Laser Heart Surgery Has High Complication Rate

	March 16, 1999 -  Heart patients who undergo 
a procedure called transmyocardial laser 
revascularization (TMR) are at high risk for 
complications following their surgery compared with 
bypass surgery patients, according to researchers.
TMR is used to open tiny channels in the heart 
muscle of patients with severe coronary artery 
disease.
	"These patients need vigilant surveillance" 
during the post-operative period, says Dr. Chad 
Hughes at Duke University Medical Center. Their 
findings are published in the March 15th issue of 
the Journal of the American College of Cardiology.
	Doctors often refer patients with angina 
for either bypass surgery or angioplasty to open 
their clogged heart arteries and reduce their risk 
of heart attack. Some patients cannot have these 
procedures. TMR has provided these patients with 
an alternative.
	The Durham investigators studied the safety 
of this procedure in 34 patients with advanced heart 
disease. They report that 2 of the patients had fatal 
heart attacks soon after the procedure, while 16 
had "adverse cardiac events" such as angina, heart 
failure or arrhythmia. Twelve patients developed 
noncardiac complications such as stroke, kidney 
failure, or pneumonia.
	Hughes points out that the real benefits of 
TMR do not kick in "until at least 3 months after
the procedure" which means that patients having the 
procedure face a higher risk of complications during 
their first 12 weeks of recovery. The authors 
advise that doctors practice "aggressive medical 
management" of patients during this critical period.

SOURCE: Journal of the American College Cardiology
1999;33:1021-1026