Holmium: YAG laser transmyocardial revascularization relieves angina and improves functional status

2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease

“…922 Various energy sources have been used, including carbon dioxide XeCl excimer and holmium:YAG lasers. [923][924][925] There is no convincing evidence that one energy source is superior to the others. TMR also has been combined with cardiac denervation by thoracic sympathectomy.…”

Mechanisms and Results of Transmyocardial Laser Revascularization

“…Because the patients were equally randomized to the medical management group there were no significant demographic differences between the TMR and the control groups for any of these trials. Three studies [12, 13, 14]employed a holmium:yttrium-aluminum-garnet (Ho:YAG) laser and three [15, 16, 17]used a carbon dioxide (CO 2 ) laser. Two of the trials [12, 15]permitted a crossover from the medical management group to laser treatment for the presence of unstable angina that necessitated intravenous antianginal therapy from which they were unweanable over a period of at least 48 h. By definition, these crossover patients were less stable and significantly different from those who had been initially randomized to TMR or medical management alone.…”

“…Although Mirhoseini et al [1, 2]and Okada et al [3, 4]pioneered the use of a laser to perform this type of revascularization in conjunction with CABG in the early 1980s, establishment of the efficacy of the use of a laser as sole therapy required advancements in the technology. Since then, over 10,000 patients have been treated with TMR around the world, and results from individual institutions, multicenter studies and prospective randomized controlled trials have been reported [5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18]. …”

“…In these pivotal trials, over 1,000 patients were enrolled and randomized to receive TMR or medical management for their severe angina [12, 13, 14, 15, 16, 17]. The six trials employed a 1:1 randomization in which one half of the patients were treated with laser and the other half continued on maximal medical therapy.…”

Therapy for Angina Pectoris Secondary to Coronary Disease

“…However, though several preliminary studies demonstrated a decrease in angina severity in most patients (Cooley et al, 1996;Horvath et al, 1996), subsequent randomized controlled trials (RCT) have reported contradictory results (Aaberge et al, 2000;Burkhoff et al, 1999;Campbell et al, 2001;Jones et al, 1999;March, 1999;van der Sloot et al, 2004). Briones et al (Briones et al, 2009) conducted a Cochrane systematic review to assess the efficacy and safety of TMR versus optimized drug therapy in alleviating angina and improving survival and heart function.…”