TRANSMYOCARDIAL REVASCULARIZATION UTILIZING A HOLMIUM, YAG LASER

Objective: To evaluate the efficacy of transmyocardial revascularizati on performed on patients with refractory class IV or unstable angina w ith a holmium:yttrium-aluminum-garnet laser. Methods: Transmyocardial revascularization with a holmium:yttrium-aluminum-garnet laser was per formed in 42 patients with refractory angina who were not candidates f or percutaneous transluminal coronary angioplasty or coronary artery b ypass grafting. Patients had either Canadian Heart Association class I V angina (II = 23) or unstable angina (n = 19) and were unable to be w eaned from intravenous nitroglycerin. Preoperative thallium studies id entified the extent and location of reversible ischemia. Operative exp osure was via a limited left anterior thoracotomy. An average of 45 +/ - 11 laser channels were created with a mean operative time of 106 +/- 38 min. Results: Perioperative mortality was 12% (5/;42) with no late deaths. Complications included ventricular 7.1%(3/42) and atrial 4.7% (2/42) arrhythmias, reoperation for chest-wall hemorrhage 2% (1/42), and respiratory failure requiring reintubation 2% (1/42). Intra-aortic balloon pump placement was required in 12% (5/42). The mean postopera tive length of stay was 5.5 +/- 4.9 (1-25) days. Mean follow-up on 100 % of patients is 5.4 +/- 3.0 (1-12) months. At 3 (n = 33) and 6 (n = 2 1) months follow-up the mean angina class was 1.5 +/- 0.1 (P < 0.002) and 1.1 +/- 0.1 (P < 0.001), respectively. Conclusions: Transmyocardia l revascularization utilizing a holmium:yttrium-aluminum-garnet laser resulted in a significant reduction in angina class and was beneficial in patients with refractory angina untreatable by conventional method s. (C) 1998 Elsevier Science B.V. All rights reserved.