Percutaneous transluminal myocardial revascularization with a holmium laser system: Procedural results and early clinical outcome

Surgical transmyocardial laser revascularization has been reported to impro ve clinical outcome in patients with refractory angina who are not candidat es for angioplasty or bypass surgery. We investigated the feasibility and s afety of a nonsurgical, percutaneous technique for laser channel creation u sing energy from a holmium:yttrium-aluminium-garnet (YAG) laser. The laser energy was directed through a fiber enclosed in a catheter to the ventricul ar myocardium creating channels between the blood pool and the myocardium, Thirty-five patients with angina and coronary anatomy not amenable to revas cularization with coronary angioplasty or bypass surgery underwent percutan eous transluminal myocardial revascularization. A total of 15 +/- 5 channel s were formed per patient, There was no procedure-related mortality. One pa tient developed cardiac tamponade requiring thoracotomy and another a minor self-limiting pericardial effusion. There was no worsening of regional wal l motion function in any patient. All patients were discharged alive after a postprocedure hospital stay of 2.1 +/- 1.4 days. Mean Canadian Cardiovasc ular Society (CCS) functional class declined from 3.68 +/- 0.4 before proce dure to 0.82 +/- 0.7 at 30 days (P < 0.01). At 3 months, mean angina class was 0.94 +/- 0.65 (n = 35; P < 0.01) and at 6 months, mean angina class was 1.08 +/- 0.58 (n = 26; P < 0.01). One patient required repeat revasculariz ation after 5 months for progression of disease in a degenerated saphenous venous graft supplying different region of myocardium. We conclude that tra nsmyocardial revascularization using holmium:YAG laser by percutaneous tech nique can be carried out safely with encouraging early results and a very l ow complication rate, The symptomatic relief seen up to 6 months has been e xcellent. The long-term effects of this technique on mortality and relief o f angina, however, remain to be defined. Cathet. Cardiovasc, Intervent, 47: 287-291, 1999, (C) 1999 Wiley-Liss, Inc.