Original Article
Transmyocardial Revascularization with a Carbon Dioxide Laser in Patients with End-Stage Coronary Artery Disease
N Engl J Med 1999; 341:1021-1028September 30, 1999
- Abstract
Background
The construction of subendocardial channels to perfuse ischemic areas of the myocardium has been investigated since the 1950s. We assessed the safety and efficacy of transmyocardial revascularization with a carbon dioxide laser in patients with refractory angina and left ventricular free-wall ischemia that was not amenable to direct coronary revascularization.
Methods
In a prospective, controlled, multicenter trial, we randomly assigned 91 patients to undergo transmyocardial revascularization and 101 patients to receive continued medical treatment. The severity of angina (according to the Canadian Cardiovascular Society [CCS] classification), quality of life, and cardiac perfusion (as assessed by thallium-201 scanning) were evaluated at base line and 3, 6, and 12 months after randomization.
Results
At 12 months, angina had improved by at least two CCS classes in 72 percent of the patients assigned to transmyocardial revascularization, as compared with 13 percent of the patients assigned to medical treatment who continued medical treatment (P<0.001). Patients in the transmyocardial-revascularization group also had a significantly improved quality of life as compared with the medical-treatment group. Myocardial perfusion improved by 20 percent in the transmyocardial-revascularization group and worsened by 27 percent in the medical-treatment group (P=0.002). In the first year of follow-up, 2 percent of patients assigned to undergo transmyocardial revascularization were hospitalized because of unstable angina, as compared with 69 percent of patients assigned to medical treatment (P<0.001). The perioperative mortality rate associated with transmyocardial revascularization was 3 percent. The rate of survival at 12 months was 85 percent in the transmyocardial-revascularization group and 79 percent in the medical-treatment group (P=0.50).
Conclusions
In patients with angina refractory to medical treatment and coronary artery disease that precluded coronary-artery bypass surgery or percutaneous transluminal coronary angioplasty, transmyocardial revascularization improved cardiac perfusion and clinical status over a 12-month period.
Media in This Article
Figure 4
Event-free Survival According to Treatment Group.Figure 2
Relief of Angina According to Treatment Group.Article Activity
- Article
In the 1950s, Goldman and associates1 and Massimo and Boffi2 proposed that natural or artificial conduits could be implanted in the subendocardium to direct left ventricular blood through the coronary sinusoids and into ischemic areas of the myocardium. In 1968, after extensive experiments in animals, Sen and colleagues3 described transmyocardial revascularization through transmural channels created with a 16-gauge intravenous cannula. In 1981, Mirhoseini and Cayton4 used a laser to create transmyocardial channels in animals; five years later, Okada and colleagues5 did the same in humans. Investigators have continued to test transmyocardial revascularization in both animals6-9 and humans.10
In a nonrandomized, longitudinal trial undertaken to establish the safety, efficacy, and value of transmyocardial revascularization performed with a laser in 201 patients at eight U.S. centers, angina was relieved and cardiac perfusion improved in 75 percent of the patients over a 12-month period.10 We conducted a prospective, randomized, multicenter trial to examine further the safety and efficacy of transmyocardial revascularization in patients with refractory angina and documented left ventricular free-wall ischemia that was not amenable to direct coronary revascularization and to compare this treatment with maximal medical therapy.
Methods
Study Design
Between July 1995 and September 1997, 12 U.S. centers participated in this prospective, randomized, controlled study. Written informed consent was obtained from each patient before enrollment. By means of randomization at a central institution, patients were assigned, in a 1:1 ratio, to undergo transmyocardial revascularization with a carbon dioxide laser (the Heart Laser System, PLC Medical Systems, Franklin, Mass.) or to receive continued medical treatment. Patients were selected by the attending cardiologist, interventional cardiologist, or surgeon after a review of clinical symptoms, recent angiograms, and perfusion scans.
To be enrolled in the trial, patients were required to meet the following criteria: Canadian Cardiovascular Society (CCS) class III or IV angina that was refractory to medical treatment, reversible ischemia of the left ventricular free wall, and coronary disease that was not amenable to coronary-artery bypass grafting or percutaneous transluminal coronary angioplasty. Patients whose coronary disease was severe and diffuse or who did not have a target vessel or conduit suitable for grafting were considered to have disease not amenable to the latter two procedures. Patients were excluded if the left ventricular ejection fraction was less than 20 percent or if they had a concurrent major illness.
Crossover from medical treatment to transmyocardial revascularization was allowed if a patient had unstable angina that necessitated intravenous antianginal therapy for 48 hours or more in an intensive care unit. After crossover, patients were followed for an additional 12 months, regardless of how long they had been in the group assigned to medical treatment. These patients were considered part of the medical-treatment group until crossover, after which they were followed separately.
Clinical Evaluation
The patients' clinical status was evaluated with respect to CCS angina class, use of cardioactive medications, and responses on quality-of-life questionnaires. Angina was classified at enrollment and at 3, 6, and 12 months according to CCS guidelines. To eliminate potential bias, angina was also classified in a blinded manner by an independent evaluator. Success at follow-up was defined as an angina class at least two classes below that at base line.
To study fully the effects of transmyocardial revascularization in comparison with medical treatment, both intention-to-treat and “on-treatment” analyses of angina were conducted. The intention-to-treat analysis, which included patients who remained in the medical-treatment group as well as patients who were crossed over to transmyocardial revascularization as part of the medical-treatment group, provided a conservative estimate of the effect of transmyocardial revascularization, preventing overly optimistic conclusions. The on-treatment analysis, which did not include patients who were crossed over to transmyocardial revascularization, was considered the best way to evaluate the results from a clinical perspective. Thus, patients assigned to transmyocardial revascularization were compared first with all the patients assigned to medical treatment and then separately with those assigned to medical treatment and not crossed over.
Quality of life was assessed in all patients at enrollment and at 3, 6, and 12 months during follow-up. At these times, each patient completed two questionnaires: the 36-item Medical Outcomes Study Short-Form General Health Survey (SF-36)11 and the Seattle Angina Questionnaire.12
Single-Photon-Emission Computed Tomography
The extent and reversibility of myocardial ischemia at rest and during exercise were assessed in each patient at enrollment and at 3, 6, and 12 months. Patients underwent thallium-201 single-photon-emission computed tomography (SPECT) with pharmacologic stress testing (with dipyridamole at a dose of 0.56 mg per kilogram of body weight, to a maximum of 6 mg) and four-hour redistribution–reinjection imaging. All the images were processed according to a standard protocol by a single technician at Cedars–Sinai Medical Center. Every image was then analyzed by an experienced nuclear cardiologist who was unaware of the patient's identity, treatment assignment, and scan date.
Each image was divided into three cross sections (apical, midventricular, and basal) parallel to the atrioventricular groove. Each of these cross sections was then divided into eight segments, which were individually analyzed to assess perfusion status. Each segment was examined for the presence of normal tissue, a fixed defect (scar), a reversible defect (ischemic or hibernating myocardium), or both fixed and reversible defects. The sum of the number of segments in each perfusion category is expressed as a percentage of all 24 segments and used to characterize the perfusion of the left side of the heart. Perfusion results at 3, 6, and 12 months were compared with the scores at base line for each patient.
Transmyocardial Revascularization
The technique of transmyocardial revascularization has been described in detail elsewhere.10 Transmural channels approximately 1 mm in diameter were created with a single pulse of the carbon dioxide laser (peak power, 850 W) through the left ventricle. Approximately one channel was created per square centimeter of myocardial surface. Transmural penetration by the laser was confirmed by transesophageal echocardiography.
Statistical Analysis
Analyses were performed with a two-sided standard t-test, paired t-test, or analysis of variance for normally distributed continuous variables; with a two-sided Wilcoxon signed-rank test, the Wilcoxon rank-sum test, or the Kruskal–Wallis test for variables not normally distributed; with a two-sided chi-square test or Fisher's exact test for discrete variables; and with the Kaplan–Meier test or a log-rank test for survival free of cardiac events. P values of less than 0.05 were considered to indicate statistical significance.
To determine whether specific outcomes, such as treatment success or mortality, could be predicted on the basis of the patient's characteristics at base line, multivariate logistic-regression analyses were conducted with stepwise regression (SAS software, version 6.12, SAS, Cary, N.C.).
