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What is TMR and how does it help?

 

If you feel like you have exhausted all options regarding your chest pain – TMR may be an option for you.

What is TMR?

Dr. Seenu Reddy on TMR

Watch Dr. Reddy explain how TMR beneftis patients with Chronic Angina
Watch Video

Transmyocardial Revascularization (TMR) is indicated for treatment of stable patients with angina refractory to medical treatment.14 TMR may help those patients suffering from:

  • Severe Angina
  • Chronic Angina
  • Chest Pain (resulting from coronary artery disease)

One of our patients, Theresa, had a long history with coronary disease. She had multiple therapies and emergency bypass surgery. Although she benefited from these procedures, Theresa suffered from debilitating chronic angina. TMR changed her life.

Watch Theresa’s story, below.

 

If you suffer from chronic angina like Theresa,
you are not alone!

How Does TMR Work?

Transmyocardial Revascularization (TMR) is performed with a low powered laser (specifically, a Holmium:YAG laser), that delivers precise laser energy directly to the target area(s) of the heart muscle.

When performed as a sole therapy, it is done through a small incision between the ribs with the patient under general anesthesia. TMR can also be performed at the same time as bypass surgery in patients that have areas of ischemic heart muscle that cannot be bypassed.

Using a very thin optical fiber, small channels are created in the target area of the heart muscle.14 The instantaneous angina relief effect of TMR may be explained by denervation, or an interruption of the nerves that feed the heart muscle, while the long-term effect of angina relief may involve formation of new blood vessels.9

Results of TMR

Studies have shown that patients with chronic angina who underwent TMR had the following results vs. patients with medical therapy alone:

  • Significantly higher rates of improvement in angina for patients who were not candidates for conventional therapies4
  • Freedom from treatment failure4
  • Freedom from cardiac-related return hospital visits compared with patients who received medical therapy alone4
  • Experienced two or more grade improvements (Canadian Cardiovascular Society, CCS, grading system for angina)4
  • Significantly higher exercise tolerance and quality of life scores4
  • Statistically significant improvements in myocardial perfusion have been observed in recent studies10

Clinical References:

  1. Williams et al. Patients with Coronary Artery Disease Not Amendable to Traditional Revascularization: Prevalence and 3-Year Mortalitiy. Catheterization Cardiovascular Interventions. 2010 May 1;75(6):886-891
  2. Slicker K, Lane WG, et al. Daily cardiac catheterization procedural volume and complications a an academic medical center. Cardiovasc Diagn Ther. 2016 Oct; 6(5): 446–452.
  3. Al-Lamee et al. Percutaneous coronary intervention in stable angina (ORBITA): a double-blind, randomised controlled trial. Lancet. November 2, 2017
  4. Allen KB, Dowling RB, Fudge TL, et al. Comparison of transmyocardial revascularization with medical therapy in patients with refractory angina. N Engl J Med. 1999;341:1029–1036.
  5. Allen, KB, et al. Adjunctive Transmyocardial Revasularization: Five-Year Follow-up of a Prospective, Randomized Trial. Ann Thorac Surg. 2004;78:458-65.
  6. Kloner et al. Angina and Its Management. Journal of Cardiovascular Pharmacology and Therapeutics 2017, Vol. 22(3) 199-209
  7. Mannheimer C, Camici P, Chester MR, et al. The problem of chronic refractory angina; report from the ESC Joint Study Group on the Treatment of Refractory Angina. Eur Heart J 2002;23:355–70.
  8. Management Of Refractory Angina Pectoris; Cheng et al. Management of Refractory Angina Pectoris. European Cardiology Review 2016;11 (2):69–76
  9. Tran R, Brazio Ps, et al. Transmyocardial Laser Revascularization Enhances Blood Flow within Bypass Grafts. Innovations 2007;2: 226-230.
  10. Iwanski et al. Clinical outcomes meta-analysis: measuring subendocardial perfusion and efficacy of transmyocardial laser revascularization with nuclear imaging. Journal of Cardiothoracic Surgery (2017) 12:37
  11. Iwanski et al. Remodeling an infarcted heart: novel hybrid treatment with transmyocardial revascularization and stem cell therapy. SpringerPlus (2016) 5:738
  12. Wehberg, KE. Et al. Improved patient outcomes when transmyocardial revascularization is used as adjunctive revascularization. Heart Surg Forum. 2003;6(5):328-30
  13. Johns Hopkins Medicine. Coronary Artery Bypass Graft Surgery. January 4, 2018
  14. CardioGenesis SoloGrip® III Handpiece IFU LC0001.002 (01/2015)

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