Abstract
Transmyocardial laser revascularization (TMLR) was introduced into the clinical practice as a method of treatment
of patients with diffuse coronary artery disease not suitable for surgical or endovascular revascularization. The procedure
is oriented to create a laser tubules in ischemic myocardium with the goal of improving perfusion of the
affected area. Today there are two varieties of devices for TMLR: holmium-lasers (Ho:YAG lasers) and lasers based on carbon dioxide (CO2-lasers). These devices differ in the output of energy, wave lengths, ability to synchronize with
the cardiac cycle and the interaction of laser and tissues. These differences form the basis for studies demonstrating
the efficiency of two types of laser devices.
Bakoulev National Medical Research Center for Cardiovascular Surgery has experience of performing over
1200 TMLR surgeries; in the world is made of more than 50 000 interventions. The use of this technique has been
shown to decrease the severity of angina, improved quality of life, and myocardial perfusion. Despite the fact that
there are several mechanisms for the development of this positive effect, the leading factor with the greatest evidence
base, is the formation of new blood vessels (angiogenesis) in the area of exposure on the affected areas of the
myocardium. Today TMLR used as a sole method of surgical treatment (isolated procedure), or in combination with
performing coronary artery bypass surgery. In the context of clinical studies has been demonstrated both safety and
efficacy in reducing the severity of angina in the remote terms of observation. In recent times, to improve the effectiveness
of the procedure started clinical trials on the combined use of stem cells and TMLR. The purpose of this
review is to present two accredited devices for TMLR, as well as evidence in favor of the safety and efficacy of
methods TMLR along with discussion of future directions for this technology.
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About the authors
- Leo A. Bockeria, Academician of RAS and RAMS, Director; orcid.org/0000-0002-6180-2619
-
Sergey A. Donakanyan, Cand. Med. Sc., Cardiovascular Surgeon, Head of the Intensive Care Unite Department; orcid.org/0000-0003-0942-2931
