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'Transmyocardial Laser Revascularization' (578)


Nov
2017

Transmyocardial laser revascularization is an established therapy for refractory coronary artery disease. However, utilization of the technology is not as widespread as expected. This is despite the fact that the efficacy of the technology has been established in multiple prospective randomized trials.

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May
2017

Randomized and nonrandomized clinical trials have tried to assess whether or not TMR patients experience an increase in myocardial perfusion. However there have been inconsistencies reported in the literature due to the use of different nuclear imaging modalities to test this metric. The primary purpose of this meta-analysis was to determine whether SPECT, MUGA and PET scans demonstrate changes in myocardial perfusion between lased and non-lased subjects and whether laser type affects myocardial perfusion.

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Dec
1969

Transmyocardial revascularization (TMR) has emerged as an additional therapeutic option for patients suffering from diffuse coronary artery disease (CAD), providing immediate angina relief. Recent studies indicate that the volume of surgical cases being performed with TMR have been steadily rising, utilizing TMR as an adjunctive therapy. Therefore the purpose of this review is to provide an up-to-date appreciation of the current state of TMR and its future developmental directions on CAD treatment.

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Apr
2016

A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was: In patients with angina pectoris refractory to medical therapy, does surgical sympathectomy improve clinical outcomes? A total of 528 papers were identified using the search protocol described, of which 6 represented the best evidence to answer the clinical question. There were 5 case series and 1 prospective cohort study.

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Jan
2016

Medically refractory angina pectoris (RAP) is defined by presence of severe angina with objective evidence of ischemia and failure to relieve symptoms with coronary revascularization. Medication and invasive revascularization are the most common approaches for treating coronary artery disease (CAD). Although symptoms are eliminated or alleviated by these invasive approaches, the disease and its causes are present after treatment.

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Mar
2015

To analyze the short-term outcomes of redo coronary artery bypass grafting (CABG) using on-pump and off-pump CABG techniques.
From January 2003 to August 2013, non-randomized 80 patients were treated with redo CABG in the Department of Cardiac Surgery, Peking University Third Hospital. Among these patients, 40 underwent on-pump CABG technique (redo-ONCAB group) and 40 underwent off-pump CABG technique (redo-OPCAB group).

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Feb
2015

This is an update of a review previously published in 2009. Chronic angina and advanced forms of coronary disease are increasingly more frequent. In spite of the improvement in the efficacy of available revascularization treatments, a subgroup of patients continue suffering from refractory angina.

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Dec
1969

Transmyocardial laser revascularization (TMR) emerged as treatment modality for patients with diffuse coronary artery disease not amendable to percutaneous or surgical revascularization. The procedure entails the creation of laser channels within ischemic myocardium in an effort to better perfuse these areas. Currently, two laser devices are approved by the US Food and Drug Administration for TMR - holmium:yttrium-aluminum-garnet and CO2.

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Apr
2015

We investigated the roles of stem cell factor (SCF)-c-kit and stromal derived factor-1 (SDF-1)-CXCR4 signaling axes in transmyocardial revascularization (TMR)-enhanced engraftment of transplanted bone marrow stem cells (BMSCs) in infarcted hearts.
3 weeks after LAD ligation, female Lewis rats underwent 10-channel needle-TMR, followed by daily IV injections of 1 million male donor BMSC for 5 days, either wild type (WT) or with knockdown (K/D) of c-kit or CXCR4, accomplished via a shRNA + plasmid in a lentiviral vector (N = 6/group).
In our rat infarct model, 3 days after last BMSC injection, the number of BMSCs that homed into infarct was affected by both TMR and donor cell type, with greater BMSC engraftment with TMR and with WT BMSC (TMR, cell type, and interaction, P < 0.

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Apr
2015

The purpose of this study was to assess the feasibility of an endoscopic, optical-fiber-based, laser delivery system (LDS) developed to perform sole-therapy transmyocardial revascularization (TMR) in a totally endoscopic, robotically assisted operation.
Forty-two patients were enrolled in a multicenter, prospective, single-arm clinical trial conducted at four US centers between 2005 and 2007. Transmyocardial revascularization was performed completely endoscopically with robotic assistance, introducing the Holmium:Yttrium aluminum garnet (YAG) LDS via a 5-mm port.

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Aug
2014

Medically refractory angina pectoris (RAP) is defined by presence of severe angina with objective evidence of ischemia and failure to relieve symptoms with coronary revascularization. Medication and invasive revascularization are the most common approaches for treating coronary artery disease (CAD). Although symptoms are eliminated or alleviated by these invasive approaches, the disease and its causes are present after treatment.

