Transmyocardial Laser Revascularization: A Consensus Statement of the International Society of Minimally Invasive Cardiothoracic Surgery (ISMICS) 2006

INTRODUCTION Dramatic advances in coronary revascularization techniques have been developed in recent years. Improved technologies and techniques for coronary artery surgery and percutaneous coronary intervention have allowed for treatment of coronary vessels that were previously considered inaccessible or not amenable to conventional treatment.1 In addition, pharmacologic management of chronic angina has improved clinical outcomes.2 Despite advances in pharmacologic therapies and catheter-based or surgical revascularization techniques, a significant number of patients with angina are poor candidates for traditional methods of treatment because of diffuse coronary disease, small distal vessels, or other comorbidities.3 Additional options are required for patients with angina refractory to maximal medical therapy who are not candidates for catheter-based therapy or bypass surgery or in whom these methods have failed.4 Whether transmyocardial laser revascularization (TMR) represents a potential option for these patients has been explored in a number of clinical trials. Given that the evidence base has begun to grow in this area and considering that decisions will need to be made regarding uptake of this procedure into practice, there is a need for international consensus regarding the evidence for the balance of benefit and risks of TMR relative to continued maximal medical therapy (MMT).