One-month histologic response of transmyocardial laser channels with molecular intervention

Kirk J. Fleischer, Pascal Goldschmidt-Clermont, James D. Fonger, Grover M. Hutchins, Ralph H. Hruban, William A. Baumgartner

Research output: Contribution to journalArticle

85 Citations (Scopus)

Abstract

Background. Transmyocardial revascularization reduces the symptoms and morbidity of patients with endstage ischemic heart disease. The mechanism is postulated to be the formation of transmural left ventricular channels through which oxygenated blood directly perfuses the myocardium. New techniques for molecular enhancement of angiogenesis and endothelial cell motility may represent strategies to augment this clinical benefit. Methods. Triads of transmyocardial revascularization channels were placed in eight separate nonischemic sites on the hearts of 7 pigs weighing 68 to 78 kg, which were allowed to recover and were then sacrificed at 28 days. In addition, one triad pair was injected with vascular endothelial growth factor, and two triad pairs received an adenovirus vector with or without the gene encoding for human profilin, which increases endothelial cell motility and adhesion. The remaining triad pair stood untreated (laser only). The histologic changes were graded (0 through 3) by an independent pathologist without knowledge of the treatment modality. Profilin production and vascular endothelial growth factor activation using a tyrosine kinase assay were monitored. Results. Transmyocardial revascularization alone resulted in a significant injury response (p < 0.01), including increased vascularity without patent channels. Vascular endothelial growth factor increased surrounding inflammation (p < 0.01) without improving vascularity or patency. Profilin content in tissues was increased but nonspecifically because inflammation resulting from adenovirus also induces higher profilin concentrations. Conclusions. The clinical benefit of transmyocardial revascularization may result simply from a nonspecific histologic response to injury. Molecular interventions appear to stimulate more inflammation but no additional angiogenesis. Further improvement in the clinical benefit of transmyocardial revascularization awaits the successful stimulation of a true angiogenic response.

Original languageEnglish
Pages (from-to)1051-1058
Number of pages8
JournalAnnals of Thoracic Surgery
Volume62
Issue number4
DOIs
StatePublished - Oct 1 1996
Externally publishedYes

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Profilins
Lasers
Vascular Endothelial Growth Factor A
Inflammation
Adenoviridae
Cell Movement
Endothelial Cells
Wounds and Injuries
Cell Adhesion
Protein-Tyrosine Kinases
Myocardial Ischemia
Myocardium
Swine
Morbidity
Genes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Fleischer, K. J., Goldschmidt-Clermont, P., Fonger, J. D., Hutchins, G. M., Hruban, R. H., & Baumgartner, W. A. (1996). One-month histologic response of transmyocardial laser channels with molecular intervention. Annals of Thoracic Surgery, 62(4), 1051-1058. https://doi.org/10.1016/0003-4975(96)00468-7

One-month histologic response of transmyocardial laser channels with molecular intervention. / Fleischer, Kirk J.; Goldschmidt-Clermont, Pascal; Fonger, James D.; Hutchins, Grover M.; Hruban, Ralph H.; Baumgartner, William A.

In: Annals of Thoracic Surgery, Vol. 62, No. 4, 01.10.1996, p. 1051-1058.

Research output: Contribution to journalArticle

Fleischer, KJ, Goldschmidt-Clermont, P, Fonger, JD, Hutchins, GM, Hruban, RH & Baumgartner, WA 1996, 'One-month histologic response of transmyocardial laser channels with molecular intervention', Annals of Thoracic Surgery, vol. 62, no. 4, pp. 1051-1058. https://doi.org/10.1016/0003-4975(96)00468-7
Fleischer KJ, Goldschmidt-Clermont P, Fonger JD, Hutchins GM, Hruban RH, Baumgartner WA. One-month histologic response of transmyocardial laser channels with molecular intervention. Annals of Thoracic Surgery. 1996 Oct 1;62(4):1051-1058. https://doi.org/10.1016/0003-4975(96)00468-7
Fleischer, Kirk J. ; Goldschmidt-Clermont, Pascal ; Fonger, James D. ; Hutchins, Grover M. ; Hruban, Ralph H. ; Baumgartner, William A. / One-month histologic response of transmyocardial laser channels with molecular intervention. In: Annals of Thoracic Surgery. 1996 ; Vol. 62, No. 4. pp. 1051-1058.
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