CA2218545A1 - Method and apparatus for thoracoscopic intracardiac procedures - Google Patents

Method and apparatus for thoracoscopic intracardiac procedures

Info

Publication number
CA2218545A1
CA2218545A1 CA002218545A CA2218545A CA2218545A1 CA 2218545 A1 CA2218545 A1 CA 2218545A1 CA 002218545 A CA002218545 A CA 002218545A CA 2218545 A CA2218545 A CA 2218545A CA 2218545 A1 CA2218545 A1 CA 2218545A1
Authority
CA
Canada
Prior art keywords
heart
access device
patch
penetration
cardiac
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Granted
Application number
CA002218545A
Other languages
French (fr)
Other versions
CA2218545C (en
Inventor
John H. Stevens
Bruce A. Reitz
Alex T. Roth
William S. Peters
Hanson S. Gifford
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Heartport Inc
Original Assignee
Heartport, Inc.
John H. Stevens
Bruce A. Reitz
Alex T. Roth
William S. Peters
Hanson S. Gifford
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Heartport, Inc., John H. Stevens, Bruce A. Reitz, Alex T. Roth, William S. Peters, Hanson S. Gifford filed Critical Heartport, Inc.
Publication of CA2218545A1 publication Critical patent/CA2218545A1/en
Application granted granted Critical
Publication of CA2218545C publication Critical patent/CA2218545C/en
Anticipated expiration legal-status Critical
Expired - Lifetime legal-status Critical Current

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Classifications

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Abstract

Devices, systems, and methods are provided for accessing the interior of the heart, and performing procedures therein while the heart is beating. A tubular access device (22) is positioned through an intercostal space and through a muscular wall of the heart. The access device (22) includes a balloon or flange for sealing (32) the penetration to prevent leakage of blood. An obturator (52) is positionable in the access device, and includes cutting means (60) located at its distal end. Elongated instruments are introduced through the access device to perform surgical procedures including septal device repair, ablation, and electrophysiological mapping.

Claims (157)

