Transmyocardial laser revascularization in the patient with unmanageable unstable angina

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.…”

Mechanisms and Results of Transmyocardial Laser Revascularization

“…Prior to the randomized studies, mortality rates in the 10–20% [5, 6, 7, 8, 9, 10, 11]range were reported for TMR patients. In the randomized trials, lower perioperative mortality rates were reported, ranging from 1 to 5% [12, 13, 14, 15, 16, 17].…”

“…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]. …”

Is transmyocardial revascularisation of benefit to people with ?no option? angina?

“…Hattler et al [10] reported the findings of a multicentre cohort study comparing TMR for chronic angina with TMR for unstable angina in patients who were taken from the CCU after 7 days of iv nitrates and 3 failed attempts to wean this therapy. They found that in the 76 patients who had unstable angina, there was a 16% perioperative mortality compared to 5% in the chronic angina group, and only a 25% improvement of more than 2 CCS grades, although angina was not assessed independently.…”