BACKGROUND: When administered intravenously at the time of percutaneous coronary revascularization, glycoprotein IIb/IIIa receptor antagonists decrease the incidence of death and nonfatal myocardial infarction and the need for urgent revascularization. We hypothesized that long-term administration of oral glycoprotein IIb/IIIa antagonists, which block the aggregation of platelets, might stabilize intravascular plaque ...

Late patency of the infarct-related artery has been shown to be associated with improved long-term survival rates in observational cohort studies. However, there is a dearth of randomized trials correlating the opening of persistently occluded infarct-related arteries with clinical outcomes. Recent technological advances have improved the success and safety of ...

BACKGROUND: Many reports in the literature have found the use of invasive cardiac procedures in black patients to be less common than in white patients. These reports tend to have small numbers of black patients compared with white patients or rely on the information contained in claims or administrative data. ...

Compared with stable clinical conditions, unstable angina carries an increased risk of immediate and delayed cardiac adverse events after balloon coronary angioplasty. The influence of stent use in reducing these differences remains unknown. We analyzed the early (30 days) and late outcome of a cohort of 459 consecutive patients who ...

OBJECTIVES: We evaluated the short- and long-term clinical outcomes after percutaneous revascularization of the internal mammary artery (IMA) graft. BACKGROUND: Previous reports in a relatively small number of patients have indicated the safety of balloon angioplasty for the treatment of stenoses in the IMA graft. However, the use of alternative ...

OBJECTIVES: The purpose of this study was to determine the short-term effects of transmyocardial laser revascularization (TMR) on regional left ventricular systolic and diastolic function, myocardial blood flow (MBF) and myocardial water content (MWC). BACKGROUND: Clinical studies of TMR have noted a significant incidence of cardiac complications in the early ...

Mounting evidence showing that transmyocardial laser revascularization (TMR) is a safe and effective treatment for angina pectoris arrives just as an increasing number of patients who have undergone angioplasty and coronary artery bypass grafting experience failure with time. TMR, nevertheless, remains controversial. It appears to relieve the symptoms without treating ...

Cardiac procedures are performed less frequently in Canada than in the United States (US), yet rates of cardiac death and myocardial infarction are similar. We therefore sought to compare long-term symptoms and quality of life in Canadian and American patients undergoing initial coronary revascularization. The 161 patients enrolled in the ...

Myocardial revascularisation by laser is an emerging treatment for refractory angina in patients with coronary artery disease that is not amenable to conventional revascularisation. With the original technique, laser energy was applied to epicardial surface of the heart through a lateral thoracotomy; so-called transmyocardial laser revascularisation (TMR). It is now ...

The clinical and experimental data relevant to the theoretical mechanisms and clinical results of laser myocardial revascularization are reviewed. Both transmyocardial and percutaneous approaches are considered. Both types result in a reduction in anginal symptoms in patients refractory to conventional therapy and are likely to act through common pathways. The ...

The goals of treatment of ischemic heart disease are to relieve symptoms, prevent unstable angina or myocardial infarction, and prolong life. Over the past four decades, significant advances in therapy have occurred, initially involving revascularization procedures. Although coronary bypass surgery and percutaneous catheter-based interventions continue to play an important role ...

The value of 31P-magnetic resonance spectroscopy (MRS) as a possible tool to distinguish viable from non-viable tissue after myocardial infarction was analysed in humans. Fifteen patients 3 weeks after anterior myocardial infarction were studied with breath-hold cine MRI and 3D-CSI MRS (1.5 T system). 31P-spectra were obtained from infarcted as ...

BACKGROUND: Evidence from numerous studies of coronary angiography show differences between observers' assessments of 15% to 45%. The implication of this variation is serious: If readings are erroneous, some patients will undergo revascularization procedures unnecessarily and others will be denied an essential treatment. We evaluated the variation in interpretation of ...

BACKGROUND: Postinfarction ventricular septal rupture requires urgent closure. The role of systematic coronarography and coronary revascularization needs clarification. METHODS: Fifty-four patients who underwent patch closure of postinfarction ventricular septal defect were reviewed. A coronarography had been systematically and myocardial revascularization selectively (when significant coronary artery stenosis existed) performed. RESULTS: No ...

BACKGROUND AND OBJECTIVE: Transmyocardial revascularization (TMR) relieves angina and improves exercise tolerance in patients. Angiogenesis and myocardial denervation have been proposed as factors contributing to these benefits. To test whether radio frequency transmyocardial revascularization (RF-TMR) enhances angiogenesis and causes myocardial denervation. STUDY DESIGN/MATERIALS AND METHODS: RF-TMR channels were created in ...

Electromechanical mapping is a new diagnostic tool that can be used to identify viable myocardium. In the case reported here, the technique was used before intervention to map areas of viable myocardium; post-intervention mapping showed improved mechanical function of the revascularized areas. Electromechanical mapping offers the potential of assessing left ...

This article summarizes the design and findings -- both at 3 months and at 1 year follow-up -- of the Fragmin during Instability in Coronary Artery Disease (FRISC) II trial. This multicentre randomized trial compared both an early invasive with an early non-invasive stategy, and prolonged treatment with dalteparin as ...

