The Society of Thoracic Surgeons practice guideline series: transmyocardial laser revascularization

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

“…TMR has been used as either a percutaneous or a surgical procedure concomitant with CABG or as sole therapy in patients with angina refractory to medical therapy, [913][914][915]918 although the mechanism by which it might be efficacious is unknown. 919,920 Early studies of the percutaneous approach demonstrated no therapeutic benefit, and it was promptly abandoned. 921 When used as sole therapy by a surgical approach, TMR is reserved for the patient with incapacitating, medically refractory angina and no other feasible thera-…”

2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention

“…Although the mechanism by which TMR might be efficacious in these patients is unknown (213,214), several RCTs of TMR as sole therapy demonstrated a reduction in anginal symptoms compared with intensive medical therapy alone (109 -111,215-217). A single randomized multicenter comparison of TMR (with a holmium:YAG laser) plus CABG and CABG alone in patients in whom some myocardial segments were perfused by arteries considered not amenable to grafting (112) showed a significant reduction in perioperative mortality rate (1.5% versus 7.6%, respectively), and the survival benefit of the TMR-CABG combination was present after 1 year of follow-up (112).…”

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

“…TMR as an Adjunct to CABG TMR has been used on occasion in patients with severe angina refractory to GDMT in whom complete revascularization cannot be achieved with PCI and/or CABG. Although the mechanism by which TMR might be efficacious in these patients is unknown (502,503), several RCTs of TMR as sole therapy demonstrated a reduction in anginal symptoms compared with intensive medical therapy alone (397-399, 504 -506). A single randomized multicenter comparison of TMR (with a holmium:YAG laser) plus CABG and CABG alone in subjects in whom some myocardial segments were perfused by arteries considered not amenable to grafting showed a significant reduction in perioperative mortality rate (1.5% versus 7.6%, respectively), and the survival benefit of the TMR-CABG combination was present after 1 year of follow-up (400).…”