Transmyocardial laser revascularization: a review.

There is an increasing number of treatment alternatives available for those with ischemic heart disease. Surgical procedures are more sophisticated, a wide array of medications are available, and numerous catheter techniques have evolved to treat patients with coronary artery disease. Technical advances and lifestyle modifications have contributed to a decline in age-adjusted death rates. Despite these advances, there remain a significant number of patients with myocardial ischemia who are not candidates for conventional therapies. Transmyocardial laser revascularization may be a viable adjunct or alternative therapy. In performing this technique, channels are made, from the epicardial surface of the heart through the left ventricle and endocardium, with the CO 2 laser. Perfusion is from the blood supply in the left ventricle via the channels. Postoperative thallium stress tests and left ventriculography indicate that the channels remain patent and protect the ischemic muscle. Experimental and early clinical results of transmyocardial laser revascularization suggest that a group of patients may benefit from this treatment.