Transmyocardial laser revascularization is an alternative treatment option for patients with refractory angina who are not suitable candidates for more conventional coronary intervention or surgery. The laser creates channels that provide blood flow from the left ventricular chamber to areas of ischemic myocardium. Results have been impressive with patients reporting ...

The use of angioplasty and stent techniques for revascularization of the cervical carotid bifurcation has been limited. Carotid endarterectomy has been demonstrated to be safe and effective in two multicentered randomized trials. In patients who are considered at risk for excessive morbidity and mortality from open surgical revascularization, carotid endovascular ...

We report our experience with emergency surgical revascularization in 3 patients who were in cardiogenic shock as a result of acute total occlusion of the left main coronary artery. Because they were in profound shock, 2 patients required mechanical support with extracorporeal membrane oxygenation before the operation. Another patient was ...

BACKGROUND: Total myocardial revascularization without the use of cardiopulmonary bypass (CPB) has been easily achieved using a combination of: a) deep pericardial sutures, b) right pleural herniation, and c) controlled intermittent hypotension. METHODS: Five hundred fifty patients underwent revascularization off CPB, with 344 patients having three-vessel disease, 150 two-vessel disease, ...

Ischemic heart disease is one of the most common disorders managed by family physicians. Stratifying patients according to risk is important early in the course of the disease to identify patients who require invasive (percutaneous or surgical) treatment. Physical examination, clinical history, noninvasive tests and angiography are all helpful in ...

Integrated myocardial revascularization combines the advantages of angioplasty, stenting, and minimally invasive surgery to revascularize patients with multivessel coronary artery disease without cardiopulmonary bypass. This pilot study showed that a new same-day management strategy, consisting of percutaneous coronary intervention followed immediately by minimally invasive surgery, was feasible and provided complete ...

OBJECTIVES: This study evaluates the feasibility and safety of a catheter-based laser system for percutaneous myocardial revascularization and analyses the first clinical acute and long-term results in patients with end-stage coronary artery disease (CAD) and severe angina pectoris. BACKGROUND: In patients with CAD and intractable angina who are not candidates ...

Despite the proven effectiveness of coronary bypass surgery and percutaneous angioplasty techniques, an increasing number of patients are presenting with severe, medically intractable angina who are not candidates for either procedure. Two alternative strategies, transmyocardial laser revascularization and exogeneous administration of angiogenic growth factors (therapeutic angiogenesis) are currently being evaluated ...

Transmyocardial laser revascularization (TMR) is a relatively new therapy for atherosclerotic coronary artery disease. Unlike well established surgical and percutaneous revascularization procedures, TMR is reserved for patients with advanced and severe forms of coronary artery disease that is unsuitable for other forms of revascularization. The results of TMR so far ...

OBJECTIVE: It is important to apply the same rules used for classical coronary revascularization to beating heart coronary surgery. The surgeons must have a strategy, and be prepared for adverse events, and complications. METHODS: A careful analysis of the coronarography is essential to predict eventual contraindications or causes of possible ...

We report the use of transmyocardial laser revascularization in combination with partial left ventriculectomy for treatment of end-stage dilated ischemic cardiomyopathy. The disappearance of the reversible perfusion defects in the treated left ventricular territories and improvement of the systolic function led us to believe that the simultaneous use of these ...

The purpose of this study was to visualize the spatial patterns and connection of channels created after percutaneous transmyocardial revascularization (PTMR) in normal porcine hearts, and to estimate the relative contributions of transmyocardial and coronary perfusion. Six pigs underwent PTMR creating channels using radiofrequency ablative energy. Three-dimensional computed tomography imaging ...

BACKGROUND: The development of new technologies such as transmyocardial laser revascularization and, more recently, local delivery of angiogenic growth factors has refocused attention on the surgical management of diffuse coronary artery disease. In some cases, coronary endarterectomy is also technically feasible. To facilitate decision-making among these options, we reviewed our ...

BACKGROUND: The construction of subendocardial channels to perfuse ischemic areas of the myocardium has been investigated since the 1950s. We assessed the safety and efficacy of transmyocardial revascularization with a carbon dioxide laser in patients with refractory angina and left ventricular free-wall ischemia that was not amenable to direct coronary ...

The purpose of this study was to determine the impact of race on the treatment of peripheral artery occlusive disease (PAOD) and to examine the role of access to care and disease distribution on the observed racial disparity. The study was performed as a retrospective analysis of hospital discharge abstracts ...

In this paper, some controversial points regarding myocardial its definition hibernation are discussed, including its definition (improvement in contractility versus improvement in clinical or functional status or in prognosis), the histology and pathophysiology (dedifferentiation versus cellular degeneration) and the responses to the diagnostic methods more currently utilised, stress echocardiography and ...

Coronary artery bypass surgery on the beating heart either via a left anterior small thoracotomy (LAST) or a median sternotomy is becoming increasing popular world-wide. Concern still remains about the potential for a temporary regional myocardial ischaemia associated with the stabilisation and occlusion of the coronary during construction of the ...

