Early results of Transmyocardial Laser Revascularization (TMLR) with a holmium laser

Purpose: Transmyocardial Laser Revascularization is utilized for end stage coronary artery disease not amenable to coronary bypass or percutaneous intervention. We report here early follow-up of 14 patients undergoing TMLR. Methods: From February '97 to June '98 14 patients underwent TMLR according to a specific protocol; class III and IV angina patients with an ejection fraction of 30% or greater and reversible ischemia by thallium scan. Subsequent 3 month and 6 month follow-up was performed. Results: 8 patients have been followed for 1 year and have completed 3 month and 6 month thallium perfusion scans. 5 patients have shown significant improvement in ischemia and all have improved at least 2 anginal classes. There were no operative deaths, however, there were two late deaths. Conclusions: TMLR is a simple technique with low operative risk and early results that confirm marked clinical improvement in most patients. Clinical Implications: TMLR will become more frequently utilized in a broader clinical spectrum of patients. This is made possible by the low risk, morbidity, and cost of this procedure.