beating heart while providing myocardial infusion.
According to the method of the present invention, the valvular
repair and replacement of the aortic valve is performed on the
beating heart using the catheter system 100 shown in FIG. 4.
Catheter system 100 also facilitates performing posterior
epicardial revascularization on a beating heart.
[0034] Turning now to FIG. 5, there is shown a catheter system and
method of use according to a third embodiment of the present
invention. In this embodiment, a catheter 122 is inserted into the
left atrium 34 via a left atrial apendage and the mitrial valve of
the heart, as shown. Blood is drained from the left ventricle 34
via catheter 122 and conduit 110 to pump 36. The drained blood is
then returned via the conduit 40 to the aortic perfusion catheter
42 to perfuse the body as previously described with regards to FIG.
1 and FIG. 4, wherein like numerals refer to like elements.
Catheter 122 is seen to include a plurality of openings 124 at the
distal end thereof draining blood from left ventricle 34 via an
interior lumen to conduit 110. Posterior epicardial
revascularization as well as intracardiac surgery is facilitated
and can be performed on the beating heart.
[0035] Turning now to FIG. 6, there is shown a catheter system 130
and method of use thereof according to a fourth preferred
embodiment of the present invention. In this embodiment. Catheter
system 130 is seen to include a catheter 132 inserted via an
incision into the aorta 12 and advanced through the aortic valve 26
such that the distal end I34 is positioned within the left
ventricle 34, as shown. The distal end of catheter 132 is seen to
have a plurality of openings 136 for draining oxygenated blood from
left ventricle 34 to sufficiently drain all blood therefrom to
obtain an left ventricular isolation. Catheter 132 is fluidly
connected to passageway 110 which communicates the drained blood to
pump 36. Pump 36 pumps the oxygenated blood via the conduit 40 to
the aortic perfusion catheter 42 to perfuse the body as previously
described wherein like numerals refer to like elements. Catheter
132 is inserted through aorta 12 by forming an suitable incision
through the wall thereof proximate the aortic base. Catheter 132 is
then carefully inserted through the aortic valve 26 into the left
ventricle 34, as shown. In this embodiment, oxygenated blood is
adequately drained from left ventricle 34 to obtain an left
ventricular isolation without disposing a catheter through the
mitrial valve. According to the method of this embodiment,
posterior epicardial surgery is facilitated while the heart remains
beating. As shown and previously discussed, myocardial perfusion is
provided to make sure the myocardium maintains it oxygen demand
while the heart remains beating.
[0036] Turning now to FIG. 7, there is shown a catheter system 150
and method of use thereof to obtain an left ventricular isolation
on a beating heart, similar to the embodiment of FIG. 1, but
wherein myocardial infusion is performed in antegrade flow to
facilitate posterior epicardial surgery. Catheter system 150 is
similar to system 30 of FIG. 1, wherein like numerals refer to like
elements. In this embodiment, an aortic perfusion catheter 152 is
coupled to the distal end of conduit 40 and provides arterial
return to the ascending aorta 12 via the distal end 154 as shown.
Catheter 152 has a balloon 156 for controllable and selectively
occluding the aorta 12 to perfuse the body similar to balloon 48 of
aortic perfusion catheter 42 if it is desired to repair or replace
the aortic valve. Balloon 156 may not necessarily be used during
posterior epicardial surgery. Catheter 152 is further seen to
include a plurality of openings 158 adjacent and proximate the
balloon 156 for infusing oxygenated blood into the aortic base 24
to provide myocardial perfusion in antegrade flow during posterior
epicardial surgery. It is noted blood is not provided in antegrade
flow when replacing/repairing the aortic valve. Catheter 152 is
seen to include a pressure/volume control 160 similar to P/V
control 70 of FIG. 1 allowing the physician to selectively control
the pressure and volume of the antegrade flow of oxygenated blood
to the aortic base 24. When providing antegrade flow, the typical
volume is 500 milliliters per minute, and a pressure of about 50 mm
Hg, both of which can be controlled by the physician using P/V
control 160.
[0037] Catheter 152 is suitable for use with the other embodiments
of FIG. 4, FIG. 5, and FIG. 6 in combination with the various left
ventricular catheters to perform posterior epicardial surgery, and
valve repair/replacement depending on the configuration. Thus
aortic perfusion catheter 152 is interchangeable with aortic
perfusion catheter 42 allowing the physician to customly select
whether myocardial infusion is to be performed retrograde or ante
grade.
[0038] Referring now to FIG. 8, there is shown a partial sectional
side view of the aortic perfusion catheter 152 shown in FIG. 7.
