Tmr

[TennRN2004]

Are any of your surgeons doing TMR on patients? We've seen an increase in it lately. It's an interesting concept, and has been used on a few of our patients who need bypass but have no viable grafts.

[dianah, ASN]

Out of curiosity, I Googled this to read more about it. Very fascinating! I can't comment from experience working with pts who've had it, however. I only work Cath Lab, and our hospital does no cardiovascular surgery.

Hope someone will post for you/us on this! :)

[SorenDrake]

Our docs do it occasionally. Very interesting procedure.

[TennRN2004]

One of the nurses on our unit is in grad school, and she's doing a presentation on it for a class. It was interesting b/c I was talking to one of the surgeons the other day asking questions. I told him I didnt really have a good grasp of exactly how the procedure worked. He drew me pictures and was explaining to me the theory behind it. He did say that he wasn't sure if it really was a load of you know what, or if it really did help patients with no other alternatives who can't be stented or grafted. Clinically though, 6 mos out patients seem to be objectively doing better-less symptoms,less cp, less hospital admissions, better quality of life (this is all from the nurses research in the unit). I'm sure after talking to the surgeon, if you went back and did a COA 6 mos later, the patient still has the same major blockages, but the TMR allows for revascularization so the patient feels better because the heart is getting more O2. I think that was his point-the patients do feel better, but the heart is still not getting optimal blood flow. The research project that nurse did also stated there was no difference in mortality between pts who got TMR vs those who didn't but we're a surgical candidate or a PTCA cadidate. I guess it basically doesn't add any time to lifespan, but what time the patient has left is more enjoyable.

[Dinith88]

we have one surgeon who does this...though he does it at a sister hospital. He believes it to be a worthwhile procedure...and promised us (2 years ago) that we would soon be acquiring the laser...but we never have. I've not taken care of patients who've had it...but i wonder how a patient who does have it would be recoveered??? You should ask your co-worker if they're recovered just like any other cabg..or if they have fewer or greater complications (bleeding??)...?

[hrtprncss]

I haven't recovered patients who's had this procedure than as well. More info from experienced nurses would be great.

[TennRN2004]

Yes, we recover them exactly the same as our other heart surgeries. The only difference is typically they have what the docs call a "sluggish myocardium". The laser stuns the heart muscle for a few months, so instead of wanting a goal CI of 2.4, the docs are okay with maybe a 2.0. They don't have any more complications compared to the standard cab.