Reference
 
 
Evidence
Based
Guidelines
Supported by an Unrestricted Educational Grant from
Bayer Healthcare, Pharmaceuticals, West Haven, CT
 
 

REFERENCES

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    No significant perfusion noted in a canine model after Ho:YAG TMR.

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    Trial of 188 patients prospectively randomized to TMR or medical therapy in which exercise tolerance time, walk distance and angina reduction was seen in TMR patients but not in those treated medically.

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    Improved myocardial function after sole therapy CO2 TMR.

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    Significant long-term sustained angina reduction and fewer hospitalizations were seen in patients treated with CO2 TMR. As an extension of the randomized trial, the medical management cohort provides a long-term control group.

  • Allen KB, Dowling RD, Fudge TL, et al. Comparison of transmyocardial revascularization with medical therapy in patients with refractory angina. N Engl J Med 1999;341:1029-36.

    Prospective randomized controlled trial of 275 patients who had either Ho:YAG TMR or medical management. At one year 76% of the patients in the TMR group had significant angina reduction compared to 32% of the medical management group. No change in myocardial perfusion noted post-treatment.

  • Burkhoff D, Schmidt S, Schulman SP, Myers J, Resar J, Becker LC, Weiss J, Jones JW. Transmyocardial laser revascularization compared with continued medical therapy for treatment of refractory angina pectoris: a prospective randomized trial. Lancet 1999;354:885--90.

    182 patients prospectively randomized to Ho:YAG TMR or medical management. At one year, exercise tolerance was increased by 65 seconds in the TMR group with a 46 second decrease in the medical management group. Significant angina reduction was seen in 48% of the TMR group compared to 14% of the medical management group. Significant quality of life improvements were noted after TMR treatment as well.
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    Prospective randomized controlled trial of 192 patients treated with either CO2 TMR or medical management. 72% had significant angina reduction as compared to 13% of the medical management cohort. Myocardial perfusion was improved after CO2 TMR. Quality of life was also significantly improved for TMR patients, although there was no difference in one-year survival.

  • Horvath KA, Aranki SF, Cohn LH, March RJ, Frazier OH, Kadipasaoglu KA, Boyce SW, Lytle BW, Landolfo KP, Lowe JE, Hattler B, Griffith BP, Lansing AM. Sustained angina relief 5 years after transmyocardial laser revascularization with CO2 Laser. Circulation. 2001;104(12):I81-84.

    Angina improvement at one year maintained beyond five years after CO2 TMR. Similar improvements in quality of life were noted to be sustained.

  • Horvath KA, Cohn LC, Cooley DA, Crew JR Frazier OH, Griffith BP, Kadipasaoglu K, Lansing A, Mannting FR, March R, Mirhoseini MR, Smith C. Transmyocardial laser revascularization: results of multi-center trial using TLR as sole therapy for end stage coronary artery disease. J Thorac Cardiovasc Surg 1997;113:645--54.
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    Angina recurred at a significant rate 3 years after Ho:YAG TMR.
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    Outcomes of 169 patients who underwent combined CABG and TMR. Significant angina reduction with only 4% in angina class III or IV at 12 months. Age greater than 75, prolonged intensive care unit stay and in-hospital myocardial infarction were predictors of major adverse events.

  • Mack CA, Magovern CJ, Hahn RT, et al. Channel patency and neovascularization after transmyocardial revascularization using an excimer laser: results and comparison to nonlased channels. Circulation 1997;96(Suppl II):II-65-9.
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    TMR stimulates endogenous production of VEGF, which results in angiogenesis in porcine model of chronic myocardial ischemia.

  • Horvath KA, Belkind N, Wu J, Greene R, Doukas J, Lomasney JW, McPherson DD, Fullerton DA. Functional comparison of transmyocardial revascularization by mechanical and laser means. Ann Thorac Surg 2001;72:1997-2002

    Experimental investigation demonstrating similar angiogenesis with laser and mechanical TMR. Greater scar formation with various mechanical devices and only laser TMR improves the function of chronically ischemic myocardium.

  • Kwong KF, Kanellopoulos GK, Nickols JC, et al. Transmyocardial laser treatment denervates canine myocardium. J Thorac Cardiovasc Surg 1997;114:883-90.

    Initial study exploring denervation as a mechanism.

  • Hirsch GM, Thompson GW, Arora RC, Hirsch KJ, Sullivan JA, Armour JA. Transmyocardial laser revascularization does not denervate the canine heart. Ann Thorac Surg 1999;68(2):460-8.

  • Al-Sheikh T, Allen KB, Straka SP, Heimansohn DA, Fain RL, Hutchins GD, Sawada SG, Zipes DP, Engelstein ED. Cardiac sympathetic denervation after transmyocardial laser revascularization. Circulation 1999;100:135-40

  • Allen KB, Dowling RD, DelRossi AJ, Realyvasques F, Lefrak EA, Pfeffer TA, Fudge TL, Mostovych M, Schuch D, Szentpetery S, Shaar CJ. Transmyocardial laser revascularization combined with coronary artery bypass grafting: a multicenter, blinded, prospective, randomized, controlled trial. J Thorac Cardiovasc Surg 2000;119(3):540-9.

    Randomized trial comparing CABG with CABG plus TMR demonstrated improved 30 day survival in the CABG +TMR group.

  • Peterson ED, Kaul P, Kaczmarek RG, Hammill BG, Armstrong PW, Bridges CR, Ferguson TB. From Controlled Trials to Clinical Practice: Monitoring Transmyocardial Revascularization Use and Outcomes. (submitted ).
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    Fewer arrhythmias, less necrosis seen with CO2 laser vs. Ho:YAG laser in an experimental study.
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    transmyocardial revascularization. J Am Coll Cardiol 1999;34(1):55-61.
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    in relation to nonlasered perfused myocardial zones. Ann Thorac Surg 2001;71:53206.
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