10. Holmium YAG TMR Relieves Angina and Improves Functional Status

James W. Jones, Sheila E. Schmidt, Jeanne L. Holman, Charles C. Miller, III, Arthur C. Beall, Jr., John C. Baldwin

Baylor College of Medicine

Houston, Texas

Transmyocardial revascularization (TMR) hypothetically treated ischemic and angina by laser channeling of the myocardium, but actual effectiveness is unproven. We randomized 86 patients to medication control or TMR with Holmium: YAG laser. All patients were either CCSC three or four, on maximal doses of > 2 cardiac medications, and were not candidates for angioplasty or CABG. The TMR group has two preoperative MIs, including one (2.4 percent) preoperative death. The average hospital stay was 3.2 days. Four TMR patients and five controls died during the 12 month follow-up. No patient crossed groups. At 12 months TMR patients had significant angina class improvement compared to control (3.72 ± 0.09 vs 1.90 ± 0.2, P<0.0001) and their own preoperative status (3.86 ± 0.05 vs 1.90 ± 0.2, P<0.0001). Likewise, average ETT with a Modified Bruce protocol was significantly improved in the TMR group over than that reflected in preoperative values and that of the medication group after 12 months (5.12 ± 0.56 minutes vs 8.30 ± 0.5 minutes P=0.0002). Holmium: YAG laser channeling significantly improves functional status in advanced heart disease patients who lack other therapeutic options.