TRANSMYOCARDIAL LASER REVASCULARIZATION - RESULTS OF A MULTICENTER TRIAL WITH TRANSMYOCARDIAL LASER REVASCULARIZATION USED AS SOLE THERAPY FOR END-STAGE CORONARY-ARTERY DISEASE

Background: Transmyocardial laser revascularization was used as the so le therapy for patients with ischemic heart disease not amenable to pe rcutaneous transluminal coronary angioplasty or coronary artery bypass grafting. This technique uses a carbon dioxide laser to create transm yocardial channels for direct perfusion of the ischemic heart. Methods : Since 1992, 200 patients, at eight hospitals in the United States, h ave undergone transmyocardial laser revascularization. The patients ha ve a combined 1560 months of follow-up for an average of 10 +/- 3 mont hs per patient. Their age was 63 +/- 10 years and their ejection fract ion was 47% +/- 12%. Eighty-two percent had at least one previous bypa ss graft operation and 38% had a prior angioplasty. Preoperatively, th e patients underwent nuclear single photon emission computed tomograph y perfusion scans to identify the extent and severity of their ischemi a. These scans were repeated at 3, 6, and 12 months. Angina class, adm issions for angina, and medications were recorded. Results: The periop erative mortality was 9%. Angina class decreased significantly from be fore treatment to 3, 6, and 12 months (p < 0.001). Likewise, there was a significant decrease in the number of perfusion defects in the trea ted left ventricular free wall. Concomitantly, there was a significant decrease in the number of admissions for angina in the year after the procedure when compared with the year before treatment (2.5 vs 0.5 ad missions per patient-year). Conclusion: These combined results indicat e that transmyocardial laser revascularization provides angina relief, decreases hospital admissions, and improves perfusion in patients wit h severe coronary artery disease.