Clinical application of transmyocardial laser revascularization

Transmyocardial laser revascularization (TMLR), a new technique, provides direct perfusion of ischemic myocardium via laser-created transmural channels. From 1995 to 1996, we treated 7 patients (mean age 60 years, all men) with TMLR. Preperatively, 5 patients were in angina class (C. C. S) 3-4 and 2 patients had unstable angina. To identify the location and extent of their reversible ischemia, the coronary angiogram, 99mSPECT and/or dobutamine echocardiography was performed before operation in 7 patients. Through a left anterior thoractomy in the fifth intehcostal space, heart exposure was gained. With the use of a 700-watt CO2 laser, TMLR was performed on the beating heart. An average of 22 +/- 3 channels were created in 45 minutes with a total operative time of less than 2 and half hours. The in hospital mortality was one of 7 patients. Follow-up ranged from 2 to 12 months (accumulated 48 patient-months). Postoperatively, the relief of angina was noted in 6 patients. Postoperative SPECT and dubatamin-UCG were obtained at 3, 6, and 12 months. (99mTc) SPECT showed a significant improvement of myocardial perfusion in the area of reversible ischemia. Dobutamin-UCG documented an increase in the ventricular wall motion and LVEF in 2 patients as compared with basline. These early results indicate that TMLR may provide angina relief, improve myocardial perfusion and increase cardiac function for patients with ischemic heart disease.