ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Daniel Burkhoff
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Kohmoto, T.
Right arrow Articles by Burkhoff, D.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Kohmoto, T.
Right arrow Articles by Burkhoff, D.

Ann Thorac Surg 1997;63:1275-1283
© 1997 The Society of Thoracic Surgeons

Original Article: Cardiovascular

Physiology, Histology, and 2-Week Morphology of Acute Transmyocardial Channels Made With a CO2 Laser

Takushi Kohmoto, MD, Peter E. Fisher, MD, Anguo Gu, MD, Shu-Ming Zhu, MD, Carolyn M. DeRosa, BA, Craig R. Smith, MD, Daniel Burkhoff, MD, PhD

Departments of Surgery, Pathology, and Medicine, Columbia University, New York, New York

Accepted for publication November 11, 1996.

Background. Transmyocardial revascularization with a CO2 laser appears to improve symptoms in patients with refractory angina. However, it remains controversial as to whether blood flow through the channels is the mechanism of benefit, especially in the acute setting.

Methods and Results. Three protocols were used to test whether blood flows through transmyocardial CO2 laser revascularization channels. First, channels were made in excised, cross-perfused dog hearts (n = 5) using a CO2 laser (The Heart Laser; PLC Systems Inc, Milford, MA; 40 J/pulse) followed by ligation of the proximal left anterior descending coronary artery. Colored microspheres injected into the left ventricular chamber failed to detect any significant transmyocardial blood flow. In the second protocol (n = 4), laser channels were created in the left anterior descending artery territory, the left anterior descending artery was ligated, and the hearts were excised after 24 hours. Triphenyltetrazolium chloride staining revealed that no viable myocardium was detected around the laser channels in the ischemic myocardium. Finally, channels examined 2 weeks after creation in normal (n = 6) or ischemic (n = 4) myocardium did not maintain their original caliber but were invaded by granulation tissue, which included a large amount of smaller vascular spaces and vessels of various sizes.

Conclusions. Transmyocardial laser revascularization channels made with this CO2 laser did not provide acute myocardial perfusion or preserve myocardial viability in the face of acute ischemia. Channel morphology changes dramatically within the first 2 weeks. To the degree that these findings pertain to human myocardium, the results suggest that transmyocardial blood flow may not be the mechanism of benefit of this procedure, particularly in the acute setting.




This article has been cited by other articles:


Home page
 J. Thorac. Cardiovasc. Surg.Home page
P. Atluri, C. M. Panlilio, G. P. Liao, E. E. Suarez, R. C. McCormick, W. Hiesinger, J. E. Cohen, M. J. Smith, A. B. Patel, W. Feng, et al.
Transmyocardial revascularization to enhance myocardial vasculogenesis and hemodynamic function.
J. Thorac. Cardiovasc. Surg., February 1, 2008; 135(2): 283 - 291.
[Abstract] [Full Text] [PDF]

Home page
 Card Surg AdultHome page
K. A. Horvath and Y. Zhou
Transmyocardial Laser Revascularization and Extravascular Angiogenetic Techniques to Increase Myocardial Blood Flow
Card. Surg. Adult, January 1, 2008; 3(2008): 733 - 752.
[Full Text]

Home page
 J CARDIOVASC PHARMACOL THERHome page
J. Tasse and R. Arora
Transmyocardial Revascularization: Peril and Potential
Journal of Cardiovascular Pharmacology and Therapeutics, March 1, 2007; 12(1): 44 - 53.
[Abstract] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
D. D. Yuh, B. A. Simon, A. Fernandez-Bustamante, N. Ramey, and W. A. Baumgartner
Totally endoscopic robot-assisted transmyocardial revascularization
J. Thorac. Cardiovasc. Surg., July 1, 2005; 130(1): 120 - 124.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
S. K. Mouli, J. Fronza, R. Greene, E. S. Robert, and K. A. Horvath
What is the Optimal Channel Density for Transmyocardial Laser Revascularization?
Ann. Thorac. Surg., October 1, 2004; 78(4): 1326 - 1331.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
C. R. Bridges, K. A. Horvath, W. C. Nugent, D. M. Shahian, C. K. Haan, R. J. Shemin, K. B. Allen, and F. H. Edwards
The Society of Thoracic Surgeons practice guideline series: transmyocardial laser revascularization
Ann. Thorac. Surg., April 1, 2004; 77(4): 1494 - 1502.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
M. Saririan and M. J. Eisenberg
Myocardial laser revascularization for the treatment of end-stage coronary artery disease
J. Am. Coll. Cardiol., January 15, 2003; 41(2): 173 - 183.
[Abstract] [Full Text] [PDF]