Results
Characteristics of the Study Population
Ninety-one patients were randomly assigned to undergo transmyocardial revascularization, and 101 patients were assigned to receive medical therapy (Figure 1Figure 1
Overview of the Outcomes of Patients Assigned to Undergo Transmyocardial Revascularization (TMR), Those Assigned to Receive Medical Treatment Alone, and Those Crossed over from Medical Treatment to TMR.). The groups were balanced at base line with respect to sex, age, cardiac status, medical history, and cardiac risk factors (Table 1Table 1
Characteristics of the Patients at Randomization.). Approximately 60 percent of the patients in each group were considered to be at high risk for a poor outcome as determined by the established scoring system of the Cleveland Clinic for surgical revascularization.13 All the patients in both groups had severe coronary disease with lesions in all three major vessels.Results of Transmyocardial Revascularization
During surgery, a mean (±SD) of 36±13 channels were created, 30±8 of which were confirmed by transesophageal echocardiography to be transmural. Epicardial sutures were needed for hemostasis in 1 percent of the patients. There were no intraoperative deaths. The median stay in the intensive care unit for the patients who underwent transmyocardial revascularization was two days, for a median hospital stay of seven days.
Clinical Status
Two patients assigned to transmyocardial revascularization and four assigned to medical treatment were lost to follow-up. Two of the four patients in the medical-treatment group had been crossed over to transmyocardial revascularization; thus, the six patients were evenly distributed among the three groups analyzed (Figure 1) and their exclusion did not modify the results, regardless of the outcome.
Angina Class
With success at follow-up defined as a reduction of at least two angina classes as compared with base line, transmyocardial revascularization was significantly more successful in both analyses (Figure 2Figure 2
Relief of Angina According to Treatment Group.). At three months, 67 percent of the patients assigned to transmyocardial revascularization, 20 percent of those assigned to medical treatment (including those crossed over), and 6 percent of those assigned to medical treatment and not crossed over had a clinically successful result (P<0.001 for the comparison between the transmyocardial-revascularization group and each medical-treatment group) (Figure 2). At 6 months, the success rates were 67 percent, 27 percent, and 6 percent, respectively, and at 12 months, the success rates were 72 percent, 43 percent, and 13 percent, respectively (P<0.001 for both sets of comparisons).A blinded, independent assessment of angina was conducted in addition to the on-site evaluations. For 80 percent of the patients, the result of the independent assessment was within one CCS class of the result of the on-site assessment, indicating consistency in the evaluations. When the on-site and independent evaluations were compared, no significant differences were found (P=0.20).
Cardioactive Medications
Changes in the use of cardioactive medications (nitrates, beta-blockers, and calcium-channel blockers) from base line to follow-up were analyzed for their potential influence on outcomes with respect to angina. The clinical success of transmyocardial revascularization was not due to changes in medication; the use of medications decreased or remained unchanged in 83 percent of the patients in whom transmyocardial revascularization was successful. Conversely, the use of medications increased or remained unchanged in 86 percent of the patients assigned to medical treatment.
Quality of Life
According to the responses on the SF-36 questionnaire, patients in the transmyocardial-revascularization group had a greater improvement in their quality of life (38 percent improvement) than patients in the medical-treatment group (6 percent improvement) as compared with base line at three months (P<0.001). This difference was also significant at 6 and 12 months (P=0.01 and P<0.001, respectively). For each of 15 components of the Seattle Angina Questionnaire, transmyocardial revascularization was associated with a significantly better result than medical treatment.
Spect Scans
The rates of compliance with the protocol and the proportion of scans that were usable during follow-up were similar in the two groups (81 percent and 72 percent, respectively, in the transmyocardial-revascularization group and 79 percent and 69 percent, respectively, in the medical-treatment group). The mean number of segments with reversible perfusion defects at enrollment was 7.1±3.7 per patient in the transmyocardial-revascularization group and 6.8±3.3 in the medical-treatment group (P=0.60). At enrollment, the mean number of segments that were judged to have fixed defects was 9.0±3.6 in the transmyocardial-revascularization group and 9.0±3.3 in the medical-treatment group (P=0.96).
Medications were not stopped before the performance of SPECT imaging. Use of medications was balanced between the groups at each time point. Figure 3Figure 3
Change in Left-Sided Myocardial Perfusion during Follow-up, According to Treatment Assignment. shows the percent change in left-sided myocardial perfusion at 3, 6, and 12 months. In the group assigned to transmyocardial revascularization, reversible ischemia decreased by an average of 1.5 segments per patient at 3 months, 0.8 segment at 6 months, and 1.4 segments at 12 months. In contrast, in the group assigned to medical treatment, reversible ischemia increased by an average of 0.8, 0.8, and 1.3 segments, respectively (P=0.001 for the comparison between groups at 3 months, P=0.02 for the comparison at 6 months, and P=0.002 for the comparison at 12 months). However, there were no statistically significant differences between the groups at any of these time points in the number of fixed defects per patient.Morbidity
During the first 30 days after transmyocardial revascularization, 6 patients (7 percent) had acute myocardial infarction, 10 (11 percent) had congestive heart failure, 7 (8 percent) had ventricular tachycardia or ventricular fibrillation, and 1 (1 percent) had unstable angina. Sixty-two patients had no complications, 18 had one, 7 had two, 1 had three, 1 had four, and 2 had five. The only complication resulting specifically from the surgical procedure was an accidental laser-induced injury of the mitral apparatus, which was repaired, in one patient.
During the 12-month follow-up period, the rate of hospital admission due to unstable angina was 2 percent among patients assigned to transmyocardial revascularization and 69 percent among patients assigned to medical treatment (P<0.001). Rates of admission to the intensive care unit during the 12-month period were 0.02 admission per patient in the transmyocardial-revascularization group and 1.37 admissions per patient in the medical-treatment group. There was no significant difference in the rate of freedom from acute myocardial infarction between patients assigned to transmyocardial revascularization (87 percent) and those assigned to medical treatment who did not cross over (80 percent, P=0.24), but the rate of freedom from unstable angina was significantly higher after transmyocardial revascularization (84 percent, as compared with 25 percent after medical treatment only; P<0.001). The proportion of patients who did not die and who were free of acute myocardial infarction, unstable angina, and class IV angina was also significantly higher in the transmyocardial-revascularization group (66 percent, as compared with 11 percent in the medical-treatment group; P<0.001). Event-free survival is shown in Figure 4Figure 4
Event-free Survival According to Treatment Group..Mortality
There were no intraoperative deaths among the patients assigned to transmyocardial revascularization; the 12-month survival rate was 85 percent. In comparison, the 12-month survival rate was 79 percent among the 41 medically treated patients who were not crossed over to transmyocardial revascularization (P=0.50). Of the patients assigned to transmyocardial revascularization, 3 (3 percent) died perioperatively, and 10 (11 percent) died from cardiac causes during follow-up (Table 2Table 2
Causes of Death According to Treatment Group.).The sole predictor of perioperative mortality was the occurrence of unstable angina. The time between an occurrence of unstable angina and surgery was significantly related to the risk of perioperative death (P<0.001): the risk increased by a factor of 22.9 when the time between angina and surgery decreased to less than 2 weeks (1 to 7 days: 8 of 30 patients died [27 percent; 95 percent confidence interval, 11 to 43 percent]; 8 to 14 days: 3 of 19 died [16 percent; 95 percent confidence interval, 0 to 32 percent]; ≥15 days: 1 of 102 died [1 percent; 95 percent confidence interval, 0 to 3 percent]) (P<0.001). A low left ventricular ejection fraction was a significant predictor of overall mortality in the transmyocardial-revascularization group (P=0.02). The incidence of acute myocardial infarction during the study was significantly associated with overall mortality in both groups (transmyocardial revascularization, P= 0.05; medical treatment, P=0.03). The treatment-group assignment was not predictive of mortality, confirming the similarity of overall mortality in the two groups.
Crossover Group
Of the 101 patients assigned to medical treatment 60 (59 percent) were crossed over to transmyocardial revascularization a mean of 107±89 days after randomization. Because of their unstable angina, these patients were considered to be at high risk for a poor outcome (Cleveland Clinic risk score, 9.3±3.6, as compared with a score of 5.8±2.9 at enrollment for all patients assigned to medical treatment, where a score of ≥5 indicates a high risk; P=0.02). During the first 30 days after surgery, 3 of the 60 patients (5 percent) had acute myocardial infarction, 2 (3 percent) had unstable angina, 3 (5 percent) had arrhythmias, and 3 (5 percent) had congestive heart failure. One patient sustained laser-induced damage to the mitral apparatus during surgery. Twenty-three of the patients who were crossed over underwent the 12-month follow-up assessment of angina; 16 of these 23 patients (70 percent) had CCS class I or II angina, 3 (13 percent) had class III, and 4 (17 percent) had class IV.
