Abstract
To patients, but to doctors too, the word laser represents highly advanced technology, of a degree similar to that which sent man to the moon, and it carries a magical resonance. The creation, by a laser beam, of channels between the left-ventricular cavity and the myocardium was expected to partly restore myocardial perfusion. The myocardium would be perfused by passive diffusion of oxygenated blood, as happens in reptiles, in which the myocardium has a sinusoidal structure. This concept attracted considerable interest as a possible treatment for the increasing number of patients with symptomatic coronary artery disease not responding to conventional revascularisation techniques. Early findings of a decrease in severity of angina pectoris were encouraging. 1 Frazier OH Cooley DA Kadipasaoglu KA et al. Myocardial revascularization with laser: preliminary findings. Circulation. 1995; 92: 58-65 Crossref Google Scholar , 2 Cooley DA Frazier OH Kadipasaoglu KA et al. Transmyocardial laser revascularization: clinical experience with twelve-month follow-up. J Thorac Cardiovasc Surg. 1996; 111: 791-797 Summary Full Text Full Text PDF PubMed Scopus (242) Google Scholar , 3 Horvath KA Cohn LH Cooley DA et al. Transmyocardial laser revascularization: results of a multicenter trial with transmyocardial laser revascularization used as sole therapy for end-stage coronary artery disease. J Thorac Cardiovasc Surg. 1997; 113: 645-653 Summary Full Text Full Text PDF PubMed Scopus (302) Google Scholar , 4 Vincent JG Bardos P Kruse J Maass D End stage coronary disease treated with the transmyocardial CO2 laser revascularization: a chance for the `inoperable' patient. Eur J Cardiothorac Surg. 1997; 11: 888-894 Crossref PubMed Scopus (63) Google Scholar This apparently positive response, much publicised by the manufacturers, led to an unexpected boom in laser therapy, although improvement in myocardial perfusion, exercise capacity, or survival had not been scientifically proven. The excitement over this technique finally led initially doubting surgeons to buy the costly machine. Transmyocardial laser revascularisation in patients with refractory angina: a randomised controlled trialOur findings show that the adoption of TMLR cannot be advocated. Further research may be appropriate to assess any potential benefit for sicker patients. Full-Text PDF
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