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J Thorac Cardiovasc Surg 1996;111:1047-1053
© 1996 Mosby, Inc.

SURGERY FOR ACQUIRED HEART DISEASE

TRANSMYOCARDIAL LASER REVASCULARIZATION: OPERATIVE TECHNIQUES AND CLINICAL RESULTS AT TWO YEARS

Keith A. Horvath, MDa, Finn Mannting, MD, PhDb, Nancy Cummings, RNa, Stanton K. Shernan, MDc, Lawrence H. Cohn, MDa

Received for publication June 21, 1995 Revisions requested Oct. 24, 1995; revisions received Nov. 20, 1995 Accepted for publication Dec. 26, 1995. Address for reprints: Lawrence H. Cohn, MD, Department of Cardiac Surgery, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115.

Abstract

Objectives: A new technique, transmyocardial laser revascularization, provides direct perfusion of ischemic myocardium via laser-created transmural channels. From 1993 to 1995, we have treated 20 patients (mean age 61 years, four women and 16 men) with transmyocardial laser revascularization. Preoperatively, the average angina class was 3.7. The patients were screened before the operation by a technetium sestamibi perfusion scan to identify the location and extent of their reversible ischemia.
Methods: Operative exposure is gained via a left anterior thoracotomy. With the use of a 850-watt carbon dioxide laser, an average of 21 ± 4 channels were created in 22 minutes with a total operative time of less than 2 hours.
Results: The in-hospital mortality was two of 20 patients. Three additional patients died after discharge. After an accumulated 172 patient-months (mean follow-up 11 ± 8 months, range 1 to 26 months), the mean angina class is I (p= 0.01). Postoperative sestamibi scans were obtained at 3, 6, and 12 months. Using the septum as a control and comparing the postoperative results with the preoperative baseline, we noted a significant improvement in perfusion particularly in the areas of reversible ischemia.
Conclusion: These early results indicate that transmyocardial laser revascularization is a simple operative technique that may improve myocardial perfusion and provide angina relief for patients in whom standard methods of revascularization is contraindicated.




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