Transmyocardial revascularization utilizing a holmium:YAG laser

Keith B. Allen, Robert Dowling, David A. Heimansohn, Eileen Reitsma, Luanne Didelot, Carl J. Shaar

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Objective: To evaluate the efficacy of transmyocardial revascularization performed on patients with refractory class IV or unstable angina with a holmium:yttrium-aluminum-garnet laser. Methods: Transmyocardial revascularization with a holmium:yttrium-aluminum-garnet laser was performed in 42 patients with refractory angina who were not candidates for percutaneous transluminal coronary angioplasty or coronary artery bypass grafting. Patients had either Canadian Heart Association class IV angina (n = 23) or unstable angina (n = 19) and were unable to be weaned from intravenous nitroglycerin. Preoperative thallium studies identified the extent and location of reversible ischemia. Operative exposure was via a limited left anterior thoracotomy. An average of 45 ± 11 laser channels were created with a mean operative time of 106 ± 38 min. Results: Perioperative mortality was 12% (5/42) with no late deaths. Complications included ventricular 7.1% (3/42) and atrial 4.7% (2/42) arrhythmias, reoperation for chest-wall hemorrhage 2% (1/42), and respiratory failure requiring reintubation 2% (1/42). Intra-aortic balloon pump placement was required in 12% (5/42). The mean postoperative length of stay was 5.5 ± 4.9 (1-25) days. Mean follow-up on 100% of patients is 5.4 ± 3.0 (1-12) months. At 3 (n = 33) and 6 (n = 21) months follow-up the mean angina class was 1.5 ± 0.1 (P < 0.002) and 1.1 ± 0.1 (P < 0.001), respectively. Conclusions: Transmyocardial revascularization utilizing a holmium:yttrium-aluminum-garnet laser resulted in a significant reduction in angina class and was beneficial in patients with refractory angina untreatable by conventional methods.

Original languageEnglish (US)
JournalEuropean Journal of Cardio-thoracic Surgery
Volume14
Issue numberSUPPL. 1
StatePublished - Oct 1 1998

Fingerprint

Solid-State Lasers
Holmium
Unstable Angina
Coronary Balloon Angioplasty
Thallium
Nitroglycerin
Thoracic Wall
Thoracotomy
Operative Time
Reoperation
Coronary Artery Bypass
Respiratory Insufficiency
Cardiac Arrhythmias
Length of Stay
Lasers
Ischemia
Hemorrhage
Mortality

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Allen, K. B., Dowling, R., Heimansohn, D. A., Reitsma, E., Didelot, L., & Shaar, C. J. (1998). Transmyocardial revascularization utilizing a holmium:YAG laser. European Journal of Cardio-thoracic Surgery, 14(SUPPL. 1).
Allen, Keith B. ; Dowling, Robert ; Heimansohn, David A. ; Reitsma, Eileen ; Didelot, Luanne ; Shaar, Carl J. / Transmyocardial revascularization utilizing a holmium:YAG laser. In: European Journal of Cardio-thoracic Surgery. 1998 ; Vol. 14, No. SUPPL. 1.
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abstract = "Objective: To evaluate the efficacy of transmyocardial revascularization performed on patients with refractory class IV or unstable angina with a holmium:yttrium-aluminum-garnet laser. Methods: Transmyocardial revascularization with a holmium:yttrium-aluminum-garnet laser was performed in 42 patients with refractory angina who were not candidates for percutaneous transluminal coronary angioplasty or coronary artery bypass grafting. Patients had either Canadian Heart Association class IV angina (n = 23) or unstable angina (n = 19) and were unable to be weaned from intravenous nitroglycerin. Preoperative thallium studies identified the extent and location of reversible ischemia. Operative exposure was via a limited left anterior thoracotomy. An average of 45 ± 11 laser channels were created with a mean operative time of 106 ± 38 min. Results: Perioperative mortality was 12{\%} (5/42) with no late deaths. Complications included ventricular 7.1{\%} (3/42) and atrial 4.7{\%} (2/42) arrhythmias, reoperation for chest-wall hemorrhage 2{\%} (1/42), and respiratory failure requiring reintubation 2{\%} (1/42). Intra-aortic balloon pump placement was required in 12{\%} (5/42). The mean postoperative length of stay was 5.5 ± 4.9 (1-25) days. Mean follow-up on 100{\%} of patients is 5.4 ± 3.0 (1-12) months. At 3 (n = 33) and 6 (n = 21) months follow-up the mean angina class was 1.5 ± 0.1 (P < 0.002) and 1.1 ± 0.1 (P < 0.001), respectively. Conclusions: Transmyocardial revascularization utilizing a holmium:yttrium-aluminum-garnet laser resulted in a significant reduction in angina class and was beneficial in patients with refractory angina untreatable by conventional methods.",
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Allen, KB, Dowling, R, Heimansohn, DA, Reitsma, E, Didelot, L & Shaar, CJ 1998, 'Transmyocardial revascularization utilizing a holmium:YAG laser', European Journal of Cardio-thoracic Surgery, vol. 14, no. SUPPL. 1.

