Procedural results and early clinical outcome of percutaneous transluminal myocardial revascularization

Shawl, Fayaz A; Domanski, Michael J; Kaul, Upendra; Dougherty, Kathy G; Hoff, Susan; Rigali, Gina E; Cornell, Stephanie L; Shahab, S.Tariq

« Previous Next »American Journal of Cardiology
Volume 83, Issue 4 , Pages 498-501, 15 February 1999

Procedural results and early clinical outcome of percutaneous transluminal myocardial revascularization

Fayaz A Shawl, MD
- Department of Interventional Cardiology, Washington Adventist Hospital, Takoma Park, Maryland, USA
- Address for reprints: Fayaz A. Shawl, MD, Department of Interventional Cardiology, Washington Adventist Hospital, 7600 Carroll Avenue, Takoma Park, Maryland 20912
Michael J Domanski, MD
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
Upendra Kaul, MD
- Department of Interventional Cardiology, Washington Adventist Hospital, Takoma Park, Maryland, USA
Kathy G Dougherty (CRTT)
- Department of Interventional Cardiology, Washington Adventist Hospital, Takoma Park, Maryland, USA
Susan Hoff, RN
- Department of Interventional Cardiology, Washington Adventist Hospital, Takoma Park, Maryland, USA
Gina E Rigali, RN
- Department of Interventional Cardiology, Washington Adventist Hospital, Takoma Park, Maryland, USA
Stephanie L Cornell, RN
- Department of Interventional Cardiology, Washington Adventist Hospital, Takoma Park, Maryland, USA
S.Tariq Shahab, MD
- Department of Interventional Cardiology, Washington Adventist Hospital, Takoma Park, Maryland, USA

Received 25 June 1998; received in revised form 23 September 1998; accepted 23 September 1998.

Abstract

A substantial number of patients present with medically refractory angina who are not candidates for angioplasty or bypass surgery. The creation of channels between the myocardium and the ventricular blood pool has been performed after thoracotomy with excellent relief of symptoms but has been associated with high perioperative mortality. We investigated the safety of a nonoperative, percutaneous technique for channel creation. Twenty-seven patients with angina and coronary anatomy not amenable to revascularization with coronary angioplasty or bypass surgery underwent percutaneous transluminal myocardial revascularization (PTMR). Energy from a Holmium:yttrium-aluminum-garnet (YAG) laser was directed through a fiber enclosed in a catheter to the ventricular myocardium creating channels between the blood pool and the myocardium. On average, 17 ± 4 channels were formed per patient. There were no procedure-related deaths, episodes of tamponade, or other complications except for an increase in creatine phosphokinase in 1 patient. Immediately after the procedure, there was no worsening of regional wall motion function in any patient, but rather improvement in some. All patients were discharged alive after a hospital stay of 1.8 ± 1.5 days. Mean Canadian Cardiovascular Society functional class declined from 3.6 ± 0.5 before the procedure to 0.65 ± 0.8 at 30 days after the procedure (p <0.01). For 12 patients eligible for 6-month follow-up, mean functional class was 0.94 ± 0.97. At 6-month stress testing, 9 of these 12 had no electrocardiographic evidence of ischemia. Thus, PTMR can be performed safely in the cardiac catheterization laboratory with a complication rate lower than that reported in surgical series and with excellent near-term symptomatic relief. The long-term effect of PTMR on mortality and relief of angina as well as its safety and effectiveness compared with the surgical approach remains to be defined.