Horvath K A, Mannting F, Cummings N, Shernan S K, Cohn L H
Department of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
J Thorac Cardiovasc Surg. 1996 May;111(5):1047-53. doi: 10.1016/s0022-5223(96)70381-1.
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.
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.
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.
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.
一种新技术，即心肌激光血运重建术，可通过激光制造的透壁通道直接灌注缺血心肌。1993年至1995年，我们对20例患者（平均年龄61岁，4名女性和16名男性）进行了心肌激光血运重建术治疗。术前，平均心绞痛分级为3.7级。术前通过锝- sestamibi灌注扫描对患者进行筛查，以确定其可逆性缺血的部位和范围。
通过左前开胸手术获得手术暴露。使用850瓦二氧化碳激光，平均在22分钟内制造21±4个通道，总手术时间少于2小时。
20例患者中有2例住院死亡。另外3例患者出院后死亡。在累计172个患者月（平均随访11±8个月，范围1至26个月）后，平均心绞痛分级为I级（p = 0.01）。在术后3、6和12个月进行了sestamibi扫描。以间隔为对照，将术后结果与术前基线进行比较，我们注意到灌注有显著改善，特别是在可逆性缺血区域。
这些早期结果表明，心肌激光血运重建术是一种简单的手术技术，可能改善心肌灌注，并为标准血运重建方法禁忌的患者缓解心绞痛。
