Krabatsch T, Petzina R, Baretti R, Hausmann H, Hetzer R
Department of Thoracic and Cardiovascular Surgery, Deutsches Herzzentrum, Berlin, Germany.
J Clin Laser Med Surg. 2001 Oct;19(5):251-9. doi: 10.1089/10445470152611982.
Transmyocardial laser revascularization (TMR) is the only surgical treatment for patients with severe diffuse coronary artery disease, who are not candidates for bypass grafting or percutaneous angioplasty. However, vaporization of tissue during the creation of channels leads to a certain loss of viable myocardium during every TMR procedure.
We analyzed serum levels of creatine kinase and creatine kinase MB subtype in 163 patients after sole TMR with a CO2 laser (wave length 10.6 microm, 800-watt power). The control group consisted of 35 consecutive CABG patients and 30 consecutive redo-CABG patients. Additionally, in the TMR group we measured echocardiographically the left ventricular ejection fraction before and after TMR. We recorded the total amount of laser energy applied, average and maximum energy per channel, and the number of created channels, in order to calculate the correlation between these parameters and postoperative enzyme levels or changes in the LVEF.
After TMR, we measured higher creatine kinase levels compared to those in CABG patients (607.8+/-558.4 U/L vs. 285.0+/-292.3 U/L, p < 0.01). The relative proportion of CK-MB of total CK, however, was significantly lower after TMR, compared to that of the control group (4.5+/-3.0% vs. 10.1+/-6.4%, p < 0.01). Patients with a pronounced postoperative increase in CK-MB levels or a higher percentage of CK-MB of total CK also after TMR operations show a decline in left ventricular contractility. In the laser group, the maximum enzyme levels were detected significantly later than in the control group (25.0+/-19.4 h postoperatively vs. 8.7+/-9.1 h, p < 0.01). There was no significant correlation between the technical laser parameters or the number of created channels and the percentage of CK-MB of total CK or changes in left ventricular ejection fraction.
CO2 laser TMR does not result in significant injury to the myocardium. Cardiac enzymes play an important role in the detection of perioperative myocardial infarction in TMR patients.
心肌激光血运重建术（TMR）是治疗严重弥漫性冠状动脉疾病患者的唯一外科手术方法，这些患者不适合进行搭桥手术或经皮血管成形术。然而，在创建通道的过程中组织汽化会导致每次TMR手术期间有一定量的存活心肌损失。
我们分析了163例仅接受二氧化碳激光（波长10.6微米，功率800瓦）TMR手术患者的血清肌酸激酶和肌酸激酶MB亚型水平。对照组包括35例连续接受冠状动脉旁路移植术（CABG）的患者和30例连续接受再次CABG手术的患者。此外，在TMR组中，我们通过超声心动图测量了TMR前后的左心室射血分数。我们记录了所施加的激光能量总量、每个通道的平均能量和最大能量以及创建的通道数量，以计算这些参数与术后酶水平或左心室射血分数变化之间的相关性。
与CABG患者相比，TMR术后我们测量到更高的肌酸激酶水平（607.8±558.4 U/L对285.0±292.3 U/L，p<0.01）。然而，与对照组相比，TMR术后总肌酸激酶中CK-MB的相对比例显著更低（4.5±3.0%对10.1±6.4%，p<0.01）。TMR手术后CK-MB水平术后明显升高或总肌酸激酶中CK-MB百分比更高的患者，其左心室收缩力下降。在激光组中，酶的最高水平比对照组明显出现得更晚（术后25.0±19.4小时对8.7±9.1小时，p<0.01）。激光技术参数或创建的通道数量与总肌酸激酶中CK-MB的百分比或左心室射血分数的变化之间没有显著相关性。
二氧化碳激光TMR不会对心肌造成显著损伤。心脏酶在检测TMR患者围手术期心肌梗死中起重要作用。