Home page
 Card Surg AdultHome page
F. J. Schoen and R. F. Padera Jr.
Cardiac Surgical Pathology
Card. Surg. Adult, January 1, 2003; 2(2003): 119 - 185.
[Full Text]

Home page
 Card Surg AdultHome page
M. Ruel, R. A. Kelly, and F. W. Sellke
Therapeutic Angiogenesis, Transmyocardial Laser Revascularization, and Cell Therapy
Card. Surg. Adult, January 1, 2003; 2(2003): 715 - 750.
[Full Text]

Home page
 Ann. Thorac. Surg.Home page
M. Huikeshoven, J. F. Beek, J. A.P. van der Sloot, R. Tukkie, J. van der Meulen, and M. J.C. van Gemert
35 years of experimental research in transmyocardial revascularization: what have we learned?
Ann. Thorac. Surg., September 1, 2002; 74(3): 956 - 970.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
D. Meerkin, M. Pellerin, H. T. Aretz, P. Paiement, S. L. Houser, and R. Bonan
Transmyocardial coil implants: a novel approach to transmyocardial revascularization
Ann. Thorac. Surg., August 1, 2002; 74(2): 488 - 492.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
E.-J. Kim, R.-K. Li, R. D. Weisel, D. A.G. Mickle, Z.-Q. Jia, S. Tomita, T. Sakai, and T. M. Yau
Angiogenesis by endothelial cell transplantation
J. Thorac. Cardiovasc. Surg., November 1, 2001; 122(5): 963 - 971.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
R. C. Arora, G. M. Hirsch, K. Hirsch, and J. A. Armour
Transmyocardial Laser Revascularization Remodels the Intrinsic Cardiac Nervous System in a Chronic Setting
Circulation, September 18, 2001; 104(90001): I-115 - 120.
[Abstract] [Full Text] [PDF]

Home page
 HeartHome page
X M Mueller, H T Tevaearai, P Chaubert, C-Y Genton, and L K von Segesser
Does laser injury induce a different neovascularisation pattern from mechanical or ischaemic injuries?
Heart, June 1, 2001; 85(6): 697 - 701.
[Abstract] [Full Text]

