Adjustable heart surface stabilizer

This invention relates to a device for stabilizing a particular area of the heart surface tissue for performing an anastomosis. In one embodiment the invention is comprised of a rectangular flat plate frame stabilizer having a bottom gripping surface for pressing against the surface tissue of the heart and minimizing motion during a heart bypass operation. Opposite closed sides or ends of the rectangular flat plate stabilizer substantially occlude the vessel while the surgery is being performed. A gap or opening in a side of the stabilizer allows for removal after the operation is completed. Various methods are described for locking the position of the stabilizer once it is pressed firmly in position against surface tissue of the heart. In one embodiment a knurled cylindrical rail is mounted on the stabilizer and engages a socket in a rigid shaft. A locking mechanism is provided by a pin and a handle for locking the rail in the socket in the rigid shaft. Other embodiments include a ball and socket mechanism that allows a wide range of adjustments, a hinged end on the rectangular frame to allow the stabilizer to be closed when the surgical procedure is being performed and an embodiment that allows external adjustment of the rectangular flat plate frame stabilizing plate against heart surface tissue from outside the surgical site.

BACKGROUND OF THE INVENTION 
1. Field of the Invention 
This invention relates to surgical instruments for use in heart bypass 
surgery and more particularly relates to an adjustable heart surface 
stabilizer to stabilize a surgical site on heart surface tissue against 
the motion of the beating heart. 
2. Background Information 
Heart bypass surgery known as coronary artery bypass graft (CABG) procedure 
has become a widely used effective treatment for a heart ailment known as 
arteriosclerosis. This disease is a restriction "clogging" of blood to the 
heart muscle. This condition is treated by performing a coronary artery 
bypass graft procedure to bypass the clogged arteries. In some cases when 
there are blockages to several arteries double, triple, and quadruple 
bypass grafts have to be made. The grafts bypass the obstructed or 
occluded portion restoring normal life giving blood flow to the heart 
muscle. The graft is usually obtained from an artery or vein in another 
part of the body. 
When surgeons initially began using this surgical technique heart bypass 
machines were used and the heart was temporarily stopped. This resulted in 
long surgical procedures necessary to hook the patient up to a heart 
bypass machine so their blood was circulated and oxygenated while surgery 
was being performed on the heart. This made the surgery long increasing 
the trauma to the patient and made the procedure risky to the patient's 
health. 
When the grafts were completed the patient had to be removed from the heart 
bypass machine and the heart re-started. The risk to the patient to stop, 
bypass and re-start the heart was very great. Efforts have been made to 
improve the treatment to reduce the trauma to the patient. These efforts 
are directed to procedures that are less invasive and less traumatic but 
are techniques that still require the use of heart bypass (cardiopulmonary 
bypass) machines and stopping the heart (cardioplagia). The risk to the 
patient could be greatly reduced if the need to stop the heart could be 
avoided. Without the need to stop the heart the intensive surgical 
procedure of connecting the patient to a cardiopulmonary bypass machine 
would be eliminated. 
New procedures have been developed to perform the heart bypass surgery 
without stopping the heart. In these procedures the heart is still beating 
while the surgery is being performed to attach a graft to the effected 
area. The surgery can be performed without the necessity to make a large 
incision down the center of the chest and cut through the entire sternum 
in order to connect the patient to a heart bypass machine. The surgery is 
thus much less invasive and can be performed through the smaller incisions 
between the ribs. A graft is sewn in to bypass an obstruction while the 
heart is still beating. 
The grafting procedure known as "anastomosis" restores blood flow with a 
vein or arterial graft that "bypasses" a clogged or obstructed artery such 
as the left anterior descending artery or other vessel. Typically a bypass 
is grafted to a blood source that is unobstructed to bypass the occlude 
artery obstruction restoring blood flow to the heart muscle. In some cases 
several grafts are required to bypass two, three or more obstructions. 
This procedure is difficult with the heart beating. Ends of the graft must 
be carefully sewn to the arteries on either sides of the obstruction with 
delicate small sutures to firmly attach the graft to prevent any leaks. 
Methods have been devised to stabilize the outer layer of the heart surface 
tissue with limited success. One method is to place sutures on opposite 
sides of the surgical site in the outer layer where the surgery is to be 
performed and stretch the tissue to minimize movement. The tissue is 
stretched tightly to minimize movement while the heart muscle continues to 
beat. This procedure presents some risk of temporary damage to the outer 
tissue involved. Also this procedure takes additional time and is less 
than ideal. 
