Anesthesia for transmyocardial revascularization with autologous bone marrow stem cell transplantation

ABSTRACT

Transmyocardial Irevascularization with stem cell transplantation is an alternative treatment option for patients with refractory angina who are not suitable candidates for more conventional coronary intervention or surgery. It is done by creating transmyocardial channels that provide blood flow from the left ventricular chamber to areas of ischemic myocardium. The concept behind this technique is these channels causes increase vascular density around the channels that create Platelet activation with Growth factor release that assumes it promote amgioneogenesis when stem cell is transplanted in these channels [1] Innovations in this relatively new procedure include less invasive approaches and using it as an adjunctive or delivery modality for gene therapy. The original work in TMLR was done with a high powered infrared C02 laser. This laser is capable of creating 1 mm diameter channels with a single burst that penetrates the entire depth of the myocardium