• D Abramov, G Bhatnagar, M Tamariz, V Guru, and B S Goldman.
• Sunnybrook Health Science Centre, University of Toronto, Toronto, Canada.
• Can J Cardiol. 1999 Mar 1; 15 (3): 303-10.

BackgroundTransmyocardial laser revascularization (TMLR) is a new procedure for the treatment of angina pectoris in which high power laser energy is used to create channels in ischemic myocardium.ObjectiveTo describe in detail the historical, experimental and state-of-the-art studies regarding TMLR.Data SourcesThe English-language literature published from 1966 to 1998 was thorougly searched in MEDLINE. Further information regarding unpublished data was obtained on request.Study SelectionThe most important experimental studies and randomized prospective clinical trials were examined. Additional papers were selected to provide a historical perspective and future prospects of TMLR.Data SynthesisAlthough the results of TMLR in terms of angina relief are impressive, the procedure is associated with significant mortality and morbidity, and the results of objective cardiac perfusion measurements such as radionucleic perfusion scans and positron emission tomography are not conclusive. Furthermore, little information is available concerning the effect of this procedure on life expectancy. This article reviews the historical background of TMLR and possible mechanisms by which it may work, and discusses existing evidence for and against the procedure and how it may be applied in the future.ConclusionsAt present, TMLR is potentially indicated for patients with severe angina that is refractory to medical therapy and who have contraindications for the more traditional therapies (coronary artery bypass grafting, percutaneous transluminal coronary angioplasty and transplantation). More data are needed to evaluate fully the indications for this procedure.

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