Another alternative is to use a suction device to stabilize the outer 
surface tissue of the heart where the surgery is to be performed. A 
suction device with several ports is attached to the heart outer surface 
tissue to reduce motion of the outer layer. This method while effective 
can cause bruising and temporary small hematomas at the site of e suction 
parts. There is a need for a surgical instrument that can effectively 
reduce motion and stabilize a localize small area of heart surface tissue 
where an anastomosis is to be performed. An instrument that can be quickly 
and easily installed would allow an anastomosis to be performed more 
effectively, more easily, more quickly, more safely with much less trauma 
to the patient. 
A device for stabilizing an area of surface tissue of the heart is 
described in European Patent Application Number 97102789.1 published on 
Aug. 27, 1997. In this application numerous configuration and variation of 
planar members attached to shafts are described. A plethora of complicated 
shafts and mechanisms for mounting and manipulating the contrast members 
are shown as well as numerous design for the contact members. 
It is one object of the present invention to provide a surgical instrument 
that can stabilize a localized surgical site on surface tissue of the 
heart for performing an anastomosis. 
Another object of the present invention is to provide a surgical instrument 
comprised of a rectangular flat frame having sections that press against a 
heart surface tissue at a surgical site and minimize motion. 
Yet another object of the present invention is to provide a flat 
stabilizing plate having gripping surfaces to firmly stabilize and cushion 
a surgical site and a heart surface tissue against heart beat motion. 
Still another object of the present invention is to provide a simple, easy 
way manipulate a flat rectangular stabilizer that is adjustable to angles 
and conform to the shape of the heart. 
Yet another object of the present invention is to provide a rectangular 
flat plate heart surface stabilizer that is simple in construction and 
easy to use. 
Still another object of the invention is to provide a heart stabilizer 
attached to a rigid shaft that can be quickly and easily attached to a 
retractor. 
Yet another object of the present invention is to provide a rectangular 
flat plate stabilizer having an adjustable locking connection to a rigid 
shaft for adjusting the angle of the stabilizer. 
Still another object of the present invention is to provide a heart surface 
area stabilizer that can apply pressure to a blood vessel to reduce the 
flow of blood at the surgical site. 
Another object of the present invention is to provide a rectangular flat 
plate stabilizer for occluding the flow of blood in a vessel during an 
anastomosis. 
Still another object of the invention is to provide a rectangular flat 
plate stabilizer having a hinged side for removing the stabilizer after 
completion of an anastomosis. 
Another object of the present invention is to provide a flat plate heart 
surface stabilizer adjustably connected to a rigid shaft having clamps 
means in said shaft for locking the position of the stabilizer after 
positioning and adjustment. 
Still another object of the present invention is to provide a surgical 
instrument of a rectangular flat frame for stabilized surface tissue on 
the heart during heart surgery including an arrangement for adjusting the 
angle of the flat rectangular plate from outside the incision. 
Yet another object of the present invention is to provide a heart surface 
tissue stabilizing device that is adjustable by means of a wobble plate 
mounted on the outer end of a shaft for making adjustments from outside 
the incision. 
Still another object of the present invention is to provide a heart surface 
tissue stabilizing device of an adjustable flat rectangular plate having a 
gimbal or yoke arrangement for adjusting the position of the plate against 
the heart surface tissue from outside the incision. 
BRIEF DESCRIPTION OF THE INVENTION 
The purpose of the present invention is to provide a heart surface 
stabilizing device having an adjustable mechanism for adjusting the 
position of the stabilizer to conform to the surface area at the heart at 
the surgical site. 
There are heart stabilizing devices in use comprised of a flat planar 
member for contacting the surface of the heart at a surgical site to 
stabilize the motion against the beating of the heart. The present 
invention seeks to improve on this principle by providing a device that is 
simple and easy to use and can be manipulated to adjust the angle of the 
stabilizer to the position or shape of the heart at the surgical site. 
