Source: http://www.google.com/patents/US6673013?dq=6,044,471
Timestamp: 2017-03-24 13:32:26
Document Index: 643396715

Matched Legal Cases: ['art.\n3', 'art. 10', 'art. 11', 'art. 12', 'art.\n14', 'art.\n18']

Patent US6673013 - Surgical instruments and procedures for stabilizing the beating heart during ... - Google PatentsSearch Images Maps Play YouTube News Gmail Drive More »Sign inPatentsMethods and devices used to stabilize a beating heart during a surgical procedure on the heart and to expose a surgical site are disclosed. The stabilizing device is introduced through an opening through the chest and brought into contact with the beating heart, and by exerting a stabilizing force on...http://www.google.com/patents/US6673013?utm_source=gb-gplus-sharePatent US6673013 - Surgical instruments and procedures for stabilizing the beating heart during coronary artery bypass graft surgeryAdvanced Patent SearchTry the new Google Patents, with machine-classified Google Scholar results, and Japanese and South Korean patents.Publication numberUS6673013 B2Publication typeGrantApplication numberUS 09/832,356Publication dateJan 6, 2004Filing dateApr 9, 2001Priority dateFeb 20, 1996Fee statusLapsedAlso published asUS5894843, US6050266, US6213941, US6315717, US6346077, US6701930, US20010044572, US20020010388, US20020040182, US20040087834Publication number09832356, 832356, US 6673013 B2, US 6673013B2, US-B2-6673013, US6673013 B2, US6673013B2InventorsFederico J. Benetti, Charles S. Taylor, Ivan Sepetka, Amr Salahieh, Robert C. Glines, William N. Aldrich, Brent Regan, John J. FrantzenOriginal AssigneeCardiothoracic Systems, Inc.Export CitationBiBTeX, EndNote, RefManPatent Citations (158), Non-Patent Citations (62), Referenced by (13), Classifications (38), Legal Events (8) External Links: USPTO, USPTO Assignment, EspacenetSurgical instruments and procedures for stabilizing the beating heart during coronary artery bypass graft surgery
US 6673013 B2Abstract
Methods and devices used to stabilize a beating heart during a surgical procedure on the heart and to expose a surgical site are disclosed. The stabilizing device is introduced through an opening through the chest and brought into contact with the beating heart, and by exerting a stabilizing force on the device, the motion of the heart caused by the contractions of the heart muscles is effectively eliminated. Exposure members are actuable to reposition a portion of the surface of the heart to better expose a target artery or other surgical site. Accordingly, the heart is stabilized and movement of the site of the surgery is minimized. Typically, in separate steps, a surgeon contacts the heart with the stabilizing device, assesses the degree of movement of the anastomosis site, and exerts a force with a stabilizing device such that the contractions of the beating heart causes only minimal excess motion at the surgery site, whereupon exposure members further reposition heart tissue to better expose the surgical site. The stabilizing device may be attached to a rigid support or may be attached to a semi-rigid support which is rendered motionless mechanically, chemically or by human intervention.
What is claimed is: 1. A device for use in cardiovascular surgery on a beating heart, comprising:
a stabilizing member including at least one contact member adapted to engage a surface of the beating heart, and at least one exposure member operable in concert with said at least one contact member to reposition a portion of the surface of the beating heart, thereby providing improved exposure of a target surgical site, wherein said at least one exposure member is biased for movement toward said at least one contact member. 2. The device of claim 1, wherein said at least one contact member comprises a bottom surface shaped to engage the beating surface of the heart, and said at least one exposure member is movable toward said at least one contact member after engagement of both said at least one contact member and said at least one exposure member with the surface of the beating heart.
3. A device for use in cardiovascular surgery on a beating heart, comprising:
a stabilizing member including at least a pair of contact members adapted to engage a surface of the beating heart, and at least a pair of exposure members operable in concert with said at least a pair of contact members to reposition a portion of the surface of the beating heart, thereby providing improved exposure of a target surgical site. 4. The device of claim 3, wherein said pair of contact members, together with respective ones of said pair of exposure members, are adapted to engage a surface of the beating heart on opposite sides of a target artery.
