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Is transmyocardial revascularisation of benefit to people with 'no option' angina?

Aliu Sanni1, Joel Dunning

  • 1Department of Cardiothoracic Surgery, Freeman Hospital, Freeman Road, Newcastle NE7 7DN, UK.

Interactive Cardiovascular and Thoracic Surgery
|August 3, 2007
PubMed

Insights

Transmyocardial revascularization (TMR) offers significant angina relief for selected severe angina patients unsuitable for bypass surgery. However, this cardiac surgery intervention carries a notable perioperative mortality risk of approximately 5%.

Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology

Background:

  • Severe angina pectoris often presents in patients with coronary artery disease unsuitable for traditional bypass grafting.
  • Transmyocardial revascularization (TMR) has been proposed as an alternative therapy for refractory angina in 'no option' patients.

Purpose of the Study:

  • To evaluate the efficacy and safety of transmyocardial revascularization (TMR) in patients with severe angina and ungraftable myocardium.

Main Methods:

  • A systematic review of best-evidence studies was conducted.
  • 345 relevant papers were identified, with 11 selected for detailed analysis.
  • Data on patient characteristics, study design, outcomes, and limitations were tabulated.

Main Results:

  • Transmyocardial revascularization (TMR) significantly reduced angina grade in selected stable patients with CCS grade III-IV angina.
  • The perioperative mortality associated with TMR was approximately 5%.

Conclusions:

  • Transmyocardial revascularization (TMR) is a viable option for select 'no option' patients with severe angina.
  • The benefits of angina reduction must be weighed against the significant perioperative risks.

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