[The role of transmyocardial laser revascularization in congestive heart failure]

Transmyocardial laser revascularization (TMLR) has been approved as an indirect coronary revascularization measure through angiogenesis around created channels in patients who are not amenable to direct revascularization methods such as coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA). TMLR is less invasive and there are no contraindications in terms of left ventricular function. Therefore all patients who have untreatable lesions by CABG or PTCA with reversible ischemia are candidates for TMLR therapy. In a Japanese clinical trial, improvement of left ventricular function associated with relief of persistent angina and improved perfusion was seen in 54% of patients. Significant reduction of operative risk in adjunctive TMLR (combination of TMLR with CABG) compared with isolated CABG has been also demonstrated in a randomized trial. These results indicate the usefulness of adjunctive TMLR in multivessel-disease patients with left ventricular dysfunction. Because TMLR is a simple and less-invasive technique, combined use of TMLR with off-pump CABG or MIDCAB is also an attractive revascularization strategy in ischemic cardiomyopathy patients.