5. The device of claim 3, further comprising a pair of connecting shafts mounted to said pair of contact members, respectively.
6. The device of claim 5, wherein said pair of connecting shafts further interconnect with shaft means, said shaft means adapted to be fixed to a stationary object.
7. The device of claim 5, further comprising actuator means interconnecting said connecting shafts and adapted to move said connecting shafts and said contact members toward or away from one another.
8. A device for use in cardiovascular surgery on a beating heart, comprising:
a stabilizing member including at least one contact member adapted to engage a surface of the beating heart, and at least one exposure member operable in concert with said at least one contact member to reposition a portion of the surface of the beating heart, thereby providing improved exposure of a target surgical site, wherein said at least one contact member comprises a spring tensioned frame, and said at least one exposure member is mounted to said spring tensioned frame and movable with respect thereto. 9. A device for use in cardiovascular surgery on a beating heart, comprising:
a stabilizing member including at least one contact member adapted to engage a surface of the beating heart, and at least one exposure member operable in concert with said at least one contact member to reposition a portion of the surface of the beating heart, thereby providing improved exposure of a target surgical site, wherein said at least one exposure member comprises friction means on a surface adapted to engage the surface of the heart. 10. A device for use in cardiovascular surgery on a beating heart, comprising:
a stabilizing member including at least one contact member adapted to engage a surface of the beating heart, and at least one exposure member operable in concert with said at least one contact member to reposition a portion of the surface of the beating heart, thereby providing improved exposure of a target surgical site, wherein said at least one exposure member comprises pins on a surface adapted to engage the surface of the heart. 11. A device for use in cardiovascular surgery on a beating heart, comprising:
a stabilizing member including at least one contact member adapted to engage a surface of the beating heart, and at least one exposure member operable in concert with said at least one contact member to reposition a portion of the surface of the beating heart, thereby providing improved exposure of a target surgical site, wherein said at least one contact member comprises friction means on a surface adapted to engage the surface of the heart. 12. A device for use in cardiovascular surgery on a beating heart, comprising:
a stabilizing member including at least one contact member adapted to engage a surface of the beating heart, and at least one exposure member operable in concert with said at least one contact member to reposition a portion of the surface of the beating heart, thereby providing improved exposure of a target surgical site, wherein said at least one contact member comprises a stabilizing plate and said at least one exposure member comprises an edge of said stabilizer plate, said edge deflected downwardly out of a general plane of said stabilizer plate. 13. The device of claim 12, further comprising a lever member adapted to contact a bottom surface of said stabilizing plate, wherein said stabilizing plate may be rotated against said lever member to actuate said edge to apply pressure to the surface of the heart.
14. The device of claim 12, further comprising a shaft means connected to said stabilizing plate, said shaft means being adapted to be fixed to a stationary object.
15. The device of claim 14, wherein said shaft means is adjustable in length.
16. A device for use in cardiovascular surgery on a beating heart, comprising:
a pair of contact members adapted to engage a surface of the beating heart; and a pair of exposure members operable to reposition a portion of the surface of the beating heart with respect to positioning of said contact members, thereby providing improved exposure of a target surgical site. 17. The device of claim 16, further comprising a pair of shafts respectively connected to said pair of contact members and operable to control placement of said contact members against the surface of the beating heart.
18. The device of claim 17, further comprising a shaft means interconnecting said pair of shafts, said shaft means adapted to be fixed to a stationary object.
19. The device of claim 18, further comprising an actuator interconnecting said pair of shafts, said actuator being operable to spread said pair of shafts and said contact members apart or to draw said pair of shafts and said contact members together.
20. The device of claim 17, wherein said pair of shafts are adapted to be fixed to a stationary object.
21. The device of claim 17, further comprising a pair of lever members adapted to engage a bottom surface of respective one of said contact members.
