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

This Article 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 Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Vincent, J. G. Articles by Maass, D. Search for Related Content PubMed PubMed Citation Articles by Vincent, J. G. Articles by Maass, D.

European Journal of Cardio-Thoracic Surgery, Vol 11, 888-894, Copyright © 1997 by European Association for Cardio-thoracic Surgery

ARTICLES

End stage coronary disease treated with the transmyocardial CO2 laser revascularization: a chance for the 'inoperable' patient

JG Vincent, P Bardos, J Kruse and D Maass
Herz-Zentrum Bodensee, Kreuzlingen, Switzerland.

OBJECTIVE: The aim of this study is to evaluate the short and mid-term efficacy of the Transmyocardial High Power CO2 Laser Revascularisation (TMLR) as a last resource method for end-stage coronary disease patients. METHOD AND PATIENTS: The High Power CO2 Laser 800 W Heart Laser (PLC Medical Systems) was used since February 1994 to treat 268 patients. In 52% of the cases (140) the indication for TMLR treatment was virtual inoperability by the classical bypass revascularisation. In the other 128 patients (48%), where only an incomplete revascularisation was expected, the TMLR was combined with a feasible bypass revascularisation (CABG). Of all patients, 71% were operated on 1-5 times before and or treated by several percutaneous transluminal coronary angioplasty (PTCA). All patients were sufferers of angina pectoris and most were classified Canadian Cardiac Society (CCS) 3-4, despite the maximal medical treatment. The ejection fraction was normal in 13% of patients only, and in 47% of them it was below 40% (10-68%). RESULTS: The operation itself was generally well tolerated. We lost only one patient at the table. The hospital survival was 89.2%; 88.2% in the combined group and 90.3% in the TMLR only group. After the routine follow up screening 3, 6 and 12 months postoperatively (262 patients--131 TMLR and 131 TMRL/CABG), 40% of the TMLR patients upgraded into the functional class CCS 0-1; the combined group of patients scored up even in 84%. All considering their quality of life to be 'better than years ago'. The ergometry stress test, impossible for most of them before, became feasible and better in 80% of the patients. In the follow up period of the combined group, another 6 (4.7%), and in the TMLR only group, 12 (9.4%) patients died. CONCLUSION: The short and middle term results of this--until now the largest single institution series of TMLR treated patients--were that patients almost without exception were refused for any kind of surgery by several other centres; this shows an acceptable survival rate and a surprising level of pain relief, increased activity and better quality of life then ever expected. In our experience, TMLR is a suitable method for treatment of end stage coronary disease, if all standard measures, medical therapy, PTCA and redo coronary revascularisation possibilities are exhausted. The favourable results imply the question as to whether this method will become an alternative for a second bypass operation in the future. The TMLR as an alternative for heart transplant is already a reality for some of our patients.

This article has been cited by other articles:

				M. B. Leon, R. Kornowski, W. E. Downey, G. Weisz, D. S. Baim, R. O. Bonow, R. C. Hendel, D. J. Cohen, E. Gervino, R. Laham, et al. A Blinded, Randomized, Placebo-Controlled Trial of Percutaneous Laser Myocardial Revascularization to Improve Angina Symptoms in Patients With Severe Coronary Disease J. Am. Coll. Cardiol., November 15, 2005; 46(10): 1812 - 1819. [Abstract] [Full Text] [PDF]

				A. Sanni and J. Dunning Is transmyocardial revascularisation of benefit in addition to coronary artery bypass grafting for patients with diffuse coronary disease? Interactive CardioVascular and Thoracic Surgery, December 1, 2004; 3(4): 581 - 585. [Abstract] [Full Text] [PDF]

				M. Loubani, D. Chin, J. N. Leverment, and M. Galinanes Mid-term results of combined transmyocardial laser revascularization and coronary artery bypass Ann. Thorac. Surg., October 1, 2003; 76(4): 1163 - 1166. [Abstract] [Full Text] [PDF]

				M. Saririan and M. J. Eisenberg Myocardial laser revascularization for the treatment of end-stage coronary artery disease J. Am. Coll. Cardiol., January 15, 2003; 41(2): 173 - 183. [Abstract] [Full Text] [PDF]

				X M Mueller, H T Tevaearai, P Chaubert, C-Y Genton, and L K von Segesser Does laser injury induce a different neovascularisation pattern from mechanical or ischaemic injuries? Heart, June 1, 2001; 85(6): 697 - 701. [Abstract] [Full Text]

				G. C. Hughes, A. S. Shah, B. Yin, M. Shu, C. L. Donovan, D. D. Glower, J. E. Lowe, and K. P. Landolfo Early postoperative changes in regional systolic and diastolic left ventricular function after transmyocardial laser revascularization: A comparison of holmium:YAG and CO2 lasers J. Am. Coll. Cardiol., March 15, 2000; 35(4): 1022 - 1030. [Abstract] [Full Text] [PDF]

				K. B. Allen, R. D. Dowling, A. J. DelRossi, F. Realyvasques, E. A. Lefrak, T. A. Pfeffer, T. L. Fudge, M. Mostovych, D. Schuch, S. Szentpetery, et al. TRANSMYOCARDIAL LASER REVASCULARIZATION COMBINED WITH CORONARY ARTERY BYPASS GRAFTING: A MULTICENTER, BLINDED, PROSPECTIVE, RANDOMIZED, CONTROLLED TRIAL J. Thorac. Cardiovasc. Surg., March 1, 2000; 119(3): 540 - 549. [Abstract] [Full Text] [PDF]

				K. B. Allen, R. D. Dowling, T. L. Fudge, G. P. Schoettle, S. L. Selinger, D. M. Gangahar, W. W. Angell, M. R. Petracek, C. J. Shaar, and W. W. O'Neill Comparison of Transmyocardial Revascularization with Medical Therapy in Patients with Refractory Angina N. Engl. J. Med., September 30, 1999; 341(14): 1029 - 1036. [Abstract] [Full Text] [PDF]

				X. M. Mueller, H. T. Tevaearai, C.-Y. Genton, P. Chaubert, and L. K. von Segesser Are there vascular density gradients along myocardial laser channels? Ann. Thorac. Surg., July 1, 1999; 68(1): 125 - 129. [Abstract] [Full Text] [PDF]

				G. Lutter, J. Martin, N. Takahashi, M. Yoshitake, J. Schwarzkopf, E. Nitzsche, and F. Beyersdorf Transmyocardial laser revascularization: experimental studies in healthy porcine myocardium Ann. Thorac. Surg., June 1, 1999; 67(6): 1708 - 1713. [Abstract] [Full Text] [PDF]

				X. M. Mueller, H. H. Tevaearai, C.-Y. Genton, D. Bettex, and L. K. von Segesser Transmyocardial laser revascularisation in acutely ischaemic myocardium Eur. J. Cardiothorac. Surg., February 1, 1998; 13(2): 170 - 175. [Abstract] [Full Text] [PDF]