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The Annals of Thoracic Surgery, Vol 45, 415-420, Copyright © 1988 by The Society of Thoracic Surgeons
M Mirhoseini, S Shelgikar and MM Cayton
The concept of direct revascularization of ischemic myocardium by
transmural left ventricular conduits has been investigated by several
researchers. Early success was followed by closure of the pathways by
fibrosis and scarring caused by mechanical trauma. The CO2 laser was
examined as an alternative method of creating channels. Early experiments
supported the hypothesis that laser channels would perfuse ischemic areas
and would remain patent. Histological examination showed patent,
endothelialized channels more than 2 years following operation in the
experimental model. A clinical protocol was designed to assess the results
of laser revascularization in a series of 12 patients. Patients selected
were candidates for bypass grafting, but because of the coronary artery
pathology involved, it was thought bypass grafting alone would result in
incomplete revascularization. None of the 12 patients have died. Follow-up
ranges from 3 to 32 months. Postoperative thallium stress tests and left
ventriculography indicate that channels have remained patent and that they
perfuse the myocardium. Direct laser revascularization of the myocardium
may offer a viable adjunct in the treatment of ischemic heart disease.
ARTICLES
New concepts in revascularization of the myocardium
Department of Cardiothoracic Surgery, St. Luke's Hospital, Milwaukee, WI.
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T. Kohmoto, P. E. Fisher, A. Gu, S.-M. Zhu, O. J. Yano, H. M. Spotnitz, C. R. Smith, and D. Burkhoff Does Blood Flow Through Holmium:YAG Transmyocardial Laser Channels? Ann. Thorac. Surg., March 1, 1996; 61(3): 861 - 868. [Abstract] [Full Text]
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