Agarwal R, Ajit M, Kurian V M, Rajan S, Arumugam S B, Cherian K M
Institute of Cardiovascular Diseases, Madras, Mogappair, India.
Ann Thorac Surg. 1999 Feb;67(2):432-6. doi: 10.1016/s0003-4975(98)01156-4.
Transmyocardial revascularization using a high-energy CO2 laser has emerged as a new therapeutic option for patients with severe diffuse coronary artery disease refractory to conventional modes of therapy.
From December 1994 to September 1997, 102 patients underwent isolated transmyocardial revascularization. The mean age was 56.7 +/- 9.2 years and 92.15% were men. Mean preoperative angina class and ejection fraction were 2.6 +/- 0.7 and 44.7% +/- 10.5%, respectively. Diabetes was present in 49.01% of patients, 32.3% had history of previous myocardial infarction, and 12.7% had undergone a previous coronary artery bypass graft procedure. An average number of 23 +/- 8 channels were created in each patient using an 800-W CO2 laser.
The early mortality was 14.7% and univariate predictors of mortality were age more than 55 years, female sex, creatine kinase more than 1,600 IU, absence of intercoronary collaterals, and mean pulmonary artery pressure greater than 21 mm Hg. At 1-year follow-up there was significant improvement in angina class and effort tolerance but no significant change in left ventricular ejection fraction.
We conclude that transmyocardial revascularization provides symptomatic benefit and improves exercise tolerance in a group of patients suffering from disabling angina not amenable to other modes of treatment. The high early mortality can be brought down with strict patient selection criteria. The mechanism of beneficial effects is uncertain and patency of laser channels is controversial, but laser-induced neoangiogenesis is being looked on as a possible explanation.
使用高能二氧化碳激光进行心肌血运重建已成为传统治疗方式难以治愈的严重弥漫性冠状动脉疾病患者的一种新的治疗选择。
1994年12月至1997年9月，102例患者接受了单纯心肌血运重建术。平均年龄为56.7±9.2岁，男性占92.15%。术前平均心绞痛分级和射血分数分别为2.6±0.7和44.7%±10.5%。49.01%的患者患有糖尿病，32.3%有既往心肌梗死病史，12.7%曾接受过冠状动脉旁路移植术。使用800瓦二氧化碳激光，每位患者平均创建23±8个通道。
早期死亡率为14.7%，死亡率的单因素预测指标为年龄超过55岁、女性、肌酸激酶超过1600国际单位、缺乏冠状动脉间侧支以及平均肺动脉压大于21毫米汞柱。在1年随访时，心绞痛分级和运动耐量有显著改善，但左心室射血分数无显著变化。
我们得出结论，心肌血运重建为一组患有无法通过其他治疗方式缓解的致残性心绞痛的患者带来了症状改善并提高了运动耐量。通过严格的患者选择标准可降低高早期死亡率。有益效果的机制尚不确定，激光通道的通畅性存在争议，但激光诱导的新生血管形成被视为一种可能的解释。
