Our experience with percutaneuos transmyocardial revascularization (PTMR) by YAG laser - Holmium

E. Piccaluga, A. Colombo, P. Danna, M. Viecca, R. Seregni, C. Fiorentini, S. Guzzetti, S. Porcellini, L. Pastori, J. Tao

Research output: Contribution to journalArticle

Abstract

Between April 1998 and May 1999, we treated 30 patients-aged 44-79 yrs with severe chronic angina (CCS class 3 or 4) due to 3 vessels disease (CAD) who were not suitable for myocardial revascularization by CABG or PTCA. All of them were on maximal multidrug treatment The ischemic threshold was tested by Naughton exercise stress test (NEST) 3 days before the PTMR only in 12 pts, whilst the remaining showed angina on minimal effort or at rest. All patients received Holmium laser pulses in order to create 6 to 15 myocardial channels throughout the left ventricular regions, which appeared more severely affected by CAD, based on angiographic data. Clinical and NEST follow-up was performed at 7 days, 30 days, 3 and 6 months after PTMR. Results: Pericardial effusion developed immediately after the procedure in 2 pts; 1 necessitated drainage. No threatening ventricular arrhytmia, death or AMI occurred during the in-hospital stay. One patient died 1 month after the procedure due to irreversible cardiogenic shock. Improvement in CCS angina class was significant in 26 pts at 7 days after PTMR (2.1+/-0.96 vs 3.3+/-0.6 baseline p<0.001) and was maintained at 30 days, 3 months and 6 months. In 3 pts there was no significant improvement of CCS angina class. Before PTMR, NEST was always angina-limited, whilst fatigue or St segment horizontal shift were the prevalent reasons for termination. During the follow-up, total time of exercise increased, though not significantly, and remained substantially similar at 30 days, 3 and 6 months (5.′34″+/-2′.29′ baseline, 7′+/-1′ at 6 months). Time to 1mm Horizontal ST segment depression did not significantly change during the follow-up. Conclusion: PTMR induced an improvement in every day activity and sustained symptomatic relief in most of the patients, even if there was no improvement in the ischemic EKG threshold. The mechanism of such effect remains to be explained.

Original languageEnglish
JournalHeart
Volume83
Issue numberSUPPL. 2
Publication statusPublished - Jun 2000

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Solid-State Lasers
Exercise Test
Myocardial Revascularization
Cardiogenic Shock
Pericardial Effusion
Fatigue
Drainage
Length of Stay
Electrocardiography
Exercise

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Piccaluga, E., Colombo, A., Danna, P., Viecca, M., Seregni, R., Fiorentini, C., ... Tao, J. (2000). Our experience with percutaneuos transmyocardial revascularization (PTMR) by YAG laser - Holmium. Heart, 83(SUPPL. 2).

Our experience with percutaneuos transmyocardial revascularization (PTMR) by YAG laser - Holmium. / Piccaluga, E.; Colombo, A.; Danna, P.; Viecca, M.; Seregni, R.; Fiorentini, C.; Guzzetti, S.; Porcellini, S.; Pastori, L.; Tao, J.

In: Heart, Vol. 83, No. SUPPL. 2, 06.2000.

Research output: Contribution to journalArticle

Piccaluga, E, Colombo, A, Danna, P, Viecca, M, Seregni, R, Fiorentini, C, Guzzetti, S, Porcellini, S, Pastori, L & Tao, J 2000, 'Our experience with percutaneuos transmyocardial revascularization (PTMR) by YAG laser - Holmium', Heart, vol. 83, no. SUPPL. 2.
Piccaluga E, Colombo A, Danna P, Viecca M, Seregni R, Fiorentini C et al. Our experience with percutaneuos transmyocardial revascularization (PTMR) by YAG laser - Holmium. Heart. 2000 Jun;83(SUPPL. 2).
Piccaluga, E. ; Colombo, A. ; Danna, P. ; Viecca, M. ; Seregni, R. ; Fiorentini, C. ; Guzzetti, S. ; Porcellini, S. ; Pastori, L. ; Tao, J. / Our experience with percutaneuos transmyocardial revascularization (PTMR) by YAG laser - Holmium. In: Heart. 2000 ; Vol. 83, No. SUPPL. 2.
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abstract = "Between April 1998 and May 1999, we treated 30 patients-aged 44-79 yrs with severe chronic angina (CCS class 3 or 4) due to 3 vessels disease (CAD) who were not suitable for myocardial revascularization by CABG or PTCA. All of them were on maximal multidrug treatment The ischemic threshold was tested by Naughton exercise stress test (NEST) 3 days before the PTMR only in 12 pts, whilst the remaining showed angina on minimal effort or at rest. All patients received Holmium laser pulses in order to create 6 to 15 myocardial channels throughout the left ventricular regions, which appeared more severely affected by CAD, based on angiographic data. Clinical and NEST follow-up was performed at 7 days, 30 days, 3 and 6 months after PTMR. Results: Pericardial effusion developed immediately after the procedure in 2 pts; 1 necessitated drainage. No threatening ventricular arrhytmia, death or AMI occurred during the in-hospital stay. One patient died 1 month after the procedure due to irreversible cardiogenic shock. Improvement in CCS angina class was significant in 26 pts at 7 days after PTMR (2.1+/-0.96 vs 3.3+/-0.6 baseline p<0.001) and was maintained at 30 days, 3 months and 6 months. In 3 pts there was no significant improvement of CCS angina class. Before PTMR, NEST was always angina-limited, whilst fatigue or St segment horizontal shift were the prevalent reasons for termination. During the follow-up, total time of exercise increased, though not significantly, and remained substantially similar at 30 days, 3 and 6 months (5.′34″+/-2′.29′ baseline, 7′+/-1′ at 6 months). Time to 1mm Horizontal ST segment depression did not significantly change during the follow-up. Conclusion: PTMR induced an improvement in every day activity and sustained symptomatic relief in most of the patients, even if there was no improvement in the ischemic EKG threshold. The mechanism of such effect remains to be explained.",
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AU - Piccaluga, E.

AU - Colombo, A.

AU - Danna, P.

AU - Viecca, M.

AU - Seregni, R.

AU - Fiorentini, C.

AU - Guzzetti, S.

AU - Porcellini, S.

AU - Pastori, L.

AU - Tao, J.

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