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

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. (Ann Thorac Surg 2000;70:1130-33) (C) 2000 by The Society of Thoracic Surgeons.