Coronary artery bypass grafting with concurrent transmyocardial laser revascularization

An increasing number of patients suffer from chronic and unremitting angina pectoris that severely impacts their quality of life. The use of traditional techniques, such as coronary artery bypass graft surgery, may not provide complete revascularization in up to 25% of patients due to the severe and diffuse nature of coronary artery disease. Transmyocardial laser revascularization has emerged as a feasible surgical modality for patients with refractory angina pectoris who have exhausted standard medical and interventional options. Based on the cumulative clinical evidence, transmyocardial laser revascularization plus coronary artery bypass grafting has been shown to provide significant symptomatic relief against angina and improve overall outcomes. As a result, the use of adjunctive transmyocardial laser revascularization with coronary artery bypass grafting is warranted in select patients not amenable to complete myocardial revascularization with conventional interventions.

A DECADE OF EXPERIENCE IN APPLICATION OF TRANSMYOCARDIAL LASER REVASCULARIZATION IN COMBINATION WITH AORTOCORONARY SHUNTING

Objective: to study the security and the effect of transmyocardial laser revascularization in combination with aortocoronary shunting in patience with diffuse coronary artery disease.Materials and methods: the study compared the results of surgical treatment in patients with diffuse distal coronary artery disease in the period from 2007 to 2013. Patients were divided into two groups, the first group consisted of patients who underwent CABG in combination with TMLR (n-60), the second group includes patients who underwent isolated CABG (n-46). According to the initial demographic data and comorbidity, the groups were not significantly different from each other. Subsequent observation (on average 7, 5±0, 9 years) included rating of survival and return of angina. Results: remote mortality during the observation period in the first group was 7, 6 % (n = 4), and in the second group — 18, 9 % (n = 7). In both groups the functional class of angina pectoris significantly decreased, however, in the first group this tendency was more expressed (exertional angina I EF in the CABG + TMLR group have 54 (90 %) patients, in the second group — 33 (71,7 %), p = 0,02. Conclusions: transmyocardial laser revascularization in combination with aortocoronary shunting in high-risk patients with diffuse atherosclerotic lesions of the coronary arteries contributed to an increase in exercise tolerance, reduced symptoms, and provided an acceptable quality of life in the long term.