| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
J Thorac Cardiovasc Surg 2000;119:540-549
© 2000 Mosby, Inc.
SURGERY FOR ACQUIRED CARDIOVASCULAR DISEASE |
From the Departments of Cardiothoracic Surgery, St Vincent Hospital, Indiana Heart Institute,a Indianapolis, Ind; University of Louisville, Jewish Heart & Lung Institute,b Louisville, Ky; Cooper Hospital,c Camden, NJ; Redding Medical Center,d Redding, Pa; Fairfax Hospital,e Falls Church, Va; Kaiser Permanente Medical,f Los Angeles, Calif; Terrebonne General Medical Center,g Houma, La; St Vincent’s Medical Center,h Jacksonville, Fla; Sutter Memorial Hospital,i Sacramento, Calif; and Sentara Norfolk General Hospital,j Norfolk, Va.
Address for reprints: Keith B. Allen, MD, 8333 Naab Rd, Suite 300, Indianapolis, IN 46260 (E-mail: cvsurgeon{at}iquest.net ).
Objective: We sought to assess the safety and efficacy of transmyocardial revascularization combined with coronary artery bypass grafting in patients not amenable to complete revascularization by coronary bypass alone.
Methods: A total of 263 patients whose standard of care was coronary artery bypass grafting and who had one or more ischemic areas not amenable to bypass grafting were prospectively randomized to receive coronary bypass of suitable vessels plus transmyocardial revascularization to areas not graftable (n = 132) or coronary bypass alone with nongraftable areas left unrevascularized (n = 131). Group preoperative demographics and operative characteristics were similar.
Results: The operative mortality rate after coronary bypass/transmyocardial revascularization was 1.5% (2/132) versus 7.6% (10/131) after coronary bypass alone (P = .02). Patients undergoing both coronary bypass and transmyocardial revascularization required less postoperative inotropic support (30% vs 55%, P = .0001) and had a trend toward fewer insertions of intra-aortic balloon pumps (4% vs 8%, P = .13) than did patients having coronary bypass alone. Multivariable predictors of operative mortality were coronary artery bypass alone (odds ratio, 5.3; 95% confidence interval, 1.1-25.7; P = .04) and increased age (odds ratio, 1.1; 95% confidence interval, 1.0-1.2; P = .03). One-year Kaplan-Meier survival (95% vs 89%, P = .05) and freedom from major adverse cardiac events defined as death or myocardial infarction (92% vs 86%, P = .09) favored the combination of coronary bypass and transmyocardial revascularization. Baseline to 12-month improvement in angina and exercise treadmill scores was similar between groups.
Conclusions: In a prospective, randomized, multicenter trial, transmyocardial revascularization combined with coronary artery bypass grafting in patients not amenable to complete revascularization by coronary bypass alone was safe; however, angina relief and exercise treadmill improvement were indistinguishable between groups at 12 months of follow-up. Operative and 1-year survival benefits observed after adjunctive transmyocardial revascularization require confirmation by a larger validation study, which is ongoing.
This article has been cited by other articles:
|
|
 |
|
  P. Atluri, C. M. Panlilio, G. P. Liao, E. E. Suarez, R. C. McCormick, W. Hiesinger, J. E. Cohen, M. J. Smith, A. B. Patel, W. Feng, et al. Transmyocardial revascularization to enhance myocardial vasculogenesis and hemodynamic function. J. Thorac. Cardiovasc. Surg., February 1, 2008; 135(2): 283 - 291. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. A. Horvath and Y. Zhou Transmyocardial Laser Revascularization and Extravascular Angiogenetic Techniques to Increase Myocardial Blood Flow Card. Surg. Adult, January 1, 2008; 3(2008): 733 - 752. [Full Text]
|
|
|
|
 |
|
 M. B. Leon Reply J. Am. Coll. Cardiol., December 5, 2006; 48(11): 2355 - 2355. [Full Text] [PDF]
|
|
|
|
 |
|
