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Symptomatic improvement after transmyocardial laser revascularization: how long does it last?
M De Carlo1, A D Milano, S Pratali
1CardioThoracic Department, University of Pisa, Italy.
The Annals of Thoracic Surgery
|October 4, 2000
Summary
Transmyocardial holmium laser revascularization (TMLR) initially improves angina in coronary artery disease patients. However, long-term follow-up shows a return of symptoms, questioning the lasting benefit of TMLR.
Area of Science:
- Cardiology
- Minimally Invasive Surgery
Background:
- Coronary artery disease (CAD) often requires advanced treatment options when traditional methods fail.
- Transmyocardial holmium laser revascularization (TMLR) is a less invasive surgical option for select CAD patients.
Purpose of the Study:
- To evaluate the durability of short-term clinical improvements following TMLR in patients with refractory coronary artery disease.
- To assess long-term outcomes, including symptom recurrence and survival, after TMLR.
Main Methods:
- A cohort of 34 patients with coronary artery disease underwent TMLR between 1995 and 1999.
- Patients had a mean age of 67 years, with 76% having prior revascularization.
- Preoperative assessment included angina class and left ventricular ejection fraction.
Main Results:
- One early death occurred due to low cardiac output; no major postoperative complications were noted.
- Late deaths (n=8) were attributed to stroke, cardiac failure, and myocardial infarction.
- While angina improved at 1 year (mean class 1.8), it worsened by 35 months (mean class 2.2, p=0.005).
- Three-year actuarial survival was 76%, with 44% freedom from cardiac events.
Conclusions:
- Initial clinical improvement after TMLR is often not sustained long-term.
- Many patients experience a recurrence of angina or cardiac events, diminishing the long-term symptomatic benefit.
- The long-term efficacy of TMLR for coronary artery disease requires further investigation.