Cardiovascular damage after cw and Q-switched 2μ m laser irradiation

Aiming for laser-assisted resection of calcified aortic valve structures for Transcatheter Aortic Valve Implantation (TAVI), a Q-switched Tm:YAG laser emitting at a wavelength of 2.01 μm was used to evaluate the cutting efficiency on highly calcified human aortic leaflets in-vitro. The calcified aortic leaflets were examined regarding ablation rates and debris generation, using a pulse energy of 4.3 mJ, a pulse duration of 0.8-1 μs and a repetition rate of 1 kHz. The radiation was transmitted via a 200 μm core diameter quartz fiber. Resection was performed in a fiber-tissue contact mode on water-covered samples in a dish. The remnant particles were analyzed with respect to quantity and size by light microscopy. Additionally, soft tissue of porcine aortic vessels was examined for histologically detectable thermomechanical damage after continuous wave and Q-switched 2μm laser irradiation. An ablation rate of 36.7 ± 25.3 mg/min could be realised on highly calcified aortic leaflets, with 85.4% of the remnant particles being <6 μm in diameter. The maximum damaged area of the soft tissue was < 1 mm for both, cw and pulsed laser irradiation. This limits the expected collateral damage of healthy tissue during the medical procedure. Overall, the Q-switched Tm:YAG laser system showed promising results in cutting calcified aortic valves, transmitting sufficient energy through a small flexible fibre.