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Transmyokardiale Laserrevaskularisation mit einem Holmium: YAG-Laser: Klinische Erfahrungen

Transmyocardial laser revascularization with a holmium: YAG laser: Clinical experience

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Zusammenfassung

Grundlagen: Patienten mit therapierefraktärer Angina pectoris waren bislang nicht mit konventionellen Methoden behandelbar. Die Transmyokardiale Laserrevaskularisation (TMR) stellt eine therapeutische Option dar. Das Ziel dieser Studie war es, die Sicherheit und die klinische Effektivität der TMR zu evaluieren.

Methodik: Die TMR wurde bei 40 Patienten unter erstmaliger Verwendung eines neuen Holmium: YAG-Lasers durchgeführt. Davon wurden 24 Patienten, die in 96 % mindestens eine vorangegangene Bypassoperation (ACBP) aufwiesen, nur mit einer TMR behandelt. Im Durchschnitt wurden 24 Kanäle angelegt. 16 Patienten erhielten eine Kombination mit einer herkömmlichen Bypassoperation, wobei 25 % der Patienten bereits eine frühere Bypassoperation hatten. Bei diesen Patienten wurden im Durchschnitt 17,3 Kanäle angelegt.

Ergebnisse: Bei allen Patienten kam es zu einer signifikanten Verbesserung der AP-Symptomatik um 2 CCS-Klassen (Canadian Cardiovascular Society) und einer Verbesserung der Leistungsfähigkeit in der Fahrradergometrie um 21 %. Ein Unterschied hinsichtlich dieser Parameter war zwischen der TMR und der TMR+CABG nicht festzustellen. Perioperativ verstarb 1 Patient an einem Myokardinfarkt (nur TMR). Sonstige Komplikationen waren Wundinfektionen (n=7,5 %) und Pneumonien (n=5 %).

Schlußfolgerungen: Diese Studie zeigt, daß die TMR mit einem neuen Holmium: YAG-Laser eine sichere und effektive Methode mit einer geringen perioperativen Mortalität ist. Sie führt zu einer Reduktion der Angina pectoris und zur Verbesserung der Lebensqualität bei Patienten mit schwerer diffuser Koronarsklerose.

Summary

Background: Patients with therapy refractory angina pectoris constitute a problem group, not amendable by conventional treatment. Transmyocardial laser revascularization (TMR) offers a new therapeutic option. The purpose of this study was to evaluate the safety and clinical efficacy of TMR.

Methods: TMR was performed in 40 patients using a new Holmium: YAG laser. In 24 patients TMR (only) was performed with an average of 24 channels/patient. Ninety six percent of these patients had already undergone at least one prior coronary artery bypass grafting procedure (CABG). In 16 patients a CABG in combination with TMR was performed. In this group 25 % had already undergone at least one prior CABG-procedure and received an average of 17,3 channels/patient.

Results: All patients demonstrated a significant improvement in angina pectoris and an average decrease in two CCS-classes, leading to an improvement of exercise capacity by 21 %. With regard to the above parameters there was no difference between TMR and TMR+CABG. Postoperatively, one patient died following acute myocardial infarction (only TMR). Other complications were wound infections (n=7,5 %) and pneumonias (n=5 %).

Conclusions: This study clearly demonstrates that TMR with a new Holmium: YAG laser is a safe method with low perioperative mortality. It is effective in relieving anginal pain and increasing quality of life in patients with severe coronary artery disease.

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Authors and Affiliations

  1. Klinische Abteilung für Herz-Thorax-Chirurgie, Universitätsklinik für Chirurgie, Währinger Gürtel 18-20, A-1090, Wien

    T. Wild, J. Wolfram, S. C. Beutelspacher, S. Memtsoudis, E. Wolner & R. Seitelberger

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  1. T. Wild
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  2. J. Wolfram
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  3. S. C. Beutelspacher
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  4. S. Memtsoudis
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  5. E. Wolner
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  6. R. Seitelberger
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Correspondence to T. Wild.

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Wild, T., Wolfram, J., Beutelspacher, S.C. et al. Transmyokardiale Laserrevaskularisation mit einem Holmium: YAG-Laser: Klinische Erfahrungen. Acta Chir Austriaca 31, 325–329 (1999). https://doi.org/10.1007/BF02619938

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