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Eur J Cardiothorac Surg 1998;13:170-175
© 1998 Elsevier Science NL
a Clinic for Cardiovascular Surgery, CHUV (Centre Hospitalier Universitaire Vaudois), CH-1011 Lausanne, Switzerland
b Institute of Pathology, CHUV (Centre Hospitalier Universitaire Vaudois), CH-1011 Lausanne, Switzerland
c Department of Anaesthesia, CHUV (Centre Hospitalier Universitaire Vaudois), CH-1011 Lausanne, Switzerland
Received 30 September 1997; received in revised form 10 November 1997; accepted 19 November 1997.
Corresponding author. Tel.: +41 21 3142280; fax: +41 21 3142278; e-mail: Xavier.Mueller@chuv.hospvd.ch
Objective: Although recent experience suggests that transmyocardial laser revascularisation (TMLR) relieves angina, its mechanism of action remains undefined. We examined its functional effects and analysed its morphological features in an animal model of acute ischaemia. Methods: A total of 15 pigs were randomised to ligation of left marginal arteries (infarction group, n=5), to TMLR of the left lateral wall using a holmium:yttrium–aluminium garnet (Ho:YAG) laser (laser group, n=5), and to both (laser–infarction group, n=5). All the animals were sacrificed 1 month after the procedure. Haemodynamics and echocardiography with segmental wall motion score were carried out at both time intervals (scale 0–3: 0, normal; 1, hypokinesia; 2, akinesia; 3, dyskinesia). Histology of the involved area was analysed. Results: Laser group showed no change of the segmental wall motion score of the involved area 30 min after the laser channels were made (score: 0±0). Infarction and laser–infarction groups both showed a persistent and definitive increase of the segmental wall motion score (at 30 min: 1.6±0.3 and 2±0, respectively; at 1 month: 1.8±0.2 and 1.8±0.4, respectively). These increases were all statistically significant in comparison with baseline values (P<0.5), however comparison between infarction and laser–infarction groups showed no significant difference. On macroscopic examination of the endocardial surface, no channel was opened. On histology, there were signs of neovascularisation around the channels in the laser group, whereas in the laser–infarction group the channels were embedded in the infarction scar. Conclusions: In this acute pig model, TMLR did not provide improvement of contractility of the ischaemic myocardium. To the degree that the present study pertains to the clinical setting, the results suggest that mechanisms other than blood flow through the channels should be considered, such as a laser-induced triggering of neovascularisation or neural destruction.
Key Words: Laser • Revascularization • Myocardium
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