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Long-term outcomes after transmyocardial revascularization.

Publication ,  Journal Article
Tavris, DR; Brennan, JM; Sedrakyan, A; Zhao, Y; O'Brien, SM; Peterson, ED; Gross, TP; Marinac-Dabic, D; Horvath, KA
Published in: Ann Thorac Surg
November 2012

BACKGROUND: Two independent reports documented substantially higher operative mortality associated with transmyocardial revascularization (TMR) when used in isolation than that reported in the premarket clinical trials. To clarify the state of the art, this article assesses temporal trends in the use of TMR, short-term and long-term outcomes, and outcomes stratified by procedure type (TMR only and TMR + coronary artery bypass graft [CABG]) and by the 2 specific TMR devices. METHODS: The study population included all patients undergoing TMR in isolation or in combination with CABG at 435 cardiothoracic hospitals in the United States participating in the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database (ACSD) from January 2000 through November 2006 (n = 15,386). Analysis of long-term outcomes was accomplished through linkage to Medicare claims data. Short-term and long-term (7 years) adverse outcomes were assessed and compared between the 2 TMR device types. RESULTS: The use of TMR in conjunction with CABG surgery is increasing. This study showed modest differences in short-term morbidity and mortality between the 2 devices. In combination with CABG, after risk adjustment, patients treated with the holmium:YAG laser (experienced a higher rate of operative mortality (3.5% vs 2.5%; adjusted hazard ratio 1.39, 95% confidence level 1.03 to 1.87) but no difference in the composite short-term rate of major morbidity or mortality, compared with the Heart Laser CO2 transmyocardial revascularization system (PLC Medical Systems, Inc, Milford, MA). However, there were no clinically meaningful differences in long-term results. CONCLUSIONS: Modest differences in short-term morbidity and mortality between the 2 devices suggest the usefulness of further research.

Duke Scholars

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

November 2012

Volume

94

Issue

5

Start / End Page

1500 / 1508

Location

Netherlands

Related Subject Headings

  • Treatment Outcome
  • Respiratory System
  • Postoperative Complications
  • Myocardial Revascularization
  • Middle Aged
  • Male
  • Humans
  • Female
  • Coronary Artery Bypass
  • Aged
 

Citation

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Tavris, D. R., Brennan, J. M., Sedrakyan, A., Zhao, Y., O’Brien, S. M., Peterson, E. D., … Horvath, K. A. (2012). Long-term outcomes after transmyocardial revascularization. Ann Thorac Surg, 94(5), 1500–1508. https://doi.org/10.1016/j.athoracsur.2012.05.068
Tavris, Dale R., James Matthew Brennan, Art Sedrakyan, Yue Zhao, Sean M. O’Brien, Eric D. Peterson, Thomas P. Gross, Danica Marinac-Dabic, and Keith A. Horvath. “Long-term outcomes after transmyocardial revascularization.Ann Thorac Surg 94, no. 5 (November 2012): 1500–1508. https://doi.org/10.1016/j.athoracsur.2012.05.068.
Tavris DR, Brennan JM, Sedrakyan A, Zhao Y, O’Brien SM, Peterson ED, et al. Long-term outcomes after transmyocardial revascularization. Ann Thorac Surg. 2012 Nov;94(5):1500–8.
Tavris, Dale R., et al. “Long-term outcomes after transmyocardial revascularization.Ann Thorac Surg, vol. 94, no. 5, Nov. 2012, pp. 1500–08. Pubmed, doi:10.1016/j.athoracsur.2012.05.068.
Tavris DR, Brennan JM, Sedrakyan A, Zhao Y, O’Brien SM, Peterson ED, Gross TP, Marinac-Dabic D, Horvath KA. Long-term outcomes after transmyocardial revascularization. Ann Thorac Surg. 2012 Nov;94(5):1500–1508.
Journal cover image

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

November 2012

Volume

94

Issue

5

Start / End Page

1500 / 1508

Location

Netherlands

Related Subject Headings

  • Treatment Outcome
  • Respiratory System
  • Postoperative Complications
  • Myocardial Revascularization
  • Middle Aged
  • Male
  • Humans
  • Female
  • Coronary Artery Bypass
  • Aged