Discussion
Before this study was conducted, the potential benefits of transmyocardial revascularization performed with a carbon dioxide laser had been observed in most of the 2500 patients who had undergone this treatment. A nonrandomized study of these patients showed significant improvement in symptoms and perfusion after the laser treatment.10 Whether this improvement would have occurred without transmyocardial revascularization was unknown. This question prompted the current randomized investigation.
In this study, the proportion of patients who had relief from angina was greater in the group assigned to undergo transmyocardial revascularization (72 percent) than in the patients in the group assigned to receive maximal medical therapy who did not cross over to transmyocardial revascularization (13 percent). This significant decrease in the patients' CCS class was confirmed by a blinded, independent assessment and with use of the Seattle Angina Questionnaire. Moreover, patients who were assigned to medical treatment had a rate of hospital admission for unstable angina of 69 percent, as compared with only 2 percent in the transmyocardial-revascularization group. Among patients who underwent transmyocardial revascularization, relief of acute and chronic angina resulted in an improved quality of life, as measured by the SF-36 questionnaire, and reduced use of antianginal medications.
In addition, myocardial perfusion improved after transmyocardial revascularization and worsened with medical treatment alone. The price of the benefits of transmyocardial revascularization was a 3 percent rate of perioperative mortality. If the procedure was deferred for two weeks, this rate decreased to 1 percent, making the mortality associated with transmyocardial revascularization less than that associated with coronary-artery bypass grafting.14 Overall survival at 12 months was similar in the two groups (transmyocardial revascularization, 85 percent; medical treatment, 79 percent; P=0.50).
This study did not directly address the mechanisms underlying the benefits of transmyocardial revascularization; however, several inferences can be made. There may be a short-lived placebo effect. In a nonrandomized trial, long-term follow-up of patients who underwent transmyocardial revascularization showed no change in the improvement in symptoms after 3 years (average CCS class, 3.8±0.4 at base line, 1.4±1.2 at 12 months, and 1.5±1.2 at 36 months).15 The conversion of ischemic myocardi-um to infarcted myocardium may also improve anginal symptoms. In our study, however, the extent of fixed defects in perfusion over the 12-month period was similar in the two groups, and there was no significant increase in fixed defects after transmyocardial revascularization as compared with medical treatment. Denervation is another possible mechanism of the benefit. If this were the explanation, however, one would expect to see an increase in myocardial infarction, sudden death, and heart failure with transmyocardial revascularization — none of which increased in the patients assigned to this treatment.
Improved perfusion and relief of symptoms after transmyocardial revascularization could result from patent channels created by the laser or from laser-induced angiogenesis. Isolated anatomical evidence of patent channels has been reported.16,17 In addition, real-time, high-resolution contrast echocardiography has shown patent laser channels perfusing a 1.5-cm3 section of myocardium with each systole.18 In our study, perfusion improved over a period of 12 months, indicating that the laser may increase perfusion by stimulating angiogenesis.
Although we assume that transmyocardial revascularization directly enhances myocardial perfusion, providing relief of angina, we cannot establish a direct correlation. Changes in clinical symptoms and changes on perfusion scans reflect two related but distinct phenomena, and in our study the degree of symptomatic improvement was not necessarily matched by the degree of improvement in the results on scanning. Symptoms and perfusion improved in most of the patients assigned to transmyocardial revascularization but not in those assigned to medical treatment who did not cross over to transmyocardial revascularization.
The option for crossover from the medical-treatment group to the transmyocardial-revascularization group was the greatest limitation of this study. Crossover was allowed as an incentive for patients assigned to maximal medical therapy to remain in the study if medical therapy failed. The attrition rate in this group was considerable because the condition of these patients did not improve substantially and because, by definition, they had unstable angina that required intravenous medication. Despite the limitation inherent in the crossover design, the patients assigned to transmyocardial revascularization showed improvement at three and six months as compared with their base-line values and as compared with values in their medically treated counterparts. In addition, although lifestyle changes can be limiting factors in clinical trials, there were no significant differences in lifestyle or medication use that might have influenced the outcomes.
In a recent report on a randomized study at a single center,19 Schofield et al. concluded that transmyocardial revascularization should not be recommended because it did not significantly increase exercise capacity or 12-minute walking distance at 12 months. However, the patients who underwent transmyocardial revascularization did have significantly decreased angina (as indicated by the CCS class), increased functional capacity, less need for antianginal medications, and fewer hospital admissions as compared with medically treated patients. With respect to exercise capacity and walking times, comparisons were made between the groups at each follow-up period, not between base line and follow-up within each group. The authors reported similar decreases in reversible defects in the two groups. However, they did not consider the effect of changes in fixed defects.
With regard to fixed defects, there was no significant change from base line to 12 months in the transmyocardial-revascularization group.19 The medically treated group, however, had a significant increase in fixed defects from base line (38 segments [8 percent]) to 12 months (68 segments [17 percent]); in other words, reversible defects decreased when fixed defects increased, as ischemic areas became scarred. In addition, follow-up data on perfusion were pooled, and comparisons were again made between the groups rather than between base line and follow-up.
In general, the study by Schofield et al.19 is not closely comparable with our multicenter trial. Patients in our trial were much sicker (70 to 80 percent had CCS class IV angina at base line, as compared with 27 percent in the study by Schofield et al.19), and we did not exclude patients with unstable angina, whereas Schofield et al. did. If patients with unstable angina are excluded, the perioperative mortality rate in our study falls to 1 percent, which is less than the 5 percent reported in the other series.19
In summary, we conducted this multicenter, randomized, controlled trial to determine the effect of transmyocardial revascularization with a carbon dioxide laser on symptoms and cardiac perfusion in patients with end-stage coronary disease. We found that transmyocardial revascularization significantly alleviated angina and improved cardiac perfusion in patients with severe angina that was refractory to conventional medical therapy or revascularization procedures.
We are indebted to Philip T. Lavin, Ph.D. (Boston Biostatistics, Boston), for statistical assistance and to Marianne Mallia (Texas Heart Institute, Houston) for editorial assistance in the preparation of the manuscript.
Source Information
From the Department of Cardiovascular Surgery and Research, Texas Heart Institute, Houston (O.H.F.); the Department of Cardiovascular Surgery, Rush–Presbyterian–St. Luke's Medical Center, Chicago (R.J.M.); and the Division of Cardiothoracic Surgery, Northwestern University Medical School, Chicago (K.A.H.).
Address reprint requests to Dr. Frazier at the Texas Heart Institute, P.O. Box 20345, Houston, TX 77225-0345.
Other members of the Transmyocardial Carbon Dioxide Laser Revascularization Study Group are listed in the Appendix.
Appendix
Other members of the Transmyocardial Carbon Dioxide Laser Revascularization Study Group were A.M. Lansing (Audubon Regional Medical Center, Louisville, Ky.), L.H. Cohn and S.F. Aranki (Brigham and Women's Hospital, Boston), G. Fontana (Cedars–Sinai Medical Center, Los Angeles), B.W. Lytle (Cleveland Clinic, Cleveland), C. Smith (Columbia–Presbyterian Medical Center, New York), K.P. Landolfo and J.E. Lowe (Duke University Hospital, Durham, N.C.), J.R. Crew (Seton Medical Center, San Francisco), M.R. Mirhoseini (St. Luke's Medical Center, Milwaukee), D.A. Cooley and K.A. Kadipasaoglu (Texas Heart Institute, Houston), B.P. Griffith and B. Hattler (University of Pittsburgh Presbyterian Hospital, Pittsburgh), and S.W. Boyce (Washington Hospital, Washington, D.C.).
