Transmyocardial laser revascularization for inoperable coronary artery disease

Current Opinion in Cardiology

Volumn 12, Issue 5, 1997, Pages 441-446

  Sundt III, Thoralf M ^a   Rogers, Joseph G ^a  

^a BARNES JEWISH HOSPITAL   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ANGINA PECTORIS; AUTOPSY; CARBON DIOXIDE LASER; CORONARY ARTERY DISEASE; EXCIMER LASER; EXERCISE TOLERANCE; FIBEROSCOPE; HEART MUSCLE PERFUSION; HEART MUSCLE REVASCULARIZATION; HISTOLOGY; HOLMIUM LASER; HUMAN; LASER SURGERY; PRIORITY JOURNAL; REVIEW; SYMPTOM; TREATMENT OUTCOME;

EID: 0030869533     PISSN: 02684705     EISSN: None     Source Type: Journal    
DOI: 10.1097/00001573-199709000-00002     Document Type: Review

References (23)

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8. Frazier OH, Cooley DA, Kadipasaoglu KA, Pehlivanoglu S, Lindenmeir M, Barasch E, Conger JL, Wilansky S, Moore WH: Myocardial revascularization with laser: preliminary findings. Circulation 1995, 92(suppl II):II-58-II-65.
9. Cooley DA, Frazier OH, Kadipasaoglu KA, Lindenmeir MH, Pehlivanoglu S, Kolff JW, Wilansky S, Moore WH: Transmyocardial laser revascularization: clinical experience with twelve-month follow-up. J Thorac Cardiovasc Surg 1996, 111:791-799. The authors summarize their experience with 1-year follow-up for 21 consecutive patients undergoing TMR at the THI. This is the first clinical report of a series. It is also the most extensively evaluated both preoperatively and postoperatively with dobutamine echocardiography, PET and SPECT imaging as well as assessment of angina class. Their decision to use subregion analysis in the evaluation of PET scans should be read carefully and critically.
10. Horvath KA, Mannting F, Cummings N, Sherman SK, Cohn LH: Transmyocardial laser revascularization: operative techniques and clinical results at two years. J Thorac Cardiovasc Surg 1996, 111:1047-1053. This report from the BWH describes their experience with 20 patients with a mean follow-up of 11 ± 8 months. These early results are similar to those reported by Cooley et al. (J Thorac Cardiovasc Surg 1996, 111:791-799). although SPECT imaging suggested improved perfusion in treated areas.
11. 2 laser system represents the largest published series. Results are essentially the same as those reported for the smaller BWH experience. A critical reading of the data, particularly with respect to perfusion analysis, is recommended.
12. Cooley DA, Frazier OH, Kadipasaoglu K, Pehlivanoglu S, Shannon R, Angelini P: Transmyocardial laser revascularization: anatomic evidence of long-term channel patency. Tex Heart Inst J 1994, 21:220-224.
13. Burkhoff D, Fisher PE, Apfelbaum M, Kohmoto T, DeRosa CM, Smith CR: Histologic appearance of transmyocardial laser channels after 4 1/2 weeks. Ann Thorac Surg 1996, 61:1532-1535. These investigators present autopsy results from a patient who died 4.5 weeks after operation secondary to complications unrelated to failure of the treatment. No patent channels were identified.
14. Gassler N, Wintzer HO, Stubbe HM, Wullbrand A, Helmchen U: Transmyocardial laser revascularization: histological features in human nonresponder myocardium. Circulation 1997, 95:371-375. Histologic features of human myocardium taken from patients at autopsy who died at varying times following TMR are presented. All channels were closed. The authors label these individuals as nonresponders and imply that histologic findings may be different among successfully treated responding patients.
15. Krabatsch T, Schaper F, Leder C, Tulsner J, Thalmann U, Hetzer R: Histological findings after transmyocardial laser revascularization. J Card Surg 1996, 11:326-331. Histologic material from eight patients in whom a total of 250 channels had been created were examined without evidence for patent channels in patients dying early or late after treatment. Networks of new capillaries were observed within granulation tissue at the site of tissue injury; however, no connections were observed between these capillaries and the ventricular cavity. The authors conclude that the clinical effects of TMR are unlikely based on the principle of the amphibian heart.
16. Hardy RI, Bove KE, James FW, Kaplan S, Goldman L: A histologic study of laser-induced transmyocardial channels. Lasers Surg Med 1987, 6:563-573.
17. Horvath KA, Smith WJ, Laurence RG, Schoen FJ, Appleyard RF, Cohn LH: Recovery and viability of an acute myocardial infarct after transmyocardial laser revascularization. J Am Coll Cardiol 1995, 25:258-263.
18. 2 laser "revascularization" of the myocardium. Lasers Surg Med 1991, 11:35-52.
19. Whittaker P, Kloner RA, Przyklenk K: Laser-mediated transmural myocardial channels do not salvage acutely ischemic myocardium. J Am Coll Cardiol 1993, 22:302-309.
20. Kadipasaoglu KA, Pehlivanoglu S, Conger JL, Sasaki E, DeVillalobos DH, Cloy M, Piluiko V, Clubb FJ, Cooley DA, Frazier OH: Long- and short-term effects of transmyocardial laser revascularization in acute myocardial ischemia. Lasers Surg Med 1997, 10:6-14. These authors have been long-standing advocates of the patent channel hypothesis. In a canine model of acute ischemia. TMR was carried out either immediately prior to epicardial coronary ligation or 3 months prior to induction of acute ischemia. Among animals with acute ischemia, there was no effect of TMR. Among animals with chronic ischemia, TMR appeared to limit infarct expansion and improve ventricular function.
21. Kohmoto T, Fisher PE, Gu A, Zhu SM, Yano OJ, Spotnitz HM, Smith CR, Burkoff D: Does blood flow through holmium: YAG transmyocardial laser channels? Ann Thorac Surg 1996, 61:861-868. This series of experiments from a laboratory that continues to provide outstanding experimental studies concerning the mechanism of TMR provides the most convincing evidence against the patent channel theory. Using a sophisticated model, isolated canine hearts underwent evaluation of transmyocardial blood flow using colored microspheres acutely and chronically after TMR. The results indicate small amounts of intramyocardial flow in animals acutely after laser treatment but no flow in animals studied 2 weeks after TMR.
22. Whittaker P, Rakusan K, Kloner RA: Transmyocardial channels can protect ischemic tissue. Circulation 1996, 93:143-152. These authors have previously published results of TMR with a Holmium:YAG laser in a canine model of acute ischemia, concluding that there was no immediate benefit. In this study channels were made with hollow-bore needles or holmium:YAG lasers in rat hearts 2 months prior to epicardial coronary occlusion. There was greater protection in animais in whom channels were created with hollow-bore needles than with lasers. Because no increase in capillary density was identified, the authors conclude that channels may be able to provide blood flow directly into the ventricular cavity.
23. Fleischer KJ, Goldschmidt-Clermont PJ, Fonger JD, Hutchins GM, Hruban RH, Baumgartner WA: One-month histologic response of transmyocardial laser channels with molecular intervention. Ann Thorac Surg 1996, 62:1051-1058. In a nonischemic porcine model an attempt was made to increase neovascularization secondary to TMR via the addition of growth factors. Local vascular endothelial growth factor increased inflammation around channels but not angiogenesis.