Transmyocardial laser revascularization using the Holium-YAG laser for treatment of end stage coronary artery disease.

Abstract

Transmyocardial Laserrevascularization (TMLR) is a treatment for end-stage coronary artery disease, that is not eligible for surgery or PTCA. The experience with TMLR using the Holium YAG laser is presented. Transmyocardial Laserrevascularization (TMLR) was performed in 28 patients with end stage coronary artery disease, using a new Holium YAG Laser. All patients were refractory to a maximum of medical treatment. In 16 patients TMLR was used as the sole therapy with a mean of 28 +/- 4 laser created channels (group A). In 12 patients TMLR was combined with coronary artery bypass graft surgery with a mean of 17 +/- 2 channels and 1.3 +/- 0.2 grafts (group B). Preoperative and postoperative examination included angina classification, exercise test and thallium scan. Postoperative demographics were as follows: (a) age 55-71 years (mean 63.9 +/- 6.5 years); (b) Canadian Cardiovascular Society Angina Scale (CCS) mean 3.3 +/- 0.5; (c) ejection fraction 35-71% (mean 54 +/- 13.7%). All patients had an peri- and postoperative course without major complications and a duration of hospitalization of 8.2 +/- 1.9 days. Minor complications were a clinically silent myocardial infarction n = 1, atrial arrhythmia n = 2 and pneumothorax n = 2. A follow-up at 3-12 months was completed in 23 patients (82%). Only one patient died 5 months after surgery (cardiac related death). In all remaining patients CCS had improved with a mean of 1.6 +/- 0.3, P < 0.01. The exercise tolerance test (bicycle) improved in 17 patients with a mean 26.5 +/- 6.5 watt, P < 0.01. The ejection fraction did not significantly improve. The repeated thallium scan did not show an improvement of perfusion in the lasered area to a significant level. Subjective benefit from the treatment was confirmed by 21 patients. Based on these results it is concluded that TMLR with the Holium-YAG laser is a safe therapy for the treatment of end stage coronary artery disease. The postoperative clinical results are comparable to that achieved with the CO2-laser in terms of reducing angina symptoms and improving exercise tolerance and quality of life. However. relief of symptoms is not correlated to objective findings of cardiac function.