TMLR With and Without Additional Single Grafting: Differences in Postoperative Outcome?
In the past few years transmyocardial laser revascularisation (TMLR) has been introduced into clinical practice as a new operative technique. It constitutes a new therapeutic concept for those patients who suffer angina despite maximal anti-ischaemic medication and who are not suitable for conventional interventional procedures like coronary artery bypass grafting (CABG) or percutaneous transluminal angioplasty (PTCA) due to severe diffuse coronary artery disease (CAD). TMLR has been accepted as a procedure for myocardial revascularisation because postoperative results reveal an improvement of clinical symptoms and myocardial perfusion [3, 5, 6, 9, 16]. However, TMLR is still the subject of controversy, since the exact mechanism of action has not been unequivocally clarified to date. The basic principles of myocardial laser treatment are the techniques to achieve improved myocardial perfusion as delineated by Beck  and Vineberg , as well as by Massimo and Boffi  and later by Sen et al. . Alligator hearts serve as an anatomic model because, of all amphibians, they possess a complete interventricular septum, and therefore a parallel to the human heart can be drawn. On the other hand, in alligators left ventricular myocardial perfusion is - to a large extent - supplied directly by channels originating from the left ventricle . Following further development of laser therapy, the first clinical TMLR trials with an 800-watt carbon dioxide laser were conducted by Mirhoseini and co-workers . In this first series of investigations 16 patients had improved with regard to their clinical symptoms at follow-up 6 years after the operation.
KeywordsCatheter Dioxide Nicotine Peri Catecholamine
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