Transmyocardial revascularization (TMR) was used as a sole therapy treatment for patients with severe angina not amenable to CABG and PCI. Several clinical trials have demonstrated significant angina relief at 12 months and beyond. Our single center results in patients who had TMR with a Holmium:YAG laser were previously reported and demonstrated significant angina improvement at 12 months. This longitudinal follow-up evaluated mid-term (3-year) mortality and angina status in those patients who received TMR.
From July 1999 to August 2002, thirty-nine (39) limited-option patients underwent TMR via left anterior thoracotomy. Baseline characteristics included ejection fraction (mean 50), age (mean 67), previous CABG and/or PTCA [93%(36/39)], hypertension [90% (35/39)], triple-vessel disease [90%(35/39)]. Mean follow-up was 3.1+1.2 years (range 0.1 to 4 years). Canadian Cardiovascular Society Angina Scores (CCSAS) were determined in all consenting patients.
Mean angina class was 3.1 at baseline and 1.2 at mean of three years, demonstrating significant angina relief (p<0.0001). Angina improvement (>2 class CCSAS reduction) was 78% (21/27) at 3 years. No patients required additional revascularization procedures (e.g. CABG, PCI and/or redo TMR) subsequent to their TMR therapy. At a mean of 3 years, the overall mortality was 13% (5/39).
The significant angina relief that had been observed 12 months following sole therapy TMR in limited-option patients was sustained for three years. TMR data seen here, and in other reports, supports the application of TMR as an alternative revascularization strategy in this challenging patient population.
TMR provides significant long term angina relief in patients who suffered end stage angina. It improves patient’s quality of life.
M. Alzeerah, None.