Transmyocardial laser revascularization with excimer laser: Clinical results at 1 year

Background. Transmyocardial laser revascularization, a new strategy for the treatment of diffuse ischemic heart disease, uses laser technology for the theoretical purpose of forming transmyocardial channels in the heart to in crease perfusion to ischemic zones. This report summarizes our initial clin ical experience with the procedure. Methods. Excimer transmyocardial laser revascularization was performed in a reversibly ischemic region of the heart in 15 patients. Ischemia and myoca rdial viability were evaluated by assessment of symptoms and of results of radionuclide single photon emission computed tomography imaging, exercise t olerance testing, and 24-hour Holter monitoring. Results. No adverse events occurred as a result of the laser revascularizat ion, although 1 patient with preoperative ventricular arrhythmias died 48 h ours postoperatively as a result of refractory ventricular tachycardia. Ang ina class decreased significantly from base line values in patients who had undergone the procedure (mean Canadian Cardiovascular Association angina c lass, 3.5 +/- 0.5 at base line, 1.6 +/- 0.6 at 1 month, 1.5 +/- 0.8 at 3 mo nths, 1.9 +/- 0.9 at 6 months, 1.8 +/- 0.8 at 12 months; p < 0.002), and ni troglycerin requirements were similarly decreased in patients who had under gone laser revascularization (mean g/wk of sublingual nitroglycerin, 19 +/- 4 at baseline, 5 +/- 3 at 1 month, 4 +/- 2 at 3 months, 4 +/- 2 at 6 month s, 2 +/- 1 at 12 months; p <0.02). Exercise tolerance testing demonstrated increase in exercise duration compared with base line values (mean minutes, 7.4 +/- 3.1 at base line, 8.0 +/- 3.9 at 1 month, 8.5 +/- 4.4 at 3 months, and 9.0 +/- 3.9 at 12 months; p >0.05); those increases were not large eno ugh to be statistically significant, however. Conclusions. Our data are consistent with the concept that excimer transmyo cardial laser revascularization in individuals with significant ischemic he art disease appears to be well tolerated, can be performed safely, and may lead to a reduction in ischemic symptomatology. (C) 2000 by The Society of Thoracic Surgeons.