1. A method for accessing an interior chamber of a beating heart, said method comprising:
forming a penetration through a muscular wall of the heart into the interior chamber;
positioning a distal end of a tubular access device having an inner lumen through the penetration; and forming a hemostatic seal between the device and the penetration to inhibit blood loss through the penetration.
2. A method as in claim 1 wherein the interior chamber is selected from a right atrium, a right ventricle, and a left atrium.
3. A method as in claim 2, wherein a proximal end of the tubular access device is open to the exterior and wherein blood flow through the inner lumen is prevented by the pressure head of blood within the inner lumen.
4. A method as in claim 3, wherein a lateral side of the patient is disposed upward to permit vertical entry of the tubular access device into the interior chamber from a lateral portion of the chest.
5. A method as in claim 1, wherein the tubular access device is introduced percutaneously through an intercostal space.
6. A method as in claim 5, wherein the tubular access device is passed percutaneously through an intercostal space selected from the second, third, fourth, fifth, sixth or seventh intercostal space.
7. A method as in claim 1, wherein a lung is collapsed to provide a working space between the ribs and the pericardium.
8. A method as in claim 7, further comprising percutaneously introducing a viewing scope into the working space and viewing the heart while forming the penetration and positioning the distal end of the access device.
9. A method as in claim 8, wherein the heart is viewed by viewing a video image obtained from a camera mounted to the viewing scope.
10. A method as in claim 8, wherein the heart is directly viewed through an optical passage in the viewing scope.
11. A method as in claim 1, wherein the hemostatic seal is formed by expanding a balloon around the access device to occlude the penetration.
12. A method as in claim 1, wherein the hemostatic seal is formed by radially expanding the access device.
13. A method as in claim 1, wherein the hemostatic seal is formed by tightening a purse-string suture in the heart wall around the penetration.
14. A method as in claim 1, further comprising performing a procedure on the heart using one or more instruments introduced through the inner lumen of the access device.
15. A method as in claim 14 wherein the procedure comprises repairing a septal defect in the heart.
16. A method as in claim 14 wherein the procedure comprises performing electrophysiological mapping.
17. A method as in claim 14 wherein the procedure comprises performing electrophysiological abalation.
18. A method as in claim 14 wherein the procedure comprises repairing a heart valve in the heart.
19. A method as in claim 14 wherein the procedure comprises removing a material from the heart selected from thrombi, vegetations, myxomas, and neoplasms.
20. A method as in claim 1, wherein the heart remains beating throughout each of the steps of forming a penetration, positioning, and forming a hemostatic seal.
21. A method as in claim 1 wherein the penetration is formed by an obturator removably positioned in the inner lumen of the tubular access device.
22. A method as in claim 1 wherein ribs and sternum remain intact during each step of forming a penetration, positioning, and forming a hemostatic seal.
23. A method for closing a cardiac septal defect in a heart, said method comprising:
positioning a tubular access device percutaneously through an intercostal space and through a penetration in a muscular wall of the heart; and passing one or more instruments from a proximal end of the access device, through an inner lumen of the access device, and out of a distal end of the access device into a cardiac chamber in the heart, wherein the one or more instruments are used to close the septal defect.
24. A method as in claim 23, wherein the septal defect is closed while the heart continues to beat.
25. A method as in claim 23, wherein the cardiac chamber is selected from the right atrium, the right ventricle, and the left atrium.
26. A method as in claim 25, wherein a proximal end of the inner lumen is open to an exterior of the tubular access device, and wherein the tubular access device is oriented generally vertically so that blood flow through the inner lumen is prevented by the pressure head of blood within the inner lumen.
27. A method as in claim 26, wherein a lateral side of the patient is disposed upward to permit vertical entry of the tubular access device into the cardiac chamber from a lateral portion of the patient's chest.
28. A method as in claim 23, wherein a lung is at least partially collapsed to provide a working space between the ribs and the pericardium.
29. A method as in claim 28, wherein the tubular access device is passed percutaneously through an intercostal space selected from the second, third, fourth, fifth, sixth or seventh intercostal space.
30. A method as in claim 28, further comprising percutaneously introducing a viewing scope into the working space and viewing the heart while forming the penetration and positioning the distal end of the access device.
31. A method as in claim 30, wherein the heart is viewed by viewing a video image from a camera mounted to the viewing scope.
32. A method as in claim 30, wherein the heart is viewed directly through an optical passage of the viewing scope.
33. A method as in claim 23, further comprising forming a hemostatic seal between the access device and the muscular wall of the heart to inhibit blood loss through the penetration in the muscular wall of the heart.
34. A method as in claim 33, wherein the hemostatic seal is formed by expanding a balloon around the access device to occlude the penetration.
35. A method as in claim 33, wherein the hemostatic seal is formed by radially expanding the access device.
