Key result
Transmyocardial revascularization combined with CABG resulted in similar 30-day mortality compared to CABG alone (5.7% vs. 4.3%, P=0.70) and comparable long-term survival.
Why the study?
Does TMR combined with CABG improve mortality compared to CABG alone in patients with circumflex coronary artery disease and no bypassable distal targets?
Cohort (n=140)
No
Does TMR combined with CABG improve mortality compared to CABG alone in patients with circumflex coronary artery disease and no bypassable distal targets?
TMR combined with CABG is safe and provides similar long-term survival compared to CABG alone in patients with nonbypassable distal targets, with potential for symptom improvement.
TMR plus CABG was associated with similar mortality to CABG alone; leaves open incremental benefit in nonbypassable targets.
OBJECTIVES: : Transmyocardial revascularization (TMR) has been used as an isolated or adjunctive revascularization therapy in patients presumed to have nonbypassable coronary artery disease. The purpose of this study is to evaluate the short- and midterm mortality for patients with complete revascularization using TMR and coronary artery bypass grafting (CABG) compared with those patients with incomplete CABG revascularization and to document long-term follow-up in patients receiving TMR + CABG. METHODS: : Seventy TMR + CABG patients were cohort matched with 70 patients undergoing isolated CABG with circumflex coronary artery disease, but with no bypassable distal targets, from 1999 to 2005 at Emory University Hospital. The data were retrospectively reviewed from a database after being prospectively entered. Results are presented in mean ± standard deviation, and Kaplan-Meier curves were created for long-term all-cause mortality. RESULTS: : The TMR + CABG patients had a similar incidences to the CABG only group for preoperative ejection fraction (50.9 ± 11.2% vs. 50.7 ± 10.3%, P = 0.93), number of grafts (2.6 ± 1.1 vs. 2.5 ± 1.3, P = 0.5), and number of diseased vessels (2.8 ± 0.3 vs. 2.9 ± 0.4, P = 0.26). Off-pump surgery was used more often in the CABG alone group versus the TMR combined with CABG group (74.3% vs. 41.4%, P < 0.001). Postoperatively, there was no statistical difference among the TMR + CABG and the CABG alone groups for intensive care unit length of stay (4.3 ± 7.8 days vs. 2.6 ± 3.4 days, P = 0.026), postsurgical length of stay (7.6 ± 6.1 days vs. 6.8 ± 4.5 days, P = 0.31), stroke events (1.4% vs. 1.4%, P = 1.00), myocardial infarction (4.3% vs. 2.9%, P = 0.65), and 30-day mortality (5.7% vs. 4.3%, P = 0.70). Long-term survival rate was not statistically significant. In addition, 4-year follow-up in the TMR + CABG group had symptom improvement with reduction in New York Heart Association classification for class III/IV (P < 0.0001, baseline vs. 4-year follow-up). CONCLUSIONS: : The combination of TMR and CABG for complete revascularization is safe and carries no further risk to patients compared with CABG only. CABG + TMR patients tend to have increased resource utilization. Long-term follow-up shows similar survival between the groups. TMR can be a useful adjunct to CABG for complete revascularization.
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Eldaif et al. (2010) conducted a cohort in Circumflex coronary artery disease with no bypassable distal targets (n=140). Transmyocardial revascularization (TMR) combined with CABG vs. CABG alone was evaluated on 30-day mortality (p=0.70). Transmyocardial revascularization combined with CABG resulted in similar 30-day mortality compared to CABG alone (5.7% vs. 4.3%, P=0.70) and comparable long-term survival.
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