Method for arterial harvest and anastomosis for coronary bypass grafting

Claim 1

A method of harvesting an arterial vessel of a patient using a dissection cannula having a substantially rigid and transparent tissue-separating blunt tip covering a distal end of the cannula, and having a balloon attached to an exterior wall of the cannula near the blunt tip for peripheral expansion in response to selective inflation thereof, and having an endoscope disposed within the cannula with a viewing end positioned in alignment with the transparent tip for viewing therethrough tissue bluntly dissected thereby, the method comprising the steps of: forming a subcostal incision to expose a superior epigastric vessel; introducing the dissection cannula into the incision and advancing the blunt tip through tissue planes with visualization thereof through the blunt tip and endoscope while selectively inflating and deflating the balloon for sclectively dissecting the tissue planes to form a working cavity adjacent to and along the length of the arterial vessel substantially along the internal mammary artery to the region of the subclavian artery; and selectively occluding side branches from the internal mammary artery and providing a distal free end of the artery for anastomosis with a coronary artery.

Claim 2

A method of harvesting an arterial vessel of a patient using a dissection cannula having a substantially rigid and transparent tissue-separating blunt tip covering a distal end of the cannula, and having a balloon attached to an exterior wall of the cannula near the blunt tip for peripheral expansion in response to selective inflation thereof, and having an endoscope disposed within the cannula with a viewing end positioned in alignment with the transparent tip for viewing therethrough tissue bluntly dissected thereby, the method comprising the steps of: forming a subcostal incision to expose a superior epigastric vessel; introducing the dissection cannula into the incision and advancing the blunt tip through tissue planes with visualization thereof through the blunt tip and endoscope while selectively inflating and deflating the balloon for sclectively dissecting the tissue planes to form a working cavity adjacent to and along the length of the arterial vessel substantially along the internal mammary artery to the region of the subclavian artery; and selectively occluding side branches from the internal mammary artery and providing a distal free end of the artery for anastomosis with a coronary artery.

Claim 8

A method for harvesting an arterial vessel of a patient using a dissection cannula comprising the steps of: forming a subcostal incision to expose a superior epigastric vessel; introducing the dissection cannula into the incision for selectively dissecting tissue planes to form a working cavity along the length of the arterial vessel substantially along the internal mammary artery to the region of the subclavian artery; selectively occluding side branches from the internal mammary artery and providing a distal free end of the artery for anastomosis with a coronary artery; harvesting the inferior epigastric artery as a free graft for proximal anastomosis with the subclavian artery and distal anastomosis with a coronary artery as an additional coronary bypass conduit; forming a supraclavicular incision to expose the subclavian artery; grafting an end of the harvested inferior epigastric artery to the subclavian artery substantially at the site of the supraclavicular incision; and grafting another end of the harvested inferior epigastric artery to a coronary artery.

Claim 9

A method for harvesting an arterial vessel of a patient using a dissection cannula comprising the steps of: forming a subcostal incision to expose a superior epigastric vessel; introducing the dissection cannula into the incision for selectively dissecting tissue planes to form a working cavity along the length of the arterial vessel substantially along the internal mammary artery to the region of the subclavian artery; selectively occluding side branches from the internal mammary artery and providing a distal free end of the artery for anastomosis with a coronary artery; harvesting the inferior epigastric artery as a free graft for proximal anastomosis with the subclavian artery and distal anastomosis with a coronary artery as an additional coronary bypass conduit; forming a supraclavicular incision to expose the subclavian artery; grafting an end of the harvested inferior epigastric artery to the subclavian artery substantially at the site of the supraclavicular incision; and grafting another end of the harvested inferior epigastric artery to a coronary artery.

