Quality of life and survival after transmyocardial laser revascularization with the holmium:YAG laser.
BACKGROUND
The purpose of this investigation was to assess postoperative survival and quality of life with transmyocardial laser revascularization (TMR) in high-risk patients.


METHODS
During a 24-month period, 81 consecutive patients underwent either sole therapy TMR (n = 34) or TMR with coronary artery bypass grafting (n = 47) using a holmium:yttrium-aluminum-garnet (YAG) laser. Outcomes were assessed in three high-risk groups, including patients with left ventricular dysfunction (ejection fraction < or = 0.40) (n = 37), unstable angina (n = 30), and congestive heart failure (n = 33). Disease-specific quality of life was assessed using the Seattle Angina Questionnaire in 58 late survivors and compared with an age-matched cohort undergoing coronary artery bypass grafting only (no TMR) (n = 20).


RESULTS
Overall mortality was 6% +/- 3% (+/- 70% confidence limit) and appeared higher with left ventricular dysfunction (11% +/- 5% vs 2% +/- 2%), but the difference did not reach statistical significance (p = 0.17; power = 0.16). There was also no statistical difference with unstable angina (10% +/- 6% vs 4% +/- 3%; p > 0.53) or congestive failure (9% +/- 5% vs 4% +/- 3%; p > 0.66). However, survival at 18 months was significantly lower with left ventricular dysfunction (62% +/- 9% vs 90% +/- 5%; p < 0.003) and congestive failure (48% +/- 10% vs 96% +/- 3%; p < 0.001). For sole therapy TMR, quality of life was diminished comparing TMR with coronary artery bypass grafting (p < 0.004) and coronary artery bypass grafting only (p < 0.002).


CONCLUSIONS
Transmyocardial laser revascularization can be performed in high-risk patients, but survival is significantly impaired in patients with left ventricular dysfunction and congestive failure, and quality of life is diminished without some degree of direct revascularization.
Guleserian
Kristine J
KJ
Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
Maniar
Hersh S
HS
Camillo
Cindy J
CJ
Bailey
Marci S
MS
Damiano
Ralph J
RJ
Moon
Marc R
MR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D011788:Quality of Life / Q000523:psychology; D012307:Risk Factors; D016019:Survival Analysis; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000401:mortality / Q000601:surgery