36. A method as in claim 33, wherein the hemostatic seal is formed by tightening a purse-string suture in the muscular wall of the heart around the penetration.
37. A method as in claim 23, further comprising visualizing the interior chamber of the heart to identify the septal defect.
38. A method as in claim 37, wherein the step of visualizing is performed with an ultrasonic probe.
39. A method as in claim 38 wherein the ultrasonic probe is placed in an esophagus of the patient.
40. A method as in claim 37 wherein the step of visualizing is performed with a scope introduced through inner lumen of the access device into the cardiac chamber.
41. A method as in claim 40 wherein the scope has a transparent bulb at its distal end, the step of visualizing comprising positioning the transparent bulb near the defect and viewing the defect through the scope.
42. The method of claim 41 wherein the transparent bulb comprises an inflatable balloon attached to the distal end of the scope, the balloon being inflated after the scope is introduced into the chamber of the heart.
43. A method as in claim 23, wherein the cardiac septal defect is closed by positioning a patch across the defect and securing the patch to the cardiac septum.
44. A method as in claim 43 wherein the patch is collapsible for introduction through the inner lumen of the access device.
45. A method as in claim 43 wherein the patch is introduced using an elongated introducer shaft having means at its distal end for releasably holding the patch.
46. A method as in claim 45 wherein the patch is collapsed in an aperture at the distal end of the introducer shaft during introduction through the access device.
47. A method as in claim 23, wherein the cardiac septal defect is closed by applying at least one suture to the cardiac septum using a suturing instrument introduced into the cardiac chamber through the inner lumen of the access device.
48. A method as in claim 47, wherein the step of applying at least one suture comprises:
inserting through the defect a plurality of needles connected by at least one length of suture, the needles being inserted while in a retracted position;
repositioning the needles to a radially expanded position;
drawing the needles through the cardiac septum while in the radially expanded position to position the length of suture across the defect; and tensioning the length of suture to close the defect.
49. A method as in claim 23, further comprising harvesting a portion of pericardium, wherein the cardiac septal defect is closed by securing said pericardium portion to the cardiac septum across the defect.
50. A method of claim 49, further comprising securing the pericardium portion to a frame and securing the frame to the cardiac septum.
51. An improved method for closing a cardiac septal defect of the type in which a patch of material is secured over the defect, wherein the improvement comprises introducing and securing the patch through an inner lumen of a tubular access device positioned through a muscular wall of the heart.
52. A method as in claim 51, wherein the repair patch is introduced and secured while the heart is beating.
53. A method as in claim 51, wherein the ribs and sternum are maintained intact while the repair patch is introduced and secured, the access device being percutaneously positioned through an intercostal space and through the muscular wall of the heart.
54. An improved method for closing a cardiac septal defect of the type in which a pericardium patch is secured over the defect, wherein the improvement comprises harvesting the pericardium patch using instruments introduced through one or more intercostal spaces, and introducing and securing the patch in the heart through an inner lumen of a tubular access device positioned through a muscular wall of the heart.
55. A method as in claim 54, wherein the pericardium patch is introduced and secured while the heart is beating.
56. A method as in claim 54 wherein the access device is percutaneously introduced through an intercostal space to maintain the ribs and sternum intact while the pericardium patch is introduced and secured through the inner lumen.
57. An improved method for closing a cardiac septal defect of the type in which the defect is sutured closed, wherein the improvement comprises suturing the defect using an instrument introduced through an inner lumen of a tubular access device positioned through a muscular wall of the heart.
58. A method as in claim 57, wherein the defect is sutured while the heart is beating.
59. A method as in claim 57, wherein the access device is percutaneously introduced through an intercostal space and the ribs and sternum remain intact while the defect is sutured.
60. A method of visualizing an interior chamber of a heart, the method comprising:
introducing a scope through a penetration in a muscular wall of the heart into the interior chamber, the scope having a proximal end, a distal end, an optical channel therebetween, and a transparent bulb at the distal end;
preventing blood from leaking from the internal chamber through the penetration; and viewing the interior chamber of the heart through the optical channel and through the transparent bulb.
61. The method of claim 60 wherein the transparent bulb comprises an inflatable balloon, further comprising inflating the balloon after the step of introducing.
62. The method of claim 61 wherein the scope is introduced through an inner lumen of a tubular access device having a distal end positioned through the penetration into the interior chamber.
63. The method of claim 62 wherein the step of preventing blood from leaking comprises placing a purse string suture in the muscular wall of the heart around the tubular access device.
64. The method of claim 62 wherein the tubular access device is introduced through an intercostal space and through the penetration into the interior chamber.
65. The method of claim 60 wherein the patient's ribs and sternum remain substantially intact during each of said steps of introducing, preventing, and viewing.
