TMR Laser revascularization...carefull..

[Chip]

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?

[Gldngrl]

I took care of these patients in late nineties in Boston...it's been around for awhile, but I heard that in some of research, the results weren't particularly effective.

[Chip]

Yes, It has been around for a while but now the laser is more refined, also much stronger therefore more edema post surgery swelling. From what I have seen the studies should be over sooner than later.

[DiannaM]

Thanks, anybody else have anything to add?

Hi there. I work for a cardiology practice in Louisville, KY. My docs were discussing TMRs the other day. We refer to the CV surgeons for TMRs as a last resort. (referred a chick last week ... 40ish, DM, HTN, s/p CABG, with progressive disease and tiny vessels ... not a candidiate for PCI or re-op CABG) I'm not entirely sure what the "success" rate is here in town .... you know, do these patients survive, how is the quality of life, etc. We did have a guy a few months ago that was s/p TMR 10 years ago!

One of my docs made the point, do the patients feel better because of the "channels" burned into the heart, or are all the nerves just severed?? Hell, I don't know ... does the heart even have nerve endings?? Something to think about.

We do use ECP for patients with intractible/inoperable angina, as well as CHF. (Chick who was referred for TMP came from our ECP clinic)

Anyone else using that??

Dianna

[oicu8bacilli]

I've seen it many times in conjunction with CABG when an area simply can't be revascularized. It's common to see something like "CABG x 2 LAD, Diag, & TMR (45) to the RV"