Induction of angiogenesis after TMR: A comparison of holmium: YAG, CO2, and excimer lasers

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

Research output: Contribution to journalArticle

58 Citations (Scopus)

Abstract

Background. Transmyocardial laser revascularization (TMR) is an emerging treatment for end-stage coronary artery disease. A variety of lasers are currently available to perform the procedure, although their relative efficacy is unknown. The purpose of this study was to compare changes in myocardial blood flow and function 6 months after TMR with holmium:yttrium-aluminum-garnet (holmium:YAG), carbon dioxide (CO2), and xenon chloride excimer lasers in a model of chronic ischemia. Methods. Miniswine underwent subtotal (90%) left circumflex coronary stenosis. Baseline positron emission tomography and dobutamine stress echocardiography were performed to document hibernating myocardium in the left circumflex coronary artery distribution. Animals were then randomized to sham redo-thoracotomy (n = 5) or TMR using a holmium:YAG (n = 5), CO2 (n = 5) or excimer (n = 5) laser. Six months postoperatively, the positron emission tomography and dobutamine stress echocardiography studies were repeated and the animals sacrificed. Results. In animals undergoing TMR with holmium: YAG and CO2 lasers, a significant improvement in myocardial blood flow to the lased left circumflex regions was seen. No significant change in myocardial blood flow was seen in sham- or excimer-lased animals. There was a significant improvement in regional stress function of the lased segments 6 months postoperatively in animals undergoing holmium:YAG and CO2 laser TMR that was consistent with a reduction in ischemia. There was no change in wall motion in sham- or excimer-lased animals. Significantly greater neovascularization was observed in the holmium:YAG and CO2 lased regions than with either the sham procedure or excimer TMR. Conclusions. Transmyocardial laser revascularization with either holmium:YAG or CO2 laser improves myocardial blood flow and contractile reserve in lased regions 6 months postoperatively. These changes were not seen following excimer TMR or sham thoracotomy, suggesting that differences in laser energy or wavelength or both may be important in the induction of angiogenesis. (C) 2000 by The Society of Thoracic Surgeons.

Original languageEnglish (US)
Pages (from-to)504-509
Number of pages6
JournalAnnals of Thoracic Surgery
Volume70
Issue number2
DOIs
StatePublished - 2000
Externally publishedYes

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Transmyocardial Laser Revascularization
Excimer Lasers
Gas Lasers
Solid-State Lasers
Holmium
Stress Echocardiography
Lasers
Thoracotomy
Positron-Emission Tomography
Ischemia
Coronary Stenosis
Carbon Dioxide
Coronary Artery Disease
Coronary Vessels
Myocardium

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Hughes, G. C., Kypson, A. P., Annex, B. H., Yin, B., St. Louis, J. D., Biswas, S. S., ... Lowe, J. E. (2000). Induction of angiogenesis after TMR: A comparison of holmium: YAG, CO2, and excimer lasers. Annals of Thoracic Surgery, 70(2), 504-509. https://doi.org/10.1016/S0003-4975(00)01569-1

Induction of angiogenesis after TMR : A comparison of holmium: YAG, CO2, and excimer lasers. / Hughes, G. Chad; Kypson, Alan P.; Annex, Brian H.; Yin, Bangliang; St. Louis, James D.; Biswas, Shankha S.; Coleman, R. Edward; DeGrado, Timothy R; Donovan, Carolyn L.; Landolfo, Kevin P.; Lowe, James E.

In: Annals of Thoracic Surgery, Vol. 70, No. 2, 2000, p. 504-509.

Research output: Contribution to journalArticle

Hughes, GC, Kypson, AP, Annex, BH, Yin, B, St. Louis, JD, Biswas, SS, Coleman, RE, DeGrado, TR, Donovan, CL, Landolfo, KP & Lowe, JE 2000, 'Induction of angiogenesis after TMR: A comparison of holmium: YAG, CO2, and excimer lasers', Annals of Thoracic Surgery, vol. 70, no. 2, pp. 504-509. https://doi.org/10.1016/S0003-4975(00)01569-1
Hughes, G. Chad ; Kypson, Alan P. ; Annex, Brian H. ; Yin, Bangliang ; St. Louis, James D. ; Biswas, Shankha S. ; Coleman, R. Edward ; DeGrado, Timothy R ; Donovan, Carolyn L. ; Landolfo, Kevin P. ; Lowe, James E. / Induction of angiogenesis after TMR : A comparison of holmium: YAG, CO2, and excimer lasers. In: Annals of Thoracic Surgery. 2000 ; Vol. 70, No. 2. pp. 504-509.
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abstract = "Background. Transmyocardial laser revascularization (TMR) is an emerging treatment for end-stage coronary artery disease. A variety of lasers are currently available to perform the procedure, although their relative efficacy is unknown. The purpose of this study was to compare changes in myocardial blood flow and function 6 months after TMR with holmium:yttrium-aluminum-garnet (holmium:YAG), carbon dioxide (CO2), and xenon chloride excimer lasers in a model of chronic ischemia. Methods. Miniswine underwent subtotal (90{\%}) left circumflex coronary stenosis. Baseline positron emission tomography and dobutamine stress echocardiography were performed to document hibernating myocardium in the left circumflex coronary artery distribution. Animals were then randomized to sham redo-thoracotomy (n = 5) or TMR using a holmium:YAG (n = 5), CO2 (n = 5) or excimer (n = 5) laser. Six months postoperatively, the positron emission tomography and dobutamine stress echocardiography studies were repeated and the animals sacrificed. Results. In animals undergoing TMR with holmium: YAG and CO2 lasers, a significant improvement in myocardial blood flow to the lased left circumflex regions was seen. No significant change in myocardial blood flow was seen in sham- or excimer-lased animals. There was a significant improvement in regional stress function of the lased segments 6 months postoperatively in animals undergoing holmium:YAG and CO2 laser TMR that was consistent with a reduction in ischemia. There was no change in wall motion in sham- or excimer-lased animals. Significantly greater neovascularization was observed in the holmium:YAG and CO2 lased regions than with either the sham procedure or excimer TMR. Conclusions. Transmyocardial laser revascularization with either holmium:YAG or CO2 laser improves myocardial blood flow and contractile reserve in lased regions 6 months postoperatively. These changes were not seen following excimer TMR or sham thoracotomy, suggesting that differences in laser energy or wavelength or both may be important in the induction of angiogenesis. (C) 2000 by The Society of Thoracic Surgeons.",
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T1 - Induction of angiogenesis after TMR

