Evaluation of Transmyocardial Laser Revascularization by Following Objective Parameters of Perfusion and Ventricular Function[1]

Background: Does transmyocardial laser revascularization (TMLR), a new surgical technique for treating patients with otherwise intractable angina pectoris, improve myocardial perfusion, metabolism, and, consequently, function? Methods: Patients referred for TMLR, alone or with coronary artery bypass grafting (CABG), were preoperatively evaluated clinically and by treadmill stress testing, echocardiography, ventriculography, radionuclide assessment of perfusion and metabolism, and hemodynamic assessment. Intraoperatively it was decided that some patients only required CABG. Follow-up evaluations were repeated after 6 (n = 40) and 12 months (n = 23) and compared with preoperative values. Results: CABG only was performed in 35 cases, TMLR + CABG in 17, TMLR only in 45. 1-year mortality was 11 % in the TMLR, zero in the TMLR + CABG, and 11 % in the CABG groups. In all groups a significantly improved CCS angina- and NYHA class was observed immediately after operation and after 6 and 12 months. In all study groups treadmill tolerance (p < 0.05) improved, but regional and global function, perfusion at rest, and metabolism were not significantly changed at 6 and 12-months follow-ups. Perfusion studies under stress demonstrated an improvement only in the CABG group after 12 months (p < 0.05), whereas in both TMLR groups the lasered ischemic segments remained unchanged. Conclusions: TMLR significantly improves long-term clinical status and treadmill stress tolerance, but appears to have little if any effect upon regional and global function, perfusion, and metabolism.

Transmyocardial laser revascularization - Coronary disease - Ischemia - Revascularization - Myocardium

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1 This paper was presented in part at the 28^th Annual Meeting of the German Society for Thoracic and Cardiovascular Surgery, Dresden, February 1999