Holmium: YAG laser transmyocardial revascularization relieves angina and improves functional status

Background. Transmyocardial revascularization (TMR) surgery uses laser chan neling of diseased myocardium to treat ischemia and angina. Rigorous prospe ctive randomized studies have been previously unavailable. Methods. Forty-three patients were randomized to a medication group and 43 to a group scheduled for TMR surgery and medication. All had advanced cardi ac ischemia with CCSA class 3 or 4 angina, took at least 2 cardiac medicati ons at maximum doses, and were ineligible for angioplasty or bypass. Results. Forty-two of 43 TMR group patients received surgery and were disch arged after hospitalizations averaging 3.2 days. Two suffered perioperative MIs, with one death. Four others died within 12 months of surgery, 3 from cardiac events and 1 from pneumonia. Five medical group patients died from cardiac events within 12 months. Three, 6, and 12 month exams showed angina class improvement in TMR patients compared to preoperative values (3.86 +/ - 0.05 vs 1.71 +/- 0.2 P < 0.0001), and to controls at 12 months (3.77 +/- 0.07 vs 1.71 +/- 0.2, P < 0.0001). Exercise tolerance improved in TMR patie nts over preoperative values, and was better than medication group scores a fter 12 months (490 +/- 17 sec. vs 294 +/- 12 sec., p = 0.0002). Conclusions. Holmium:YAG laser channeling of the myocardium improves functi on and reduces angina in advanced cardiac patients who lack alternative the rapeutic options. (C) 1999 by The Society of Thoracic Surgeons.