Transmyocardial laser revascularization with the holmium:YAG laser: loss of symptomatic improvement after 2 years
Bibliographic record
Abstract
OBJECTIVE: Whether transmyocardial laser revascularization (TMLR) provides a long-term benefit in terms of relief of angina, improvement of exercise tolerance, left ventricular function, and myocardial perfusion. METHODS: Forty-one patients underwent TMLR using a holmium:YAG-laser, 14 as TMLR alone (group A), 27 with additional aortocoronary bypass grafting (group B). Follow-up was obtained at 6, 12, 18, 24, and 36 months in this prospective study. RESULTS: In group A patients CCS-class improved up to 18 months postoperatively, after 24 and 36 months postoperatively there was absence of a positive effect of TMLR: the CCS-class decreased to 2.4 as compared to 3.5 preoperatively After combined CABG and TMLR (group B) there was a significant decrease in angina at all times. The CCS-functional class in these patients was 1.7 at 36 months as compared to 3.5 preoperatively. There was no significant change in exercise tolerance as compared to preoperatively. Left ventricular ejection fraction did not improve in either of the groups. Thallium scintigraphy indicated no improvement in myocardial perfusion in laser treated areas. The perioperative mortality was 0%, the late mortality rate was 36% in group A and 11% in group B. CONCLUSIONS: In our experience, in the vast majority of patients who are subjected to TMLR alone the benefit of reduction or relief of angina and improvement in quality of life is only temporary. In addition there is no improvement in objective clinical parameters. We believe that TMLR should only be used in patients with severe angina refractory to medical treatment and requiring a symptomatic therapy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".