What Is Transmyocardial Laser Revascularization?

What Is Transmyocardial Laser Revascularization?

Transmyocardial laser revascularization (TMR) is a treatment heart doctors use to improve blood flow to areas of the heart that were not treated by angioplasty or surgery. TMR can also be used for patients who have had surgery (like coronary bypass surgery) but their surgery won't complete their treatment.

When Would My Doctor Recommend TRM?

Doctors use interventional procedures (angioplasty and stenting), coronary artery bypass grafting, and medications to treat patients with coronary artery disease. All of these treatments improve blood flow to the heart muscle.

But sometimes these procedures don't eliminate the symptoms of chest pain. In these cases, TMR is another treatment option.

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How Is TRM Done?

During TMR, doctors use a special carbon dioxide (CO2) laser to create small channels in the heart muscle that improve blood flow in your heart. Doctors will make a small incision (cut) on the left side of your chest or in the middle of your chest.

Doctors often perform TMR with coronary artery bypass surgery, but sometimes TMR is performed by itself.

Doctors don’t fully understand how TMR reduces angina. The CO2 laser may stimulate new blood vessels to grow and/or it may destroy nerve fibers to the heart, making patients unable to feel their chest pain.

TMR won't replace coronary artery bypass or angioplasty as the most common method of treating coronary artery disease. These alternatives have been proven over time to be safe, effective ways to restore blood flow to the heart muscle. However, TMR can be considered as a type of treatment in:

  • People who are high-risk candidates for a second bypass or angioplasty;
  • People whose blockages are too diffuse (spread out) to be treated with bypass alone; or
  • some patients with heart transplants who develop atherosclerosis in their transplanted heart.