Home page
 J Am Coll CardiolHome page
L. Aaberge, K. Nordstrand, M. Dragsund, K. Saatvedt, K. Endresen, S. Golf, O. Geiran, M. Abdelnoor, and K. Forfang
Transmyocardial revascularization with CO2 laser in patients with refractory angina pectoris: Clinical results from The Norwegian Randomized Trial
J. Am. Coll. Cardiol., April 1, 2000; 35(5): 1170 - 1177.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
C. R. Bridges
Myocardial laser revascularization: the controversy and the data
Ann. Thorac. Surg., February 1, 2000; 69(2): 655 - 662.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
B. Lauer, U. Junghans, F. Stahl, R. Kluge, S. N. Oesterle, and G. Schuler
Catheter-based percutaneous myocardial laser revascularization in patients with end-stage coronary artery disease
J. Am. Coll. Cardiol., November 15, 1999; 34(6): 1663 - 1670.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
C. K. Landolfo, K. P. Landolfo, G. C. Hughes, E. R. Coleman, R. B. Coleman, and J. E. Lowe
Intermediate-Term Clinical Outcome Following Transmyocardial Laser Revascularization in Patients With Refractory Angina Pectoris
Circulation, November 9, 1999; 100(90002): II-128 - 133.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
K. A. Horvath, E. Chiu, D. C. Maun, J. W. Lomasney, R. Greene, W. H. Pearce, and D. A. Fullerton
Up-regulation of vascular endothelial growth factor mrna and angiogenesis after transmyocardial laser revascularization
Ann. Thorac. Surg., September 1, 1999; 68(3): 825 - 829.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
G. M. Hirsch, G. W. Thompson, R. C. Arora, K. J. Hirsch, J. A. Sullivan, and J. A. Armour
Transmyocardial laser revascularization does not denervate the canine heart
Ann. Thorac. Surg., August 1, 1999; 68(2): 460 - 468.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
O. Reuthebuch, T. Podzuweit, S. Thomas, K. Binz, M. Roth, W.-P. Klovekorn, and E. P. Bauer
Transmyocardial laser revascularisation has no beneficial effect on high energy phosphates and lactate content during acute myocardial ischaemia in pigs
Eur. J. Cardiothorac. Surg., August 1, 1999; 16(2): 144 - 149.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
D. Burkhoff, M. N. Wesley, J. R. Resar, and A. M. Lansing
Factors correlating with risk of mortality after transmyocardial revascularization
J. Am. Coll. Cardiol., July 1, 1999; 34(1): 55 - 61.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
J. W. Jones, S. E. Schmidt, B. W. Richman, C. C. Miller III, K. J. Sapire, D. Burkhoff, and J. C. Baldwin
Holmium: YAG laser transmyocardial revascularization relieves angina and improves functional status
Ann. Thorac. Surg., June 1, 1999; 67(6): 1596 - 1601.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
G. C. Hughes, A. P. Kypson, J. D. St. Louis, B. H. Annex, R. E. Coleman, T. R. DeGrado, C. L. Donovan, J. E. Lowe, and K. P. Landolfo
Improved perfusion and contractile reserve after transmyocardial laser revascularization in a model of hibernating myocardium
Ann. Thorac. Surg., June 1, 1999; 67(6): 1714 - 1720.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
G. C. Hughes, K. P. Landolfo, J. E. Lowe, R. B. Coleman, and C. L. Donovan
Perioperative morbidity and mortality after transmyocardial laser revascularization: incidence and risk factors for adverse events
J. Am. Coll. Cardiol., March 15, 1999; 33(4): 1021 - 1026.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
K. A. Horvath, R. Greene, N. Belkind, B. Kane, D. D. McPherson, and D. A. Fullerton
Left ventricular functional improvement after transmyocardial laser revascularization
Ann. Thorac. Surg., September 1, 1998; 66(3): 721 - 725.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
M. P. Pelletier, A. Giaid, S. Sivaraman, J. Dorfman, C. M. Li, A. Philip, and R. C.-J. Chiu
Angiogenesis and growth factor expression in a model of transmyocardial revascularization
Ann. Thorac. Surg., July 1, 1998; 66(1): 12 - 18.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
T. Kohmoto, C. M. DeRosa, N. Yamamoto, P. E. Fisher, P. Failey, C. R. Smith, and D. Burkhoff
Evidence of Vascular Growth Associated With Laser Treatment of Normal Canine Myocardium
Ann. Thorac. Surg., May 1, 1998; 65(5): 1360 - 1367.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
X. M. Mueller, H. H. Tevaearai, C.-Y. Genton, D. Bettex, and L. K. von Segesser
Transmyocardial laser revascularisation in acutely ischaemic myocardium
Eur. J. Cardiothorac. Surg., February 1, 1998; 13(2): 170 - 175.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
P. E. Fisher, T. Khomoto, C. M. DeRosa, H. M. Spotnitz, C. R. Smith, and D. Burkhoff
Histologic Analysis of Transmyocardial Channels: Comparison of CO2 and Holmium:YAG Lasers
Ann. Thorac. Surg., August 1, 1997; 64(2): 466 - 472.
[Abstract] [Full Text]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 1997 by The Society of Thoracic Surgeons.