Revascularization, myocardial

Direct laser-assisted myocardial revascularization (DMR) is an approved technique in the US, Europe, and parts of Asia to create numerous myocardial channels. This results in the induction of a massive inflammatory reaction, which in turn induces angiogenesis. The other FDA-approved pro-angiogenic therapy is the use of recombinant human platelet-derived growth factor (Regranex) for use in the treatment of diabetic neuropathic foot ulcer s. 

Akins CW, Pohost GM, Desanctis RW, Block PC. Selection of angina-free patients with severe left ventricular dysfunction for myocardial revascularization. Am J Cardiol 1980 46 695-700... 

Outside the AMI setting, stem cells have been used to treat patients with ischemic heart disease with or without systolic functional compromise and patients unsuitable for myocardial revascularization (Tables 7.3 and 7.4). Autologous bone marrow stem cells have been used to treat patients with chronic myocardial ischemia, including ischemic heart failure with or without systolic functional compromise, and patients ineligible for myocardial revascularization (Table 7.4). The preliminary clinical evidence supports the efficacy of this new therapy and, at this point, all the evidence appears to substantiate its safety. 

Rana JS, Mannam A, Donnell-Fink L, Gervino EV Sellke FW, Laham RJ. Longevity of the placebo effect in the therapeutic angiogenesis and laser myocardial revascularization trials in patients with coronary heart disease. Am J Cardiol 2005 95(12) 1456-1459. 

Kalangos A, Tayyareci G, Pretre R, Di Dio P, Sezerman O. Influence of aprotinin on early graft thrombosis in patients undergoing myocardial revascularization. Eur J Cardiothorac Surg 1994 8(12) 651-6. 

With doses up to eight times the EDgs no cardiovascular adverse effects were observed (8) and in other studies cisatracurium had only minor cardiovascular adverse effects (9,11,12). Patients with coronary artery disease undergoing myocardial revascularization tolerated cisatracurium doses up to several fold the EDgs well hemodynamic changes from pre- to postinjection were minimal (13,14). 

Another potential adverse event associated with the use of intrapleural streptokinase is the development of antistreptokinase antibodies. These antibodies have been documented after intravenous streptokinase and can cause serious adverse events with re-exposure to streptokinase or can limit the efficacy of streptokinase in myocardial revascularization. 

Mangano CM, DIamondstone LS, Ramsay JG, Aggarwal A, Herskowitz A, and Mangano DT. 1998. Renal dysfunction after myocardial revascularization risk factors, adverse outcomes, and hospital resource utilization. The Multicenter Study of Perioperative Ischemia Research Group. Ann Intern Med 128 194-203. 

D. T. Mangano, Biventricular function after myocardial revascularization in humans. Deterioration and recovery patterns during the first 24 hours, Anesthesiology 62, 571-577 (1985). 

L. Czer, A. Hamer, F. Murphy, J. Bussell, A. Chaux, T. Bateman, J. Matloff, R. J. Gray, Transient hemodynamic dysfunction after myocardial revascularization, J Thorac Cardiovasc Surg 86, 226-234 (1983). 

In the decompensated patient who presents with heart failure and normal systemic vascular resistance, afterload reduction may be contraindicated, and treatment with a parenteral agent such as dobutamine may be preferable. The risk attendant to treatment with sympathomimetic drugs is related to the increase in myocardial Oj consumption that may occur this is of particular concern in patients with left heart failure that occurs as a direct consequence of myocardial ischemia. This clinical quandary has become less common in the era of aggressive myocardial revascularization when it is encountered, coadministration of dobutamine with parenteral nitroglycerin should be considered. 

Myocardial revascularization Mechanical intervention to improve delivery to the myocardium by angioplasty or bypass grafting... 

Myocardial revascularization by coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA) have become important in the treatment of severe angina. These are the only methods capable of consistently increasing coronary flow in atherosclerotic angina and increasing the double product. 

Furuya, R. K. et al.. Original research Telephone follow-up for patients after myocardial revascularization A systematic review. Am J Nurs May 113(5) 28-31,2013. 

Myocardial revascularization, when obstructive coronary artery disease is causing active ischemia, or valve replacement, for aortic stenosis, can reduce risk in these select patient subgroups (80,99-107). Unfortunately, these therapies, although effective, do not eliminate the risk of death. The risk can remain high in patients with underlying cardiovascular disease who have congestive heart failure or ventricular dysfunction. 

An interesting fiber-based device is used in percutaneous transluminal myocardial revascularization (PTMLR). In this procedure the fiber is inserted through the femoral artery and up the aorta into the heart, where channels are created in the inner portion of the heart muscle in patients with coronary disease, who have inadequate blood perfusion into the myocardium. 

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