Transmyocardial Laser Revascularization (TMR)
What is Transmyocardial Laser Revascularization (TMR)?
TMR is a new procedure used to treat inoperable heart disease in people with persistent angina that isn’t relieved by any other method.
Most people with coronary artery disease are treated with angioplasty and stenting or, coronary bypass surgery and medications to improve blood flow to the heart muscle. If these procedures do not eliminate the symptoms of chest pain (also called angina), other treatment options are available.
TMR, or transmyocardial laser revascularization, is a new treatment aimed at improving blood flow to areas of the heart that were not treated by angioplasty or surgery. A special carbon dioxide (CO2) laser is used to create small channels in the heart muscle, improving blood flow to the heart muscle.
Read more about : heart valve replacement
Transmyocardial Laser Revascularization (TMR)
What is Transmyocardial Laser Revascularization (TMR)?
TMR is a new procedure used to treat inoperable heart disease in people with persistent angina that isn’t relieved by any other method.
Most people with coronary artery disease are treated with angioplasty and stenting or, coronary bypass surgery and medications to improve blood flow to the heart muscle. If these procedures do not eliminate the symptoms of chest pain (also called angina), other treatment options are available.
TMR, or transmyocardial laser revascularization, is a new treatment aimed at improving blood flow to areas of the heart that were not treated by angioplasty or surgery. A special carbon dioxide (CO2) laser is used to create small channels in the heart muscle, improving blood flow to the heart muscle.
Before Transmyocardial Laser Revascularization (TMR)
Who is a Candidate for TMR?
TMR is a treatment option for individuals who:
. Have severe angina, which limits their daily activities or causes them to wake from pain at night, despite medications.
. Have pre-operative tests that show ischemia (decreased blood supply to the heart muscle).
. 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 with direct bypass-surgery. This is often seen in patients with diabetes. The surgeon will bypass the targeted blockages and use the CO2 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 (inadequate blood supply).
What types of tests will I need to determine if I am a candidate?
Your doctor will first evaluate your medical condition and review your medical history. Tests required before TMR include:
. Cardiac catheterization, to visualize your coronary arteries and see if any blockages are present.
. Other tests to determine blood flow to your heart muscle and the pumping ability of your heart, such as:
. Echocardiogram
. PET (Positron Emission Tomography) study (a newer test that can evaluate the function of the heart.)
. Dobutamine Echocardiography
. Cardiac MRI
After reviewing your medical condition and history, along with your test results, your doctor will decide if you are a candidate for the TMR procedure. If you are eligible, the doctor will discuss the benefits and risks.
Read more about: Heart valve replacement surgery risks
Read more about: Heart valve replacement recovery
What to Expect
The operation will be scheduled at a time that is best for you and your surgeon, except in urgent cases. Be sure to tell your surgeon and cardiologist about any changes in your health including symptoms of a cold or the flu. Any infection may affect your recovery.
Also, review all medications (prescription as well as over-the-counter and supplements) with your cardiologist and surgeon. Before surgery, you may have to have an electrocardiogram (ECG or EKG), blood tests, urine tests, and a chest x-ray to give your surgeon the latest information about your health.
If you smoke, your doctor will want you to stop at least 2 weeks before your surgery. Smoking before surgery can lead to problems with blood clotting and breathing.
The night before surgery, you will be asked to bathe to reduce the amount of germs on your skin.
A medicine (anesthetic) will make you sleep during the operation. This is called “anesthesia.” Because anesthesia is safest on an empty stomach, you will be asked not to eat or drink after midnight the night before surgery. If you do eat or drink anything after midnight, it is important that you tell your anesthesiologist and surgeon.
During Transmyocardial Laser Revascularization (TMR)
How does TMR work?
TMR is a surgical procedure. It is performed through a small incision in either the left side or the middle of the chest. Frequently, it is performed along with coronary bypass surgery, occasionally alone.
Once the incision is made, the surgeon exposes the heart muscle. A laser hand piece is then positioned on the area of the heart to be treated. A special high-energy, computerized CO2 laser is used to create between 20 to 40 one-millimeter-wide channels (about the width of the head of a pin) in the left ventricle (left lower pumping chamber) of the heart. The doctor determines how many channels to create during the procedure. The outer areas of the channels close, but the inside of the channels remain open inside the heart to improve blood flow.
The CO2 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 electrical disturbances (arrhythmias) in the heart.
Doctors aren’t sure how TMR improves blood flow to the heart. Clinical evidence suggests blood flow is improved in two ways:
- The channels act as bloodlines. When the ventricle pumps or squeezes oxygen-rich blood out of the heart, it sends blood through the channels, restoring blood flow to the heart muscle.
- The procedure may promote angiogenesis, or the growth of new capillaries (small blood vessels) that help supply blood to the heart muscle.
TMR usually takes one to two hours. The procedure may last longer if it is combined with other heart procedures.
Read more about: What is the success rate of heart valve replacement surgery
After Transmyocardial Laser Revascularization (TMR)
Recovery Time
You can expect to stay in the hospital for between 4 and 7 days after TMR.
Recovery after TMR may take a long time. You will have to rest and limit your activities. Your doctor may want you to begin an exercise program or to join a cardiac rehabilitation program.
If you have an office job, you can usually go back to work in 4 to 6 weeks. Those who have more physically demanding jobs may need to wait longer.