22. The device of claim 21, further comprising remote actuating means actuable to pivot said contact members about said lever members to apply pressure to the surface of the beating heart through said exposure members.
23. The device of claim 16, wherein said pair of exposure members are respectively movably connected to said pair of contact members.
24. The device of claim 23, further comprising biasing means interconnecting said exposure members with said contact members.
25. A device for use in cardiovascular surgery on a beating heart, comprising:
a stabilizing member including first and second heart engaging members adapted to engage the surface of a beating heart on opposite sides of a target surgical site, at least one of said first and second heart engaging members having a first portion adapted to engage a surface of the beating heart, and a second portion movably connected to said first portion, for movement relative to said first portion, and adapted to the surface of the beating heart and operate in concert with said first portion to reposition a portion of the surface of the beating heart, relative to said first portion, thereby providing improved exposure of the target surgical site. 26. The device of claim 25, wherein said second portion is integral with said first portion.
27. The device of claim 25, further comprising a shaft means connected to and extending away from said stabilizing member.
28. The device of claim 27, wherein said shaft means comprises at least one substantially rigid elongated shaft.
29. The device of wherein said shaft means comprises at least two tubular members which telescope to adjust the length of said shaft means.
30. The device of claim 29, wherein said shaft means comprises a curved tubular member.
31. The device of claim 27, wherein said shaft means comprises a malleable elongated member.
32. The device of claim 27, wherein said shaft means comprises an elongated member formed from a plurality of interconnecting link members.
33. The device of claim 32, wherein said interconnecting link members have a first free state and a second locked state wherein adjacent link members are relatively immobile relative to each other.
34. The device of claim 32, wherein said link members are interconnected by articulating joints.
35. The device of claim 34, wherein said articulating joints comprise spherical joints.
36. The device of claim 27, wherein said shaft means is connected to said stabilizing member by a ball and socket joint.
37. The device of claim 36, wherein said ball and socket joint comprises a locking ball and socket joint.
38. A device for use in cardiovascular surgery on a beating heart, comprising:
a stabilizing member including at least one contact member having a first portion adapted to engage a surface of the beating heart, and a second portion connected to said first portion and adapted to engage a surface of the beating heart and operate in concert with said first portion to reposition a portion of the surface of the beating heart, thereby providing improved exposure of a target surgical site, wherein said second portion is biased for movement toward said first portion.
This application is a continuation of U.S. application Ser. No. 09/102,827 filed Jun. 23, 1998, now U.S. Pat. No. 6,213,941, which is a divisional of U.S. application Ser. No. 08/603,758, filed Feb. 20, 1996, now U.S. Pat. No. 5,894,843.
Despite the advantages, the beating-heart CABG procedure is not widely practiced, in part, because of the difficulty in performing the necessary surgical procedures using conventional instruments. If specially designed instruments were available so that the CABG procedure could be performed on the beating hear, the beating-heart CABG procedure would be more widely practiced and the treatment of cardiovascular disease in a significant patient population would be improved.
The advantages provided to a surgeon by the instruments and techniques of the invention allow the beating heart CABG procedures to be performed more rapidly, with less trauma to the patient, and without CPB or cardioplegia. This invention provides devices and methods for stabilizing the motion of the heart and exposing an artery or other surgical target using mechanical instruments specially designed to apply a stabilizing force to the heart to minimize the motion of the beating heart during a surgical procedure. The invention enables a surgeon to readily and rapidly perform a beating-heart CABG procedure without the need for cardioplegia or cardiopulmonary bypass. In particular, the methods and devices described here enable the surgeon to stabilize the heart such that an anastomosis can be more readily accomplished by enabling the surgeon to attach the graft to a target coronary artery whose motion is minimized for the duration of the surgical procedure.
