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Ann Thorac Surg 2005;80:553-558
© 2005 The Society of Thoracic Surgeons

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Original article: Cardiovascular

Mid-Term Results After Thoracoscopic Transmyocardial Laser Revascularization

Department of Cardiothoracic Surgery, Cardiovascular Surgeons, PA, Orlando, Florida, and Osceola Regional Medical Center, Kissimmee, Florida

Accepted for publication February 14, 2005.

^_* Address reprint requests to Dr Allen, 700 W Oak St, Kissimmee, FL 34741 (Email: gary.allen{at}hcahealthcare.com).

BACKGROUND: Transmyocardial revascularization is a surgical therapy for the relief of severe angina in patients who are not suitable candidates for coronary artery bypass graft surgery or percutaneous coronary interventions. Historically, surgical techniques employed a left thoracotomy with or without thoracoscopic assist for visualization. This study evaluated the feasibility and midterm outcomes after transmyocardial laser revascularization performed using a completely thoracoscopic, closed chest approach.

METHODS: Patients (9 men [90%] and 1 woman [10%]) at a mean age of 66 ± 10 years who were ineligible for coronary artery bypass graft surgery or percutaneous coronary intervention underwent sole therapy transmyocardial laser revascularization using a completely thoracoscopic surgical approach using a holmium:yttrium-aluminum-garnet laser system. Preoperatively, patients had a mean ejection fraction of 0.51 ± 0.09 and a mean angina class of 3.7 ± 0.5.

RESULTS: A mean of 30 ± 2.4 channels were created during mean laser and operative procedure times of 14 ± 2.9 and 133 ± 32 minutes, respectively. Patients were extubated at a mean of 7.6 ± 12 hours and were discharged from the hospital at a mean of 5.4 ± 3.4 days. There were no hospital deaths or major complications. At a mean of 8.4 ± 5.5 months postoperatively, all patients survived and significant clinical improvement with a mean angina class of 1.3 ± 0.5 (p < 0.001).

CONCLUSIONS: A completely thoracoscopic surgical approach is feasible for sole therapy transmyocardial revascularization that affords improved visualization over a limited thoracotomy approach. Limited complications and significant clinical improvement after the procedure were observed. With minimal port manipulation, there is an opportunity for decreased postoperative pain; however, larger studies are warranted to verify this hypothesis.

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