Maryland Heart Center

Surgical Treatments

Trans-Myocardial Revascularization (TMR)

Patients with severe coronary artery disease and angina, who are not amenable to balloon dilatation (PTCA) or coronary artery bypass graft (CABG), may meet the criteria for trans-myocardial revascularization (TMR).

This procedure, which can be done by itself or in combination with conventional coronary bypass surgery, consists of the creation of channels through the heart muscle. In time, as these channels heal, they stimulate the creation of new small vessels or capillaries by a process known as angiogenesis. While the resolution of the angina may take weeks to a few months, surgical scars and the length of hospitalization may be minimized, especially in cases in which no other procedures are performed.

What is Angina?

All cells, muscles, and tissues in your body need the oxygen carried in your blood. This is the same for your body's main blood pump, the heart muscle. If blood vessels which bring blood to the heart muscle are clogged or damaged, the heart muscle doesn't get the oxygen it needs and you may feel a pain called angina in your chest, neck, jaw or shoulders. This pain can limit your physical activity and ability to do the things you want to do.

What is TMR?

Trans-myocardial revascularization is a new surgical procedure using a laser to make "channels", or small holes, directly into the heart muscle. The outside of the heart muscle seals up immediately. TMR has been shown to reduce angina and improve the quality of life in patients with coronary artery disease. This laser for TMR was approved by the U.S. FDA as a safe and effective device for the treatment of angina due to advanced cardiovascular disease.

You may be a candidate for the TMR procedure if:

You have angina due to advanced cardiovascular disease
(Your physician believes that) you are not a candidate for standard therapy (for example balloon angioplasty or bypass surgery)
The heart muscle around these affected blood vessels is healthy
Your angina cannot be managed with medications or these medications are causing serious side effects

TMR requires a surgical procedure and there are risks associated with any surgery in general and with the TMR procedure itself. Risks include those normally associated with chest surgery, such as death, heart attack (myocardial infarction), stroke, and heart failure as well as risk of disruption of normal rhythm of the heart during and/or after the procedure. Your doctor will discuss all the risks and benefits of surgery and the TMR procedure with you.

Your follow-up requirements for recovery after a TMR procedure are similar to those following other heart surgeries. You will undergo regular check-ups by your physician. Your physician will advise you when you may return to more normal activities.

Benefits of TMR

Treatment with TMR may reduce your angina pain and help you return to a more active lifestyle.
Treatment with TMR may also reduce the need for some of the medications you are currently taking to manage your angina pain.
TMR has been shown to reduce angina pain and improve the quality of life in patients with coronary artery disease.

TMR may not be appropriate for you if you:

are unable to undergo general anesthesia
have had a heart attack (myocardial infarction) within three weeks
have uncontrollable or severe heart rhythm problems
have debilitating chronic lung disease, such as chronic obstructive pulmonary disease, which significantly impairs your ability to breathe
have heart failure, also known as congestive heart failure, usually associated with shortness of breath due to "fluid in the lungs" or with swelling in the lower extremities

For more information on TMR, see CardioGenisis Corporation.

Please call if you would like to make an appointment or talk to someone about our services. Patients dial 1-800-492-5538 or 410-328-5842, physicians dial 410-328-6622 or 1-800-318-1019.