Pursuant to the invention, a stabilizing device is introduced through a suitable opening in the chest to provide access to the beating heart. By contacting the heart with the stabilizing means of this invention and by exerting a stabilizing force on the heart, the motion of the heart caused by the contraction of the heart muscles is effectively eliminated such that movement of the target artery at the site of the surgery is minimized. By contacting the heart with exposure members of the stabilizing means, the exposure members can be moved to further expose the target artery. The remainder of the heart may be allowed to contract normally or may have additional devices in place to support the heart or to restrain its motion. An important advantage of this invention is derived from the discovery that an effective procedure can be followed using the devices of the invention to provide an advantageous technique for stabilizing the beating heart. The procedure requires exerting a stabilizing force on the beating heart using devices constructed as described herein. Typically, in separate steps, the surgeon contacts the heart with the stabilizing means, assesses the degree of movement at the site of the surgery and positions the stabilizing means proximate to the target coronary artery. With the stabilizing means in place, the surgeon applies a stabilizing force to the stabilizing means by applying a force such that the portion of the instrument in contact with the surface of the heart displaces the surface of the heart a sufficient distance that the contraction of the heart does not cause either vertical or horizontal motion at the surgery site. A portion of the stabilizing means is movable to further retract or displace the heart tissue to further expose or present the target artery.
By fixing the position of the stabilizing means in a configuration where the motion of the beating heart is effectively eliminated, the surgeon maintains the stabilizing force on the beating heart for the duration of the procedure. To fix the position of the stabilizing means, the means may be attached to a retractor used to separate the ribs or to another fixed support. Alternatively, the stabilizing means may be attached to a semi-rigid conformable arm which is rendered rigid mechanically, chemically, or by human intervention. In certain preferred embodiments, the stabilizing means has an adjustable shaft means which may be oriented in several directions and has a fixture adapted to be attached to a retractor. In a preferred technique of the invention, the surgeon first performs a thoracotomy, retracts the ribs using a retractor which is locked in an open position providing access to the beating heart. The surgeon then contacts the surface of the heart with the stabilizing means at a point proximate to the target coronary artery, and exerts a stabilizing force on the stabilizing means until the site of the surgery is substantially motionless. At this point, the adjustable shaft means is positioned and fixed in place by attachment to the retractor thereby rendering the target coronary artery substantially motionless of the duration of the procedure.
FIGS. 2A and 2B show an alternate embodiment of a stabilizing means having a single shaft means associated with each contact member and where the shaft means are interconnected and can be moved independently about a pivot such that the contact members spread the surface tissue of the heart proximate to the target coronary artery to increase exposure of the target artery at the site of the anastomosis.
FIG. 5A is a partial side view of the system of FIG. 5.
The present invention includes surgical instruments for stabilizing the beating heart and methods for their use. The means for stabilizing the beating heart comprise several alternative structures which engage the surface of the heat to stabilize the beating heart during coronary surgery. The instruments provide the capability to exert and maintain a stabilizing force on the heart by contacting the heart with the stabilizing means and by fixing the position of the stabilizing means throughout the duration of a surgical procedure.
Referring to FIG. 1, a stabilizing means comprises one or more, and preferably two, contact members 1, which are attached to a rigid or semi-rigid connecting shaft 2 which is in turn connected to shaft means 3. The contact members 1 may be substantially planar or may be slightly curved to conform to the shape of the heart. The contact members 1 may have any of several alternate shapes including cylindrical members formed into a U-shape or may comprise a pair of substantially parallel members spaced apart in a parallel configuration such that a target artery can be positioned between the contact members. The shaped of the contact members may be varied depending on the clinical assessment by the surgeon, the design of the other features of the stabilizing means, or the design of other instruments used to complete the anastomosis. In some embodiments, as described herein, the contact members 1 may have apertures, openings or attachments to facilitate connection with sutures or other devices to achieve the requisite stabilization. In a preferred embodiment, a pair of substantially planar rectangular contact members 1 are attached at one end to a continuous connecting shaft 2 and are oriented in a substantially parallel fashion such that a target cardiac artery is positioned therebetween and passes along the length of the contact members 1 when the stabilizing means engages the heart. See FIGS. 9A-C. While the contact members 12 may each be connected to the connecting shaft 2 at one end, with the connecting shaft 2 operably attached to shaft means 3, the configuration of the connecting shaft 2 relative to the contact members 1 may be altered depending on the configuration of the contact members 1 and the clinical aspects of the procedure. For example, the connecting shaft may be continuous to connect with the contact members 1 without touching the artery or may include an additional member which may be operated to contact the target artery positioned between the contact members 1, see FIG. 8, to occlude the passage of blood through the target artery. The contact members 1, connecting shaft 2 and shaft means 3 may be composed of any non-toxic material such as a biocompatible plastic or stainless steel, having sufficient tensile strength to withstand a stabilizing force exerted on the heart via manipulation of the shaft means 3 to cause the contact members 1 to exert a stabilizing force on the beating heart.
