Transmyocardial laser revascularization.
نویسندگان
چکیده
Low-powered lasers were first used in the early 1980s to produce transventricular channels as an adjunct to coronary artery bypass graft surgery (CABG). Early results were encouraging, but because of the combined procedure, could not be attributed directly to use of the laser [1]. High-powered lasers were introduced into clinical practice in 1990 [2]. These lasers are powerful enough to create a transmyocardial channel with minimal thermal damage to surrounding tissues [3]. Clinical studies, using transmyocardial laser revascularization (TMR) as the sole operative therapy for patients with severe and diffuse coronary artery disease (CAD) who have Class III or IV angina, and are on medical therapy, have been conducted since 1993. Based on the results of these studies, the FDA granted approval for the use of TMR as a sole therapy. Clinical studies are currently underway to assess the results of combined TMR and CABG [4]. Results of four controlled randomized studies have been published [5-8]. The data from two of these studies formed the basis for FDA approval of two different types of laser systems. The results of these studies have not provided any additional insights into the mechanism of action of TMR, which remains the Achilles' heel of this procedure. In this review, background information about the TMR procedure will be discussed along with an analysis of the recently published randomized studies.
منابع مشابه
Mechanism of TMR; the debate continues.
Clinical experience with transmyocardial laser revascularization has increased significantly over the last few years. Since several transmyocardial laser revascularization studies reported an apparent effect on the relief of angina and the FDA approved reimbursement of transmyocardial laser revascularization procedures in the USA, thousands of patients have been treated worldwide with different...
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OBJECTIVES The purpose of this study was to investigate whether a novel fibroblast growth factor-2 gene formulation, providing a localized and sustained availability of the adenoviral vector from a collagen-based matrix, in combination with CO 2 transmyocardial laser revascularization would lead to an enhanced angiogenic response and improved myocardial function. METHODS Fibroblast growth fac...
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AIMS This report aimed to provide an analysis of the data submitted from Europe and Asia on transmyocardial laser revascularization. METHODS AND RESULTS Prospective data was recorded on 967 patients with intractable angina not amenable to conventional revascularization in 21 European and Asian centres performing transmyocardial laser revascularization using the PLC Medical Systems CO2 laser. ...
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AIMS Transmyocardial laser revascularization is a treatment for patients with severe angina pectoris not eligible for conventional revascularization. The effects on myocardial function and reversible ischaemia have not been clarified. METHODS AND RESULTS One hundred patients with refractory angina not eligible for conventional revascularization were randomized 1:1 to receive continued optimal...
متن کاملMyocardial laser revascularization.
Some patients with severe angina have coronary artery disease which is unsuitable for conventional forms of revascularization — coronary angioplasty/ stenting or coronary artery bypass surgery. These patients have usually undergone previous revascularization procedures and have disease which is diffuse and affects the distal part of the coronary circulation. Transmyocardial laser revascularizat...
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عنوان ژورنال:
- Journal of cardiothoracic and vascular anesthesia
دوره 18 1 شماره
صفحات -
تاریخ انتشار 2001