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Ann Thorac Surg 2006;82:771
© 2006 The Society of Thoracic Surgeons

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Correspondence

Light and Ice Cream

National Heart Lung and Blood Institute, National Institutes of Health, Building 10, CRC, Rm 6-5140, Bethesda, MD 20892

(Email: khorvath{at}nih.gov).

To the Editor:

The Annals of Thoracic Surgery published the results of an experimental study [1] that demonstrated evidence of denervation after transmyocardial revascularization (TMR) with a holmium:yttrium–aluminum–garnet laser and an ultrasonic device. As this work was done in the normal canine myocardium, its applicability to the clinical scenario is questionable, but of greater concern is the incorrect interpretation afforded by the concomitant invited commentary [2].

In this opinion the authors lump together laser revascularization by three different wavelengths of light, cryoablation, radiofrequency, and mechanical methods as the same. This oversimplified view is analogous to stating that the different methods of TMR are akin to different flavors of ice cream. This ignores the well-established fact that with lasers alone, each wavelength of light incites a different tissue reaction and therefore may work by different mechanisms. Furthermore, to give credence to denervation as the key mechanism of laser TMR ignores the thallium, sestamibi, positron-emission tomography, magnetic resonance imaging, echocardiography, and exercise tolerance test data from over 2,000 patients that demonstrate improvement after TMR that can not be attributed to the nervous system [3]. They cite the absence of angina in diabetic patients as similar to TMR patients, but diabetics continue to have infarctions and worsening function, whereas the opposite is seen after TMR treatment. In addition, they surmise that catheter-based percutaneous laser revascularization failed because it could not reach the nerves. More likely it was because the device created less than half the number of the reported surgical TMR channels to a depth of less than one sixth the thickness of the myocardium.

Nihilistic commentaries on revascularization are not new and if we heeded them we would not be using internal mammary arteries except for Vineberg procedures.

	References

Top References

 

1. Asai T, Yammamoto S, Ishino K, et al. Time-dependent regional myocardial denervation as a nonspecific response to transmyocardial laser revascularization Ann Thorac Surg 2005;80:1362-1370.[Abstract/Free Full Text]
2. Beek JF, van der Sloot JAP. Invited commentary Ann Thorac Surg 2005;80:1369-1370.[Free Full Text]
3. Bridges CR, Horvath KA, Nugent WC, et al. The society of thoracic surgeons practice guideline seriestransmyocardial laser revascularization. Ann Thorac Surg 2004;77:1494-1502.[Abstract/Free Full Text]

This article has been cited by other articles:

				J. F. Beek, J. A.P. van der Sloot, and M. J.C. van Gemert Reply Ann. Thorac. Surg., August 1, 2006; 82(2): 771 - 772. [Full Text] [PDF]

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 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 Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Horvath, K. A. Search for Related Content PubMed PubMed Citation Articles by Horvath, K. A. Related Collections Coronary disease Related Article