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Ann Thorac Surg 1999;68:460-468
© 1999 The Society of Thoracic Surgeons
a Departments of Department of Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
b Department of Physiology and Biophysics, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
c Department of Anesthesiology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
Address reprint requests to Dr Hirsch, Division of Cardiovascular Surgery, Department of Surgery, Queen Elizabeth II Health Sciences Center, 1796 Summer St, Room 2271, Halifax, NS B3H 3A7, Canada
Background. Transmyocardial laser revascularization has been used as an indirect approach to improve myocardial perfusion in patients with refractory angina not amenable to conventional therapy. Three mechanisms have been proposed for its therapeutic effects: direct perfusion of the ischemic myocardium through patent channels; induction of angiogenesis; and regional denervation. We sought to determine whether transmyocardial laser revascularization modifies afferent and efferent axonal function within the affected myocardium.
Methods. Studies were performed in 9 dogs that were artificially ventilated and underwent thoracotomy. Changes in ventricular dynamics and intrinsic cardiac neuronal activity were monitored before and after creating 20 transmural channels in the left ventricular ventral free wall with a holmium:yttrium-aluminum-garnet laser in response to three stimuli: application of veratridine or bradykinin to the epicardial sensory neurites of intrinsic cardiac afferent neurons; sympathetic or parasympathetic efferent neuronal activation either electrically (4 V, 10 Hz, 5 ms) or chemically (nicotine, 5 µg/kg intravenously), and direct cardiomyocyte ß-adrenergic receptor stimulation (isoproterenol hydrochloride, 5 µg intravenously).
Results. Sensory neurites of right atrial afferent neurons in the studied epicardial region responded similarly to chemical stimulation before and after transmyocardial laser revascularization. Transmyocardial laser treatment did not reduce local ventricular contractile responses to direct activation of sympathetic or parasympathetic efferent neurons by electrical or chemical means, nor did it affect cardiomyocyte augmentor responses elicited by exogenous ß-adrenergic receptor challenge.
Conclusions. As transmyocardial laser revascularization does not affect afferent or efferent axonal function in the affected ventricle, the efficacy of this form of therapy cannot be ascribed to local denervation.
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Ann. Thorac. Surg. 1999 68: 468-469.
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