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[Current status and 21 century in the laser transmyocardial revascularization (LTMR)]
1Kobe University School of Medicine, Department of Surgery, Division II, Japan.
Insights
Laser transmyocardial revascularization (TMR) offers a new channel for blood flow to the heart muscle in patients with ischemic heart disease. This laser TMR procedure provides a viable alternative for those unsuitable for bypass or angioplasty.
Area of Science:
- Cardiovascular Surgery
- Medical Technology
- Laser Applications in Medicine
Context:
- Ischemic heart disease and peripheral arterial disease management increasingly utilize endovascular interventions.
- Coronary artery bypass grafting and percutaneous transluminal coronary angioplasty (PTCA) have limitations for patients with small or diffuse coronary artery stenoses.
- A subset of patients with complex coronary artery disease remains underserved by current revascularization techniques.
Purpose:
- To introduce and evaluate laser-assisted transmyocardial revascularization (TMR) as an alternative treatment for myocardial revascularization.
- To explore the creation of new arterial blood channels directly into the myocardium using a CO2 laser.
- To assess the hemodynamic and histological viability of laser TMR.
Summary:
- A novel transmyocardial revascularization (TMR) technique using a CO2 laser was developed to supply arterial blood from the left ventricle to ischemic myocardium.
- This procedure creates new channels within the myocardium, bypassing blockages in coronary arteries.
- The study details the mechanism, technique, and clinical results of laser TMR, first employed in 1985.
Impact:
- Laser TMR provides a potential alternative revascularization strategy for patients with complex coronary artery disease unsuitable for conventional treatments.
- The development of laser TMR expanded therapeutic options for ischemic heart disease.
- This research laid groundwork for further advancements in minimally invasive cardiac procedures.
Abstract:
Recently, much attention has been paid to promote endovascular intervention for the patients with ischemic heart disease and occlusive peripheral arterial disease. There are a few patients for whom coronary artery bypass grafting and repeated PTCA can not be carried out, because small branches or diffuse stenoses of the coronary arteries. To resolve these problems author tried to supply arterial blood from the left ventricle into the ischemic myocardium through new channels created into the myocardium by CO2 laser. Consequently, it could be clarified that this procedure could be hemodynamically, or histologically used as an alternative transmyocardial revascularization (TMR) by laser. Finally, this TMR was clinically employed in 1985. Mechanism, technique and its results of TMR are discussed in detail.