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Ann Thorac Surg 2000;69:1811-1816
© 2000 The Society of Thoracic Surgeons

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Original articles: Cardiovascular

Excimer versus carbon dioxide transmyocardial laser revascularization: effects on regional left ventricular function and perfusion

^a Division of Cardiac Surgery, Harvard Medical School, Brigham and Women’s Hospital, Boston, Massachusetts, USA

Address reprint requests to Dr Byrne, Division of Cardiac Surgery, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115
e-mail: jgbyrne{at}bics.bwh.harvard.edu

Background. Transmyocardial laser revascularization (TMR) has been established with the carbon dioxide (CO₂) laser. The largely unstudied excimer laser creates channels through chemical bond dissociation instead of thermal ablation, thereby avoiding thermal injury. We sought to compare the effects of CO₂ and excimer TMR in a porcine model of chronic ischemia.

Methods. Pigs underwent ameroid constrictor placement on the circumflex artery to create chronic ischemia. TMR was performed with CO₂ (n = 8) or excimer (n = 8) laser 6 weeks later; controls (n = 7) had ameroid placement only. Regional myocardial blood flow (RMBF), determined by radioactive microspheres, and regional myocardial function, determined by percent segmental shortening (%SS), were assessed 18 weeks after ameroid placement.

Results. Values are mean ± SD. In the ischemic zone, RMBF (mL/min/g) was improved in the CO₂ (0.73 ± 0.19) and excimer (0.78 ± 0.22) groups when compared with controls (0.55% ± 0.12%, p < 0.05). %SS was also improved in the CO₂ (15.2% ± 5.5%) and excimer (15.3% ± 5.1%) groups when compared with controls (8.0% ± 4.2%, p < 0.05).

Conclusions. Excimer and CO₂ TMR significantly improve RMBF and regional function in this porcine model of chronic myocardial ischemia despite fundamentally different tissue interactions.

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