Because angiogenesis appears to be a fundamental mechanism associated with direct myocardial revascularization (DMR) procedures, it seems natural to combine the overall field of DMR with angiogenesis therapy. Such myocardial treatment strategy can thus be termed "mechanical approach for myocardial angiogenesis." In this article, we review the myocardial response to ...

BACKGROUND: Laser transmyocardial revascularization (TMR) appears to improve symptoms in patients with refractory angina. However, it remains a controversial treatment modality for relieving ischemia. We conducted our study in dogs and evaluated the changes in morphology and histology of the myocardium after laser TMR. METHODS: The hearts of 10 mongrel ...

Recent advances in techniques of coronary artery exposure and myocardial stabilization in off-pump myocardial revascularization have provided cardiac surgeons with a wide variety of new devices and techniques. Until recently, the main obstacle to performing complete myocardial revascularization without using cardiopulmonary bypass (CPB) has been the technical difficulties of exposing ...

OBJECTIVE: We reviewed our experience with myocardial revascularization without cardiopulmonary by-pass (CPB) to evaluate early- and mid-term results compared with those obtained using CPB. METHODS: From May 21, 1997 to November 1998, 747 patients had isolated myocardial revascularization, 480 without CPB (Group A) and 267 with CPB (Group B). Exposure ...

BACKGROUND: The leading cause of death in patients hospitalized for acute myocardial infarction is cardiogenic shock. We conducted a randomized trial to evaluate early revascularization in patients with cardiogenic shock. METHODS: Patients with shock due to left ventricular failure complicating myocardial infarction were randomly assigned to emergency revascularization (152 patients) ...

AIM: To compare the clinical characteristics, at the time of admission and after coronary revascularization by bypass surgery, among British patients of Indo-Asian and white Caucasian descent. METHOD: One hundred and ninety-four pairs of patients admitted between November 1994 and January 1997 were matched for age (within 3 years), sex ...

OBJECTIVE: Transmyocardial laser revascularisation (TMLR) is used to treat endstage coronary heart disease. There is evidence that angina is significantly reduced after TMLR. However, the precise mechanism by which symptoms disappear remains unknown. The objective of the present study was to examine the potential effects of TMLR on high-energy phosphates ...

OBJECTIVE: To assess the blood flow supply offered to the myocardium by surgical revascularization using bilateral internal mammary (IMAs) and gastroepiploic (GEA) arteries. METHODS: Two-year assessment by exercise thallium myocardial scintigraphy without medical treatment was performed in 122 patients (mean age 61 +/- 9 years) who underwent coronary artery bypass ...

The most frequent cause of cardiogenic shock complicating acute myocardial infarction is extensive myocardial damage involving a relevant amount of myocardium. Treatment is aimed at support for the circulation with the use of drugs and mechanical devices and at restoration of perfusion to the ischemic myocardium as soon as possible. ...

Use of catheter-based and surgical coronary revascularization has steadily increased in North America. Introduction of catheter-based "new devices," including intracoronary stents, has expanded the range of patients who can be treated with percutaneous approaches. We sought to address trends in the practice of catheter-based and surgical coronary revascularization during 1989 ...

BACKGROUND: Previous studies showed that thallium scintigraphy and dobutamine echocardiography were accurate, noninvasive ways of predicting contractile recovery after revascularization in patients with left ventricular (LV) dysfunction. However, the prognostic impact of such methods remains uncertain. METHODS AND RESULTS: We prospectively studied 137 consecutive patients with coronary disease and LV ...

BACKGROUND: Transmyocardial laser revascularization (TMR) is an emerging therapy for the treatment of coronary artery disease not amenable to percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass surgery (CABG). OBJECTIVE: To summarize the experimental and clinical experience to date with TMR. Specifically, the history of the technique, preclinical and ...

Transmyocardial revascularization (TMR) is a novel strategy designed to improve anginal symptoms and enhance myocardial perfusion by applying laser energy directly into the ischemic myocardium. Preliminary surgical experiences using TMR have indicated a significant reduction in angina severity, improved quality of life, and some evidence of improved myocardial perfusion in ...

BACKGROUND: Beating heart surgery is a technique currently used for revascularization of the anterior and inferior territory. However, revascularization of the circumflex artery is more problematic. With a specific apparatus and surgical technique, we have extended the use of beating heart surgery to more than 90% of patients with multivessel ...

OBJECTIVES: This analysis was carried out to determine if revascularized patients derive benefit from the 3-hydroxy-3 methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor pravastatin. BACKGROUND: The HMG-CoA reductase inhibitors result in substantial reductions in serum cholesterol and stabilization of atherosclerotic plaques in patients with coronary artery disease. METHODS: Pravastatin was found ...

Myocardial hibernation is defined as a state of chronically reduced contractility in response to a reduction in blood supply and the ability to recover function after revascularization. There is controversy about the chronicity of a reduction in myocardial perfusion for induction of the adaptive mechanisms of hibernation. A search was ...