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The Annals of Thoracic Surgery, Vol 56, 46-53, Copyright © 1993 by The Society of Thoracic Surgeons
OJ Yano, MR Bielefeld, V Jeevanandam, MR Treat, CC Marboe, HM Spotnitz and CR Smith
Laser myocardial revascularization has been shown to reduce mortality and
infarct size after left anterior descending coronary artery (LAD) ligation
in dogs. It has not been shown to improve myocardial contractility in acute
ischemia. In this study a holmium-yttrium- aluminum garnet laser
(wavelength, 2.14 microns) was used to create nontransmural myocardial
channels from the endocardial surface in the ischemic regions of the canine
left ventricle. Twelve mongrel dogs (6 controls, 6 laser myocardial
revascularizations) underwent 90 minutes of LAD ligation followed by 6
hours of reperfusion. The ischemic region was determined by methylene blue
injection during brief LAD occlusion. Laser myocardial revascularization
averaged three channels per square centimeter in the ischemic region
created using 12 J/channel (600 mJ/pulse, 10 Hz) before LAD ligation.
Contractility was assessed from regional preload recruitable stroke work
(RPRSW), using pairs of segment length ultrasonic transducers in the
ischemic and the nonischemic regions. Two-dimensional echocardiography
corroborated with segmental length findings. In control dogs, the ischemic
region was dyskinetic during LAD ligation and reperfusion. Dyskinesis of
the ischemic region during systole produced negative values for regional
stroke work, and RPRSW was considered zero. In 4 of 6 laser- revascularized
dogs, RPRSW remained positive in the ischemic region. Two dogs had
intermittent dyskinesis. The difference between laser- revascularized and
control dogs in ischemic region RPRSW was significant (p < 0.01 by
Fischer's exact test).(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Prevention of acute regional ischemia with endocardial laser channels
Department of Surgery, College of Physicians and Surgeons of Columbia University, New York, New York.
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