Despite surgical intervention and regular medication, many patients with coronary disease experience chest pain, or angina, due to a lack of blood flow to the heart tissue. Severe chest pain can greatly affect a patient’s quality of life and when bypass surgery is not an appropriate choice to manage angina, Transmyocardial Revascularization may be an option to improve blood flow to the heart muscle.

What is Transmyocardial Revascularization (TMR)?


TMR uses carbon dioxide lasers to improve blood circulation to the regions of the heart that are unsuitable for bypass or stenting. The surgeon makes a small chest incision to expose the heart and applies the laser to the muscle of the left ventricle of the heart. (The left ventricle is the portion of the heart that pumps oxygenated blood to the rest of the body.) Using a computer-guided laser, the surgeon creates several 1mm channels in the heart muscle. The channels quickly close on the outside of the heart, while they stay open inside and help restore blood flow to the heart muscle. TMR takes about 1 to 2 hours.

TMR can be done while the heart is still beating and does not require an incision into the heart, although it is sometimes performed during coronary artery bypass surgery. Research suggests that this procedure may actually promote the growth of new blood vessels. TMR can decrease chest pain and increase a patients’ tolerance for activity.

Who is the Ideal Candidate for TMR?

Transmyocardial Revascularization can reduce chest pain related to angina for patients who are unsuited to undergo traditional bypass surgery or angioplasty. It is appropriate for patients who experience severe angina despite regular medication that limits daily activities and who have been told by doctors that all treatment options have been exhausted.

Who Is Not an Ideal Candidate for this Procedure?

Patients whose angina is not caused by decreased blood flow to the heart, or patients whose prior heart attack left significant scarring of the heart muscle.

What is the average length of stay for this Procedure?

The average hospital stay for patients who undergo TMR is 4-5 days.