TMLR TMLR

ä ä TMLR ä ä TMLR CABG TMLR ä ä TMLR / ä ä Off-pump CABG TMLR

TMLR : ä ä Mirhoseini W CO 2,. ä ä 1981 Mirhoseini ä ä 1983 (CABG) ä ä 1986 Okada 1. ä ä (80-400W) CO 2 ä ä 1988 (800W) CO 2. ä ä 1990 Crow 1. ä ä 1994 Cooley ä ä TMLR ä ä 1998 FDA CO 2 Heart Laser TMLR. ä ä 1999 FDA TLMR ä ä CABG+TMLR ä ä 2006 MHLW CO 2 Heart Laser

TMLR/PTMR ä CO 2 ä CO 2 TMR FDA ä Ho:YAG ä Ho:YAG TMR: 1999 FDA

TMLR ä ä, ä ä CABG + TMLR ä ä TMLR. ä ä TMLR + GENE (VEGF, bFGF) ä ä TMLR + Stem Cell

TMLR

CABG+TMLR

TMLR

TMLR+Gene Therapy

TMLR + Stem Cells

TMLR 1 TMR (91 ) (101 ) P 2 72% 13%<0.001 (SF-36) 38% 6%< % 27%= % 69%< % 1 85% 79%=0.50 Frazier et al. N Engl J Med 1999

CABG TMLR CABG+TMR CABG P CABG+TMR CABG P (n=132) (n=131) (n=132) (n=131) 1.5% 7.6% % 55% IABP 4% 8% % 9% % 11.2% % 89% 0.05 J Thorac Cardiovasc Surg 2000,119:540

TMLR 1 2 TMR MM TMR MM TMR Schofield et al CO21885% 96% 89% 4% 25% Burkhoff et al Ho:YAG1821% 90% 95% 11% 61% Frazier et al CO21923% 79% 85% 13% 72% Allen et al Ho:YAG2755% 84% 89% 32% 76% (Horvath KA. CVR 2000,1:63-69)

TMLR ä Allen KB, et al: Follow-up 5.5±1.0 years (2004) 1. Angina CCS 4.0± ±1.1 ( <0.001) 2. 2 class improvement (laser) 88% vs (med) 44% ( <0.001) 3. Kaplan-Meier Survival 65% vs 52 ( p=0.05) ä Horvath KA, et al: Follow-up 5 years (2001) 1. Angina CCS 3.7± ±1.1 ( <0.001) 2. 2 class improvement is 68%. No angina 17% ä Aaberge L, et al: Follow-up 3-5 years (2002) 2 NYHA class improvement with TMLR is 24% 2 NYHA class improvement with TMLR is 24% with medicine is 3% with medicine is 3%

94 TMLR 5 94 TMLR 5 5.5± ± % 1 69% 2 45% 2 45% 25% 25% 6% 6%

TMLR % % % % 5.5± % 5.5± % (n=51 ) (n=51 ) (n=25) (n=25) p 33.3%60.0% p< %72.0% p>0.05 LVEF LVEF 0.57± ±0.13 p> %

TMLR ä ä PMR ä PMR ä

TMLR ä ä

( ) ( ) ä Kohomoto TMR DeGrado TMR 6 7 ä Yamamoto TMR 1.4 ä Horvath TMR VEGFmRNA ä Horvath TMR VEGFmRNA ä CO 2 VEGF FGF TGF- ß, ä CO 2 VEGF FGF TGF- ß,

TMLR,,,, TMLR p (μm 2 / ) ± ± <0.001 (μm / ) ± ± ( / ) 61.51± ±2.45 <0.001 <25 μ m( / ) 58.73± ±2.53 < μ m( / ) 2.58± ±0.38 <0.001

( ) ( ) ä ä Mirhoseini, Okada, Cooley TMLR ä ä Hardy, Zlotnick, Krabatsch, ä ä Berwing (MCE) TMLR 60 ä ä Sequoia 4~12,,, 5/11.

TMLR ä : 13 TMLR ä : 13 TMLR TMLR ;, ; TMLR ;, ;

( ) ( ) ä Domkowski CO2 Ho:YAG Excimer 3 6 TYR-OH ä Domkowski CO2 Ho:YAG Excimer 3 6 TYR-OH ä 3 TYR-OH 6 TYR-OH ä 3 TYR-OH 6 TYR-OH ä TMR/PTMR ä TMR/PTMR The ISMICS 3th Ann Scientific Meeting, June 8-10,2000, Atlanta.

PMLR TMLR PMLR TMLR

ä ä ä ä ä Off-pump CABG

STS TMLR 1 TMLR 1 TMLR LVEF>0.30 CCSIII CABG PCI LVEF>0.30 CCSIII CABG PCI 2 TMR 2 TMR 1 EF0.30 IABP 1 EF0.30 IABP CCS II 3 CCS II 3 TMLR 3 TMLR 1 CCS I 1 CCS I mmHg 1.8L/min/m2 3 80mmHg 1.8L/min/m Ann Thorac Surg 2004

TMLR GENE LCX 29 A n=5 B TMLR n=5, TMLR C n=7 PcDNA3.1VEGF 165 D (n=5) PcDNA3.1 E n=7 TMLR PcDNA3.1VEGF 165

TMLR GENE VEGF 165 VEGF 121 VEGF 165 VEGF 121 ä VEGF TMLR VEGF TMLR ä VEGF TMLR VEGF TMLR

TMLR Stem Cells A (n=8): A (n=8): B (n=8): MSCs B (n=8): MSCs C (n=8): TMLR C (n=8): TMLR D (n=8): MSCs+TMLR D (n=8): MSCs+TMLR

TMLR Stem Cells ä ä MSC MSC

STS TMLR+CABG ä ä A CABG CABG ä ä B CABG CABG ä CABG CABG

Off-Pump CABG+TMLR

CABG+TMLR+Stem Cells

TMLR+Stem Cells