Percutaneous transluminal myocardial revascularization with a holmium laser system: Procedural results and early clinical outcome
| Autor: | Upendra Kaul, Tapan Ghose, Rakesh Sapra, Sudan D, Fayaz A. Shawl, Balbir Singh, Dixit Ns |
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| Rok vydání: | 1999 |
| Předmět: |
Male
Cardiac Catheterization medicine.medical_specialty Time Factors Percutaneous medicine.medical_treatment Revascularization Angina Pectoris Angina Angioplasty Internal medicine Myocardial Revascularization medicine Humans Radiology Nuclear Medicine and imaging business.industry General Medicine Canadian Cardiovascular Society Middle Aged Transmyocardial revascularization medicine.disease Symptomatic relief Surgery Treatment Outcome Bypass surgery Cardiology Feasibility Studies Female Laser Therapy Safety Cardiology and Cardiovascular Medicine business |
| Zdroj: | Catheterization and Cardiovascular Interventions. 47:287-291 |
| ISSN: | 1522-726X 1522-1946 |
| DOI: | 10.1002/(sici)1522-726x(199907)47:3<287::aid-ccd5>3.0.co;2-o |
| Popis: | Surgical transmyocardial laser revascularization has been reported to improve clinical outcome in patients with refractory angina who are not candidates for angioplasty or bypass surgery. We investigated the feasibility and safety of a nonsurgical, percutaneous technique for laser channel creation using energy from a holmium:yttrium-aluminium-garnet (YAG) laser. The laser energy was directed through a fiber enclosed in a catheter to the ventricular myocardium creating channels between the blood pool and the myocardium. Thirty-five patients with angina and coronary anatomy not amenable to revascularization with coronary angioplasty or bypass surgery underwent percutaneous transluminal myocardial revascularization. A total of 15 +/- 5 channels were formed per patient. There was no procedure-related mortality. One patient developed cardiac tamponade requiring thoracotomy and another a minor self-limiting pericardial effusion. There was no worsening of regional wall motion function in any patient. All patients were discharged alive after a postprocedure hospital stay of 2.1 +/- 1.4 days. Mean Canadian Cardiovascular Society (CCS) functional class declined from 3.68 +/- 0.4 before procedure to 0.82 +/- 0.7 at 30 days (P < 0.01). At 3 months, mean angina class was 0.94 +/- 0.65 (n = 35; P < 0.01) and at 6 months, mean angina class was 1.08 +/- 0.58 (n = 26; P < 0.01). One patient required repeat revascularization after 5 months for progression of disease in a degenerated saphenous venous graft supplying different region of myocardium. We conclude that transmyocardial revascularization using holmium:YAG laser by percutaneous technique can be carried out safely with encouraging early results and a very low complication rate. The symptomatic relief seen up to 6 months has been excellent. The long-term effects of this technique on mortality and relief of angina, however, remain to be defined. Cathet. Cardiovasc. Intervent. 47:287-291, 1999. |
| Databáze: | OpenAIRE |
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