Transmyocardial Revascularization

Transmyocardial Revascularization

The most procedures used to help patients with coronary heart disease are coronary artery bypass grafting (CABG) and percutaneous intervention (PTCA). Because of complicating factors however, a significant percentage of patients are not candidates for CABG or PTCA and must be managed through other means.

Patients with inoperable coronary disease routinely suffer from angina. Though medication provides relief for some, others do not respond well to medication and suffer from frequent episodes of pain and hospitalization. Transmyocardial Revascularization (TMR) is a new surgical treatment option for angina patients who cannot be helped through medical management by their cardiologists. TMR, which uses a laser to promote increased blood flow in ischemic regions, is approved by the FDA, reimbursed by Medicare, and is available in Chattanooga through the Alliance of Cardiac, Thoracic and Vascular Surgeons.

TMR is indicated for patients with chronic, severe angina who are not candidates for other revascularization procedures. While other medical problems may increase the risk of the procedure, there are few absolute contraindications for the procedure. Patients with previous bypass grafts, but who still suffer from angina, are potential candidates.

TMR is performed while the patient is under general anesthesia. After the surgeon has exposed the heart, the TMR hand-piece is placed against the heart muscle. The laser is then fired and the laser energy directed to the muscle tissue creating a channel in the ventricular wall. A channel is created approximately every square centimeter. On average, about 40 channels are created per procedure.

Angina pain is the result of inadequate oxygen supply to the heart muscle. The new channels created by TMR promote revascularization and help to increase blood flow to the affected area thus relieving angina pain for a significant percentage of patients. Recovery from TMR is similar to bypass surgery, with an average length of stay in the hospital of seven days.

Clinical trials have shown that while there are risks associated with TMR, significant percentages of the study groups (72% in a study by the Texas Heart Institute; 82% in a study by the University of Pittsburgh) saw their angina improve. Other benefits of TMR include reduced episodes of hospitalization, reduced consumption of medications, increased exercise tolerance and improved quality of life.

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