 K. A. Horvath, T. B. Ferguson Jr, R. A. Guyton, and F. H. Edwards Impact of Unstable Angina on Outcomes of Transmyocardial Laser Revascularization Combined With Coronary Artery Bypass Grafting Ann. Thorac. Surg., December 1, 2005; 80(6): 2082 - 2085. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Sanni and J. Dunning Is transmyocardial revascularisation of benefit in addition to coronary artery bypass grafting for patients with diffuse coronary disease? Interactive CardioVascular and Thoracic Surgery, December 1, 2004; 3(4): 581 - 585. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. B. Allen, R. D. Dowling, D. R. Schuch, T. A. Pfeffer, S. Marra, E. A. Lefrak, T. L. Fudge, M. Mostovych, S. Szentpetery, S. P. Saha, et al. Adjunctive transmyocardial revascularization: five-year follow-up of a prospective, randomized trial Ann. Thorac. Surg., August 1, 2004; 78(2): 458 - 465. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. B. Allen, R. D. Dowling, and W. Richenbacher From controlled trials to clinical practice: monitoring transmyocardial revascularization use and outcomes J. Am. Coll. Cardiol., June 16, 2004; 43(12): 2364 - 2365. [Full Text] [PDF]
|
|
|
|
|
|
E. D. Peterson and T. B. Ferguson Jr Reply J. Am. Coll. Cardiol., June 16, 2004; 43(12): 2365 - 2366. [Full Text] [PDF]
|
|
|
|
|
|
C. R. Bridges, K. A. Horvath, W. C. Nugent, D. M. Shahian, C. K. Haan, R. J. Shemin, K. B. Allen, and F. H. Edwards The Society of Thoracic Surgeons practice guideline series: transmyocardial laser revascularization Ann. Thorac. Surg., April 1, 2004; 77(4): 1494 - 1502. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Svorkdal Treatment of Inoperable Coronary Disease and Refractory Angina: Spinal Stimulators, Epidurals, Gene Therapy, Transmyocardial Laser, and Counterpulsation Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2004; 8(1): 43 - 58. [Abstract] [PDF]
|
|
|
|
|
|
E. D. Peterson, P. Kaul, R. G. Kaczmarek, B. G. Hammill, P. W. Armstrong, C. R. Bridges, T. B. Ferguson Jr, and Society of Thoracic Surgeons From controlled trials to clinical practice: monitoring transmyocardial revascularization use and outcomes J. Am. Coll. Cardiol., November 5, 2003; 42(9): 1611 - 1616. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Loubani, D. Chin, J. N. Leverment, and M. Galinanes Mid-term results of combined transmyocardial laser revascularization and coronary artery bypass Ann. Thorac. Surg., October 1, 2003; 76(4): 1163 - 1166. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. J. Guleserian, H. S. Maniar, C. J. Camillo, M. S. Bailey, R. J. Damiano Jr, and M. R. Moon Quality of life and survival after transmyocardial laser revascularization with the holmium:YAG laser Ann. Thorac. Surg., June 1, 2003; 75(6): 1842 - 1848. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Saririan and M. J. Eisenberg Myocardial laser revascularization for the treatment of end-stage coronary artery disease J. Am. Coll. Cardiol., January 15, 2003; 41(2): 173 - 183. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Ruel, R. A. Kelly, and F. W. Sellke Therapeutic Angiogenesis, Transmyocardial Laser Revascularization, and Cell Therapy Card. Surg. Adult, January 1, 2003; 2(2003): 715 - 750. [Full Text]
|
|
|
|
|
|
M. Huikeshoven, J. F. Beek, J. A.P. van der Sloot, R. Tukkie, J. van der Meulen, and M. J.C. van Gemert 35 years of experimental research in transmyocardial revascularization: what have we learned? Ann. Thorac. Surg., September 1, 2002; 74(3): 956 - 970. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. J. Laham, M. Simons, J. D. Pearlman, K. K. L. Ho, and D. S. Baim Magnetic resonance imaging demonstrates improved regional systolic wall motion and thickening and myocardial perfusion of myocardial territories treated by laser myocardial revascularization J. Am. Coll. Cardiol., January 2, 2002; 39(1): 1 - 8. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. W. Emery, F. Eales, C. H. Van Meter Jr, M. B. Knudson, E. E. Solien, and K. S. Tweden Ventriculocoronary artery bypass results using a mesh-tipped device in a porcine model Ann. Thorac. Surg., September 1, 2001; 72(3): S1004 - 1008. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Nathanson and K. Ihnken Transmyocardial laser channeling, coronary artery bypass, statistical analyses, and their interpretations J. Thorac. Cardiovasc. Surg., March 1, 2001; 121(3): 601 - 601. [Full Text] [PDF]
|
|
|
|
|
|
K. B. Allen, R. D. Dowling, and C. J. Shaar Reply J. Thorac. Cardiovasc. Surg., March 1, 2001; 121(3): 601 - 603. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
