Short- and intermediate-term clinical outcomes from direct myocardial laser revascularization guided by biosense left ventricular electromechanical mapping

Background-Direct myocardial revascularization (DMR) has been examined as a n alternative treatment for patients with chronic refractory myocardial isc hemic syndromes who are not candidates for conventional coronary revascular ization, Methods and Results-We used left ventricular electromagnetic guidance in 77 patients with chronic refractory angina (56 men, mean age 61+/-11 years, e jection fraction 0.48+/-0.11) to perform percutaneous DMR with an Ho:YAG la ser at 2 J/pulse, Procedural success (laser channels placed in prespecified target zones) was achieved in 76 of 77 patients with an average of 26+/-10 channels (range Ii to 50 channels). The rate of major in-hospital cardiac adverse events was 2.6%, with no deaths or emergency operations, 1 patient with postprocedural pericardiocentesis, and 1 patient with minor embolic st roke. The rate of out-of-hospital adverse cardiac events (up to 6 months) w as 2.6%, with 1 patient with myocardial infarction and I patient with strok e. Exercise duration after DMR increased from 387+/-179 to 454+/-166 second s at 1 month and to 479+/-161 seconds at 6 months (P=0.0001). The time to o nset of angina increased from 293+/-167 to 377+/-176 seconds at 1 month and to 414+/-169 seconds at 6 months (P=0.0001). Importantly, the time to ST-s egment depression (greater than or equal to 1 mm) also increased from 327+/ -178 to 400+/-172 seconds at 1 month and to 436+/-175 seconds at 6 months ( P=0.001). Angina (Canadian Cardiovascular Society classification) improved from 3.3+/-0.5 to 2.0+/-1.2 at 6 months (P<0.001). Nuclear perfusion imagin g studies with a dual-isotope technique, however, showed no significant imp rovements at 1 or 6 months. Conclusions-Percutaneous DMR guided by left ventricular mapping is feasible and safe and reveals improved angina and prolonged exercise duration for u p to a 6-month follow-up.