Acute and chronic effects of transmyocardial laser revascularization in the nonischemic pig myocardium by using three laser systems
✍ Scribed by Igor A. Genyk; Martin Frenz; Beat Ott; Beat H. Walpoth; Thomas Schaffner; Thierry P. Carrel
- Publisher
- John Wiley and Sons
- Year
- 2000
- Tongue
- English
- Weight
- 1015 KB
- Volume
- 27
- Category
- Article
- ISSN
- 0196-8092
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✦ Synopsis
Background and
Objective: Transmyocardial laser revascularization (TMLR) improves symptoms in patients with coronary heart disease. It is based on the hypothesis of direct perfusion of ischemic myocardium by means of laser-created channels. Three different lasers were used to study alternative effects on myocardium. Study Design/Materials and Methods: The present study was conducted to evaluate comprehensively and compare the short and long-term tissue effects and the basic interaction mechanisms of CO 2 , Ho:YAG, and Er:YAG laser radiation with myocardium. The dynamics of laserinduced impacts in gel used as tissue phantom was visualized by timeresolved flash photography. Pressure measurements performed during perforation of myocardium in vitro revealed the explosive character of the ablation process. Channels made into the left ventricle of normal pig hearts were examined immediately and 6 weeks after creation. Results: Regardless of laser source, all channels became occluded within 6 weeks by scar. Minimal acute thermal damage by Er:YAG laser corresponded to smaller scars. Pulsed Ho:YAG caused stronger tissue tearing than continuous wave CO 2 irradiation. An increased volume density of intramyocardial vessels was found about the scars 6 weeks after treatment with all lasers.
Conclusion:
The laser sources permitted to study outcome of pressure effects and thermal damage in vivo. There were only minor differences between the three laser systems used. Rapid channel occlusion suggests that rather than revascularization, subsidiary physiologic tissue effects elicited by the thermal, oxidative, or mechanical action of the laser impact may contribute to the beneficial clinical effects of TMLR.