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A Journal on Cardiac, Vascular and Thoracic Surgery

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The Journal of Cardiovascular Surgery 1999 June;40(3):325-31

language: English

Transmyocardial ­laser induc­es cor­o­nary hyper­emia and reduc­es ische­mia-relat­ed arrhyth­mi­as, but ­fails to ­delay devel­op­ment of myo­car­dial necro­sis after cor­o­nary ­artery occlu­sion in ­pigs

Tjomsland O. * **, Grund F. **, Kanellopoulos G. K. **, Kvernebo K. *, Ilebekk A. **

From the * Department of Cardiovascular Surgery ** Institute for Experimental Medical Research Ullevaal Hospital, University of Oslo, Norway


Background. Several inves­ti­ga­tors ­have report­ed ­that trans­myo­car­dial revas­cu­lar­iza­tion (TMR) ­prior to ­acute cor­o­nary ­artery occlu­sion ­improves region­al myo­car­dial func­tion and reduc­es the ­infarct ­size in ani­mals ­with sig­nif­i­cant cor­o­nary col­lat­er­al cir­cu­la­tion. Whether the pro­tec­tive ­effect of TMR is due to per­fu­sion ­through the ­laser-­made chan­nels, ­increased col­lat­er­al ­flow or oth­er mech­a­nisms ­remains unre­solved. The aim of ­this ­study was to inves­ti­gate wheth­er TMR per­formed ­prior to ­acute cor­o­nary ­artery occlu­sion ­could ­offer pro­tec­tion ­from ischem­ic inju­ry in the pig, an ani­mal ­with lim­it­ed ­native col­lat­er­al cor­o­nary cir­cu­la­tion.
Methods. In one ­group (n=4), TMR was per­formed in the ante­ri­or ­wall of the ­left ven­tri­cle 30 min­utes ­prior to occlu­sion of the prox­i­mal LAD for 45 min­utes. The oth­er ­group (n=6) was sub­ject­ed to tran­sient ische­mia of the ­same dura­tion with­out pre­vi­ous TMR. Area at ­risk and ­infarct ­size ­were deter­mined ­after sac­ri­fice.
Results. No sig­nif­i­cant dif­fer­ence was ­found in the ­infarct ­size ­between the two ­groups (69±2% in the TMR ­group ver­sus 62±4% in the con­trol ­group). However, the arrhyth­mic ­index dur­ing the peri­od of ische­mia was sig­nif­i­cant­ly low­er in the TMR ­group (1.0±0.3 vs 8.3±2.2, p<0.001). Blood ­flow in LAD ­increased to a max­i­mum of 135±6% of base­line lev­el ­three min­utes ­after the end of the TMR pro­ce­dure.
Conclusions. TMR ­failed to ­reduce the ­infarct ­size fol­low­ing ­acute cor­o­nary ­artery occlu­sion in the pig, an ani­mal ­with a ­small col­lat­er­al cor­o­nary ­flow capac­ity, but ­reduced ische­mia-relat­ed arrhyth­mi­as and ­increased cor­o­nary ­flow tran­si­ent­ly.

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