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Apr
2014

The purpose of this study was to determine the combined effect of transmyocardial laser revascularization (TMLR) and the implantation of endothelial progenitor cells (EPCs) on cardiac function of ischemic hearts in canines. The left anterior descending artery (LAD) was occluded to establish the canine model of acute myocardial infarct (AMI). Four weeks later, the animals were randomly divided into four groups: TMLR group, in which transmyocardial laser-induced channels were established at the ischemic region; EPCs+TMLR group, in which EPCs were locally transplanted into laser-induced channels at the ischemic region; EPCs group, in which the EPCs were injected into the ischemic region; control group, in which the AMI animals received neither TMLR nor EPCs.

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Mar
2013

Myocardial ischemia and cardiac dysfunction have been known to follow ischemic heart disease cell therapy and laser revascularization harbors a promising potential for vascular and cardiac reparation, which is corroborated by adequate preclinical evidence. In this review we present an analysis research of mesenchymal stem cells transplantation and transmyocardial laser revascularization for myocardial repair.

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Dec
1969

We report the case of a 59-year-old woman who presented with symptoms of angina that was refractory to medical management. Although her cardiac catheterization revealed microvascular coronary artery disease, her symptoms were refractory to optimal medical management that included ranolazine. After undergoing transmyocardial revascularization, her myocardial ischemia completely resolved and her symptoms dramatically improved.

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Dec
1969

There are a growing number of patients with end-stage coronary artery disease (CAD) and refractory angina. Angiogenesis may be induced by intramyocardial injection of autologous bone marrow stem cells, intensified by inflammation around channels performed by laser.
To assess the effect of a combined treatment consisting of transmyocardial laser revascularisation (TLMR) and intramyocardial injection of bone-marrow derived stem cells (bone marrow laser revascularisation, BMLR) in patients with refractory angina one year after the procedure.

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Feb
2013

The purpose of this study was to investigate whether transmyocardial jet revascularization (TMJR) with chitosan scaffolds retains channel patency and enhances angiogenesis after acute myocardial infarction (AMI) in a canine model. A total of 32 canines were randomly divided into four groups: myocardial infarction (MI), normal saline (NS), chitosan hydrogel (CH), and chitosan plus growth factor (CH + GF) groups. TMJR was performed surgically using a needle-free injector from the epicardium of canines in the NS, CH, and CH + GF groups; channels were filled with NS, CH, and CH + GF, respectively.

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Dec
1969

Analysed herein are the results of treating a total of 471 patients operated on at the Department of Surgical Treatment for Arterial Pathology of the Research Centre of Cardiovascular Surgery named after A. N. Bakulev under the Russian Academy of Medical Sciences for an aneurysm of the infrarenal portion of the abdominal aorta.

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Nov
2012

Two independent reports documented substantially higher operative mortality associated with transmyocardial revascularization (TMR) when used in isolation than that reported in the premarket clinical trials. To clarify the state of the art, this article assesses temporal trends in the use of TMR, short-term and long-term outcomes, and outcomes stratified by procedure type (TMR only and TMR + coronary artery bypass graft [CABG]) and by the 2 specific TMR devices.
The study population included all patients undergoing TMR in isolation or in combination with CABG at 435 cardiothoracic hospitals in the United States participating in the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database (ACSD) from January 2000 through November 2006 (n = 15,386).

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Jun
2012

Conventional coronary angiography (CCA) has considerable limitations regarding visualization of distal vessel segments in chronic total occlusion. We assessed the ability of coronary computed tomographic angiography (CCTA) to predict the success of coronary artery bypass grafting (CABG) to the chronically occluded left anterior descending coronary artery (LAD) incompletely visualized on CCA. Thirty symptomatic patients rejected for CABG on the basis of the CCA findings underwent preoperative CCTA before intended transmyocardial laser revascularization.

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Feb
2012

Thoracic compartment syndrome has been observed after trauma and after mediastinal and cardiac procedures; however, an adult respiratory distress syndrome (ARDS)-like presentation has not been described as a part of thoracic compartment syndrome. We describe the case of an obese patient who underwent coronary artery bypass (his third such procedure) and hiatal hernia reduction during the same operation, followed by transmyocardial laser revascularization and full chest closure the next day. The patient was hypoxic after chest closure.

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Feb
2012

Indirect revascularization is a therapeutic approach in case of severe angina not suitable for percutaneous or surgical revascularization. Transmyocardial revascularization (TMR) is one of the techniques used for indirect revascularization and it allows to create transmyocardial channels by a laser energy bundle delivered on left ventricular epicardial surface. Benefits of the procedure are related mainly to the angiogenesis caused by inflammation and secondly to the destruction of the nervous fibers of the heart.

