new approach to revascularize the ischemic myocardium

ABSTRACT

There are an increased number of treatment alternatives available today, as compared to as little as ten ears ago, for those with ischemic heart disease. Surgical procedures are more sophisticated, a wide array of medications are available, and numerous catheter techniques have evolved to treat patients with coronary artery disease. These technical advanced, combined with life style modifications, have contributed to a decline in age adjusted death rates. Despite these advances there remains a significant number of patients with myocardial ischemia who are not candidates for conventional therapies or who do not respond to regimes of treatment Transmyocardial Laser Revascularization, investigated by us in our laboratory and clinically for more than two decades, may be a viable adjunctive or alternative therapy. A high power carbon dioxide laser is used to create channels from the epicardial surface of the heart through the left ventricular wall, and penetrating the endocardium. Perfusion occurs from the blood supply in the left ventricular chamber which fills the channels in retrograde fashion. Blood from the channels seeps into the system of myocardial sinusoids and provides nourishment for the ischemic tissue. The channels remain patent Other methods utilized to perfuse myocardial tissue from the ventricular chamber provided immediate protection but quickly closed due to tissue reaction and scarring. The laser vaporizes tissue within milliseconds, there is little pyknosis or scarring, damage to adjacent cells is minimal The background for a clinical study utilizing the laser as sole therapy was preceded by extensive experimental investigation and early clinical experience which combined laser revascularization with coronary artery bypass. Patient evaluation, follow-up and preliminary results in a group of 24 patients in the sole therapy group will be discussed. The follow-up time ranges from three to 15 months. Evaluation includes nuclear, studies, stress testing, echocardiography, and cardiac catheterization, Early results suggest that a group of patients may benefit from this technique