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ARTICLE

Transmyocardial revascularization with CO₂ laser in patients with refractory angina pectoris

Clinical results from The Norwegian Randomized Trial

^a Division of Heart and Lung Diseases, The National Hospital, University of Oslo, Oslo, Norway
^b The Feiring Heart Clinic, Feiring, Norway

Manuscript received July 9, 1999; revised manuscript received October 25, 1999, accepted December 15, 1999.

Reprint requests and correspondence: Dr. Lars Aaberge, Department of Cardiology, Rikshospitalet, N-0027 Oslo, Norway
laaaberg{at}online.no

OBJECTIVES

The purpose of the study was to evaluate clinical effects, exercise performance and effect on maximal oxygen consumption (MVO₂) of transmyocardial revascularization with CO₂-laser (TMR) in patients with refractory angina pectoris.

BACKGROUND

Transmyocardial laser revascularization is a new method to treat patients with refractory angina pectoris not eligible for conventional revascularization. Few randomized studies comparing TMR with conventional treatment have been published.

METHODS

One hundred patients with refractory angina not eligible for conventional revascularization were block-randomized in a 1:1 ratio to receive continued optimal medical treatment (MT) or TMR in addition to MT. The patients were evaluated at baseline and at three and 12 months with end points to symptoms, exercise capacity and MVO₂.

RESULTS

Transmyocardial laser revascularization resulted in significant relief in angina symptoms after three and 12 months compared to baseline. Time to chest pain during exercise increased from baseline by 78 s after three months (p = NS) and 66 s (p < 0.01) after 12 months in the TMR group, whereas total exercise time and MVO₂ were unchanged. No significant changes were observed in the MT group. Perioperative mortality was 4%. One year mortality was 12% in the TMR group and 8% in the MT group (p = NS.)

CONCLUSIONS

Transmyocardial laser revascularization was performed with low perioperative mortality and caused significant symptomatic improvement, but no improvement in exercise capacity.

Abbreviations and Acronyms   CABG = coronary artery bypass grafting   CCS = Canadian Cardiovascular Society   ECG = electrocardiogram   LVEF = left ventricular ejection fraction   MI = myocardial infarction   MT = medical treatment   MVO2 = maximal oxygen consumption   NYHA = New York Heart Association   TMR = transmyocardial laser revascularization

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