Does laser type impact myocardial function following transmyocardial laser revascularization?

Soren K. Estvold, Frederico Mordini, Yifu Zhou, Zu X. Yu, Vandana Sachdev, Andrew Arai, Keith A. Horvath

Research output: Contribution to journalArticlepeer-review

Abstract

Background Transmyocardial laser revascularization (TMR) is currently clinically performed with either a CO2 or Ho:YAG laser for the treatment of severe angina. While both lasers provide symptomatic relief, there are significant differences in the laser-tissue interactions specific to each device that may impact their ability to enhance the perfusion of myocardium and thereby improve contractile function of the ischemic heart. Methods A porcine model of chronic myocardial ischemia was employed. After collecting baseline functional data with cine magnetic resonance imaging (MRI) and dobutamine stress echo (DSE), 14 animals underwent TMR with either a CO2 or Ho:YAG laser. Transmural channels were created with each laser in a distribution of 1/cm2 in the ischemic zone. Six weeks post-treatment repeat MRI as well as DSE were obtained after which the animals were sacrificed. Histology was preformed to characterize the laser-tissue interaction. Results CO2 TMR led to improvement in wall thickening in the ischemic area as seen with cine MRI (40.3% vs. baseline, P < 0.05) and DSE (20.2% increase vs. baseline, P < 0.05). Ho:YAG treated animals had no improvement in wall thickening by MRI (-11.6% vs. baseline, P = .67) and DSE (-16.7% vs. baseline, P = 0.08). Correlative semi-quantitative histology revealed a significantly higher fibrosis index in Ho:YAG treated myocardium versus CO2 (1.81 vs. 0.083, P < 0.05). Conclusions In a side-by-side comparison CO2 TMR resulted in improved function of ischemic myocardium as assessed by MRI and echocardiography. Ho:YAG TMR led to no improvement in regional function likely due to concomitant increase in fibrosis in the lasered area.

Original languageEnglish (US)
Pages (from-to)906-911
Number of pages6
JournalLasers in Surgery and Medicine
Volume42
Issue number10
DOIs
StatePublished - Dec 2010

Keywords

  • Ho:YAG laser
  • laser-tissue interaction
  • myocardial function

ASJC Scopus subject areas

  • Surgery
  • Dermatology

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