- References
References
1
Goldman A ,Greenstone SM ,Preuss FS ,Strauss SH ,Chang E-S . Experimental methods for producing a collateral circulation to the heart directly from the left ventricle. J Thorac Surg 1956;31:364-374
Medline2
Massimo C ,Boffi L . Myocardial revascularization by a new method of carrying blood directly from the left ventricular cavity into the coronary circulation. J Thorac Surg 1957;34:257-264
Medline3
Sen PK ,Daulatram J ,Kinare SG ,Udwadia TE ,Parulkar GB . Further studies in multiple transmyocardial acupuncture as a method of myocardial revascularization. Surgery 1968;64:861-870
Web of Science | Medline4
Mirhoseini M ,Cayton M . Revascularization of the heart by laser. J Microsurg 1981;2:253-260
CrossRef | Medline5
Okada M ,Ikuta H ,Shimizu K ,Horii H ,Nakamura K . Alternative method of myocardial revascularization by laser: experimental and clinical study. Kobe J Med Sci 1986;32:151-161
Medline6
Mirhoseini M ,Shelgikar S ,Cayton MM . New concepts in revascularization of the myocardium. Ann Thorac Surg 1988;45:415-420
CrossRef | Web of Science | Medline7
Yano OJ ,Bielefeld MR ,Jeevanandam V , et al. Prevention of acute regional ischemia with endocardial laser channels. Ann Thorac Surg 1993;56:46-53
CrossRef | Web of Science | Medline8
Horvath KA ,Smith WJ ,Laurence RG ,Schoen FJ ,Appleyard RF ,Cohn LH . Recovery and viability of an acute myocardial infarct after transmyocardial laser revascularization. J Am Coll Cardiol 1995;25:258-263
CrossRef | Web of Science | Medline9
Kadipasaoglu KA ,Pehlivanoglu S ,Conger JL , et al. Long- and short-term effects of transmyocardial laser revascularization in acute myocardial ischemia. Lasers Surg Med 1997;20:6-14
CrossRef | Web of Science | Medline10
Horvath KA ,Cohn LH ,Cooley DA , et al. Transmyocardial laser revascularization: results of a multicenter trial with transmyocardial laser revascularization used as sole therapy for end-stage coronary artery disease. J Thorac Cardiovasc Surg 1997;113:645-654
CrossRef | Web of Science | Medline11
Ware JE Jr ,Sherbourne CD . The MOS 36-item short-form health survey (SF-36). 1. Conceptual framework and item selection. Med Care 1992;30:473-483
CrossRef | Web of Science | Medline12
Spertus JA ,Winder JA ,Dewhurst TA , et al. Development and evaluation of the Seattle Angina Questionnaire: a new functional status measure for coronary artery disease. J Am Coll Cardiol 1995;25:333-341
CrossRef | Web of Science | Medline13
Higgins TL ,Estafanous FG ,Loop FD ,Beck GJ ,Blum JM ,Paranandi L . Stratification of morbidity and mortality outcome by preoperative risk factors in coronary artery bypass patients: a clinical severity score. JAMA 1992;267:2344-2348[Erratum, JAMA 1992;268:1860.]
CrossRef | Web of Science | Medline14
Pires LA ,Wagshal AB ,Lancey R ,Huang SKS . Arrhythmias and conduction disturbances after coronary artery bypass graft surgery: epidemiology, management, and prognosis. Am Heart J 1995;129:799-808
CrossRef | Web of Science | Medline15
Horvath KA ,Cohn LH ,Cooley DA , et al. Functional improvement, long term survival and angina relief after transmyocardial revascularization with a CO2 laser. Circulation 1998;98:Suppl I:I-217 abstract.16
Cooley DA ,Frazier OH ,Kadipasaoglu KA ,Pehlivanoglu S ,Shannon RL ,Angelini P . Transmyocardial laser revascularization: anatomic evidence of long-term channel patency. Tex Heart Inst J 1994;21:220-224
Web of Science | Medline17
Mirhoseini M ,Shelgikar S ,Cayton MM . Transmyocardial laser revascularization: a review. J Clin Laser Med Surg 1993;11:15-19
Medline18
Berwing K ,Bauer EP ,Strasser R ,Klovekorn WP ,Reuthebuch O ,Bertschmann W . Functional evidence of long-term channel patency after transmyocardial laser revascularization. Circulation 1997;96:Suppl I:I-564 abstract.19
Schofield PM ,Sharples LD ,Caine N , et al. Transmyocardial laser revascularisation in patients with refractory angina: a randomised controlled trial. Lancet 1999;353:19-24
CrossRef
- Citing Articles (133)
Citing Articles
1
Sofoclis Mitsos, Konstantinos Katsanos, Efstratios Koletsis, George C. Kagadis, Nikolaos Anastasiou, Athanasios Diamantopoulos, Dimitris Karnabatidis, Dimitris Dougenis. (2011) Therapeutic angiogenesis for myocardial ischemia revisited: basic biological concepts and focus on latest clinical trials. Angiogenesis
CrossRef2
L. David Hillis, Peter K. Smith, Jeffrey L. Anderson, John A. Bittl, Charles R. Bridges, John G. Byrne, Joaquin E. Cigarroa, Verdi J. DiSesa, Loren F. Hiratzka, Adolph M. Hutter, Michael E. Jessen, Ellen C. Keeley, Stephen J. Lahey, Richard A. Lange, Martin J. London, Michael J. Mack, Manesh R. Patel, John D. Puskas, Joseph F. Sabik, Ola Selnes, David M. Shahian, Jeffrey C. Trost, Michael D. Winniford. (2011) 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery. Journal of the American College of Cardiology
CrossRef3
Glenn N. Levine, Eric R. Bates, James C. Blankenship, Steven R. Bailey, John A. Bittl, Bojan Cercek, Charles E. Chambers, Stephen G. Ellis, Robert A. Guyton, Steven M. Hollenberg, Umesh N. Khot, Richard A. Lange, Laura Mauri, Roxana Mehran, Issam D. Moussa, Debabrata Mukherjee, Brahmajee K. Nallamothu, Henry H. Ting. (2011) 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. Journal of the American College of Cardiology
CrossRef4
Juan Ruiz-Garcia, Amir Lerman. (2011) Cardiac shock-wave therapy in the treatment of refractive angina pectoris. Interventional Cardiology 3:2, 191-201
CrossRef5
Shigeru Saito. (2011) Treatment Option Approaches to the Management of Chronic Total Occlusions. Current Treatment Options in Cardiovascular Medicine 13:1, 4-15
CrossRef6
Glenn N. Levine, Eric R. Bates, James C. Blankenship, Steven R. Bailey, John A. Bittl, Bojan Cercek, Charles E. Chambers, Stephen G. Ellis, Robert A. Guyton, Steven M. Hollenberg, Umesh N. Khot, Richard A. Lange, Laura Mauri, Roxana Mehran, Issam D. Moussa, Debabrata Mukherjee, Brahmajee K. Nallamothu, Henry H. Ting, Alice K. Jacobs, Jeffrey L. Anderson, Nancy Albert, Mark A. Creager, Steven M. Ettinger, Robert A. Guyton, Jonathan L. Halperin, Judith S. Hochman, Frederick G. Kushner, E. Magnus Ohman, William Stevenson, Clyde W. Yancy. (2011) 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. Catheterization and Cardiovascular Interventionsn/a-n/a
CrossRef7
Soren K. Estvold, Frederico Mordini, Yifu Zhou, Zu X. Yu, Vandana Sachdev, Andrew Arai, Keith A. Horvath. (2010) Does laser type impact myocardial function following transmyocardial laser revascularization?. Lasers in Surgery and Medicine 42:10, 746-751
CrossRef8
Joel D. Cooper. (2010) Randomized clinical trials for new surgical operations: Square peg in a round hole?. The Journal of Thoracic and Cardiovascular Surgery 140:4, 743-746
CrossRef9
Steve Attanasio, Gary Schaer. (2010) Therapeutic Angiogenesis for the Management of Refractory Angina: Current Concepts. Cardiovascular Therapeutics
CrossRef10
Shady M. Eldaif, Omar M. Lattouf, Patrick Kilgo, Robert A. Guyton, John D. Puskas, Vinod H. Thourani. (2010) Long-Term Outcomes After CABG With Concomitant CO2 Transmyocardial Revascularization in Comparison With CABG Alone. Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 5:2, 103-108
CrossRef11
Y. Wang, X.-C. Liu, G.-W. Zhang, J. Zhao, J.-M. Zhang, R.-F. Shi, Y.-Z. Huang, C.-H. Zhao, T.-J. Liu, C.-X. Song, F. Lu, Q. Yang, G.-W. He. (2009) A new transmyocardial degradable stent combined with growth factor, heparin, and stem cells in acute myocardial infarction. Cardiovascular Research 84:3, 461-469
CrossRef12
Andrew W. ElBardissi, Jorge M. Balaguer, John G. Byrne, Sary A. Aranki. (2009) Surgical Therapy for Complex Coronary Artery Disease. Seminars in Thoracic and Cardiovascular Surgery 21:3, 199-206
CrossRef13
Pavan Atluri, Elliott D. Kozin, William Hiesinger, Y. Joseph Woo. (2009) Off-pump, minimally invasive and robotic coronary revascularization yield improved outcomes over traditional on-pump CABG. The International Journal of Medical Robotics and Computer Assisted Surgery 5:1, 1-12
CrossRef14
Eduardo Briones, Juan Ramon Lacalle, Ignacio Marin, Eduardo Briones. 2009. Transmyocardial laser revascularization versus medical therapy for refractory angina. .