66. The method of claim 60 wherein the transparent bulb is positioned in contact with a tissue structure in the interior chamber to displace blood away from the tissue structure to allow visualization thereof.
67. Apparatus for accessing an interior chamber of a beating heart, said apparatus comprising:
an access device configured to extend through an intercostal space and through a muscular wall of the heart, the access device comprising a tubular shaft having a proximal end, a distal end, and an inner lumen therebetween; and penetration means at the distal end of the access device for penetrating the muscular wall of the heart.
68. Apparatus as in claim 67, wherein the access device comprises means on a distal portion thereof for hemostatically sealing a penetration through the muscular wall of the heart.
69. Apparatus as in claim 68 wherein the sealing means comprises an external flange near the distal end of the access device.
70. Apparatus as in claim 68, wherein the sealing means comprises an inflatable balloon attached to the distal end of the access device.
71. Apparatus as in claim 68, wherein the sealing means comprises a radially expandable portion of the access device.
72. Apparatus as in claim 67, wherein the access device includes a hemostasis valve in the inner lumen to prevent blood flow therethrough.
73. Apparatus as in claim 67 wherein the shaft is substantially rigid.
74. Apparatus as in claim 73 wherein the shaft is a material with a minimum durometer of 75 Shore A.
75. Apparatus as in claim 67 wherein the inner lumen has a diameter of at least 5 mm.
76. Apparatus as in claim 67 wherein the shaft has a length of at least 10 cm.
77. Apparatus as in claim 67 further comprising an obturator removably positionable in the inner lumen.
78. Apparatus of claim 77 wherein the penetration means comprises a cutting means at a distal end of the obturator.
79. Apparatus of claim 78 wherein the cutting means comprises a retractable blade or point.
80. An access device for accessing an interior chamber of a beating heart, comprising:
an elongate body configured to extend through an intercostal space and through a penetration in a muscular wall of the heart, the body having a proximal end, a distal end, and an inner lumen extending between the proximal and distal ends; and means near the distal end for sealing the penetration to inhibit leakage of blood from the interior chamber.
81. The access device of claim 80 wherein the sealing means comprises a balloon, the body further including an inflation lumen for delivering an inflation fluid to the balloon.
82. The access device of claim 80 wherein the sealing means comprises a flange.
83. The access device of claim 80 wherein the sealing means comprises a radially expanding portion of the body.
84. An access device as in claim 80, further comprising an obturator having a proximal end and a distal end, the obturator being removably positionable within the inner lumen of the body.
85. An access device as in claim 80, wherein the obturator includes means at a distal end thereof for penetrating through the muscular wall of the heart.
86. An access device as in claim 85, wherein the penetrating means is retractable.
87. An access device as in claim 80 wherein the inner lumen has a diameter of at least 5 mm.
88. An access device as in claim 80 wherein the body has a length of at least 10 cm.
89. An access device as in claim 80 wherein the elongate body is substantially rigid.
90. An access device as in claim 89 wherein the elongate body has a minimum durometer of 75 Shore A.
91. Apparatus as in claim 80, wherein the elongate body includes a hemostasis valve to prevent blood flow within the inner lumen of the elongate body.
92. A system for closing a cardiac septal defect in a chamber of a heart, said system comprising:
a patch for securing across the cardiac septal defect to occlude blood flow therethrough;
an introducing instrument comprising an elongate shaft having a proximal end, a distal end, and means at the distal end for releasably holding the patch; and access means for providing a passage through a penetration in a muscular wall of the heart for introduction of the patch into the chamber using the introducing instrument.
93. The system of claim 92 wherein the access means comprises a tubular body having an inner lumen for introducing the patch into the chamber through the inner lumen.
94. The system of claim 92 wherein the access means is configured to be positioned through an intercostal space and through the penetration in the muscular wall of the heart.
95. The system of claim 92 wherein the access means includes sealing means for inhibiting blood flow through the penetration around the access means.
96. The system of claim 93 wherein the inner lumen has a diameter of at least 5 mm.
97. The system of claim 92 wherein the patch is collapsible into a collapsed configuration for introduction through the access means.
98. The system of claim 97 further comprising a delivery sleeve positionable through the access means, the delivery sleeve having an interior lumen for slidably receiving the introducing instrument and the patch in the collapsed configuration.
99. The system of claim 92 wherein the patch includes a wire frame for supporting the patch in a generally planar configuration.
100. The system of claim 92 wherein the patch includes means for at least partially penetrating the cardiac septum to anchor the patch thereto.
101. The system of claim 92 wherein the patch includes a rigid hub attached to a central portion of the patch.
102. The system of claim 101 wherein the rigid hub includes means for releasable attachment to the introducing instrument.
103. The system of claim 102 wherein the means for releasable attachment comprises a threaded hole in the hub, the introducing instrument having a threaded tip for engagement with the hole.
