Transmyocardial laser revascularization versus medical therapy for refractory angina

Briones, Eduardo; Lacalle-Remigio, Juan R.; Marin, Ignacio

doi:10.1002/14651858.cd003712.pub2

Cited by 23 publications

(18 citation statements)

References 59 publications

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“…Indeed, total and cardiac mortality, which are in the range of 6-10% and 4-6% per year, respectively, are similar in SCS patients to those [44]) and European (b, [49]) prospective registries, respectively. reported in patients with RAP randomized in the placebo arms of studies assessing the effect of myocardial laser revascularization (51). Similar results also have been shown for the occurrence of nonfatal acute myocardial infarction, which in SCS patients has been reported in the range of 3-5% per year.…”

Section: Scs and The Issue Of Ischemic Pain Inhibitionsupporting

confidence: 79%

Effect of Spinal Cord Stimulation in Patients With Refractory Angina: Evidence From Observational Studies

Lanza

Barone

Monaco

2012

Neuromodulation: Technology at the Neural Interface

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Section: Scs and The Issue Of Ischemic Pain Inhibitionsupporting

confidence: 79%

Effect of Spinal Cord Stimulation in Patients With Refractory Angina: Evidence From Observational Studies

Lanza

Barone

Monaco

2012

Neuromodulation: Technology at the Neural Interface

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“…Over the past two decades, results from prospective and retrospective studies on TMR have been reported. 15 – 31 A few meta-analyses have also been reported, along with an FDA review on short-term and long-term outcomes with the use of TMR. 29 , 31 – 33 This review covers two different FDA-approved devices for TMR, evidence-based practice, and future directions aimed at utilizing a combined TMR and stem cell therapy approach.…”

Section: Introductionmentioning

confidence: 99%

Transmyocardial revascularization devices: technology update

Kindzelski¹,

Zhou²,

Horvath³

2014

MDER

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Transmyocardial laser revascularization (TMR) emerged as treatment modality for patients with diffuse coronary artery disease not amendable to percutaneous or surgical revascularization. The procedure entails the creation of laser channels within ischemic myocardium in an effort to better perfuse these areas. Currently, two laser devices are approved by the US Food and Drug Administration for TMR – holmium:yttrium–aluminum–garnet and CO2. The two devices differ in regard to energy outputs, wavelengths, ability to synchronize with the heart cycle, and laser–tissue interactions. These differences have led to studies showing different efficacies between the two laser devices. Over 50,000 procedures have been performed worldwide using TMR. Improvements in angina stages, quality of life, and perfusion of the myocardium have been demonstrated with TMR. Although several mechanisms for these improvements have been suggested, evidence points to new blood vessel formation, or angiogenesis, within the treated myocardium, as the major contributory factor. TMR has been used as sole therapy and in combination with coronary artery bypass grafting. Clinical studies have demonstrated that TMR is both safe and effective in angina relief long term. The objective of this review is to present the two approved laser devices and evidence for the safety and efficacy of TMR, along with future directions with this technology.

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“…Specific limitations preclude wide acceptance of these methods. TMLR is associated with high early mortality (6.8% 30-day mortality rate) [7] . Molecular therapies via the coronary artery and cardiac surgery have both failed to support revascularization of the myocardium [8] .…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Middle Cardiac Vein Arterialization via Internal Mammary/Thoracic Artery Anastomosis

Gao

et al. 2013

PLoS ONE

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ObjectiveCardiac vein arterialization is seldom applied for treating right coronary artery disease. This study aimed to improve outcomes of cardiac vein arterialization in a porcine model using intramammary artery anastomosis.MethodsA chronic, stenotic coronary artery model was established in 12 of 14 Chinese experimental miniature pigs of either sex, which were randomly divided into equal control (n = 6) and experimental (n = 6) groups. In experimental animals, blood flow was reconstructed in the right coronary artery using intramammary artery. Arterialization involved dissection of right internal mammary artery from bifurcation to apex of thorax followed by end-to-side anastomosis of internal mammary artery and middle cardiac vein plus posterior descending branch of right coronary artery. Intraoperative heart rate was maintained at 110 beats/min. Graft flow assessment and echocardiography were performed when blood pressure and heart rate normalized.ResultsThe experimental group had significantly higher mean endocardial and epicardial blood flow postoperatively than control group (mean endocardial blood flow: 0.37 vs. 0.14 ml/(g*min), p<0.001; mean epicardial blood flow: 0.29 vs. 0.22, p = 0.014). Transmural blood flow was also higher in experimental group than in control group (0.33 vs. 0.19, p<0.001); ejection fraction increased from 0.46% at baseline to 0.51% (p = 0.0038) at 6 hours postoperatively, and mean blood flow of internal mammary artery was 44.50, perfusion index 0.73 at postoperative 6 months, 43.33 and 0.80 at 3 months.ConclusionSuccessful cardiac vein arterialization via intramammary artery in a porcine model suggests that this may be a viable method for reconstructing blood flow in chronic, severe coronary artery disease.

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Transmyocardial laser revascularization versus medical therapy for refractory angina

Abstract: There is insufficient evidence to conclude that the clinical benefits of TMLR outweigh the potential risks. The procedure is associated with a significant early mortality.

Cited by 23 publications

References 59 publications

Effect of Spinal Cord Stimulation in Patients With Refractory Angina: Evidence From Observational Studies

Effect of Spinal Cord Stimulation in Patients With Refractory Angina: Evidence From Observational Studies

Transmyocardial revascularization devices: technology update

Outcomes of Middle Cardiac Vein Arterialization via Internal Mammary/Thoracic Artery Anastomosis

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