Late angiograms ten years after transmyocardial laser revascularization

Sansone, Fabrizio; Dato, Guglielmo Mario Actis; Zingarelli, Edoardo; Punta, Giuseppe; Parisi, Francesco; Forsennati, Pier Giuseppe; Flocco, Roberto; Bardi, Gian Luca; Ponte, Stefano del; Casabona, Riccardo

doi:10.1097/mca.0b013e32834c7534

Cited by 3 publications

(2 citation statements)

References 4 publications

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“… 56 – 59 The role of angiogenesis was further supported by a study that showed emergence of small vessels perfusing the heart on follow-up angiography 10 years after TMR. 60 These secondary blood vessels were not present prior to TMR. Thus, neovascularization and angiogenesis seem to be the predominant driving force for angina improvement and increased myocardial perfusion.…”

Section: Proposed Mechanismmentioning

confidence: 98%

Transmyocardial revascularization devices: technology update

Kindzelski¹,

Zhou²,

Horvath³

2014

MDER

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Transmyocardial laser revascularization (TMR) emerged as treatment modality for patients with diffuse coronary artery disease not amendable to percutaneous or surgical revascularization. The procedure entails the creation of laser channels within ischemic myocardium in an effort to better perfuse these areas. Currently, two laser devices are approved by the US Food and Drug Administration for TMR – holmium:yttrium–aluminum–garnet and CO2. The two devices differ in regard to energy outputs, wavelengths, ability to synchronize with the heart cycle, and laser–tissue interactions. These differences have led to studies showing different efficacies between the two laser devices. Over 50,000 procedures have been performed worldwide using TMR. Improvements in angina stages, quality of life, and perfusion of the myocardium have been demonstrated with TMR. Although several mechanisms for these improvements have been suggested, evidence points to new blood vessel formation, or angiogenesis, within the treated myocardium, as the major contributory factor. TMR has been used as sole therapy and in combination with coronary artery bypass grafting. Clinical studies have demonstrated that TMR is both safe and effective in angina relief long term. The objective of this review is to present the two approved laser devices and evidence for the safety and efficacy of TMR, along with future directions with this technology.

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Section: Proposed Mechanismmentioning

confidence: 98%

Transmyocardial revascularization devices: technology update

Kindzelski¹,

Zhou²,

Horvath³

2014

MDER

View full text Add to dashboard Cite

show abstract

“…Denervation [1, 6], angiogenesis [8–11], and redistribution of wall stress [12] have been attributed to the postoperative improvements noted in severe angina patients [13]. Despite the positive reverberations of laser therapy in these individuals, it still remains unclear whether TMR increases myocardial perfusion within an infarcted myocardium.…”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes meta-analysis: measuring subendocardial perfusion and efficacy of transmyocardial laser revascularization with nuclear imaging

Iwanski

Knapp

Avery

et al. 2017

J Cardiothorac Surg

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IntroductionRandomized and nonrandomized clinical trials have tried to assess whether or not TMR patients experience an increase in myocardial perfusion. However there have been inconsistencies reported in the literature due to the use of different nuclear imaging modalities to test this metric. The primary purpose of this meta-analysis was to determine whether SPECT, MUGA and PET scans demonstrate changes in myocardial perfusion between lased and non-lased subjects and whether laser type affects myocardial perfusion. The secondary purpose was to examine the overall effect of laser therapy on clinical outcomes including survival, hospital re-admission and angina reduction.MethodsSixteen studies were included in the primary endpoint analysis after excluding all other non-imaging TMR papers. Standardized mean difference was used as the effect size for all quantitative outcomes and log odds ratio was used as the effect size for all binary outcomes.ResultsStatistically significant improvements in myocardial perfusion were observed between control and treatment groups in myocardial perfusion at 6-month follow up using PET imaging with a porcine model. However non-significant differences were observed in patients at 3 and 12 months using SPECT, PET or MUGA scans. Both CO2 and Ho:YAG laser systems demonstrated an increase in myocardial perfusion however this effect was not statistically significant. In addition both laser types displayed statistically significant decreases in patient angina at 3, 6 and 12 months but non-significant increases in survival rates and decreases in hospital re-admissions.ConclusionIn order to properly assess myocardial perfusion in TMR subjects, subendocardial perfusion needs to be analyzed via nuclear imaging. PET scans can provide this level of sensitivity and should be utilized in future studies to monitor and detect perfusion changes in lased and non-lased subjects.

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Saphenous Vein Graft Failure After Coronary Artery Bypass Surgery

et al. 2013

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Despite advances in management, VGF remains one of the leading causes of poor in-hospital and long-term outcomes after coronary artery bypass graft surgery. New developments in VGF prevention such as gene therapy, external graft support, fully tissue-engineered grafts, hybrid grafts, and synthetic conduits are promising but unproven. Future efforts to reduce VGF require a multidisciplinary approach with a primary focus on prevention.

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Late angiograms ten years after transmyocardial laser revascularization

Cited by 3 publications

References 4 publications

Transmyocardial revascularization devices: technology update

Transmyocardial revascularization devices: technology update

Clinical outcomes meta-analysis: measuring subendocardial perfusion and efficacy of transmyocardial laser revascularization with nuclear imaging

Saphenous Vein Graft Failure After Coronary Artery Bypass Surgery

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