HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Keith A. Horvath David A. Fullerton Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Horvath, K. A. Articles by Fullerton, D. A. Search for Related Content PubMed PubMed Citation Articles by Horvath, K. A. Articles by Fullerton, D. A. Related Collections Coronary disease

Ann Thorac Surg 2001;72:1997-2002
© 2001 The Society of Thoracic Surgeons

---

Original article: cardiovascular

Functional comparison of transmyocardial revascularization by mechanical and laser means

^a Division of Cardiothoracic Surgery, Northwestern University Medical School, Chicago, Illinois, USA
^b Selective Genetics, Inc, San Diego, California, USA

* Address reprint requests to Dr Horvath, Division of Cardiothoracic Surgery, Northwestern University Medical School, 201 E Huron St, Galter 10-105, Chicago, IL 60611, USA
e-mail: khorvath{at}nmh.org

Presented at the Poster Session of the Thirty-seventh Annual Meeting of The Society of Thoracic Surgeons, New Orleans, LA, Jan 29–31, 2001.

Background. As a result of the clinical benefit observed in angina patients treated by transmyocardial revascularization (TMR) with a laser, interest in mechanical TMR has been renewed. Although the injury induced by mechanical TMR is similar to laser TMR, the resultant impact on myocardial contractility is unknown. The purpose of this study was to determine whether mechanical TMR improves ventricular function as compared with laser TMR in chronically ischemic myocardium.

Methods. After establishing an area of chronic myocardial ischemia, 25 domestic pigs were randomized to treatment by: excimer laser (group I), a hot needle (50°C) (group II), a normothermic needle (group III), an ultrasonic needle (40 KHz) (group IV), or no treatment (group V). All devices create a transmural channel of the same diameter; 22 ± 1 transmural channels were created in each animal. Regional myocardial contractility was assessed by measuring ventricular wall thickening at rest and with dobutamine stress echocardiography. Six weeks after revascularization, the animals were restudied at rest and with stress. Postsacrifice and histologic analysis of angiogenesis and TMR effects was then assessed.

Results. Laser TMR provided significant recovery of ischemic myocardial function. This improvement in contractility after laser TMR was a 75% increase over the baseline function of the ischemic zone (p < 0.01). Mechanical TMR provided no significant improvement in function posttreatment. In fact, TMR achieved with an ultrasonic needle demonstrated a 40% worsening of the contractility versus the pretreatment baseline (p < 0.05). Histologic analysis demonstrated a significant increase in new blood vessels in the ischemic zone after laser TMR, which was not demonstrated for any of the other groups (p < 0.05). Additionally, evaluation of the mechanical TMR channels demonstrated significant scarring, which correlated with the functional results.

Conclusions. Using devices to create an injury analogous to the laser, mechanical TMR failed to improve the function of chronically ischemic myocardium. Only laser TMR significantly improved myocardial function.

This article has been cited by other articles:

				K. A. Horvath and Y. Zhou Transmyocardial Laser Revascularization and Extravascular Angiogenetic Techniques to Increase Myocardial Blood Flow Card. Surg. Adult, January 1, 2008; 3(2008): 733 - 752. [Full Text]

				S. K. Mouli, J. Fronza, R. Greene, E. S. Robert, and K. A. Horvath What is the Optimal Channel Density for Transmyocardial Laser Revascularization? Ann. Thorac. Surg., October 1, 2004; 78(4): 1326 - 1331. [Abstract] [Full Text] [PDF]

				C. R. Bridges, K. A. Horvath, W. C. Nugent, D. M. Shahian, C. K. Haan, R. J. Shemin, K. B. Allen, and F. H. Edwards The Society of Thoracic Surgeons practice guideline series: transmyocardial laser revascularization Ann. Thorac. Surg., April 1, 2004; 77(4): 1494 - 1502. [Abstract] [Full Text] [PDF]

				M. Ruel, R. A. Kelly, and F. W. Sellke Therapeutic Angiogenesis, Transmyocardial Laser Revascularization, and Cell Therapy Card. Surg. Adult, January 1, 2003; 2(2003): 715 - 750. [Full Text]

				W. Li, K. Tanaka, Y. Chiba, T. Kimura, K. Morioka, T. Uesaka, A. Ihaya, M. Sasaki, T. Tsuda, and N. Yamada Role of MMPs and plasminogen activators in angiogenesis after transmyocardial laser revascularization in dogs Am J Physiol Heart Circ Physiol, January 1, 2003; 284(1): H23 - H30. [Abstract] [Full Text] [PDF]

				C. Heilmann, P. von Samson, K. Schlegel, T. Attmann, B.-U. von Specht, F. Beyersdorf, and G. Lutter Comparison of protein with DNA therapy for chronic myocardial ischemia using fibroblast growth factor-2 Eur. J. Cardiothorac. Surg., December 1, 2002; 22(6): 957 - 964. [Abstract] [Full Text] [PDF]