Myocardial laser revascularization in the year 2000 as seen by a Norwegian specialist panel. The process of evaluating and implementing new methods in clinical practice.
OBJECTIVE
In Norway "Transmyocardial laser revascularization" as a routine method was prohibited by the Ministry of Health in 1995 due to lacking evidence of treatment effect and concerns about procedural morbidity and mortality. In 1999 Norwegian health authorities asked for a re-evaluation of the method based on a systematic review of literature.


METHODS
Medline and Embase were searched and a total of 267 articles were identified. Publications were classified by an expert panel according to type of study and importance for the project.


RESULTS
Based on the literature review the panel concluded that heart laser treatment does not have a life-saving effect, nor does it improve myocardial function. However, the method has a considerable short-term symptomatic effect, the mechanism of which is not understood. Neoangiogenesis, denervation and placebo may play a role. Based on the report the Norwegian health authorities recommended use of this method be restricted to scientific trials only.


CONCLUSIONS
Based on a systematic literature review it was concluded that the only documented effect of heart laser treatment is symptom relief, the mechanism for which is unclear. It could partly or totally be a placebo effect. A conflict of interest may arise when new technologies are to be implemented in health care. The communication between professionals evaluating scientific results and decision makers is challenging. Quality assurance of this process may be obtained by use of expert panels working under the auspices of an official institution.
Wiseth
R
R
Division of Cardiology, Norwegian Univerity of Science and Technology, Trondheim. rune.wiseth@medisin.ntnu.no
Forfang
K
K
Ilebekk
A
A
Myhre
K I
KI
Nordrehaug
J E
JE
Sørlie
D
D
D006331:Heart Diseases / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects / Q000401:mortality* / Q000639:trends*; D009204:Myocardial Revascularization / Q000009:adverse effects / Q000401:mortality* / Q000639:trends*; D009664:Norway; D015996:Survival Rate