title: Improved patient outcomes when transmyocardial revascularization is used as adjunctive revascularization.
abstract: BACKGROUND
  Transmyocardial revascularization (TMR) has been recently used to treat patients with angina for whom angioplasty/stenting and/or coronary artery bypass grafting (CABG) is no longer an option.
  
  
  METHODS
  A retrospective review of 255 consecutive patients who required CABG was done. Group 1 patients (n = 219) underwent complete revascularization with CABG alone. Group 2 patients (n = 36) received CABG plus TMR. TMR was performed in regions of nongraftable coronary targets. Indications for surgery in both groups were Canadian Cardiovascular Society angina scores III or IV and an ejection fraction > or = 30%. Exclusion criteria were an emergency procedure within 12 hours, unstable angina, or an acute myocardial infarction within 72 hours. Thirty-day outcomes of the two groups were compared. The means +/- SD of patient ages (63.3 +/- 1.6 years versus 65.4 +/- 1.4 years) and ejection fractions (51.6% +/- 0.9% versus 48.5% +/- 1.6%) were similar for the two groups.
  
  
  RESULTS
  The number of grafts performed and operating room times for the two groups were similar (3.1 +/- 0.1 versus 2.9 +/- 0.1 and 276.7 +/- 4.4 minutes versus 272.3 +/- 10.7 minutes, respectively). Intensive care unit times and lengths of stay (emergency room to discharge) were significantly shorter in the CABG plus TMR group (2.1 +/- 0.2 days versus 1.6 +/- 0.2 days [P < .001] and 8.2 +/- 0.4 days versus 7.1 +/-0.6 days [P < .001], respectively). The 30-day readmission rate was lower in the CABG plus TMR group (7.8% versus 2.8%; P < .5). The frequency of atrial fibrillation was also significantly lower in the CABG plus TMR group (37.4% versus 16.7%; P < .025). Major adverse outcomes, such as reoperation for bleeding, respiratory failure, renal failure, stroke, and mortality were similar in the two groups, although there were no mortalities in the CABG plus TMR group.
  
  
  CONCLUSIONS
  TMR as an adjunctive revascularization to CABG in selected patients with limited options may improve in-hospital outcomes.
authors.affiliation: Peninsula Heart Center, Salisbury, Maryland, USA. KWEHBERG@MSN.COM
authors.forename: Kurt E
authors.initials: KE
authors.lastname: Wehberg
authors.forename: J Stephens
authors.initials: JS
authors.lastname: Julian
authors.forename: James C
authors.initials: JC
authors.lastname: Todd
authors.forename: Nicholas
authors.initials: N
authors.lastname: Ogburn
authors.forename: Edward
authors.initials: E
authors.lastname: Klopp
authors.forename: Michael
authors.initials: M
authors.lastname: Buchness
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000379:methods; D006801:Humans; D053685:Laser Therapy; D007902:Length of Stay; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods*; D012189:Retrospective Studies; D013318:Stroke Volume; D016896:Treatment Outcome