- Email: [email protected]
Transmyocardial laser revascularisation
76
Heart, Lung and Circulation 2009;18:65–88
Abstracts of the ASCTS Annual Scientific Meeting 2007
ABSTRACTS
Results: CABG induced phenotypic and functional changes to circulating PMNs that have variable duration. Short term changes included a decrease in expression of CD16 (a receptor for IgG) and CD18. Longer term changes included: (i) a significant rise in CD43, a long negatively charged, innately anti-adhesive molecule, (ii) depressed ability to up-regulate CD11b expression following priming and activation and (iii) reduced NADPH oxidase activity that endured past day 5. Discussion: The raised CD43, down regulated CD11b response and reduced NADPH oxidase activity intimates depressed PMN function. This is important in the critical care setting as it implies that the PMNs response in an inflammation and/or infection may be depressed after CABG for a longer period than previously thought. doi:10.1016/j.hlc.2008.11.031 22 Transmyocardial laser revascularisation Thomas A. Pfeffer Southern California Permanente Medical Group, Los Angeles, CA, USA Incomplete revascularisation occurs in about 15–25% of coronary bypass patients. Increasingly, patients are referred for surgery who have had prior surgical or percutaneous interventions with refractory angina but poor targets for standard revascularisation. Transmyocardial laser revascularisation (TMR) is a technique of non-anatomic myocardial revascularisation. A number of randomised, prospective trials comparing sole therapy TMR versus maximal medical therapy, and as an adjunct to coronary bypass have demonstrated significant angina relief, decreased hospitalisations for angina, decreased medication usage, and a trend towards survival benefit. Proper patient selection is critical with patients having Class IV angina and reasonable ejection fraction with no congestive failure symptoms the most likely to benefit. The present Class I recommendation for sole therapy TMR is for patients with Class III or IV angina refractory to medical therapy, with ejection fraction greater than 30%, demonstrating reversible ischaemia in the corresponding myocardial territory, and who are not candidates for coronary bypass or percutaneous intervention due to lack of suitable targets.
doi:10.1016/j.hlc.2008.11.032 23 Endovascular repair of traumatic aortic transaction using a thoracic device: A single centre experience P. Shah, A. Azizzadeh, A. Estera, H. Safi Department of Cardiovascular Surgery, University of Texas, Houston Medical School, United States Objective: Endovascular treatment of traumatic aortic transaction (TAT) is an alternative to open repair in patients with blunt trauma. We report our initial experience using the TAG device (W.L.Gore, Flagstaff, AZ). Methods: Between September 2005 and January 2007, 10 patients with TAT underwent endovascular repair using the TAG device at our institution. Data was collected prospectively. Seven patients were male. The mean age was 47 (range 29–87). All patients had a lesion limited to the isthmus. Initial management included resuscitation, blood pressure management, and treatment of associated injuries. The median interval between admission and repair was 6.8 days (range 0–109 days). The mean injury severity score was 33 (range 24–38). Results: Endovascular treatment was successful in all patients. The mean proximal diameter was 24.8 mm. The mean distal diameter was 22.7 mm. All patients received a single device. The mean operative time was 46 min
Heart, Lung and Circulation 2009;18:65–88
Abstracts of the ASCTS Annual Scientific Meeting 2007
ABSTRACTS
Results: CABG induced phenotypic and functional changes to circulating PMNs that have variable duration. Short term changes included a decrease in expression of CD16 (a receptor for IgG) and CD18. Longer term changes included: (i) a significant rise in CD43, a long negatively charged, innately anti-adhesive molecule, (ii) depressed ability to up-regulate CD11b expression following priming and activation and (iii) reduced NADPH oxidase activity that endured past day 5. Discussion: The raised CD43, down regulated CD11b response and reduced NADPH oxidase activity intimates depressed PMN function. This is important in the critical care setting as it implies that the PMNs response in an inflammation and/or infection may be depressed after CABG for a longer period than previously thought. doi:10.1016/j.hlc.2008.11.031 22 Transmyocardial laser revascularisation Thomas A. Pfeffer Southern California Permanente Medical Group, Los Angeles, CA, USA Incomplete revascularisation occurs in about 15–25% of coronary bypass patients. Increasingly, patients are referred for surgery who have had prior surgical or percutaneous interventions with refractory angina but poor targets for standard revascularisation. Transmyocardial laser revascularisation (TMR) is a technique of non-anatomic myocardial revascularisation. A number of randomised, prospective trials comparing sole therapy TMR versus maximal medical therapy, and as an adjunct to coronary bypass have demonstrated significant angina relief, decreased hospitalisations for angina, decreased medication usage, and a trend towards survival benefit. Proper patient selection is critical with patients having Class IV angina and reasonable ejection fraction with no congestive failure symptoms the most likely to benefit. The present Class I recommendation for sole therapy TMR is for patients with Class III or IV angina refractory to medical therapy, with ejection fraction greater than 30%, demonstrating reversible ischaemia in the corresponding myocardial territory, and who are not candidates for coronary bypass or percutaneous intervention due to lack of suitable targets.
doi:10.1016/j.hlc.2008.11.032 23 Endovascular repair of traumatic aortic transaction using a thoracic device: A single centre experience P. Shah, A. Azizzadeh, A. Estera, H. Safi Department of Cardiovascular Surgery, University of Texas, Houston Medical School, United States Objective: Endovascular treatment of traumatic aortic transaction (TAT) is an alternative to open repair in patients with blunt trauma. We report our initial experience using the TAG device (W.L.Gore, Flagstaff, AZ). Methods: Between September 2005 and January 2007, 10 patients with TAT underwent endovascular repair using the TAG device at our institution. Data was collected prospectively. Seven patients were male. The mean age was 47 (range 29–87). All patients had a lesion limited to the isthmus. Initial management included resuscitation, blood pressure management, and treatment of associated injuries. The median interval between admission and repair was 6.8 days (range 0–109 days). The mean injury severity score was 33 (range 24–38). Results: Endovascular treatment was successful in all patients. The mean proximal diameter was 24.8 mm. The mean distal diameter was 22.7 mm. All patients received a single device. The mean operative time was 46 min