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Ann Thorac Surg 2000;69:1995
© 2000 The Society of Thoracic Surgeons

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Correspondence

Reply

^a Institute of Cardiovascular Diseases, 4A Dr. JJ Nagar, Mogappair, Chennai 600 050, India

To the Editor

We appreciate the comments of Actis Dato and coworkers concerning our article "Transmyocardial laser revascularization: early results and 1-year follow-up." The letter very rightly points out the beneficial effects of combining TMLR with CABG, which not only improves the perioperative outcome but is also expected to provide long-term benefit due to optimal myocardial revascularisation.

As has been presented in our article, the univariate analysis of isolated TMLR data revealed that it is not suitable for patients with unprotected myocardium (left main disease, poorly developed collaterals) and left ventricular dysfunction. In such cases, adding a bypass graft to any one of the graftable vessels even after endarterectomy provides immediate support to the ischemic myocardium and reduces perioperative mortality.

We have combined TMLR with CABG (n = 41) and CABG + endarterectomy (n = 44) in patients with diffuse coronary artery disease to achieve optimal myocardial revascularisation, and our results have been encouraging [1]. It is of particular interest to note that 24 of them had LAD endarterectomy and 18 had multiple endarterectomies.

Regarding the observation of desaturated blood coming out through the laser hole, we have seen that the initial spurt of blood just after lasing the channel is always of bright red color and is supposed to be from the left ventricle. In fact, it is considered to be a sign of transmural penetration of the laser. Later on, of course, the channel does not remain patent in its whole length and desaturated blood may come from a small vein in the viscinity of the channel that got opened up due to laser penetration.

It is difficult to imagine how a laser channel can reduce the resistance in the coronary bed so as to improve the runoff in the native vessel or the bypass graft immediately. But it is possible that laser-induced neoangiogenesis may in due course expand the coronary vascular bed and improve the long-term patency of the bypass graft by improving the distal runoff.

References

1. Cherian KM, Agarwal R, Sankar NM. Transmyocardial laser revascularization. In: Karp RB, ed. Advances in cardiac surgery, Vol. 11. Mosby Inc, 1999:55–68.

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Kotturathu M. Cherian Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Agarwal, R. Articles by Cherian, K. M. Search for Related Content PubMed Articles by Agarwal, R. Articles by Cherian, K. M. Related Collections Related Article