Laser surgery keeps heart patients out of hospital

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The Independent Online
Drilling tiny holes in the heart with a laser dramatically reduces chest pain and the need for hospital care for people with severe heart disease, new findings showed yesterday.

The pioneering technique, transmyocardial revascularisation (TMR), allows blood from the heart's pumping chamber to percolate through the laser holes and supply the surrounding heart muscle.

Researchers from three centres in the United States studied 160 individuals with severe chest pain, or "refractory angina". Angina is caused when the heart muscle does not get enough oxygen-rich blood.

A total of 74 patients underwent the procedure. Surgeons drilled about 40 holes, each one millimetre in diameter, through each patient's left ventricle. Another 86 patients received the usual medical treatment, including multiple drugs. After three months the angina had improved dramatically in 86 per cent of the TMR patients, compared with only 12 per cent of those on medication alone.

Chest pain is rated on a scale of one to four. In the study, the drilling treatment improved pain from class four to class two or better. After three months, 20 per cent of the TMR patients had returned to hospital compared with 43 per cent of the medication-only group. No significant difference in death-rate was reported between the two groups, however.

The results were presented at an American Heart Association conference in Orlando, Florida. Leading researcher Dr Keith Allen, a cardiothoracic surgeon at St Vincent Hospital, Indianapolis, said: "A lot of these individuals have diabetes or severe heart disease or they have had multiple heart operations and have reached the end of the road as far as the potential for further interventions to be successful. TMR offers real hope for these patients.

"We don't know if it will make people live longer or decrease the incidence of heart attacks, but it clearly improves their ability to function and their quality of life."

A spokesman for the British Heart Foundation said: "This is something that's arousing a lot of interest in the cardiology world, and is definitely something we are keeping an eye on. However, there's quite a long way to go yet before it becomes a mainstream procedure."

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