Transmyocardial laser revascularization with the holmium : YAG laser: lossof symptomatic improvement after 2 years

Objective: Whether transmyocardial loser revascularization (TMLR) provides a long-term benefit in terms of relief of angina, improvement of exercise t olerance, left ventricular function, and myocardial perfusion. Methods: For ty-one patients underwent TMLR using a holmium:YAG-laser, 14 as TMLR alone (group A), 27 with additional aortocoronary bypass grafting (group B). Foll ow-up was obtained at 6, 12, 18, 24, and 36 months in this prospective stud y. Results. In group A patients CCS-class improved up to 18 months postoper atively, after 34 and 36 months postoperatively there was absence of a posi tive effect of TMLR: the CCS-class decreased to 2.4 as compared to 3.5 preo peratively After combined CABG and TMLR (group B) there was a significant d ecrease in angina at all times. The CCS-functional class in these patients was 1.7 at 36 months as compared to 3.5 preoperatively. There was no signif icant change in exercise tolerance as compared to preoperatively. Left vent ricular ejection fraction did not improve in either of the groups. Thallium scintigraphy indicated no improvement in myocardial perfusion in laser tre ated areas. The perioperative mortality was 0%, the late mortality rate was 36% in group A and 11% in group B. Conclusions: In our experience, in the vast majority of patients who are subjected to TMLR alone the benefit of re duction or relief of angina and improvement in quality of life is only temp orary. In addition there is no improvement in objective clinical parameters . We believe that TMLR should only be used in patients with severe angina r efractory to medical treatment and requiring a symptomatic therapy. (C) 200 1 Elsevier Science B.V. All rights reserved.