Perioperative cardiac function and predictors for adverse events after transmyocardial laser treatment

Background. Previous studies have reported that mortality and morbidity aft er transmyocardial laser treatment (TML) mainly occur perioperatively. The present study was designed to evaluate left-ventricular function and identi fy risk factors for cardiac-related adverse events in this phase. Methods. Forty-nine patients were studied. The inclusion criteria were angi na pectoris Canadian Cardiovascular Society Angina Score (CCSAS) class III and IV refractory to medical therapy and untreatable by coronary artery byp ass graft or percutaneous transluminal coronary angioplasty, age less than 75 years, left ventricular ejection fraction greater than or equal to 30%, and myocardial regions with reversible ischemia. Hemodynamic data and cardi ac adverse events were registered. The follow-up time was 30 days. Results. A transient decrease in mean cardiac index (CI) was observed, reac hing its minimum immediately after end of the surgical procedure (1.8 +/- 0 .4, p < 0.01 vs baseline). Two patients (4%) died during the postoperative period (30 days). Seventeen patients (35%) experienced adverse cardiac-rela ted events, where CCSAS class IV, unprotected left main stem stenosis, and diabetes mellitus were identified as risk factors in a multivariate analysi s. Conclusions. A transient impairment of left ventricular function was observ ed after TML. The morbidity and mortality after TML were almost exclusively cardiac-related, identifying CCSAS class IV, unprotected left main stem st enosis, and diabetes as risk factors. (C) 2000 by The Society of Thoracic S urgeons.