Transmyocardial laser revascularization with excimer laser: clinical results at 1 year

Abstract

Background. Transmyocardial laser revascularization, a new strategy for the treatment of diffuse ischemic heart disease, uses laser technology for the theoretical purpose of forming transmyocardial channels in the heart to increase perfusion to ischemic zones. This report summarizes our initial clinical experience with the procedure. Methods. Excimer transmyocardial laser revascularization was performed in a reversibly ischemic region of the heart in 15 patients. Ischemia and myocardial viability were evaluated by assessment of symptoms and of results of radionuclide single photon emission computed tomography imaging, exercise tolerance testing, and 24-hour Holter monitoring. Results. No adverse events occurred as a result of the laser revascularization, although 1 patient with preoperative ventricular arrhythmias died 48 hours postoperatively as a result of refractory ventricular tachycardia. Angina class decreased significantly from base line values in patients who had undergone the procedure (mean Canadian Cardiovascular Association angina class, 3.5 ± 0.5 at base line, 1.6 ± 0.6 at 1 month, 1.5 ± 0.8 at 3 months, 1.9 ± 0.9 at 6 months, 1.8 ± 0.8 at 12 months; p < 0.002), and nitroglycerin requirements were similarly decreased in patients who had undergone laser revascularization (mean g/wk of sublingual nitroglycerin, 19 ± 4 at baseline, 5 ±3 at 1 month, 4 ± 2 at 3 months, 4 ± 2 at 6 months, 2 ± 1 at 12 months; p <0.02). Exercise tolerance testing demonstrated increase in exercise duration compared with base line values (mean minutes, 7.4 ± 3.1 at base line, 8.0 ± 3.9 at 1 month, 8.5 ± 4.4 at 3 months, and 9.0 ± 3.9 at 12 months; p >0.05); those increases were not large enough to be statistically significant, however. Conclusions. Our data are consistent with the concept that excimer transmyocardial laser revascularization in individuals with significant ischemic heart disease appears to be well tolerated, can be performed safely, and may lead to a reduction in ischemic symptomatology.