Ray Mitchell was doing all the right things after triple-bypass heart surgery in 1986.
The former accountant for General Electric Co. was exercising seven days a week, eating the proper foods and trying to cope with everyday stresses.
But it wasn't working. He was having chest pain. He became winded after minor tasks. He was getting weaker.
"I became frustrated and didn't want to tell anybody," said Mitchell, 47, who first suffered a heart attack while running in a marathon in 1982. "It came to the point where I prayed and wished to die."
Doctors told him he wasn't a good candidate for another bypass operation. He also had had five angioplasties that failed to open up clogged arteries around his heart. It seemed he was out of options.
Then Mitchell met Allan Lansing, M.D., a nationally recognized surgeon who once worked on the artificial heart team with William DeVries, M.D.
On Valentine's Day last year, Mitchell underwent a new surgical procedure Lansing is performing called transmyocardial revascularization-or TMR-at Audubon Regional Medical Center in Louisville, Ky.
Using a newly developed heart laser, Lansing pierces 15 to 30 one-millimeter holes through the outside wall on the left side of the heart to create a secondary circulation system.
The outer layers of the heart heal almost immediately, but the continued beating action forces the holes to stay open in the interior, diffusing oxygenated blood into the oxygen-starved tissue.
Since the operation, Mitchell has returned to an active lifestyle that includes playing golf twice a week.
"I haven't felt anything (pain) since the procedure," said Mitchell, who also lectures about heart attacks at Audubon.
The U.S. Food and Drug Administration recently put the heart laser on the fast track toward being approved for general use by granting an expedited review to the laser's maker, PLC Medical Systems of Milford, Mass.
In initial trials of TMR last year, 40 patients treated at Audubon had Class IV angina, the most severe classification of chest pain on a four-step scale. After one year, 90% were reduced to Class I or II, or had no angina at all.
A TMR procedure costs an average $12,000 with a five-to-seven day hospital stay, while an average heart-bypass surgery has a nine-day stay and a $42,000 cost, according to Audubon.
Besides Audubon, other hospitals participating in the second phase of the clinical trials on TMR are Seton Medical Center in Daly City, Calif., University of Pittsburgh Medical Center, Columbia-Presbyterian Medical Center in New York, St. Luke's Medical Center in Milwaukee, Brigham and Women's Hospital in Boston, Texas Heart Institute in Houston and Rush-Presbyterian-St. Luke's Medical Center in Chicago.
Lansing, a heart surgeon for 37 years who has performed more than 70 TMR operations, is impressed with the results.
"It's not as spectacular as the first open-heart operations, and it's not as spectacular as the transplantations," he said. "But the number of people who can be helped by this is enormous."
Clinical results at six other U.S. hospitals showed 83% of patients had a reduction of two or more angina classes after the surgery.
There are 25 heart lasers in use around the world, and more than 600 TMR procedures have been performed, according to PLC Medical Systems. Despite the promising tests, Lansing doesn't believe that TMR will replace a first-time bypass operation.
"The bypass is a well-established procedure," he said. "We know it works immediately."
TMR offers hope to those who can't undergo a second bypass operation.
Joan Latham had a double-bypass in October 1993. She underwent TMR in March 1994 after it was determined that her veins were too small for another bypass.
"It seemed with the first open heart I couldn't bounce back," said Latham, 59.
But a month after the TMR, she was busy taking care of her granddaughter after her 27-year-old daughter, Rhonda, had a heart attack and bypass surgery.
"I feel all right," Latham said. "There are limitations. I can't get down and run a three-legged race. But it's the best I've felt in a long time."