Title of Invention	A PROXIMAL ANASTOMOTIC DEVICE FOR ANASTOMOSING VEIN GRAFTS ON TO THE AORTA WITHOUT USING SIDE CLAMP
Abstract	An inexpensive reusable device (5) which could plug the punch hole on the aorta, keep the field clean thereby showing the edges of the punch hole clearly, and could ensure safe intima anastamoses during coronary artery bypass grafting surgery without side clamping the aorta. Device (5) comprises a holding part(l) and an inserting part (1 A) with grooves separated by a ridge (2) which projects perpendicularly like a shelf (3)from the rod with smooth edges.

Title of Invention

A PROXIMAL ANASTOMOTIC DEVICE FOR ANASTOMOSING VEIN GRAFTS ON TO THE AORTA WITHOUT USING SIDE CLAMP

Abstract

An inexpensive reusable device (5) which could plug the punch hole on the aorta, keep the field clean thereby showing the edges of the punch hole clearly, and could ensure safe intima anastamoses during coronary artery bypass grafting surgery without side clamping the aorta. Device (5) comprises a holding part(l) and an inserting part (1 A) with grooves separated by a ridge (2) which projects perpendicularly like a shelf (3)from the rod with smooth edges.

Full Text	The invention relates to surgical equipment, and more particularly to an instrument used in Coronary Artery Bypass Grafting or Bypass Surgery avoiding side clamping of aorta. With the advent of beating heart surgery, more than 50% of Coronary Artery bypass graft surgeries were performed in most Coronary centers in India as well as in other countries without the use of heart-lung machine. But the neurological problems caused by side clamping the aorta in performing the proximal anastomoses still remains. Off Pump Coronary Artery Bypass Grafting (OPCAB) has been shown to improve the prospective base of patients under going coronary artery bypass grafting (CABG) surgery, but the need for side clamping of the aorta to perform the proximal anstomoses is still a risk factor for causing neurological injury post operatively. During beating heart surgery the use of side clamp for proximal anastomoses of vein graft in-patient with diseased aorta has actually increased the incidence of abnormahties in the patients. This was the reason why the beating heart surgical centers, which performs coronary artery bypass graft (CABG) on beating heart had to search for ways to avoid side clamping. During this time, two such anastomotic devices namely Symmetry Aortic Connector and Heart - String Devices came in to market. They are single use devices, and are so prohibitively expensive that their use in the Indian scenario is out of question and beyond the reach of population in the third world countries. In open-heart surgery done under cardio pulmonary bypass, patients are connected to the heart -lung machine using an aortic candle and one or two venous annular. Rarely the aortic candle site may give way during dissimulation and start bleeding. Such defects tend to occur in patient with fragile unhealthy aortas and have a tendency to enlarge further due to the blood pressure in the aorta. In such cases the surgeons introduce a Hegars Dilator in to the aorta to plug the hole, thereby reducing blood loss and allowing the surgeon to place purse string sutures around the hole. The Hedgers Dilator is taken off, while the purse string sutures are tied to seal the connotation site. While it was possible to plug a hole on the aorta to a certain degree, suturing a vein graft into the hole, using a Hegars Dilator alone was simply not possible as it was difficult to keep the field clear enough for a more safe and perfect anastomoses and it was impossible to make sure that the intimae lining of the both aorta and sphenoid vein were included in the sutures. To overcome the shortcomings, the present invention provides an inexpensive reusable instrument which could plug the punch hole on the aorta, keep the field clean thereby showing the edges of the punch hole clearly, and could ensure safe intimate anastamoses.lt comprises a holding part and an inserting part with grooves separated by a ridge which projects perpendicularly like a shelf from the rod with smooth edges. The device may be made by Stainless steel or any suitable material. Further objects, advantage and use of this invention will be more apparent from the ensuing description when read in conjunction with the accompanying drawing and wherein Fig. 1 is a perspective view of proximal anastomotic device. With reference to Fig. 1, proximal anastomotic device (5) made of solid steel about 180 mm in length and about 5mm in diameter. It includes a holding part (1) and an inserting part (1 A) separated by a 2mm wide ridge (2), 25mm from the inserting end (IB) of the device projects perpendicularly like a shelf (3) 2mm from the steel rod. There are about three "U" shaped equidistant grooves (4) in the inserting end that are 1mm deep and 1mm wide. And these grooves extend 15mm from the inserting end (IB) of the device. The ridge (2) helps to prevent the blood from spurting directly in to the eye. The grooves (4) allow the needle to pass through the rod and there by include the aortic intimae in the suture). The holding part (1) is about 153 mm from the ridge. The device allows surgeons to anatomies the proximal end of the vein graft or after distal anastomoses. The aortic site proposed for anastomoses is marked with diathermy. Two 3.0 polypropylene purse-string sutures are applied 1 cm apart from the site. The aorta is stabbed with a blade knife, followed by a 4mm aortic punch for the 5 mm proximal anastomotic device. The punch hole is blocked with the left index finger. Proximal anastomotic device is introduced into the punch hole. The purse strings are tightened just enough to prevent excessive bleeding. Once the device is in and the snares are tightened, the proximal vein anastomoses is performed with 5.0 polypropylene suture. The sutures in the vein have to be inside out, and in the aorta, they have to be out side in. The aortic are placed so that the needle passes through the aortic wall, goes onto the groove (4) of the device and comes out between the aorta and the metal, thus taking the intimate. The sutures are placed all around the aortic punch hole and are loosely held. Once the suturing is complete, the device is removed, and the left index finger is positioned on the aortic punch hole to prevent bleeding. The loose sutures are pulled and tightened with a nerve hook. The two ends of the sutures are held firmly with controlled traction by the assistant during the procedure. Once all the sutures are in place, the two ends are tied snugly. The two snares on the purse string are removed, and they are tied in place with care, to avoid a purse string effect. The vein is then desired and homeostasis is attained. While using the proximal anastomotic device no injury to the vein intimae is caused because nothing is introduced into the vein and the suturing procedure takes not more than 10 minutes. This device can also be used in Calcified aortas if a small island of normal aorta is available interiorly. Even though many characteristics and advantages of the invention has been set forth in the foregoing description, together with structure and function of the invention, the disclosure is illustrative only. Changes may be made, especially in matters of size, shape, substances used within the principles of the invention to the full extent indicated by the broad general meaning of the terms in which the appended claims are expressed. I CLAIM 1. A proximal anastomoses enabling device characterized by a ridge (2) which projects perpendicularly in a ring like shelf (3) from the rod with plurality of "U" shaped equidistant grooves at the inserting end. 2. The device as claimed in Claim 1 wherein the device is made of solid steel. 3. The device as claimed in Claim 1&2 wherein the device has a total length of about 180mm and rod diameter of about 5mm. 4. The device as claimed in Claim 1,2,& 3 wherein the device has a ridge (2) about 25mm from the inserting end having a width of about 2mm which projects perpendicularly like shelf (3) about 3mm from the rod. 5. The device as claimed in Claim 1, 2, 3 & 4 wherein the device has about three "U" shaped equidistant grooves (4) with about 1mm width, about 1mm depth and 15mm length from the inserting end (IB). 6. The device as claimed in Claim 1, 2, 3, 4 & 5 wherein the device has a holding part (1) 15mm from the ridge (2) separating the inserting part (lA).

