ORLANDO, Nov. 12, 1997 -- Using a laser to drill tiny holes in the heart to provide new blood flow dramatically reduces chest pain and cuts hospitalizations for individuals whose heart disease makes them poor candidates for surgery or angioplasty, according to a report today at the American Heart Association's 70th Scientific Sessions.
The procedure, called transmyocardial revascularization (TMR), allows blood from the pumping chamber of the heart to percolate up through the laser holes and supply the surrounding heart muscle with blood. TMR is available at only a few medical centers conducting Food and Drug Administration-approved investigations.
Keith B. Allen, M.D., a cardiothoracic surgeon at St. Vincent Hospital in Indianapolis, Ind., says of the multicenter study, "A lot of these individuals have diabetes or severe heart disease or they have had multiple heart operations and have reached the end of the road as far as the potential for further interventions to be successful. TMR offers real hope for these patients."
If the current study's results are supported by future research, Allen estimates between 50,000 and 100,000 U.S. patients could benefit from TMR each year. Those patients are in the Class IV category. Their heart muscles are so deprived of oxygen they experience chest pain even at rest and their activities are extremely limited.
"We don't know if it will make people live longer or decrease the incidence of heart attacks," he says, "but it clearly improves their ability to function and their quality of life."
The researchers studied 162 individuals with severe chest pain, or "refractory angina." Angina, or chest pain, is caused when the heart muscle does not get enough oxygen-rich blood. Of the 76 assigned to TMR, 74 underwent the procedure. Surgeons drilled about 40 holes, each one-millimeter in diameter, through each person's left ventricle. Another 86 people received only medical treatment, which included multiple drugs.
After three months, angina had improved from Class IV to Class II or better for 86 percent of the TMR patients compared to only 12 percent of those treated with medication alone. Chest pain is rated on a scale of I-IV, with I representing the least pain and class IV being the worst. Those improvements continued at six months, with 85 percent of the TMR patients still reporting improvement versus 18 percent of the medically managed group. In contrast to the extreme debilitation seen with Class IV angina, Class II patients have only slight limitation of normal activity, Allen says.
Another significant difference between the TMR and non-TMR treated was in rehospitalizations due to heart disease. At three months, 20 percent of the TMR patients had returned to the hospital compared to a 43 percent rehospitalization rate reported in the medication-only group. No significant difference in mortality was reported between the two groups.
Co-authors include Tommy L. Fudge, M.D., Terrebonne General Medical Center, Houma, La.; Samuel L. Selinger, M.D., Sacred Heart Medical Center, Spokane, Wash., and Robert D. Dowling, M.D., Jewish Hospital, Louisville, Ky.
Materials provided by American Heart Association. Note: Content may be edited for style and length.
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