Single-center report of 5-year follow-up on 94 patients underwent transmyocardial laser revascularization

<正> Background Transmyocardial laser revascularization(TMLR)has been used in the treatment of patients withend-stage coronary artery disease(CAD)since 1990.The aim of this study was to evaluate the long-term effectivenessof TMLR in patients with diffuse CAD.Methods Ninety-four consecutive patients underwent TMLR in one center from July 1997 to December 2000.Thefollow-up data of these patients were obtained through face-to-face,mail questionnaires,or telephone interviews in July2004 and December 2004.Four cases failed to respond.Mean follow-up time was(5.5±1.0)years.Results Mean Canadian Cardiovascular Society(CCS)angina scores of TMLR patients were 3.1±0.8 at baseline,1.7±0.9 at 1 year(P<0.05),1.7±0.9 at 3 years(P<0.05),and 1.9±0.9 at 5 years(P<0.05).At an average of 5 years,69%of the patients had≥1 angina class reduction,mean NYHA class level(1.9±0.9)ameliorated compared to the baseline(2.5±0.7,P<0.001),the rate of re-hospitalization was 2.7 times/person.Kaplan-Meier survival rate was 87% at 1 year,69% at 3 years and 64% at 5 years.The causes of death were attributed more to heart failure(58.9%)and myocardialinfraction(14.7%)after TMLR.The patients with no angina relief,or who died after TMLR,had a higher percentage ofpreoperative unstable anginas or prior myocardial infraction compared to the survivors.The assorted shapes ofmyocardial laser channels were detected in some patients by the color Doppler velocity technique.Conclusions TMLR provided a long-term improvement in the quality of life,including CCS angina class or NYHA heartfunctional class for about 70% of Chinese patients with severely disabling angina pectoris.The various myocardial laserchannels would always be visible after TMLR.5-years after TMLR as a sole therapy,the survival rate of the patients was 64%.