Long-term results of isolated transmyocardial laser revascularization in combination with the intramyocardial autologous bone marrow stem cells injection

  • O. L. Bockeria
  • A. D. Petrosyan
  • V. A. ShvartzEmail author
  • S. A. Donakanyan
  • M. B. Biniashvili
  • M. A. Sokolskaya
  • A. Y. Ispiryan
  • L. A. Bockeria
Original Article


To evaluate the long-term results of TMLR using a CO2 laser in combination with intramyocardial injection of ABMSC as an isolated procedure in patients with the end-stage coronary artery disease, the study included 20 patients (90% male), with a mean age of 58.4 ± 8.7 years. To assess the long-term results, patients were examined in a hospital. The Minnesota Living with Heart Failure Questionnaire (MLHFQ) and the Seattle Angina Questionnaire (SAQ) were used. The evolution of laboratory and instrumental indices, as well as medical therapy, was assessed. The end points of the study were death, acute myocardial infarction (AMI), repeated myocardial revascularization, recurrent hospitalizations due to coronary artery disease, and stroke. The changes in angina functional class were also evaluated. The median of follow-up period was 54 (36; 83) months, that is, 4.5 years. The analysis of the evolution of echocardiographic data showed the absence of statistically significant changes in the following parameters: left ventricular end-diastolic diameter (EDD) (p = 0.967), end-systolic diameter (ESD) (p = 0.204), end-diastolic volume (EDV) (p = 0.852), end-systolic volume (ESV) (p = 0.125), and left ventricular ejection fraction (LVEF) (p = 0.120). The patients continued to regularly take the main groups of medications. Nitrate consumption was significantly reduced (p < 0.001). Significant positive dynamics were observed in the changes in angina functional class. At the baseline, all patients had angina III FC, in the long term, 3 patients had II FC, 11 patients had I FC, and 6 patients had no angina. Clinical outcomes (mortality, recurrent myocardial infarction, stroke) were absent during the follow-up period. There were two cases of repeated myocardial revascularization. Regression analysis revealed that SYNTAX score was associated with the clinical outcome “repeated revascularization.” TMLR in combination with intramyocardial injection of ABMSC is a safe method to achieve a statistically significant antianginal effect and reduce the need for “nitrates,” which in turn improves the quality of life and reduces the frequency of hospitalizations due to coronary artery disease. These results can be achieved with strict adherence to the certain indications for the intervention.


Coronary artery disease Transmyocardial laser myocardial revascularization Autologous bone marrow stem cells, Chronic heart failure CO2 laser 


