TMR takes between one and two hours to perform and patients typically stay in the hospital for between four and seven days. Studies suggest that it may work by stimulating angiogenesis, or the growth of new blood vessels, and also by destroying nerve fibers that cause the patient to experience chest pain. The advantage of TMR is that it provides a last-resort option to patients with severe angina.
It can be especially effective in patients with other conditions — such as diabetes — that preclude the use of bypass surgery. Although clinical data are still somewhat limited, 80 to 90 percent of patients have seen significant improvement in their symptoms at least a 50 percent improvement at one-year follow up.
SURG Transmyocardial Revascularization
A New England Journal of Medicine study concluded that patients who had TMR had relief of chest pain as well as improved quality of life, improved blood flow to the heart, and decreased hospital admissions. The procedure is relatively quick and is also covered by most insurance companies. But in patients with coronary artery disease CAD , the coronary arteries are clogged and diseased and can no longer deliver enough blood to the heart.
Not getting enough oxygen to the heart muscle increases the risk of heart attack and may cause a painful condition called angina.
Transmyocardial Laser Revascularization in Patients with Diffuse Coronary Artery Disease
Most of the time, the best treatment for angina is coronary artery bypass surgery. But for some patients with very serious heart disease or other health problems, bypass surgery may be too dangerous. Also, some patients may have had many coronary artery bypass operations and be unable to have more bypass operations. For patients who cannot have bypass surgery, there is a procedure called transmyocardial laser revascularization , also called TMLR or TMR.
TMLR is a type of surgery that uses a laser to make tiny channels through the heart muscle and into the lower-left chamber of the heart the left ventricle. After TMLR, when oxygen-rich blood enters the left ventricle, some of that blood can flow through the tiny channels and carry much-needed oxygen to the starving heart muscle. No one really knows why TMLR helps reduce the pain of angina.
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Some doctors think that TMLR helps the growth of tiny new blood vessels in the heart muscle wall. This process is called angiogenesis. These new blood vessels bring more blood to the heart muscle, making it healthier. Others think that the TMLR laser destroys some of the pain-causing nerves in the heart muscle. Still others think that patients feel a placebo effect.
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This means that patients feel better because they got treatment, not because the treatment really worked. Doctors came up with the idea for TMLR by studying the hearts of alligators and snakes, where blood to feed the heart muscle goes straight from the ventricle and into the muscle, not through coronary arteries.
Doctors thought this might work in human hearts, too. TMLR is surgery, but it can be done while the heart is still beating and full of blood.
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That means that a heart-lung machine is not needed. Herz [01 Sep , 25 6 ].
Abstract In patients with severe angina pectoris due to coronary artery disease, who are not candidates for either percutaneous coronary angioplasty or coronary artery bypass surgery, transmyocardial laser revascularization TMR often leads to improvement of clinical symptoms and increased exercise capacity. One drawback of TMR is the need for surgical thoracotomy in order to gain access to the epicardial surface of the heart.
Therefore, a catheter-based system has been developed, which allows creation of laser channels into the myocardium from the left ventricular cavity. Between January and November , this "percutaneous myocardial laser revascularization" PMR has been performed in patients at the Herzzentrum Leipzig.
In 63 patients, only 1 region of the heart anterior, lateral, inferior or septal was treated with PMR, in 38 patients 2 or 3 regions were treated in 1 session. There were After 3 months, the majority of patients reported significant improvement of clinical symptoms CCS class at baseline: 3.
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After 2 years, the majority of patients had experienced sustained clinical benefit after PMR, the CCS class after 2 years was 1. However, thallium scintigraphy failed to show increased perfusion in the PMR treated regions. The pathophysiologic mechanisms of myocardial laser revascularization is not yet understood.