Transmyocardial laser revascularisation in acutely ischaemic myocardium.

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Serval ID
serval:BIB_E07814A19CE9
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Transmyocardial laser revascularisation in acutely ischaemic myocardium.
Journal
European Journal of Cardio-Thoracic Surgery
Author(s)
Mueller X.M., Tevaearai H.H., Genton C.Y., Bettex D., von Segesser L.K.
ISSN
1010-7940
Publication state
Published
Issued date
1998
Peer-reviewed
Oui
Volume
13
Number
2
Pages
170-175
Language
english
Abstract
OBJECTIVE: Although recent experience suggests that transmyocardial laser revascularisation (TMLR) relieves angina, its mechanism of action remains undefined. We examined its functional effects and analysed its morphological features in an animal model of acute ischaemia. METHODS: A total of 15 pigs were randomised to ligation of left marginal arteries (infarction group, n = 5), to TMLR of the left lateral wall using a holmium:yttrium-aluminium garnet (Ho:YAG) laser (laser group, n = 5), and to both (laser-infarction group, n = 5). All the animals were sacrificed 1 month after the procedure. Haemodynamics and echocardiography with segmental wall motion score were carried out at both time intervals (scale 0-3: 0, normal; 1, hypokinesia; 2, akinesia; 3, dyskinesia). Histology of the involved area was analysed. RESULTS: Laser group showed no change of the segmental wall motion score of the involved area 30 min after the laser channels were made (score: 0 +/- 0). Infarction and laser infarction groups both showed a persistent and definitive increase of the segmental wall motion score (at 30 min: 1.6 +/- 0.3 and 2 +/- 0, respectively; at 1 month: 1.8 +/- 0.2 and 1.8 +/- 0.4, respectively). These increases were all statistically significant in comparison with baseline values (P < 0.5), however comparison between infarction and laser-infarction groups showed no significant difference. On macroscopic examination of the endocardial surface, no channel was opened. On histology, there were signs of neovascularisation around the channels in the laser group, whereas in the laser-infarction group the channels were embedded in the infarction scar. CONCLUSIONS: In this acute pig model, TMLR did not provide improvement of contractility of the ischaemic myocardium. To the degree that the present study pertains to the clinical setting, the results suggest that mechanisms other than blood flow through the channels should be considered, such as a laser-induced triggering of neovascularisation or neural destruction.
Keywords
Animals, Disease Models, Animal, Evaluation Studies as Topic, Laser Therapy, Myocardial Contraction, Myocardial Ischemia, Myocardial Revascularization, Random Allocation, Swine
Pubmed
Web of science
Open Access
Yes
Create date
14/02/2008 15:17
Last modification date
25/09/2019 7:11
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