Study On Clinical Effect Of Transmyocardial Laser (CO₂) Revascularization

Objectives: Since 1983, Transmyocardial laser revascularization (TMLR) was firstused for treatment of coronary heart disease(CHD)by Mirhoseini, there have almost been more than 20,000 patients who received this treatment. Transmyocardial laser revascularization(TMLR) has recently emerged as a valid alternative in patients with refractory angina and with coronary artery disease not suitable for coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTC A). The aim of this study was to determine whether short-term(l month) and long-term(3 year) clinical improvement of the angina pectoris, the myocardial ischemic size and the left ventricular ejection after isolated transmyocardial CO2 laser revascularization in patients with coronary artery disease not amenable to traditional treatment.Methods: Since 1999, we select 2 group patients. The first group involves 10patients who suffered CHD, angina pectoris. We call this group as medication group. These patients who had accepted in internal medicine receive regular medication and continue to accept medical therapy out of hospital. The second group involves 10patients who suffered CHD, angina pectoris, too. We call this group as TMLR group. These patients accept TMLR therapy by the high power 850w CO2 heart laser machine which was made by Beijing Meiman company( HL-100 type). We compare grade of angina pectoris in 1 month, 6 months, 1 year, 3 years after therapy between two groups. We compare the myocardial ischemic size in 1 year, 3 years after therapy between the two groups. We compare the left ventricular ejection fraction in 1 year,3 years between two groups, too.Result:(l) In the TMLR groups: All patients' grade of angina pectoris at 1 month, 6months, 1 year, 3 years after operation are reduced more than preoperation, and there is significant difference between each groups (P<0.01). The myocardial ischemic size at 1 year, 3 years after operation are significant reduced than preoperation (p<0.01), and the angina pectoris at 3 years after operation is more reduced than 1 year, but there is no significant difference between two groups (p>0.05). The left ventricular ejection fraction at 3 years, 1 year after operation is more increased than preoperation, too. (2) In the medication groups: The grade of angina pectoris at 1 month, 6 months, 1 year, 3 years after therapy is no significant difference with preoperation. The myocardial ischemic size and ejection fraction at 1 year, 3 years after therapy are no significant change. (3)Between the two groups: The grade of angina pectoris at 1 month, 6 months, 1 year, 3 years after therapy, the myocardial ischemic size and the left ventricular ejection fraction at 1 year, 3 years after therapy all have significant difference between two groups (p<0.01).Conclusion: These results suggest that revascularization by this laser technique as asole therapy result in clinical benefits for patients with reversible myocardial ischemic. The results indicate that TMLR can provide angina relief, improve myocardial perfusion and increase the left ventricular ejection fraction at short-term and long-term for patients with ischemic heart disease. Then TMLR is the best choice for patients with ischemic heart disease not amenable to percutaneous transluminal coronary angioplasty or coronary artery bypass grafting.