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Eur J Cardiothorac Surg 1998;13:694-701
© 1998 Elsevier Science NL
a Division of Cardiovascular Surgery, Albert-Ludwigs-University, School of Medicine, Freiburg, Germany
b Division of Cardiovascular Surgery, Jikei University Medical Center, Tokyo, Japan
c Division of Thoracic Surgery, Sapporo University Medical Center, Sapporo, Japan
d Division of Nuclear Medicine, Albert-Ludwigs-University, School of Medicine, Freiburg, Germany
Received 10 November 1997; received in revised form 9 March 1998; accepted 17 March 1998.
Corresponding author. Division of Cardiovascular Surgery, Department of Surgery, University of Freiburg, Hugstetter Strasse 55, D-79106 Freiburg, Germany. Tel.: +49 761 2702818; fax: +49 761 2702550; e-mail: lutter@ch11.ukl.uni-freiburg.de
Objective: This experimental study in pigs was undertaken to answer the question whether TMLR after acute myocardial infarction may improve regional myocardial perfusion, left ventricular function and diminish myocardial necrosis in the area at risk. Methods: Thirty open-chest anesthetized pigs were observed for 6 h, six pigs served as controls. In 24 pigs, occlusion of the left anterior descending artery (LAD) beyond the first diagonal branch was performed: seven pigs had LAD occlusion only (ischemia group), and 17 pigs were treated by TMLR (using a CO2-laser, energy: 40 J) prior to coronary occlusion; nine pigs received one laser channel (1 mm diameter) per cm2 (laser group 1) and eight pigs two channels per cm2 in the LAD territory (laser group 2). Regional myocardial blood flow by microspheres, function (franc starling curves), histochemical assessment (triphenyl tetrazolium chloride, TTC and histology), were performed. Results: The lased pigs were less prone to ventricular fibrillation (laser group 2, 38%; laser group 1, 56%; ischemic group, 100%; P<0.05), and showed a significant smaller area of necrosis (TTC) in the area at risk (laser group 1, 23%; laser group 2, 14%; vs. ischemia group, 31%; P<0.01). There was no significant difference between laser-treated and ischemia hearts regarding the amount of blood flow into the infarcted LAD region and the maximal left ventricular stroke work index after 6 h (P=n.s). Regional myocardial blood flow: ischemia group, 4±5 ml/100 g/min; laser group 1, 3±10 ml/100 g/min, and laser group 2, 2±10 ml/100 g/min; maximal left ventricular stroke work index: ischemia group, 1.8 mJ/g; laser group 1, 2.1 mJ/g and laser group 2, 2.1 mJ/g. Conclusions: This model of acute regional ischemia demonstrates that CO2-laser revascularization diminish significantly the incidence of ventricular fibrillation and necrosis in the area at risk, and does not change regional myocardial perfusion and global left ventricular function. This experiment indicates that TMLR may be an alternative in treating advanced ischemic heart disease.
Key Words: Laser • Coronary disease • Ischemia • Myocardium • Transmyocardial laser revascularization
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