Morbidity in the SICU after transmyocardial laser revascularization

Background

Transmyocardial laser revascularization (TMLR) is a modern technique of myocardial revascularization in patients with symptomatic coronary artery disease that is refractory to maximal medical therapy and who are unsuitable candidates for conventional methods of myocardial revascularization [1,2,3]. There are no studies showing the clinical events of the early postoperative period.

Objectives

To report the morbidity appeared in the surgical intensive care unit (SICU) after TMLR.

Methods

Description of the postoperative evolution in the SICU of patients who underwent TMLR between March and October 1997. Postoperative complications, clinical trendmarks and length of stay were recorded. Data are presented as mean values (range).

Results

TMLR was performed in eight patients, four men and four women, age 62 years (51-74), angina class 4. Cardiac events were: low cardiac output, 5; acute myocardial infarction, 1. Symptomatic angina, 1 and silent ischemia, 1. One patient received mechanical ventilation during 17 days because severe acute lung injury with a lung injury score (LIS) of 2.6; extubation was performed in the remaining 9.5 h (4-24) after admittance in the SICU, with a maximal LIS of 1.08 (0.5-2). Postoperative chest tubes drainage ranged between 280 and 1890 ml. Thrombocytopenia was a constant finding. No other complications were found and no patient died. The patient with prolonged mechanical ventilation stayed in the SICU 27 days; length of stay was 3.7 days (1-6) in the remaining.

Conclusions

Morbidity in the SICU after TMLP seems to be focused in the cardiovascular, respiratory and hematological systems. These preliminary findings need to be confirmed with other similar studies.