Full Text

The invention relates to surgical equipment, and more particularly to an instrument used in Coronary Artery Bypass Grafting or Bypass Surgery avoiding side clamping of aorta.
With the advent of beating heart surgery, more than 50% of Coronary Artery bypass graft surgeries were performed in most Coronary centers in India as well as in other countries without the use of heart-lung machine. But the neurological problems caused by side clamping the aorta in performing the proximal anastomoses still remains. Off Pump Coronary Artery Bypass Grafting (OPCAB) has been shown to improve the prospective base of patients under going coronary artery bypass grafting (CABG) surgery, but the need for side clamping of the aorta to perform the proximal anstomoses is still a risk factor for causing neurological injury post operatively. During beating heart surgery the use of side clamp for proximal anastomoses of vein graft in-patient with diseased aorta has actually increased the incidence of abnormahties in the patients. This was the reason why the beating heart surgical centers, which performs coronary artery bypass graft (CABG) on beating heart had to search for ways to avoid side clamping. During this time, two such anastomotic devices namely Symmetry Aortic Connector and Heart - String Devices came in to market. They are single use devices, and are so prohibitively expensive that their use in the Indian scenario is out of question and beyond the reach of population in the third world countries.
In open-heart surgery done under cardio pulmonary bypass, patients are connected to the heart -lung machine using an aortic candle and one or two venous annular. Rarely the aortic candle site may give way during

dissimulation and start bleeding. Such defects tend to occur in patient with fragile unhealthy aortas and have a tendency to enlarge further due to the blood pressure in the aorta. In such cases the surgeons introduce a Hegars Dilator in to the aorta to plug the hole, thereby reducing blood loss and allowing the surgeon to place purse string sutures around the hole. The Hedgers Dilator is taken off, while the purse string sutures are tied to seal the connotation site. While it was possible to plug a hole on the aorta to a certain degree, suturing a vein graft into the hole, using a Hegars Dilator alone was simply not possible as it was difficult to keep the field clear enough for a more safe and perfect anastomoses and it was impossible to make sure that the intimae lining of the both aorta and sphenoid vein were included in the sutures.
To overcome the shortcomings, the present invention provides an inexpensive reusable instrument which could plug the punch hole on the aorta, keep the field clean thereby showing the edges of the punch hole clearly, and could ensure safe intimate anastamoses.lt comprises a holding part and an inserting part with grooves separated by a ridge which projects perpendicularly like a shelf from the rod with smooth edges.
The device may be made by Stainless steel or any suitable material.
Further objects, advantage and use of this invention will be more apparent from the ensuing description when read in conjunction with the accompanying drawing and wherein
Fig. 1 is a perspective view of proximal anastomotic device.
With reference to Fig. 1, proximal anastomotic device (5) made of

