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J Thorac Cardiovasc Surg 2003;125:S74-S75
© 2003 The American Association for Thoracic Surgery

Editorials

Shedding light on denervation and transmyocardial laser revascularization

From the Department of Cardiac and Thoracic Surgery, Northwestern Medical Faculty Foundation, Chicago, Ill.

Received for publication June 5, 2001. Accepted for publication June 8, 2001. Address for reprints: Keith A. Horvath, MD, Department of Cardiac and Thoracic Surgery, Northwestern Medical Faculty Foundation, 201 E Huron Ave, 10-125, Chicago, IL 60611-3008.

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With more than 6000 patients treated and with 70% to 75% of these patients having a significant improvement in their angina symptoms, one would think that the mechanism whereby transmyocardial laser revascularization (TMLR) achieves its effect would be well understood. Of the many possible mechanisms, including angiogenesis, channel patency, alterations of ventricular compliance, placebo effect, and denervation, it is the latter that is the most difficult to prove or disprove. Clinical studies have indirectly demonstrated that denervation does not play the primary role, a virtue of improvement in perfusion, as demonstrated by nuclear spec scans and positron emission tomograpic scans. ^1-5 Additionally, functional improvement with dobutamine stress echocardiography ⁶ and cine magnetic resonance imaging ⁷ also indicates that denervation is not the . . . [Full Text of this Article]