The effectiveness and safety of a surgical intervention using a laser device directly on the heart surface for patients suffering from angina who are not suitable for other interventions
Patients with prolonged or recurrent chest pain due to heart disease have different treatment options, such as medication, catheter interventions, or coronary artery surgery. In spite of the optimal use of such treatments, an increasing number of patients progress to advanced disease, becoming less responsive to medical treatment, suffering from more severe symptoms, very limited exercise capacity and poor quality of life. Transmyocardial laser revascularization (TMLR) is a surgical intervention intended to re-establish blood flow in some areas of the heart, using a laser device directly on the heart surface, thereby relieving angina and improving symptoms.
Several studies have been carried out to determine the efficacy and safety of this intervention, but had important methodological weaknesses and none of them fulfilled all the established quality criteria. Overall, 43.8 % of patients in the group treated with laser had their chest pain improved significantly, compared with 14.8 % in the medication group. However, the evaluation of chest pain was performed without blinding (patients and doctors were aware of the intervention) and it may bias the results. On the other hand, the risk of dying at one year was similar in the groups, but there is an excess risk of early mortality after the intervention in the laser group.
Based on the review of all available studies we can not conclude that the clinical benefits of TMLR outweigh the potential risks. It is suggested that application of TMLR in clinical practice should be restricted to research or special situations.