Perioperative morbidity and mortality alter transmyocardial laser revascularization: Incidence and risk factors for adverse events

OBJECTIVES The purpose of this study was to describe the incidence and spec trum of perioperative cardiac and noncardiac morbidity and mortality after transmyocardial laser revascularization (TMR) and to identify predictors of these adverse clinical events. BACKGROUND Clinical studies have demonstrated the efficacy of TMR for relie ving angina pectoris, although no study to date has specifically addressed the associated perioperative morbidity and mortality. METHODS Between October 1995 and August 1997, 34 consecutive patients with end-stage coronary artery disease (CAD) underwent isolated TMR. The majorit y of patients (94%) had class III or IV angina pectoris, and two patients ( 6%) had unstable symptoms preoperatively. Patient records were reviewed for fatal and nonfatal adverse cardiac and noncardiac events. RESULTS Perioperative death occurred in two patients (5.9%) due to cardioge nic shock complicating acute myocardial infarction. Perioperative cardiac m orbidity occurred in 16 patients (47.1%); noncardiac morbidity was seen in 12 patients (35.3%). Preoperative unstable angina was the only variable pre dictive of perioperative death (p = 0.005). Cardiac (p = 0.005) and noncard iac (p < 0.001) morbidity rates were significantly higher for the initial 1 5 patients undergoing the procedure. Other predictors of perioperative comp lications included lack of postoperative treatment with a furosemide infusi on (p less than or equal to 0.04) and preoperative unstable angina (p = 0.0 5). CONCLUSIONS Perioperative mortality in patients undergoing isolated TMR is low. Transmyocardial laser revascularization patients are at higher risk fo r adverse perioperative cardiac and noncardiac events, likely reflecting th e lack of immediate benefit from the procedure in the setting of severe CAD . These patients merit vigilant surveillance for adverse events and aggress ive medical management in the perioperative period. (J Am Coll Cardiol 1999 ;33:1021-6) (C) 1999 by the American College of Cardiology.