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Transmyocardial revascularization with holmium laser
F García Corrales1, J C García-Rubira, J I Font
1Department of Cardiovascular Medicine and Surgery, University Hospital V. Macarena, Sevilla, Spain.
Insights
Transmyocardial laser revascularization using holmium laser effectively treated refractory angina in patients ineligible for surgery. Survivors showed reduced angina, improved myocardial perfusion, and decreased ischemic burden.
Area of Science:
- Cardiology
- Minimally Invasive Surgery
Background:
- Angina refractory to medical therapy poses significant challenges.
- Standard revascularization options are not suitable for all patients.
Purpose of the Study:
- To evaluate the efficacy of transmyocardial laser revascularization (TMLR) with holmium laser in patients with severe angina ineligible for conventional treatments.
Main Methods:
- Sixteen patients with refractory angina underwent TMLR with holmium laser.
- Outcomes assessed included angina class, ejection fraction, Holter monitoring for ischemic burden, and myocardial perfusion imaging (201Tl SPECT).
Main Results:
- A significant reduction in angina class was observed at 6 months (p = 0.002).
- Myocardial perfusion improved in treated segments (p = 0.015), and Holter-measured ischemic burden decreased (p = 0.046).
- Ejection fraction did not significantly change, though baseline values were lower in non-responsive patients.
Conclusions:
- Holmium laser TMLR is an effective treatment for ischemic patients unsuitable for standard revascularization.
- Further research is needed to identify specific patient profiles that benefit most from this therapy.
Abstract:
Sixteen patients with angina refractory to medical therapy who were not considered suitable for standard revascularization underwent transmyocardial revascularization with holmium laser. The average age of the patients was 63.2 +/- 10.5 years. All of them had angina class 3 or 4, and 9 (56%) had previously undergone an aortocoronary bypass grafting. Four patients died during the 6-month follow-up period (25%). Among the survivors, anginal class decreased to class 2 or 1 at the 6th month (p = 0.002). Ejection fraction did not change. The ischemic burden by Holter decreased from 85.3 +/- 656 to 5.5 +/- 9.7 min (p = 0.046). Myocardial perfusion with 201Tl single photon emission computed tomography (SPECT) images at rest and after dipyridamole showed a significant improvement among the ischemic treated segments (p = 0.015). Baseline ejection fraction was somehow lower in nonresponsive than in responsive patients (33 +/- 13 vs. 49 +/- 10, p = 0.052). We conclude that transmyocardial laser revascularization with holmium laser is effective in treatment in ischemic patients not amenable to surgery or percutaneous procedures, as previously reported with CO2 laser. Further investigation is needed to determine which clinical profiles identify the patients for whom this therapy is suitable.