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Mid-term results after thoracoscopic transmyocardial laser revascularization
1Department of Cardiothoracic Surgery, Cardiovascular Surgeons, PA, Orlando, Florida, USA. gary.allen@hcahealthcare.com
The Annals of Thoracic Surgery
|July 26, 2005
Summary
This study shows that a completely thoracoscopic transmyocardial laser revascularization is a feasible surgical option for severe angina. The procedure resulted in significant symptom improvement with minimal complications.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Procedures
- Interventional Cardiology
Background:
- Transmyocardial revascularization (TMR) treats severe angina in patients unsuitable for traditional revascularization.
- Historically, TMR utilized thoracotomy, often with thoracoscopic assistance.
- This study explores a novel, completely thoracoscopic, closed-chest TMR approach.
Purpose of the Study:
- To evaluate the feasibility of a completely thoracoscopic TMR.
- To assess midterm clinical outcomes of this minimally invasive TMR technique.
- To compare this approach to historical thoracotomy methods.
Main Methods:
- Ten patients (90% male, mean age 66) ineligible for CABG/PCI underwent TMR.
- A holmium:yttrium-aluminum-garnet laser system was used via a completely thoracoscopic approach.
- Preoperative assessment included mean ejection fraction of 0.51 and angina class of 3.7.
Main Results:
- A mean of 30 channels were created in an average procedure time of 133 minutes.
- Patients were extubated at 7.6 hours and discharged in 5.4 days, with no hospital deaths or major complications.
- At 8.4 months post-procedure, all patients survived with significant angina class improvement to 1.3 (p < 0.001).
Conclusions:
- A completely thoracoscopic TMR approach is feasible and offers improved visualization.
- The procedure demonstrated limited complications and significant midterm clinical improvement.
- Further research is needed to confirm reduced postoperative pain and validate findings in larger cohorts.