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ULTIMO FASCICOLOTHE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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The Journal of Cardiovascular Surgery 2001 Giugno;42(3):353-7

CARDIAC SECTION 

 TECHNICAL NOTES

Technique of transmyocardial revascularization: avoiding complications in high-risk patients

Jones J. W., Richman B. W., Crigger N. A. *, Baldwin J. C. **

From the Depart­ment of Sur­gery, Uni­ver­sity of Mis­souri ­Columbia, Mis­souri
*­School of ­Nursing Purdue Uni­ver­sity, Lafay­ette, ­Indiana
**­Office of the ­Dean Dart­mouth Med­ical ­School Han­over, New Hamp­shire, USA

Back­ground. Trans­myo­car­dial revas­cu­lar­iza­tion (TMR) is an ­emerging ­therapy for cor­o­nary ­artery dis­ease, ­with 7 ­years of pub­lished clin­ical ­research and ­nearly three ­years of clin­ical appli­ca­tion. ­Every ­report ­thus far has con­firmed ­that TMR ­relieves ­severe ­angina pec­toris. It is pri­marily an alter­na­tive ­therapy for ­angina ­which has ­been refrac­tory to con­ven­tional med­ical and sur­gical treat­ment. Oper­a­tive mor­tality of 3% to 10% has ­been ­reported.
­Methods. Sev­enty-­seven ­patients ­were ­treated ­with TMR ­using a Hol­mium: YAG ­laser. Admis­sion cri­teria ­included ­severe ­angina ­despite ­high ­doses of at ­least two ­anti-­angina med­i­ca­tions and nitro­gly­cerin, rever­sible ­ischemia by thal­lium ­scan, and unsuit­ability for ­CABG or angio­plasty. ­Patients had end-­stage ­ischemic ­heart dis­ease and mul­tiple pre­vious con­ven­tional pro­ce­dures. TMR was per­formed ­through ­small ­left ante­rior thor­a­cot­o­mies ­using a 10.16 cm or ­less inci­sion.
­Results. Sev­enty-­five ­patients recov­ered ­from sur­gery ­without ­major com­pli­ca­tions. One ­patient (1.3%) ­died of an ­autopsy-­proven myo­car­dial infarc­tion in the ­treated ­region, and two addi­tional ­patients had a myo­car­dial infarc­tion (4.3%). ­Four ­patients had ­paresis of the ­left ­phrenic ­nerve, as deter­mined by an ele­vated ­left ­hemi-dia­phragm on ­chest X-ray, ­from ­which ­three recov­ered ­fully. ­Patients had no ­bleeding or ­wound infec­tions. ­Patients ­were intu­bated for an ­average of 1.5 ­hours and ­remained in ICU an ­average 0.8 ­days. ­Mean hos­pi­tal­iza­tion was 3.4 ­days.
Con­clu­sions. Tech­ni­cally ­well-­done TMR ­through a ­small ante­rior thor­a­cotomy can ­have ­good ther­a­peutic ­results and low mor­bidity and mor­tality. We ­will ­describe oper­a­tive tech­niques ­which min­i­mize ­pain and ­stress and ­help to ­insure sur­gical suc­cess.

lingua: Inglese


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