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Abstract

Apparatus and method for performing surgical procedures within the mediastinum and within the pericardium include an endoscopic cannula having at least one lumen, a transparent tip, and an endoscope for introduction into the mediastinum and optionally into the pericardium via a single subxiphoid incision. A cavity may be initially dilated for advancing the endoscopic cannula using a dilating tool have an inner cannula and an outer expansible sheath that exerts a lateral-expansive, tissue-dilating force against the surrounding tissue cavity to allow the larger endoscopic cannula to be introduced into the mediastinum. Other surgical instruments, including a pericardial entry instrument are positioned through a lumen of the endoscopic cannula to cut a flap of the pericardium and create a small opening through which other surgical instruments such as an ablation probe or a restraining jacket may be introduced. All regions of the heart may be accessed by sweeping the endoscopic cannula around the heart through an aperture near the apex of the heart. Such access facilitates placement of epicardial tacks about the annulus of the mitral valve for supporting a tensioned suture or band to decrease the size of the mitral annulus to repair a regurgitant valve. Tensioning bands may also be tacked to the pericardium in order to inhibit distention of the heart.

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First Claim