Transmyocardial revascularization (TMR) enhanced treatment for coronary artery disease

摘要

A transmyocardial revascularization (TMR) enhanced treatment for coronary artery disease and other medical procedures utilizing a source of laser energy and a laser delivery means attached thereto, the treatment or other medical procedure being one in which the coronary artery is temporarily occluded during a surgical procedure, the enhanced treatment comprising the steps of positioning the laser delivery means adjacent the distal anatomy of the heart muscle, delivering laser energy to the distal anatomy of the heart muscle through the laser delivery means to create at least one TMR channel communicating oxygenated blood from the left ventricle to myocardium of the distal anatomy of the heart muscle, such that during treatment or other medical procedure in which the coronary artery is temporarily occluded, the distal anatomy of the heart is essentially continuously supplied with oxygenated blood, and performing the treatment or other medical procedure in which the coronary artery is temporarily occluded during a surgical or other procedure. A device for TMR enhanced treatment of coronary artery disease and other medical procedures in which the coronary artery is temporarily occluded during a surgical procedure, the device having first tubular means communicating oxygenated blood in the left ventricle with the device, second tubular means for perfusing oxygenated blood directly into myocardium in the distal anatomy of the heart muscle, and fluid communication means for communicating oxygenated blood between the first tubular means and the second tubular means. In preferred embodiments, both the first and the second tubular means have sharpened distal ends for mechanically piercing tissue of the heart muscle, and the second tubular means has at least one perfusion aperture on the sidewall adjacent the distal end of the tubular means. Additionally, a pump means for pumping oxygenated blood through the TMR device is disclosed, the pump means to be actuated either manually or automatically, and optionally repeated at a specific rate during the treatment or other medical procedure. The treatment or other medical procedure includes, and is not limited to, coronary artery angioplasty, coronary artery bypass grafting (CABG), and minimally invasive direct coronary artery bypass grafting (MIDCAB).