Transmyocardial revascularization utilizing a holmium:YAG laser. / Allen, Keith B.; Dowling, Robert; Heimansohn, David A.; Reitsma, Eileen; Didelot, Luanne; Shaar, Carl J.

In: European Journal of Cardio-thoracic Surgery, Vol. 14, No. SUPPL. 1, 01.10.1998.

Research output: Contribution to journalArticle

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T1 - Transmyocardial revascularization utilizing a holmium:YAG laser

AU - Allen, Keith B.

AU - Dowling, Robert

AU - Heimansohn, David A.

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AU - Didelot, Luanne

AU - Shaar, Carl J.

PY - 1998/10/1

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N2 - Objective: To evaluate the efficacy of transmyocardial revascularization performed on patients with refractory class IV or unstable angina with a holmium:yttrium-aluminum-garnet laser. Methods: Transmyocardial revascularization with a holmium:yttrium-aluminum-garnet laser was performed in 42 patients with refractory angina who were not candidates for percutaneous transluminal coronary angioplasty or coronary artery bypass grafting. Patients had either Canadian Heart Association class IV angina (n = 23) or unstable angina (n = 19) and were unable to be weaned from intravenous nitroglycerin. Preoperative thallium studies identified the extent and location of reversible ischemia. Operative exposure was via a limited left anterior thoracotomy. An average of 45 ± 11 laser channels were created with a mean operative time of 106 ± 38 min. Results: Perioperative mortality was 12% (5/42) with no late deaths. Complications included ventricular 7.1% (3/42) and atrial 4.7% (2/42) arrhythmias, reoperation for chest-wall hemorrhage 2% (1/42), and respiratory failure requiring reintubation 2% (1/42). Intra-aortic balloon pump placement was required in 12% (5/42). The mean postoperative length of stay was 5.5 ± 4.9 (1-25) days. Mean follow-up on 100% of patients is 5.4 ± 3.0 (1-12) months. At 3 (n = 33) and 6 (n = 21) months follow-up the mean angina class was 1.5 ± 0.1 (P < 0.002) and 1.1 ± 0.1 (P < 0.001), respectively. Conclusions: Transmyocardial revascularization utilizing a holmium:yttrium-aluminum-garnet laser resulted in a significant reduction in angina class and was beneficial in patients with refractory angina untreatable by conventional methods.

AB - Objective: To evaluate the efficacy of transmyocardial revascularization performed on patients with refractory class IV or unstable angina with a holmium:yttrium-aluminum-garnet laser. Methods: Transmyocardial revascularization with a holmium:yttrium-aluminum-garnet laser was performed in 42 patients with refractory angina who were not candidates for percutaneous transluminal coronary angioplasty or coronary artery bypass grafting. Patients had either Canadian Heart Association class IV angina (n = 23) or unstable angina (n = 19) and were unable to be weaned from intravenous nitroglycerin. Preoperative thallium studies identified the extent and location of reversible ischemia. Operative exposure was via a limited left anterior thoracotomy. An average of 45 ± 11 laser channels were created with a mean operative time of 106 ± 38 min. Results: Perioperative mortality was 12% (5/42) with no late deaths. Complications included ventricular 7.1% (3/42) and atrial 4.7% (2/42) arrhythmias, reoperation for chest-wall hemorrhage 2% (1/42), and respiratory failure requiring reintubation 2% (1/42). Intra-aortic balloon pump placement was required in 12% (5/42). The mean postoperative length of stay was 5.5 ± 4.9 (1-25) days. Mean follow-up on 100% of patients is 5.4 ± 3.0 (1-12) months. At 3 (n = 33) and 6 (n = 21) months follow-up the mean angina class was 1.5 ± 0.1 (P < 0.002) and 1.1 ± 0.1 (P < 0.001), respectively. Conclusions: Transmyocardial revascularization utilizing a holmium:yttrium-aluminum-garnet laser resulted in a significant reduction in angina class and was beneficial in patients with refractory angina untreatable by conventional methods.

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Allen KB, Dowling R, Heimansohn DA, Reitsma E, Didelot L, Shaar CJ. Transmyocardial revascularization utilizing a holmium:YAG laser. European Journal of Cardio-thoracic Surgery. 1998 Oct 1;14(SUPPL. 1).