New research published in the September 30 issue of the New England Journal of Medicine shows that the use of a laser to drill holes in heart muscle to restore blood flow significantly reduces pain and discomfort associated with heart disease, according to one of the lead authors of the paper, Dr. Robert March. March is a cardiothoracic surgeon at the Rush Heart Institute at Rush-Presbyterian-St. Luke's Medical Center in Chicago.
During transmyocardial laser revascularization, (TMR) surgeons use a carbon dioxide laser to cut 15 to 30 one-millimeter-size holes through the wall of the heart to improve blood flow to the heart muscle. The outside surface of the heart seals immediately, but the channels remain open to provide oxygen-rich blood to previously deprived areas with a corresponding decrease in pain associated with angina. The firing of the laser beams is synchronized to the patient's heartbeat, allowing surgeons to create these channels without stopping the patient's heart.
In the New England Journal of Medicine article, the first peer-reviewed study of its kind, researchers from 12 medical centers studied 192 patients who were randomly selected for treatment using TMR (91) or continued medical management drugs such as nitrates, beta blockers and calcium channel blockers (101).
The researchers found that after 12 months, angina improved at least 2 classes, based on the Canadian Cardiovascular Society angina scale, in 72 percent of the TMR patients compared to 13 percent of the medically managed patients.
"In lay terms, this improvement means these patients went from being bedridden with severe chest pain to being able to move about with little or no pain," March said. The study also found that myocardial perfusion, or the heart's ability to pump oxygen and nutrient rich blood to other parts of the body, improved by 20 percent in TMR patients but worsened by 27 percent in those who received only medications. Additionally, the rate of hospital admissions for unstable angina was 2 percent for TMR versus 69 percent for patients on medications.
"In patients who cannot benefit from bypass surgery or angioplasty, TMR safely and effectively improved their heart's ability to pump blood over a 12-month period," said March. "Moreover, the improved blood flow demonstrated by this index study will drive use of TMR in conjunction with difficult coronary bypass and angioplasty procedures."
March established Rush as a Center for Excellence in TMR, training dozens of surgeons each year on the procedure, which is now covered by Medicare. He began performing TMR procedures in 1995 and has done 140 since then.
Each year, approximately 80,000 Americans develop severe coronary artery disease that cannot be treated by conventional techniques, including bypass surgery or angioplasty. More than 7 million suffer from chest pain due to coronary artery disease.
PLC Systems, Inc., Franklin, Mass., developed and provided the carbon dioxide laser equipment used in this study.
Journal
New England Journal of Medicine