procedure, surgeons gain access to the heart through a six- to eight-inch incision through the patient's side. Once the surface of the heart is exposed, they fire short pulses of laser energy into the left ventricle -- the heart's main pumping chamber -- while it is engorged with blood. A computer synchronizes the laser pulses with the pumping of the heart, and the blood in the chamber keeps the laser burst from traveling any further.

Depending on the extent of the heart disease, the surgeons create 20 to 40 channels in the moribund heart muscle, and the holes on the heart's surface seal themselves with clotted blood and heal over. Patients typically go home after four days in the hospital.

"The patients are now doing things they couldn't before -- shopping, gardening, driving and other everyday activities -- and without debilitating pain," Lowe said. "They have also lessened the amount of heart medications. If these benefits are sustained over time, this will be another important therapy for a very sick group of patients."

Specifically, the procedure is approved for patients who have not responded to the two standard therapies for blocked or diseased coronary arteries: coronary artery bypass surgery or balloon angioplasty. In a bypass procedure, veins from the leg are used to redirect oxygen-rich blood around blockages and directly to heart muscle. In angioplasty, a tiny balloon is threaded through the arteries feeding the heart and inflated, clearing plaque blocking the artery.

"At this point, we do not know exactly why this procedure works," he explained. "We do know that there is new capillary growth into the new channels. It could be that when oxygen-rich blood reaches heart muscle starved for oxygen, growth factors are released that encourage the ingrowth of capillaries.

"In the laboratory, we are exami
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Contact: Richard Merritt
merri006@mc.duke.edu
919-660-1309
Duke University Medical Center
29-Apr-1997


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