One embodiment of the invention is a flat rectangular frame having a slot 
in one side for removing the stabilizing device after a completion of an 
anastomosis. The rectangular frame has a surface constructed to grip the 
surface tissue of the heart and hold it firmly against the motion of the 
beating of the heart. The rectangular frame stabilizer is attached to a 
rigid shaft by a mechanism which allows the angle of the stabilizer to be 
adjusted to conform to the surgical site. In one embodiment the adjustable 
devices is in the form of a curved rail attached to the top of the 
rectangular framed stabilizer engaging a socket or channel in the end of 
the mounting shaft. A pin slidably inserted in the mounting shaft clamps 
the rail securely in the socket. Loosening the pin allows the rectangular 
frame stabilizer rail to be adjustably positioned in the socket to vary 
the angle of the stabilizer to conform to the surface area at the surgical 
site on the heart. 
Various configurations are provided on the bottom surface on the 
rectangular frame stabilizer to improve the frictional grip on the surface 
tissue. In one of these embodiments a dimpled surface is provided to 
provide increasing friction. In another embodiment the surface is 
variegated similar to the tracks of a tire. Still another embodiment the 
undersurface of the rectangular framed stabilizer is cross-cut to provide 
a rough firm gripping on the surface. Still another embodiment the 
gripping surface is provided by parallel slots to provide an uneven 
contact surface. In still another embodiment the bottom of the rectangular 
flat stabilizer is provided with a resilient cushioning material such as a 
plastic forming a chamber that can be filled with a liquid or a gel to 
provide a soft cushioning surface. 
Another alternative is to construct the rail for the adjustable stabilizer 
with only one end connected. This allows the rail to pass through a bore 
in the end of the shaft to be clamped by the pin. Preferably the pin has a 
semi-circular end that fits the contour of the mounting rail to provide a 
more positive locking action to hold the stabilizing member in the 
adjusted position. Further, the rail is preferably provided with a 
cross-cut knurled surface to increase the friction and provide positive 
locking without the need for a great amount of force. 
In the embodiments with the adjustable rail, the stabilizer is first 
positioned at the surgical site with the stabilizer pressing on the 
surface area of the heart at the surgical site. A handle on the pin is 
then rotated to tighten the shaft to securely lock the stabilizer in the 
adjusted position. 
Another alternate embodiment involves the use of a ball and socket for 
providing an adjustable stabilizer. The rectangular frame stabilizer has a 
flange that is attached to a ball for engaging a socket in the end of the 
mounting shaft. The ball is mounted by inserting it through a hole in the 
shaft and seating it in the socket. The rectangular frame stabilizer may 
then be positioned at a surgical site to hold the area firmly against the 
motion of the beating heart and the pin screwed down to securely clamp the 
ball locking the position of the stabilizer. Preferably the end of the pin 
has a concave recess matching the contour of the ball to provide a more 
positive lock with minimum force. 
In still another embodiment the ball on the rectangular frame stabilizer is 
in the form of a half sphere having a central cavity. The ball is inserted 
through a hole in the shaft and engages the socket. The locking pin has an 
end shaped to conform to the cavity in the half-sphere ball to securely 
clamp and lock the stabilizer into position. 
Preferably the stabilizer is constructed to occlude the flow of blood in 
the vessel where the graft is being made. Thus, in one embodiment the 
stabilizer is a closed rectangular frame having one end hinged when the 
surgical procedure is complete so the stabilizer may be removed. The 
stabilizer has sides that are pressed firmly on a surface vessel on 
opposite sides where an incision is to be made to occlude blood flow and 
reduce bleeding. In this embodiment the flat rectangular frame stabilizer 
is adjustably connected to a shaft with either of the methods such as the 
ball or half ball and socket previously described. The free end of the 
rectangular frame stabilizer is closed but is provided with a hinge to 
provide a gate for opening when the stabilizer is removed after completion 
of the surgery. 
In another embodiment of the invention the stabilizer is comprised of a 
flat plate having a boss for attaching the stabilizer to a shaft. In this 
embodiment the shaft is secured to the stabilizer by a conical pin passing 
through an eyelet on the end of the clamping pin. Both the boss and the 
conical head on the pin allow for a wide range of adjustments for the 
stabilizing device. 