CrossRef15
Minoru Tabata, Prem S. Shekar, Gregory S. Couper, Sary F. Aranki. (2008) Early and Late Outcomes of Multiple Coronary Endarterectomy. Journal of Cardiac Surgery 23:6, 697-700
CrossRef16
Luís Henrique W. Gowdak, Isolmar T. Schettert, Carlos Eduardo Rochitte, Marcos Rienzo, Luiz Augusto F. Lisboa, Luís Alberto O. Dallan, Luiz Antônio M. César, José Eduardo Krieger, José Antônio F. Ramires, Sérgio A. de Oliveira. (2008) Transmyocardial laser revascularization plus cell therapy for refractory angina. International Journal of Cardiology 127:2, 295-297
CrossRef17
Keith A. Horvath. (2008) Transmyocardial Laser Revascularization. Journal of Cardiac Surgery 23:3, 266-276
CrossRef18
Deepak D. Banerjee, M. Susan Quinn, Laxmi B. Mohanty, Anthony J. Minisi. (2008) Failure of chronic transmyocardial laser revascularization to alter cardiac nociceptive reflexes: implications for the treatment of angina pectoris. Lasers in Medical Science 23:2, 155-161
CrossRef19
E. Marc Jolicoeur, E. Magnus Ohman, Robert Temple, Norman Stockbridge, Sidney Smith, Daniel Mark, Robert M. Califf, Timothy D. Henry, Bernard R. Chaitman, Christopher B. Granger. (2008) Clinical and research issues regarding chronic advanced coronary artery disease Part II: Trial design, outcomes, and regulatory issues. American Heart Journal 155:3, 435-444
CrossRef20
E. Marc Jolicoeur, Christopher B. Granger, Timothy D. Henry, David J. Holmes, Carl J. Pepine, Daniel Mark, Bernard R. Chaitman, Bernard J. Gersh, E. Magnus Ohman. (2008) Clinical and research issues regarding chronic advanced coronary artery disease. American Heart Journal 155:3, 418-434
CrossRef21
Pavan Atluri, Corinna M. Panlilio, George P. Liao, Eric E. Suarez, Ryan C. McCormick, William Hiesinger, Jeffrey E. Cohen, Maximilian J. Smith, Abha B. Patel, Wei Feng, Y. Joseph Woo. (2008) Transmyocardial revascularization to enhance myocardial vasculogenesis and hemodynamic function. The Journal of Thoracic and Cardiovascular Surgery 135:2, 283-291.e1
CrossRef22
Osman A. Latif, P. Prithvi Raj. (2008) Spinal Cord Stimulation: A Comparison of Efficacy versus Other Novel Treatments for Refractory Angina Pectoris. Pain Practice 1:1, 36
CrossRef23
Davy Cheng, Anno Diegeler, Keith Allen, Richard Weisel, Georg Lutter, Michele Sartori, Tohru Asai, Lars Aaberge, Keith Horvath, Janet Martin. (2007) Transmyocardial Laser Revascularization: A Meta-Analysis and Systematic Review of Controlled Trials. Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 1:6, 295-313
CrossRef24
Anno Diegeler, Davy Cheng, Keith Allen, Richard Weisel, Georg Lutter, Michele Sartori, Tohru Asai, Lars Aaberge, Keith Horvath, Janet Martin. (2007) Transmyocardial Laser Revascularization: A Consensus Statement of the International Society of Minimally Invasive Cardiothoracic Surgery (ISMICS) 2006. Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 1:6, 314-322
CrossRef25
Gary S. Allen. (2007) What Do We Have Against Operations That Lack Mechanistic Gratification?. Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 1:4, 137-139
CrossRef26
Gary S. Allen, Jason Budde. (2007) Thoracoscopic Transmyocardial Laser Revascularization: Is Prior Coronary Artery Bypass Grafting a Contraindication?. Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 2:3, 112-115
CrossRef27
Tomasz Timek, Kai Ihnken. (2007) Surgical therapy for heart failure. Expert Review of Cardiovascular Therapy 5:2, 251-263
CrossRef28
Elisabetta Lapenna, Dino Rapati, Paola Cardano, Michele De Bonis, Francesca Lullo, Alberto Zangrillo, Ottavio Alfieri. (2006) Spinal Cord Stimulation for Patients With Refractory Angina and Previous Coronary Surgery. The Annals of Thoracic Surgery 82:5, 1704-1708
CrossRef29
Mohamed Salem, Svein Rotevatn, Jan Erik Nordrehaug. (2006) Long-term results following percutaneous myocardial laser therapy. Coronary Artery Disease 17:4, 385-390
CrossRef30
Keith A Horvath. 2006. Transmyocardial Laser Revascularization. , 383-400.
CrossRef31
David D. Yuh. 2006. New Surgery for Congestive Heart Failure. , 633-652.
CrossRef32
Eric H Yang, Gregory W Barsness. (2006) Evolving treatment strategies for chronic refractory angina. Expert Opinion on Pharmacotherapy 7:3, 259-266
CrossRef33
Helen E. Campbell, Sue Tait, Linda D. Sharples, Noreen Caine, Timothy J. Gray, Peter M. Schofield, Martin J. Buxton. (2005) Trial-based cost-utility comparison of percutaneous myocardial laser revascularisation and continued medical therapy for treatment of refractory angina pectoris. The European Journal of Health Economics 6:4, 288-297
CrossRef34
Keith A. Horvath, T. Bruce Ferguson, Robert A. Guyton, Fred H. Edwards. (2005) Impact of Unstable Angina on Outcomes of Transmyocardial Laser Revascularization Combined With Coronary Artery Bypass Grafting. The Annals of Thoracic Surgery 80:6, 2082-2085
CrossRef35
Manuel Galiñanes. (2005) Nuevas expectativas en la revascularización miocárdica quirúrgica. Revista Española de Cardiología 58:12, 1459-1468
CrossRef36
Martin B. Leon, Ran Kornowski, William E. Downey, Giora Weisz, Donald S. Baim, Robert O. Bonow, Robert C. Hendel, David J. Cohen, Ernest Gervino, Roger Laham, Nicholas J. Lembo, Jeffrey W. Moses, Richard E. Kuntz. (2005) A Blinded, Randomized, Placebo-Controlled Trial of Percutaneous Laser Myocardial Revascularization to Improve Angina Symptoms in Patients With Severe Coronary Disease. Journal of the American College of Cardiology 46:10, 1812-1819
CrossRef37
Robert S. Kellar, Benjamin R. Shepherd, Doug F. Larson, Gail K. Naughton, Stuart K. Williams. (2005) Cardiac Patch Constructed from Human Fibroblasts Attenuates Reduction in Cardiac Function after Acute Infarct. Tissue Engineering 11:11-12, 1678-1687
CrossRef38
Miroslaw A. Dziuk, Ana Canizales, Nidhal Ali, Hany El-Deeb, Keith E. Britton, Duncan S. Dymond, Stephen J. Edmondson. (2005) The prospective clinical and scintigraphic assessment of patients with preserved left ventricular systolic function after transmyocardial laser revascularisation. The International Journal of Cardiovascular Imaging 21:4, 405-412
CrossRef39
Gary S. Allen. (2005) Mid-Term Results After Thoracoscopic Transmyocardial Laser Revascularization. The Annals of Thoracic Surgery 80:2, 553-558
CrossRef40
Luís Henrique W. Gowdak, Isolmar T. Schettert, Carlos Eduardo Rochitte, Luiz Augusto F. Lisboa, Luís Alberto O. Dallan, Luiz Antônio M. César, José Eduardo Krieger, José Antônio F. Ramires, Sérgio A. de Oliveira. (2005) Cell Therapy Plus Transmyocardial Laser Revascularization for Refractory Angina. The Annals of Thoracic Surgery 80:2, 712-714
CrossRef41
David D. Yuh, Brett A. Simon, Ana Fernandez-Bustamante, Nicholas Ramey, William A. Baumgartner. (2005) Totally endoscopic robot-assisted transmyocardial revascularization. The Journal of Thoracic and Cardiovascular Surgery 130:1, 120-124
CrossRef42
Julie A. Stanik-Hutt. (2005) Management Options for Angina Refractory to Maximal Medical and Surgical Interventions. AACN Clinical Issues: Advanced Practice in Acute and Critical Care 16:3, 320-332
CrossRef43
Keith B. Allen, Robert D. Dowling, Wayne Richenbacher. (2005) Reply. The Annals of Thoracic Surgery 79:6, 2200-2201
CrossRef44
