STATE-OF-THE-ART PAPER
Myocardial laser revascularization for the treatment of end-stage coronary artery disease
Mehrdad Saririan, MD* and
Mark J. Eisenberg, MD, MPH, FACC ,*
* Division of Cardiology, McGill University Health Center, Montreal, Quebec, Canada
Divisions of Cardiology and Clinical Epidemiology, Jewish General Hospital, Montreal, Quebec, Canada
Manuscript received February 14, 2002;
revised manuscript received June 26, 2002,
accepted August 29, 2002.
* Reprint requests and correspondence: Dr. Mark J. Eisenberg, Divisions of Cardiology and Clinical Epidemiology, Jewish General Hospital/McGill University, 3755 Côte St. Catherine Road, Room A-118, Montreal, Quebec H3T 1E2, Canada.
marke{at}epid.jgh.mcgill.ca
Myocardial laser revascularization is a novel therapeutic technique aimed at delivering oxygenated blood via a series of channels to the ischemic regions of the heart. These channels may be created surgically or via a less invasive percutaneous approach. In patients with end-stage coronary artery disease, both transmyocardial laser revascularization (TMR) and percutaneous myocardial laser revascularization (PMR) have been associated with a reduction in symptoms, improved exercise tolerance, and enhanced quality of life. However, the mechanism of action of laser therapy is incompletely understood, the results of objective cardiac perfusion measurements are inconclusive, and multiple randomized trials have failed to demonstrate an increase in survival. In addition, the positive results seen in TMR trials have been questioned because of a lack of blinding, raising the possibility that the benefit may have been due to the placebo effect. Finally, two recent sham-controlled, randomized clinical trials of PMR have not shown any benefit of the procedure, but instead have highlighted the important role of the placebo effect in the response to PMR. Further research is, therefore, needed to elucidate the value of myocardial laser revascularization.
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Abbreviations and Acronyms
| | BELIEF | | Blinded Evaluation of Laser Intervention Electively for Angina Pectoris trial | | CABG | | coronary artery bypass graft surgery | | CAD | | coronary artery disease | | CCS | | Canadian Cardiovascular Society | | CO2 | | carbon dioxide | | DIRECT | | Direct Myocardial Revascularization in Regeneration of Endomyocardial Channels trial | | DMR | | direct myocardial revascularization | | FDA | | Food and Drug Administration | | Ho:YAG | | holmium:yttrium-argon-garnet | | IABP | | intraaortic balloon pump | | MRI | | magnetic resonance imaging | | PCI | | percutaneous coronary intervention | | PET | | positron emission tomography | | PMR | | percutaneous myocardial laser revascularization | | SPECT | | single-photon emission computed tomography | | TEE | | transesophageal echocardiography | | TMR | | transmyocardial laser revascularization | | VEGF | | vascular endothelial growth factor |
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