THORACOSCOPIC TRANSMYOCARDIAL LASER REVASCULARIZATION

Background. Transmyocardial laser revascularization is a promising sur gical technique used to treat nonreconstructable ischemic heart diseas e. Recent clinical data show that this technique improves the regional perfusion of ischemic myocardium and reduces angina. Presently transm yocardial laser revascularization requires an open, lateral thoracotom y. We report here the use of thoracoscopic techniques to perform trans myocardial laser revascularization in a closed chest fashion. Methods. Five Yorkshire farm pigs underwent left chest thoracoscopic explorati on and pericardiotomy. A specialized laser handpiece then was introduc ed into the chest and thoracoscopic transmyocardial laser revasculariz ation was performed (one channel per square centimeter) using an 800-W CO2 laser. Results. Video analysis and gross pathology revealed that the anatomic area accessible to thoracoscopic transmyocardial laser re vascularization included the entire left ventricular free wall distrib utions of the left anterior descending, left circumflex, and posterior descending arteries, from base to apex. Standard hematoxylin and eosi n staining confirmed the creation of complete and patent 1-mm-diameter transmural channels throughout these distributions. Conclusion. We ha ve shown that transmyocardial laser revascularization can be performed effectively and safely by thoracoscopy, and that this less invasive t echnique may reduce morbidity and provide a more cost-effective altern ative therapy for nonreconstructable ischemic heart disease. (C) 1997 by The Society of Thoracic Surgeons.