[Current topics on coronary artery surgery: clinical experience of laser application]

In recent years, laser has been gradually utilized in cardiovascular surgery. Since 1980, we have applied lasers experimentally in the following three categories in the fields of cardiovascular surgery. That is, Group 1: new myocardial revascularization in the patients for whom coronary artery bypass surgery can not be performed, because of small or diffuse coronary arteries, Group 2: laser vascular anastomosis especially for small-caliber vessels, Group 3: laser angioplasty for obstructive arterial disease. Subsequently, efficacy of laser application could be obviously recognized in these fields. On the basis of good results of our experimental studies, laser was clinically employed for 112 patients with anginal pain, intermittent claudication or renal failure. Optimal conditions of vascular anastomosis were 20-40 mW in output and 6-12 sec/mm in irradiation time. They consisted of new myocardial revascularization in 1 case and vascular anastomosis including 7 cases of coronary artery bypass surgery in 89 cases and laser angioplasty with 5 cases of intraoperative laser coronary angioplasty in 22 cases. Optimal conditions for laser angioplasty were 6 watts in output and 3 sec in irradiation time for each shot. Laser irradiation was carefully repeated according to the grade of atherosclerotic changes. Vascular endoscopy was useful to keep safe procedures. These patients are doing well without complications throughout laser. Our clinical experience of laser application in the cardiovascular surgery is presented in detail.