Claim 10

A method for performing coronary artery bypass grafting using a balloon dissection cannula having a substantially rigid and transparent tissue-separating blunt tip covering a distal end of the cannula, and having a balloon attached to an exterior wall of the cannula near the blunt tip for peripheral expansion in response to selective inflation thereof, and having an endoscope disposed within the cannula with a viewing end positioned in alignment with the transparent tip for viewing therethrough tissue bluntly dissected thereby, the method comprising the steps of: forming a subcostal incision to expose a superior epigastric vessel; introducing the dissection cannula into the incision and selectively advancing the cannula through tissue planes with visualization thereof through the blunt tip and endoscope while selectively inflating and deflating the balloon to advance the cannula along the vessel in a superior direction toward the subclavian artery to form a working cavity along the vessel with intermittent advancement of the cannula and inflation of the balloon on the cannula; introducing the dissection cannula into the incision and selectively advancing the cannula through tissue planes with visualization thereof through the blunt tip and endoscope while selectively inflating and deflating the balloon to advance the cannula along the vessel in an inferior direction away from the subclavian artery to form a working cavity along the vessel with intermittent advancement of the cannula and inflation of the balloon on the cannula; selectively occluding side branches along the vessel, within the working cavity; transecting the side branches within the working cavity; and transecting the distal end of the exposed vessel within the working cavity to provide an extended length of graft vessel.

Claim 11

A method for performing coronary artery bypass grafting using a balloon dissection cannula having a substantially rigid and transparent tissue-separating blunt tip covering a distal end of the cannula, and having a balloon attached to an exterior wall of the cannula near the blunt tip for peripheral expansion in response to selective inflation thereof, and having an endoscope disposed within the cannula with a viewing end positioned in alignment with the transparent tip for viewing therethrough tissue bluntly dissected thereby, the method comprising the steps of: forming a subcostal incision to expose a superior epigastric vessel; introducing the dissection cannula into the incision and selectively advancing the cannula through tissue planes with visualization thereof through the blunt tip and endoscope while selectively inflating and deflating the balloon to advance the cannula along the vessel in a superior direction toward the subclavian artery to form a working cavity along the vessel with intermittent advancement of the cannula and inflation of the balloon on the cannula; introducing the dissection cannula into the incision and selectively advancing the cannula through tissue planes with visualization thereof through the blunt tip and endoscope while selectively inflating and deflating the balloon to advance the cannula along the vessel in an inferior direction away from the subclavian artery to form a working cavity along the vessel with intermittent advancement of the cannula and inflation of the balloon on the cannula; selectively occluding side branches along the vessel, within the working cavity; transecting the side branches within the working cavity; and transecting the distal end of the exposed vessel within the working cavity to provide an extended length of graft vessel.

Claim 13

A method for performing coronary artery bypass grafting using a balloon dissection cannula comprising the steps of: forming a subcostal incision to expose a superior epigastric vessel; introducing the dissection cannula into the incision and selectively advancing the cannula along the vessel in a superior direction toward the subclavian artery to form a working cavity along the vessel with intermittent advancement of the cannula and inflation of the balloon on the cannula: introducing the dissection cannula into the incision and selectively advancing the cannula along the vessel in an inferior direction away from the subclavian artery to form a working cavity along the vessel with intermittent advancement of the cannula and inflation of the balloon on the cannula: selectively occluding side branches along the vessel within the working cavity; transecting the side branches within the working cavity; transecting the distal end of the exposed vessel within the working cavity to provide an extended length of graft vessel; transecting the internal mammary portion of the vessel to use as coronary graft, with a distal anastomosis to the coronary artery; transecting the inferior epigastric portion of the vessel to use as a free graft; and forming a proximal anastomosis of the free graft to the subclavian artery and a distal anastomosis of the free graft to the subclavian artery and a distal anastomosis of the free graft to the coronary artery.

Claim 14

A method for performing coronary artery bypass grafting using a balloon dissection cannula comprising the steps of: forming a subcostal incision to expose a superior epigastric vessel; introducing the dissection cannula into the incision and selectively advancing the cannula along the vessel in a superior direction toward the subclavian artery to form a working cavity along the vessel with intermittent advancement of the cannula and inflation of the balloon on the cannula: introducing the dissection cannula into the incision and selectively advancing the cannula along the vessel in an inferior direction away from the subclavian artery to form a working cavity along the vessel with intermittent advancement of the cannula and inflation of the balloon on the cannula: selectively occluding side branches along the vessel within the working cavity; transecting the side branches within the working cavity; transecting the distal end of the exposed vessel within the working cavity to provide an extended length of graft vessel; transecting the internal mammary portion of the vessel to use as coronary graft, with a distal anastomosis to the coronary artery; transecting the inferior epigastric portion of the vessel to use as a free graft; and forming a proximal anastomosis of the free graft to the subclavian artery and a distal anastomosis of the free graft to the subclavian artery and a distal anastomosis of the free graft to the coronary artery.

