BACKGROUND: Clinical studies suggest that transmyocardial laser revascularization may improve regional blood flow of the subendocardial layer. The vascular growth pattern of laser channels was analyzed. METHODS: Twenty pigs were randomized to undergo ligation of left marginal arteries (n = 5), to undergo transmyocardial laser revascularization of the left lateral ...

BACKGROUND: Clinical studies have demonstrated a significant reduction of cardiac index shortly after transmyocardial laser revascularization in patients with low ejection fraction. We analyzed the influence of transmyocardial laser revascularization on healthy myocardium in pigs. METHODS: Carbon dioxide channels were created in 20 pigs which were observed for 6 hours. ...

This article describes the design of an ongoing randomized trial intended to test whether patients who require elective vascular surgery would benefit from preoperative coronary artery revascularization prior to the vascular procedure. The primary objective is to determine whether coronary artery revascularization reduces long-term mortality (mean 3.5 years) in patients ...

Transmyocardial revascularization (TMR) is a new treatment modality under evaluation in patients with severely symptomatic, diffuse coronary artery disease, in whom the potential for medical or interventional management has been exhausted. Preliminary clinical trials show improved ischemic symptoms within the first 3 months in about 70% of TMR-treated patients. The ...

BACKGROUND: Patients with angina after a Q-wave myocardial infarction benefit from elective revascularization, but it is not known whether asymptomatic patients, including those with a totally occluded infarct-related artery, improve after revascularization. OBJECTIVE: To determine the effect of early postinfarction revascularization of asymptomatic patients on left ventricular remodeling. METHODS: We ...

BACKGROUND: This study was performed to assess patient preferences for consequences of 3 coronary revascularization procedures: angioplasty, conventional coronary bypass surgery, and minimally invasive coronary bypass surgery. METHOD: A nationwide sample of 3 types of respondents was recruited: respondents with no heart disease (n = 89), respondents with heart disease ...

OBJECTIVE: This experimental study was initiated to determine whether transmyocardial laser revascularization (TMLR) after acute myocardial ischemia may improve clinical chemistry and diminish the amount of necrosis. In addition, the influence of TMLR on healthy myocardium was analyzed. METHODS: The prolonged short-term effectiveness of TMLR was evaluated in 44 open-chest ...

BACKGROUND: Revascularization of occluded coronary arteries after myocardial infarction (MI) may restore flow to viable myocardium and improve ventricular function. The aim of this pilot study was to determine the potential utility of thallium-201 viability imaging for the prediction of recovery of regional ventricular function in patients undergoing revascularization of ...

Median sternotomy or combined multiple minimally invasive approaches are currently used to revascularize patients with multivessel coronary artery disease on the beating heart. We present here a new alternative approach for minimally invasive coronary surgery on the beating heart: the reversed-J inferior sternotomy. Through this approach, the left anterior descending, ...

Transmyocardial revascularization (TMR) is a new surgical procedure aimed at increasing blood flow to the ischemic myocardium. It has been used for treatment of patients with end-stage coronary artery disease who are not candidates for conventional measures such as medication, percutaneous transluminal coronary angioplasty, and coronary artery bypass grafting. TMR ...

There is a slowly increasing amount of information on surgical revascularization of high-risk patients with lower ejection fractions. Many of these patients, formerly thought to be best treated by transplantation, can undergo safe and effective revascularization with excellent medium-term results. Factors that are important in predicting the success of surgical ...

This report focuses on novel revascularization strategies presented at this meeting. An estimated 20 to 30% of symptomatic patients with advanced ischemic coronary disease are not eligible for standard therapeutic options including coronary angioplasty or coronary bypass surgery because of the extent and location of coronary stenoses, small distal vessels, ...

OBJECTIVES: This study evaluated the risks of sternal wound infections in patients undergoing myocardial revascularization using bilateral skeletonized internal mammary arteries (IMAs). BACKGROUND: The skeletonized IMA is longer than the pedicled one, thus providing the cardiac surgeon with increased versatility for arterial myocardial revascularization without the use of vein grafts. ...