The shaft means 3 may be a simple rigid post or may comprise a multi-component system designed to be adjustable in length and orientation at at least one point along its length. Thus, the length of the shaft means 3 and the orientation of the contact members 1 at the distal (lower) end of the shaft means 3 can be altered by the surgeon. Preferably, the length and orientation at the shaft means 3 relative to the contact members 1 can be adjusted by controls located at the proximate (upper) end of shaft means 3. This design provides the advantage that the surgeon can introduce the stabilizing means to the beating heart by placing the contact members 1 on the surface of the heart, exerting a stabilizing force, and then locking the contact members 1 in place relative to the shaft means 3. Furthermore, the surgeon may then lock the shaft means 3 into a fixed position by attachment to a stable support such as the retractor, thereby maintaining the stabilizing force for the duration of the procedure. In one embodiment, the shaft means 3 has a housing 11 whose overall length is adjustable by a telescoping release of additional housing 11 length operated by an annular thumbscrew 10 which tightens about the housing 11. The position and orientation of the contact members 1 relative to the shaft means 3 is adjustable by virtue of a locking ball joint 5 which is interposed between the connecting shaft 2 and which is located at the distal end of shaft means 3. The locking all joint 5 allows the position of the shaft means 3 to be positioned with three degrees of freedom relative to the contact members 1.
Referring again to FIG. 1, a locking ball joint 5 is provided by including a block 6 within the shaft means 3 which conformingly contacts the ball joint 5 and fixes the position of the ball joint 5. Block 6 is compressed against ball joint 5 when a threaded push block 7 connected to a long allen 9 is actuated by means such as a thumbscrew 8 at the upper end of the shaft means 3. In operation, a rotation of the top thumbscrew 8 loosens the lower ball joint 5 to allow continuous positioning of the shaft means 3 relative to the contact members 1, and a counterrotation locks the ball joint 5 into place, fixing the position of the contact members 1 relative to the shaft means 3.
The shaft means 3 may also be attached to, or comprise a conformable arm which is used to position the stabilizing means against the heart and then to lock the stabilizing means in place once a stabilizing force has been exerted. The conformable arm is flexible and lockable and may have several configurations including a plurality of links, segments or universal joints in serial configuration and having a cable fixture passed through the interior of the links which cause the entire conformable arm to become rigid by tightening the cable fixture. Also, the conformable arm may comprise a synthetic gel or polymer contained within a conformable cylindrical housing which becomes rigid upon exposure to light or heat, such as the commercially available Dymax 183-M. Where the shaft means 3 further comprises the conformable arm, the conformable arm may be attached directly to the connecting shaft 2 or the contact members 1.