Claim 15

A method for performing coronary artery bypass grafting using a balloon dissection cannula comprising the steps of: forming a subcostal incision to expose a superior epigastric vessel; introducing the dissection cannula into the incision and selectively advancing the cannula along the vessel in a superior direction toward the subclavian artery to form a working cavity along the vessel with intermittent advancement of the cannula and inflation of the balloon on the cannula; introducing the dissection cannula into the incision and selectively advancing the cannula along the vessel in an inferior direction away from the subclavian artery to form a working cavity along the vessel with intermittent advancement of the cannula and inflation of the balloon on the cannula; selectively occluding side branches along the vessel, within the working cavity; transecting the side branches within the working cavity; transecting the distal end of the exposed vessel within the working cavity to provide an extended length of graft vessel; and anastomosing the free end of the internal mammary artery to the coronary artery and the free end of the inferior epigastric portion of the graft vessel to the coronary artery, while the heart is in a beating state.

Claim 16

A method for performing coronary artery bypass grafting using a balloon dissection cannula comprising the steps of: forming a subcostal incision to expose a superior epigastric vessel; introducing the dissection cannula into the incision and selectively advancing the cannula along the vessel in a superior direction toward the subclavian artery to form a working cavity along the vessel with intermittent advancement of the cannula and inflation of the balloon on the cannula; introducing the dissection cannula into the incision and selectively advancing the cannula along the vessel in an inferior direction away from the subclavian artery to form a working cavity along the vessel with intermittent advancement of the cannula and inflation of the balloon on the cannula; selectively occluding side branches along the vessel, within the working cavity; transecting the side branches within the working cavity; transecting the distal end of the exposed vessel within the working cavity to provide an extended length of graft vessel; and anastomosing the free end of the internal mammary artery to the coronary artery and the free end of the inferior epigastric portion of the graft vessel to the coronary artery, while the heart is in a beating state.

Claim 17

A method for performing coronary artery bypass grafting using a balloon dissection cannula comprising the steps of: forming a subcostal incision to expose a superior epigastric vessel; introducing the dissection cannula into the incision and selectively advancing the cannula along the vessel in a superior direction toward the subclavian artery to form a working cavity along the vessel with intermittent advancement of the cannula and inflation of the balloon on the cannula; introducing the dissection cannula into the incision and selectively advancing the cannula along the vessel in an inferior direction away from the subclavian artery to form a working cavity along the vessel with intermittent advancement of the cannula and inflation of the balloon on the cannula; selectively occluding side branches along the vessel, within the working cavity; transecting the side branches within the working cavity; transecting the distal end of the exposed vessel within the working cavity to provide an extended length of graft vessel: forming a tunnel from the subclavian artery at the supraclavicular incision to the parasternal subcostal incision used for access to the heart and coronary artery; and positioning the free end of the inferior epigastric portion of the graft vessel though the tunnel for anastomosis to the coronary artery.

Claim 18

A method for performing coronary artery bypass grafting using a balloon dissection cannula comprising the steps of: forming a subcostal incision to expose a superior epigastric vessel; introducing the dissection cannula into the incision and selectively advancing the cannula along the vessel in a superior direction toward the subclavian artery to form a working cavity along the vessel with intermittent advancement of the cannula and inflation of the balloon on the cannula; introducing the dissection cannula into the incision and selectively advancing the cannula along the vessel in an inferior direction away from the subclavian artery to form a working cavity along the vessel with intermittent advancement of the cannula and inflation of the balloon on the cannula; selectively occluding side branches along the vessel, within the working cavity; transecting the side branches within the working cavity; transecting the distal end of the exposed vessel within the working cavity to provide an extended length of graft vessel: forming a tunnel from the subclavian artery at the supraclavicular incision to the parasternal subcostal incision used for access to the heart and coronary artery; and positioning the free end of the inferior epigastric portion of the graft vessel though the tunnel for anastomosis to the coronary artery.