Two additional embodiments provide adjustment of the stabilizing flat 
rectangular plate from outside the incision. In both embodiments the flat 
rectangular plate stabilizer is adjustably attached to the end of the 
shaft. In one embodiment the flat rectangular stabilizer is adjusted by a 
wobble plate mounted on a ball and connected to the stabilizing plate by 
cables. The wobble plate at the top of the shaft adjusts the flat 
rectangular stabilizing plate by tilting the wobble plate on the spherical 
ball. In this embodiment the stabilizer may be positioned in the incision 
and pressed against the heart surface tissue where there is an occluded 
artery. The position is then adjusted to the heart contour by tilting the 
wobble plate to move the heart stabilizing flat rectangular plate up or 
down or side to side until it is in proper position against surface tissue 
of the heart. The position of the stabilizing plate is then fixed by 
tightening a rod passing through the stabilizer shaft. 
In another embodiment adjustment from outside the incision is provided by a 
gimbal arrangement comprised of coaxial yokes mounted on the exterior or 
distal end of the stabilizer shaft connected to the adjustable flat 
rectangular plate by cables. In this embodiment the position of the flat 
rectangular plate after placement against the heart tissue is adjusted by 
tilting the coaxial yoke from side to side or forward or back until the 
position of the flat rectangular plate matches the contour of the heart at 
the occluded artery. 
In each of the embodiments described above the stabilizing device can be 
constructed of surgical steel or a rigid disposable synthetic disposable 
material if desired. The synthetic material allows the stabilizer to be 
removed from the shaft for disposal after use in the surgical procedure.

DETAILED DESCRIPTION OF THE INVENTION 
This invention is for an improvement in a stabilizing device for use in 
heart bypass surgery or anastomosis. The stabilizing device as previously 
conceived apply damping or stabilizing pressure to the surgical site on a 
surface area of the heart. The purpose of the device is to minimize 
movement of the surface tissue of the heart so that a graft can be 
attached to bypass an obstructed vessel. This device substantially reduces 
the trauma to the patient by allowing the operation to be complete in much 
less time without the need to connect the patient to a cardiopulmonary 
bypass machine. 
A heart surface stabilizing device 10 is illustrated in FIGS. 1 through 4. 
The heart stabilizing device is comprised of a rectangular flat frame 12 
having a slot or opening 14 on one side to allow the device to be removed 
after completion of the surgical procedure. Preferably rectangular flat 
frame 12 is constructed of surgical steel but it may also be manufactured 
of a rigid synthetic material to be disposable. Rigid rectangular frame 12 
is connected to a rigid shaft 16 by means of a curved rail 18 attached to 
the upper surface of the rectangular flat frame 12. Rail 18 engages a 
socket 20 on the end of rigid shaft 16. Rail 18 is securely clamped in 
socket 20 by applying pressure through knob or handle 22 compressing and 
clamping rod 24 against rail 18. Shaft 16 can be secured to a retractor 
frame 26 by any suitable means. 
Stabilizing rectangular flat frame 12 allows pressure and compression of a 
vessel 28 for attachment of a graft to an incision 30 in the vessel. 
Closed ends 32 and 34 apply pressure to vessel 28 on opposite sides of 
incision 30 to substantially occlude the flow of blood minimizing blood 
loss. 
The construction and arrangement of rail 18 and its attachment to rigid 
shaft 16 allows placement at a wide variety of angles and positions as 
shown in FIG. 2. For example for a vessel 36 on the side of heart 35 
rectangular flat stabilizer 12 can be adjusted by rotating and sliding 
rail 18 in socket 20 of the end 25 of shaft 16. Once the proper angle and 
position is required pressure is applied to vessel 36 on either side where 
incision 38 is to be made to substantially occlude blood flow. The 
position of rectangular flat frame stabilizer 12 is locked by rotating 
knob 22 to clamp pin 24 against rail 18. With the construction and 
arrangement as shown in FIG. 3 rectangular frame stabilizer 12 can be 
adjusted right or left, up or down as well as a wide range of angular 
positions by sliding rail 18 in socket 20. Flat rectangular stabilizer 12 
could be positioned anywhere from right angles to rigid shaft 16 to 
positions almost at 180.degree. with gripping surface upside down. 
The connection of flat rectangular stabilizer 12 to rigid shaft 16 is 
illustrated in greater detail in sectional view of FIG. 4. Rail 18 is 
securely attached to upper surface of rectangular frame stabilizer 12 
which has a lower surface 13 constructed to improve gripping force against 
the surface tissue of the heart as will be described in greater detail 
hereinafter. Rail 18 passes through socket 20 which preferably has a 
concave recess 21 conforming to the cylindrical shape of rail 18. Threaded 
end of pin 24 passing through bore 17 in shaft 16 engages rail 18 and is 
clamped by applying force through handle 22. Preferably end 40 of threaded 
rod 24 has a concave annulus 40 having a curvature shaped to fit the shape 
of the cylindrical rail 18 to provide a firm locking action when rod 24 is 
screwed tightly down with handle 22. Additionally cylindrical rail has a 
cross-cut knurled surface to increase the frictional force and improve 
locking by rod 24. 
