Transmyocardial Laser Revasularization (TMR): Procedure & Risks

TMR Heart Procedure

TMR (Transmyocardial Revascularization) is a technique of surgery used in the management of angina (chest pain) in those patients who should not be easily subjected to CABG or angioplasty. This is because it is primarily intended to enhance blood supply through the heart tissue.

What is TMR (Transmyocardial Revascularization)?

Laser TMR is a technique in which small pathways are made in the heart muscle tissue. These vessels enable blood with adequate oxygen to be supplied to other parts of the heart not supplied with enough blood by the blocked coronary arteries.

Transmyocardial Laser Revascularization

Transmyocardial Laser Revascularization or Transmyocardial Revascularization is a surgical treatment with the use of laser for the treatment of patients with inoperable angina or chronic chest pain due to coronary artery disease that cannot undergo angioplasty or bypass surgery.

What Happens During TMR?

• A laser (normal CO2 or Holmium:YAG) is applied to drill little holes with the diameter of 1mm on the wall of the left ventricle of the heart.
• ‘These channels run from the epicardium, which is the outer layer of the heart towards the endocardium and which is the inner layer of the organ.
• They perfuse the isotropic myocardium with the oxygenated blood that is within the heart’s chamber.
• Channelling on the outer surface is complete while inside it is open whereby it continues to provide micro-perfusion.

TMR Surgery for Angina

TMR for angina or Transmyocardial Revascularization is laser based heart treatment given to patients suffering from chronic and severe angina, who cannot go for angioplasty or bypass surgery because of the complex blocks in their coronary arteries.

Why It's Done:

TMR is specific for those patients with:

• Severe, stable angina (usually Class III or IV angina on the Canadian Cardiovascular Society scale)
• There are no other options of ever doing surgery and such like operations through the use of catheter balloon.
• The lack of blood flow to the heart tissue in spite of medical treatment by drugs and other measures
• This may well be seen as a kind of “end-of-the-line” therapy, but can markedly help to ease chest pain and enhance the patient’s general well-being.

How the Surgery Works:

• General anaesthesia is given.
• It is accesses through an intercostal incision on left side or median sternotomy.
• Through a “side fire” technique a COâ‚‚ or Holmium: YAG laser is employed to make 20–40 microscopic holes in the left ventricle wall.

These channels:

• Blood inside the cardiac muscle cannot be allowed to pass through the coronary circulation, and be allowed to flow directly to the starved heart muscle instead.
• It may encourage the growth of fresh vessels also known as angiogenesis
• Laser’s holes are sealed at outside but the inner passages are left open to enhance blood flow.

TMR Heart Surgery Recovery

The TMR heart surgery (Transmyocardial Revascularization) takes a few weeks of recovery period, which includes after care treatment at hospital and at home. These are the following stages involved during the recovery phase:

Hospital Recovery (5–7 Days):

ICU Stay (First 24–48 hours):

• Continuous heart monitoring
• Pain control with IV medications
• Breathing support if needed

General Ward:

• The progress of development of movement distinctive for instance sitting, walking.
• Transition to oral pain meds
• Breathing exercises to prevent pneumonia
• Conditions for which DBPC was monitored for: arrhythmia, bleeding, and infection

At-Home Recovery (6–12 Weeks):

Physical Recovery:

• Activity: slow and gradual increase in general mobility and performance of activities of daily living

Restrictions:

• No heavy lifting (typically >5–10 lbs for 6–8 weeks)
• Do not drive until your doctor gives you to go ahead which is usually after 4-6 weeks.
• Cardiac rehab: This is normally prescribed for exercise prescription and supervision

Diet and Lifestyle:

• Heart-healthy, low-sodium, low-fat diet
• Hydration and balanced meals for wound healing
• Avoid alcohol and smoking

Medications:

• Pain relievers
• Beta-blockers or anti-arrhythmics
• Blood thinners (if prescribed)
• Stable anti-anginal medications should be continued or if tolerated, the dose lowered.

TMR Procedure Risks

Transmyocardial Revascularization (TMR) procedure which has been described as being advantageous for patients with severe angina comes with certain risks and potential complications given the fact that it is commonly performed on the patient with proliferating coronary artery disease and few other available therapeutic options.

TMR heart procedure side effects:

• Cardiac Arrhythmias
• Heart Attack (Myocardial Infarction)
• Stroke
• Bleeding
• Infection
• Pericardial Effusion or Tamponade
• Death

Factors Affecting TMR Heart Surgery Cost

The cost of TMR (Transmyocardial Revascularization) heart surgery can be greatly influenced by elements concerning the patient’s medical history, medical facility, or regions. When it comes to deciding the overall cost, these are seven fundamental aspects that will help in estimating it:

• Hospital and Facility Charges
• Surgeons and Medical Team Fees
• Type of Procedure
• Preoperative Tests and Evaluations
• Medications and Consumables
• Length of Hospital Stay
• Geographic Location

Benefits of TMR Surgery

• Significant Relief from Angina
• Improved Quality of Life
• Enhanced Blood Flow to the Heart Muscle
• Can Be Combined with CABG
• Reduced Hospital Readmissions
• Durable Results

TMR Heart Surgery Success Rate

TMR’s overall efficacy is viewed as high since the operation is done on carefully evaluated patients, especially those with inoperable severe angina and diffuse CAD. The relief of symptoms and Chronic Stable Angina can be found in 70–90% of patients.

TMR Heart Surgery Hospitals

TMR heart surgery in India:

• Fortis Escorts Heart Institute, Okhla
• Max Hospital, Saket
• Max Hospital, Shalimar Bagh
• Indraprastha Apollo Hospital, Delhi
• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon

TMR Heart Surgery Reviews

• Pain Relief: The post-operative finding of the clinical trials indicated of the show that the severity of angina was reduced in 70-90% of patients after TMR surgery.
• General New Developments: According to the clinical studies, TMR has been revealing an enhanced exercise tolerance in patients and an improved general quality of life. 
• Long-term effects: Some publications also conclude that the positive outcomes of TMR like the reduction of symptoms and enhancements of cardiac functions have been long-term results which are seen even after years of the operation.