Transmyocardial laser revascularization in the treatment of myocardial ischemia

Since 1990, over five thousand patients worldwide have undergone transmyocardial laser revascularization (TMR) for the treatment of myocardial ischemia due to end-stage coronary artery disease. Recently four prospective randomized controlled clinical trials have reported their results in comparing TMR to maximal medical therapy. All of the trials demonstrated that TMR provided notable relief of angina when compared to medical management. Additional objective data in the form of exercise tolerance and myocardial perfusion scanning are used to support the symptomatic improvement. Although the trials are similar, they are not identical, and this review provides an update and comparison of their results.