Transmyocardial Laser Revascularisation

Abstract

Despite the advances made in direct myocardial revascularisation by surgical as well as interventional techniques, there is an increasing number of highly symptomatic patients for whom for none of these methods are suited. This has led to a renewed interest in techniques of indirect myocardial revascularisation, which were abandoned years ago because of the success achieved with bypass grafting and PTCA. Transmyocardial laser revascularisation has picked up the idea of transmural channels, filling with blood from the left ventricle, as first described by Sen et al. in 1965 [4]. Primarily used in combination with coronary bypass grafting, it has now become a sole therapy for end-stage coronary artery disease. While the mechanism of action of this new indirect procedure is still not quite clear, clinical improvements have been demonstrated in numerous studies.