System for cardiac procedures

A system for arresting a patient's heart comprising:

• a flexible shaft having a distal end, a proximal end, a first inner lumen extending therebetween, an opening at the distal end in fluid communication with the first inner lumen, and a preshaped distal portion configured to conform generally to at least a portion of the patient's aortic arch;
• a straightening element for straightening the preshaped distal portion of the shaft to facilitate introducing the shaft into an artery downstream of the patient's ascending aorta;
• an occluding member near the distal end of the shaft proximal to the opening in the first inner lumen configured to sealingly engage an inner wall of the aorta for occluding the ascending aorta between the coronary ostia and the brachiocephalic artery so as to block substantially all blood flow therethrough without occluding either the coronary ostia or the brachiocephalic artery;
• and
• a cardioplegic fluid supply in communication with the first inner lumen for delivering cardioplegic fluid into the ascending aorta distal to the occluding member for paralyzing the patient's myocardium.

A closed-chest cardiopulmonary bypass (CPB) system comprising:

• an arterial cannula having a distal end configured for percutaneous introduction into a peripheral artery, a proximal end, an inner lumen extending therebetween, and an outflow port at the distal end in fluid communication with the inner lumen;
• a venous cannula having a distal end configured for percutaneous introduction into a peripheral vein, a proximal end, an inner lumen extending therebetween, and an inflow port at the distal end in fluid communication with the inner lumen;
• an aortic catheter having a distal end configured for percutaneous introduction into a peripheral artery downstream of the aortic arch, a proximal end, an inner lumen extending therebetween, a distal port at the distal end in fluid communication with the inner lumen, the aortic catheter having a length selected to facilitate transluminal positioning of the distal port from the peripheral artery to an ascending aortic location downstream of the aortic valve, and an occluding member proximal to the distal port configured to occlude the ascending aorta between the coronary ostia and the brachiocephalic artery to block substantially all blood flow therethrough without occluding either the coronary ostia or the brachiocephalic artery when the distal port is in the ascending aortic location;
• a cardioplegic fluid supply in communication with the inner lumen of the aortic catheter for delivering cardioplegic fluid through the inner lumen into the ascending aorta distal to the occluding member so as to arrest the heart;
• means at the proximal end of the venous cannula in fluid communication with the inner lumen of the venous cannula for receiving deoxygenated blood from the patient's venous system;
• an oxygenator for oxygenating the deoxygenated blood;
• means at the proximal end of the aortic catheter in fluid communication with the inner lumen thereof for receiving blood from the aortic root and delivering the blood to the oxygenator;
• and
• means connecting the oxygenator to the inner lumen of the arterial cannula for delivering oxygenated blood into the patient's arterial system.

A system for accessing a patient's heart to facilitate performing a cardiac procedure, the heart having a left ventricle and a myocardium and being in communication with an arterial system having an aorta leading from the left ventricle to a peripheral artery, two coronary arteries each connected to the aorta for supplying blood to the myocardium, and a brachiocephalic artery connected to the aorta downstream of the coronary arteries, the system comprising:

• a) an elongated aortic catheter adapted to be advanced to a location within an ascending portion of the aorta, the aortic catheter having proximal and distal ends, having a partitioning member at the distal end for partitioning both coronary arteries from the arterial system at a location upstream of the brachiocephalic artery, having first and second lumens extending between the proximal and distal ends, and having first and second ports distal to the partitioning member connected to the first and second lumens, respectively;
• b) a cardiopulmonary bypass system including a venous cannula to withdraw blood from a venous system of the patient, an oxygenator to oxygenate the withdrawn blood and an arterial cannula to direct the oxygenated blood into the arterial system of the patient;
• and
• c) means for delivering cardioplegic fluid to the myocardium.

