Montefiore Einstein Center for Heart and Vascular Care – Surgical Services – Transmyocardial Revascularization - New York

Transmyocardial revascularization (TMR) uses a Holmium: YAG laser to create channels that pass through a patient's heart muscle into the left ventricle. This procedure reduces the chronic chest pain experienced by patients with severe angina who are not candidates for coronary artery bypass (CABG). For patients suffering with angina, the strain daily activities, such as enjoying a big meal or rushing to catch a train, can stress the heart and cause chest pain ranging from tight pressure in the chest to a burning sensation.

Surgeons also perform TMR on areas of the heart too weak to withstand angioplasty, stent or CABG. If a patient can receive bypass in one area of the heart but not another, TMR is combined with bypass to increase the patient's overall pain relief.

How is Transmyocardial Revascularization Performed?

During a transmyocardial revascularization (TMR) procedure, the patient is put under general anesthesia and a cardiothoracic surgeon accesses the patient's heart through a thoracotomy. The surgeon guides a laser to the part of the heart receiving therapy, where energy is delivered in precise bursts. These electric pulses create 20 to 45 tiny channels through the heart muscle into the left ventricle, which allows the surrounding heart tissue to be flooded with oxygen-rich blood.

Why does TMR provide relief?

While TMR is still being studied, the most current research and clinical studies suggest that the blood flowing through the channels created during this procedure encourages the growth of new blood vessels. Theoretically, these new blood vessels may increase the blood and oxygen supply in damaged heart muscle. Studies show that 75 percent of patients who receive TMR report drastically reduced pain and increased quality of life.