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Adjunctive transmyocardial revascularization: five-year follow-up of a prospective, randomized trial

Keith B Allen1, Robert D Dowling, Douglas R Schuch

  • 1Department of Cardiothoracic Surgery, St. Vincent Hospital, Indiana Heart Institute, 10590 N. Meridian Street, Suite 105, Indianapolis, IN 46260, USA. kallen2340@aol.com

The Annals of Thoracic Surgery
|July 28, 2004
PubMed

Insights

Transmyocardial revascularization (TMR) added to coronary artery bypass grafting (CABG) significantly improved angina relief in patients with diffuse coronary artery disease over five years, with similar survival rates compared to CABG alone.

Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology
  • Regenerative Medicine

Background:

  • Coronary artery bypass grafting (CABG) alone may result in incomplete revascularization for patients with diffuse coronary artery disease.
  • Transmyocardial revascularization (TMR) is a potential adjunct to improve outcomes in such cases.

Purpose of the Study:

  • To evaluate the long-term efficacy of CABG plus TMR compared to CABG alone in patients with diffuse coronary artery disease.
  • To assess differences in angina relief and survival rates between the two treatment groups.

Main Methods:

  • A prospective, randomized trial involving 218 patients with diffusely diseased coronary arteries.
  • Patients were randomized to receive either holmium:yttrium-aluminum-garnet (holmium:YAG) CABG/TMR or CABG alone.
  • Long-term follow-up included survival assessment and blinded angina class evaluation over a mean of 5.0 years.

Main Results:

  • At 5-year follow-up, both groups showed angina improvement, but CABG/TMR had a significantly lower mean angina score (p=0.05) and a lower proportion of patients with severe angina (0% vs 10%, p=0.009).
  • A trend towards more angina-free patients was observed in the CABG/TMR group (78% vs 63%, p=0.08).
  • Kaplan-Meier survival rates at 6 years were similar between the CABG/TMR and CABG alone groups (76% vs 80%, p=0.90).

Conclusions:

  • The addition of TMR to CABG in patients with diffuse coronary artery disease provides superior long-term angina relief compared to CABG alone.
  • CABG/TMR does not compromise long-term survival rates compared to CABG alone in this patient population.
Abstract

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