Effekte der direkten und indirekten Myokardrevaskularisation auf die kardiopulmonale Leistungsfähigkeit, die myokardiale Ischämielast und die Lebensqualität von Patienten mit (prä)terminaler koronarer HerzkrankheitDarstellung einer klinisch orientierten Methodik zur Evaluation der Effekte der aortokoronaren Bypass-Operation (ACB), der indirekten Myokardrevaskularisation (TMR) und der Kombination beider Verfahren (TMR+ACB)

Background: Transmyocardial laser revascularisation (TMR) is used to treat patients with refractory angina pectoris due to severe coronary artery disease, which is not suitable for conventional revascularisation such as bypass surgery or percutaneous transluminal angioplasty (PTCA). We aimed to assess the effectiveness of the ultimately performed revascularisation method in patients who were assigned to the “Department of Cardiovascular Surgery of the Philipps-University Marburg” with the option to be treated by TMR. Methods: In initially 102 patients with refractory angina pectoris the clinical effect of TMR, TMR in combination with coronary artery bypass grafting (CABG) and sole coronary artery bypass grafting (CABG) was examined approximately 12 months after treatment. We assessed the objective and subjective exercise capacity, the ischemic burden and the objective and subjective quality of life in these patients. Results: Of the initial 102 patients 26 were treated with TMR alone, 31 patients with TMR + CABG and 37 patients with sole CABG. In 8 patients their conventional medical treatment was continued. 21 patients of the TMR group, 23 patients of the TMR + CABG group and 35 of the CABG group could be assessed completely preoperatively. 14 patients of the TMR group, 12 patients of the TMR + CABG group and 23 patients of the CABG group could be examined pre- and postoperatively with the complete assessment programme. The effect of each technique concerning ischemic burden, objective and subjective exercise capacity and objective and subjective quality of life was examined 8-14 months after the operation. Mortality 30 days after the operation was 15,4 % in the TMR group, 12,9 % in the TMR + CABG group and 2,7 % in the CABG group. All patients showed a slight improvement in their exercise capacity, ischemic burden and quality of life. Those patients who were treated with the combination of TMR and CABG had tendential the most benefit of their therapy. No significant results were found. Conclusion: Our findings show that TMR might be an alternative treatment option in patients with refractory angina pectoris. As the exact mechanisms of TMR are still not known further clinical, histological and pathophysiological studies have to be performed.