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(Circulation. 2000;102:e9044.)
© 2000 American Heart Association, Inc.

Cardiovascular News

Cardiovascular News

Ruth SoRelle, MPH, Circulation Newswriter

Controversy Over Myocardial Revascularization, Either Transmyocardial or Percutaneous, Continues as Experts Spar Over Advantages of Each

In the wake of the controversial results of the Direct Myocardial Revascularization (DMR) In Regeneration of Endomyocardial Channels Trial (DIRECT), proponents of percutaneous myocardial revascularization, transmyocardial revascularization, and permutations of the various techniques sparred over effectiveness and the placebo effect during the Scientific Sessions of the American Heart Association in New Orleans. The proponents of transmyocardial revascularization, led by Kenneth A. Horvath, MD, of Northwestern University Medical School in Chicago, maintained that their procedure differs markedly from the percutaneous method used in the DIRECT trial and should not have been lumped in with the catheter-based techniques.

In transmyocardial revascularization (TMR), the chest is opened and a laser (usually a CO₂ laser) is used to open channels through the myocardium. In percutaneous transmyocardial revascularization (PMR), the laser is fed into the heart via the usual catheter route. A cardiologist uses a (usually) less powerful laser to cut small channels into but not through the myocardium.

Dr Horvath reported that 66% of 78 patients who had undergone TMR and were then followed for as long as 7 years could be categorized as having angina classes I or II. Before undergoing the procedure, the average angina class was 3.7±0.5. Five years after TMR, the average angina class was 1.6±1 (P=0.0001). Sixty percent of the patients had a decrease in angina of at least 2 classes.

These results conflict directly with the placebo-controlled DIRECT. The results of DIRECT were first released at the conference "Transcatheter Cardiovascular Therapeutics 2000" in Washington, DC, on . . . [Full Text of this Article]