Abstract
At the moment transmyocardial lazer revascularization (TMR) is the only alternative indirect
technique for nonsurgical IHD patients. To the best of our knowledge, comparison to clinical
TMR results found in literature, performed with different lasers is not presented. In this
connection, we tried to assess and compare TMR results, performed with different lasers.
Material and methods. 741 TMR operations were performed in A.N. Bakoulev SCCVS between
April 1997 and April 2011. We tried to compare the results of CO2-laser procedures (232 procedures
- group I), XeCL-excimer laser (29 procedures - group II) and semiconducting diodelaser
«Lazon 10» (23 procedures - group III). The follow-up period was 10 years (mean -
4 years).
Results. The improvement of angina class in the CO2 laser group was better than in the XeCL
group in 48 months of follow-up. Dynamics of nitrate requirement was significantly better in
CO2 group during the whole follow-up period. Total left ventricle ejection fraction (LVEF) did
not improve significantly in group I and decreased significantly in group II. LVEF in the CO2
laser group was significantly better (p<0.001) than in the XeCL laser group in 4 years of followup.
In CO2-laser group the actuarial survival was 90.1% and in XeCl laser group it was 72,4%.
Freedom from myocardial infarction (MI) was 94.3 and 77.1%, respectively.
Comparison of combined coronary artery bypass grafting (CABG) and TMR. The improvement of
angina functional class was noted in both groups, but at 12-month of follow-up it worsened significantly
in the CO2 laser group. Nitrate requirement decreased significantly in both groups.
LVEF improved significantly and did not change in group II. Significant improvement of physical
and psychoemotional state was revealed at evaluation of physical state in the CO2 laser
group. Life-quality in semiconductor laser group improved only before 6 months of follow-up.
Later it had a tendency toward deterioration. Survival of patients was 94.1% in CO2 laser and
72.1% in semiconductor laser group. Freedom from MI was 93.7 and 79.6%, respectively.
Conclusion. Efficiency of TMR with improvement of myocardial perfusion can be achieved only
with high-energy CO2 laser. Application of low-energy lasers for TMR is not advisable.
References
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