Allen K B, Dowling R D, Heimansohn D A, Reitsma E, Didelot L, Shaar C J
Department of Cardiovascular/Thoracic Surgery, St. Vincent Hospital and Health Care Center Indianapolis, IN, USA.
Eur J Cardiothorac Surg. 1998 Oct;14 Suppl 1:S100-4. doi: 10.1016/s1010-7940(98)00114-6.
To evaluate the efficacy of transmyocardial revascularization performed on patients with refractory class IV or unstable angina with a holmium:yttrium-aluminum-garnet laser.
Transmyocardial revascularization with a holmium:yttrium-aluminum-garnet laser was performed in 42 patients with refractory angina who were not candidates for percutaneous transluminal coronary angioplasty or coronary artery bypass grafting. Patients had either Canadian Heart Association class IV angina (n = 23) or unstable angina (n = 19) and were unable to be weaned from intravenous nitroglycerin. Preoperative thallium studies identified the extent and location of reversible ischemia. Operative exposure was via a limited left anterior thoracotomy. An average of 45+/-11 laser channels were created with a mean operative time of 106+/-38 min.
Perioperative mortality was 12% (5/42) with no late deaths. Complications included ventricular 7.1% (3/42) and atrial 4.7% (2/42) arrhythmias, reoperation for chest-wall hemorrhage 2% (1/42), and respiratory failure requiring reintubation 2% (1/42). Intra-aortic balloon pump placement was required in 12% (5/42). The mean postoperative length of stay was 5.5+/-4.9 (1-25) days. Mean follow-up on 100% of patients is 5.4+/-3.0 (1-12) months. At 3 (n = 33) and 6 (n = 21) months follow-up the mean angina class was 1.5+/-0.1 (P < 0.002) and 1.1+/-0.1 (P < 0.001), respectively.
Transmyocardial revascularization utilizing a holmium:yttrium-aluminum-garnet laser resulted in a significant reduction in angina class and was beneficial in patients with refractory angina untreatable by conventional methods.
评估用钬：钇铝石榴石激光对IV级难治性或不稳定型心绞痛患者进行心肌血运重建的疗效。
对42例难治性心绞痛患者进行钬：钇铝石榴石激光心肌血运重建，这些患者不适合经皮腔内冠状动脉成形术或冠状动脉旁路移植术。患者为加拿大心脏协会IV级心绞痛（n = 23）或不稳定型心绞痛（n = 19），且无法停用静脉硝酸甘油。术前铊研究确定了可逆性缺血的范围和位置。手术暴露通过有限的左前开胸术进行。平均创建了45±11个激光通道，平均手术时间为106±38分钟。
围手术期死亡率为12%（5/42），无晚期死亡。并发症包括7.1%（3/42）的室性和4.7%（2/42）的房性心律失常，因胸壁出血再次手术2%（1/42），以及需要重新插管的呼吸衰竭2%（1/42）。12%（5/42）的患者需要放置主动脉内球囊泵。术后平均住院时间为5.5±4.9（1 - 25）天。对100%的患者平均随访5.4±3.0（1 - 12）个月。在3个月（n = 33）和6个月（n = 21）随访时，平均心绞痛分级分别为1.5±0.1（P < 0.002）和1.1±0.1（P < 0.001）。
使用钬：钇铝石榴石激光进行心肌血运重建可使心绞痛分级显著降低，对常规方法无法治疗的难治性心绞痛患者有益。
