Transmyocardial laser revascularization for diffuse coronary artery disease: Early results

• Published in: Current science (Bangalore) Vol. 77; no. 7; pp. 904 - 907
• Main Authors: Agarwal, Ravi, Ajit, Mullasari, Kurian, Valikapathalil Mathew, Rajan, Sethuratnam, Arumugam, Sarasa Bharati, Cherian, Kottoorathu Mammen
• Format: Journal Article
• Language: English
• Published: Current Science Association 10.10.1999
• Subjects: Coronary artery bypass; Follow up studies; Lasers; Mortality; Myocardial infarction; Myocardium; Perfusion; Predisposing factors; Pulse duration; SPECIAL SECTION: BIOMEDICAL APPLICATIONS OF LASERS; Thallium; Transmyocardial revascularization
• ISSN: 0011-3891

Transmyocardial revascularization (TMR) using a high energy CO2 laser has emerged as a new therapeutic option for patients with severe diffuse coronary artery disease refractory to conventional modes of therapy. TMR has shown symptomatic benefit and improvement in the exercise tolerance in a group of patients suffering from disabling angina, not amenable to other modes of treatment. However, this procedure resulted in 14 to 18% high early mortality in various series. The univariate predictors of mortality were age > 55 years, female sex, CKP > 1600 IU, absence of inter coronary collaterals, and mean PAP > 21 mm Hg. At one-year follow-up studies, a significant improvement in the angina class (II, III, IV), and treadmill testing (TMT) effort tolerance were observed; but without any significant change in the left ventricular ejection fraction. The high early mortality can be brought down with strict patient selection criteria. The mechanism of beneficial effects remains uncertain, and the patency of laser channels is controversial; but laser-induced neoangiogenesis is being looked upon as a plausible explanation.