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 may be done if you:

• Have severe chest pain that limits your daily activities or wakes you up at night, even after taking medicine for the pain.
• Have medical tests that show the heart muscle is not getting enough blood.
• Have previously had bypass surgery or angioplasty and still have angina.

TMR is not recommended if:

• Your heart muscle is severely damaged or scarred from heart attacks.
• Your heart is getting enough blood.

How do I prepare for the procedure?

Get any tests you need before 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 after the procedure and during recovery at home. Find someone to give you a ride home after 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 these reasons, 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.

Your healthcare provider may ask you not to eat or drink anything after midnight on the night 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 keep you from feeling pain during the operation.

The surgeon will make a small cut in the left side or the middle of the chest. A laser is then used to create 20 to 40 channels in the left ventricle. (The left ventricle is the 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 will close so that the heart does not leak after the procedure.

TMR usually takes 1 to 2 hours. The procedure may last longer if other procedures are done at the same time. You will stay in the hospital for 4 to 7 days, depending on your overall health and how quickly you recover.

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.