Authors' objectives:

To assess the available evidence on heart laser treatment (transmyocardial laser revascularisation).

Authors' recommendations: The following conclusions have been reached: Treatment with heart laser does not save lives. On the contrary, mortality related directly to the procedure is significant (3-20%). Mortality appears to be particularly high among patients with unstable angina or cardiac failure. Survival after one year has been shown to be approximately the same in treatment and control groups in randomised studies. Treatment with heart laser does not lead to improved cardiac function, on the contrary, in all instances a temporary decline has been recorded. Methods used to monitor heart function directly have not demonstrated any significant difference between treatment and control groups after 6-12 months. Some studies have concluded that treatment with heart laser has resulted in a general improvement in work capacity one-year following treatment. Heart laser treatment does result in pain reduction for many (around 70%) of those treated. Patients who have received treatment report less pain than those in the control group one year after treatment. Both the mechanisms behind this pain reduction and the duration of the effect beyond one year are uncertain. There is clearly some placebo effect at work, but it is not certain to what degree this is responsible for the reported favourable effects. Blood does not pass through laser canals to the heart muscle as was previously believed. Other hypotheses for pain reduction include formation of new blood vessels or destruction of nerve fibres, but these hypotheses are still unproven. The expert group recommends further research to clarify the mechanics of heart laser treatment, the effect of heart laser treatment given by other methods than via thoracotomy as well as the long-term effects of such treatment. The expert group acknowledges the need for large, blind, randomised controlled trials in this field of medicine.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.nokc.no/

Year Published: 2000

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Norway

Organisation Name: Norwegian Institute of Public Health

Contact Address: Universitetsgata 2, Postbox 7004 St. Olavs plass, NO-0310 Oslo NORWAY. Tel: +47 23 25 50 00; Fax: +47 23 25 50 10;

Contact Name: Berit.Morland@nokc.no, dagny.fredheim@nokc.no

Contact Email: Berit.Morland@nokc.no, dagny.fredheim@nokc.no

Copyright: The Norwegian Knowledge Centre for the Health Services