Transmyocardial Revascularization may help some patients with severe coronary artery disease who may not have other options.

When the number, location, and extent of coronary artery stenosis injuries (occlusions) present a significant risk of heart attack for coronary artery disease patient, coronary artery bypass surgery is the preferred method of treatment for CAD. However, some severely diseased patients may not be candidates for the surgery due to their health or medical history, and may not be able to be helped with medication or intervention. TransMyocardial Laser Revascularization (TMLR) is one of the latest approaches in treating CAD that offers a new alternative to these patients. It has been under evaluation by the FDA for several years, and its use has been restricted to patients who have severe unstable angina and who cannot be helped with medication or any other form of intervention. However, now it is available to patients with badly diseased arteries based on their doctor's judgment.

Coronary artery disease (CAD) is occlusion (obstruction) of the coronary arteries resulting from atherosclerosis. Just like other organs, the heart needs a constant supply of oxygenated blood. The coronary arteries supply the heart muscle with the fresh blood nourishment it needs to do the work of pumping blood throughout the rest of the body. When the heart's own need for oxygen rich blood rises, occlusions in coronary arteries prevent it from receiving the necessary amount. This insufficient supply of blood results in oxygen deprivation, a condition called myocardial (heart) ischemia. An ischemic heart reacts by giving off a sensation of pain, which we call angina, or, more technically, angina pectoris. A complete blockage of an artery results in a heart attack. The heart tissue supplied by that coronary artery begins to die, and some of the heart muscle may be permanently damaged, or, in very severe cases, may result in death of the patient.

In Transmyocardial Revascularization the surgeon creates new perfusion channels in the heart muscle to supplement the diseased coronary arteries

In TMLR the surgeon makes use of a laser to create blood perfusion channels in the heart muscle to supplement the function of the coronary arteries. The heart then feeds itself by taking blood from within its chambers, just like in reptiles, whose hearts have no coronary arteries.

During the TMLR procedure the surgeon makes an incision in the patient's left chest. With the heart exposed, the surgeon uses a laser to create multiple narrow channels through the wall of the left ventricle into the ventricular cavity in the area of the heart suffering form ischemia (lack of oxygenated blood). The inside surface of the channels develop a smooth, permeable membrane that allows blood to perfuse to heart muscle. The exterior surface opening of the channel is sealed off as blood coagulates and scar tissue closes the hole. When the surgeon has covered the ischemic areas of the heart with sufficient revascularization channels and verified that there is no bleeding from them, the access incision is closed. Recovery is usually rapid, requiring only three to four days in hospital.

When the condition of the patient is so serious that even this procedure would not be tolerated easily, surgeons at Surgical Associates of Texas, P.A. can use heart assist devices as bridges to this procedure. By implanting the assist device and permitting the heart to rest, the damaged heart cells may return to normal. The assist device can then be removed, and a TMLR can be performed. Thus far, the results have been promising.

If you have been advised that neither heart bypass surgery nor interventional cardiology are options for your condition, we encourage you to contact us for a TMLR evaluation.

The surgeons who make up Surgical Associates of Texas, P.A. are distinguished by their extensive experience in coronary bypass surgery, valvular repair and replacement, aortic and left-ventricular aneurysm surgery, and successful outcomes with high-risk patients with multiple disease comorbidities. They are deeply involved in clinically oriented research where advances and developments are transferred directly to patient care, and have long term relationships with an excellent team of cardiovascular anesthesiologists and cardiologists. Based at the Texas Heart Institute, our surgeons are affiliated with St. Luke's Episcopal Hospital, and Texas Children's Hospital. They hold academic appointments at The University of Texas Medical School, Houston, and Baylor College of Medicine, Houston.