Referring to FIG. 2, the stabilizer means may also comprise a single shaft means 3 connected to each contact member 1. In a preferred embodiment, the shaft means 3 are interconnected at an intermediate pivot point 16 which permits the contact members 1 to be continuously positioned in parallel fashion relative to one another. The proximate (upper) portion of the individual shaft means 3 may have grips adapted to be grasped by the hand or may have an anchor portion 15 for attachment to a retractor or other fixed support. As with the other embodiments described herein, the length of the shaft means 3 may be adjustable by a conventional telescope configuration. In such a configuration, a first shaft 18 has a partially hollow segment 17 adapted to receive the complimentary portion of the second shaft 19. Either first 18 or second 19 shafts may be connected to the contact members 1 and may each have a conventional locking mechanism (not shown). The shaft means may also have a tensioning spring mechanism having an axis 21 which is displaced between a portion of the shaft means 3 affixed to the contact members 1 and the remainder of the shaft means 3. In this configuration, the contact members 1 remain tensioned against the heart proximate to the anastomosis site when the proximal end of the shaft means 3 is affixed to a stable support. The shaft means may also comprise an interlocking mechanism 90 to fix the position of a single shaft 18 relative to the other. This embodiment also preferably has a friction means 4 as described above attached to each contact member 1. An additional advantage of this embodiment is derived from the capability to move the contact members 1 apart from one another in a parallel configuration. Thus, the contact members 1 can first be positioned to engage the surface of the heart tissue, followed by the application of a stabilizing force in combination with spreading of the proximate(upper) end of the shaft means 3. Application of a stabilizing force causes the tissue on either side of the target artery to be stabilized. By coincidentally spreading the proximate portion of the shaft means 3, the tissue engaged by the contact members 1 is stretched to provide stabilization and improved exposure of the target coronary artery.
Referring to FIG. 3, the contact members 1 may further comprise a spring-tensioned frame 210 having a movable frame extension 22 which may have pins or an associated friction means 4 to engage the tissue proximate to the target artery. The movement of the frame extension 22 is tensioned by a spring means 23 which draws the frame extension 22 toward the contact member 1 after the frame extension 22 has been manually positioned to engage the tissue. The use of this embodiment of the invention is the same as is described for the other embodiments herein, with the frame extension 22 providing improved exposure of the target artery. As with the other embodiments of the invention disclosed herein, the contact members 1 may be attached at one end by a connecting shaft 2 which is attached to a shaft means 3 as described above. The connecting shafts 2 may also be positioned relative to one another by a conventional threaded post 24 with a positioning thumbscrew 25.
FIG. 4 shows an embodiment of a stabilizing means comprising an elongated sheath member 26 which wraps around the heart in a strap-like fashion to restrict the motion of the heart. This embodiment is particularly useful when access to the beating heart is provided by a sternotomy. The sheath member 26 is positioned to surround the heart and can be manipulated so that each end of the sheath member 26 extends out of the chest cavity through the sternotomy. If desired, at least one end of each sheath member 26 is attached to the retractor to secure the position of the sheath member 26. The sheath member 26 may have a plurality of support attachments 27 which engage the exterior of the heart to hold it in place. At the point where the support attachments 27 contact the surface of the heart, the support attachments 27 may have friction means 4 attached to the surfaces which are in direct contact with the heart. The support attachments 27 may have, or comprise inflatable members 28 which suction the heart against the sheath member 26, and absorb the motion of the heart while it is stabilized. Where the sheath member 26 has a plurality of inflatable members 28, the sheath member 26 is preferably further comprises at least one lumen 29 for introduction of air or other biocompatible fluid to the inflatable members 28, which may be inflated separately or simultaneously. In the former instance, a separate lumen 29 is provided for each inflatable member 28. The insertion of the sheath member 26 into the chest cavity should be performed while the inflatable members 28 are deflated and is achieved manually or by a conventional guide and/or guidewire. Each of the support attachments 27 may be permanently attached to the sheath member 26 or may slide along the length of the sheath member 26. Alternatively, alone or in combination with at least one other inflatable member 28, an inflatable member 28 may be positioned immediately proximate to the target coronary artery to achieve a more localized stabilization. The inflatable member 28 is positioned to lie next to, or may surround, the target coronary artery and may have openings or apertures placed in the body of the member through which surgical procedures are performed.
