NEW YORK, Sep 29 (Reuters Health) -- Creating tiny tunnels into the walls of the heart using lasers, a surgery called transmyocardial revascularization, improves the symptoms of patients with severe chest pain (angina).
Patients who underwent transmyocardial revascularization experienced fewer spells of uncontrollable chest pain, fewer hospitalizations for chest pain, and a better quality of life than patients treated with conventional medical therapy, according to two studies published in the September 30th issue of The New England Journal of Medicine.
The research team found that one year after treatment, 72% of laser-treated patients had significantly less chest pain compared with 13% of patients treated with medical therapy alone. Quality of life in the surgery group improved 38%, compared with 6% in the medically-treated group, report Dr. O.H. Frazier from the Texas Heart Institute in Houston, and colleagues in the Transmyocardial Carbon Dioxide Laser Revascularization Study Group.
But whereas the rates of admission for unstable chest pain were far lower in the transmyocardial revascularization group (2% versus 69%), the death rate was no different for the two groups, the report indicates.
The second study, conducted by Dr. Keith Allen from the Indiana Heart Institute in Indianapolis, and investigators from 17 other medical centers, showed similar improvements in patients treated with laser surgery. Success rates in the transmyocardial revascularization group reached 73% at one year, compared to 47% in the medical therapy group, according to their results. At 12 months, quality of life scores were 75% higher in the group treated with laser surgery.
Both studies conclude that transmyocardial revascularization using lasers may be useful in patients with chest pain despite medical therapy who cannot undergo heart bypass surgery or balloon angioplasty because of extensive disease.
But transmyocardial revascularization "is not a risk-free procedure," with mortality rates ranging from 5% to 20% or more, depending on how sick the patients are, note Drs. Richard Lange and L. David Hillis from the University of Texas Southwestern Medical Center in Dallas, in a related editorial. They argue that the lack of objective evidence -- in the form of improved exercise stress tests or imaging studies that show improved blood flow -- calls into question the superiority of surgery over medical therapy.
"Before the use of transmyocardial revascularization is embraced enthusiastically," Lange and Hillis suggest, "objective evidence of its (effectiveness) should be strong."