Keith A. Horvath, Chia Yang J. Lu, Emmanuel Robert, Glenn F. Pierce, Rodney Greene, Barbara A. Sosnowski, John Doukas. (2005) Improvement of myocardial contractility in a porcine model of chronic ischemia using a combined transmyocardial revascularization and gene therapy approach. The Journal of Thoracic and Cardiovascular Surgery 129:5, 1071-1077
CrossRef45
G Chad Hughes, Brian H Annex. (2005) Angiogenic therapy for coronary artery and peripheral arterial disease. Expert Review of Cardiovascular Therapy 3:3, 521-535
CrossRef46
JOHN P. REILLY, MARK A. GRISE, F. DAVID FORTUIN, PETER R. VALE, GARY L. SCHAER, JOHN LOPEZ, JOSEPH R. VAN CAMP, TIMOTHY HENRY, WAYNE E. RICHENBACHER, DOUGLAS W. LOSORDO, RICHARD A. SCHATZ, JEFFREY M. ISNER. (2005) Long-Term (2-Year) Clinical Events Following Transthoracic Intramyocardial Gene Transfer of VEGF-2 in No-Option Patients. Journal of Interventional Cardiology 18:1, 27-31
CrossRef47
Gregory J. Klein, Jean-Philippe Thirion. (2005) Cardiovascular imaging to quantify the evolution of cardiac diseases in clinical development. Biomarkers 10:s1, 1-9
CrossRef48
Osami Honjo, Kozo Ishino, Takeshi Matsumoto, Shu Yamamoto, Tomohiro Asai, Takushi Kohmoto, Fumihiko Kajiya, Shunji Sano. (2005) Digital Radiographic Quantification of Myocardial Blood Flow Around a Transmyocardial Laser Channel in Rabbit Hearts. Circulation Journal 69:4, 488-492
CrossRef49
Mohamed Salem, Svein Rotevatn, Reidar J. Pettersen, Karel Kuiper, Thorvald Sætersdal, Jan Erik Nordrehaug. (2004) Only transient increase of vascular growth factors and microvascular density after percutaneous myocardial laser. Coronary Artery Disease 15:7, 441-448
CrossRef50
H.-M. Klein, A. Ghodsizad, A. Borowski, A. Saleh, J. Draganov, L. Poll, V. Stoldt, N. Feifel, C. Piecharczek, E.R. Burchardt, M. Stockschläder, E. Gams. (2004) Autologous Bone Marrow-Derived Stem Cell Therapy in Combination with TMLR. A Novel Therapeutic Option for Endstage Coronary Heart Disease: Report on 2 Cases. The Heart Surgery Forum 7:5, E416-E419
CrossRef51
Samdeep K. Mouli, Jeffrey Fronza, Rodney Greene, Emmanuel S. Robert, Keith A. Horvath. (2004) What is the Optimal Channel Density for Transmyocardial Laser Revascularization?. The Annals of Thoracic Surgery 78:4, 1326-1331
CrossRef52
E. H. Yang, G. W. Barsness, B. J. Gersh, K. Chandrasekaran, A. Lerman. (2004) Current and Future Treatment Strategies for Refractory Angina. Mayo Clinic Proceedings 79:10, 1284-1292
CrossRef53
Olaf M. Mühling, Ying Wang, Michael Jerosch-Herold, Mary M. Cayton, L.Samuel Wann, Mahmood M. Mirhoseini, Norbert M. Wilke. (2004) Improved myocardial function after transmyocardial laser revascularization according to cine magnetic resonance in a porcine model. The Journal of Thoracic and Cardiovascular Surgery 128:3, 391-395
CrossRef54
Jos A.P. van der Sloot, Menno Huikeshoven, Raymond Tukkie, Hein J. Verberne, Jan van der Meulen, Berthe L.F. van Eck-Smit, Martin J.C. van Gemert, Jan G.P. Tijssen, Johan F. Beek. (2004) Transmyocardial revascularization using an XeCl excimer laser: Results of a randomized trial. The Annals of Thoracic Surgery 78:3, 875-881
CrossRef55
Keith B Allen, Robert D Dowling, Douglas R Schuch, Thomas A Pfeffer, Steven Marra, Edward A Lefrak, Tommy L Fudge, Mark Mostovych, Szabolc Szentpetery, Sibu P Saha, Douglas Murphy, Hugh Dennis. (2004) Adjunctive transmyocardial revascularization: five-year follow-up of a prospective, randomized trial. The Annals of Thoracic Surgery 78:2, 458-465
CrossRef56
Manuel Galiñanes, Mahmoud Loubani, Penelope R Sensky, Ashraf Hassouna, Graham R Cherryman, Joseph N Leverment, Nilesh J Samani. (2004) Efficacy of transmyocardial laser revascularization and thoracic sympathectomy for the treatment of refractory angina. The Annals of Thoracic Surgery 78:1, 122-128
CrossRef57
Menno Huikeshoven, Jeroen A.M. Beli
n, Raymond Tukkie, Johan F. Beek. (2004) The vascular response induced by transmyocardial laser revascularization is determined by the size of the channel scar: Results of CO2, holmium and excimer lasers. Lasers in Surgery and Medicine 35:1, 35-40
CrossRef58
Louis Samuels, Robert Emery, Omar Lattouf, Michael Grosso, Masoud AlZeerah, Masoud AlZeerah, Kurt Wehberg, Derek Muehrcke, Robert Dowling. (2004) Transmyocardial Laser Therapy: A Strategic Approach. The Heart Surgery Forum 7:3, E218-E229
CrossRef59
Keith B Allen, Robert D Dowling, Wayne Richenbacher. (2004) From controlled trials to clinical practice: monitoring transmyocardial revascularization use and outcomes. Journal of the American College of Cardiology 43:12, 2364-2365
CrossRef60
Melanie Gatterer, Mariann Gyöngyösi, Wolfgang Sperker, Christoph Strehblow, Aliasghar Khorsand, Senta Graf, Heinz Sochor, Dietmar Glogar. (2004) Langzeitergebnisse der „Perkutanen transmyokardialen Laser-Revaskularisations-Therapie” am AKH Wien. Wiener Klinische Wochenschrift 116:7-8, 252-259
CrossRef61
Keith B Allen, Robert D Dowling, William W Angell, Deepak M Gangahar, Tommy L Fudge, Wayne Richenbacher, Samuel L Selinger, Michael R Petracek, Douglas Murphy. (2004) Transmyocardial revascularization: 5-year follow-up of a prospective, randomized multicenter trial. The Annals of Thoracic Surgery 77:4, 1228-1234
CrossRef62
Charles R Bridges, Keith A Horvath, William C Nugent, David M Shahian, Constance K Haan, Richard J Shemin, Keith B Allen, Fred H Edwards. (2004) The Society of Thoracic Surgeons practice guideline series: transmyocardial laser revascularization. The Annals of Thoracic Surgery 77:4, 1494-1502
CrossRef63
Jaro Hubacek, Eugene K.W. Sim, Li Zhang, Winston S.N. Shim. (2004) Chronic Effects of Transmyocardial Laser Revascularization in the Nonischemic Myocardium:. A Word of Caution. Journal of Cardiac Surgery 19:2, 161-166
CrossRef64
Bharathi H. Scott, Anthony J. Ippolito, Irvin B. Krukenkamp. (2004) Damage to Pulmonary Artery Catheter During Transmyocardial Laser Revascularization. Anesthesia & Analgesia614-616
CrossRef65
S.L. Waters. (2004) A mathematical model for the laser treatment of heart disease. Journal of Biomechanics 37:3, 281-288
CrossRef66
Robert C. Gorman, Benjamin M. Jackson, Joseph H. Gorman. (2004) The potential role of ventricular compressive therapy. Surgical Clinics of North America 84:1, 45-59
CrossRef67
Johan F. Beek, Jos A.P. van der Sloot, Menno Huikeshoven, Hein J. Verberne, Berthe L.F. van Eck-Smit, Jan van der Meulen, Jan G.P. Tijssen, Martin J.C. van Gemert, Raymond Tukkie. (2004) Cardiac denervation after clinical transmyocardial laser revascularization: short-term and long-term iodine 123–labeled meta-iodobenzylguanide scintigraphic evidence. The Journal of Thoracic and Cardiovascular Surgery 127:2, 517-524
CrossRef68
L.Henry Edmunds. (2004) Reading tarot cards. Surgical Clinics of North America 84:1, 323-331
CrossRef69
Keith A. Horvath. (2004) Transmyocardial laser revascularization. Current Treatment Options in Cardiovascular Medicine 6:1, 53-59
CrossRef70
G. Chad Hughes, Dmitri V. Baklanov, Shankha S. Biswas, Anne M. Pippen, Timothy R. DeGrado, R. Edward Coleman, Carolyn K. Landolfo, James E. Lowe, Brian H. Annex, Kevin P. Landolfo. (2004) Regional Cardiac Sympathetic Innervation Early and Late After Transmyocardial Laser Revascularization. Journal of Cardiac Surgery 19:1, 21-27
CrossRef71
Christoph Strehblow, Mariann Gy
CrossRef72
