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Titolo:
Transmyocardial laser revascularization in ischemic cardiomyopathy
Autore:
Grauhan, O; Krabatsch, T; Lieback, E; Hetzer, R;
Indirizzi:
Deutsch Herzzentrum Berlin, Dept Cardiothorac & Vasc Surg, D-13353 Berlin,Germany Deutsch Herzzentrum Berlin Berlin Germany D-13353 D-13353 Berlin,Germany
Titolo Testata:
JOURNAL OF HEART AND LUNG TRANSPLANTATION
fascicolo: 6, volume: 20, anno: 2001,
pagine: 687 - 691
SICI:
1053-2498(200106)20:6<687:TLRIIC>2.0.ZU;2-2
Fonte:
ISI
Lingua:
ENG
Soggetto:
CORONARY-ARTERY DISEASE; REFRACTORY ANGINA; HEART; TRANSPLANTATION; MYOCARDIUM; CO2-LASER; REGISTRY;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
28
Recensione:
Indirizzi per estratti:
Indirizzo: Grauhan, O Deutsch Herzzentrum Berlin, Dept Cardiothorac & Vasc Surg, Augustenburger Pl 1, D-13353 Berlin, Germany Deutsch Herzzentrum Berlin Augustenburger Pl 1 Berlin Germany D-13353
Citazione:
O. Grauhan et al., "Transmyocardial laser revascularization in ischemic cardiomyopathy", J HEART LUN, 20(6), 2001, pp. 687-691

Abstract

Background: In ischemic cardiomyopathy (left ventricular ejection fraction[LVEF] less than or equal to 30%), myocardial revascularization by coronary artery surgery has better results than heart transplantation, provided there is sufficient ischemic but viable myocardium. The mode of action of transmyocardial laser revascularization (TMR) is still being debated, but if the procedure induces improved myocardial perfusion it could be a "bridge," or alternative, to heart transplantation. Methods: We retrospectively analyzed 194 patients, who underwent TMR between July 1997 and October 1999. Patients with TMR as an adjunct to coronary artery surgery (n = 30) and those who did not provide written consent to the procedure (n = 8) were excluded; 126 patients had normal or moderately reduced left ventricular function, and 30 patients with ischemic cardiomyopathy (LVEF less than or equal to 30%) were included. Results: After 12 months, the Canadian Cardiovascular Society (CCS) score dropped significantly from 3.6 (3 to 4) to 2.4 (1 to 4) and maximum work load increased significantly from 58 W (25 to 100 W) to 73 W (25 to 120 W). However, thallium score and LVEF did not improve significantly (27% [15% to 30%] to 32% [15% to 45%]). Prior to the TMR procedure, all 30 patients had a "low risk" or "medium risk" of death according to the Aaronson classification. The 30-day, 1-year, and 2-year survival rates were 83%, 50%, and 47%,respectively. Conclusions: We conclude that TMR in ischemic cardiomyopathy (LVEF less than or equal to 30%) has a perioperative risk comparable to that for heart transplantation, but there is no improvement of myocardial performance or life expectancy. Therefore, TMR cannot be regarded as a "bridge," or alternative, to transplantation. However, in individual cases with contraindications for transplantation the anti-anginal effect may justify use of the procedure.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 25/01/20 alle ore 15:58:10