An endovascular system for accessing a patient's heart having a left ventricle, an aorta having an aortic lumen therein leading away from the left ventricle to a peripheral artery, a coronary artery branching from the aorta at a first location, and a brachiocephalic artery branching from the aorta at a second location downstream of the first location, the system comprising:

• a) an elongated intra-aortic catheter having proximal and distal ends, a port at the distal end, an inner lumen extending from the proximal end to the port, and an expandable member on a distal portion thereof proximal to the port, the intra-aortic catheter having a length to allow the port and the expandable member to be positioned in an ascending aortic location in the aortic lumen between the first and second locations with the proximal end extending intraluminally to the peripheral artery, the expandable member being configured to expand into sealing engagement with an inner wall of the aorta to occlude the aortic lumen to prevent the passage of blood therethrough without blocking the coronary artery or the brachiocephalic artery;
• b) a fluid receiving device at the proximal end of the catheter in communication with the inner lumen for receiving fluid withdrawn from within the aortic lumen through the port;
• and
• c) a cardiopulmonary by-pass system including a venous cannula to withdraw blood from a venous system of the patient, an oxygenator to oxygenate the blood withdrawn from the venous system, and an arterial cannula positionable in an artery downstream of the expandable member to direct oxygenated blood into the artery.

A method of accessing a patient's heart having a left ventricle, an aorta having an aortic lumen leading away from the left ventricle to a peripheral artery, a coronary artery branching from the aorta at a first location and a brachiocephalic artery branching from the aorta at a second location downstream from the first location, the method comprising:

• a) providing an elongated intra-aortic catheter which has proximal and distal ends, an inner access lumen extending within the catheter to a port in the distal end, and an expandable occluding member on a distal portion thereof proximal to the port which is configured to occlude the aortic lumen in an ascending portion of the patient's aorta between the first and second locations;
• b) introducing the elongated intra-aortic catheter into the peripheral artery of the patient;
• c) advancing the elongated intra-aortic catheter through the peripheral artery and into the aorta until the expandable occluding member on the distal portion thereof is located within the aortic lumen in the ascending portion of the patient's aorta;
• d) expanding the expandable occluding member into sealing engagement with an inner wall of the aorta to occlude the aortic lumen in the ascending portion of the patient's aorta between the first and second locations to prevent passage of blood therethrough without blocking the coronary artery or the brachiocephalic artery;
• e) venting fluid from within the aorta through the port and through the access lumen of the intra-aortic catheter;
• and
• f) withdrawing deoxygenated blood from a vein of the patient, oxygenating the blood withdrawn from the vein, and directing oxygenated blood to an artery of the patient through an arterial cannula positioned in the artery downstream of the occluding member.

A method of inducing cardioplegic arrest in a patient having a heart, an aorta having an aortic lumen leading away from the heart to a peripheral artery, coronary arteries branching from the aorta at a first location and leading to a coronary vasculature, and a brachiocephalic artery branching from the aorta at a second location downstream of the first location, the method comprising:

• removing oxygenated blood from a vein, oxygenating the withdrawn blood, and returning the oxygenated blood to an artery through an arterial cannula positioned percutaneously into the artery;
• occluding the aortic lumen between the first and second locations by expanding an expandable member into sealing engagement with an inner wall of the aorta to prevent the flow of blood therethrough, the expandable member being mounted on a distal portion of an intra-aortic catheter positioned intraluminally from the peripheral artery into the aorta;
• delivering cardioplegic fluid into the coronary vasculature through a lumen in a catheter positioned intraluminally through a peripheral blood vessel;
• and
• venting fluid from the heart through a catheter positioned intraluminally through a peripheral blood vessel.

An endovascular device for partitioning a human patient's ascending aorta between a coronary ostium and a brachiocephalic artery, comprising:

• a flexible shaft having a distal end, a proximal end, a first inner lumen extending therebetween, an opening at the distal end in fluid communication with the first inner lumen, and a preshaped distal portion configured to conform generally to the patient's aortic arch, the inner lumen being configured for delivering a cardioplegic fluid into the ascending aorta at a rate sufficient to arrest the heart;
• a straightener for straightening the distal portion of the shaft to facilitate introducing the shaft into an artery downstream of the patient's ascending aorta;
• and
• occluding means near the distal end of the shaft proximal to the opening in the first inner lumen configured to sealingly engage an inner wall of the aorta for occluding the ascending aorta between the coronary ostia and the brachiocephalic artery so as to block substantially all blood flow therethrough.