Guidelines for the clinical use of transmyocardial laser revascularization.
Patients with chronic, severe angina refractory to medical therapy who cannot be completely revascularized with either percutaneous catheter intervention or coronary artery bypass graft surgery (CABG) are clinically challenging. Transmyocardial laser revascularization (TMR), as sole therapy or as an adjunct to CABG, may be appropriate therapy for these patients. The recommendations are based on a review of the available evidence including expert consensus opinions. The author follows the format of the American Heart Association and the American College of Cardiology guidelines for diagnostic and therapeutic procedures. There are class I indications for sole therapy TMR and class IIA indications for TMR as an adjunct to CABG. TMR is indicated for selected patients: as sole therapy for a subset of patients with refractory angina. It also may be effective as an adjunct to CABG for a subset of patients with angina who cannot be completely revascularized surgically.
Bridges
Charles R
CR
Department of Surgery, the University of Pennsylvania Health System Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. cbridges@pahosp.com
D000787:Angina Pectoris / Q000601:surgery; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000401:mortality / Q000601:surgery*; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects; D009204:Myocardial Revascularization / Q000009:adverse effects; D017410:Practice Guidelines as Topic; D012307:Risk Factors