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Abstract

A method for performing transmyocardial revascularization (TMR) uses a cardioplegic agent to briefly stop the heartbeat long enough to create 10 to 40 carefully placed transmyocardial blood flow channels using a laser. The cardioplegic agent used may be adenosine or an adenosine triphosphate-sensitive potassium channel opener, such as aprikalim, or a standard hyperkalemic cardioplegic agent. The temporarily induced motionlessness of the heart allows accurate and efficient placement of the blood flow channels, while the short duration of the cardioplegic effect obviates the need for cardiopulmonary bypass. The blood flow channels can be formed from the exterior or the interior of the heart. Preferably, the TMR procedure is performed using an infrared laser, such as a CO.sub.2 laser with an articulated-arm waveguide or a pulsed Nd:YAG laser with a flexible fiberoptic delivery system, or a near infrared laser, such as a holmium:YAG or erbium laser with a flexible fiberoptic delivery system, because of their ability to efficiently ablate clearly defined passages through myocardial tissue without inducing significant thermal damage to the surrounding myocardium. The laser delivery device or a separate probe can be used to verify the depth of the blood flow channels and their connection with the ventricular chamber. The heart resumes beating spontaneously after reperfusion, with no need for defibrillation or cardioversion. The TMR procedure can be performed by a cardiac or thoracic surgeon using standard open-chest surgical techniques or using a minimally invasive surgical approach or by an interventional cardiologist using a percutaneous transluminal intravascular approach.

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