Transmyocardial Laser Revascularization: Saudi Experience

Abstract

One hundred transmyocardial revascularization procedures were performed between February 1994 and January 1996, using the C02 Heart Laser on 90 patients with stable angina and 10 with unstable angina. This was the sole therapy in 98 cases and utilized in combination with open-heart surgery in 2 others. Most patients (96) had this procedure without having undergone previous coronary artery bypass graft surgery; 66 patients were deemed to have nongraftable vessels, while 34 patients had coronary artery anatomy that was favorable to bypass graft surgery but elected to undergo laser revascularization instead. The majority (86%) were male and ages ranged from 30 to 82 (mean 55) years. At 12 months after the procedure, 92% of patients reported that they were free of angina, while mean exercise tolerance increased from 7 minutes preoperatively to 15 minutes, and metabolic equivalent units rose from 4.8 to 10.2. The average increase in Karnofsky performance score was 51%, and oxygen consumption improved by 93%. The increase in left ventricular ejection fraction was not statistically significant. Most patients resumed work within 18 days of the procedure. Consumption of antianginal medication was reduced to minimal in 83% of the patients at the end of one year. There were 10 deaths in the series, chiefly in patients with extremely low ejection fractions. We conclude that the application of this rapidly evolving procedure as a primary therapy in ungraftable patients, appears to be safe and deserving further study.