Mid-Term Results After Thoracoscopic Transmyocardial Laser Revascularization

Background Transmyocardial revascularization is a surgical therapy for the relief of severe angina in patients who are not suitable candidates for coronary artery bypass graft surgery or percutaneous coronary interventions. Historically, surgical techniques employed a left thoracotomy with or without thoracoscopic assist for visualization. This study evaluated the feasibility and midterm outcomes after transmyocardial laser revascularization performed using a completely thoracoscopic, closed chest approach. Methods Patients (9 men [90%] and 1 woman [10%]) at a mean age of 66 ± 10 years who were ineligible for coronary artery bypass graft surgery or percutaneous coronary intervention underwent sole therapy transmyocardial laser revascularization using a completely thoracoscopic surgical approach using a holmium:yttrium-aluminum-garnet laser system. Preoperatively, patients had a mean ejection fraction of 0.51 ± 0.09 and a mean angina class of 3.7 ± 0.5. Results A mean of 30 ± 2.4 channels were created during mean laser and operative procedure times of 14 ± 2.9 and 133 ± 32 minutes, respectively. Patients were extubated at a mean of 7.6 ± 12 hours and were discharged from the hospital at a mean of 5.4 ± 3.4 days. There were no hospital deaths or major complications. At a mean of 8.4 ± 5.5 months postoperatively, all patients survived and significant clinical improvement with a mean angina class of 1.3 ± 0.5 (p< 0.001). Conclusions A completely thoracoscopic surgical approach is feasible for sole therapy transmyocardial revascularization that affords improved visualization over a limited thoracotomy approach. Limited complications and significant clinical improvement after the procedure were observed. With minimal port manipulation, there is an opportunity for decreased postoperative pain; however, larger studies are warranted to verify this hypothesis.