Combined Transmyocardial Laser Revascularization with Off-Pump Coronary Artery Bypass Grafting in Management of Patients with Severe Isehemic Heart Disease

Objectives To assess the safety and effecacy of combining transmyocardial laser revascularization (TMLR) with off-pump coronary artery bypass grafting (OPCAB) in patients, who were not amenable to complete revascularization by coronary artery bypass alone. Methods From October 1999 to June 2002, 10 patients whose standand of care were off-pump coronary artery bypass grafting and who had one or more nongraftable areas which were treated with Holmium YAG laser transmyocardial revasculariaztion as an adjunt. Results The mean number of vessels bypassed was 2.6±4 and the mean number of laser channels was 19.5±9. All patients were uneventful in the early postoperative period. Mean follow-up was 18.1±5 months. At this time, all patients were alive and had good quality of life. Mean CCS angina class decreased significantly from the baseline of 3.2±0.8 to 0.2±0.4(P 0.000 1), with 8 patients angina free. Non-patient had to use nitrates or readmit for cardiac events after operation. Mean resting left ventricular EF increased from baseline of 53.2% to 65.4% at follow-up, and left ventricular wall motion score was improved. Conclusions TMLR combined with OPCAB is a safe and effective surgical procedure to achieve complete myocardial revascularization in severe coronary artery disease patients with some ungraftable areas. As the long-term symptomatic benefits of sole TMLR is still uncertain, except in special conditions, it is best used as an adjunct to CABG.