solid steel about 180 mm in length and about 5mm in diameter. It includes a holding part (1) and an inserting part (1 A) separated by a 2mm wide ridge (2), 25mm from the inserting end (IB) of the device projects perpendicularly like a shelf (3) 2mm from the steel rod. There are about three "U" shaped equidistant grooves (4) in the inserting end that are 1mm deep and 1mm wide. And these grooves extend 15mm from the inserting end (IB) of the device. The ridge (2) helps to prevent the blood from spurting directly in to the eye. The grooves (4) allow the needle to pass through the rod and there by include the aortic intimae in the suture). The holding part (1) is about 153 mm from the ridge.
The device allows surgeons to anatomies the proximal end of the vein graft or after distal anastomoses. The aortic site proposed for anastomoses is marked with diathermy. Two 3.0 polypropylene purse-string sutures are applied 1 cm apart from the site. The aorta is stabbed with a blade knife, followed by a 4mm aortic punch for the 5 mm proximal anastomotic device. The punch hole is blocked with the left index finger. Proximal anastomotic device is introduced into the punch hole. The purse strings are tightened just enough to prevent excessive bleeding. Once the device is in and the snares are tightened, the proximal vein anastomoses is performed with 5.0 polypropylene suture.
The sutures in the vein have to be inside out, and in the aorta, they have to be out side in. The aortic are placed so that the needle passes through the aortic wall, goes onto the groove (4) of the device and comes out between the aorta and the metal, thus taking the intimate. The sutures are placed all around the aortic punch hole and are loosely held. Once the suturing is complete, the device is removed, and the left index finger is

positioned on the aortic punch hole to prevent bleeding. The loose sutures are pulled and tightened with a nerve hook. The two ends of the sutures are held firmly with controlled traction by the assistant during the procedure. Once all the sutures are in place, the two ends are tied snugly. The two snares on the purse string are removed, and they are tied in place with care, to avoid a purse string effect. The vein is then desired and homeostasis is attained. While using the proximal anastomotic device no injury to the vein intimae is caused because nothing is introduced into the vein and the suturing procedure takes not more than 10 minutes. This device can also be used in Calcified aortas if a small island of normal aorta is available interiorly.
Even though many characteristics and advantages of the invention has been set forth in the foregoing description, together with structure and function of the invention, the disclosure is illustrative only. Changes may be made, especially in matters of size, shape, substances used within the principles of the invention to the full extent indicated by the broad general meaning of the terms in which the appended claims are expressed.

I CLAIM
1. A proximal anastomoses enabling device characterized by a ridge (2)
which projects perpendicularly in a ring like shelf (3) from the rod
with plurality of "U" shaped equidistant grooves at the inserting end.
2. The device as claimed in Claim 1 wherein the device is made of solid
steel.
3. The device as claimed in Claim 1&2 wherein the device has a total
length of about 180mm and rod diameter of about 5mm.
4. The device as claimed in Claim 1,2,& 3 wherein the device has a
ridge (2) about 25mm from the inserting end having a width of about
2mm which projects perpendicularly like shelf (3) about 3mm from
the rod.
5. The device as claimed in Claim 1, 2, 3 & 4 wherein the device has
about three "U" shaped equidistant grooves (4) with about 1mm width,
about 1mm depth and 15mm length from the inserting end (IB).
6. The device as claimed in Claim 1, 2, 3, 4 & 5 wherein the device has a
holding part (1) 15mm from the ridge (2) separating the inserting part
(lA).

Documents:

1037-che-2004 abstract-duplicate.pdf

1037-che-2004 abstract.jpg

1037-che-2004 abstract.pdf

1037-che-2004 claims-duplicate.pdf

1037-che-2004 claims.pdf

1037-che-2004 correspondence-others.pdf

1037-che-2004 correspondence-po.pdf

1037-che-2004 description (complete)-duplicate.pdf

1037-che-2004 description (complete).pdf

1037-che-2004 drawings-duplicate.pdf

1037-che-2004 drawings.pdf

1037-che-2004 form-1.pdf

1037-che-2004 form-18.pdf

1037-che-2004 form-26.pdf

1037-che-2004 form-3.pdf

1037-che-2004 form-9.pdf

1037-che-2004 others.pdf

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Patent Number

218526

Indian Patent Application Number

1037/CHE/2004

PG Journal Number

21/2008

Publication Date

23-May-2008

Grant Date

02-Apr-2008

Date of Filing

07-Oct-2004

Name of Patentee

DR. MURALI P. VETTATH

Applicant Address

KERA VIEW, # 28/1240, VELLIGAL, KOTTAKUNNU, NELLIKODE, KOZHIKODE 673 017,

Inventors:

#	Inventor's Name	Inventor's Address
1	MURALI P. VETTATH	KERA VIEW, # 28/1240, VELLIGAL, KOTTAKUNNU, NELLIKODE, KOZHIKODE 673 017,

PCT International Classification Number

A61B17/08

PCT International Application Number

N/A

PCT International Filing date

PCT Conventions:

#	PCT Application Number	Date of Convention	Priority Country
1			NA