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[Transmyocardial laser revascularization and rehabilitation]
T Kruse1, H Höffken, R Moosdorf
1Abteilung Innere Medizin-Kardiologie, Herzzentrum der Philipps-Universität Marburg.
Insights
Transmyocardial laser revascularization (TMLR) offers benefits for coronary artery disease patients. Combining TMLR with coronary artery bypass grafting (CABG) resulted in faster recovery and improved quality of life compared to TMLR alone.
Area of Science:
- Cardiology
- Minimally Invasive Cardiac Surgery
Background:
- Transmyocardial laser revascularization (TMLR) is an alternative therapy for ischemic myocardium when bypass grafting is not feasible.
- Coronary artery disease (CAD) and heart attack patients often have limited revascularization options.
Purpose of the Study:
- To evaluate the efficacy of TMLR, both as a standalone procedure and in combination with coronary artery bypass grafting (CABG).
- To assess patient well-being, quality of life, and functional capacity in the short term (3 months) post-TMLR.
Main Methods:
- Observational study of 86 patients (out of 110 operated between 1994-1996) undergoing TMLR or TMLR/CABG.
- Evaluations included quality of life assessments (NYHA, CCS classifications), stress tests, and myocardial perfusion scintigraphy.
- Data collected pre-operatively, within 10 days post-surgery, and at 3 months post-procedure.
Main Results:
- Both TMLR and TMLR/CABG groups showed improvements, with the TMLR/CABG group demonstrating a faster recovery and better outcomes.
- 85% of TMLR/CABG patients reported significant quality of life improvements versus 57% in the TMLR group.
- Stress test results showed substantial increases in power and endurance for both groups, with greater gains in the TMLR/CABG cohort.
Conclusions:
- TMLR provides benefits for symptomatic CAD patients, particularly when combined with CABG, leading to enhanced quality of life and functional capacity.
- A 3-month follow-up suggests positive outcomes, but longer-term data from randomized trials are necessary to confirm the definitive impact of TMLR and rehabilitation on prognosis.
Abstract:
Transmyocardial laser revascularization (TMLR) is a new technique for patients with CAD or heart attack to revascularize ischemic areas of the myocardium in which the localisation or the condition of the vessels does not allow bypass grafting. This study shows the results in observation of patients before and during the first 3 months after TMLR. Of 110 patients operated on from 1994 to 1996, 86 were evaluated for well being (quality of life), using NYHA- and CCS-classification, stress test and nitril-scintigraphy at rest and under stress conditions. 51 patients, of whom 11 were females, underwent TMLR combined with coronary artery bypass graft (CABG). 35 male patients were treated singularly with TMLR. The average age in both groups was 59 years (+/- 23). All patients were subject to phase I rehabilitation in specialised institutions after being mobilised in the operating hospital. The evaluations took place on the day of admission to the hospital prior to surgery, within 10 days after surgery and 3 months following. The average stay in the rehabilitation-institution was between 4 and 6 weeks. Our findings demonstrate that both groups profited from the procedures, while the TMLR/CABG group showed a faster recovery and a better outcome. In comparison to 57% of the TMLR group, 85% of the patients in the TMLR/CABG group reported an improvement ranging from good to significant in quality of life assessments. The TMLR/CABG rated from an average of initially 3.4 (+/- 0.6) to 2.1 (+/- 0.8) after 3 months at NYHA- and 3.3 (+/- 0.7) to 1.7 (+/- 0.8) at CCS-classification. The TMLR group rated from 3.6 (+/- 0.5) to 2.4 (+/- 0.8) in NHYA- and from 3.4 (+/- 0.5) to 1.9 (+/- 0.7) on the CSS-scales. A remarkable improvement was noted in the stress test with an increase in power and endurance from 21 to 89 watts for the combined group and 8 to 81 watts for the TMLR treated patients, who generally recovered more slowly. The perfusion scan showed the same tendencies as previously reported but in some cases the results were not congruent with other findings. Overall, our findings indicate that there is a benefit for terminally symptomatic CAD patients after TMLR, but an observation period of 3 months does not allow for final conclusions on this matter. Rehabilitation seems to be of value for TMLR-patients since they have shown a markedly better performance following 3-month treatment, but further data from clinical randomised trials are needed to determine the influence of TMLR with short- and long-term rehabilitation on the prognosis of the disease.