Induction of angiogenesis after TMR: a comparison of holmium:YAG, CO2, and excimer lasers G.Chad Hughes, MD, Alan P Kypson, MD, Brian H Annex, MD, Bangliang.

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Induction of angiogenesis after TMR: a comparison of holmium:YAG, CO2, and excimer lasers G.Chad Hughes, MD, Alan P Kypson, MD, Brian H Annex, MD, Bangliang Yin, MD, James D St. Louis, MD, Shankha S Biswas, MD, R.Edward Coleman, MD, Timothy R DeGrado, PhD, Carolyn L Donovan, MD, Kevin P Landolfo, MD, James E Lowe, MD The Annals of Thoracic Surgery Volume 70, Issue 2, Pages 504-509 (August 2000) DOI: 10.1016/S0003-4975(00)01569-1

Fig 1 (A) Normalized LCX region myocardial blood flow by PET preoperatively and 6 months postoperatively. Note significant increase in myocardial blood flow to the lased LCX distribution following TMR with both holmium:YAG (0.72 ± 0.04 before versus 0.92 ± 0.04 after TMR) and CO2 (0.79 ± 0.03 before versus 0.94 ± 0.03 after TMR) lasers. No significant change in myocardial blood flow was seen after excimer TMR (0.76 ± 0.04 before versus 0.87 ± 0.05 after TMR, p = 0.11) or sham thoracotomy (0.75 ± 0.04 before versus 0.78 ± 0.05 after sham procedure, p = 0.2). (B) Resting regional WMSI by DSE preoperatively and 6 months postoperatively. See text for details. (C) Peak stress regional WMSI by DSE preoperatively and 6 months postoperatively. Note significant decrease in stress WMSI consistent with a reduction in ischemia following holmium:YAG (2.0 ± 0.1 before versus 1.5 ± 0.2 after TMR) and CO2 (1.9 ± 0.3 before versus 1.5 ± 0.3 after TMR) laser TMR. No significant change in peak stress WMSI was seen following excimer TMR (2.2 ± 0.2 before versus 2.2 ± 0.3 after TMR, p > 0.2) or sham thoracotomy (2.3 ± 0.2 before versus 2.2 ± 0.3 after sham procedure, p > 0.2). (D) Quantitative vascular density analysis. See text for details. (CO2 = carbon dioxide; DSE = dobutamine stress echocardiography; LCX = left circumflex coronary artery; PET = positron emission tomography; TMR = transmyocardial laser revascularization; WMSI = wall motion score index; YAG = yttrium-aluminum-garnet.) The Annals of Thoracic Surgery 2000 70, 504-509DOI: (10.1016/S0003-4975(00)01569-1)

Fig 2 Endogenous endothelial alkaline phosphatase staining (original magnification, 100×) of representative sections from hibernating myocardium lased with (A) holmium:YAG , (B) CO2, and (C) excimer lasers and from (D) nonlased hibernating myocardium in an animal from the sham group. Note the progressive decrease in blue staining intensity characteristic of endothelial cells from figures 2A to 2D. (Asterisk = location of channel remnant.) The Annals of Thoracic Surgery 2000 70, 504-509DOI: (10.1016/S0003-4975(00)01569-1)