Transmyocardial revascularization or TMLR is a procedure used to relieve severe angina or chest pain in very ill patients who aren't candidates for bypass surgery or angioplasty.Patients with coronary artery disease are treated with interventional procedures(angioplasty and stenting), coronary artery byass grafting (surgery) and medications to improve blood flow to the heart muscle. If these procedures donot eliminate the symptoms of chest pain (also called angina), transmyocardial laser revascularization or TMLR is another treatment option our surgeons can offer to patients.
During the procedure a surgeon uses a laser to carve minuscule channels in the heart muscle. It is thought that the channels become new pathways for blood to enter the heart muscle. After recovery, most patients who have undergone transmyocardial revascularization report less chest pain and have less risk of further cardiac events.
Transmyocardial revascularization was traditionally performed during open-chest surgery, involving a lengthy recovery time. With the advent of minimally invasive robotic-assisted surgery, however, a new technique became available involving less trauma, less pain and faster recovery. Robotic transmyocardial revascularization permits the surgeon to work through small incisions with a great degree of dexterity and visualization.
How TMR is Done
A special carbon dioxide (CO 2) laser is used to create small channels in the heart muscle, improving blood flow in the heart. TMR is a surgical procedure.
The surgeon creates a small left chest incision to access the beating heart. A laser probe is placed on the surface of the heart and the laser beam creates a 1mm (size of a pin) channel through the heart muscle. The blood inside the heart acts as a backstop for the laser beam after it has penetrated the entire depth of the heart wall. Between ten and 50channels are created to restore blood flow to an area of concern.
Clinical evidence suggests blood flow is improved in two ways:
The channels act as bloodlines. When the ventricle pumps or squeezes oxygen-rich blood out of the heart, it sends blood through the channels,restoring blood flow to the heart muscle.
The procedure may promote angiogenesis, or growth of new capillaries(small blood vessels) that help supply blood to the heart muscle.
TMR usually takes one to two hours. The procedure may last longer if it is combined with other heart procedures.
Potential Patient Benefits
The patients post-surgical care and hospital stay are similar to that of patients undergoing other types of minimally invasive cardiac surgery. The full clinical benefits of TMR may take several months.
SaintJoseph's Visconti Center for Robotics offers this new approach to transmyocardial revascularization through the use of the da Vinci SurgicalSystem. For the clinically appropriate patient, da Vinci transmyocardial revascularization offers a number of potential benefits, including:
Less post-operative pain
Less risk of infection
Less anesthesia
Less blood loss
Shorter hospital stay
Faster and more complete recovery
Quicker return to normal daily activities
For more information about robotic surgery, call 1-866-SJ-ROBOT (1-866-757-6268) or click here .