Catheter 152 is seen to include an inflation lumen 160 extending
along the length thereof to a balloon cavity 162 defined by balloon
156. Lumen 160 terminates via an opening 164 into cavity 162.
Catheter 152 is further seen to include a large main lumen 170
having a sufficiently large diameter to allow a flow of oxygenated
blood at sufficient flow rate and pressure to adequately perfuse
the body. Main lumen 170 is seen to terminate at an output port 172
at the distal end 154. At the proximal end of catheter 152 is seen
a smaller passageway 176 in communication with main lumen 172 for
diverting a small portion of the oxygenated blood flowing through
main lumen 170 to the pressure/volume control 160. Lumen 176
extends through a housing finger 178 which angles rearwardly from
the connector body 180 as shown. Body 180 is adapted to couple to a
balloon inflation source and lumen 40 as shown in FIG. 7. The
pressure/volume control 160 communicates the regulated blood flow
to a conduit 180, which in turn communicates the blood via lumen
182 into an elongated passageway 184 of catheter 152. Openings 158
communicate the inner lumen 184 with the ambient adjacent and
proximal of the balloon 156, as shown. Antegrade infusion of the
myocardium is thus facilitated by diverting a small portion of the
oxygenated blood from the main lumen 170 to the pressure/volume
control 160, and then communicating this diverted blood at a
controlled rate and pressure to the inner lumen 184 for dispensing
out openings 158 into the aortic base 24 as shown in FIG. 7. The
catheter body of catheter 152 is comprised of conventional
materials and is sufficiently flexible to allow manipulation within
the ascending aorta without creating trauma thereto as shown in
FIG. 7.
[0039] Referring now to FIG. 9, there is shown a catheter system
200 and method and of use thereof according to a sixth embodiment
of the present invention. Catheter system 200 provides an left
ventricular isolation of the left ventricle 34 by draining blood
returning from the left pulmonary veins 104 and 105, and the right
pulmonary veins (not shown). A pulmonary vein catheter 202 includes
a pair of distal ends 204 and 206 each adapted to be placed within
one of the left pulmonary veins 104 and 105 as shown. A second
identical catheter 202 is placed in each of the two right pulmonary
veins to draw blood therefrom. Two catheters 202 are thus used in
this embodiment and coupled to pump 36. However, a single catheter
having four distal ends could be used if desired to drain the left
and right pulmonary veins if desired. Distal end 204 is seen to
include an occlusion balloon 208, and distal end 206 is seen to
include an occlusion balloon 210. Each of the occlusion balloons
208 and 210 are adapted to effectively occlude the respective right
and left pulmonary veins. The distal end 204 is further seen to
include an opening 214 for draining blood from the left pulmonary
vein 105, wherein distal end 206 is seen to include a similar
opening 216 for draining blood from the pulmonary vein 104.
Openings 214 and 216 fluidly communicate with a combiner valve 220.
Combiner valve 220 merges the two conduits to a common output in
communication with a passageway 222 extending to pump 36. Pump 36
in turn communicates the drained blood from the two catheters 202
via conduit 40 to the aortic perfusion catheter 42 to perfuse the
body as shown, but could also communicate the blood to the aortic
perfusion catheter 152 if myocardial infusion is to be provided in
antegrade flow if desired.
[0040] Catheter system 200 allows returning oxygenated blood from
the four pulmonary veins to be directed to the pump 36 before the
oxygenated blood actually returns to heart 10, thereby achieving an
left ventricular isolation to facilitate a bloodless left ventricle
34. The surgeon can then perform intracardiac surgery, including
repair or replacement of the mitrial valve on a beating heart,
repair or replace the aortic valve, or provide other posterior
epicardial surgical repair to the heart as desired. In summary,
catheter system 200 bypasses blood flow around the heart from the
four pulmonary veins to the ascending aorta and performs an left
ventricular isolation.
[0041] Turning now to FIG. 10, there is shown a partial sectional
side view of catheter 202. Distal end 204 is seen to include an
inner lumen 230 and distal end 206 is seen to include an inner
lumen 232. Both lumen 230 and lumen 232 are seen to extend through
the respective distal ends and fluidly merge together and
communicate with one another at the valve 234 within body 220 as
shown. Passageways 230 and 232 merge to form a common passageway
236 extending through passageway 222 and which is adapted to
communicate with pump 36 as shown in FIG. 9.
[0042] Distal end 204 is further seen to include a balloon
inflation lumen 240, whereas distal end 206 is seen to include a
balloon inflation lumen 242. Each of the balloon inflation lumens
240 and 242 are in fluid communication with each other and are
coupled to a manual inflation device (not shown) for use by the
surgeon to selectively inflate the respective balloons 208 and 210.
Lumen 240 communicates fluid pressure via opening 244 into cavity
246, whereas lumen 242 communicates fluid pressure via opening 248
into cavity 250, as shown.
[0043] Referring now to FIG. 11, there is shown a catheter system
270 and a method use thereof according to a seventh embodiment of
the present invention. Catheter system 270 is distinguished from
the other embodiments in that catheter system 270 achieves a right
ventricular isolation to allow repair or replacement of the
pulmonic valve and the tricuspid valve while the heart is beating.
