Transmyocardial Revascularization

What is Transmyocardial Revascularization (TMR)?

When performing TMR with a low powered Holmium:YAG laser, a qualified cardiac surgeon delivers precise laser energy directly to the target area(s) of the heart muscle. When performed as a sole therapy, it is done through a small incision between the ribs (thoracotomy) with the patient under general anesthesia. TMR can also be performed as a complement to bypass surgery in patients that have diseased areas of the heart that cannot be bypassed. The precise laser energy is delivered to create small channels into the heart chamber. During a typical procedure, approximately 20 – 45 channels are made in the heart muscle.

The channels in the heart muscle seal over immediately with little blood loss while the new channels allow fresh blood to perfuse the heart wall immediately. According to research and clinical studies, these channels promote growth microvascularization, or angiogenesis, over time. That, in turn, may provide damaged heart tissue with a better supply of blood and oxygen. Angina symptoms, including chest pain, usually subsides over time in the majority of patients treated with TMR.

What to expect following the procedure.

The follow-up requirements for recovery after a TMR procedure are similar to those following other heart surgeries, including regular check-ups by your physician. Your physician will advise you when you may expect to return to more normal activities.

How TMR works

At this time it is not fully understood how TMR relieves angina, although there are several theories that are under investigation for the way in which TMR works including:

• Directly increasing the blood flow to the heart muscle
• Stimulating the growth of new small blood vessels within the heart muscle
• Reducing angina or chest pain by impairing the nerves and/or placebo effect

TMR May Benefit You

• TMR may benefit you if there is an area of your heart that is not receiving enough oxygen and your disease cannot be treated by balloon angioplasty or bypass surgery.
• TMR has been proven to reduce angina or chest pain and improve the quality of life in patients with coronary artery disease.
• Treatment with TMR may help you return to a more active lifestyle.
• Treatment with TMR may also reduce the need for some of the medications you are currently taking to manage your angina symptoms, including, chest pain.

How to determine if TMR is an option for you.

Patients who are candidates for TMR usually have severe chest pain, often even at rest. They may or may not have had a previous heart surgery.