[Coronary artery bypass graft combined with transmyocardial laser revascularization. Survival and functional class at one-year follow-up].
OBJECTIVE
The use of Transmyocardial Laser Revascularization (TMLR) as a strategy to treat unstable angina has been reported in many studies. We analyze its safety and effectiveness in combined procedures (CABG + TMLR).


METHODS
A non-randomized, retrospective cohort study was performed from May 4, 1999 to May 25, 2000 in 21 TMLR patients (18 combined CABG + TMLR) and 118 CABG only procedures. Mortality and NYHA analyses were determined by telephone at follow-up.


RESULTS
Three hospital deaths were observed: one isolated TMLR patient, one valvular + CABG + TMLR patient, and one CABG + TMLR patient. A significantly higher incidence of preoperative angina was found in the group of patients with TMLR + CABG, than in the group with only CABG (83 vs 25%; p < 0.001). There were no differences in age, gender, ejection fraction, Parsonnet and EuroSCORE risk estimation, or mortality (5.1% isolated CABG, 5.6% combined). No episode of angina was detected during follow-up in the CABG + TMLR group: 88% patients were NYHA I, and 21% NYHA II.


CONCLUSIONS
Incomplete coronary revascularization may be complemented with TMLR in the areas in which CABG is not possible without increased mortality. This technique may avoid postoperative unstable angina due to residual ischemic areas.
Díaz De Tuesta
I
I
Hospital Universitario de Canarias, 38190 La L aguna, SC Tenerife. tuesta@usa.net
Martínez
R
R
D000368:Aged; D015331:Cohort Studies; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass / Q000379:methods / Q000401:mortality; D003327:Coronary Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000379:methods* / Q000401:mortality; D008297:Male; D009204:Myocardial Revascularization / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies