Transmyocardial laser revascularization

Methods: Between October 1997 and August 2005, a total of 83 patients were referred for (end stage) coronary artery disease (Figure 1). Twenty-six of these patients underwent coronary artery bypass grafting (CABG) only. Another 13 patients continued medical therapy. The remaining 44 patients underwent TMLR alone (8 patients) or TMLR plus CABG (36 patients). The mean age was 57.4 ± 9.1 years. They were 27.3% female and 72.7% male; 63.6% were diabetic and 36% had some degree of renal impairment. Seventy percent had a previous cardiovascular intervention. Angina was stable in 93.2% and unstable in 6.8%. Most of the patients were in Class IV (75%), the remainder in class II (2.3%) and III (22.7%). The mean ejection fraction was 56.4± 13.4. TMLR alone was performed in 8 cases through a left anterolateral thoracotomy. TMLR plus CABG was performed through standard sternotomy.

Results: In hospital all cause mortality was 3 (3.6%). All of these patients were unstable in hospital prior to surgery. There were no deaths in the stable group. The majority had Inotropic support leaving the operating room (68.2%). The median length of stay from O.R. to discharge was 9 days. Follow up was 93.2%. At follow-up, most of the patients are in class I-II (34/38, 89.5%), two patients (5.3%) are in class III, and only four patients (10.5%) are in class IV.

Conclusions: 1) TMLR and TMLR plus CABG are effective in the relief of angina. 2) Mortality rate is low, especially in stable patients.