Transmyocardial laser revascularization in the treatment of end-stage coronary artery disease.

Transmyocardial laser revascularization has been used in 171 patients suffering from severe angina pectoris unresponsive to medical therapy at Deutsches Herzzentrum Berlin within the period from 7/1994 to 12/1997. In all patients conventional bypass surgery or PTCA, did not seem to offer the possibility of success. Postoperatively, the majority of the patients experienced a significant decrease in angina and better physical endurance. A statistically significant increase in myocardial perfusion or left ventricular contractility has not been detected. Perioperative mortality after TMR decreased from 8% among the first 40 patients to 2.5% among the 40 patients operated on most recently, with an overall mortality of 7%. The relief of angina symptoms and the improved quality of life after TMR seems to justify the use of the method in patients who presented with urgent indications for CABG surgery, although their coronary vessel status did not seem to promise success for this procedure. However, considering its experimental foundation and long-term effects, it seems that a conclusive assessment of TMR is not yet possible.