104. The system of claim 92 wherein the patch includes means for engaging the cardiac septum for securing the patch thereto.
105. The system of claim 104 wherein engaging means is configured to engage the cardiac septum on a side of the cardiac septum opposite the patch.
106. The system of claim 105 wherein the engaging means comprises a plurality of struts attached to a central portion of the patch and having outer ends biased toward the patch for engaging the cardiac septum.
107. The system of claim 106 wherein the struts are connected to a rigid hub so as to extend radially outward therefrom, the hub being attached to a central portion of the patch.
108. The system of claim 107 wherein the hub includes means for releasable attachment to the introducing instrument.
109. The system of claim 106 wherein the outer ends of the struts have points oriented generally perpendicular to the struts for penetrating into the cardiac septum.
110. The system of claim 92 wherein the patch comprises a material selected from polyester, expanded polytetrafluoroethylene, pericardial tissue, and polyhydroxybutyrate.
111. A septal defect repair device for repairing a defect in a cardiac septum, the septal defect repair device comprising:
a rigid hub;
a flexible patch attached to the hub for occluding the defect, the patch having an outer edge configured to engage the cardiac septum on a first side thereof; and a plurality of struts coupled to the hub and oriented generally parallel to the patch, the struts having outer ends for engaging the cardiac septum on a second side thereof opposite the first side, wherein the outer ends of the struts are deflectable away from the patch and are biased toward the patch.
112. The septal defect repair device of claim 111 further comprising a wire frame for supporting the patch on the first side of the cardiac septum.
113. The septal defect repair device of claim 112 wherein the wire frame extends around the outer edge of the patch.
114. The septal defect repair device of claim 112 wherein the wire frame includes a plurality of radially extending members coupled to the hub.
115. The septal defect repair device of claim 114 wherein the radially extending members of the wire frame are connected to the struts.
116. The septal defect repair device of claim 115 wherein each strut and each of the radially extending members are formed from a single length of wire.
117. The septal defect repair device of claim 114 wherein the radially-extending members of the hub are biased toward the struts so as to compress the cardiac septum therebetween.
118. The septal defect repair device of claim 117 wherein a spring is interconnected between each of the radially-extending members and each strut so as to bias the radially-extending members toward the struts.
119. The septal defect repair device of claim 111 wherein the struts are deflectable relative to the hub about an axis generally perpendicular to a central axis of the hub such that the struts are movable between an expanded configuration generally perpendicular to the central axis and a collapsed configuration generally parallel to the central axis.
120. The septal defect repair device of claim 119 wherein the struts are biased into the expanded configuration.
121. The septal defect repair device of claim 111 wherein the patch has an expanded configuration in which the patch is generally planar and perpendicular to a central axis of the hub, and the patch is collapsible into a collapsed configuration in which said outer edge is closer to the central axis than in the expanded configuration.
122. The septal defect repair device of claim 121 wherein the patch is biased into the expanded configuration.
123. The septal defect repair device of claim 111 further comprising a flexible second patch coupled to the hub, the second patch having an outer edge for engaging the cardiac septum on the second side thereof.
124. The septal defect repair device of claim 111 wherein the hub comprises a means for detachable connection to an introducing instrument.
125. The septal defect repair device of claim 124 wherein the means for detachable connection comprises a threaded hole in the hub.
126. The septal defect repair device of claim 111 wherein the outer end of each strut includes a point oriented generally perpendicular to the strut for at least partially penetrating the cardiac septum.
127. The septal defect repair device of claim 111 wherein the patch comprises a material selected from polyester, expanded polytetrafluoroethylene, pericardial tissue, and polyhydroxybutyrate.
128. Apparatus for repairing a septal defect in a cardiac septum of a heart, the apparatus comprising:
an elongated shaft having a distal end and a proximal end;
a plurality of needles releasably held at the distal end of the shaft, at least two of the needles being interconnected by a length of suture, each needle having a tip for penetrating the cardiac septum and each needle being held so that the tip points in a proximal direction;
means at the distal end of the shaft for moving the needles between a contracted configuration in which the needles are close together and an expanded configuration in which the needles are spaced apart by a distance larger than a width of the septal defect; and means for capturing the needles after penetrating the cardiac septum.
129. The apparatus of claim 128 wherein the needle moving means comprises an expandable member positionable between the plurality of needles.
130. The apparatus of claim 129 wherein the expandable member comprises an inflatable balloon.
131. The apparatus of claim 128 wherein each needle is held at a distal end of a flexible rod coupled to the shaft.
132. The apparatus of claim 131 wherein each flexible rod is biased outwardly to position the needles in the expanded configuration.
133. The apparatus of claim 132 further comprising a sleeve slidable over the flexible rods, wherein sliding the sleeve distally relative to the rods moves the needles into the contracted configuration.
