Transmyocardial Laser Revascularisation: Are New Approaches with New Lasers Possible?

Ivanenko, Mikhail; Hering, P.; Klein, M.; Gams, E.

doi:10.1007/978-3-642-72134-2_13

Cited by 2 publications

(4 citation statements)

References 19 publications

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“…In addition, fiber-based delivery of 1,064-nm laser pulses is possible at a laser intensity of 3.0 GW/cm 2 (140 mJ/pulse). Currently, holmium:YAG lasers and XeCl excimer lasers are applied to clinical PTMR, but a time of 3-10 seconds is needed to ablate only one channel with these lasers [1]. This study shows that there is possibility to realize more rapid myocardium channeling by using the 1,064-nm Q-switched Nd:YAG laser.…”

Section: Application To Tmlrmentioning

confidence: 81%

“…In transmyocardial laser revascularization (TMLR), a laser beam irradiates ischemic myocardium tissue to create channels, based on the laser ablation process [1,2]. Currently, three types of lasers are clinically applied to TMLR; these are 10.6-mm CO 2 [3][4][5][6], 2.1-mm holmium: YAG [2,7,8], and 308-nm XeCl excimer [9] lasers.…”

Section: Introductionmentioning

confidence: 99%

“…With a holmium:YAG laser and a XeCl excimer laser, the treatment can be accomplished percutaneously, because their laser beams can be delivered through optical fibers. But, it takes 3-10 seconds to create one channel with these lasers and it is desired to improve the ablation efficiency [1].…”

Section: Introductionmentioning

confidence: 99%

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Myocardium tissue ablation with high‐peak‐power nanosecond 1,064‐ and 532‐nm pulsed lasers: Influence of laser‐induced plasma

Ogura¹,

Sato²,

Ishihara³

et al. 2002

Lasers Surg Med

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We considered that for the 1,064-nm laser ablation, the tissue removal was achieved through a photodisruption process at laser intensities of > approximately 0.8 GW/cm(2). At laser intensities of > 3.0 GW/cm(2), however, the ablation efficiency decreased; this can be attributed to the absorption of incoming laser pulses by the plasma. For the 532-nm laser ablation, the tissue removal was achieved through a photothermal process at laser intensities of > approximately 1.6 GW/cm(2). At laser intensities of > 2.4 GW/cm(2), a photodisruption process may also contribute to the tissue removal, in addition to a photothermal process. With regard to the ablation rates, the 1,064-nm laser was more suitable for TMLR than the 532-nm laser. We concluded that the 1,064-nm Q-switched Nd:YAG laser would be a potential candidate for a laser source for TMLR because of possible fiber-based beam delivery, its compact structure, cost effectiveness, and easy maintenance. Animal trials, however, have to be carried out to evaluate the influence of the tissue damage.

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Section: Application To Tmlrmentioning

confidence: 81%

Section: Introductionmentioning

confidence: 99%

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Myocardium tissue ablation with high‐peak‐power nanosecond 1,064‐ and 532‐nm pulsed lasers: Influence of laser‐induced plasma

Ogura¹,

Sato²,

Ishihara³

et al. 2002

Lasers Surg Med

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“…This laser system has been used in a variety ofmedical fields to ablate hard and soft tissue and has also been introduced to TMR to create myocardial channels [1 1 -13]. Laser pulse energies commonly used are 1-2 J with a pulse duration around 350 is [14]. In this energy range several laser pulses are needed for a sufficient channel depth in the order of 10 mm [10,15].…”

Section: Introductionmentioning

confidence: 99%

<title>Myocardial tissue ablation by single high-energy laser pulses for ELR and TMR</title>

Theisen

Brinkmann

Stubbe³

et al. 1999

SPIE Proceedings

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The objective of this study is to compare the ablation sites induced by two different laser and application systems for myocardial laser revascularization. One system used was an 800W CO2 laser, which is clinically established for transmyocardial laser revascularization (TMR). The second system was a self-designed Holmium laser emitting single high energy pulses for the minimal invasive approach of endocardial laser revascularization (ELR), whereby the laser light is transmitted via optical fibre into the left ventricle to ablate the myocardial channels from the inside.The laser energy was applied to Polyacrylamide (PAA) as transparent tissue phantom and in water as blood phantom. The ablation dynamics were investigated by high speed flash photography recording a picture series of a single event. Reperfused ex-vivo porcine hearts were treated to quantify differences in the thermal-mechanical damage ranges by polarisation light microscopy. Ablation dynamics in water revealed oscillatory changes of the axial length of the steam bubbles between 3mm and 12mm during the CO2 laser pulse. For the Holmium laser pulse a maximal axial and lateral length of 5mm was observed. The lateral dimensions ofthe bubbles were maximal 1mm with the C02-and 3.5 mm with the Holmium laser system. In PAA bubbles also collapse during the laser pulse which affects the size of the ablated channels. Using 12J Holmium laser pulses for ablation ofPAA, channel depths around 7mm were found.Single Holmium laser pulses demonstrate ablations comparable in size and thermal-mechanical collateral damage to those achieved with the standard CO2 laser. The results are very encouraging for single pulse ELR and demonstrate the potential of a catheter based minimal invasive procedure for laser heart reperfusion.

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Transmyocardial Laser Revascularisation: Are New Approaches with New Lasers Possible?

Cited by 2 publications

References 19 publications

Myocardium tissue ablation with high‐peak‐power nanosecond 1,064‐ and 532‐nm pulsed lasers: Influence of laser‐induced plasma

Myocardium tissue ablation with high‐peak‐power nanosecond 1,064‐ and 532‐nm pulsed lasers: Influence of laser‐induced plasma

<title>Myocardial tissue ablation by single high-energy laser pulses for ELR and TMR</title>

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