Transmyocardial revascularization: The magic of drilling holes in the heart

Rudolf M. Verdaasdonck*

*Corresponding author for this work

Research output: Chapter in Book/Report/Conference proceedingConference contributionAcademicpeer-review

1 Citation (Scopus)
4 Downloads (Pure)

Abstract

Drilling holes in myocardial tissue using high-power lasers has shown to be effective in relieving angina in patients in an end-stage coronary heart disease who do not respond to medication and are unsuitable for standard revascularization techniques. An overview is presented of the interaction of various laser systems with myocardial tissue and the many experimental and clinical studies that have been conducted to elucidate the mechanism of the therapeutic effect of transmyocardial (laser) revascularization (TMR or TMLR). An angina relief of 2 classes with an acceptable mortality (5-10 %) and morbidity (20-30 %) rate is achieved in the majority of patients. Adverse effects can be minimized by critical patient selection and by a percutaneous approach (PMR). There is no significant difference in the results between the treatment modalities. The acute beneficial effect of TMLR might be attributed to sympathetic denervation. The combined thermal and mechanical injury has shown to provoke an angiogenic response that may be enhanced by adding growth factors. Consequent improvement of the myocardial reperfusion and functionality has been observed but needs further verification with, e.g., high-resolution scintigraphic techniques. Based on the experience in over 7000 patients, TMLR shows to be an effective and safe procedure resulting in a significant improvement in the quality of life for a carefully selected patient group suffering from end-stage coronary disease.

Original languageEnglish
Title of host publicationMatching the Energy Source to the Clinical Need: A Critical Review; 102970B
PublisherSPIE
Pages99-138
Number of pages40
DOIs
Publication statusPublished - 24 Jan 2000
Externally publishedYes
EventMatching the Energy Source to the Clinical Need: A Critical Review 1990 - Los Angeles, United States
Duration: 15 Jan 199016 Jan 1990

Publication series

NameProceedings of SPIE - the international society for optical engineering
PublisherSPIE
Volume10297
ISSN (Print)0277-786X

Conference

ConferenceMatching the Energy Source to the Clinical Need: A Critical Review 1990
Country/TerritoryUnited States
CityLos Angeles
Period15/01/9016/01/90

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