In addition the bottom surface 13 of stabilizer 12 can be provided with a 
variety of textures to improve the gripping and holding force applied to 
the surface tissue of the heart. The rectangular flat stabilizer 12 shown 
in FIGS. 4 and 5 is provided with a surface 13 having a plurality of 
parallel grooves 42 to improve the gripping surface. In the embodiment 
shown in FIG. 6 stabilizer 12 has a bottom surface 13 comprised of 
cross-cut serrations 44 providing a very rough surface to firmly hold the 
heart tissue. FIG. 7 shows yet another embodiment of stabilizer 12 having 
a plurality of dimples 46 on surface 13 providing an improved gripping 
force. And still another surface is provided by "tire track" or V-groove 
treads 48 cut into the surface. 
Another embodiment to provide an improved gripping surface is shown in the 
bottom view of FIG. 9 and sectional view of FIG. 10. This embodiment 
provides a cushioning surface comprised of a flexible synthetic material 
50 attached to stabilizer 12 around the peripheral slot 52 being engaged 
by a flange 54 on flexible material 50. When flexible synthetic material 
50 is attached to stabilizer 12 a cavity 56 is provided which can be 
filled with any suitable pliable material such as a gel or a flue 
A variation of the embodiment in FIGS. 1 thorough 4 is illustrated in FIGS. 
11 through 13. In this embodiment a stabilizer 62 is substantially 
rectangular with an opening at the rear end 64. Stabilizer 62 is attached 
to a rail 68 only at one end 70. Rail 68 curves upward and toward the 
opposite side of stabilizer 62 from fixed end 70 terminating in free end 
72. Thus rail 68 has a non-linear curvature allowing a wide range of 
sideways and up and down adjustments of stabilizer 62. 
This design also allows rail to be attached to rigid shaft 66 by passing 
through a bore 74 in end 75 on the rigid shaft 66. Rectangular flat 
stabilizer 62 has a bottom surface 63 having a plurality of cut grooves as 
shown in the embodiment of FIG. 5. However the bottom surface 63 of the 
embodiment of FIGS. 11 through 13 could have any one of the configurations 
illustrated in FIGS. 6 through 10. 
With the open-ended construction of rail 68 shown in the embodiment of 
FIGS. 11 through 13 stabilizer 62 can be adjusted to a wide variety of 
positions from side to side or front to back as illustrated in FIG. 13. 
Flat rectangular stabilizer can thus be positioned on the surgical site of 
the heart at almost any angle and then locked in position by tightening 
down handle 76. Tightening handle 76 tightens rod 78 having concave 
angular groove 80 against the surface of cylindrical rail 68. 
Another embodiment is illustrated in FIGS. 14 through 16. The purpose of 
these various embodiment is to provide a wide variety of adjustment angles 
for stabilizing a small surface area in the heart where an anastomosis is 
to be performed. As shown in FIG. 14 that rectangular stabilizer 82 has a 
vertical flange 84 securely attached to a ball 86 fitting socket 88 in end 
90 of rigid shaft 92. Socket 88 is accessed through hole 89 in end 90. The 
position of flat rectangular stabilizer 82 is locked by means of a locking 
rod 94 inside rigid shaft 92 that is screwed down by handle 96. In this as 
well as other embodiments rectangular flat plate stabilizer 82 can be 
disposable. Stabilizer 82 can be easily removed from rigid shaft 92 by 
loosening rod 94 and slipping ball 86 out of socket 88 as before the 
bottom side 83 of stabilizer 82 can be made with any of the gripping 
configurations illustrated in FIGS. 5 through 10. 
As shown in FIG. 16 the configuration of embodiments as shown in FIGS. 14 
through 16 can be easily adjusted by rotating ball 86 in socket 88. Thus 
by rotating ball 86 in socket 88 flat rectangular stabilizer 82 can be 
moved from side to side or up and down or tilted to whatever angle is 
required. Stabilizer 82 is firmly placed on the surface of the area tissue 
on the heart where the anastomosis is required and locked in place by 
tightening end 95 of rod 94 with nob 96. 
