Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SUNDAY, January 30, 1994 TAG: 9401300055
SECTION: NATIONAL/INTERNATIONAL PAGE: B-7 EDITION: METRO
SOURCE: Los Angeles Times
DATELINE: LENGTH: Medium
Pioneered by surgeons at the San Francisco Heart Institute, the technique punctures holes in the heart wall that allow blood to enter capillaries in the muscle, providing oxygen and nutrients to tissues that blocked arteries have starved.
The procedure has reduced pain in 91 percent of the 46 patients who have received it in a clinical trial and has increased mobility in 76 percent, surgeons reported at a meeting of the Society for Thoracic Surgery in New Orleans.
The laser procedure represents a radical departure from the conventional methods of treating coronary artery disease.
"This is a totally revolutionary way to get blood supply to heart muscle," said Dr. Lawrence H. Cohn of Harvard Medical School, chairman of the Department of Thoracid Surgery at Brigham and Women's Hospital in Boston.
Proponents are not yet touting the procedure, transmyocardial revascularization, as an alternative to bypasses or angioplasty. Rather - at least until enough data is accumulated to asses the procedure's long-term effectiveness - they say it is a last resort for patients for whom all other treatments have failed.
Nonetheless, proponents say it is significantly cheaper than bypass surgery and easier to perform, and preliminary evidence suggests its beneficial effects may persist longer because - unlike grafted arteries - the laser holes do not seem to plug up again. But surgeons note that it has not worked for everybody, and they are not yet sure why. Four of the 46 patients died from complications of the surgery.
Coronary artery disease is the leading cause of death in the United States. More than 400,000 coronary artery bypasses are performed in this country each year, in which a vein reroutes blood around the blockage. Surgeons also perform almost that many angioplasties, in which a balloon is inflated inside an artery to compress blockages and restore blood flow. But tens of thousands of patients who have undergone such therapies and suffered relapses have arteries that are too fragile for further treatment. The new approach could be their only salvation, some surgeons said.
"We are trying to be very conservative and assess the results from this technique objectively, but we are really quite encouraged," said noted heart surgeon Dr. Denton Cooley of the Texas Heart Institute, who has treated 12 patients.
"This sounded far-fetched when we were first approached to participate in trials," Cohn said. "But now that we have done eight patients, it's proved extremely interesting and makes us somewhat optimistic that this will have a place for treatment of patients who have no other recourse."
Erroll Taylor, 86, a retired butcher, was the first to undergo the procedure, in San Francisco in January 1990. Taylor had already had two bypass operations, the first at age 67, as well as angioplasty. But since 1977, he had been in virtually constant pain as his heart muscles screamed for oxygen.
"The pains were terrible. There is no way I can describe what those pains were like," Taylor said in an interview. "When they hit me, I was virtually helpless." He was housebound for 13 years, checking into the hospital frequently to receive injections of a blood thinner that reduced the pain somewhat.
Within a month of his operation, Taylor said, "My life was back to normal." He is able to walk comfortably around the neighborhood, go fishing, and enter fly-casting contests, his favorite pastime. "I've even won a couple of medals since the operation," he said.
by CNB