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Transmyocardial revascularization utilizing a holmium:YAG laser
K B Allen1, R D Dowling, D A Heimansohn
1Department of Cardiovascular/Thoracic Surgery, St. Vincent Hospital and Health Care Center Indianapolis, IN, USA.
Summary
Transmyocardial revascularization using a holmium:yttrium-aluminum-garnet laser effectively reduced angina class in patients with refractory angina. This laser treatment proved beneficial for those untreatable by conventional methods.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Procedures
- Interventional Cardiology
Background:
- Refractory angina significantly impacts patient quality of life.
- Conventional treatments like percutaneous transluminal coronary angioplasty and coronary artery bypass grafting are not suitable for all patients.
- Intravenous nitroglycerin dependence indicates severe, untreatable angina.
Purpose of the Study:
- To evaluate the efficacy of transmyocardial revascularization (TMR) using a holmium:yttrium-aluminum-garnet (Ho:YAG) laser.
- To assess TMR in patients with refractory class IV or unstable angina.
- To determine if Ho:YAG laser TMR offers a viable treatment option for patients ineligible for standard revascularization procedures.
Main Methods:
- Ho:YAG laser transmyocardial revascularization was performed on 42 patients with refractory angina.
- Patients included those with Canadian Heart Association class IV (n=23) or unstable angina (n=19), dependent on intravenous nitroglycerin.
- Preoperative thallium studies assessed ischemic areas, with an average of 45+/-11 laser channels created during a mean 106+/-38 minute procedure via left anterior thoracotomy.
Main Results:
- Perioperative mortality was 12% (5/42), with no late deaths. Complications included arrhythmias (ventricular 7.1%, atrial 4.7%) and respiratory failure.
- Mean angina class significantly improved from baseline to 1.5+/-0.1 at 3 months (P < 0.002) and 1.1+/-0.1 at 6 months (P < 0.001).
- Mean follow-up was 5.4+/-3.0 months, with a mean postoperative length of stay of 5.5+/-4.9 days.
Conclusions:
- Transmyocardial revascularization utilizing a Ho:YAG laser significantly reduces angina class in patients with refractory angina.
- Ho:YAG laser TMR is a beneficial therapeutic option for patients with severe angina untreatable by conventional revascularization methods.
- The study demonstrates the potential of laser-based TMR in managing complex coronary artery disease.