Transmyocardial revascularization devices: technology update
نویسندگان
چکیده
Transmyocardial laser revascularization (TMR) emerged as treatment modality for patients with diffuse coronary artery disease not amendable to percutaneous or surgical revascularization. The procedure entails the creation of laser channels within ischemic myocardium in an effort to better perfuse these areas. Currently, two laser devices are approved by the US Food and Drug Administration for TMR - holmium:yttrium-aluminum-garnet and CO2. The two devices differ in regard to energy outputs, wavelengths, ability to synchronize with the heart cycle, and laser-tissue interactions. These differences have led to studies showing different efficacies between the two laser devices. Over 50,000 procedures have been performed worldwide using TMR. Improvements in angina stages, quality of life, and perfusion of the myocardium have been demonstrated with TMR. Although several mechanisms for these improvements have been suggested, evidence points to new blood vessel formation, or angiogenesis, within the treated myocardium, as the major contributory factor. TMR has been used as sole therapy and in combination with coronary artery bypass grafting. Clinical studies have demonstrated that TMR is both safe and effective in angina relief long term. The objective of this review is to present the two approved laser devices and evidence for the safety and efficacy of TMR, along with future directions with this technology.
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...
متن کاملMyocardial performance after transmyocardial revascularization with CO(2)laser. A dobutamine stress echocardiographic study.
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 کاملThe Society of Thoracic Surgeons practice guideline series: Antibiotic prophylaxis in cardiac surgery, part II: Antibiotic choice.
BACKGROUND Patients with chronic severe angina refractory to medical therapy who cannot be completely revascularized with either percutaneous catheter intervention or coronary artery bypass graft surgery present clinical challenges. Transmyocardial laser revascularization, either as sole therapy or as an adjunct to coronary artery bypass graft surgery, may be appropriate for some of these patie...
متن کاملImproved myocardial perfusion after transmyocardial laser revascularization in a patient with microvascular coronary artery disease
We report the case of a 59-year-old woman who presented with symptoms of angina that was refractory to medical management. Although her cardiac catheterization revealed microvascular coronary artery disease, her symptoms were refractory to optimal medical management that included ranolazine. After undergoing transmyocardial revascularization, her myocardial ischemia completely resolved and her ...
متن کامل