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Is transmyocardial revascularisation of benefit to people with ‘no option’ angina?

Department of Cardiothoracic Surgery, Freeman Hospital, Freeman Road, Newcastle NE7 7DN, UK

^* Corresponding author. Tel./fax: +44-780-154-8122. (E-mail: joeldunning{at}doctors.org.uk).

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether the use of transmyocardial revascularisation is of benefit in patients with severe angina but ungraftable areas of myocardium. Altogether 345 papers were found using the reported search, of which 11 represented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses were tabulated. We conclude that in selected stable patients with ‘no option’ CCS grade III–IV angina, TMR can significantly reduce the grade of angina at the cost of a perioperative mortality of around 5%.