Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Angiogenic Responce to Transmyocardial Mechanical Reveascularization(TMMR) with Polymer Myocardial Stent

고분자 중합체 심근 스템트를 이용한 기계적 경심근 혈류재건술의 혈관생성 반응

  • Choi, Ho (Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine) ;
  • Lee, Cheol-Joo (Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine) ;
  • Moon, Kwang-Deok (Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine) ;
  • Kim, Young-Jin (Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine) ;
  • Kang, Joon-Kyu (Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine) ;
  • Hong, Jun-Wha (Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine) ;
  • Jee, Kyung-Soo (Department of Molecular Science & Technology, Ajou University) ;
  • Han, Man-Jung (Department of Molecular Science & Technology, Ajou University) ;
  • Cho, Sang-Ho (Department of Pathology, College of Medicine, Yeonsei University)
  • 최호 (아주대학교병원 의과대학 흉부외과학교실) ;
  • 이철주 (아주대학교병원 의과대학 흉부외과학교실) ;
  • 문광덕 (아주대학교병원 의과대학 흉부외과학교실) ;
  • 김영진 (아주대학교병원 의과대학 흉부외과학교실) ;
  • 강준규 (아주대학교병원 의과대학 흉부외과학교실) ;
  • 홍준화 (아주대학교병원 의과대학 흉부외과학교실) ;
  • 지경수 (아주대학교병원 분자과학 기술학과) ;
  • 한만정 (아주대학교병원 분자과학 기술학과) ;
  • 조상호 (연세대학교 의과대학 병리학교실)
  • Published : 2000.06.01
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Abstract

Background: Transmyocardial laser revascularization(TMLR) for revascularizing ischemic myocardium in patients was originally based on the assumption that laser channels remain their patency much longer. But recent studies show that laser channels did not remain open and that TMLR could achieve treatment benefits without long-term channel patency. The angiongencesis is currently thought to be induced by non-specific inflammatory response to mechanical tissue injury. This study is to evaluate hypothesis that various transmyocaridal mechanical revascularization(TMMR) may induce the angiogenic responses similar to that seen with TMLR, and transmyocaridal polymer stent revascularization(TMSR), the polymer stent in the myocardial tissue is hydrolyzed in 2 weeks, may enhance the non-specific inflammatory reaction resulting angiogenesis. Furthermore, polymer myocaridal stent channels remain long-term patency. Material and Method: Eight domestic pigs underwent ligation of the proximal circumflex artery, and 2 weeks later they were randomized to undergo transmycardial acupunctural revascularization (TMPR, Group I) of the left lateral wall with 18-G needle(n=2), to undergo transmyocardial (TMDR, Group II) with industrial 2mm steel drill(n=2), to undergo transmyocardial polymer stent revascularization (TMSR, Group III) after drilling the infarcted myocardium(n=2), the stent is poly(lactic acid-co-glycolic acid), which is self-degradated in the myocardium, and to a control group the ischemic zone was unterated(n=2). All the pigs were sacrificed after 4 weeks TMMR. Sections from the ischemic zone were submitted for vascular endothelial growth factor (VEGF) ELISA and histology. Result: There were makedly increase in the VEGF immunoassay in the ischemic zone of the TMMR group compared to the ischemic zone of the control group(control: each 30.85 and 43.15pg/mg protein, TMPR: each 44.14 and 68.61 pg/mg protein, TMDR: each 65.92 and 78.65 pg/mg protein, TMSR: each 177.39 and 168.87 pg/mg protein). TMSR channels caused greatest VEGF expression than channels made by other group and the polymer stent channels remained vacuole after 4 weeks. Conclusion: Transmyocardial polymer stent revascularization promoted the most angiogenci response by the VEGF immunoassay, although our study did not show the statistical significancy. The channels remained but the flow patency was not verified. Transmyocardial polymer stent revascularization (TMSR) is desirable in future experimental trials and in view of the significant cost implications comparable to that of laser.

Keywords

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