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(Circulation. 2001;104:I-81.)
© 2001 American Heart Association, Inc.

Surgery for Coronary Artery Disease

Sustained Angina Relief 5 Years After Transmyocardial Laser Revascularization With a CO₂ Laser

Keith A. Horvath, MD; Sary F. Aranki, MD; Lawrence H. Cohn, MD; Robert J. March, MD; O. Howard Frazier, MD; Kamuran A. Kadipasaoglu, PhD; Steven W. Boyce, MD; Bruce W. Lytle, MD; Kevin P. Landolfo, MD; James E. Lowe, MD; Brack Hattler, MD; Bartley P. Griffith, MD; Allan M. Lansing, MD, PhD

From the Northwestern University Medical School (K.A.H.), Chicago, Ill; Brigham and Women’s Hospital (S.F.A., L.H.C.), Boston, Mass; Rush-Presbyterian-St Luke’s Medical Center (R.J.M.), Chicago, Ill; Texas Heart Institute (O.H.F., K.A.K.), Houston, Tex; Washington Hospital (S.W.B.), Washington, DC; Cleveland Clinic (B.W.L.), Cleveland, Ohio; Duke University Hospital (K.P.L., J.E.L.), Durham, NC; University of Pittsburgh Hospital (B.H., B.P.G.), Pittsburgh, Pa; and Norton Audubon Hospital (A.M.L.), Louisville, Ky.

Correspondence to Keith A. Horvath, MD, Division of Cardiothoracic Surgery, Northwestern University Medical School, 201 E Huron St, Galter 10-105, Chicago, IL 60611. E-mail khorvath{at}nmh.org

Background— Although transmyocardial laser revascularization (TMR) has provided symptomatic relief of angina over the short term, the long-term efficacy of the procedure is unknown. Angina symptoms as assessed independently by angina class and the Seattle Angina Questionnaire (SAQ) were prospectively collected up to 7 years after TMR.

Methods— Seventy-eight patients with severe angina not amenable to conventional revascularization were treated with a CO₂ laser. Their mean age was 61±10 years at the time of treatment. Preoperatively, 66% had unstable angina, 73% had had 1 myocardial infarction, 93% had undergone 1 CABG, 42% had 1 PTCA, 76% were in angina class IV, and 24% were in angina class III. Their average pre-TMR angina class was 3.7±0.4.

Results— After an average of 5 years (and up to 7 years) of follow-up, the average angina class was significantly improved to 1.6±1 (P=0.0001). This was unchanged from the 1.5±1 average angina class at 1 year postoperatively (P=NS). There was a marked redistribution according to angina class, with 81% of the patients in class II or better, and 17% of the patients had no angina 5 years after TMR. A decrease of 2 angina classes was considered significant, and by this criterion, 68% of the patients had successful long-term angina relief. The angina class results were further confirmed with the SAQ; 5-year SAQ scores revealed an average improvement of 170% over the baseline results.

Conclusions— The long-term efficacy of TMR persists for 5 years. TMR with CO₂ laser as sole therapy for severe disabling angina provides significant long-term angina relief.

Key Words: laser • revascularization • coronary disease • angina