Procedural results and early clinical outcome of percutaneous transluminalmyocardial revascularization

A substantial number of patients present with medically refractory angina w ho are not candidates for angio plasty or bypass surgery. The creation of c hannels between the myocardium and the ventricular blood pool has been perf ormed after thoracatomy with excellent relief of symptoms but has been asso ciated with high perioperative mortality. We investigated the safety of a n onoperative, percutaneous technique for channel creation. Twenty-seven pati ents with angina and coronary anatomy not amenable to revascularization wit h coronary angioplasty or bypass surgery underwent percutaneous translumina l myocardial revascularization (PTMR), Energy from a Holmium:yttrium-alumin um-garnet (YAG) laser was directed through a fiber enclosed in a catheter t o the ventricular myocardium creating channels between the blood pool and t he myocardium, On average, 17 +/- 4 channels were formed per patient, There were no procedure-related deaths, episodes of tamponade, or other complica tions except for an increase in creatine phosphokinase in 1 patient. Immedi ately after the procedure, there was no worsening of regional wall motion f unction in any patient, but rather improvement in some. All patients were d ischarged alive after a hospital stay of 1.8 +/- 1.5 days. Mean Canadian Ca rdiovascular Society functional class declined from 3.6 +/- 0.5 before the procedure to 0.65 +/- 0.8 at 30 days after the procedure (p <0.01). For 12 patients eligible for 6-month follow-vp, mean functional class was 0.94 +/- 0.97. At 6-month stress testing, 9 of these 12 had no electrocardiographic evidence of ischemia. Thus, PTMR can be performed safely in the cardiac ca theterization laboratory with a complication rate lower than that reported in surgical series and with excellent near-term symptomatic relief. The lon g-term effect of PTMR on mortality and relief of angina as well as its safe ty and effectiveness compared with the surgical approach remains to be defi ned. (C) 1999 by Excerpta Medica, Inc.