Devices and methods for port-access multivessel coronary artery bypass surgery

A method of performing coronary artery bypass graft surgery at a surgical site on a heart within a chest of a patient, the chest having a sternum and a plurality of ribs, each rib being connected to the sternum by a costal cartilage, the method comprising the steps of:

• creating a mediastinotomy by a method selected from (i) making an intercostal incision between two ribs and (ii) cutting a costal cartilage to disconnect a rib from the sternum;
• introducing a retraction instrument through the mediastinotomy;
• arresting the patient's heart:
• manipulating the retraction instrument to reposition the heart within the chest into a retracted position wherein an aspect of the heart containing the surgical site is visible through the mediastinotomy;
• and
• anastomosing a vascular graft to a coronary artery at the surgical site using an anastomosing instrument introduced through the mediastinotomy.

A method of performing coronary artery bypass graft surgery at a surgical site on a heart within a chest of a patient, the chest having a sternum and a plurality of ribs, each rib being separated from an adjacent rib by an intercostal space, the method comprising the steps of:

• placing a catheter in an ascending aorta leading away from the patient's heart;
• arresting the patient's heart;
• occluding the ascending aorta by means of an occluding member on the catheter;
• circulating oxygenated blood through the patient's arterial system downstream of the occluding member;
• making at least one access port into the chest through at least one intercostal space, the surgical site being on an aspect of the heart facing away from the access port;
• introducing a retraction instrument through one of the at least one access ports;
• manipulating the retraction instrument to reposition the heart within the chest into a retracted position wherein the aspect of the heart containing the surgical site is visible through one of the at least one access ports;
• and
• anastomosing a vascular graft to a coronary artery at the surgical site using an anastomosing instrument introduced through one of the at least one access ports.

A method of performing coronary artery bypass graft surgery at first and second surgical sites on a heart within a chest of a patient, the chest having a sternum and a plurality of ribs, each rib being separated from an adjacent rib by an intercostal space, the method comprising the steps of:

• making at least one access port into the chest through at least one intercostal space, the first surgical site being on a first aspect of the heart facing the access port;
• arresting the patient's heart;
• anastomosing a first vascular graft to a first coronary artery at the first surgical site using an anastomosing instrument, the anastomosing instrument being manipulated from outside the chest by means of a handle extending out of the chest through one of the at least one access ports;
• introducing a retraction instrument through one of the at least one access ports, the retraction instrument having a proximal end extending out of the chest through one of the at least one access ports;
• manipulating the proximal end of the retraction instrument to reposition the heart within the chest into a retracted position wherein a second aspect of the heart containing a second surgical site is facing one of the at least one access ports;
• and
• anastomosing a second vascular graft to a second coronary artery at the second surgical site using an anastomosis instrument having an elongaged handle after the manipulating step, the anastomosis instrument being manipulated from outside the chest by means of the handle which extends out of the chest through one of the at least one access ports.

A method of performing coronary artery bypass graft surgery at a surgical site on a heart within a chest of a patient, the chest having a sternum and a plurality of ribs, each rib being separated from an adjacent rib by an intercostal space, the method comprising the steps of:

• making at least one access port into the chest through at least one intercostal space, the surgical site being on an aspect of the heart facing away from the access port;
• arresting the patient's heart;
• introducing a retraction instrument through one of the at least one access ports;
• manipulating the retraction instrument to reposition the heart within the chest into a retracted position wherein the aspect of the heart containing the surgical site is visible through one of the at least one access ports;
• and
• anastomosing a vascular graft to a coronary artery at the surgical site using an anastomosing instrument introduced through one of the at least one access ports, wherein the retraction instrument and the anastomosing instrument are manipulated substantially entirely from outside the chest.