[Long-term results of percutaneous transmyocardial laser revascularization therapy at the University of Vienna Medical Center].
BACKGROUND
Percutaneous transmyocardial laser revascularization (PTMR) was used for treating patients with therapy refractory angina pectoris who are not amenable for angioplasty or bypass surgery ("no-option patients"). The aim of this study was to evaluate the short- and long-term results of PTMR-interventions performed at the University of Vienna between February 1999 and May 2000.


METHODS
Twenty-four "no-option" patients underwent PTMR. The chronically ischemic myocardial areas were determined by perfusion scintigraphy; after coronary angiography and contrast ventriculography 10 patients were treated with the Biosense laser using 3D-NOGA-mapping guidance and 14 patients with the Eclipse laser using biplane fluoroscopic guidance. After an average follow-up period (FUP) of 7.7 +/- 4.2 months, all patients underwent perfusion scintigraphy, coronary angiography and contrast ventriculography. Global and regional left ventricular (LV) function were calculated by the area-length method.


RESULTS
The ischemic myocardial areas of the patients were treated with an average of 16 laser points. In one patient, an intramural hematoma caused by the Biosense laser catheter was observed, in another patient the ventricular wall was perforated by the Eclipse laser (both events were resolved conservatively); during the in-hospital stay 2 patients suffered from severe angina pectoris and in one patient a pacemaker was implanted. During the 7-month-FUP one patient had a myocardial infarction; in one patient a stent implantation, in another one coronary bypass surgery had to be performed (in not-lasered areas), 2 patients died. Thus, the composite MACE rate was 33.3%. Angina class improved significantly during the FUP, but a trend to deterioration of global ejection fraction was observed. The rest and late rest myocardial perfusion remained unchanged.


CONCLUSIONS
While the angina class of the patients improved significantly, no significant change of myocardial perfusion but a trend to deterioration of LV function after the FUP were observed.
Gatterer
Melanie
M
Abteilung für Kardiologie, Universitätsklinik für Innere Medizin II, Wien, Osterreich.
Gyöngyösi
Mariann
M
Sperker
Wolfgang
W
Strehblow
Christoph
C
Khorsand
Aliasghar
A
Graf
Senta
S
Sochor
Heinz
H
Glogar
Dietmar
D
D000368:Aged; D000787:Angina Pectoris / Q000000981:diagnostic imaging / Q000601:surgery*; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods*; D011877:Radionuclide Imaging; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left