Transmyocardial Laser Revascularization as Sole Therapy in Coronary Disease

This prospective study evaluated the medium-term efficacy of transmyocardial laser revascularization as the sole therapy in patients with ischemic heart disease. A carbon dioxide laser was used to create channels through ischemic areas of the myocardium in 33 patients with a mean age of 58.8 ± 10.4 years. The mean left ventricular ejection fraction determined by echocardiography was 44.8% ± 14%. Preoperatively, the patients underwent coronary artery angiography, single photon emission computed tomography perfusion scans, and positron emission tomography metabolism scans to determine the extent and severity of ischemia and myocardial viability. Total follow-up of 327 patient-months was obtained for 26 patients with a mean follow-up of 12.6 ± 9 months. The scans were repeated at 3, 6, 12, and 24 months postoperatively. The perioperative mortality was 9% due to ventricular fibrillation. Morbidity was minimal. The number of perfusion defects decreased significantly after treatment and there was a significant increase in myocardial viability in the treated left ventricular free wall. The success rate, defined as a decrease of 2 angina classes, was approximately 80% during the follow-up, reflected in a significant decrease in the number of admissions for angina in the year after the procedure (mean, 0.5 ± 0.4) compared with the previous year (mean, 2 ± 1.1) and in decreased use of antianginal medications.