Quality of life and survival after transmyocardial laser revascularization with the holmium: YAG laser

Kristine J. Guleserian, Hersh S. Maniar, Cindy J. Camillo, Marci S. Bailey, Ralph J. Damiano, Marc R. Moon, Thoralf Sundt, Glenn Pennington, James Jones

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background. The purpose of the this investigation was to assess postoperative survival and quality of life with transmyocardial laser revascularization (TMR) in high-risk patients. Methods. During a 24-month period, 81 consecutive patients underwent either sole therapy TMR (n = 34) or TMR with coronary artery bypass grafting (n = 47) using a holmium:yttrium-aluminum-garnet (YAG) laser. Outcomes were assessed in three high-risk groups, including patients with left ventricular dysfunction (ejection fraction ≤ 0.40) (n = 37), unstable angina (n = 30), and congestive heart failure (n = 33). Disease-specific quality of life was assessed using the Seattle Angina Questionnaire in 58 late survivors and compared with an age-matched cohort undergoing coronary artery bypass grafting only (no TMR) (n = 20). Results. Overall mortality was 6% ± 3% (±70% confidence limit) and appeared higher with left ventricular dysfunction (11% ± 5% vs 2% ± 2%), but the difference did not reach statistical significance (p = 0.17; power = 0.16). There was also no statistical difference with unstable angina (10% ± 6% vs 4% ± 3%;p > 0.53) or congestive failure (9% ± 5% vs 4% ± 3%; p > 0.66). However, survival at 18 months was significantly lower with left ventricular dysfunction (62% ± 9% vs 90% ± 5%; p < 0.003) and congestive failure (48% ± 10% vs 96% ± 3%; p < 0.001). For sole therapy TMR, quality of life was diminished comparing TMR with coronary artery bypass grafting (p < 0.004) and coronary artery bypass grafting only (p < 0.002). Conclusions. Transmyocardial laser revascularization can be performed in high-risk patients, but survival is significantly impaired in patients with left ventricular dysfunction and congestive failure, and quality of life is diminished without some degree of direct revascularization.

Original languageEnglish (US)
Pages (from-to)1842-1848
Number of pages7
JournalAnnals of Thoracic Surgery
Volume75
Issue number6
DOIs
StatePublished - Jun 1 2003

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Transmyocardial Laser Revascularization
Holmium
Solid-State Lasers
Quality of Life
Left Ventricular Dysfunction
Survival
Coronary Artery Bypass
Unstable Angina
Stroke Volume
Survivors
Heart Failure
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

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Quality of life and survival after transmyocardial laser revascularization with the holmium : YAG laser. / Guleserian, Kristine J.; Maniar, Hersh S.; Camillo, Cindy J.; Bailey, Marci S.; Damiano, Ralph J.; Moon, Marc R.; Sundt, Thoralf; Pennington, Glenn; Jones, James.

In: Annals of Thoracic Surgery, Vol. 75, No. 6, 01.06.2003, p. 1842-1848.

Research output: Contribution to journalArticle

Guleserian, KJ, Maniar, HS, Camillo, CJ, Bailey, MS, Damiano, RJ, Moon, MR, Sundt, T, Pennington, G & Jones, J 2003, 'Quality of life and survival after transmyocardial laser revascularization with the holmium: YAG laser', Annals of Thoracic Surgery, vol. 75, no. 6, pp. 1842-1848. https://doi.org/10.1016/S0003-4975(03)00178-4
Guleserian, Kristine J. ; Maniar, Hersh S. ; Camillo, Cindy J. ; Bailey, Marci S. ; Damiano, Ralph J. ; Moon, Marc R. ; Sundt, Thoralf ; Pennington, Glenn ; Jones, James. / Quality of life and survival after transmyocardial laser revascularization with the holmium : YAG laser. In: Annals of Thoracic Surgery. 2003 ; Vol. 75, No. 6. pp. 1842-1848.
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abstract = "Background. The purpose of the this investigation was to assess postoperative survival and quality of life with transmyocardial laser revascularization (TMR) in high-risk patients. Methods. During a 24-month period, 81 consecutive patients underwent either sole therapy TMR (n = 34) or TMR with coronary artery bypass grafting (n = 47) using a holmium:yttrium-aluminum-garnet (YAG) laser. Outcomes were assessed in three high-risk groups, including patients with left ventricular dysfunction (ejection fraction ≤ 0.40) (n = 37), unstable angina (n = 30), and congestive heart failure (n = 33). Disease-specific quality of life was assessed using the Seattle Angina Questionnaire in 58 late survivors and compared with an age-matched cohort undergoing coronary artery bypass grafting only (no TMR) (n = 20). Results. Overall mortality was 6{\%} ± 3{\%} (±70{\%} confidence limit) and appeared higher with left ventricular dysfunction (11{\%} ± 5{\%} vs 2{\%} ± 2{\%}), but the difference did not reach statistical significance (p = 0.17; power = 0.16). There was also no statistical difference with unstable angina (10{\%} ± 6{\%} vs 4{\%} ± 3{\%};p > 0.53) or congestive failure (9{\%} ± 5{\%} vs 4{\%} ± 3{\%}; p > 0.66). However, survival at 18 months was significantly lower with left ventricular dysfunction (62{\%} ± 9{\%} vs 90{\%} ± 5{\%}; p < 0.003) and congestive failure (48{\%} ± 10{\%} vs 96{\%} ± 3{\%}; p < 0.001). For sole therapy TMR, quality of life was diminished comparing TMR with coronary artery bypass grafting (p < 0.004) and coronary artery bypass grafting only (p < 0.002). Conclusions. Transmyocardial laser revascularization can be performed in high-risk patients, but survival is significantly impaired in patients with left ventricular dysfunction and congestive failure, and quality of life is diminished without some degree of direct revascularization.",
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T1 - Quality of life and survival after transmyocardial laser revascularization with the holmium

