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Ann Thorac Surg 2000;70:1130-1133
© 2000 The Society of Thoracic Surgeons

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Supplement: cardiothoracic techniques & technologies

Symptomatic improvement after transmyocardial laser revascularization: how long does it last?

^a CardioThoracic Department, University of Pisa, Pisa, Italy

Address reprint requests to Dr Bortolotti, U.O. Cardiochirurgia, Ospedale Cisanello, Via Paradisa 2, 56124 Pisa, Italy
e-mail: u.bortolotti{at}cardchir.med.unipi.it

Presented at the Sixth Annual Cardiothoracic Techniques and Technologies Meeting 2000, Fort Lauderdale, FL, Jan 27–29, 2000

Background. The aim of this study was to determine whether short-term clinical improvement after isolated transmyocardial holmium laser revascularization (TMLR) in patients with coronary artery disease not amenable to traditional treatment is maintained through a longer follow-up.

Methods. Between November 1995 and June 1999 34 patients underwent TMLR (mean age, 67 ± 7 years); previous revascularization procedures had been performed in 76%. Preoperatively, mean angina class was 3.6 ± 0.5 in 12 patients with unstable angina; mean left ventricular ejection fraction was 47% ± 9%.

Results. There was 1 early death due to low cardiac output. Mean duration of TMLR and of the entire operation was 25 ± 12 minutes and 125 ± 43 minutes, respectively. There were no major postoperative complications; mean hospital stay was 8 ± 4 days. There were 8 late deaths caused by stroke (2 patients), cardiac failure (1 patient), and myocardial infarction (5 patients). Follow-up of current survivors ranges from 4 to 48 months (mean, 32 ± 12 months). At 1-year follow-up mean angina class was 1.8 ± 0.8; but at a later follow-up (mean, 35 ± 10 months) it significantly increased to 2.2 ± 0.7 (p = 0.005). Three-year actuarial survival was 76% ± 8% and freedom from cardiac events 44% ± 10%.

Conclusions. Our results show that after initial clinical improvement many patients experience return of angina or cardiac events; this questions the long-term symptomatic benefit of TMLR.

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