An increasing number of patients with advanced, diffuse coronary artery disease suffer from unremitting chronic angina pectoralis. The management of this condition remains a challenge, particularly in patients who experience symptoms refractory to maximal medical therapy. This severe coronary artery disease can lead to incomplete revascularization following coronary artery bypass surgery (CABG), a powerful predictor for perioperative mortality and adverse events. In carefully selected patients, transmyocardial laser revascularization (TMR) is a surgical option for patients who have exhausted nonsurgical therapies and are not amenable to complete revascularization. TMR, whether used as sole therapy or in conjunction with CABG, has been demonstrated to provide significant symptomatic angina relief and improve overall patient outcomes. As reflected by practice guidelines issued by the Society of Thoracic Surgeons (STS), consideration for TMR+CABG is warranted in select patients with chronic refractory angina pectoralis despite optimal pharmacological and interventional therapies.
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