Transmyocardial revascularization
Encyclopedia
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.
and stenting or coronary bypass surgery and medications to improve blood flow to the heart muscle. The objective of each of these approaches is to increase blood flow through the coronary arteries to the heart. When these treatment options are exhausted, the patient is left with no viable surgical alternative other than, in limited cases, heart transplantation. Without a viable surgical alternative, the patient is generally managed with drug therapy, often with significant lifestyle limitations.
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.
When performing TMR a qualified cardiac surgeon delivers a precise laser therapy (either with a Holmium:YAG laser
or CO2), directly to the target area(s) of the heart muscle. When performed as a primary therapy, it is done through a small incision between the ribs (thoracotomy) with the patient under general anesthesia. Transmyocardial laser revascularization (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 precise laser therapy is delivered to create small channels into the heart chamber. During a typical procedure, approximately 10 –50 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.
The 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 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 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 disease
Heart disease, cardiac disease or cardiopathy is an umbrella term for a variety of diseases affecting the heart. , it is the leading cause of death in the United States, England, Canada and Wales, accounting for 25.4% of the total deaths in the United States.-Types:-Coronary heart disease:Coronary...
in people with persistent angina
Angina
Angina pectoris, commonly known as angina, is chest pain due to ischemia of the heart muscle, generally due to obstruction or spasm of the coronary arteries . Coronary artery disease, the main cause of angina, is due to atherosclerosis of the cardiac arteries...
that isn't relieved by any other method.
Introduction
Most people with coronary artery disease are treated with angioplastyAngioplasty
Angioplasty is the technique of mechanically widening a narrowed or obstructed blood vessel, the latter typically being a result of atherosclerosis. An empty and collapsed balloon on a guide wire, known as a balloon catheter, is passed into the narrowed locations and then inflated to a fixed size...
and stenting or coronary bypass surgery and medications to improve blood flow to the heart muscle. The objective of each of these approaches is to increase blood flow through the coronary arteries to the heart. When these treatment options are exhausted, the patient is left with no viable surgical alternative other than, in limited cases, heart transplantation. Without a viable surgical alternative, the patient is generally managed with drug therapy, often with significant lifestyle limitations.
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.
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.When performing TMR a qualified cardiac surgeon delivers a precise laser therapy (either with a Holmium:YAG laser
Laser
A laser is a device that emits light through a process of optical amplification based on the stimulated emission of photons. The term "laser" originated as an acronym for Light Amplification by Stimulated Emission of Radiation...
or CO2), directly to the target area(s) of the heart muscle. When performed as a primary therapy, it is done through a small incision between the ribs (thoracotomy) with the patient under general anesthesia. Transmyocardial laser revascularization (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 precise laser therapy is delivered to create small channels into the heart chamber. During a typical procedure, approximately 10 –50 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.
The 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 demand
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 ischemiaIschemiaIn medicine, ischemia is a restriction in blood supply, generally due to factors in the blood vessels, with resultant damage or dysfunction of tissue. It may also be spelled ischaemia or ischæmia...
- 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 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