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J Thorac Cardiovasc Surg 1997;113:645-654
© 1997 Mosby, Inc.

SURGERY FOR ACQUIRED HEART DISEASE

TRANSMYOCARDIAL LASER REVASCULARIZATION: RESULTS OF A MULTICENTER TRIAL WITH TRANSMYOCARDIAL LASER REVASCULARIZATION USED AS SOLE THERAPY FOR END-STAGE CORONARY ARTERY DISEASE

Keith A. Horvath, MDa, Lawrence H. Cohn, MDa, Denton A. Cooley, MDb, John R. Crew, MDc, O. Howard Frazier, MDb, Bartley P. Griffith, MDd, Kamuran Kadipasaoglu, PhDb, Allan Lansing, MDe, Finn Mannting, MD, PhDa, Robert March, MDg, Mahmood R. Mirhoseini, MDh, Craig Smith, MDa

Received for publication May 6, 1996 revisions requested July 9, 1996; revisions received Nov. 8, 1996 accepted for publication Dec. 31, 1996. Address for reprints: Lawrence H. Cohn, MD, Department of Cardiac Surgery, Brigham & Women's Hospital, 75 Francis St., Boston, MA 02115.

Abstract

Background: Transmyocardial laser revascularization was used as the sole therapy for patients with ischemic heart disease not amenable to percutaneous transluminal coronary angioplasty or coronary artery bypass grafting. This technique uses a carbon dioxide laser to create transmyocardial channels for direct perfusion of the ischemic heart.

Methods: Since 1992, 200 patients, at eight hospitals in the United States, have undergone transmyocardial laser revascularization. The patients have a combined 1560 months of follow-up for an average of 10 ± 3 months per patient. Their age was 63 ± 10 years and their ejection fraction was 47% ± 12%. Eighty-two percent had at least one previous bypass graft operation and 38% had a prior angioplasty. Preoperatively, the patients underwent nuclear single photon emission computed tomography perfusion scans to identify the extent and severity of their ischemia. These scans were repeated at 3, 6, and 12 months. Angina class, admissions for angina, and medications were recorded.

Results: The perioperative mortality was 9%. Angina class decreased significantly from before treatment to 3, 6, and 12 months (p < 0.001). Likewise, there was a significant decrease in the number of perfusion defects in the treated left ventricular free wall. Concomitantly, there was a significant decrease in the number of admissions for angina in the year after the procedure when compared with the year before treatment (2.5 vs 0.5 admissions per patient-year). Conclusion: These combined results indicate that transmyocardial laser revascularization provides angina relief, decreases hospital admissions, and improves perfusion in patients with severe coronary artery disease.




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R. R. Arora, T. M. Chou, D. Jain, B. Fleishman, L. Crawford, T. McKiernan, and R. W. Nesto
The multicenter study of enhanced external counterpulsation (MUST-EECP): effect of EECP on exercise-induced myocardial ischemia and anginal episodes
J. Am. Coll. Cardiol., June 1, 1999; 33(7): 1833 - 1840.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
J. W. Jones, S. E. Schmidt, B. W. Richman, C. C. Miller III, K. J. Sapire, D. Burkhoff, and J. C. Baldwin
Holmium: YAG laser transmyocardial revascularization relieves angina and improves functional status
Ann. Thorac. Surg., June 1, 1999; 67(6): 1596 - 1601.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
G. Lutter, J. Martin, N. Takahashi, M. Yoshitake, J. Schwarzkopf, E. Nitzsche, and F. Beyersdorf
Transmyocardial laser revascularization: experimental studies in healthy porcine myocardium
Ann. Thorac. Surg., June 1, 1999; 67(6): 1708 - 1713.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
G. C. Hughes, A. P. Kypson, J. D. St. Louis, B. H. Annex, R. E. Coleman, T. R. DeGrado, C. L. Donovan, J. E. Lowe, and K. P. Landolfo
Improved perfusion and contractile reserve after transmyocardial laser revascularization in a model of hibernating myocardium
Ann. Thorac. Surg., June 1, 1999; 67(6): 1714 - 1720.
[Abstract] [Full Text] [PDF]

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 Eur. J. Cardiothorac. Surg.Home page
F. S. Eckstein, A. M. Scheule, U. Vogel, S. T. Schmid, S. Miller, M. J. Jurmann, and G. Ziemer
Transmyocardial laser revascularization in the acute ischaemic heart: no improvement of acute myocardial perfusion or prevention of myocardial infarction
Eur. J. Cardiothorac. Surg., May 1, 1999; 15(5): 702 - 708.
[Abstract] [Full Text] [PDF]

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 Eur. J. Cardiothorac. Surg.Home page
A. Diegeler, J. Schneider, B. Lauer, F.W. Mohr, and R. Kluge
Transmyocardial laser revascularization using the Holium-YAG laser for treatment of end stage coronary artery disease
Eur. J. Cardiothorac. Surg., April 1, 1999; 13(4): 392 - 397.
[Abstract] [Full Text] [PDF]

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 Eur. J. Cardiothorac. Surg.Home page
M. Misfeld, K. Szabo, E.-G. Kraatz, M. Grossherr, C. Schmidtke, M. Pilgrim, W. Kuhnel, and H. H. Sievers
Electron-microscopic findings after transmyocardial laser revascularization in an acute ischemic pig model
Eur. J. Cardiothorac. Surg., April 1, 1999; 13(4): 398 - 403.
[Abstract] [Full Text] [PDF]

