Some patients still experience angina despite optimal therapy as they are no more
candidates for CABG or PTCA. From April 1996 to April 97, 52 pts were referred to us for
transmyocardial laser revascularisation (TMR). 23 pts were treated by TMR, 17 received
CABG and the 13 remainders were medically treated. All patients treated with TMR had
angina as main symptom (Canadian Class III n = 6, Class IV n = 14). None of them had
unstable angina. 19 were males, mean age was 64 (37 to 83). Only 4 of them did not have
previous CABG. Fourteen had experienced one CABG, and five had had two CABG. Their
ejection fraction preoperatively was above 30% in all cases except for one of them. All
received quadruple therapy. Surgery was performed through a small left thoracotomy in the
4th intercostal space, without cardiopulmonary bypass. All patients showed a significant
decrease in their anginal status after TMR. Five pts died in the early post-operative period
due to congestive heart failure without pain and myocardial infarction in three pts. Among
the 18 survivors, 15 are in Canadian Class I or II, 3 remain symptomatic for angina.
Treadmill test performed pre and post operatively were significantly improved in 60% of
the pts, and Thallium Scans showed an increased uptake in 70%.
In conclusion, TMR is effective to relieve angina in pts not treatable by conventional means.
TMR improves myocardial perfusion in 70% of the pts, and increases exercise capacity.