The embodiment shown in FIG. 6 is a means for stabilizing the beating heart wherein the shaft means comprises a flexible, lockable arm 37 having a plurality of interconnecting links 38 which allow positioning of the flexible arm 37 in every direction until the desired configuration is achieved at which point the flexible arm 37 may be locked into a fixed configuration by tightening a cable fixture (not shown) attached to a cable 39 running axially through the interconnecting links 38. Each interconnecting link comprises a ball portion 38 a and a receiving portion 38 b such that the ball portion 38 a fits conformingly within the receiving portion 38 b. The proximate (uppermost) end of the flexible, lockable arm 37 can be attached to a stable support, or to the retractor. In a preferred embodiment, the flexible, lockable arm 37 is a series of interconnecting links 38 having a cable 39 running through the center of each interconnecting link 38 such that when tension is exerted on the cable 39, the flexible, lockable arm 37 is fixed in a rigid position. FIG. 6 also shows air embodiment of the invention wherein the contact members 1 comprise a pair of substantially parallel elements 1 a, 1 b which are positioned to receive a simple snap fixture 40 which is affixed to the surface of the heart. In this embodiment, the snap fixture 40 is positioned between the two parallel elements 1 a, 1 b of the contact members 1, in order to fix the position of the heart tissue relative to the contact members 1. As in above embodiments, the contact members 1 are preferably oriented in a substantially parallel fashion with the target artery of the anastomosis passing therebetween. The snap fixtures 40 are affixed to the heart by a suture, wherein the suture line 41 may then also be attached to the contact member 1 via a notch, which may form a one-way locking mechanism to secure the suture line 41, or may be attached to a circular post disposed in the body of the contact member 1. The suture line 41 then may be tied through the notch or to the post in the contact member 1 to more tightly secure the heart to the contact member 1. An additional advantage of this embodiment is that the stabilizing means is actually affixed to the cardiac tissue via the suture line 41, such that when the heart is moving laterally or downward the artery being stabilized remains immobile.
Referring to FIG. 10, as noted above, attachment to a rib retractor is a preferred technique for fixing the position and orientation of the stabilizing means. The stabilizing means of the invention may therefor be advantageously attached to a fixture attached to a rib retractor 50 or may be configured to be directly incorporated into the body of a portion of the rib retractor 50.
A surgical rib retractor 50 is generally comprised of a body 54 having blades 53 attached thereto, which engage the ribs and spread the ribs when the retractor 50 is operated to move the blades 53 apart from one another. The space created by the retracted blades 53 provides access to the heart. Thus, once the retractor 50 is locked into the open position, the stabilizing means may be applied to the heart and a stabilizing force maintained at the site of the anastomosis by fixing the position and orientation of the shaft means 3 relative to the rib retractor 50. Referring to FIG. 10, the shaft means 3 traverses the width of the body 54 of the retractor 50 and is held in place by an upper plate 57 and a lower plate 58 having circular openings 59 therein through which the shaft means 3 passes and which maintain the position 6 f a sphere 56 positioned between the upper plate 57 and lower plate 58. The size of the openings 59 is larger than the diameter of the shaft means 3 but smaller than the largest diameter of the sphere 56. Thus, the shaft means 3 passes through the sphere 56 and may pivot about a point approximately at the center of the sphere 56.
Referring to FIG. 11, rib retractor 50 is shown in an open position whereby blades 53 engage and spread the ribs. A pair of stabilizing bars 72 having a conventional ratchet means 73 attached at the end thereof are positioned beneath the retractor. The ratchet means 73 comprises a plurality of teeth 74 on the stabilizing bars 72 and a ratcheting aperture 75 permitting one-way passage of the stabilizing bars 72 unless released by a release mechanism The stabilizing bars 72 are curved downward such that as the bars are advanced through the ratchet means 73, the lowermost portions 76 of the stabilizing bars 72 engage the beating heart proximate to the anastomosis site.
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