Transmyocardial laser revascularisation as an adjunct to CABG

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Medical Technology

Background:

• Ischemic heart disease remains a significant global health challenge.
• Transmyocardial laser revascularization (TMLR) offers a novel approach to perfuse ischemic myocardium through laser-created channels.
• TMLR can be performed independently or in conjunction with Coronary Artery Bypass Grafting (CABG).

Purpose of the Study:

• To evaluate the efficacy and safety of Transmyocardial laser revascularization (TMLR) in patients with ischemic myocardium.
• To assess the impact of TMLR on myocardial perfusion, angina symptoms, and functional status.
• To analyze early clinical outcomes and long-term follow-up results of TMLR procedures.

Main Methods:

• Transmyocardial laser revascularization (TMLR) was performed on 116 patients, with 104 undergoing combined TMLR and CABG.
• Patient demographics included ages 37-73, with significant pre-operative angina (CCS class III/IV) and reduced LVEF in 19%.
• Thirteen patients underwent TMLR without cardiopulmonary bypass (beating heart procedure).

Main Results:

• Early mortality was low at 2.88%, with minimal cardiac enzyme elevations (CPK-MB, Troponin T) and ECG changes.
• Myocardial perfusion scans showed progressive improvement, with the perfusion index increasing from 52% at 3 months to 91% at 12 months.
• At 12-month follow-up, 91.6% of patients were angina-free, and Karnofsky scores improved from 46% to 86%.

Conclusions:

• Transmyocardial laser revascularization (TMLR) is a safe and effective treatment for ischemic heart disease, significantly improving myocardial perfusion.
• TMLR leads to substantial and sustained relief from angina symptoms and enhances patients' functional capacity.
• The combined TMLR and CABG approach is indicated for patients with bypassable vessels and diffuse coronary disease, offering favorable outcomes.