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Cardiac Surgery

CO2 Laser Revascularization

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CO2 laser revascularization, also known as transmyocardial revascularization, is a surgical procedure used to relieve severe angina, or chest pain, in patients who aren't candidates for bypass surgery or angioplasty. Angina is a symptom of coronary artery disease, in which an accumulation of plaque narrows or blocks the arteries, resulting in a shortage of blood and oxygen to the heart.

CO2 laser revascularization creates channels through the wall of the heart to promote increased blood flow into oxygen-deprived areas of the heart. It can also be used to treat patients whose coronary artery blockages are too diffuse to be treated with bypass surgery alone, as well as heart transplant patients who develop coronary artery disease after their transplant.

How CO2 laser revascularization reduces angina still is not fully understood. The laser may stimulate new blood vessels to grow, or it may destroy nerve fibers to the heart, making patients unable to feel their chest pain. The angina of 80-90% of patients has significantly improved for as long as one year after the procedure. Beyond that, it is unknown how long the results might last.

The Surgery

The procedure is performed without having to stop the heart or use a heart-lung machine. The surgeon makes a small incision on the left side of the chest to expose the heart muscle. A laser hand piece is positioned on the outside of the oxygen-deprived area of the heart. Using the laser, the surgeon creates a tiny 1 mm channel through the heart muscle to the inside of the heart chamber. The surgeon determines the number of channels to create based on the size of the oxygen-deprived areas of the heart. The laser is automatically synchronized to your heartbeat, so the channels are created when your heart is at rest, preventing damage to other tissue in the heart. Bleeding from the laser channels on the outside of the heart stops after a few minutes of pressure from the surgeon's finger. The surgery typically takes from one to two hours.

In some patients, CO2 laser revascularization is combined with coronary artery bypass surgery.

For postoperative information, see After Cardiac Surgery.

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