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CLINICAL STUDIES

Early postoperative changes in regional systolic and diastolic left ventricular function after transmyocardial laser revascularization

A comparison of holmium:YAG and CO₂ lasers

^a Duke University Medical Center, Durham, North Carolina, USA

Manuscript received March 25, 1999; revised manuscript received October 15, 1999, accepted November 22, 1999.

Reprint requests and correspondence: Dr. G. Chad Hughes, Box 3857, Duke University Medical Center, Durham, North Carolina 27710
chadh{at}acpub.duke.edu

OBJECTIVES

The purpose of this study was to determine the short-term effects of transmyocardial laser revascularization (TMR) on regional left ventricular systolic and diastolic function, myocardial blood flow (MBF) and myocardial water content (MWC).

BACKGROUND

Clinical studies of TMR have noted a significant incidence of cardiac complications in the early postoperative period. However, the early post-treatment effects of laser therapy on the myocardium and their potential contribution to postoperative cardiac morbidity are unknown.

METHODS

Swine underwent holmium:yttrium-aluminum-garnet (holmium:YAG) (n = 12) or carbon dioxide (CO₂) (n = 12) laser TMR. Regional systolic function for the lased and nonlased regions was quantitated using preload recruitable work area (PRWA) and regional diastolic function with the ventricular stiffness constant alpha.

RESULTS

Preload recruitable work area was significantly decreased in the lased regions both 1 (59.8 ± 13.0% of baseline, p = 0.02) and 6 h (64.2 ± 9.4% of baseline, p = 0.02) after holmium:YAG TMR. This decreased PRWA was associated with a significant reduction in MBF to the lased regions (13.2% reduction at 1 h, p = 0.02; 18.4% decrease at 6 h post-TMR, p = 0.01). These changes were not seen after CO₂ laser TMR. A significant increase in MWC (1.4 ± 0.3% increase with holmium:YAG, p = 0.004; 1 ± 0.2% increase with CO₂, p = 0.002) and alpha (217.4 ± 44.2% of baseline 6 h post-holmium:YAG TMR, p = 0.05; 206 ± 36.7% of baseline 6 h post-CO₂ TMR, p = 0.03) was seen after TMR with both lasers.

CONCLUSIONS

In the early postoperative setting, impaired regional systolic function in association with regional ischemia is seen after TMR with a holmium:YAG laser. Both holmium:YAG and CO₂ lasers are associated with increased MWC and impaired diastolic relaxation in the lased regions. These changes may explain the significant incidence of early postoperative cardiac morbidity. The impact of these findings on anginal relief and long-term outcome are not known.

Abbreviations and Acronyms   ANOVA = analysis of variance   CABG = coronary artery bypass grafting   CO2 = carbon dioxide   dP/dt = first derivative of left ventricular transmural pressure   EDL = end diastolic segment length   holmium:YAG = holmium:yttrium-aluminum-garnet   l = regional segment length   MBF = myocardial blood flow   MWC = myocardial water content   PRSW = preload recruitable stroke work   PRWA = preload recruitable work area   PTCA = percutaneous transluminal coronary angioplasty   SW = stroke work   TMR = transmyocardial laser revascularization

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