What is transmyocardial revascularization?
Transmyocardial revascularization (TMR) is a recently approved treatment for patients with severe cases of angina. These cases of angina are so intractable that the individual is unable to carry out any physical activity without discomfort or chest pain. Individuals who, previously, had no successful treatment options such as angioplasty or bypass surgery because of the diffuseness of this type of heart disease now have TMR as a treatment alternative at the Inova Heart Center. TMR potentially offers patients with severe angina a means to alleviate symptoms and improve quality of life.
TMR uses a laser device to create pathways or channels through the heart muscle directly into the heart chamber. These channels are intended to enhance the blood supply to the oxygen-starved heart muscle. When performed in conjunction with coronary artery bypass surgery, only an additional few minutes are needed to accomplish the laser procedure.
What are the risks of TMR?
Risks for TMR include irregular heart rhythms, post-operative bleeding, accidental laser damage to a heart valve, and myocardial infarction (heart attack). These complications are exceedingly rare.
Preparing for the procedure
Patients will be asked to come into the hospital's Same Day Admission Program a day or two before surgery to have lab work, a chest x-ray, an EKG and a physical exam. A nurse practitioner or physician assistant will discuss the risks of surgery and ask you to sign a consent form. They will also talk with you and your family about what you can expect while you are in the hospital. An anesthesiologist will talk with you about your medical history and will explain how medication will be given to keep you asleep and free of pain during your surgery.
During the procedure
The procedure is performed by opening the chest and exposing the heart. The patient is placed on the heart-lung machine. Inova's cardiac surgeons create as many coronary artery bypass grafts as possible. The portion of ischemic myocardium (heart muscle with insufficient blood supply) that cannot be treated with bypass grafts is managed by creating muscle channels with the laser device. Successful laser penetrations are evidenced on a transesophageal echocardiogram that is performed simultaneously during surgery.
After the procedure
Recovery from TMR is the same as from traditional bypass. Patients are typically admitted to the intensive care unit for frequent assessment and to facilitate early recognition of complications. They are transferred to a cardiac unit and stay in the hospital for 3-5 days, depending on their progress.
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