Eric D. Peterson, Padma Kaul, Ronald G. Kaczmarek, Bradley G. Hammill, Paul W. Armstrong, Charles R. Bridges, T.Bruce Ferguson. (2003) From controlled trials to clinical practice. Journal of the American College of Cardiology 42:9, 1611-1616
CrossRef73
Mahmoud Loubani, Derek Chin, Joseph N Leverment, Manuel Galiñanes. (2003) Mid-term results of combined transmyocardial laser revascularization and coronary artery bypass. The Annals of Thoracic Surgery 76:4, 1163-1166
CrossRef74
Amit Segev, Bradley H. Strauss, Geoffry Coates, Michael R. Freeman, Richard Gallo. (2003) Endocardial cryotherapy as a novel strategy of improving myocardial perfusion in a patient with severe coronary artery disease. Catheterization and Cardiovascular Interventions 60:2, 229-232
CrossRef75
Francis Q. Almeda, Joseph E. Parrillo, Lloyd W. Klein. (2003) Alternative therapeutic strategies for patients with severe end-stage coronary artery disease not amenable to conventional revascularization. Catheterization and Cardiovascular Interventions 60:1, 57-66
CrossRef76
Wael Abo-Auda, Raymond L Benza. (2003) Transmyocardial and percutaneous myocardial revascularization: current concepts and future directions. The Journal of Heart and Lung Transplantation 22:8, 837-842
CrossRef77
Menno Huikeshoven, Jos A.P. van der Sloot, Raymond Tukkie, Martin J.C. van Gemert, Jan G.P. Tijssen, Johan F. Beek. (2003) Improved quality of life after XeCl excimer transmyocardial laser revascularization: Results of a randomized trial. Lasers in Surgery and Medicine 33:1, 1-7
CrossRef78
Kristine J Guleserian, Hersh S Maniar, Cindy J Camillo, Marci S Bailey, Ralph J Damiano, Marc R Moon. (2003) Quality of life and survival after transmyocardial laser revascularization with the holmium:YAG laser. The Annals of Thoracic Surgery 75:6, 1842-1848
CrossRef79
Mehrdad Saririan, Mark Eisenberg. (2003) Reply. Journal of the American College of Cardiology 41:12, 2298-2299
CrossRef80
Africa Muxı́, Jordi Magriñá, Francisco Martı́n, Miguel Josa, David Fuster, Francisco J Setoain, Félix Pérez-Villa, Javier Pavı́a, Xavier Bosch. (2003) Technetium 99m-labeled tetrofosmin and iodine 123-labeled metaiodobenzylguanidine scintigraphy in the assessment of transmyocardial laser revascularization. The Journal of Thoracic and Cardiovascular Surgery 125:6, 1493-1498
CrossRef81
Holli A. DeVon, Carol Estwing Ferrans. (2003) The Psychometric Properties of Four Quality of Life Instruments Used in Cardiovascular Populations. Journal of Cardiopulmonary Rehabilitation 23:2, 122-138
CrossRef82
Sam Horng, Franklin G. Miller. (2003) Ethical framework for the use of sham procedures in clinical trials. Critical Care Medicine 31:Supplement, S126-S130
CrossRef83
Raymond J Gibbons, Jonathan Abrams, Kanu Chatterjee, Jennifer Daley, Prakash C Deedwania, John S Douglas, T.Bruce Ferguson, Stephan D Fihn, Theodore D Fraker, Julius M Gardin, Robert A O’Rourke, Richard C Pasternak, Sankey V Williams, Raymond J Gibbons, Joseph S Alpert, Elliott M Antman, Loren F Hiratzka, Valentin Fuster, David P Faxon, Gabriel Gregoratos, Alice K Jacobs, Sidney C Smith. (2003) ACC/AHA 2002 guideline update for the management of patients with chronic stable angina—summary article. Journal of the American College of Cardiology 41:1, 159-168
CrossRef84
Mehrdad Saririan, Mark J Eisenberg. (2003) Myocardial laser revascularization for the treatment of end-stage coronary artery disease. Journal of the American College of Cardiology 41:2, 173-183
CrossRef85
Dusko Nezic, Predrag Milojevic, Aleksandar Knezevic, Milan Cirkovic, Ljiljana Lausevic-Vuk, Miomir Jovic, Bosko Djukanovic. (2003) Hirurška revaskularizacija miokarda. Acta chirurgica iugoslavica 50:2, 87-98
CrossRef86
Menno Huikeshoven, Johan F Beek, Jos A.P van der Sloot, Raymond Tukkie, Jan van der Meulen, Martin J.C van Gemert. (2002) 35 years of experimental research in transmyocardial revascularization: what have we learned?. The Annals of Thoracic Surgery 74:3, 956-970
CrossRef87
E Briones, JR Lacalle, I Marin, Eduardo Briones. 2002. Transmyocardial laser revascularization versus medical therapy for refractory angina. .
CrossRef88
(2002) Laser Literature Watch. Journal of Clinical Laser Medicine <html_ent glyph="@amp;" ascii="&"/> Surgery 20:3, 151-181
CrossRef89
Thomas Krabatsch, Rainer Petzina, Harald Hausmann, Andreas Koster, Roland Hetzer. (2002) Factors influencing results and outcome after transmyocardial laser revascularization. The Annals of Thoracic Surgery 73:6, 1888-1892
CrossRef90
Lars Aaberge, Kjell Rootwelt, Svein Blomhoff, Kjell Saatvedt, Michel Abdelnoor, Kolbjorn Forfang. (2002) Continued symptomatic improvement three to five years after transmyocardial revascularization with co2 laser. Journal of the American College of Cardiology 39:10, 1588-1593
CrossRef91
S Kumar, M Loubani, D Chin, JN Leverment, M Galifianes. (2002) Transmyocardial laser revascularization in combination with coronary artery bypass: Clinical, wall motion and perfusion effects. Indian Journal of Thoracic and Cardiovascular Surgery 18:2, 91-95
CrossRef92
G.Chad Hughes, Shankha S Biswas, Bangliang Yin, Dmitri V Baklanov, Brian H Annex, R.Edward Coleman, Timothy R DeGrado, Carolyn K Landolfo, Kevin P Landolfo, James E Lowe. (2002) A comparison of mechanical and laser transmyocardial revascularization for induction of angiogenesis and arteriogenesis in chronically ischemic myocardium. Journal of the American College of Cardiology 39:7, 1220-1228
CrossRef93
Stuart D. Jackson, Antonio Lauto. (2002) Diode-pumped fiber lasers: A new clinical tool?. Lasers in Surgery and Medicine 30:3, 184-190
CrossRef94
Michael C Kim, Annapoorna Kini, Samin K Sharma. (2002) Refractory angina pectoris. Journal of the American College of Cardiology 39:6, 923-934
CrossRef95
Richard Lee, Keith C Fischer, Marc R Moon. (2002) Reoperative transmyocardial laser revascularization for late recurrent angina. The Annals of Thoracic Surgery 73:2, 650-652
CrossRef96
Arie Szatkowski, Christopher Ndubuka-Irobunda, Stephen N. Oesterle, Daniel Burkhoff. (2002) Transmyocardial Laser Revascularization. American Journal of Cardiovascular Drugs 2:4, 255-266
CrossRef97
Roger J Laham, Michael Simons, Justin D Pearlman, Kalon K.L Ho, Donald S Baim. (2002) Magnetic resonance imaging demonstrates improved regional systolic wall motion and thickening and myocardial perfusion of myocardial territories treated by laser myocardial revascularization. Journal of the American College of Cardiology 39:1, 1-8
CrossRef98
Ben-Gary Harvey, Jaman Maroni, Kelley A. O'Donoghue, Karen W. Chu, Jolene C. Muscat, Allison L. Pippo, Connie E. Wright, Charleen Hollmann, Juan P. Wisnivesky, Paul D. Kessler, Henrik S. Rasmussen, Todd K. Rosengart, Ronald G. Crystal. (2002) Safety of Local Delivery of Low- and Intermediate-Dose Adenovirus Gene Transfer Vectors to Individuals with a Spectrum of Morbid Conditions. Human Gene Therapy 13:1, 15-63
CrossRef99
Shoichi Miyamoto, Masatoshi Fujita, Kinzo Ueda, Shun-ichi Tamaki, Koji Hasegawa, Noritoshi Nagaya, Shigetake Sasayama. (2002) Shunt Between the Ventricular Chamber and Coronary Arteries Preserves Left Ventricular Function in Acute Myocardial Infarction. Circulation Journal 66:7, 633-633
CrossRef100
