title: [Transmyocardial revascularization with a holmium laser: preliminary results].
abstract: BACKGROUND
  Transmyocardial laser revascularization (TMLR) aims to improve perfusion of the ventricular wall via laser-created transmural channels. We present the results of TMLR with a holmium laser as sole therapy in patients with angina refractory to medical treatment and extensive coronary artery disease unsuitable for angioplasty or coronary artery by-pass grafting.
  
  
  METHODS
  From November 1995 to February 1997, twenty-two patients underwent isolated TMLR with a holmium laser. Five patients (23%) were female; the mean age was 67 +/- 7 years (range 53 to 74 years). Previous myocardial revascularization procedures had been performed in 17 patients (77%). Mean preoperative angina class was 3.4 +/- 0.5 and unstable angina was present in 7 patients (32%).
  
  
  RESULTS
  There were no hospital deaths. The only postoperative complications were transient supraventricular arrhythmias in 6 patients (27%). Each patient received a mean of 33 +/- 8 channels in 27 +/- 13 minutes. There were two late deaths, 40 days and 4 months after TMLR, due to stroke and myocardial infarction, respectively. Mean follow-up duration was 8 +/- 5 months (range 40 days-15 months). The mean number of hospitalizations due to angina fell from 4.9 +/- 1.5 in the 6 months before TMLR to 1.5 +/- 1.0 in the 6 months following surgery (p < 0.001). At follow-up, mean angina class had significantly improved (1.8 +/- 0.6, p < 0.001), as well as effort tolerance, which increased from a mean of 3.5 +/- 1.4 minutes to 5.1 +/- 1.7 minutes (p = 0.01). 201Tl SPECT at 3 and 6 months did not show any significant changes in the segmental perfusion of the lased and unlased areas.
  
  
  CONCLUSIONS
  TMLR with a holmium laser is a simple procedure with low operative mortality and morbidity. Short-term results confirm that clinical improvement is obtained in most patients, although this is not supported by significant changes in myocardial perfusion at short-term follow-up.
authors.affiliation: Cattedra di Cardiochirurgia, Università degli Studi, Pisa.
authors.forename: A
authors.initials: A
authors.lastname: Milano
authors.forename: M
authors.initials: M
authors.lastname: De Carlo
authors.forename: S
authors.initials: S
authors.lastname: Pratali
authors.forename: C
authors.initials: C
authors.lastname: Barzaghi
authors.forename: C
authors.initials: C
authors.lastname: Nardi
authors.forename: G
authors.initials: G
authors.lastname: Paterni
authors.forename: C R
authors.initials: CR
authors.lastname: Bellina
authors.forename: R
authors.initials: R
authors.lastname: Mariotti
authors.forename: U
authors.initials: U
authors.lastname: Bortolotti
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000601:surgery; D003327:Coronary Disease / Q000601:surgery; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006695:Holmium; D006801:Humans; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications; D013997:Time Factors
chemical_list: D006695:Holmium