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Cardiac Surgery | by Dr. Manoj Kumar Daga | Published on 02/02/2023
Transmyocardial laser revascularization is a surgical procedure to make tiny channels through the heart muscles to reduce the symptoms of angina and improve the health of the heart. The procedure is widely recommended for patients suffering from coronary artery disease which results in clogged arteries that can no longer deliver enough blood to the heart.
The procedure uses a special carbon dioxide laser to shoot tiny pinholes through the heart muscles and into the heart's lower ventricle. The new channel created by the laser improves the flow of oxygen-rich blood to the heart muscles. If you are planning to undergo a transmyocardial revascularization (TMR) procedure, this blog can provide a reference to help you prepare for the procedure. However, please note that this blog is only for reference purposes, and it is important to consult a cardiac surgeon in Kolkata to know if the procedure is the best treatment option for you.
Transmyocardial laser revascularization requires a small incision on the left side of the chest through which a laser drills tiny channels into the heart muscle. The heart continues to beat during the procedure, so there is no need for a heart-lung bypass machine.
Subsequently, the surgeon uses a special carbon dioxide laser to make tiny channels in the heart muscle. The channels, around 1 mm wide, and about the size of the head of a pin, are made when the heart’s walls are the thickest and are least likely to be damaged (most likely during systole). Sometimes, the surgeon treats one side of the heart with bypass surgery and the other with TMLR. The channels may bleed for a short while but it subsequently stops when the surgeon applies slight pressure on the channels.
Transmyocardial revascularization procedure benefits patients with symptoms of coronary artery disease and angina. The recovery period may vary depending on several factors but on average, it takes 3 months to observe the difference.
Patients after their TMR surgery experience reduced symptoms of CAD and usually undergo activities that they initially couldn’t. TMR procedure reduces the reliability of medications significantly and leads to an improved quality of life. Most doctors believe that around 80-90% of patients who undergo trans myocardial revascularization procedures feel better after a year than they did before the procedure. Finally, TMR is shown to lower the risk of a heart attack in most patients.
Transmyocardial revascularization is done to treat a blockage or congestion in one or more coronary arteries. The procedure is recommended when a bypass surgery is not recommended. TMR is also performed in patients with coronary artery disease to relieve symptoms such as -
Patients with chronic angina who cannot undergo traditional bypass surgery or have exhausted other treatment options often benefit from Transmyocardial Revascularization (TMR). Additionally, if the symptoms of angina do not improve despite regular medications, TMR can significantly treat such patients to improve their quality of life.
Who should not undergo trans myocardial revascularization (TMR)?
Transmyocardial Revascularization (TMR) is usually not recommended for patients with significant scarring in the heart muscle due to a prior heart attack. Also, patients whose angina is not caused by decreased blood flow to the heart must also avoid undergoing TMR.
The surgical duration of the trans myocardial revascularization (TMR) procedure is usually 1 to 2 hours. However, the OT time can vary depending on the severity of the disease, the medical condition of the patient, and the surgical expertise of the surgeon.
Recovery after the TMR procedure can vary depending on several factors, but it usually takes 3 months or more. With certain post-operative care, most patients can resume their work within 4 to 6 weeks after the procedure. However, it is recommended that you consult a doctor before resuming your daily activities.
The average hospital stay for patients after the trans myocardial revascularization procedure is usually 4-5 days. However, the length of stay can vary depending on the post-surgery recovery and medical health of the patient.