Keith A Horvath, Noam Belkind, Irene Wu, Rodney Greene, John Doukas, Jon W Lomasney, David D McPherson, David A Fullerton. (2001) Functional comparison of transmyocardial revascularization by mechanical and laser means. The Annals of Thoracic Surgery 72:6, 1997-2002
CrossRef101
Jos A.P. van der Sloot, Menno Huikeshoven, Allard C. van der Wal, Raymond Tukkie, Martin J.C. van Gemert, Jan van der Meulen, Johan F. Beek. (2001) Angiogenesis three months after clinical transmyocardial laser revascularization using an excimer laser. Lasers in Surgery and Medicine 29:4, 369-373
CrossRef102
PETER R. VALE, JEFFREY M. ISNER, KENNETH ROSENFIELD. (2001) Therapeutic Angiogenesis in Critical Limb and Myocardial Ischemia. Journal of Interventional Cardiology 14:5, 511-528
CrossRef103
Daniel Burkhoff, James W Jones, Lewis C Becker. (2001) Variability of myocardial perfusion defects assessed by thallium-201 scintigraphy in patients with coronary artery disease not amenable to angioplasty or bypass surgery. Journal of the American College of Cardiology 38:4, 1033-1039
CrossRef104
Thomas Krabatsch, Rainer Petzina, Rufus Baretti, Harald Hausmann, Roland Hetzer. (2001) Extent of Myocardial Tissue Damage During Transmyocardial Laser Revascularization with the CO2 Heart LaserR. Journal of Clinical Laser Medicine <html_ent glyph="@amp;" ascii="&"/> Surgery 19:5, 251-259
CrossRef105
Meena Nathan, Sary Aranki. (2001) Transmyocardial laser revascularization. Current Opinion in Cardiology 16:5, 310-314
CrossRef106
Adam H Hamawy, Leonard Y Lee, Sanjay A Samy, Dean R Polce, Massimiliano Szulc, Madeline Vazquez, Todd K Rosengart. (2001) Transmyocardial laser revascularization dose response: enhanced perfusion in a porcine ischemia model as a function of channel density. The Annals of Thoracic Surgery 72:3, 817-822
CrossRef107
H Campbell. (2001) A UK trial-based cost–utility analysis of transmyocardial laser revascularization compared to continued medical therapy for treatment of refractory angina pectoris. European Journal of Cardio-Thoracic Surgery 20:2, 312-318
CrossRef108
Onnen Grauhan, T Krabatsch, Elke Lieback, R Hetzer. (2001) Transmyocardial laser revascularization in ischemic cardiomyopathy. The Journal of Heart and Lung Transplantation 20:6, 687-691
CrossRef109
G Lutter. (2001) Microperfusion enhancement after TMLR in chronically ischemic porcine hearts. Cardiovascular Surgery 9:3, 281-291
CrossRef110
Roger J. Laham, Donald S. Baim. (2001) Combined percutaneous biosense-guided laser myocardial revascularization and coronary intervention. Catheterization and Cardiovascular Interventions 53:2, 235-240
CrossRef111
Zoltan G. Turi. (2001) Guided laser myocardial revascularization with coronary angioplasty: The emperor shops for new clothes. Catheterization and Cardiovascular Interventions 53:2, 241-242
CrossRef112
Nasser Hayat, Mohamed Share, Mohammed Kamelgumaa, Nazir Khan. (2001) Transmyocardial laser revascularization: Is the enthusiasm justified?. Clinical Cardiology 24:4, 321-324
CrossRef113
Osman A. Latif, P. Prithvi Raj. (2001) Spinal Cord Stimulation: A Comparison of Efficacy versus Other Novel Treatments for Refractory Angina Pectoris. Pain Practice 1:1, 36-45
CrossRef114
Glenn Van Langenhove, Ken Kozuma, Patrick W. Serruys. (2001) Nonfluoroscopic Endoventricular Electromechanical Three-Dimensional Mapping. Japanese Circulation Journal 65:8, 695-701
CrossRef115
Leif Thuesen. (2001) Myocardial Laser Revascularization ? The End of a New Therapy?. Scandinavian Cardiovascular Journal 35:1, 6-7
CrossRef116
R. Wiseth, K. Forfang, A. Ilebekk,. (2001) Myocardial Laser Revascularization in the Year 2000 as seen by a Norwegian Specialist Panel. The Process of Evaluating and Implementing New Methods in Clinical Practice. Scandinavian Cardiovascular Journal 35:1, 14-18
CrossRef117
Andrew D. Staniforth. (2001) Contemporary Management of Chronic Stable Angina. Drugs & Aging 18:2, 109-121
CrossRef118
Lars Aaberge, Kjell Rootwelt, Hans-. (2001) Effects of Transmyocardial Revascularization on Myocardial Perfusion and Systolic Function Assessed by Nuclear and Magnetic Resonance Imaging Methods. Scandinavian Cardiovascular Journal 35:1, 8-13
CrossRef119
Ali Moustapha, H. Vernon Anderson. (2000) Revascularization interventions for ischemic heart disease. Current Opinion in Cardiology 15:6, 463-471
CrossRef120
M Singh, D R Holmes, A J Tajik, G W Barsness. (2000) Noninvasive revascularization by enhanced external counterpulsation: a case study and literature review.. Mayo Clinic Proceedings 75:9, 961-965
CrossRef121
G.Chad Hughes, Alan P Kypson, Brian H Annex, Bangliang Yin, James D St. Louis, Shankha S Biswas, R.Edward Coleman, Timothy R DeGrado, Carolyn L Donovan, Kevin P Landolfo, James E Lowe. (2000) Induction of angiogenesis after TMR: a comparison of holmium:YAG, CO2, and excimer lasers. The Annals of Thoracic Surgery 70:2, 504-509
CrossRef122
James F. Symes. (2000) Focal Angiogenic Therapy for Myocardial Ischemia. Journal of Cardiac Surgery 15:4, 283-290
CrossRef123
Keith A. Horvath. (2000) Transmyocardial Laser Revascularization in the Treatment of Myocardial Ischemia. Journal of Cardiac Surgery 15:4, 271-277
CrossRef124
Avinoam Shiran, Steven A. Goldstein, Samer Ellahham, Martin B. Leon, Ran Kornowski. (2000) Immediate effect of Biosense guided percutaneous direct myocardial revascularization with holmium:yttrium aluminium garnet laser on myocardial contractility assessed by transesophageal echocardiography. Coronary Artery Disease 11:4, 359-361
CrossRef125
Thierry H. Jemtel. (2000) Management of heart failure. Current Cardiology Reports 2:3, 221-224
CrossRef126
Steven C. Hao, Manish Parikh, Timothy A. Sanborn. (2000) Percutaneous myocardial revascularization. Current Treatment Options in Cardiovascular Medicine 2:3, 197-201
CrossRef127
Lars Aaberge, Kenneth Nordstrand, Morten Dragsund, Kjell Saatvedt, Knut Endresen, Svein Golf, Odd Geiran, Michel Abdelnoor, Kolbjorn Forfang. (2000) Transmyocardial revascularization with CO2 laser in patients with refractory angina pectoris. Journal of the American College of Cardiology 35:5, 1170-1177
CrossRef128
Keith B. Allen, Robert D. Dowling, Anthony J. DelRossi, Fidel Realyvasques, Edward A. Lefrak, Thomas A. Pfeffer, Tommy L. Fudge, Mark Mostovych, Douglas Schuch, Szabolc Szentpetery, Carl J. Shaar. (2000) Transmyocardial laser revascularization combined with coronary artery bypass grafting: A multicenter, blinded, prospective, randomized, controlled trial. The Journal of Thoracic and Cardiovascular Surgery 119:3, 540-549
CrossRef129
(2000) Transmyocardial Laser Revascularization. New England Journal of Medicine 342:6, 436-438
Full Text130
Charles R Bridges. (2000) Myocardial laser revascularization: the controversy and the data. The Annals of Thoracic Surgery 69:2, 655-662
CrossRef131
Norbert M. Wilke, Andrey Zenovich, Olaf Muehling, Michael Jerosch-Herold. (2000) Novel revascularization therapies — TMLR and growth factor-induced angiogenesis monitored with cardiac MRI. Magma: Magnetic Resonance Materials in Physics, Biology, and Medicine 11:1, 61-64
CrossRef132
James W Jones, Sheila E Schmidt, Bruce W Richman. (2000) Lasers in the treatment of ischaemic heart disease. Annals of Medicine 32:2, 113-117
CrossRef133
Lange, Richard A., Hillis, L. David, . (1999) Transmyocardial Laser Revascularization. New England Journal of Medicine 341:14, 1075-1076
Full Text
