Results of transmyocardial laser revascularization in non-revascularizable coronary artery disease after 3 years follow-up

Abstract

Fifty percent of patients with non-revascularizable coronary artery disease submitted for transmyocardial laser revascularization can be stabilized medically. Transmyocardial laser revascularization led to a rapid early relief of symptoms, but with a trend towards worsening over time and showed a high peri-operative risk (> 10%) dependent on the pre-operative ejection fraction. Our data were in contrast to other published reports on the more beneficial effects of transmyocardial laser revascularization and should lead to further investigation of this experimental method. Transmyocardial laser revascularization should only be performed after failure of maximal anti-anginal therapy, and should be avoided when the left ventricular ejection fraction is < 40%.

The prospective clinical and scintigraphic assessment of patients with preserved left ventricular systolic function after transmyocardial laser revascularisation

“…Nevertheless we found that one segment in the inferior wall improved, however it may have been caused by the general worsening of perfusion at 6 months and thus relatively better uptake in this particular segment. No changes between rest scans were noted confirming the results of other investigators [4,5,8].…”

“…The deterioration of global ejection fraction after TMR procedures is consistent with other studies [8,13]. On the other hand Agarval et al [9] and Shawl et al [14] reported no significant changes in ejection fraction.…”

“…However other workers failed to show improvement of perfusion [11,21]. Neither Thallium nor PET myocardial uptake showed significant improvement reported by Nagele et al [8]. Differences in method (laser type, various radiopharmaceuticals, stress modalities, acquisition protocols, number of segments) and analysis of the scans make the comparison impossible.…”

Fatality, morbidity and quality of life in patients with refractory angina pectoris

“…However, additional symptomatic non-revascularization interventions for refractory angina pectoris have evolved during the last decades. Transcutaneous electrical nerve stimulation, spinal cord stimulation, thoracic epidural anaesthesia, laser revascularization and enhanced external counterpulsation are treatment modalities used for symptomatic treatment in refractory angina pectoris [4,[19][20][21][22][23]. Studies paying attention to possible additional treatment modalities are urgently needed, as the management of this patient group is very heterogeneous at present [4].…”

A Blinded, Randomized, Placebo-Controlled Trial of Percutaneous Laser Myocardial Revascularization to Improve Angina Symptoms in Patients With Severe Coronary Disease

“…Previous clinical trials have repeatedly shown improved angina and have also shown improved exercise tolerance in patients treated with surgical transmyocardial laser revascularization (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). A catheter-based laser revascularization approach was developed to provide equal clinical efficacy without the need for a thoracotomy or general anesthesia, thereby reducing procedural complications and perhaps costs.…”