Transmyocardial Laser Revascularization (TMR)

What is Transmyocardial Laser Revascularization?

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

During the procedure, the surgeon makes a small incision in the left side of the chest. He or she then uses a special carbon dioxide laser to create channels in the heart muscle, which will improve blood flow. Twenty to 40 one-millimeter channels are made, depending on the patient’s situation. A computer directs the laser beams to the appropriate area of the heart in between heartbeats, which helps prevent electrical disturbances. Bleeding stops once the surgeon places his or her finger over the channel openings for a few moments. TMR takes between one and two hours to perform and patients typically stay in the hospital for between four and seven days. Studies suggest that it may work by stimulating angiogenesis, or the growth of new blood vessels, and also by destroying nerve fibers that cause the patient to experience chest pain.

What are the advantages?

The advantage of TMR is that it provides a last-resort option to patients with severe angina. It can be especially effective in patients with other conditions – such as diabetes – that preclude the use of bypass surgery. Although clinical data are still somewhat limited, 80 to 90 percent of patients have seen significant improvement in their symptoms (at least a 50 percent improvement) at one-year follow up. A New England Journal of Medicine study concluded that patients who had TMR had relief of chest pain as well as improved quality of life, improved blood flow to the heart, and decreased hospital admissions. The procedure is relatively quick and is also covered by most insurance companies.

The Boston Medical Center difference

Our team of compassionate experts has vast experience in the area of angina treatment, and especially in TMR. Drawing on our long history of exceptional cardiac services, Boston Medical Center provides quality care in a state-of-the-art environment. One of the pioneers in cardiac surgery, Boston Medical Center is one of the leading programs in the United States. In addition to providing a full range of traditional cardiac surgical treatments, our attention to the most current yet proven techniques and technologies places Boston Medical Center’s Cardiac Surgery program at the leading edge of innovative surgical and minimally invasive treatments.

Your care is our top priority. That’s why we use a collaborative care approach. A highly specialized and expertly skilled group of cardiac surgeons, physician assistants, nurse practitioners, and surgical nurses work together to ensure that you receive the treatment that’s right for you and a patient experience that is second to none. We partner with you, your cardiologist, and other physicians to provide you with the most advanced and effective cardiac care available in New England.