Patient Care — Transmyocardial revascularization (TMR)

V. Seenu Reddy, MD, MBA | More about Dr. Reddy

Appointments and referrals: 210-450-0999

July 2010 KENS-5 News – Heart
laser and bypass treats crushing chest pain

Transmyocardial laser revascularization (TMR) is a new procedure used to treat
inoperable heart disease in people with persistent angina that isn’t relieved by
any other method.

Most people with coronary artery disease are treated with angioplasty and
stenting or coronary bypass surgery and medications to improve blood flow to the
heart muscle. If these procedures do not eliminate the symptoms of angina, other
treatment options are available.

TMR, or transmyocardial laser revascularization, is a newer treatment aimed at
improving blood flow to areas of the heart that were not treated by angioplasty
or surgery. A special carbon dioxide (CO2) laser is used to create small
channels in the heart muscle, improving blood flow to the heart muscle.

How TMR works:
TMR is a surgical procedure. It is performed through a small incision in the
left side of the chest. Frequently, it is performed along with coronary bypass
surgery, occasionally alone.

Once the incision is made, the surgeon exposes the heart muscle. A laser hand
piece is then positioned on the area of the heart to be treated. A special
high-energy, computerized CO2 laser is used to create between 20 to 40
one-millimeter-wide channels (about the width of the head of a pin) in the left
ventricle of the heart. The doctor determines how many channels to create during
the procedure. The outer areas of the channels close, but the inside of the
channels remain open inside the heart to improve blood flow.

The CO2 Heart Laser uses a computer to direct laser beams to the appropriate
area of the heart in between heartbeats, when the ventricle is filled with blood
and the heart is relatively still. This helps to prevent arrhythmias in the
heart.

TMR is a treatment option for patients who:

Have severe chest pain (angina), which limits the patient’s daily
activities or causes the patient to wake from pain at night, despite medications
Have pre-operative tests that show ischemia
Have a history of previous bypass surgery or angioplasty, and no further
intervention is available.
Have been told by their doctor that there is nothing that can be further
done to help their symptoms.

TMR has shown positive clinical benefits for patients who may require one or two
bypass grafts, yet also have other areas of the heart that are not able to be
bypassed by direct bypass-surgery. This is often seen in patients with diabetes.
The surgeon will bypass the targeted blockages and use the CO2 Heart Laser on
the heart muscle with diffuse disease to achieve more complete blood flow to the
heart.

TMR is not suitable for patients whose heart muscle is severely damaged due to heart attacks; the heart muscle is dead
or scarred rather than affected by inadequate blood supply (ischemic) Heart
muscle has no areas of ischemia.

Information above courtesy of Wikipedia.

Additional information on TMR: (links will open in a new window)

Windows Media animation video demonstrating the TMR procedure
(video courtesy of Cardiogenesis)
American Heart Association
eMedicine
Cleveland Clinic
National Heart, Lung and Blood Institute