Does transmyocardial laser revascularization improve anginal status and cardiac function in patients with refractory symptomatic coronary artery disease?
Background We assessed the transmyocardial laser revascularization (TMLR) as sole therapy in patients with symptomatic coronary artery disease refractory to interventional or medical treatment. Methods and Results Thirty-one patients were evaluated with positron emission tomography (PET), dobutamine echocardiography, 201 Tl single–photon emission computed tomography ( 201 Tl-SPECT), and multigated acquisition radionuclide ventriculography (MUGA). TMLR was performed in 21 patients who had demonstrable ischemia in viable myocardium. The mean Canadian Cardiovascular Society (CCS) angina class was 3.70±0.7 (4 patients with unstable angina). Untreated septal segments were used as controls. At 3 months, ( n =15 patients), the mean CCS angina class was to 2.43±0.9 ( P <.05). On dobutamine echocardiography, the mean resting wall motion score index was improved by 16% in lased segments ( P <.03 vs control), and mean LVEF at peak stress increased by 19% ( P =NS vs baseline). On 201 Tl-SPECT, perfusion of lased and nonlased segments did not change. On PET, the mean ratio of subendocardial to subepicardial perfusion (SEn/SEp) increased 14% over baseline ( P <.001 vs control). At 6 months (n=15 patients), the mean CCS angina class was 1.7±0.8 ( P <.05). The mean resting wall motion score index was up by 13% in lased segments ( P <.05 vs control). Resting LVEF was unchanged. Stress LVEF increased 21% ( P =NS vs baseline). Myocardial perfusion remained unchanged by 201 Tl-SPECT. On PET, 36% of the lased segments were better, and 25% were worse compared with baseline. The resting SEn/SEp by PET was up 21% ( P <.001 vs control). All deaths (two perioperative and three late) occurred in patients with preoperative congestive heart failure. Two patients required repeat revascularization of new coronary lesions. Conclusions These results suggest that TMLR improves anginal status, relative endocardial perfusion, and cardiac function in patients who do not have preoperative congestive heart failure.
Frazier et al. (Wed,) studied this question.