Document Detail


Transmyocardial laser revascularization: clinical experience with twelve-month follow-up.
MedLine Citation:
PMID:  8614139     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We are investigating a new technique for myocardial revascularization in which an 800 W carbon dioxide laser is used to drill 1 mm diameter channels into a beating heart after left thoracotomy. Clotting occludes the channels on the subepicardium, and in the long-term setting, blood from the left ventricular cavity flows through these channels to perfuse the ischemic subendocardium. To test the efficacy of this technique in a preliminary clinical trial, we used it as sole therapy for 21 consecutive patients. All patients had hibernating myocardium, reduced coronary flow reserve, or both, had distal diffuse coronary artery disease, and had angina refractory to normal therapy. Eight patients were excluded from follow-up because of death (n=5), rerevascularization (n=2), or diaphragmatic paralysis resulting in postoperative respiratory incapacity (n=1). In the remaining 13 patients available for follow-up, the mean angina class (Canadian Cardiovascular Society) was 3.7 +/- 0.4 before operation and 1.8 +/- 0.6 12 months after operation (p < 0.01). Mean resting left ventricular ejection fraction was 48% +/- 10% before operation and 50% +/- 8% at 12-month follow-up. At 12 months, resting mean subendocardial/subepicardial perfusion ratio had increased by 20% +/- 9% in septal regions treated by laser but decreased by 2% +/- 5% in untreated regions (n=11, p <.001). These results suggest that revascularization by this laser technique positively affects subregional myocardial perfusion and may result in clinical benefits for patients with reversible myocardial ischemia. Studies to date have not demonstrated significant changes in global and regional ventricular contractile function.
Authors:
D A Cooley; O H Frazier; K A Kadipasaoglu; M H Lindenmeir; S Pehlivanoglu; J W Kolff; S Wilansky; W H Moore
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  111     ISSN:  0022-5223     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  1996 Apr 
Date Detail:
Created Date:  1996-06-03     Completed Date:  1996-06-03     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  791-7; discussion 797-9     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiovascular Surgery, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Coronary Disease / physiopathology,  surgery*
Follow-Up Studies
Humans
Laser Therapy*
Middle Aged
Myocardial Contraction
Myocardial Revascularization / methods*
Stroke Volume
Treatment Outcome
Ventricular Function, Right

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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