Immediate effect of percutaneous myocardial laser revascularization on hemodynamics and left ventricular systolic function in severe angina pectoris

Experimental data suggest that myocardial revascularization with a high-ene rgy laser may cause a significant reduction in left ventricular (LV) functi on immediately after creation of myocardial channels. We sought to determin e if percutaneous myocardial laser revascularization (PMR) causes immediate deterioration in hemodynamic parameters or regional LV systolic function. PMR was performed in 40 patients (mean age 62.9 +/- 10.8 years) using the E clipse Holmium laser (26 had PMR alone; 14 patients underwent PMR plus perc utaneous coronary intervention). Intracardiac pressures and left ventriculo grams were recorded before and after PMR. Regional wall motion was assessed using the centerline method. A mean of 18 +/- 5 channels were created per patient. There was no significant change in LV ejection fraction immediatel y after PMR (56 +/- 9% vs 55 +/- 10%, p = 0.25). No deterioration in region al wall motion was demonstrated in the lased region (mean chard motion for anterior wall PMR: -1.5 +/- 0.8 before vs -1.5 +/- 0.8 after the procedure, p = 0.93; inferior wall PMR: -1.5 +/- 0.9 before vs -1.6 +/- 0.8 after the procedure, p = 0.43). Similarly, there was no change in the number of hypo kinetic chards in the treated region. Systemic blood pressure, LV end-diast olic pressure, heart rate, and right-sided heart pressures were not signifi cantly different after laser revascularization. In patients with refractory angina, PMR did not cause immediate deterioration in hemodynamic status or regional LV function. (C) 2001 by Excerpta Medica, Inc.