T2 - YAG laser

AU - Guleserian, Kristine J.

AU - Maniar, Hersh S.

AU - Camillo, Cindy J.

AU - Bailey, Marci S.

AU - Damiano, Ralph J.

AU - Moon, Marc R.

AU - Sundt, Thoralf

AU - Pennington, Glenn

AU - Jones, James

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Y1 - 2003/6/1

N2 - Background. The purpose of the this investigation was to assess postoperative survival and quality of life with transmyocardial laser revascularization (TMR) in high-risk patients. Methods. During a 24-month period, 81 consecutive patients underwent either sole therapy TMR (n = 34) or TMR with coronary artery bypass grafting (n = 47) using a holmium:yttrium-aluminum-garnet (YAG) laser. Outcomes were assessed in three high-risk groups, including patients with left ventricular dysfunction (ejection fraction ≤ 0.40) (n = 37), unstable angina (n = 30), and congestive heart failure (n = 33). Disease-specific quality of life was assessed using the Seattle Angina Questionnaire in 58 late survivors and compared with an age-matched cohort undergoing coronary artery bypass grafting only (no TMR) (n = 20). Results. Overall mortality was 6% ± 3% (±70% confidence limit) and appeared higher with left ventricular dysfunction (11% ± 5% vs 2% ± 2%), but the difference did not reach statistical significance (p = 0.17; power = 0.16). There was also no statistical difference with unstable angina (10% ± 6% vs 4% ± 3%;p > 0.53) or congestive failure (9% ± 5% vs 4% ± 3%; p > 0.66). However, survival at 18 months was significantly lower with left ventricular dysfunction (62% ± 9% vs 90% ± 5%; p < 0.003) and congestive failure (48% ± 10% vs 96% ± 3%; p < 0.001). For sole therapy TMR, quality of life was diminished comparing TMR with coronary artery bypass grafting (p < 0.004) and coronary artery bypass grafting only (p < 0.002). Conclusions. Transmyocardial laser revascularization can be performed in high-risk patients, but survival is significantly impaired in patients with left ventricular dysfunction and congestive failure, and quality of life is diminished without some degree of direct revascularization.

AB - Background. The purpose of the this investigation was to assess postoperative survival and quality of life with transmyocardial laser revascularization (TMR) in high-risk patients. Methods. During a 24-month period, 81 consecutive patients underwent either sole therapy TMR (n = 34) or TMR with coronary artery bypass grafting (n = 47) using a holmium:yttrium-aluminum-garnet (YAG) laser. Outcomes were assessed in three high-risk groups, including patients with left ventricular dysfunction (ejection fraction ≤ 0.40) (n = 37), unstable angina (n = 30), and congestive heart failure (n = 33). Disease-specific quality of life was assessed using the Seattle Angina Questionnaire in 58 late survivors and compared with an age-matched cohort undergoing coronary artery bypass grafting only (no TMR) (n = 20). Results. Overall mortality was 6% ± 3% (±70% confidence limit) and appeared higher with left ventricular dysfunction (11% ± 5% vs 2% ± 2%), but the difference did not reach statistical significance (p = 0.17; power = 0.16). There was also no statistical difference with unstable angina (10% ± 6% vs 4% ± 3%;p > 0.53) or congestive failure (9% ± 5% vs 4% ± 3%; p > 0.66). However, survival at 18 months was significantly lower with left ventricular dysfunction (62% ± 9% vs 90% ± 5%; p < 0.003) and congestive failure (48% ± 10% vs 96% ± 3%; p < 0.001). For sole therapy TMR, quality of life was diminished comparing TMR with coronary artery bypass grafting (p < 0.004) and coronary artery bypass grafting only (p < 0.002). Conclusions. Transmyocardial laser revascularization can be performed in high-risk patients, but survival is significantly impaired in patients with left ventricular dysfunction and congestive failure, and quality of life is diminished without some degree of direct revascularization.

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