A variation of the embodiment of FIGS. 14 through 16 is illustrated in FIG. 
15A. Instead of ball 86 a half-spherical ball 86' is provided having a 
socket 87 for receiving convex 98 on rod 94. As before half-spherical ball 
86' is slipped through hole 89 in end 90 of rigid shaft 92 and seated in 
socket 88. Rod 94 then locks rectangular flat stabilizer 82 in place by 
engaging concave cavity 87 in half-spherical ball 86'. 
In the embodiment of FIGS. 17 through 19 a rectangular frame stabilizer 102 
is provided having a hinged end 104 to allow the stabilizer to be open and 
closed for removal after the completion of the surgery. In this embodiment 
rectangular flat plate stabilizing 102 is connected by a flange 106 to a 
ball 108 in a socket 110 in end 112 of rigid shaft 114. Head member 112 on 
rigid shaft 114 is detachable so that stabilizer 102 and head member can 
be disposable. 
As shown in FIG. 19 rectangular frame stabilizer 102 is rotatable 
360.degree. around rigid shaft 114 and tiltable from side to side and up 
and down. The position of rigid stabilizing frame 102 is locked by 
tightening nob 116 to clamp end 120 of rod 118 against ball 108. Holes or 
bores 111 in head end 112 of rigid shaft 114 allow ball 108 and thus 
rectangular frame stabilizer 102 to freely move in a wide variety of 
adjustable positions. 
An optional variation of the embodiment of FIGS. 7 through 19 is 
illustrated in FIG. 18a. In this embodiment ball 108 is replaced with a 
half-spherical ball 108' having a cavity 109 to receiving the convex tip 
120' of rod 118. Convex tip 120' is contoured to fit cavity 109 in 
half-spherical ball 108' to lock rectangular frame stabilizer in a preset 
position. 
FIGS. 20 through 24 illustrated an embodiment in which a flat plate 
stabilizer 122 is offset from the rigid shaft 124. Rigid shaft 124 has a 
tubular head end 126 attached to flat plate stabilizer 122 by rod 128 
having ring or eyelet 130. A conical, flat head screw 132 passes through 
eyelet 130 into slot 134 on boss 136 engaging threaded hole 138 in pin 
140. Angled surfaces on boss 136 and conical head on screw 132 provide 
opposing locking surfaces as will be described in greater detail 
hereinafter. 
This embodiment is assembled as shown in FIG. 24 by passing screw 132 
through ring or eyelet 130 on rod 128 into slot 134 and threading it into 
threaded hole 138 in pin 140. Rod 128 is then passed through bore 129 in 
shaft 124. Handle 125 is then threaded on threads 131 on rod 128. This 
construction and arrangement allows flat plate stabilizer 122 to rotate 
freely up and down rotate in a plane from side to side with shaft 124 
being positioned as necessary and fastened to a retractor frame. The 
embodiment on FIGS. 20 through 24 is positioned with the flat plate 
stabilizer 122 pressing on surface tissue of the heart where an 
anastomosis is to be performed. The position is then locked by rotating 
handle 125 drawing rod 128 into bore 129 of shaft 124. This draws conical 
head 133 and angled surfaces on boss 130 (FIG. 22) up against an oblique 
angled surface 127 and on head end 126 of shaft 124 firmly locking the 
position of flat plate stabilizer 122. 
When assembled as shown in FIG. 23 flat plate stabilizer 122 can freely 
move in a vertical direction and rotate in a horizontal position for 
position on the surface tissue of the heart. The position is then locked 
by tightening handle 125 drawing rod 128 into shaft 124 forcing head in 
126 firmly down against opposing conical surfaces of head 133 on screw 132 
and similar angled surfaces on boss 134. Adjustments can be made by 
loosening handle 125 releasing clamping force of oblique surface 127 on 
conical surface 133 of screw 132. This will then again allow flat plate 
stabilizer 122 to be freely moved vertically or horizontally for 
positioning onto a heart vessel to perform an anastomosis. 
