What I have learned.......
The TMR laser, literally blasts holes through the heart and creates "channels", in which blood supply may return to ischemic myocardial tissue. This is done when there are difficult targets for bypass grafts. The surgeon will fire between 30-50 channels into the heart sometimes having to suture holes that do not stop bleeding.
The danger is that the heart is quite stiff and sometimes swollen after the procedure. Patients may decompensate for many reasons. If the heart is dry and filling pressures are low, the stiff heart will not provide adequate cardiac output when stressed.
This is a fairly new procedure and in my CVICU we have observed this instability. So baby these patients, keep a close eye on PA pressures and cardiac index. Have two people available when getting these patients out of bed. Thanks, anybody else have anything to add?