T2 - A comparison of holmium: YAG, CO2, and excimer lasers

AU - Hughes, G. Chad

AU - Kypson, Alan P.

AU - Annex, Brian H.

AU - Yin, Bangliang

AU - St. Louis, James D.

AU - Biswas, Shankha S.

AU - Coleman, R. Edward

AU - DeGrado, Timothy R

AU - Donovan, Carolyn L.

AU - Landolfo, Kevin P.

AU - Lowe, James E.

PY - 2000

Y1 - 2000

N2 - Background. Transmyocardial laser revascularization (TMR) is an emerging treatment for end-stage coronary artery disease. A variety of lasers are currently available to perform the procedure, although their relative efficacy is unknown. The purpose of this study was to compare changes in myocardial blood flow and function 6 months after TMR with holmium:yttrium-aluminum-garnet (holmium:YAG), carbon dioxide (CO2), and xenon chloride excimer lasers in a model of chronic ischemia. Methods. Miniswine underwent subtotal (90%) left circumflex coronary stenosis. Baseline positron emission tomography and dobutamine stress echocardiography were performed to document hibernating myocardium in the left circumflex coronary artery distribution. Animals were then randomized to sham redo-thoracotomy (n = 5) or TMR using a holmium:YAG (n = 5), CO2 (n = 5) or excimer (n = 5) laser. Six months postoperatively, the positron emission tomography and dobutamine stress echocardiography studies were repeated and the animals sacrificed. Results. In animals undergoing TMR with holmium: YAG and CO2 lasers, a significant improvement in myocardial blood flow to the lased left circumflex regions was seen. No significant change in myocardial blood flow was seen in sham- or excimer-lased animals. There was a significant improvement in regional stress function of the lased segments 6 months postoperatively in animals undergoing holmium:YAG and CO2 laser TMR that was consistent with a reduction in ischemia. There was no change in wall motion in sham- or excimer-lased animals. Significantly greater neovascularization was observed in the holmium:YAG and CO2 lased regions than with either the sham procedure or excimer TMR. Conclusions. Transmyocardial laser revascularization with either holmium:YAG or CO2 laser improves myocardial blood flow and contractile reserve in lased regions 6 months postoperatively. These changes were not seen following excimer TMR or sham thoracotomy, suggesting that differences in laser energy or wavelength or both may be important in the induction of angiogenesis. (C) 2000 by The Society of Thoracic Surgeons.

AB - Background. Transmyocardial laser revascularization (TMR) is an emerging treatment for end-stage coronary artery disease. A variety of lasers are currently available to perform the procedure, although their relative efficacy is unknown. The purpose of this study was to compare changes in myocardial blood flow and function 6 months after TMR with holmium:yttrium-aluminum-garnet (holmium:YAG), carbon dioxide (CO2), and xenon chloride excimer lasers in a model of chronic ischemia. Methods. Miniswine underwent subtotal (90%) left circumflex coronary stenosis. Baseline positron emission tomography and dobutamine stress echocardiography were performed to document hibernating myocardium in the left circumflex coronary artery distribution. Animals were then randomized to sham redo-thoracotomy (n = 5) or TMR using a holmium:YAG (n = 5), CO2 (n = 5) or excimer (n = 5) laser. Six months postoperatively, the positron emission tomography and dobutamine stress echocardiography studies were repeated and the animals sacrificed. Results. In animals undergoing TMR with holmium: YAG and CO2 lasers, a significant improvement in myocardial blood flow to the lased left circumflex regions was seen. No significant change in myocardial blood flow was seen in sham- or excimer-lased animals. There was a significant improvement in regional stress function of the lased segments 6 months postoperatively in animals undergoing holmium:YAG and CO2 laser TMR that was consistent with a reduction in ischemia. There was no change in wall motion in sham- or excimer-lased animals. Significantly greater neovascularization was observed in the holmium:YAG and CO2 lased regions than with either the sham procedure or excimer TMR. Conclusions. Transmyocardial laser revascularization with either holmium:YAG or CO2 laser improves myocardial blood flow and contractile reserve in lased regions 6 months postoperatively. These changes were not seen following excimer TMR or sham thoracotomy, suggesting that differences in laser energy or wavelength or both may be important in the induction of angiogenesis. (C) 2000 by The Society of Thoracic Surgeons.

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