Optional embodiments that allow for external adjustments of the heart 
stabilizing plate are illustrated in FIGS. 25 through 34. In the 
embodiment on FIGS. 25 through 29 heart stabilizing plate 142 is mounted 
on end 144 of shaft 146 in a manner similar to that shown in the 
embodiment of FIGS. 17 and 18. Barrel shaped end 144 has a socket 148 for 
receiving a ball 150 attached to stabilizing plate 142. This allows 
stabilizing plate 142 to be moved up or down or side to side to adjust it 
to the contour of the surface tissue of the heart. 
Since on the purposes of these devices is to minimize trauma to the patient 
it is also important to keep the incision as small as possible. Therefore, 
it is an advantage if the heart stabilizing device can be manipulated and 
adjusted from outside the incision. Thus the embodiment of FIGS. 25 
through 34 are conceived to provide such external adjustments. 
In the embodiment of FIG. 25, stabilizing plate 142 is adjusted by a wobble 
plate 152 mounted on a spherical ball 154 on the upper or distal end of 
shaft 146. Wobble plate 152 can be adjusted by tilting at any angle or 
direction forward, backward, or side to side. Wobble plate 152 is 
connected to stabilizing plate 142 by cables 156 which are attached to 
stabilizing plate 142 by annulets 158. Lanyards or cables 156 are 
restrained and guided by rings 160. The upper end of lanyards 156 are 
connected to wobble plate 152 also by annulets 159. After adjusting the 
position of stabilizing plate 142 against the heart tissue the position is 
locked as before by rotating handle 162 clamping rod 164 against ball 150 
attached to stabilizing plate 142 as before. 
The method of using the externally adjustable stabilizing device is 
illustrated in FIGS. 26 through 29. The stabilizing device is passed 
through an incision and stabilizing plate 142 positioned near the surface 
tissue of the heart on the artery that is occluded. The surgeon can then 
manipulate or adjust the side to side or up and down position of 
stabilizing plate 142 by tilting wobble plate 152 mounted on stabilizing 
ball 154 (FIG. 29). To adjust the position of stabilizing plate once it is 
placed against the surface tissue of the heart, wobble plate 152 is tilted 
forward, backward or side to side, or any angle around the circumference 
of spherical ball 154 which adjusts stabilizing plate accordingly. Wobble 
plate 152 pulls on lanyards or cables 156 to tilt the stabilizing plate 
142 up or down or side to side. Once the stabilizing plate 142 is properly 
positioned, it is locked in place by rotating handle 162 forcing rod 164 
against ball 150 securely clamping the stabilizing plate in the adjusted 
position. With the device shown in FIGS. 25 through 29, stabilizing plate 
142 can be manipulated and adjusted externally through a small incision. 
An optional embodiment in which wobble plate 152 is replaced by a 
gimbal-type arrangement of concentric yokes is illustrated in FIGS. 30 
through 34. In this embodiment stabilizing plate 142 is connected to 
barrel end 144 on shaft 46 with ball 150 seated in socket 148 as before. 
However, flat rectangular frame or plate 142 is adjusted by means of 
concentric yoke 166 and 168 mounted on shaft 146 as shown in the sectional 
views of FIGS. 32 and 34. Circular yoke 168 is attached to rigid shaft 146 
by pins 170 perpendicular to the axis of shaft 146. Outer yoke 166 is 
attached to both inner concentric yoke 168 and shaft 146 by similar pins 
172 perpendicular to the axis of shaft 146. Inner mounting pins 170 are at 
right angles to outer yoke 166 mounting pins 172. This allows outer yoke 
166 to move independent of inner yoke 168 around the axis of pins 172 and 
in conjunction with yoke 166 around the axis of inner yoke mounting pins 
170. 
Outer yoke 166 is connected to flat rectangular plate 142 by three lanyards 
174 connected between annulets 176 and 177 attached to either side and the 
rear of flat rectangular frame or plate 142 and to outer yoke 166 by 
annulets 178 and 179. Cable or lanyards 174 are restrained by rings 160 
around shaft 146 as before. 
As can be seen by reference to FIGS. 32 through 34 side to side angular 
adjustment is accomplished by tilting outer yoke 166 from side to side 
operating cables 174 connected to annulets 176 on plate 142 adjusting the 
side to side angle of the flat rectangular plate. Front to back angular 
adjustment is accomplished by rotating outer yoke 166 simultaneously with 
inner yoke 168 which moves cable 175 connected between eyelet 177 and 179 
on the rear of flat rectangular frame 142 and outer yoke 166 respectively. 