We herein report the case of a patient with idiopathic thrombocytopenic purpura (Werlhof disease) and coronary artery disease undergoing myocardial revascularization. The use of monomeric immunoglobulins, corticosteroids, platelets transfusion, use of a cell saver, normothermic cardiopulmonary bypass, aprotinine and homologous blood transfusion were combined in order to minimize the risk ...

Myocardial viability assessment is useful in patients with severe coronary artery disease and severe left ventricular dysfunction. Whereas most studies have focused on recovery of regional function, there are emerging data on patient outcome. Review of these data suggests that patients with chronic ischemia, cardiomyopathy, and viable myocardium who are ...

OBJECTIVE: Integrated coronary revascularization combines minimally invasive coronary artery bypass grafting (MICABG) with left internal thoracic artery-left anterior descending artery grafting and percutaneous coronary intervention. We hypothesized that integrated coronary revascularization could result in successful revascularization in suitable patients with multivessel coronary artery disease. METHODS: Between September 1996 and January ...

BACKGROUND: Transmyocardial laser revascularization (TMLR) is a new procedure for the treatment of angina pectoris in which high power laser energy is used to create channels in ischemic myocardium. OBJECTIVE: To describe in detail the historical, experimental and state-of-the-art studies regarding TMLR. DATA SOURCES: The English-language literature published from 1966 ...

BACKGROUND: Significant regional variation in procedural frequencies has led to the development of the RAND and American College of Cardiology/American Heart Association (ACC/AHA) guidelines; however, they may be difficult to apply in clinical practice. The University of Maryland Revascularization Appropriateness Score (RAS) was created to address the need for a ...

BACKGROUND: Transmyocardial revascularization using a high-energy CO2 laser has emerged as a new therapeutic option for patients with severe diffuse coronary artery disease refractory to conventional modes of therapy. METHODS: From December 1994 to September 1997, 102 patients underwent isolated transmyocardial revascularization. The mean age was 56.7 +/- 9.2 years ...

BACKGROUND: Percutaneous coronary revascularization frequently relieves angina in patients with ischemic heart disease and may obviate the need for antianginal medications. OBJECTIVE: To examine the use of antianginal medications after successful percutaneous coronary revascularization. DESIGN: Retrospective cohort study of the Mayo Clinic PTCA [percutaneous transluminal coronary angioplasty] Registry. SETTING: Tertiary ...

The decision for revascularization in patients with intermediate coronary lesions remains a challenging topic, particularly when objective data of reversible ischemia are lacking. In some of the patients, coronary revascularization is performed or deferred without definitive evidence on the clinical significance of the coronary stenosis. We investigated the usefulness of ...

Transmyocardial laser revascularisation has emerged as a new therapeutic option for patients with severe diffuse coronary artery disease refractory to conventional modes of therapy. One hundred and two patients underwent isolated transmyocardial laser revascularisation between December 1994 and November 1997. After transmyocardial laser revascularisation, angina class improved from 2.56 +/- ...

Transmyocardial laser revascularization (TMR) has emerged as a promising therapy for ischemic heart disease in patients who are not candidates for more conventional therapies such as percutaneous transluminal coronary angioplasty or coronary artery bypass grafting. Although TMR provides symptomatic relief of angina and improved cardiovascular performance in a select patient ...

BACKGROUND AND AIM: The Asymptomatic Cardiac Ischemia Pilot is the first randomized trial where revascularization involved choice of either coronary bypass or angioplasty used in an early or a delayed symptom-driven approach. One-year outcomes were favorable (reduced recurrent ischemia and adverse outcomes) for an early revascularization strategy (within 4 weeks), ...

Within the past few years, transmyocardial laser revascularization (TMR) has attracted the attention of cardiologists and cardiac surgeons as a therapy for patients suffering from otherwise treatable coronary artery disease. Clinical studies have consistently shown symptomatic improvement that lasts at least 1 year in a majority of patients. The original ...

