TMR Patient Information

 

Description/What to Expect

Transmyocardial laser revascularization (also called TMR) is a treatment for coronary artery disease patients who have not responded to or are not eligible for more standard procedures such as angioplasty and stenting, medication, and coronary artery bypass graft surgery. It is a surgical procedure used to relieve angina (chest pain), which is caused by a lack of oxygen and blood flow to the heart, or ischemia.

The patient is not awake during TMR; the surgeon will insert an intravenous (IV) line, usually in the arm, to administer the anesthesia. Once the patient is asleep, the anesthesiologist will use a tube to control the level of ventilation in the right lung, thereby allowing for better access to the heart. After the surgeon makes a small incision in the patient’s left or middle chest, the heart muscle is exposed. A laser handpiece is then positioned over the affected area and the special computerized carbon dioxide laser is applied to the outer layer of the heart’s tissue. It fires energy repeatedly, creating anywhere from 20 to 40 channels. The outer areas of the channels close and heal, but the inner areas remain open, allowing blood and oxygen to flow more freely. Bleeding usually stops quickly, and the surgeon closes the chest incision.

The Advantages of TMR

The advantages of TMR, as compared to standard treatments, include:

  • Provides an option to patients with severe angina who cannot undergo other treatments;
  • Can be especially effective in patients with other conditions – such as diabetes – who can’t have bypass surgery; and
  • Eighty to 90 percent of patients have seen significant improvement in their symptoms (at least a 50 percent improvement) after one year.

Pre-procedure Information

Prior to the procedure, your surgeon will perform a physical examination and review your medical history. To determine if TMR is right for you, you will most likely have a coronary angiogram, which provides a special x-ray image of your coronary arteries. A nurse will insert a catheter (a long, thin tube) into a blood vessel in your leg or arm, and guide it to your heart. He or she will inject a contrast dye, which allows for a moving image of the arteries to be created. You may have an electrocardiogram or magnetic resonance image in addition to, or instead of, the angiogram.

Be sure to bring a list of any medications, dietary supplements, or herbal supplements that you take with you to your doctor’s appointment. Tell your doctor if you have any allergies.

Coronary artery bypass surgery and stenting are the traditional ways in which coronary artery disease and chest pain are managed, and they are considered the first-line treatment. TMR is considered a viable treatment option for those patients who:

  • Are high-risk for a second angioplasty or bypass;
  • Have blockages that are too spread out to be treated with bypass alone;
  • Have build-up in the arteries (atherosclerosis) and have had a heart transplant; or
  • Have been told there are no other options.

Post-procedure information

After TMR, you will be transferred to the intensive care unit of the hospital. After a day or so, you’ll be moved to another floor and monitored for the next 2 to 3 days, until discharge.

Follow-up care generally includes a physical examination, an evaluation of symptoms and patient history, and then a series of tests such as echocardiogram, to evaluate progress.

Recovery expectations

Patients should expect to stay in the hospital for between 4 and 7 days. Your doctor and surgeon will work together with you to determine the most appropriate amount of time for the unique situation. Tailored cardiac rehabilitation programs are often prescribed to help you recover while progressing in activity level.