Thus angular adjustment of outer yoke 166 around the axis of mounting pins 
170 tilts rectangular frame 142 from front to rear. Simultaneous 
adjustment of side to side adjustments as well as front to back 
adjustments can thus adjust flat rectangular frame 142 to any convenient 
angular position to fit the contour of the heart tissue at the occluded 
artery where surgery is to be performed. 
The embodiment shown in FIGS. 25 through 34 thus allow external adjustment 
of the heart stabilizing device without the need for the surgeon reaching 
inside the incision made to perform the operation. In the first embodiment 
wobble plate 152 can be adjusted to a variety of angular positions to 
adjust the forward, backward, side to side or any angular position in 
between. The movement of wobble plate 152 results in corresponding angular 
movement of flat rectangular frame 142. Likewise in the embodiments of 
FIGS. 30 through 34 a concentric yoke configuration allows angular 
movement of outer oval-shaped concentric yoke 166 which results in side to 
side movement of flat rectangular plate 142 while front to back movement 
of both inner concentric yoke 168 and outer concentric yoke 166 results in 
front to back movement of flat rectangular plate 142. Simultaneous front 
to back and side to side adjustments of both outer concentric yoke 166 and 
inner concentric yoke 168 above the axis of pins 170 and 172 results in 
equivalent angular adjustment of flat rectangular frame 142. 
Thus either one of the devices shown in these figures can be placed through 
an incision against the surface tissue of heart where the occluded artery 
and externally adjusted by movement of the wobble plate 152 or concentric 
yoke 166 and 168 to conform to the contour of the heart at the surgical 
site. 
The adjusted angular position of flat rectangular frame is then locked in 
place by tightening down handle 162 tightening rod 164 against ball 150 
attached to rectangular frame 142 as shown in FIG. 29. The interior end of 
rod 164 has a threaded portion 165 and a concave end 167 that matches the 
contour of ball 150 in socket 148. Once flat rectangular frame has been 
properly positioned against the heart tissue rotation of handle 162 forces 
concave end 167 against ball 150 by means of threads 165 to securely lock 
the frame in the selected angular position. 
The use of any one of the flat plate rectangular stabilizer for a 
anastomosis procedure is illustrated in FIG. 1. Rectangular flat plate 
stabilizer 12 is placed firmly in position on surface tissue of heart 35 
with ends 32 and 34 pressing on vessel 28 to substantially occlude the 
blood flow. An incision 30 can then be made in the vessel for attachment 
to a graft to bypass an obstruction. Stabilizer 12 firmly holds surface 
tissue on heart 35 in the area of vessel 28 against movement from the 
beating heart. This allows the surgeon to complete the anastomosis without 
the necessity of connecting the patient to a cardiopulmonary machine. When 
the graft is successfully and firmly attached to incision 30 in vessel 28, 
stabilizer 12 may be removed with grafted vessel passing through opening 
14. 
Thus there has been disclosed a plurality of unique configurations for 
improved stabilizers for use in stabilizing the heart during heart bypass 
surgery or anastomosis. The stabilizer allows a surgeon to firmly hold a 
small surface area of the heart stationery against the motion of the 
beating heart while surgical grafts can be performed. Stabilizing can be 
in the form of a rectangular flat plate having a gripping bottom surface 
and an upper surface configured for attachment to a rigid shaft for 
adjustment to a various number of angles and positions to perform surgical 
procedures on all areas of the heart. Optional embodiments include a 
rectangular frame flat plate stabilizer having a hinged end that can be 
closed during the surgical procedure to press on end vessel on opposite 
sides of the surgical site and then opened to allow the stabilizer to be 
removed. Other features include a cylindrical rail attached to the 
stabilizer to allow adjustments to a wide variety of positions and angles. 
In one embodiment the rail is connected only at one end to allow the rail 
to pass freely through a bore in the rigid shaft to provide a wide range 
of vertical as well as angular adjustments. In other embodiments the flat 
rectangular stabilizer is connected to the rigid shaft by a ball and 
socket arrangement or in another case of a half ball having a clamping 
cavity receiving a convex tip of a clamping pin. 
Obviously many modifications of the invention is possible in light of the 
above features. It is therefore understood that the full scope of the 
invention is not limited to the details disclosed herein and may be 
practiced otherwise then as specifically described.