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Feb
2012

To investigate whether transmyocardial drilling revascularization combined with heparinized basic fibroblast growth factor (bFGF)-incorporating degradable stent implantation (TMDRSI) can promote myocardial regeneration after acute myocardial infarction (AMI).
A model of AMI was generated by ligating the mid-third of left anterior descending artery (LAD) of miniswine. After 6 h, the animals were divided into none-treatment (control) group (n=6) and TMDRSI group (n=6).

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Dec
2011

We present the angiograms of a patient after transmyocardial laser revascularization (TMR), which were performed 10 years before by the application of holmium laser pulses. Thirteen years before the TMR procedure, the patient underwent coronary artery bypass graftings complicated by graft occlusion with no longer possibility of direct revascularization. Then, refractive angina required an alternative approach for symptom relief as the indirect revascularization by the application of the holmium laser pulses.

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May
2012

Previous studies demonstrated that failure to visualize distal chronic total occlusion in conventional coronary angiography (CCA) does not preclude procedural success of coronary artery bypass grafting (CABG). We assessed the utility of computed tomography angiography (CTA) in guiding CABG to the occluded left anterior descending artery (LAD) incompletely visualized by CCA.
Twenty-four symptomatic patients rejected for revascularization of an occluded LAD on the basis of CCA underwent a preoperative CTA before intended transmyocardial laser revascularization.

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Dec
1969

Despite significant advances in revascularization techniques and medical therapy, there remains a significant population of patients who continue to have intractable angina symptoms. This review aims to define the patients with refractory angina pectoris (RAP) and to present the therapeutic options currently available for this condition. RAP itself is defined and the pharmacological treatment options other than traditional medical therapies are discussed.

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Dec
2010

Transmyocardial laser revascularization (TMR) is currently clinically performed with either a CO(2) or Ho:YAG laser for the treatment of severe angina. While both lasers provide symptomatic relief, there are significant differences in the laser-tissue interactions specific to each device that may impact their ability to enhance the perfusion of myocardium and thereby improve contractile function of the ischemic heart.
A porcine model of chronic myocardial ischemia was employed.

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Oct
2010

We studied the peculiarities of angiogenesis in the postinfarction period after transmyocardial laser revascularization and intramyocardial implantation of mononuclear bone marrow cells into the pericicatrical zone of the left ventricular myocardium in dogs. Morphological manifestation of angiogenesis in the myocardium after application of laser and cell technologies are angiomatosis, formation of large thin-wall vessels and sinusoids. The angiogenic effect of implanted mononuclear bone marrow cells is determined by high content (43-47%) of CD31+ cells in both adherent and nonadherent fractions.

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Dec
1969

Recently, several kinds of lasers have been widely employed in the field of medicine and surgery. However, laser applications are very rare in the field of cardiovascular surgery throughout the world. So, we have experimentally tried to use lasers in the field of cardiovascular surgery.

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Sep
2011

Management of stable angina pectoris includes antianginal medications, medications to prevent progression of atherosclerosis, and aggressive treatment of causative risk factors. Antianginal medications commonly used include nitrates, beta-blockers, calcium channel blockers, and ranolazine. Antiplatelet agents, statins, and angiotensin-converting enzyme inhibitors are used in patients with these problems to prevent progression of atherosclerosis and/or premature cardiovascular death.

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Sep
2010

Refractory angina is a debilitating disease characterized by persistent cardiac pain resistant to all conventional treatments for coronary artery disease. Percutaneous myocardial laser revascularization (PMLR) has been proposed to improve symptoms in these patients. We used meta-analysis to assess the effectiveness of PMLR versus optimal medical therapy for improving angina symptoms, health-related quality of life (HRQL), and exercise performance; the impact on all-cause mortality was also examined.

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Sep
2010

To evaluate the midterm results of patients with angina and diffuse coronary artery disease treated with transmyocardial revascularization in combination with autologous stem cell therapy.
Nineteen patients with diffuse coronary artery disease and medically refractory class III/IV angina were evaluated between June 2007 and December 2009 for sole therapy TMR combined with intramyocardial injection of concentrated stem cells. At the time of surgery, autologous bone marrow (120cc) was aspirated from the iliac crest.

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Oct
2010

Transmyocardial laser revascularization 12 years later.

Interact Cardiovasc Thorac Surg 2010 Oct 15;11(4):480-1. Epub 2010 Jul 15.
Stefano Pratali, Francesca Chiaramonti, Aldo Milano, Uberto Bortolotti
We report the long-term follow-up of 34 patients who underwent transmyocardial laser revascularization (TMLR) from 1995 to 1999. At 12 years the actuarial survival is 24%±8%, actuarial freedom from cardiac deaths is 36%±10% and actuarial freedom from major adverse cardiac events 13%±8%. Mean angina class of nine current survivors is 2.

