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Ann Thorac Surg 2004;78:875-881
© 2004 The Society of Thoracic Surgeons

Original article: cardiovascular

Transmyocardial revascularization using an XeCl excimer laser: Results of a randomized trial

Jos A. P. van der Sloot, MD, PhDa,b, Menno Huikeshoven, PhDa,c, Raymond Tukkie, MD, PhDa, Hein J. Verberne, MDd, Jan van der Meulen, MDe, Berthe L. F. van Eck-Smit, MD, PhDd, Martin J. C. van Gemert, PhDc, Jan G. P. Tijssen, PhDa, Johan F. Beek, MD, PhDc,*

a Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
b Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
c Laser Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
d Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam The Netherlands
e Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands

Accepted for publication February 18, 2004.

* Address reprint requests to Dr Beek, Laser Center, Academic Medical Center, University of Amsterdam, Meiberg dreef 9, 1105AZ Amsterdam, PO Box, 22700 1100DE Amsterdam, the Netherlands
j.f.beek{at}amc.uva.nl

BACKGROUND: CO2 and holmium:yttrium aluminum garnet (YAG) transmyocardial laser revascularization (TMLR) are used to treat patients with refractory angina. A randomized trial to investigate the efficacy and safety of XeCl excimer TMLR was performed.

METHODS: Thirty patients with refractory angina were randomized in pairs to excimer TMLR or maximal medication. We assessed angina, quality of life (QOL), exercise time, myocardial perfusion, and ventricular wall motion at base line and at 3, 6, and 12 months after TMLR.

RESULTS: TMLR patients manifested a significantly better outcome with respect to angina class and quality of life. One TMLR patient died perioperatively versus none in the control group. After TMLR angina decreased from class 3.8 ± 0.4 at base line to 1.9 ± 0.9 at 12 months versus 3.9 ± 0.3 to 3.7 ± 0.6 in the control group, respectively (p = 0.000001). At 12 months a decrease of greater than or equal to two angina classes was indicated in 11 out of 14 TMLR patients versus none in the control group (p = 0.00001). Improved myocardial perfusion or exercise time was not indicated despite a small decrease in reversible wall motion abnormality score.

CONCLUSIONS: Excimer TMLR significantly relieves angina and improves QOL without evidence of improved cardiac perfusion or function.






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