Objective: 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.
Methods: 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.
Results: 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.
Conclusion: 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.