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Dec
1969

The study was designed to analyse results of alternative methods of myocardial revascularization in "no-option patients" to whom direct revascularization is not indicated. Over 600 cases were treated with the use of transmyocardial laser revascularization (TMLR), angiogenic factors (VEGF, alpha-ECGF), and cellular therapy. It was shown that TMLR is a safe and efficacious procedure increasing perfusion and normalizing myocardial metabolism.

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Dec
2009

Reportedly, patients with persistent refractory angina due to end-stage coronary artery disease (CAD) not amenable to traditional revascularization techniques have experienced symptomatic relief following laser revascularization, either surgical transmyocardial revascularization (TMR) or percutaneous myocardial revascularization (PMR). In spite of several hypotheses (i.e.

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Feb
2010

Transmyocardial laser revascularization for angina relief and intramyocardial autologous endothelial progenitor cell injection for neoangiogenesis may offer a new treatment strategy for patients with intractable ischemic heart disease.
Transmyocardial laser revascularization and intramyocardial injection of bone marrow-derived CD133+ cells was performed in six highly symptomatic patients. Transmyocardial laser channels were created and isolated CD133+ cells were injected intramyocardially.

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Sep
2009

The study looked at our results with transmyocardial laser revascularization. We also tried to ascertain the role of TMLR in current cardiothoracic surgical practice.
Twenty patients underwent TMLR at IKEM Praha in a period from 1999 to 2007.

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Jan
2010

If traditional treatment of coronary artery disease has failed, intramyocardial transplantation of CD133+ stem cells with the potential to improve myocardial function is an alternative approach to treating ischemic cardiomyopathy. The INSTEM trial aims at evaluating safety and feasibility of isolation and subsequent intramyocardial transplantation of CD133+ cells in combination with coronary artery bypass grafting (CABG). Patients suffering from severe ischemic cardiomyopathy (ejection fraction ≫15% and ≪35%) are enrolled in this trial.

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Dec
1969

Recent advances in medical therapy, percutaneous myocardial revascularization, and coronary artery bypass grafting have allowed patients to live longer without eliminating the underlying pathology of coronary artery disease. In this review the authors discuss surgical options, perioperative assessment, procedural details, and outcomes after repeated coronary artery bypass surgery and coronary endarterectomy, in patients with severe coronary artery disease that is not suited for further percutaneous coronary intervention. Furthermore, the authors also discuss the role of transmyocardial revascularization and protein/gene therapy in those extreme situations where complex coronary artery disease is no longer amenable to traditional surgical intervention.

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Jun
2009

We evaluated the effect of transmyocardial laser revascularization (TMR) on anginal symptoms and clinical results in patients in whom coronary artery bypass grafting (CABG) surgery was not sufficient to provide complete revascularization.
This retrospective study included 45 patients who underwent CABG surgery with incomplete revascularization between 2003 and 2006. Of these, 35 patients (mean age 61.

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Aug
2009

This paper details a proposed clinical identification tool, the Computerized Thermal Characterization Tool or (CT)(2), designed to precisely quantify and forecast the ablation capabilities of a CO(2) laser beam and to optimize its usage when human tissue is exposed to 10.6 microm wavelength radiation.
As seen in other studies by the same author, the correct identification of the optical absorption of polymethylmethacrylate (PMMA) allows isolating other key time-dependent coefficients, all described qualitatively rather than quantitatively in the literature, with better accuracy.

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Aug
2009

Transmyocardial laser revascularization (TMLR) is an alternative treatment modality for patients with refractory angina who are not candidates for conventional surgical or percutaneous revascularization. Clinical studies of TMLR have not shown one-to-one correlation between increased myocardial perfusion and improved clinical status.
Three patients (51, 53, and 70 years old) with severe, diffuse coronary artery disease not amenable to conventional surgical revascularization and with angina (Canadian Cardiovascular Society [CCS] class 3-4) refractory to maximal medical therapy underwent TMLR with a CO2 laser.

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Mar
2009

The effect of transmyocardial laser revascularization (TMLR) on microperfusion and oxygen supply was studied in an acute ischemia model, using 35 pigs, with 13 serving as controls.
Measurement of tissue oxygen tension was compared with the semiquantitative measurement of microperfusion using contrast echocardiography and infrared laser Doppler. All methods were used before and after coronary occlusion and after TMLR.

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Jan
2009

Chronic angina and advanced forms of coronary disease are increasingly more frequent. Although the improved efficacy of available revascularization treatments, a subgroup of patients present with refractory angina. Transmyocardial laser revascularization (TMLR) has been proposed to improve the clinical situation of these patients.

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