Transmyocardial revascularization with CO2 laser in patients with refractory angina pectoris

Abstract

Transmyocardial laser revascularization was performed with low perioperative mortality and caused significant symptomatic improvement, but no improvement in exercise capacity.

Phase 1/2 Placebo-Controlled, Double-Blind, Dose-Escalating Trial of Myocardial Vascular Endothelial Growth Factor 2 Gene Transfer by Catheter Delivery in Patients With Chronic Myocardial Ischemia

“…Although the size of this initial cohort did not permit the changes observed in exercise testing to reach statistical significance, the increase in treadmill time after VEGF2 GTx (91.8 seconds) far exceeded that observed for control subjects (3.9 seconds) and was similar to or in excess of what has been previously described for patients receiving laser myocardial revascularization or continued medical therapy in 5 contemporary controlled studies. [21][22][23][24][25] The possibility that improvement in symptomatic status documented in the current and previous trials of myocardial VEGF2 GTx constitutes evidence of bioactivity is further supported by objective evidence in these trials of enhanced myocardial perfusion. In patients undergoing intraoperative, direct myocardial injection of VEGF naked DNA, for example, stress SPECT Tc 99m sestamibi myocardial imaging disclosed that mean perfusion-defect scores for both stress and rest images were significantly decreased (ie, improved) at day 60.…”

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.…”

ACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina—Summary Article

“…Although the results of these studies appear promising, there is still a paucity of data on the intermediateand long-term benefit of these devices. [42][43][44][45][46][47][48] The goal in both approaches is to create a series of transmural endomyocardial channels to improve myocardial revascularization. Percutaneous TMR technology has not been approved by the Food and Drug Administration and should therefore be considered an experimental therapy.…”