TY - JOUR
T1 - Recovery and viability of an acute myocardial infarct after transmyocardial laser revascularization
AU - Horvath, Keith A.
AU - Smith, Wendell J.
AU - Laurence, Rita G.
AU - Schoen, Frederick J.
AU - Appleyard, Robert F.
AU - Cohn, Lawrence H.
N1 - Funding Information:
Although percutaneous transluminal coronary angioplasty and coronary artery bypass graft surgery are proved methods of treating ischemic heart disease, a significant number of patients are not amenable to these therapies. Attempts to revascularize ischemic myocardium by direct methods predate the advent of bypass grafting and angioplasty. Myopexy, omentopexy and poudrage were performed by Beck (1) in an effort to create collateral blood flow. Later, Vineberg (2) introduced implantation of the internal mammary artery into the myocardium as a means of revascularization. Another method, as performed by Sen and others (3-11), used acupuncture to create transmyocardial channels. Building on these techniques, Mirohseini and Cayton (12-17) developed the use of a laser to form transmyocardial channels that would allow ventricular blood to directly perfuse ischemic myocardium. Since then, others (18-22) have performed transmyocardial laser revascu- Boston, Massachusetts. Support for this research was provided in part by Laser Engineering, Inc., Milford, Massachusetts and the Brigham Surgical Group Foundation, Inc., Boston, Massachusetts.
PY - 1995/1
Y1 - 1995/1
N2 - Objectives. The short- and long-term effectiveness of transmyocardial laser revascularization was evaluated in the setting of an acute myocardial infarction. Background. Theoretically, transmyocardial laser revascularization allows direct perfusion of the ischemic area as ventricular blood flows through the channels to the myocardium. Methods. Infarcts were created by coronary occlusion in 30 sheep. Eighteen of these sheep were studied to assess short-term efficacy. The infarct was reperfused after 1 h by either removing the occlusion or by laser drilling using a high power carbon dioxide laser. The occlusions were left in place for the control group. To monitor regional recovery, percent systolic shortening was measured. To evaluate long-term effectiveness, 12 additional sheep underwent creation of an infarct. Six were treated with the laser, and six were untreated. The animals were restudied 30 days later. Results. In the short-term experiment, the control and reperfusion groups exhibited no recovery of regional contractility. The laser group demonstrated improvement throughout the recovery period. There was a significant difference in the area of necrosis within the same area at risk (reperfusion group 44 ± 6% and control group 39 ± 5% vs. laser group 6 ± 2%). After 30 days, none of the control animals showed evidence of contraction in the infarct, whereas the laser-treated animals did. Histologic analysis of the laser-treated infarcts revealed patent channels surrounded by viable myocardium. The control-group infarcts were necrotic and scarred. Conclusions. On the basis of both short- and long-term improved contractility, as well as diminished necrosis in the area at risk, these results indicate that transmyocardial laser revascularization may be an alternative method of treating ischemic heart disease.
AB - Objectives. The short- and long-term effectiveness of transmyocardial laser revascularization was evaluated in the setting of an acute myocardial infarction. Background. Theoretically, transmyocardial laser revascularization allows direct perfusion of the ischemic area as ventricular blood flows through the channels to the myocardium. Methods. Infarcts were created by coronary occlusion in 30 sheep. Eighteen of these sheep were studied to assess short-term efficacy. The infarct was reperfused after 1 h by either removing the occlusion or by laser drilling using a high power carbon dioxide laser. The occlusions were left in place for the control group. To monitor regional recovery, percent systolic shortening was measured. To evaluate long-term effectiveness, 12 additional sheep underwent creation of an infarct. Six were treated with the laser, and six were untreated. The animals were restudied 30 days later. Results. In the short-term experiment, the control and reperfusion groups exhibited no recovery of regional contractility. The laser group demonstrated improvement throughout the recovery period. There was a significant difference in the area of necrosis within the same area at risk (reperfusion group 44 ± 6% and control group 39 ± 5% vs. laser group 6 ± 2%). After 30 days, none of the control animals showed evidence of contraction in the infarct, whereas the laser-treated animals did. Histologic analysis of the laser-treated infarcts revealed patent channels surrounded by viable myocardium. The control-group infarcts were necrotic and scarred. Conclusions. On the basis of both short- and long-term improved contractility, as well as diminished necrosis in the area at risk, these results indicate that transmyocardial laser revascularization may be an alternative method of treating ischemic heart disease.
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U2 - 10.1016/0735-1097(94)00410-R
DO - 10.1016/0735-1097(94)00410-R
M3 - Article
C2 - 7798512
AN - SCOPUS:0028817591
SN - 0735-1097
VL - 25
SP - 258
EP - 263
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 1
ER -