激光心肌血运重建术疗效分析

目的　探讨采用激光心肌血运重建 (TMLR)治疗 77例冠心病的效果。　方法　 77例心绞痛患者采用高功率CO2 激光心脏打孔器 (TheHeartLaserTM) ,在全麻下经左胸前外侧小切口显露左室壁后行TMLR ,平均打孔 (2 3± 6 )个。　结果　术后 72h死亡 3例 ,病死率为 3 8%。术后早期并发症分别为急性心肌梗死 (3 8% )、心功能不全 (2 6 % )、一过性房颤 (6 5 % )、频发室性早搏 (5 2 % )、二次开胸止血 (2 6 % )、自发性气胸 (1 3 % )、切口感染 (2 6 % )、肺部感染 (1 3% )。随访 3～ 2 4个月 ,死亡 3例 ,其中 1例系心肌梗死 ,另 2例非心脏事件。术后 3、6、12、2 4个月心绞痛分别为 (2 1± 0 3)级、(1 7± 0 3)级、(1 7± 0 3)级、(1 8± 0 4)级 ,较术前均有明显改善 (P分别 <0 0 5 ) ,术后 6个月左室射血分数 (5 7 2 5± 9 6 9) %较术前明显提高 (P =0 0 45 7,n =13) ,而术后 3与 12个月LVEF与术前无统计学差别。心肌核素扫描提示 70 1%患者心肌灌注得到不同程度改善。术后 (平均 12 6个月 )随访2 0例平板运动试验显示 ,运动时间 (9 6± 1 3)min较术前 (7 1± 3 2 )min明显延长 (P =0 0 2 1) ,运动耐量 (METs ,5 4± 2 0 )较术前 (4 3± 2 1)明显提高 (P =0 0 37) ,ST段平均压低 (0 0 4±

Clinical results of transmyocardial laser revascularization for 77 patients with coronary artery disease

OBJECTIVE: To analyses the clinical results of transmyocardial laser revascularization (TMLR) for 77 patients with coronary artery diseases (CAD). METHODS: The mean age of the patients was (65 +/- 7) years. Previous medical record included CABG (6 patients), PTCA (9), AMI (66.2%), hypertension (70.1%), and diabetes mellitus (45.5%). TMLR was performed on the beating heart via a left anterolateral thoracotomy at the fifth intercostal space. Transesophageal echocardiography showed transmyocardial penetration of 23 +/- 6 channels. RESULTS: The hospital mortality was 3.8%, and postoperative complications were AMI (3.8%), left ventricular failure (2.6%), PVC (5.2%). After operation, the mean CCS angina class was improved from the baseline 3.5 +/- 0.7 to 2.1 +/- 0.3 at 3 months, 1.7 +/- 0.3 at 6 months, 1.7 +/- 0.3 at 12 months and 1.8 +/- 0.4 at 24 months. One patient died of AMI and two died not due to cardiac events during a follow-up of 3 to approximately 24 months. Echocardiography showed that the average of left ventricular ejection fractions was improved significantly at 6 months after operation compared with the preoperative value (P = 0.0457). (201)TI-SPECT showed a remarkable improvement in reversible ischemia in 70% patients followed up. Metabolic stress test for 20 patients followed up patients demonstrated an average increase in exercise tolerance from 7.1 +/- 3.2 min at the baseline to 9.6 +/- 1.3 min at 12 months (P = 0.021). Similarly the METs increased from 4.3 +/- 2.1 at the baseline to 5.4 +/- 2.0 at 12 months. CONCLUSIONS: TMLR is a safe and effective procedure for the treatment of end stage coronary artery diseases not amenable to PTCA or CABG. The effect of TMLR is associated with indication, correct evaluation of myocardial ischemia, and management for postoperative complications.