Transmyocardial Laser Revascularization
An Option to Significantly Reduce Angina and Improve Quality of Life Patients with refractory angina often have a limited exercise tolerance and poor quality of life. These patients may not be responsive to antianginal medication, or candidates for percutaneous coronary angioplasty or coronary artery bypass. Transmyocardial Laser Revascularization (TMR) can be a good option for patients By V Seenu with this difficult clinical Reddy MD picture. MBA FACS It has been over a decade since TMR was approved Cardiovascular for clinical use in the United Surgeon States and numerous studies in NEJM, Lancet and JACC have demonstrated the effectiveness of the procedure, yet it remains significantly underutilized. TMR, as a sole surgical technique is typically performed through a left thoracotomy, which uses a laser to bore channels in surfaces of the heart muscle and through the left ventricular myocardium of the beating heart to improve blood flow to ischemic myocardial territories not being reached by diseased arteries. TMR is a promising therapy option for patients with refractory angina and as an adjunct to coronary artery bypass graft surgery for patients with angina who cannot be completely revascularized surgically or with PCI alone. When performing TMR cardiac surgeon delivers precise laser therapy directly to target areas of the heart muscle. When performed as a primary therapy, it is done through a thoracotomy with the patient under general anesthesia. TMR can also be performed as a secondary procedure in patients that have ischemic heart disease with areas of the heart that cannot be bypassed. The Yag Holmium laser therapy is delivered to create small channels into the heart chamber. During a typical procedure, approximately 10 –40 channels are made in each targeted region of the heart muscle. The channels in the heart muscle seal over almost immediately with little blood loss while the new channels allow fresh blood to perfuse the heart wall immediately. In order to reduce risk of arrhythmia, the laser system is linked to an ECG to monitor what the heart is doing, and pulses only when the heart is at its maximum expansion. It is believed that the therapy works by triggering the body’s own ability to grow new blood vessels in the heart improving blood flow to those areas.
TMR is a treatment option for patients who: • Have severe chest pain (Class III and IV angina), which limits their daily activities or causes them to wake from pain at night, despite maximal medication therapy • Have pre-operative tests that show ischemia and have EF greater than 35% • 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. Most of the time, the best treatment for angina is either PCI or coronary artery bypass surgery, but for some patients with very serious heart disease or other health problems, bypass surgery may be too dangerous. Some patients may have had previous stents or coronary artery bypass operations and be unable to have more procedures. For many of these complex patients, TMR offers relief from the pain of angina and in many of my patients has significantly improved their quality of life, allowing them to return to work and other activities of daily living while reducing medications and recurrent visits to the ER. For more information, call 615.342.6900 or go to TriStarCardiovascularSurgery.com.
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