[Alternative methods of myocardial revascularization]

The study was designed to analyse results of alternative methods of myocardial revascularization in "no-option patients" to whom direct revascularization is not indicated. Over 600 cases were treated with the use of transmyocardial laser revascularization (TMLR), angiogenic factors (VEGF, alpha-ECGF), and cellular therapy. It was shown that TMLR is a safe and efficacious procedure increasing perfusion and normalizing myocardial metabolism. It eliminates angina and improves quality of life of the patients. Single bolus administration of angiogenic factors alone does not stabilize perfusion and patients' condition. The use of stem cells provokes the growth of new vessels and promotes restoration of viable myocardium via stimulation of angiogenesis. However, mesenchymal stem cells do not contribute to scar reparation and are inefficient in patients with a critical mass of cicatrically-altered myocardium.