134. The apparatus of claim 128 comprising between two and six pairs of needles, each pair being interconnected by a length of suture.
135. The apparatus of claim 128 wherein the needle capturing means comprises a porous material positionable in opposition to the tips of the needles so that the needles may penetrate into the porous material after penetration through the cardiac septum.
136. The apparatus of claim 135 wherein the porous material is mounted to a face of a capture disk slidably coupled to the shaft.
137. The apparatus of claim 135 wherein the porous material is mounted in a plurality of capture tubes mounted to the shaft, the capture tubes being aligned with the tips of the needles in opposition thereto.
138. The apparatus of claim 128 wherein the needle capturing means comprises an elongated instrument having a pair of opposing jaws for grasping the needles.
139. The apparatus of claim 128 wherein the needles have barbed tips.
140. The apparatus of claim 128 further comprising access means for providing a passage through a penetration in a muscular wall of the heart into an interior chamber thereof through which the needles may be introduced.
141. The apparatus of claim 140 wherein the access means comprises a rigid tubular shaft having a proximal end, a distal end, and an inner lumen therebetween.
142. The apparatus of claim 141 wherein the tubular shaft is configured to extend through an intercostal space and through the muscular wall of the heart.
143. The apparatus of claim 140 wherein the access means includes sealing means at its distal end for inhibiting leakage of blood from the interior chamber through the penetration.
144. A thoracoscopic electrophysiology device for introduction into a cardiac chamber through an intercostal space and through a muscular wall of the heart, comprising:
a substantially straight, rigid shaft having a distal end and a proximal end, the shaft being dimensioned and configured for introduction through an intercostal space;
a deflectable tip mounted to the distal end of the shaft;
a handle mounted to the proximal end of the shaft;
a movable actuator on the handle;
a linkage coupled to the actuator, extending through the shaft and coupled to the deflectable tip, wherein moving the actuator deflects the deflectable tip;
at least one electrode mounted to the deflectable tip;
an electrical connector mounted to the handle configured for connection to a radiofrequency generator or electrocardiogram machine; and electrical coupling means extending through the shaft for connecting the electrodes to the electrical connector.
145. The electrophysiology device of claim 144 wherein the shaft and deflectable tip have a combined length in a range of 10 cm to 40 cm.
146. The electrophysiology device of claim 144 wherein the shaft has a diameter of at least about 5 mm.
147. The electrophysiology device of claim 144 wherein the shaft has a minimum durometer of 75 Shore A.
148. The electrophysiology device of claim 144 wherein the deflectable tip comprises an expandable basket having a plurality of electrodes mounted thereto.
149. The electrophysiology device of claim 144 wherein a plurality of electrode bands are mounted to the deflectable tip.
150. The electrophysiology device of claim 144 wherein the linkage comprises at least one pull wire slidably disposed in a lumen in the shaft and coupled to a distal end of the deflectable tip.
151. The electrophysiology device of claim 144 further comprising a tubular access device positionable through an intercostal space and through a muscular wall of the heart, the tubular access device having an inner lumen for positioning the deflectable tip therethrough into the heart.
152. A method of performing an electrophysiological procedure in an interior chamber of a heart, the method comprising:
positioning a distal end of a tubular access device having an inner lumen in the interior chamber through a penetration in a muscular wall of the heart;
forming a hemostatic seal between the device and the penetration to inhibit blood loss through the penetration;
contacting cardiac tissue with at least one electrode on an electrophysiology instrument introduced into the interior chamber through the inner lumen of the access device;
performing a step selected from sensing electrical potential in the cardiac tissue and delivering radiofrequency current to the cardiac tissue through the electrode..
153. The method of claim 152 wherein a plurality of electrodes are positioned in contact with cardiac tissue in the chamber ,wherein said step of performing comprises sensing electrical potential across at least two of said electrodes to map conduction pathways in the chamber.
154. The method of 152 wherein radiofrequency current is delivered to the cardiac tissue through the electrode to ablate the cardiac tissue.
155. The method of claim 152 wherein the access device is positioned through an intercostal space and through the penetration in the muscular wall of the heart.
156. The method of claim 155 wherein the ribs and sternum remain substantially intact during each of said steps.
157. The method of claim 152 further comprising deflecting a distal end of the electrophysiology instrument to position the electrode adjacent an interior wall of the heart.
CA2218545A 1995-04-20 1996-03-12 Method and apparatus for thoracoscopic intracardiac procedures Expired - Lifetime CA2218545C (en)

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US08/425,179 1995-04-20
US08/425,179 US5797960A (en) 1993-02-22 1995-04-20 Method and apparatus for thoracoscopic intracardiac procedures
PCT/US1996/003349 WO1996032882A1 (en) 1995-04-20 1996-03-12 Method and apparatus for thoracoscopic intracardiac procedures

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US5855614A (en) 1999-01-05
EP0822777A4 (en) 2007-01-17

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