Transmyocardial Laser (TMR)
Of the more than 6.4
million Americans that suffer from angina, 150,000 have Class 4 symptoms
(rest pain) and are not candidates for conventional coronary artery
bypass surgery or ballon angioplasty and stenting. If these symptoms
can not be relieved with medication, transmyocardial laser revascularization
(tmr) may be an option. A hand held laser is placed against the outside
of the heart muscle, and the laser makes multiple small channels through
the entire thickness of the heart muscle wall (pictured at left). The
surgeon makes channels every 1 to 2 square centimeter to treat the area
of the heart not getting enough blood flow. 
These
newly created channels stimulate angiogenesis in the heart muscle. This
means that there is new blood vessel ingrowth into heart muscle currently
not receiving enough blood, oxygen, and nutrients. The cartoon at right
depicts a new blood vessel growing into a channel and maturing over
time to improve blood flow. A clear majority (over 75%) of patients
treated with TMR improved at least two angina classes during the first
year after TMR treatment. Longer term results show that benefit from
TMR persists at least five years. Many patients have exhibited a reduction
in major adverse cardiac events, a reduction in the need for hospitalization,
and an increase in event-free survival.