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 J Am Coll CardiolHome page
G. C. Hughes, K. P. Landolfo, J. E. Lowe, R. B. Coleman, and C. L. Donovan
Perioperative morbidity and mortality after transmyocardial laser revascularization: incidence and risk factors for adverse events
J. Am. Coll. Cardiol., March 15, 1999; 33(4): 1021 - 1026.
[Abstract] [Full Text] [PDF]

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 Asian Cardiovasc. Thorac. Ann.Home page
Z. Li, L. J. Ren, B. Wang, W. T. Xu, and G. Y. Li
Transmyocardial Laser Revascularization as Sole Therapy in Coronary Disease
Asian Cardiovasc Thorac Ann, March 1, 1999; 7(1): 23 - 26.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
K. A. Kadipasaoglu, M. Sartori, T. Masai, H. B. Cihan, F. J. Clubb Jr, J. L. Conger, and O.H. Frazier
Intraoperative arrhythmias and tissue damage during transmyocardial laser revascularization
Ann. Thorac. Surg., February 1, 1999; 67(2): 423 - 431.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
R. Agarwal, M. Ajit, V. M. Kurian, S. Rajan, S. B. Arumugam, and K. M. Cherian
Transmyocardial laser revascularization: early results and 1-year follow-up
Ann. Thorac. Surg., February 1, 1999; 67(2): 432 - 436.
[Abstract] [Full Text] [PDF]

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 Eur Heart JHome page
S.M. Burns, L.D. Sharples, S. Tait, N. Caine, J. Wallwork, and P.M. Schofield
The transmyocardial laser revascularization international registry report
Eur. Heart J., January 1, 1999; 20(1): 31 - 37.
[Abstract] [PDF]

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 Ann. Thorac. Surg.Home page
G. C. Hughes, J. E. Lowe, A. P. Kypson, J. D. St. Louis, A. M. Pippen, K. G. Peters, R. E. Coleman, T. R. DeGrado, C. L. Donovan, B. H. Annex, et al.
Neovascularization after transmyocardial laser revascularization in a model of chronic ischemia
Ann. Thorac. Surg., December 1, 1998; 66(6): 2029 - 2036.
[Abstract] [Full Text] [PDF]

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 CirculationHome page
E. J. Topol and P. W. Serruys
Frontiers in Interventional Cardiology
Circulation, October 27, 1998; 98(17): 1802 - 1820.
[Full Text] [PDF]

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 Eur. J. Cardiothorac. Surg.Home page
K. B Allen, R. D Dowling, D. A Heimansohn, E. Reitsma, L. Didelot, and C. J Shaar
Transmyocardial revascularization utilizing a holmium:YAG Laser
Eur. J. Cardiothorac. Surg., October 1, 1998; 14(suppl_1): S100 - S104.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
K. A. Horvath, R. Greene, N. Belkind, B. Kane, D. D. McPherson, and D. A. Fullerton
Left ventricular functional improvement after transmyocardial laser revascularization
Ann. Thorac. Surg., September 1, 1998; 66(3): 721 - 725.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
M. P. Pelletier, A. Giaid, S. Sivaraman, J. Dorfman, C. M. Li, A. Philip, and R. C.-J. Chiu
Angiogenesis and growth factor expression in a model of transmyocardial revascularization
Ann. Thorac. Surg., July 1, 1998; 66(1): 12 - 18.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
M. Kirsch, L. Guesnier, P. LeBesnerais, M.-L. Hillion, M. Debauchez, J. Seguin, and D. Y. Loisance
Cardiac operations in octogenarians: perioperative risk factors for death and impaired autonomy
Ann. Thorac. Surg., July 1, 1998; 66(1): 60 - 67.
[Abstract] [Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
J.E. Sigel, C.M. Abramovich, B.W. Lytle, and N.B. Ratliff
Transmyocardial laser revascularization: Three sequential autopsy cases
J. Thorac. Cardiovasc. Surg., June 1, 1998; 115(6): 1381 - 1384.
[Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
P. M. McFadden, R. J. Robbins, J. L. Ochsner, C. H. Van Meter, and S. Majorie
Transmyocardial revascularization for cardiac transplantation allograft vasculopathy
J. Thorac. Cardiovasc. Surg., June 1, 1998; 115(6): 1385 - 1388.
[Full Text] [PDF]

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 Eur. J. Cardiothorac. Surg.Home page
X. M. Mueller, H. H. Tevaearai, C.-Y. Genton, D. Bettex, and L. K. von Segesser
Transmyocardial laser revascularisation in acutely ischaemic myocardium
Eur. J. Cardiothorac. Surg., February 1, 1998; 13(2): 170 - 175.
[Abstract] [Full Text] [PDF]

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 Eur. J. Cardiothorac. Surg.Home page
G. Lutter, B. Saurbier, E. Nitzsche, F. Kletzin, J. Martin, C. Schlensak, C. Lutz, and F. Beyersdorf
Transmyocardial laser revascularization (TMLR) in patients with unstable angina and low ejection fraction
Eur. J. Cardiothorac. Surg., January 1, 1998; 13(1): 21 - 26.
[Abstract] [Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
K. F. Kwong, G. K. Kanellopoulos, J. C. Nickols, S. M. Pogwizd, J. E. Saffitz, R. B. Schuessler, and T. M. Sundt III
TRANSMYOCARDIAL LASER TREATMENT DENERVATES CANINE MYOCARDIUM
J. Thorac. Cardiovasc. Surg., December 1, 1997; 114(6): 883 - 890.
[Abstract] [Full Text]

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 Journal Watch CardiologyHome page
Laser Coronary Revascularization Revisited
Journal Watch Cardiology, May 19, 1997; 1997(519): 10 - 10.
[Full Text]


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