Transmyocardial Revascularization (TMR)

Cesar Nahas, MD

Baylor College of Medicine

Transmyocardial Revascularization (TMR) is a surgical procedure which uses a low power laser to create small passageways or channels through the heart muscle. The potential benefits of the procedure are the reduction or elimination of angina (chest pain), increased exercise tolerance, and improved quality of life.It is believed that these channels may allow oxygen rich blood to flow from the inside of the heart to regions of the heart muscle that do not have normal blood flow. The precise mechanism though is not yet clearly understood.

TMR surgery is performed under general anesthesia. After an incision is made in the chest, the TMR System will be used to create 15-30 channels from the outside of your heart to the inside of your heart. The channels will be made in the part of the heart that is not will supplied with blood. The TMR procedure itself will take 2-3 hours and the postoperative care will be the same as for any cardiac surgery. Patients can expect to stay in the hospital for 4-6 days after the surgery.

TMR is a new procedure, that is why it is being studied under FDA regulations. Several studies in many centers across the US are being conducted. Also, TMR is being studied with a number of different lasers, all in all, over 1,000 patients have been treated with TMR worldwide. In the US patients that have been treated with TMR are usually part of a study. If you suffer from severe angina, especially if you have been determined not to be a candidate for coronary bypass surgery or coronary balloon angioplasty, you may be a candidate for TMR.

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