Long-Term Outcomes After Transmyocardial Revascularization

• Published in: The Annals of thoracic surgery Vol. 94; no. 5; pp. 1500 - 1508
• Main Authors: Tavris, Dale R., MD, Brennan, James Matthew, MD, Sedrakyan, Art, MD, Zhao, Yue, DrPH, O'Brien, Sean M., PhD, Peterson, Eric D., MD, Gross, Thomas P., MD, Marinac-Dabic, Danica, MD, Horvath, Keith A., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.11.2012; Elsevier
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiology. Vascular system; Cardiothoracic Surgery; Coronary Artery Bypass; Female; Humans; Male; Medical sciences; Middle Aged; Myocardial Revascularization - adverse effects; Myocardial Revascularization - instrumentation; Myocardial Revascularization - methods; Pneumology; Postoperative Complications - etiology; Postoperative Complications - mortality; Surgery; Treatment Outcome; 23; FDA; Generalized estimating equation; IABP; myocardial infarction; HR; odds ratio; BSA; percutaneous coronary intervention; STS; Society of Thoracic Surgeons; MI; New York Heart Association (classification for heart failure); NYHA; OR; yttrium-aluminum garnet; CI; GEE; CMS; DCRI; Coronary artery bypass graft; Duke Clinical Research Institute; ACSD; Confidence interval; Intraaortic balloon pump; CCS; Centers for Medicare and Medicaid Services; transmyocardial revascularization; Food and Drug administration; PCI; Canadian Cardiovascular Society (classification system for angina); hazard ratio; TMR; CABG; YAG; adult cardiac surgery database; body surface area; Anesthesia; Prognosis; Circulatory system; Cardiology; Long term; Revascularization
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2012.05.068

Background Two independent reports documented substantially higher operative mortality associated with transmyocardial revascularization (TMR) when used in isolation than that reported in the premarket clinical trials. To clarify the state of the art, this article assesses temporal trends in the use of TMR, short-term and long-term outcomes, and outcomes stratified by procedure type (TMR only and TMR + coronary artery bypass graft [CABG]) and by the 2 specific TMR devices. Methods The study population included all patients undergoing TMR in isolation or in combination with CABG at 435 cardiothoracic hospitals in the United States participating in the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database (ACSD) from January 2000 through November 2006 (n = 15,386). Analysis of long-term outcomes was accomplished through linkage to Medicare claims data. Short-term and long-term (7 years) adverse outcomes were assessed and compared between the 2 TMR device types. Results The use of TMR in conjunction with CABG surgery is increasing. This study showed modest differences in short-term morbidity and mortality between the 2 devices. In combination with CABG, after risk adjustment, patients treated with the holmium:YAG laser (experienced a higher rate of operative mortality (3.5% vs 2.5%; adjusted hazard ratio 1.39, 95% confidence level 1.03 to 1.87) but no difference in the composite short-term rate of major morbidity or mortality, compared with the Heart Laser CO2 transmyocardial revascularization system (PLC Medical Systems, Inc, Milford, MA). However, there were no clinically meaningful differences in long-term results. Conclusions Modest differences in short-term morbidity and mortality between the 2 devices suggest the usefulness of further research.