Transmyocardial laser revascularization for diffuse coronary artery disease: Early results

Transmyocardial revascularization (TMR) using a high energy CO2 laser has e merged as a new therapeutic option for patients with severe diffuse coronar y artery disease refractory to conventional modes of therapy. TMR has shown symptomatic benefit and improvement in the exercise tolerance in a group o f patients suffering from disabling angina, not amenable to other modes of treatment. However, this procedure resulted in 14 to 18% high early mortali ty in various series. The univariate predictors of mortality were age > 55 years, female sex, CKP > 1600 IU, absence of inter coronary collaterals, an d mean PAP > 21 mm tig. At one-year follow-up studies, a significant improv ement in the angina class (II, III, IV), and treadmill testing (TR-IT) effo rt tolerance were observed; but without any significant change in the left ventricular ejection fraction. The high early mortality can be brought down with strict patient selection criteria. The mechanism of beneficial effect s remains uncertain, and the patency of laser channels is controversial; bu t laser-induced neoangiogenesis is being looked upon as a plausible explana tion.