[Treatment strategies in therapy refractory angina pectoris: transmyocardial laser revascularization].
BACKGROUND
Does transmyocardial laser revascularization (TMLR) as a new surgical technique for treating patients with otherwise intractable angina pectoris improve myocardial perfusion or contractility?


METHODS
Sixty-seven patients transferred for TMLR were evaluated by clinical evaluation, treadmill stress testing, echocardiography, ventriculography, and hybrid positron emission tomography preoperatively and in patients treated with TMLR at 6 and 12 month follow up. Hemodynamic assessment and clinical evaluation were performed perioperatively.


RESULTS
In 28/67 cases (42%) CABG, in 9/67 patients (13%) CABG in combination with TMLR (combined group), and in 30/67 patients (45%) only TMLR (sole group) were performed. Perioperative mortality in the sole group was 13%, in the combined group zero, and in the CABG group 11%. In all groups a significantly improved clinical status (p < or = 0.01) 1 week postoperatively and in TMLR groups also at 6 and 12 months was observed. In the TMLR groups treadmill tolerance (p < 0.05) improved, although function, perfusion, and metabolism did not change significantly at the 6 and 12 month follow up.


CONCLUSIONS
TMLR significantly improves clinical status and treadmill stress tolerance, but does not change function, perfusion, and metabolism.
Lutter
G
G
Abteilung für Herz- und Gefässchirurgie Albert-Ludwigs-Universität Freiburg.
Frey
M
M
Saurbier
B
B
Nitzsche
E
E
Hoegerle
S
S
Brunner
M
M
Martin
J
J
Lutz
C
C
Spillner
G
G
Beyersdorf
F
F
D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis / Q000601:surgery*; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D053685:Laser Therapy / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000295:instrumentation*; D016896:Treatment Outcome
Behandlungsstrategien bei therapierefraktärer Angina pectoris: Transmyokardiale Laserrevaskularisation.