Transmyocardial laser revascularization

Keith A. Horvath

Research output: Contribution to journalReview article

Abstract

Transmyocardial laser revascularization (TMR) has been performed on over 12,000 patients worlwide. Since 1990, the treatment has provided significant angina relief for symptomatic end-stage coronary disease that is refractory to medical therapy. Seventy-five percent of patients treated with TMR have demonstrated a decrease of two or more angina classes postoperatively. As a result, TMR has provided a significant improvement in quality of life for patients, resulting in fewer hospital admissions and decreased dependency on medications. Two different wavelengths of light, carbon dioxide (CO2) and holmium yttrium-aluminum-garnet (Ho:YAG), have been employed. Results obtained using these lasers differ. The CO2 laser has demonstrated a perfusion benefit as well as long-term improvement in quality of life and angina relief. The Ho:YAG laser has not demonstrated these results. These differences may, in part, explain the failure of percutaneous myocardial laser revascularization. This catheter-based approach was not as successful as TMR due to its partial thickness treatment of the myocardium as well as its use of the Ho:YAG laser. In addition to the patients with end-stage coronary disease who undergo TMR as sole therapy, there an increasing number of patients who been treated with a combination of coronary artery bypass grafting and TMR. This provides a more complete revascularization than leaving territories ungrafted. Further enhancement of the angiogenic response seen after TMR may be seen by the addition of gene therapy to TMR treatment.

Original languageEnglish (US)
Pages (from-to)53-59
Number of pages7
JournalCurrent Treatment Options in Cardiovascular Medicine
Volume6
Issue number1
DOIs
StatePublished - Mar 2004

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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