[Transmyocardial revascularization].

Transmyocardial laser revascularization refers to the perfusion of the reptilian heart with its large ventriculo-myocardial channels and to well-known ventriculo-coronary connections in congenital heart defects. By a high energy CO2-laser transmural channels can be created at a beating heart and may, by connecting to the intramyocardial capillary network or by inducing a neocapillarization, improve the blood supply to the ischemic myocardium. This indirect method of revascularization is indicated in symptomatic patients with diffuse coronary heart disease, not accessible by conventional methods like PTCA or coronary bypass surgery. Worldwide, this new kind of operation has already been performed in some 100 intractable patients. In our hospital 79 patients have been treated with this new technique, 37 of them in conjunction with conventional bypass surgery. The majority of those patients had already undergone one or two bypass operations. The perioperative mortality was 11.4% including three non cardiac events. Postoperative follow-up after 3 and 6 months showed among the reinvestigated patients a significant improvement concerning angina- (CCS) and clinical classification (NYHA). Scintigraphy after the same time period revealed an improvement of myocardial perfusion in 50% of the reinvestigated patients. These results as well as the international reports demonstrate a clinical efficacy of this new therapeutic approach in a selected group of severely diseased patients. Further objective data and also experimental studies have to confirm the role of this new method in the treatment of diffuse coronary heart disease.