Effects of transmyocardial laser revascularization at the character of pathomorphological and ultrastructural patterns of myocardial microcirculation flow

Objective. This study was undertaken to demonstrate that the combination of coronary artery by-pass grafting (CABG) and transmyocardial laser revascularization (TMLR) in patients with advanced coronary artery disease (CAD) improves surgical outcomes due to improved vasoconstriction. Materials and methods. 14 heart preparations from patients with IHD with diffuse lesion of coronary arteries who died after surgery were studied: 8 - after CABG (Group 1) and 6 - after CABG + TMLR (Group 2). Heart and vessel preparations were studied both macro-and microscopically. In all cases findings of histopathomorphologic examination were comparable with clinical results (hospital mortality, serious adverse effects - SAE). Results. The macro- and microscopical examination revealed that after CABG thrombosis of by-pass anastomosis and coronary arteries was seen in all hearts. It is just thrombosis that became the basic cause of death. A different picture was seen in Group 2 in which patients had CABG + TMLR surgery. There was neither any «paradoxical spasm» nor IM in coronary arteries at laser irradiation sites. High mortality rate (12.1 %) and SAE rate (33.3%) in Group 1 may be explained with the worsening of coronary spasm in patients with the terminal stage of coronary artery impairment. While much less hospital mortality (1.15%) and morbidity (2.3%) in Group 2 (CABG + TMLR) may be explained with laser-induced dilatation of coronary artery distal flow. An increased resistance of microcirculatory flow in the myocardium decreases the effectiveness of by-pass functioning and thus, restoration of myocardial blood flow. We suggest that positive intraoperative TMLR effects are promoted by myocardial microflow dilatation and improved perfusion just during the surgery. Conclusion. The worsening of catecholamine-induced vasospasm and reduction of myocardial blood flow in patients with IHD and diffuse impairment of coronary arteries is a typical event after coronary by-pass. Good outcomes after TMLR in this group of patients are likely to be explained with prevention of vasoconstriction of coronary arteries in patients with marked IHD. Better hospital parameters in patients after CABG + TMLR could be explained by vasodilatation of vessels in the microcirculatory flow.

трансмиокардиальная лазерная реваскуляризация, спазм КА, вазодилатация сосудов микрососудистого русла миокарда, transmyocardial laser revascularization, coronary spasm, vasodilatation of myocardial microvessels

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