FOR a few very sick heart patients, a new surgical technique using lasers may offer a chance of survival.
In a form of high-tech bypass called laser revascularization, surgeons create new blood supplies for the heart using computer-controlled lasers to drill tiny channels directly into heart muscle that has been starved by blocked arteries.
"Blood seeps directly into the heart muscle like a sponge," explained Dr. Mahmood Mirhoseini, who performs the experimental surgery at the Heart and Lung Institute of Wisconsin, in Milwaukee. Dr. Mirhoseini helped design the laser, which is now being used in trials at seven hospitals around the nation in an effort to win approval from the Food and Drug Administration.
Helen Eisbach, of Galena, Ill., was an early recipient of the technique. Her entire family on her mother's side -- grandparents, aunts, uncles, mother and a brother -- had died young of the heart disease that she also developed at 49.
Even after three heart-bypass operations, Ms. Eisbach's arteries kept reclogging. She had constant chest pain, difficulty breathing and was exhausted, all marks of chronic heart disease. Her doctors said they had nothing more to offer.
But research on reptiles that had been going on for decades indicated that patients like Ms. Eisbach might have an alternative after all. Cardiologists have long studied reptiles' hearts because they do not rely on veins and arteries to move blood to them. Instead, they are saturated directly. Human fetus's hearts take in blood the same way until arteries and veins fully develop. So researchers asked whether an adult human heart could not benefit from the same idea.
But it was not until cardiologists asked engineers to design a high-powered, carbon dioxide laser that technology began to catch up with theory.
Following the researchers' specifications, PLC Systems Inc. of Milford, Mass., built a 1,000-watt, carbon dioxide laser that fires in one-twentieth of a second. CO2 lasers use a single wavelength of light and are absorbed by liquid. In the heart surgery, blood acts as a backstop to prevent the laser from damaging other tissue. In 1992, the Food and Drug Administration gave the company permission to test the technique.
Since then, 127 patients have opted for laser revascularization. Dr. Denton Cooley has operated on 21 of them in the last year at the Texas Heart Institute in Houston.
"I've been involved in procedures for the treatment of angina for 50 years," Dr. Cooley said, talking about the pain caused by blocked arteries. "So far I'll say the laser is encouraging. We believe we have evidence that it is really effective in revascularizing the heart muscle." But, he added, researchers need "more time and more patients" to establish that the laser channels stay open over the long run.
"I don't want to seem overly optimistic and mislead people into thinking this is a panacea," Dr. Cooley added. But for patients who have exhausted other treatments, he said he "would recommend it."
At the Audubon Regional Medical Center in Louisville, Ky., Dr. Allan Lansing has operated on 32 patients since February. He says that 50,000 to 60,000 of the 1.5 million heart attack victims each year cannot be successfully treated with drugs, angioplasty or bypass.
"Until this came along, nothing could be done for them," Dr. Lansing said. "So far the results have been very gratifying."
The cardiologist aims the laser and arms the device. But because the laser must be fired between heart beats, the timing is controlled by computer. For the laser to be absorbed by liquid, it must be fired precisely when the heart is gorged with blood. The fluid acts as a backstop, preventing the laser from tearing into other tissue.
The blast creates swirls of white smoke, just like puffs from a gun barrel. To close the wound, the surgeon presses a finger on the surface holes for a moment to prompt clotting. Because the heart is meant to be suffused with blood, the channels themselves do not clot. Instead, as the heart beats, it pumps blood directly into the previously starved ventricle through the new tunnels.
Eugene Moser, a 57-year-old retired industrial mechanic from Knox, Ind., asked his doctors about the new technique. Mr. Moser said Veterans Affairs doctors, who had not heard of the technique, had told him "this is a bunch of charlatans." At first, he said, his doctors even refused to forward his medical records to the heart laser team. "I said if you can't do anything more for me, why can't I try something on my own?" he recalled.
He insisted, he said, because he believed that experimental surgery could not be any worse than the alternative. "I was constantly tired, had no ambition to get up or do anything, and if I was active for over 30 minutes it completely wore me out," he said. Mr. Moser had the surgery in January 1993. "Now I can go fishing, off-load my boat from the trailer into the water, spend four or five hours on a lake or a river. All the things I did before I had my heart problem."
Dr. Lansing said: "Pathological studies show the channels stay open and act like normal blood vessels. The benefits increase as more and more connections are made between the new channels and vessels of the heart."
But even with apparent early success, surgeons using the new technique say they do not see it as a replacement for current treatments. "I doubt it will supplant angioplasty, because that is so direct," Dr. Cooley said. "And it won't supplant coronary bypass. But it is an alternative when other treatments are not successful."