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| Cardioplegia catheter system |
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Compositions, apparatus and methods for facilitating surgical procedures
| Details |
Inventors: Duhaylongsod, Francis G.;
Assignee: Duke University (Durham, NC)
Primary Examiner: Krass; Frederick
Assistant Examiner:
Attorney, Agent or Firm: Morrison & Foerster LLP
Methods are provided for conducting surgical procedures in a patient wherein, during the surgical procedure, autonomous ventricular electrical conductivity and escape beats are reversibly and transiently suppressed to facilitate the surgical procedure. Also provided are compositions which are capable of inducing ventricular asystole in a patient. The compossitions may include an AV node blocker. In one embodiment, compositions including an atrioventricular (AV) node blocker and a .beta.-blocker are provided, wherein the .beta.-blocker is present in an amount sufficient to substantially reduce the amount of AV node blocker required to induce ventricular asystole in the patient. The compositions and methods may be used for inducing temporary ventricular asystole in a beating heart, and to facilitate the performance of a variety of surgical techniques, including minimally invasive microsurgical techniques. Methods for performing a surgical procedure on a human patient are provided wherein a composition capable of inducing transient reversible ventricular asystole is administered to the heart, for example by intracoronary injection. The heart then is electrically paced using an electrical pacing stysem, thereby to maintain the patient's blood circulation. The electrical pacing then is selectively intermittently stopped to allow ventricular asystole to occur, and the steps of the surgical or therapeutic procedure, such as suturing, are conducted during the time that the electrical pacing is intermittently stopped. The methods and comositions advantageously may be used in a range of different surgical procedures including cardiac, vascular and neurosurgical procedures. |
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DETAILED DESCRIPTION Methods, compositions and apparatus are provided which are useful for medical and surgical therapeutic applications.
The methods and compositions are useful for cardiac surgery and other procedures, such as neurosurgery and vascular surgery, which require precise control of cardiac contraction.
Other applications include non-invasive procedures such as percutaneous aortic aneurysm graft placement, and invasive procedures such as brain surgery.
Using the methods and compositions disclosed herein for conducting a surgical procedure, such as a coronary bypass, a substantially motionless operative field is provided.
In one aspect, there is provided a method of inducing reversible ventricular asystole in a beating heart in a human patient, the method comprising administering a compound and a .
beta.
-blocker to the heart of the patient in an amount effective to induce ventricular asystole, while maintaining the ability of the heart to be electrically paced, wherein the .
beta.
-blocker is administered in amount sufficient to substantially reduce the amount of compound required to induce ventricular asystole.
In one embodiment, the compound may be an atrioventricular (AV) node blocker.
The .
beta.
-blocker may be administered in an amount sufficient to reduce the amount of AV node blocker, which is required to induce ventricular asystole, to, for example, about 50% or less by weight of the amount of AV node blocker alone required to induce ventricular asystole.
The compound may be a cholinergic receptor agonist, such as carbachol.
The cholinergic receptor agonist, such as carbachol, may be administered in an amount, for example, of about 0.
1 to 4.
8 .
mu.
g/kg body weight/min.
The .
beta.
-blocker, may be, for example, propranolol.
The propranolol may be administered, for example, in an amount of about 0.
01 to 0.
07 mg/kg body weight.
In one embodiment, the .
beta.
-blocker is propranolol and the AV node blocker is carbachol, and the propranolol is administered prior to or during administration of the carbachol
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Heart Surgery 
