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Transmyocardial Laser Revascularization

Transmyocardial revascularization (TMR) is a surgical procedure for inoperable coronary artery disease patients with angina (chest pain)

Patients with coronary artery disease are treated with interventional procedures (angioplasty and stenting), coronary artery bypass grafting (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), transmyocardial laser revascularization or TMR is another treatment option physicians from the Center for Advanced Ischemic Heart Disease can offer to patients.

How does TMR work?

TMR is a treatment aimed at improving blood flow to areas of the heart that were not treated by angioplasty or surgery. A special carbon dioxide (CO 2) laser is used to create small channels in the heart muscle, improving blood flow in the heart. TMR is a surgical procedure. The procedure is performed through a small left chest incision or through a midline incision. Frequently, it is performed with coronary artery bypass surgery, but occasionally it is performed independently.

Once the incision is made, the surgeon exposes the heart muscle. A laser handpiece is then positioned on the area of the heart to be treated. A special high-energy, computerized carbon dioxide (CO 2) laser, called the CO 2 Heart Laser 2 1, is used to create between 20 to 40 one-millimeter-wide channels (about the width of the head of a pin) in the oxygen-poor 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 CO 2 Heart Laser 2 1 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 in the heart.

Clinical evidence suggests blood flow is improved in two ways:

  1. 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.
  2. The procedure may promote angiogenesis, or 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.

Are you a candidate for TMR?

The physicians in the Center for Advanced Ischemic Heart Disease will evaluate your medical condition, medical history and diagnostic tests to determine the best treatment for you.  They may need to obtain additional testing to determine blood flow to your heart and the pumping ability of your heart. 

At that time, they can provide you with treatment options.

How do you get evaluated for TMR?

Please see the Center for Advanced Ischemic Heart Disease to learn more about being evaluated and treatment options for advanced heart disease.

If you are being seen at the Cleveland Clinic already for treatment of your heart disease, talk to your cardiologist about whether TMR surgery is an option for you.


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Reviewed: 9/09

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This information is provided by Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.

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