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Transmyocardial Laser Revascularization


Authors: M. Urban;  J. Pirk;  O. Szárszoi;  J. Vodičková;  I. Netuka
Authors place of work: Klinika kardiovaskulární chirurgie IKEM, přednosta: prof. MUDr. Jan Pirk, DrSc.
Published in the journal: Rozhl. Chir., 2009, roč. 88, č. 9, s. 489-492.
Category: Monothematic special - Original

Summary

Aim of the study:
The study looked at our results with transmyocardial laser revascularization. We also tried to ascertain the role of TMLR in current cardiothoracic surgical practice.

Methods:
Twenty patients underwent TMLR at IKEM Praha in a period from 1999 to 2007. Patients were categorized into two separate groups. The first included patients who had TMLR as a single procedure. Second group comprised patients who underwent combined TMLR and direct bypass revascularization. Outcome measures were reduction of angina, improvements in exercise tolerance and left ventricular systolic function.

Results:
Improvement in CCS classification of two and more classes has been achieved in almost half the patients who underwent TMLR combined with CABG, but only in 20% of patients after isolated TMLR. There was no change in left ventricular systolic function either in group of patients after TMLR or in group with hybrid procedure. There was also no change detected in myocardial perfusion in thallium scintigraphy studies.

Conclusion:
The study confirmed that TMLR has minimal perioperative complication rate and is safe. On the other hand our results failed to demonstrate any significant improvement in quality of life following TMLR. In our opinion TMLR should be reserved for symptomatic patients in CCS IV class when all other conventional treatment options have been exhausted.

Key words:
transmyocardial laser revascularization – coronary artery disease – angina


Zdroje

1. Sen, P. K., Udwadia, T. E., Kimare, S. G., Paruekar, G. B. Transmyocardial Acupuncture: New Approach to Myocardial Revascularization. J. Thorac. Cardiovasc. Surg., 1965; 50: 181–189.

2. Mirhoseini, M., Shelgikar, S., Cayton, M. M. New Concepts in Revascularization of the Myocardium. Ann. Thorac. Surg., 1988; 45: 415–420.

3. Pirk, J., Šetina, M. Principy transmyokardiální laserové revaskularizace. Lék. Listy, 1999; 42: 11.

4. Jos, A. P., van der Sloot, Heikeshoven, M., Tukkie, R., et al. Transmyocardial Revascularization Using XeCl Excimer Laser: Results of a Randomized Trial. Ann. Thorac. Surg., 2004; 78: 875–882.

5. Pirk, J., Wiendl, M., Červenka, V., Staněk, V., Kasalický, J., Mašín, J., et al. První zkušenosti s transmyokardiální laserovou revaskularizací s použitím CO2 laseru LUXOR 500/800. Cor. Vasa, 2002; 44(7–8): 353–355.

6. Allen, K. B., Dowling, R. D., Angell, W. W., et al. Transmyocardial Revascularization: 5-Year Follow up of a Prospective, Randomized Multicenter Trial. Ann. Thorac. Surg., 2004; 77: 1228–1234.

7. Burns, S. M., Sharples, L. D., Tait, S., Caine, N., et al. The Transmyocardial Laser Revascularization International Registry Report. European Heart Journal, 1999; 20: 31–37.

8. Šetina, M., Pirk, J., Wiendl, M., Rohn, V., Červenka, V., et al. Transmyokardiální laserová revaskularizace myokardu a koronární rekonstrukce bez použití mimotělního oběhu. Rozhl. Chir., 2000, roč. 79, č. 10, s. 464–467.

9. Burkhoff, D., Schmidt, S., Schulman, S. P., et al. Transmyocardial Laser Revascularization Compared with Continued Medical Therapy for the Treatment of Refractory Angina: Prospective Randomized Trial. Lancet, 1999, 354: 885–890.

10. Allen, K. B., Dowling, R. D., Fudge, T. L., et al. Comparison of Transmyocardial Laser Revascularization with Medical Therapy in Patients with Refractory Angina. N. Engl. J. Med., 1999; 341: 1029–1036.

11. Horvath, K. A., Aranki, S. F., Cohn, L. C., et al. Sustained Angina Relief 5 Years After Transmyocardial Laser Revascularization with CO2 Laser. Circulation, 2001; 104(Suppl 1): I-81–84.

12. Josefson, D. FDA Approves Heart Laser Treatment. Br. Med. J., 1998; 316: 1409.

Štítky
Surgery Orthopaedics Trauma surgery
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