Transmyocardial Laser Revascularization

Abstract

There are an increasing number of patients with diffuse coronary artery disease and refractory angina who have exhausted their options for revascularization. Transmyocardial laser revascularization (TMR) has emerged as a treatment modality for this subset of patients, and has been performed in over 100,000 patients worldwide. Results have been replicated in multiple randomized, controlled trials, which have validated the safety, effectiveness, and substantially improved health. While TMR can be performed in conjunction with other procedures, such as coronary artery bypass grafting, sole TMR can be performed through a thoracotomy incision without the need for cardiopulmonary bypass or anticoagulation. The most likely mechanism for the clinical efficacy of TMR is the stimulation of angiogenesis as a result of the TMR channels. Improved angina symptoms as well as myocardial function have been observed post-TMR.