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.
In medical and surgical therapy, revascularization is the restoration of perfusion to a body part or organ that has suffered ischemia. It is typically accomplished by surgical means. Vascular bypass and angioplasty are the two primary means of revascularization.
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You may be a candidate for the TMR procedure if:
TMR may not be appropriate if you:
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You will be asleep during surgery. First, an anesthesiologist inserts a breathing tube into your trachea (the airway from your mouth to your lungs). This tube will help you breathe during surgery.
Next, the surgeon makes an incision in your chest.
If you are undergoing TMR only, the surgeon usually makes an incision in the left side of the chest.
If you are undergoing TMLR plus bypass surgery, the surgeon may make the incision in the front of the chest and split the breastbone.
If you are undergoing coronary artery bypass surgery at the same time as TMLR, the surgeon will also redirect blood from the heart to bypass machine. The bypass machine does the job of the heart and lungs during the operation. The bypass machine is usually not needed if you are undergoing TMLR by itself.
Once the heart is exposed, the surgeon places a laser handpiece on the area of the left ventricle to be treated .
The surgeon then uses a computerized laser to create 20 to 40 small channels, each approximately 1 millimeter in diameter, in the heart muscle
The laser is controlled by a computer, which synchronizes it with your heartbeat. The channels are made when the heart is in systole, which means that the ventricle is filled with blood and the heart wall is the thickest. This helps prevent electrical disturbances, abnormal heart rhythms and damage to the heart muscle.
The channels may bleed for a moment or two, but the tops of the channels quickly clot and seal.
After the channels have sealed, the surgeon then closes the incision (and the breastbone, if it was opened). The surgeon then applies bandages to the incision site.
The surgeon injects local anesthetic into an area on the groin and then makes a tiny incision to place a catheter (thin tube) in the femoral artery. A fiber-optic catheter is then placed inside the first catheter and guided through the blood vessels to the heart.
A high-energy laser beam is then emitted from the catheter through the endocardium of the left ventricle to the myocardium. In other words, the laser creates a hole through two layers of heart muscle from inside out. Once PMR is completed, the catheters are removed and the incision closed.
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After transmyocardial laser revascularization (TMLR) surgery at UW Health in Iran you will be moved to the intensive care unit (ICU). You will remain in the ICU for at least one day while we monitor your heart function, blood pressure, and other vital signs. In most cases, we are able to remove the breathing tube within six to eight hours of surgery.
You will then be moved to a regular hospital room. During your stay, we will give you medication to prevent blood clots and manage any other diseases, such as high blood pressure, high cholesterol or diabetes.
If you underwent TMR only, you should be able to go home three to five days after surgery. If you underwent TMR plus bypass, you should be able to go home 4-10 days after surgery.
Once you are home, we advise you to:
If you have had bypass surgery with TMLR, you also should not lift more than 10 pounds for the first month after surgery. This allows your breastbone to heal.
You should be able to return to work within 2-3 months after surgery.
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After TMR, some patients feel immediate relief from angina symptoms, while others feel improvement over time. Some patients do not have improved symptoms after TMR, but may have improved activity tolerance. After TMR, you may still be required to take medications to help your heart and improve blood flow to the heart. You will need to meet with a cardiologist for frequent follow-up visits so your progress after TMR can be evaluated.
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