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Ann Thorac Surg 2001;71:532-536
© 2001 The Society of Thoracic Surgeons

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Original article: cardiovascular

Survival after transmyocardial laser revascularization in relation to nonlasered perfused myocardial zones

^a Clinic of Cardiac Surgery, Medical University of Lübeck, Lübeck, Germany

Accepted for publication September 22, 2000.

Address reprint requests to Dr Sievers, Clinic of Cardiac Surgery, University Hospital of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
e-mail: sievers{at}medinf.mu-luebeck.de

Background. Transmyocardial laser revascularization for severe diffuse coronary artery disease reduces angina significantly. The effect on survival, however, is questionable, and risk factors are not adequately addressed. Considering that transmyocardial laser revascularization channels do not remain patent for improving direct myocardial blood supply, other variables such as perfusion through open native or grafted vessels in remote non–transmyocardial laser revascularization areas are probably more important for survival. This hypothesis is the subject of the study.

Methods. Transmyocardial laser revascularization was performed with a CO₂ laser system in 63 patients between October 1995 and December 1997. Patients received transmyocardial laser revascularization alone or in combination with coronary artery bypass grafting. The heart was divided into three perfusion zones as determined by the three major coronary arteries. Patients were divided into three groups according to the number of zones that were perfused by either a native coronary artery or a patent bypass graft: group 1 (n = 9), none; group 2 (n = 24), one; and group 3 (n = 30), two. Follow-up was performed at 3, 6, 12, 24, and 36 months and was 100% complete. Mean latest follow-up was 26.2 months, minimal follow-up of survivors was at least 12 months.

Results. Overall mortality was remarkably higher in group 1 (77.8%) compared with group 2 (20.8%, p = 0.005) and group 3 (13.3%, p = 0.001). Hospital mortality was 22.2% in group 1, 0% in group 2, and 3.3% in group 3. Late mortality was also higher in group 1 (55.5% versus 20.8%, and versus 9.9%, respectively). Cardiac deaths were more frequent in group 1 (55.5% versus 12.5% in group 2, p = 0.02, and versus 9.9% in group 3, p = 0.009). The number of perfused myocardial zones showed a significant influence for survival (p = 0.002).

Conclusions. These data give some directional evidence that survival seems to be beneficially affected by the number of nonlasered perfused myocardial zones through native vessels or grafts in patients undergoing transmyocardial laser revascularization.

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