Transmyocardial laser revascularization combined with coronary artery bypass grafting: A multicenter, blinded, prospective, randomized, controlled trial

Abstract

In a prospective, randomized, multicenter trial, transmyocardial revascularization combined with coronary artery bypass grafting in patients not amenable to complete revascularization by coronary bypass alone was safe; however, angina relief and exercise treadmill improvement were indistinguishable between groups at 12 months of follow-up. Operative and 1-year survival benefits observed after adjunctive transmyocardial revascularization require confirmation by a larger validation study, which is ongoing.

2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease

“…1026 At the same time, a large retrospective analysis of data from the STS National Cardiac Database, as well as a study of 169 patients from the Washington Hospital Center who underwent combined TMR-CABG, showed no difference in adjusted mortality rate compared with CABG alone. 1027,1115 In short, a TMR-CABG combination does not appear to improve survival compared with CABG alone.…”

“…A single randomized multicenter comparison of TMR (with a holmium:YAG laser) plus CABG and CABG alone in patients in whom some myocardial segments were perfused by arteries considered not amenable to grafting 1026 showed a significant reduction in perioperative mortality rate (1.5% versus 7.6%, respectively), and the survival benefit of the TMR-CABG combination was present after 1 year of followup. 1026 At the same time, a large retrospective analysis of data from the STS National Cardiac Database, as well as a study of 169 patients from the Washington Hospital Center who underwent combined TMR-CABG, showed no difference in adjusted mortality rate compared with CABG alone.…”

Mechanisms and Results of Transmyocardial Laser Revascularization

“…Myocardial laser revascularization has been performed percutaneously [74, 75, 76], thoracoscopically [77], via thoracotomy [12, 13, 14, 15, 16, 17, 18]and via sternotomy [78, 79, 80]. Aside from the percutaneous approach, all of the other surgical approaches have yielded similar symptomatic improvement.…”

“…While the results of sole-therapy TMR are encouraging, and were necessary to confirm the efficacy of the procedure, the future of TMR is in combination therapy [78, 79, 80]. Perhaps prescient, the description of Mirhoseini et al [1, 2]of using TMR with CABG provides the likely clinical scenario for the future.…”

Complex Coronary Artery Disease

“…One randomized controlled study have found that TMR combined with CABG may confer excellent perioperative and survival rates, including decreased opeartive mortality, inotropic support, and intensive care unit stay, while prolonging 1-year survival compared to those patients undergoing CABG alone. [49] Furthermore, patients who undergo both procedures appear to be less symptomatic at follow-up.…”