HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Gassler, N. Articles by Stubbe, H. M. Search for Related Content PubMed PubMed Citation Articles by Gassler, N. Articles by Stubbe, H. M.

European Journal of Cardio-Thoracic Surgery, Vol 12, 25-30, Copyright © 1997 by European Association for Cardio-thoracic Surgery

ARTICLES

Clinical data and histological features of transmyocardial revascularization with CO2-laser

N Gassler and HM Stubbe
Department of Thoracic and Cardiovascular Surgery, University Hospital Eppendorf, Hamburg, Germany.

OBJECTIVE: TMR is a modern therapeutic approach in the treatment of patients with severe chronic ischemic cardiac disease. Clinical data from world-wide over 1800 TMR-treated patients shows that TMR can improve cardiac status in cases without preoperative congestive heart failure. The mechanisms underlying beneficial TMR-effects are not well understood. METHODS: The 61 patients of the Hamburg University TMR- trial were treated with a CO2-laser. Clinically, both a 6 and a 12 months follow-up were performed. Pathologically, hearts from four patients who died 3 (2 persons), 16 and 150 days after TMR, respectively, were examined by trichrom-and immunostaining (anti- collagen types I and III). RESULTS: In a 6 months follow-up clinical data indicates that TMR was able to improve clinical status in 50 of 61 laser-treated patients (82%), whereas 5 (8.2%) did not show any benefit evaluated by CCS grading and six (9.8%) died. CCS grade reduction was found in 22 patients with a 12 months follow-up (28 patients still in evaluation). Days 30, mortality amounted to 6.5%; late mortality (over 30 days) was 3.3%. Histopathological investigations revealed tissue remodeling comparable with different stages of wound healing. The cicatricial tissue in the original laser-created channels displayed a stronger immunostaining for collagen type III than for type I. CONCLUSIONS: Clinically, TMR improves cardiac function in some patients with severe ischemic cardiac disease, but pathophysiological data as well as morphological features from human myocardium could not explain this phenomenon. Therefore, TMR treatment should be used only as 'the last chance' in patients with severe angina pectoris.

This article has been cited by other articles:

				M. B. Leon, R. Kornowski, W. E. Downey, G. Weisz, D. S. Baim, R. O. Bonow, R. C. Hendel, D. J. Cohen, E. Gervino, R. Laham, et al. A Blinded, Randomized, Placebo-Controlled Trial of Percutaneous Laser Myocardial Revascularization to Improve Angina Symptoms in Patients With Severe Coronary Disease J. Am. Coll. Cardiol., November 15, 2005; 46(10): 1812 - 1819. [Abstract] [Full Text] [PDF]

				M. Saririan and M. J. Eisenberg Myocardial laser revascularization for the treatment of end-stage coronary artery disease J. Am. Coll. Cardiol., January 15, 2003; 41(2): 173 - 183. [Abstract] [Full Text] [PDF]

				X M Mueller, H T Tevaearai, P Chaubert, C-Y Genton, and L K von Segesser Does laser injury induce a different neovascularisation pattern from mechanical or ischaemic injuries? Heart, June 1, 2001; 85(6): 697 - 701. [Abstract] [Full Text]

				P. M. Portner, P. G. M. Jansen, P. E. Oyer, D. R. Wheeldon, and N. Ramasamy Improved outcomes with an implantable left ventricular assist system: a multicenter study Ann. Thorac. Surg., January 1, 2001; 71(1): 205 - 209. [Abstract] [Full Text] [PDF]

				G. C. Hughes, A. S. Shah, B. Yin, M. Shu, C. L. Donovan, D. D. Glower, J. E. Lowe, and K. P. Landolfo Early postoperative changes in regional systolic and diastolic left ventricular function after transmyocardial laser revascularization: A comparison of holmium:YAG and CO2 lasers J. Am. Coll. Cardiol., March 15, 2000; 35(4): 1022 - 1030. [Abstract] [Full Text] [PDF]

				O. Reuthebuch, T. Podzuweit, S. Thomas, K. Binz, M. Roth, W.-P. Klovekorn, and E. P. Bauer Transmyocardial laser revascularisation has no beneficial effect on high energy phosphates and lactate content during acute myocardial ischaemia in pigs Eur. J. Cardiothorac. Surg., August 1, 1999; 16(2): 144 - 149. [Abstract] [Full Text] [PDF]

				X. M. Mueller, H. H. Tevaearai, C.-Y. Genton, D. Bettex, and L. K. von Segesser Transmyocardial laser revascularisation in acutely ischaemic myocardium Eur. J. Cardiothorac. Surg., February 1, 1998; 13(2): 170 - 175. [Abstract] [Full Text] [PDF]