Transmyocardial laser revascularization is a promising surgical technique that relieves angina and improves subendocardial perfusion in patients with chronic ischemic heart disease refractory to medical management and not amenable to conventional revascularization techniques. We detail our laboratory experience at the Brigham and Women's Hospital with transmyocardial laser revascularization and discuss ...

BACKGROUND: We evaluated the prognostic value of preoperative parameters, surgical risk, functional benefits and long-term survival after myocardial revascularization in patients with established ischemic cardiomyopathy. METHODS: Seventy-one patients with ischemic cardiomyopathy, severe left ventricular dysfunction (left ventricular ejection fraction < 30%), and myocardial perfusion evaluated by Thallium-201 scintigraphy, were studied ...

Non-Q wave myocardial infarction and unstable angina remain major causes of morbidity and mortality in patients with atherosclerotic coronary artery disease. Judicious use of cardiac catheterization and coronary revascularization may further improve the prognosis of patients with these acute coronary syndromes (ACS). Patients with ACS at high risk for further ...

BACKGROUND: The mechanism of clinical improvement after transmyocardial laser revascularization (TMR) is unknown. One hypothesis holds that TMR causes increased myocardial perfusion through neovascularization. This study sought to determine whether angiogenesis occurs after TMR in a porcine model of chronic myocardial ischemia. METHODS: Six miniature pigs underwent subtotal left circumflex ...

The introduction of transmyocardial laser revascularization for ischaemic heart disease has brought with it new challenges for anaesthetists. These include acute deterioration of cardiac function, the need for emergency cardiopulmonary bypass and difficulty weaning from haemodynamic support. Recurrent arrhythmias can occur despite amiodarone prophylaxis. We describe our initial experience and ...

A variant of the Dor cardioprotective approach for reducing ventricular volume was applied to 12 consecutive postinfarction patients with akinetic anterior segments. Cardioplegia was avoided for restoration, but used for revascularization and valve replacement. The continually perfused beating open heart was used for protection during surgical anterior ventricular restoration (SAVR). ...

OBJECTIVES: Transmyocardial laser revascularization (TMLR) of the ischemic myocardium has been recognized as a potentially useful adjunct in the treatment of coronary arterial heart disease. Although there are methods to visualize the induced channels, they have been complex or concerned with long-term patency. The present work was designed as a ...

OBJECTIVE: Transmyocardial laser revascularization is an investigational technique for revascularizing ischemic myocardium in patients with inoperable coronary arterial disease. This study tests the hypothesis that laser revascularization prevents left ventricular functional deterioration and aneurysm formation after acute anteroapical myocardial infarction. METHODS: An ultrasonic ascending aortic flow probe and snares around ...

The distinction of left ventricular (LV) dysfunction caused by fibrosis from that arising from viable (hibernating and/or stunned) myocardium has important implications for the management of patients with ischemic cardiomyopathy. In many of these patients, LV function can improve significantly after revascularization. Using positron emission tomography (PET), increased glucose uptake ...

OBJECTIVE: To evaluate the efficacy of transmyocardial revascularization performed on patients with refractory class IV or unstable angina with a holmium:yttrium-aluminum-garnet laser. METHODS: Transmyocardial revascularization with a holmium:yttrium-aluminum-garnet laser was performed in 42 patients with refractory angina who were not candidates for percutaneous transluminal coronary angioplasty or coronary artery bypass ...

Nowadays cardiomyoplasty is used in cases of cardiac insufficiency as an alternative to cardiac transplant for patients with very developed ischemic cardiopathy, refractory to pharmacological treatment and without possibility of revascularization by using conventional techniques. OBJECTIVES: Our Cardiovascular Research Group has proposed as an objective, the detection of any possible ...

