Laser transventricular revascularization

In the early 1970s, Mirhoseini applied a carbon dioxide laser to create a number of pores with a diameter of several micrometers between the myocardium and the left ventricle. It was thought that the systolic pressure difference between the left ventricular cavity and the myocardium could reach 50 mmHg or more. Oxygenated blood in the left ventricle can enter the myocardial sinusoids through the laser-pierced channel to improve oxygen supply, which is called transmyocardial laser revascularization. Subsequently, Japan, the former Soviet Union and the United States have experimental research and clinical application reports. As an auxiliary treatment, laser perforation of the myocardium that cannot be bypass grafted is performed in coronary artery bypass grafting. Early results Still satisfied. Laser sources for surgery include carbon dioxide lasers and holmium lasers, which are currently used in high-energy carbon dioxide lasers. After irradiation, the micropore of the myocardium can reach 0.5 to 1 mm, and the surrounding tissue reaction including carbonization and necrotic layers are relatively mild. Treatment of diseases: arteriosclerosis Indication Laser through the ventricular wall revascularization for: 1. CABG-added laser myocardial revascularization is the target of diffuse or small vessel disease without target vessels at the distal end, or when there is one or two myocardial ischemic areas in CABG. 2, due to extensive arteriosclerosis, ischemia, advanced age or secondary surgery in the risk of surgery under cardiopulmonary bypass, the use of off-pump cardiac do not stop CABG plus TMLR. Surgical procedure The 1000W high-energy CO2 laser currently used in clinical practice has a synchronous triggering device with ECG R wave. The laser through the ventricular wall revascularization is perpendicular to the ischemic left ventricular wall under cardiac arrest or heart beat. Irradiation, the pulse width is generally 50 to 100 ms, the laser energy is 20 to 40 J, and the channel spacing is 1 cm. According to the lesion range, 10 to 12 holes are generally used in the lower wall and the side wall, and 10 to 25 holes can be punched in the front wall. When the left ventricular wall is penetrated, blood can be seen to be ejected from the micropores, and at this time, compression or surface suture can be given to stop bleeding. Intraoperative patients were treated with general anesthesia, usually in the supine position, mediastinal sternal incision, if the right coronary artery is normal, the lesion is located in the proximal anterior descending and left circumflex lesions, you can also use the left thoracotomy, the chest should be pressed before opening The vascular bridge is routinely prepared, laser drilling is performed before the extracorporeal circulation, and the ischemic myocardial can not be punctured in the CABG. The application of extracorporeal circulation should be performed before the shutdown, and the ascending aorta should be opened first. Wait for the ventricle to fill and restore the regular heartbeat to punch, to prevent damage to the structure of the heart. After punching, the extracorporeal circulation is stopped as usual. If it is not necessary to apply extracorporeal circulation for CABG, the laser is usually perforated through the myocardium. When the laser hole is stopped, heparin (1 mg/kg) is injected intravenously to perform internal mammary artery-anterior descending anastomosis.

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