Thoracoscopic transmyocardial laser revascularization.
BACKGROUND
Transmyocardial laser revascularization is a promising surgical technique used to treat nonreconstructable ischemic heart disease. Recent clinical data show that this technique improves the regional perfusion of ischemic myocardium and reduces angina. Presently, transmyocardial laser revascularization requires an open, lateral thoracotomy. We report here the use of thoracoscopic techniques to perform transmyocardial laser revascularization in a closed chest fashion.


METHODS
Five Yorkshire farm pigs underwent left chest thoracoscopic exploration and pericardiotomy. A specialized laser handpiece then was introduced into the chest and thoracoscopic transmyocardial laser revascularization was performed (one channel per square centimeter) using an 800-W CO2 laser.


RESULTS
Video analysis and gross pathology revealed that the anatomic area accessible to thoracoscopic transmyocardial laser revascularization included the entire left ventricular free wall distributions of the left anterior descending, left circumflex, and posterior descending arteries, from base to apex. Standard hematoxylin and eosin staining confirmed the creation of complete and patent 1-mm-diameter transmural channels throughout these distributions.


CONCLUSIONS
We have shown that transmyocardial laser revascularization can be performed effectively and safely by thoracoscopy, and that this less invasive technique may reduce morbidity and provide a more cost-effective alternative therapy for nonreconstructable ischemic heart disease.
deGuzman
B J
BJ
Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
Lautz
D B
DB
Chen
F Y
FY
Laurence
R G
RG
Ahmad
R M
RM
Horvath
K A
KA
Cohn
L H
LH
D000818:Animals; D004724:Endoscopy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D053685:Laser Therapy; D008297:Male; D009204:Myocardial Revascularization / Q000379:methods*; D009206:Myocardium / Q000473:pathology; D013552:Swine; D013906:Thoracoscopy