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Ann Thorac Surg 2003;75:1842-1848
© 2003 The Society of Thoracic Surgeons

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Original article: cardiovascular

Quality of life and survival after transmyocardial laser revascularization with the holmium:YAG laser

^a Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA

^* Address reprint requests to Dr Moon, Division of Cardiothoracic Surgery, Queeny Tower, Suite 3108, One Barnes-Jewish Hospital Plaza, St. Louis, Missouri 63110-1013, USA.
e-mail: moonm{at}msnotes.wustl.edu

Presented at the Forty-ninth Annual Meeting of the Southern Thoracic Surgical Association, Miami, FL, Nov 7–9, 2002.

BACKGROUND: The purpose of the this investigation was to assess postoperative survival and quality of life with transmyocardial laser revascularization (TMR) in high-risk patients.

METHODS: During a 24-month period, 81 consecutive patients underwent either sole therapy TMR (n = 34) or TMR with coronary artery bypass grafting (n = 47) using a holmium:yttrium–aluminum–garnet (YAG) laser. Outcomes were assessed in three high-risk groups, including patients with left ventricular dysfunction (ejection fraction ≤ 0.40) (n = 37), unstable angina (n = 30), and congestive heart failure (n = 33). Disease-specific quality of life was assessed using the Seattle Angina Questionnaire in 58 late survivors and compared with an age-matched cohort undergoing coronary artery bypass grafting only (no TMR) (n = 20).

RESULTS: Overall mortality was 6% ± 3% (±70% confidence limit) and appeared higher with left ventricular dysfunction (11% ± 5% vs 2% ± 2%), but the difference did not reach statistical significance (p = 0.17; power = 0.16). There was also no statistical difference with unstable angina (10% ± 6% vs 4% ± 3%; p > 0.53) or congestive failure (9% ± 5% vs 4% ± 3%; p > 0.66). However, survival at 18 months was significantly lower with left ventricular dysfunction (62% ± 9% vs 90% ± 5%; p < 0.003) and congestive failure (48% ± 10% vs 96% ± 3%; p < 0.001). For sole therapy TMR, quality of life was diminished comparing TMR with coronary artery bypass grafting (p < 0.004) and coronary artery bypass grafting only (p < 0.002).

CONCLUSIONS: Transmyocardial laser revascularization can be performed in high-risk patients, but survival is significantly impaired in patients with left ventricular dysfunction and congestive failure, and quality of life is diminished without some degree of direct revascularization.

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