Related Experiment Video
Updated: May 23, 2026
Surgical Porcine Model of Chronic Myocardial Ischemia Treated by Exosome-laden Collagen Patch and Off-pump Coronary Artery Bypass Graft
Published on: September 15, 2023
Thoracoscopic transmyocardial laser revascularization: is prior coronary artery bypass grafting a contraindication?
1From Osceola Regional Medical Center, Orlando, Florida.
Insights
Thoracoscopic transmyocardial laser revascularization (TMR) is a safe option for patients unsuitable for other procedures. Prior coronary artery bypass graft (CABG) surgery does not contraindicate this minimally invasive TMR approach.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Procedures
- Interventional Cardiology
Background:
- Transmyocardial laser revascularization (TMR) is an option for patients ineligible for coronary artery bypass graft (CABG) or percutaneous coronary interventions.
- The safety and efficacy of thoracoscopic TMR in patients with prior CABG remain unclear.
Purpose of the Study:
- To compare the outcomes of thoracoscopic TMR in patients with and without prior CABG.
- To determine if previous CABG is a contraindication for thoracoscopic TMR.
Main Methods:
- A cohort of 23 patients underwent thoracoscopic TMR between May 2003 and October 2005.
- Patients were divided into two groups: 6 without prior CABG (Group A) and 17 with prior CABG (Group B).
- Procedures utilized a holmium:yttrium-aluminum-garnet (Ho:YAG) laser system with 3-4 port incisions.
Main Results:
- Demographics were similar between groups, with Group B patients frequently having patent left internal mammary artery grafts.
- No conversions to thoracotomy or deaths occurred in either group during a mean 12-month follow-up.
- One patient in Group A experienced an airway injury; transfusion rates were similar between groups.
Conclusions:
- Thoracoscopic TMR using a port access approach is safe and reproducible.
- Prior CABG, even with patent grafts, does not preclude successful thoracoscopic TMR.
Objective:
: Recently, thoracoscopic techniques have been used to perform transmyocardial laser revascularization (TMR) in patients who are not suitable candidates for coronary artery bypass graft (CABG) surgery or percutaneous coronary interventions. Whether or not prior CABG contraindicates a port access-only approach to TMR is unclear. This study compares patients with and without prior CABG who have undergone thoracoscopic TMR.
Methods:
: Between May 2003 and October 2005, 23 consecutive patients (6 without prior CABG, group A; and 17 with prior CABG, group B) underwent thoracoscopic TMR, using a holmium:yttrium-aluminum-garnet (Ho:YAG) laser system. Either 3 or 4 port incisions (each ≤2 cm in length) were used, depending on the patient's anatomy. Procedural success was defined as the ability to create all intended channels without conversion to thoracotomy.
Results:
: Patient demographics were not significantly different between group A and group B (mean age, 65.8 ± 4.3 years versus 67.4 ± 2.4 years, Canadian Cardiovascular Society angina class 3.7 ± 0.2 versus 3.9 ± 0.1, and Parsonnet score 12.0 ± 3.2 versus 20.5 ± 2.4). Fourteen (82.4%) group B patients had a prior left internal mammary artery to left anterior descending artery graft, of which 12 (85.7%) were patent. One patient in group A had an airway injury at intubation that led to an extended hospital stay of 30 days. One patient in group A (16.7%) and one patient in group B (5.9%) required a blood transfusion (P = NS). Adhesion lysis time in group B ranged from 0 to 68 minutes (mean, 27 ± 5.6 minutes). Neither group had a conversion to thoracotomy or any deaths through a mean combined follow-up of 12 months.
Conclusions:
: A port access approach is safe and reproducible for patients who are candidates for sole therapy TMR. Prior CABG, including patent grafts, is not a contraindication to thoracoscopic TMR.
