Coronary artery bypass surgery has relieved chest pain and added years to the lives of countless patients. However, the surgery does not put an end to the processes that cause coronary artery disease in the first place. Even after a successful bypass operation, new artery obstructions may form over time.
This was the case for Richard Lechner, who initially underwent quadruple bypass surgery in 1993 and had a re-operation bypass surgery via an alternative approach called thoracotomy in 2009. By then, his artery disease had progressed to the point that he could no longer undergo any more angioplasty procedures.
Fortunately, when Richard’s cardiac surgeon, Ali Gheissari, M.D., performed the 2009 surgery at Good Samaritan Hospital, Dr. Gheissari also performed a second procedure designed to enhance the growth of Richard’s own arteries in the heart and spare him from future incidences of chest pain.
The procedure, called transmyocardial revascularization (TMR), uses laser technology to create small channels in the heart muscle. TMR involves making between 20 and 40 tiny holes – or channels – from the outside of the heart into its pumping chamber. The outer areas of the channels close, but the scar tissue that forms stimulates creation of new blood vessels inside the heart muscle.
When Richard was at Good Samaritan this spring for a hip replacement, he awoke with severe chest pain and thought he was having a heart attack. An angiogram – an image of the heart’s blood vessels – showed that he did not have a heart attack, but that his artery disease had caused the bypassed artery to close.
Most significantly, the angiogram showed that Richard’s heart had also formed tiny new blood vessels around the areas which had previously been lasered. This phenomenon is referred to as angiogenesis because it involves the formation of new avenues that bring blood to the heart.
“These channels will continue to develop and increase blood flow to the heart via collateral arteries,” says Dr. Gheissari. “This means Richard’s chest discomfort will continue to decrease.”
Dr. Gheissari notes that TMR is not appropriate for every patient. In most cases, bypass surgery is still the best option. However, some patients who could benefit from TMR don’t receive the procedure because the majority of hospitals do not have the necessary laser equipment.
“This is a valuable alternative for those patients who are not candidates for bypass surgery or those who have exhausted all other means of treatment of their coronary disease,” says Dr. Gheissari. “We will soon initiate a clinical trial to see whether injection of stem cells in the laser channels at the time of surgery will enhance and speed up the formation of collateral blood vessels. I suspect TMR is going to become more commonplace over time.”
For a referral to a Good Samaritan Hospital specialist call (213)482-2744.
No comments:
Post a Comment