Life after TMR
Most of the time, the symptoms of coronary artery disease and angina get better after TMR, but it may take 3 months or more to see improvement.
Patients find that after TMR they can now do all of the activities that once caused them pain. They may also find that they do not need to take as many heart medicines, including nitroglycerin.
Studies have shown that 1 year after surgery, 80% to 90% of patients treated with TMR still feel better than they did before they had the surgery. They also have a lower risk of heart attack.
Before Transmyocardial Laser Revascularization (TMR)
Who is a Candidate for TMR?
TMR is a treatment option for individuals who:
. Have severe angina, which limits their daily activities or causes them to wake from pain at night, despite medications.
. Have pre-operative tests that show ischemia (decreased blood supply to the heart muscle).
. 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 with direct bypass-surgery. This is often seen in patients with diabetes. The surgeon will bypass the targeted blockages and use the CO2 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 (inadequate blood supply).
What types of tests will I need to determine if I am a candidate?
Your doctor will first evaluate your medical condition and review your medical history. Tests required before TMR include:
. Cardiac catheterization, to visualize your coronary arteries and see if any blockages are present.
. Other tests to determine blood flow to your heart muscle and the pumping ability of your heart, such as:
. Echocardiogram
. PET (Positron Emission Tomography) study (a newer test that can evaluate the function of the heart.)
. Dobutamine Echocardiography
. Cardiac MRI
After reviewing your medical condition and history, along with your test results, your doctor will decide if you are a candidate for the TMR procedure. If you are eligible, the doctor will discuss the benefits and risks.
What to Expect
The operation will be scheduled at a time that is best for you and your surgeon, except in urgent cases. Be sure to tell your surgeon and cardiologist about any changes in your health including symptoms of a cold or the flu. Any infection may affect your recovery.
Also, review all medications (prescription as well as over-the-counter and supplements) with your cardiologist and surgeon. Before surgery, you may have to have an electrocardiogram (ECG or EKG), blood tests, urine tests, and a chest x-ray to give your surgeon the latest information about your health.
If you smoke, your doctor will want you to stop at least 2 weeks before your surgery. Smoking before surgery can lead to problems with blood clotting and breathing.
The night before surgery, you will be asked to bathe to reduce the amount of germs on your skin.
A medicine (anesthetic) will make you sleep during the operation. This is called “anesthesia.” Because anesthesia is safest on an empty stomach, you will be asked not to eat or drink after midnight the night before surgery. If you do eat or drink anything after midnight, it is important that you tell your anesthesiologist and surgeon.
During Transmyocardial Laser Revascularization (TMR)
How does TMR work?
TMR is a surgical procedure. It is performed through a small incision in either the left side or the middle of the chest. Frequently, it is performed along with coronary bypass surgery, occasionally alone.
Once the incision is made, the surgeon exposes the heart muscle. A laser hand piece is then positioned on the area of the heart to be treated. A special high-energy, computerized CO2 laser is used to create between 20 to 40 one-millimeter-wide channels (about the width of the head of a pin) in the left ventricle (left lower pumping chamber) of the heart. The doctor determines how many channels to create during the procedure. The outer areas of the channels close, but the inside of the channels remain open inside the heart to improve blood flow.
The CO2 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 electrical disturbances (arrhythmias) in the heart.
Doctors aren’t sure how TMR improves blood flow to the heart. Clinical evidence suggests blood flow is improved in two ways:
- The channels act as bloodlines. When the ventricle pumps or squeezes oxygen-rich blood out of the heart, it sends blood through the channels, restoring blood flow to the heart muscle.
- The procedure may promote angiogenesis, or the growth of new capillaries (small blood vessels) that help supply blood to the heart muscle.
TMR usually takes one to two hours. The procedure may last longer if it is combined with other heart procedures.
After Transmyocardial Laser Revascularization (TMR)
Recovery Time
You can expect to stay in the hospital for between 4 and 7 days after TMR.
Recovery after TMR may take a long time. You will have to rest and limit your activities. Your doctor may want you to begin an exercise program or to join a cardiac rehabilitation program.
If you have an office job, you can usually go back to work in 4 to 6 weeks. Those who have more physically demanding jobs may need to wait longer.
Life after TMR
Most of the time, the symptoms of coronary artery disease and angina get better after TMR, but it may take 3 months or more to see improvement.
Patients find that after TMR they can now do all of the activities that once caused them pain. They may also find that they do not need to take as many heart medicines, including nitroglycerin.
Studies have shown that 1 year after surgery, 80% to 90% of patients treated with TMR still feel better than they did before they had the surgery. They also have a lower risk of heart attack.
8 Responses
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hey there, I’m looking for a treatment for my father
he s 56 year old, he doesn’t smoke,drinks time to time, no sporting.
he already had a bypass surgery but we still have the same problems
and I want to know if he can be a candidate for TMR method
Have severe angina, which limits their daily activities or causes them to wake from pain at night, despite medications.
Have pre-operative tests that show ischemia (decreased blood supply to the heart muscle).
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 with direct bypass-surgery. This is often seen in patients with diabetes. The surgeon will bypass the targeted blockages and use the CO2 Heart Laser on the heart muscle with diffuse disease to achieve more complete blood flow to the heart