Transmyocardial laser revascularization: from randomized trials to clinical practice. A review of techniques,
Keith B Allen1, James Kelly, A Michael Borkon
1Department of Cardiothoracic Surgery, Mid America Heart Institute, St. Luke's Hospital, 4320 Wornall Road, Suite 50, Kansas City, MO 64111, USA. kallen2340@aol.com
Insights
For complex coronary artery disease, transmyocardial revascularization (TMR) offers benefits alone or with coronary artery bypass grafting (CABG). Increased use of TMR is warranted for patients with diffuse disease unsuitable for CABG alone.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Patients with diffuse coronary artery disease present complex challenges for complete revascularization using coronary artery bypass grafting (CABG) alone.
- Incomplete revascularization increases operative and long-term cardiac risks.
Purpose of the Study:
- To evaluate the efficacy of transmyocardial revascularization (TMR) as a sole therapy or adjunctive treatment in patients with diffuse coronary artery disease.
- To support increased utilization of TMR in specific patient populations.
Main Methods:
- Review of randomized trials and clinical data on patients with diffuse coronary artery disease.
- Analysis of outcomes for patients treated with sole TMR versus adjunctive TMR with CABG.
Main Results:
- Transmyocardial revascularization (TMR) demonstrates documented operative and long-term benefits.
- These benefits are observed in randomized patients with diffuse coronary artery disease when TMR is used as sole therapy or adjunctively.
Conclusions:
- Transmyocardial revascularization (TMR) is a valuable therapeutic option for patients with diffuse coronary artery disease not amenable to complete revascularization by CABG alone.
- Increased use of sole therapy and adjunctive TMR is recommended to mitigate risks associated with incomplete revascularization.
Abstract:
Cardiac surgeons are increasingly faced with a more complex patient who has developed a pattern of diffuse coronary artery disease that cannot be completely revascularized by CAGB alone. Considering the increased operative and long-term cardiac risks predicted by incomplete revascularization, and the documented operative and long-term benefits associated with sole therapy and adjunctive TMR in randomized patients with diffuse coronary artery disease, increased use of sole therapy and adjunctive TMR therapy is warranted.
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