This is achieved by draining blood from the inferior vena cava 18
and the superior vena cava 20, as shown, before it enters the right
half of the heart 14. The drained systemic blood is directed via a
venous return catheter 272 and a passageway 274 to a pump 36. Pump
36 provides the drained blood via conduit 278 to a pulmonary artery
catheter 280 for returning the blood to the pulmonary artery 282.
Venous return catheter 272 includes a plurality of openings 275 for
draining blood from the superior vena cava 20, and a plurality of
openings 276 for draining blood from the inferior vena cava 18.
Venous return catheter 272 also includes a proximal balloon 277 for
occluding the superior vena cava 20 and a distal balloon 278 for
occluding the inferior vena cava 18. Openings 275 are proximal of
balloon 277, and openings 276 are distal of distal balloon 278.
[0044] Pulmonary artery catheter 280 is seen to include an
occlusion balloon 284 for selectively and effectively occluding the
pulmonary artery 282, and has a distal end 286 for providing
arterial return of oxygenated blood into the pulmonary artery as
shown. Balloon 284 is selectively inflated by the physician to
occlude the pulmonary artery 282 and prevent leakage of blood back
into the heart, thereby providing a bloodless right atrium and
right ventricle (collectively the right side) of the beating heart.
According to the method of this embodiment, the right ventricular
isolation is obtained by draining the systemic blood, facilitating
posterior epicardial surgery and intracardiac surgery including
valvular repair and/or replacement on the beating heart including
the pulmonic valve and the tricuspid valve. No myocardial infusion
is required according to this method.
[0045] It is noted blood could also be drained from the superior
vena cava and inferior vena cava using a femorally inserted
catheter (not shown), or using a catheter having inflatable
balloons to isolate the superior vena cava and the inferior vena
cava from the bloodless right atrium, and these procedures are
within the scope of the present invention.
[0046] Turning now to FIG. 12, there is shown a cross sectional
view of the pulmonary artery catheter 280 of FIG. 11. Catheter 280
is seen to include a main infusion lumen 290 having a sufficient
diameter to provide an adequate flow of oxygenated blood at a
suitable pressure for infusing the pulmonary artery 282 of the body
as shown in FIG. 11. Main lumen 290 is seen to terminate at a
distal opening 292 which is positioned upwardly into the pulmonary
artery as shown in FIG. 11. Catheter 280 is further seen to include
a balloon inflation lumen 296 extending therethrough and
terminating through an opening 298 into a cavity 300 of balloon
284. The proximal end 302 of catheter 280 is adapted to fluidly
couple to conduit 278 whereas balloon lumen 296 is eventually
communicated to a manual inflation device controllable by the
surgeon to control the inflation of balloon 284. Catheter body 280
is comprised of a suitable flexible material such as silicone, PVC
and the like to provide suitable manipulation within the pulmonary
artery 282 through an incision made by the surgeon in the artery
(not shown).
[0047] Referring now to FIG. 13, there is shown a side view of the
venous return catheter 272 utilized to drain the systemic blood
from the superior vena cava and inferior vena cava. Catheter 272 is
seen to include a distal portion 310 having a first diameter and
the inflatable distal balloon 278, a transition portion 312, and a
second proximal portion 314 extending from the transition portion
312 and having a second diameter including distal inflatable
balloon 277. The proximal portion 314 has a larger diameter than
the proximal portion 310 to facilitate effectively draining blood
from the superior vena cava 20. Catheter 272 is comprised of a
suitable material such as silicone, PVC and the like to facilitate
effective manipulation without kinking. Catheter 272 is further
seen to include a lumen 316 extending therethrough in fluid
communication with both sets of openings 274 and 276 providing a
fluid flow path to the proximal end thereof and conduit 274 as
shown in FIG. 11.
[0048] In summary, the present invention comprises catheter systems
and methods of use thereof for performing posterior epicardial
revascularization as well as intracardiac surgery including
valvular repair or replacement on a beating heart. Both a left
ventricular isolation and an right ventricular isolation can be
obtained as required on a beating heart to facilitate the valvular
repair and/or replacement, such as repair to the mitrial valve, the
aortic valve, the pulmonic valve and the tricuspid valve.
Myocardial infusion is provided, either in antegrade flow or
retrograde flow as desired, to insure that the myocardium meets its
oxygen demand. The catheter system facilitates least invasive
cardiac surgery on a beating heart.
[0049] Though the invention has been described with respect to a
specific preferred embodiment, many variations and modifications
will become apparent to those skilled in the art upon reading the
present application. It is therefore the intention that the
appended claims be interpreted as broadly as possible in view of
the prior art to include all such variations and modifications.
* * * * *