Transmyocardial Laser Revascularization

What is transmyocardial laser revascularization?

Transmyocardial laser revascularization (TMR) is a procedure used to treat angina (chest pain) that is not relieved by any other method. A special laser is used to create small channels in the heart muscle. This improves blood flow to the heart muscle.

When is it used?

TMR is often done at the same time as coronary bypass surgery. TMR is used to treat people who:

• Have severe angina that limits their daily activities or wakes them up from pain at night, even after taking medicines.
• Have medical tests that show decreased blood supply to the heart muscle.
• Have previously had bypass surgery or angioplasty and still have angina.

TMR is not recommended if your heart muscle is severely damaged or scarred due to heart attacks, or if your heart already has an adequate blood supply.

How do I prepare for the procedure?

If you need a minor pain reliever in the week before surgery, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This helps avoid extra bleeding during surgery. If you are taking daily aspirin for a medical condition, ask your provider if you need to stop taking it before your surgery.

Plan for your care and transportation after the procedure and during recovery at home. Your healthcare provider may ask you not to eat or drink anything after midnight on the night before the procedure.

Follow your provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For this reason, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery. Also, your wounds will heal much better if you do not smoke after the surgery.

You will have blood tests, an electrocardiogram (ECG), and a chest X-ray before the procedure.

What happens during the procedure?

You will be given a general anesthetic. It will relax your muscles and put you in a deep sleep. It will prevent you from feeling pain during the operation.

The surgeon will make a small incision in either the left side or the middle of the chest. A special high-energy, computerized laser is then positioned on the area of the heart to be treated. The laser is used to create between 20 to 40 channels in the left ventricle (left lower pumping chamber of the heart). Each channel is about the width of the head of a pin. The surgeon decides how many channels to create during the procedure. The outer areas of the channels close so the heart does not leak after the procedure.

TMR usually takes 1 to 2 hours. The procedure may last longer if it is combined with other heart procedures. You will stay in the hospital for 4 to 7 days, depending on your overall health and rate of recovery.

What are the benefits?

After TMR, most people have:

• relief from chest pain
• better quality of life
• fewer trips to the hospital.

Some people feel immediate relief from angina symptoms, while others feel improvement over time. Exercise according to your healthcare provider's instructions. A supervised cardiac rehabilitation program is recommended.