Transmyocardial Laser Revascularization In Septa And Octagenerian Geriatric Population

Abstract

Introduction
The treatment of Ischaemic Heart Disease is the improvement of blood flow to underperfused myocardium. The mainstay of this treatment are Coronary Artery Bypass Graft surgery (CABG) and Percutaneous Transluminal Coronary Angioplasty PTCA). Even with the success of these interventions, there remain many patients with disabling angina who are not candidates for these procedures because of diffuse and small vessel disease, endstage coronary . vascular disease, low LVEF or elderly population over 65 patients of age with associated reversible risk factors . Like anaemia, Congestive Heart Failure, Systemic.

Material & Methods
To benefit the older population from the highly sophisticated technology of TMR we have evaluated 23 patients retrospectively. This analysis revolves round the pre and post-operative date and results with view to follow up regarding clinical improvement, regression of anginal class, complications in a detailed analysis. There are 18 males and 5 females with age range of 65 years - 8 3 years and a mean average age of 6 9 . 0 8 years. 21 are Saudi national. 20 patients belonged to stable angina group while 3 had unstable angina. The coronary angiograms revealed 20 patients with 3VD, 2 patients with 2VD and only 1 patient had single vessel. 14 patients hadnon graftable diffuse small vessel disease while 9 were graftable. 1 7 patients underwent left anterior thoracotomy while 6 underwent sternotomy. Risk factor evaluation revealed that 1 7 patients were hypertensive, 1 5 were diabetic and 5 were obese, 3 patients had hypercholesterolaemia and 1 patient had peripheral artery disease of both legs.

Results

All the patients were followed up at 6 months and 12 months and were compared to their values pf pre TMR level and data were analysed.

Conclusion

The prevalence and severity of coronary atherosclerosis increases so dramatically with age that more than one-half of all deaths in people aged 65 years of older are due to coronary disease and about three fourth of all deaths from ischaemic heart disease occurs in the elderly.