Measurements of resting myocardial blood flow (MBF) in patients with chronic left ventricular ischemic dysfunction by 15O-water with 13N-ammonia and PET have yielded conflicting results. The aim of this study was to perform a head-to-head comparison of both tracers in the same patient population and to answer the question of ...

BACKGROUND: Transmyocardial laser revascularization is a new therapeutic option for end-stage coronary artery disease if no other cardiological or cardiosurgical intervention is possible. Data are few on how patients fare after more than 1 year follow-up. METHODS AND RESULTS: From a total of 157 patients who were suggested for transmyocardial ...

OBJECTIVES: The purpose of our study was to assess the prognostic importance of the amount of dysfunctional but viable myocardium in revascularized patients with coronary artery disease (CAD) and left ventricular (LV) dysfunction. BACKGROUND: The amount of dysfunctional but viable myocardium predicts the functional improvement after revascularization and may offer ...

BACKGROUND: To achieve complete myocardial revascularization in patients with diffuse coronary artery disease and patients at high risk if they undergo cardiopulmonary bypass such as severe systemic disease or diffuse arteriosclerosis of the aorta, we have adopted the technique of combining direct coronary artery bypass grafting without cardiopulmonary bypass with ...

Results of a 30-patient pilot study of a recently developed percutaneous myocardial revascularization approach are described. The feasibility and positive safety profile of percutaneous myocardial revascularization are clearly demonstrated, with no mortality associated with the treatment or in the immediate post-treatment period and an incidence of only 1 major complication.

AIMS: There is little evidence to inform routine practice in the use of coronary angiography and revascularization procedures after acute myocardial infarction. Large differences in the uptake of these procedures have been reported but representative data are scarce. Outcome studies have produced opposing conclusions concerning the impact of the high ...

OBJECTIVES: The purpose of this study was to determine if early triage angiography with revascularization, if indicated, favorably affects clinical outcomes in patients with suspected acute myocardial infarction who are ineligible for thrombolysis. BACKGROUND: The majority of patients with acute myocardial infarction and other acute coronary syndromes are considered ineligible ...

Volatile anesthetics, particularly the new generation of agents, have a very rapid onset and offset of action. These properties allow for quick recovery from clinical anesthesia. Because there is additional evidence that these agents have protective effects during myocardial ischemia, there may be advantages for 'fast tracking' patients undergoing coronary ...

BACKGROUND: To assess the overuse and underuse of medical procedures, various methods have been developed, but their reproducibility has not been evaluated. This study estimates the reproducibility of one commonly used method. METHODS: We performed a parallel, three-way replication of the RAND-University of California at Los Angeles appropriateness method as ...

Preserved myocardial viability and recurrent symptomatic ischemia are the most widely accepted criteria indicating that coronary revascularization should take place in patients with postischemic left ventricular dysfunction. However, the presence of viable myocardium within the infarct zone does not necessarily imply recovery of function after coronary revascularization. The complex relation ...

Much attention has been paid to surgical intervention for those patients with small branches or diffuse stenotic lesions of the coronary arteries, for whom coronary artery bypass grafting can not be carried out at all. For resolving these problems, we have planned to supply arterial blood from the left ventricular ...

Direct myocardial revascularization (DMR), either surgical or catheter-based, uses lasers to create channels between ischemic myocardium and the left ventricular cavity to improve perfusion and decrease angina. This technique can also be used to deliver drugs to the damaged tissue. Candidates include patients with chronic, severe, refractory angina and those ...

By means of a special catheter system, a total of 76 endomyocardial laser channels were percutaneously produced in a controllable manner at selected sites in 6 beating canine hearts. Acute patency of channels (length = 4-11 mm, diameter = 0.5-1.2 mm) was documented angioscopically and histologically. This minimally invasive method ...

Since the advent of bypass surgery in the late 1960s and catheter-based intervention in the late 1970s, the treatment of coronary artery disease has been revolutionized by the concept of revascularization. Surveys have demonstrated that the practice patterns around the world and within the US are inconsistent for these important ...