Funding information

The article is written in the framework of the project of the Russian Science Foundation, grant № 18-74-10064.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Pratalia S, Chiaramontia F, Milanob A, Bortolottia U (2010) Transmyocardial laser revascularization 12 years later. Interact Cardiovasc Thorac Surg 11:480–481. CrossRefGoogle Scholar
  2. 2.
    Schofield PM, Sharples LD, Caine N, Burns S, Tait S, Wistow T, Buxton M, Wallwork J (1999) Transmyocardial laser revascularisation in patients with refractory angina: a randomized controlled trial. Lancet 353:519–524CrossRefGoogle Scholar
  3. 3.
    Allen KB, Dowling RD, Fudge TL, Schoettle GP, Selinger SL, Gangahar DM, Angell WW, Petracek MR, Shaar CJ, O'Neill WW (1999) Comparison of transmyocardial revascularization with medical therapy in patients with refractory angina. N Engl J Med 341:1029–1036. CrossRefPubMedGoogle Scholar
  4. 4.
    Burkhoff D, Schmidt S, Schulman SP, Myers J, Resar J, Becker LC, Weiss J, Jones JW (1999) Transmyocardial laser revascularisation compared with continued medical therapy for treatment of refractory angina pectoris: a prospective randomised trial. ATLANTIC Investigators. Angina Treatments–Lasers and Normal Therapies in Comparison. Lancet 354:885–890CrossRefGoogle Scholar
  5. 5.
    Kindzelski BA, Zhou Y, Horvath KA (2015) Transmyocardial revascularization devices: technology update. Med Devices 8.
  6. 6.
    Iwanski J, Knapp SM, Avery R, Oliva I, Wong RK, Runyan RB, Khalpey Z (2017) Clinical outcomes meta-analysis: measuring subendocardial perfusion and efficacy of transmyocardial laser revascularization with nuclear imaging. J Cardiothorac Surg 12:37. Published online 2017 May 19. CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Strauer B-E, Steinhoff G (n.d.) 10 years of intracoronary and intramyocardial bone marrow stem cell therapy of the heart from the methodological origin to clinical practice. J Am Coll Cardiol 58(11). CrossRefGoogle Scholar
  8. 8.
    Santosh K Sanganalmath, Roberto Bolli. Cell therapy for heart failure: a comprehensive overview of experimental and clinical studies, current challenges, and future directions. Circulation Research is available at CrossRefGoogle Scholar
  9. 9.
    Heke M, Klein H-M (2014) Endogenous laser induced ventricular enhancement (ELIVETM) therapy: a new paradigm for treating heart failure? J Stem Cell Res Ther 4(9).
  10. 10.
    Shahzad U, Li G, Zhang Y, Yau TM (2012) Transmyocardial revascularization induces mesenchymal stem cell engraftment in infarcted hearts. Ann Thorac Surg 94:556–563. CrossRefPubMedGoogle Scholar
  11. 11.
    Iwanski J, Wong RK, Larson DF, Ferng AS, Runyan RB, Goldstein S, Khalpey Z (2016) Remodeling an infarcted heart: novel hybrid treatment with transmyocardial revascularization and stem cell therapy. SpringerPlus 5:738. CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Chernyavskiy A, Fomichev A, Minin S, Nikitin N, Kareva J (2017) Transmiocardial laser revascularization in combination with bone marrow cells implantation in the ischemic heart disease surgery: long-term results. Russ Open Med J 6:e0410. CrossRefGoogle Scholar
  13. 13.
    Konstanty-Kalandyk J, Piatek J, Miszalski-Jamka T, Rudzinski P, Zbigniew W, Bartus K, Urbanczyk-Zawadzka M, Sadowski J (2013) The combined use of transmyocardial laser revascularisation and intramyocardial injection of bone-marrow derived stem cells in patients with end-stage coronary artery disease: one year follow-up. Kardiol Pol 71(5):485–492. CrossRefPubMedGoogle Scholar
  14. 14.
    Bockeria LA, Bockeria OL, Schwartz VA, Petrosyan AD, Donakanyan SA, Biniashvili MB (2016) "RENAISSANCE" - a randomized clinical study of the results of various strategies of surgical treatment of coronary artery disease with incomplete myocardial revascularization. Bulletin Bakulev Scientific Center for Cardiovascular Surgery Cardiovascular diseases 17(S6):235Google Scholar
  15. 15.
    Briones E, Lacalle JR, Marin-Leon I, Rueda JR (2015) Transmyocardial laser revascularization versus medical therapy for refractory angina. Cochrane Database Syst Rev (2. Art. No.: CD003712).
  16. 16.
    Bockeria LA, Bockeria OL, Petrosyan AD, Schwartz VA, Donakanyan SA, Biniashvili MB (2016) The direct results of isolated transmyocardial laser revascularization in combination with the intramyocardial administration of autologous bone marrow stem cells. Bulletin Bakulev Scientific Center for Cardiovascular Surgery Cardiovascular diseases 17(6):42–52Google Scholar
  17. 17.
    Horvath KA, Mannting F, Cummings N, Shernan SK, Cohn LH (1996) Transmyocardial laser revascularization: operative techniques and clinical results at two years. J Thorac Cardiovasc Surg 111:1047–1053. CrossRefPubMedGoogle Scholar
  18. 18.
    Frazier OH, Cooley DA, Kadipasaoglu KA, Pehlivanoglu S, Lindenmeir M, Barasch E, Conger JL, Wilansky S, Moore WH (1995) Myocardial revascularization with laser/preliminary findings. Circulation 92(9 Suppl):II58–II65CrossRefGoogle Scholar
  19. 19.
    Lutter G, Saurbier B, Nitzsche E, Kletzin F, Martin J, Schlensak C, Lutz C, Beyersdorf F (1998) Transmyocardial laser revascularization (TMLR) in patients with unstable angina and low ejection fraction. Eur J Cardiothorac Surg 13(1):21–26. CrossRefPubMedGoogle Scholar
  20. 20.
    Hughes GC, Landolfo KP, Lowe JE, Coleman RB, Donovan CL (1999) Perioperative morbidity and mortality after transmyocardial laser revascularization: incidence and risk factors for adverse events. J Am Coll Cardiol 33(4):1021–1026. CrossRefPubMedGoogle Scholar
  21. 21.
    Tjomsland O, Aaberge L, Almdahl SM, Dragsund M, Moelstad P, Saatvedt K, Nordstrand K (2000) Perioperative cardiac function and predictors for adverse events after transmyocardial laser treatment. Ann Thorac Surg 69(4):1098–1103. CrossRefPubMedGoogle Scholar
  22. 22.
    Burkhoff D, Wesley MN, Resar JR, Lansing AM (1999) Factors correlating with risk of mortality after transmyocardial revascularization. J Am Coll Cardiol 34(1):55–61. CrossRefPubMedGoogle Scholar
  23. 23.
    Bockeria LA, Bockeria OL, Petrosyan AD, Shvartz VA, Donakanyan SA, Biniashvili MB (2017) Immediate effects of isolated transmyocardial laser revascularization procedures combined with intramyocardial injection of autologous bone marrow stem cells in patients with terminal stage of coronary artery disease. Russ Open Med J 2:e0205. CrossRefGoogle Scholar
  24. 24.
    Anderson JJ (2000 Summer) Transmyocardial laser revascularization. Prog Cardiovasc Nurs 15(3):76–81CrossRefGoogle Scholar
  25. 25.
    Bridges CR (2000) Angiogenesis in myocardial laser «revasculariazation». Herz 25(6):183–189CrossRefGoogle Scholar
  26. 26.
    Burkhoff D, Kornowski R (2000 Jun) An examination of potential mechanisms underlying transmyocardial laser revascularization: channels, angiogenesis and neuronal effects. Semin Interv Cardiol 5(2):71–74PubMedGoogle Scholar
  27. 27.
    Dallan LAO, Gowdak LH, Lisbo LAF, Schettert I, Kriegar JE, Cesar LAM, de Olivera SA, Stolf NAG (2008) Cell therapy plus transmyocardial laser revascularization: a proposed alternative procedure for refractory angina. Rev Bras Cir Cardiovasc 23(1):46–52CrossRefGoogle Scholar
  28. 28.
    VM Shipulin, SL Andreev, EN Pavlyukova. The use of lasers in cardiovascular surgery: from experiment to practice. 2010 STT (Publishing House "STT"), Novosibirsk. 238 pGoogle Scholar

Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2019

Authors and Affiliations

  1. 1.Bakulev National Medical Research Center for Cardiovascular SurgeryMoscowRussia

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