Current and Alternative Methods for Myocardial Revascularization in Patients with Complicated Forms of Coronary Heart Disease
The main tendency of today's coronary surgery consists in the increase of the number of patients with increased surgical risk. Due to progressive deterioration of general and cardiac status of patients referred for surgical myocardial revascularization as well as to the growth of the number of patients with diffuse coronary lesions and different forms of ischemic and dilated cardiomyopathy, those last times the accent is being made on alternative methods of myocardial revascularization. Among those methods one can cite transmyocardial laser revascularization, as well as the se of different gene agents and stem cells.
- Life Science
While the first method is already widely used in clinical settings, the methods of cell and gene therapy still are on the stage of pre-clinical trials and require serious summarizing for the development of a strategy line of use.
Different alternative methods of myocardial revascularization are used in a centre for Surgery since 1997.
They have an experience with about 400 operations using transmyocardial laser revascularization (TMLR). Those operations are carried out in isolated form, as well as in combination with different types of direct myocardial revascularization and in combination with angiogenic factors.
We possess strictly defined indications for such operations and a system for careful examination of patients using SPECT and PET and the study of the quality of life. The obtained data revealed that the effectiveness of TNLR is based upon the neoangiogenesis with subsequent improvement of the perfusion and the normalization of myocardial metabolism
The results of operations were followed up for 8 years. Total hospital and late mortality is 3,8 %, which is obviously encouraging taking into the account the severity of coronary lesion.
The experience with the operations performed in patients with coronary heart disease, with vascular pathology and with some congenital heart diseases for different indications and with the use of angiogenic factors and stem cells amounts to about 150 cases. The results of those operations are being summarized and will be rendered public after the end of the analysis.