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TRANSMYOCARDIAL LASER REVASCULARIZATION(TMR) - DOES LASER TYPE IMPACT RESULTS OF TMR?
Leo A. Bokeria, Ilia I. Berishvili, Marat Ch. Semenov, Maia T. Kozaeva, Peter V. Gusev.
Bakoulev Cardiovascular Scientific Center, RAMS, Moscow
BACKGROUND: Different laser sources and ablation modalities have been proposed for TMR. We investigated the results of TMR with three different lasers(CO2, XeCl, Diode)
Methods: From April 1997 to October 2011 776 patients underwent TMR. Isolated TMR was performed in 245 patients, 531 patients underwent combined CABG and TMR. Out of 531 procedures 159 patients had TMR in combination with CABG on a beating heart. In 717 cases TMR was performed with high power CO2 laser, 29 - with XeCl laser and 23 - with low energy laser «LASON».
Results: Overall mortality rate was 2.8%. Mortality rate after operations with CO2 laser was 1,5%, after low power lasers - 17%.
With the carbon dioxide laser there was progressive improvement in both angina relief and perfusion by thallium scan up to 10 years. With the XeCl and diode lasers there was improvement up to 6 months, sometimes - up to 1 year, but none thereafter, and within 3 years after the surgery 50% of the patients were still class II.
A comparative assessment of the available rates of postoperative congestive heart failure, myocardial infarction, and arrhythmias demonstrated a higher rate of all of these complications for patients treated with low energy lasers.
It appeared that different lasers had different impact on the ischemic myocardial tissue
Conclusions: The distinction in wavelengths of light between low energy and CO2 lasers has increasing importance on the results. Significant differences in results and clinical improvement have been illustrated in our study. We explained these differences by physical differences of laser properties. Operations performed with low energy lasers demonstrated significant mortality and morbidity. TMR created with CO2 laser is safe and effective procedure. 7-year follow-up in the patients with end-stage CAD for whom conventional modes of therapy were contraindicated CO2 laser TMR showed significant functional improvement as well as improvement of quality of life.