Transmyocardial Laser Revascularization

Transmyocardial Laser Revascularization (TMR) stands at the forefront of innovative therapies for patients with severe coronary artery disease (CAD) who are not candidates for traditional revascularization procedures. This minimally invasive technique utilizes laser energy to create channels within the myocardium, promoting blood flow to ischemic regions of the heart. In this article, we explore the principles, indications, procedural aspects, and clinical outcomes of Transmyocardial Laser Revascularization.

Understanding Transmyocardial Laser Revascularization (TMR): Transmyocardial Laser Revascularization involves the creation of channels or “transmyocardial channels” directly into the ischemic myocardium using laser energy. These channels serve as conduits for blood flow from the left ventricle to the myocardium, bypassing obstructed coronary arteries and improving perfusion to ischemic regions of the heart.

Accredited by the Joint Commission International (JCI) and the National Accreditation Board for Hospitals & Healthcare Providers (NABH), the hospital boasts a 200-bed capacity along with 7 cutting-edge operating rooms.

Specializing in various disciplines such as oncology, orthopedics, neurosciences, liver transplant, kidney transplant, cardiac sciences, and emergency care services, Fortis Hospital, Noida has garnered a reputation for excellence and trust. TMR is typically performed as a standalone procedure or in combination with other cardiac surgeries in patients with refractory angina or diffuse CAD.

Indications for Transmyocardial Laser Revascularization: Transmyocardial Laser Revascularization may be indicated in patients with severe coronary artery disease who are not candidates for traditional revascularization procedures, such as percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Common indications include:

  1. Refractory Angina: Patients with severe angina that is not responsive to medical therapy or traditional revascularization techniques may benefit from TMR to alleviate symptoms and improve quality of life.
  2. Inoperable CAD: Individuals with diffuse CAD or high surgical risk who are not candidates for CABG or PCI may undergo TMR as an alternative therapy to improve myocardial perfusion and alleviate ischemic symptoms.
  3. Adjunct to CABG: TMR may be performed in combination with CABG in select patients to augment blood flow to areas of the myocardium not amenable to traditional revascularization techniques.

Procedural Aspects of Transmyocardial Laser Revascularization: Transmyocardial Laser Revascularization involves several key procedural aspects:

  1. Preoperative Evaluation: Patients undergo comprehensive preoperative evaluation, including cardiac imaging, coronary angiography, and assessment of ischemic burden, to determine the optimal candidacy for TMR and assess the extent of myocardial ischemia.
  2. Surgical Approach: TMR is typically performed under general anesthesia with the patient in a supine position. A small thoracotomy incision is made in the left lateral chest wall to access the heart and myocardium.
  3. Laser Energy Delivery: A specialized laser probe is inserted into the myocardium, and laser energy is delivered to create transmyocardial channels. The depth and number of channels are carefully controlled to ensure adequate myocardial perfusion without compromising cardiac function.
  4. Postoperative Care: Following TMR, patients require close monitoring in the intensive care unit (ICU) to assess cardiac function, hemodynamics, and pain control. Long-term follow-up is essential to evaluate symptomatic relief, functional status, and durability of the procedure.

Clinical Outcomes and Long-Term Efficacy: Transmyocardial Laser Revascularization has been shown to provide significant symptomatic relief and functional improvement in patients with refractory angina and diffuse CAD. Clinical studies have demonstrated:

  1. Reduction in Angina Severity: TMR has been associated with a significant reduction in angina frequency, severity, and nitroglycerin usage, leading to improved quality of life and functional capacity.
  2. Enhanced Myocardial Perfusion: Histological studies have shown the formation of patent transmyocardial channels with neovascularization and improved myocardial perfusion in ischemic regions.
  3. Durability of Benefits: Long-term follow-up studies have demonstrated sustained symptomatic relief and functional improvement in patients undergoing TMR, with durable benefits extending beyond five years post-procedure.

 

Discover world-class medical care and cultural wonders.

Contact us today and start your healing journey!