Transmyocardial laser revascularization: Early results and 1-year follow-up

Background Transmyocardial revascularization using a high-energy CO,laser h as emerged as a new therapeutic option for patients with severe diffuse cor onary artery disease refractory to conventional modes of therapy. Methods, From December 1994 to September 1997,102 patients underwent isolat ed transmyocardial revascularization. The mean age was 56.7 +/- 9.2 years a nd 92.15% were men. Mean preoperative angina class and ejection fraction we re 2.6 +/- 0.7 and 44.7% +/- 10.5%, respectively. Diabetes was present in 4 9.01% of patients, 32.3% had history of previous myocardial infarction, and 12.7% had undergone a previous coronary artery bypass graft procedure. An average number of 23 +/- 8 channels were created in each patient using an 8 00-W CO2 laser. Results. The early mortality was 14,7% and univariate predictors of mortali ty were age more than 55 years, female sex, creatine kinase more than 1,600 IU, absence of intercoronary collaterals, and mean pulmonary artery pressu re greater than 21 mm Hg. At 1-year follow-up there was significant improve ment in angina class and effort tolerance but no significant change in left ventricular ejection fraction. Conclusions. We conclude that transmyocardial revascularization provides sy mptomatic benefit and improves exercise tolerance in a group of patients su ffering from disabling angina not amenable to other modes of treatment, The high early mortality can be brought down with strict patient selection cri teria. The mechanism of beneficial effects is uncertain and patency of lase r channels is controversial, but laser-induced neoangiogenesis is being loo ked on as a possible explanation. (C) 1999 by The Society of Thoracic Surge ons.