MYOCARDIAL REVASCULARIZATION WITH LASER - PRELIMINARY FINDINGS

Citation
Oh. Frazier et al., MYOCARDIAL REVASCULARIZATION WITH LASER - PRELIMINARY FINDINGS, Circulation, 92(9), 1995, pp. 58-65
Citations number
24
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Cardiac & Cardiovascular System",Hematology
Journal title
Circulation → ACNP
ISSN journal
0009-7322
Volume
92
Issue
9
Year of publication
1995
Supplement
S
Pages
58 - 65
Database
ISI
SICI code
0009-7322(1995)92:9<58:MRWL-P>2.0.ZU;2-J
Abstract
Background We assessed the transmyocardial laser revascularization (TM LR) as sole therapy in patients with symptomatic coronary artery disea se refractory to interventional or medical treatment. Methods and Resu lts Thirty-one patients were evaluated with positron emission tomograp hy (PET), dobutamine echocardiography, Tl-201 single-photon emission c omputed tomography (Tl-201-SPECT), and multigated acquisition radionuc lide ventriculography (MUGA). TMLR was performed in 21 patients who ha d demonstrable ischemia in viable myocardium. The mean Canadian Cardio vascular Society (CCS) angina class was 3.70+/-0.7 (4 patients with un stable angina). Untreated septal segments were used as controls. At 3 months, (n=15 patients), the mean CCS angina class was to 2.43+/-0.9 ( P<.05). On dobutamine echocardiography, the mean resting wall motion s core index was improved by 16% in lased segments (P<.03 vs control), a nd mean LVEF at peak stress increased by 19% (P=NS vs baseline). On Tl -201-SPECT, perfusion of lased and nonlased segments did not change. O n PET, the mean ratio of subendocardial to subepicardial perfusion (SE n/SEp) increased 14% over baseline (P<.001 vs control). At 6 months (n =15 patients), the mean CCS angina class was 1.7+/-0.8 (P<.05). The me an resting wall motion score index was up by 13% in lased segments (P< .05 vs control). Resting LVEF was unchanged. Stress LVEF increased 21% (P=NS vs baseline). Myocardial perfusion remained unchanged by Tl-201 -SPECT. On PET, 36% of the lased segments were better, and 25% were wo rse compared with baseline. The resting SEn/SEp by PET was up 21% (P<. 001 vs control). All deaths (two perioperative and three late) occurre d in patients with preoperative congestive heart failure. Two patients required repeat revascularization of new coronary lesions. Conclusion s These results suggest that TMLR improves anginal status, relative en docardial perfusion, and cardiac function in patients who do not have preoperative congestive heart failure.