India Cardiac Surgery Site is associated with experienced cardiologists to deliver the perfect treatment and recuperative plan. Before the surgery, we will educate the patient with every fact involved in surgery and maintain the transparency in procedure, facilities and the related costs. We provide quality services and also assists with arrangements by keeping the concerns of the international patients in mind, providing you the utmost care and professionalism.

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What is Transmyocardial Laser Revacularization (TMR)?

Transmyocardial Laser Revacularization (TMR) is a surgery performed in people with persistent angina, whose condition cannot be treated with other methods. TMR is a type of surgery that uses a laser to make tiny channels through the heart muscle and into the lower-left chamber of the heart. The lower-left chamber or the left ventricle is the main pumping chamber of the heart.

Transmyocardial Laser Revacularization

After TMR, the oxygen-rich blood enters the left ventricle such that some of the blood can flow through the tiny channels and carry much-needed oxygen to the starving heart muscle. No one really knows why this procedure helps reduce the pain of angina, but some doctors think that it helps the growth of tiny new blood vessels in the heart muscle wall. This process is known as angiogenesis and it helps to bring more blood to the heart muscle, making it healthier. Other’s think that the TMR laser destroys some of the pain causing nerves in the heart muscle. Some doctors think that the patients feel a placebo effect that means they feel better because of the treatment they got and not because the treatment really worked.

Doctors came up with the idea for TMR by studying the hearts of snakes and alligators, where the blood to feed the heart muscle goes straight from the ventricle into the muscle and not through the coronary arteries. They through this might work in the human hearts, too.

TMR is a surgery that can be done while the heart is still beating and full of blood indicating that a heart-lung machine is not required. Also, the surgeons do not cut open the heart chambers and hence it is not an open-heart surgery.

Who is a Candidate for Transmyocardial Laser Revascularization?

Like every other organ in the body, the heart muscle also requires oxygen-rich blood to survive. The heart gets this blood from the coronary arteries. Patients with coronary artery disease (CAD) have clogged or diseased coronary arteries and can no longer deliver enough blood to the heart. This will increase the risk of a heart attack and may cause a painful condition called angina. Although, coronary artery bypass surgery (CABG) is one of the best treatment for angina but for some patients with serious heart disease or other health problems, bypass surgery can be very dangerous. Also, some patient may have had many CABG operations, but are unable to have more bypass operations.

Transmyocardial Laser Revascularization (TMR or TMLR) is a procedure for patients who cannot undergo the bypass surgery. This procedure cannot cure CAD, but it may reduce the pain of angina.

TMR is a treatment option for people who:

  • Have severe angina that limits their daily activities or causes them to wake from pain at night, despite taking medications.
  • Have a history of previous bypass surgery or angioplasty and no further intervention is available.
  • Have pre-operative test that shows ischemia or decreased blood supply to the heart muscle.
  • Have been told by their doctor that there is nothing which can be done further to help their symptoms.

TMR has shown positive clinical benefits for patients requiring one or two bypass grafts or having other areas of the heart that cannot be bypassed with direct bypass-surgery. This is often seen in patients with diabetes.

Who is NOT a candidate for TMR?

Patients with severely damaged heart muscles due to heart attacks, where the heart muscle is scarred or dead rather than affected by inadequate blood supply (ischemic) are not candidates for TMR. Patients with heart muscle having no areas of inadequate blood supply or ischemia.

Check out the Patient Testimonial, where the patient shares about their success stories from treatments through India Cardiac Surgery Consultants.

How does TMR work?

TMR is a surgical procedure performed through a small incision in either the left side or middle of the chest. Frequently, it is performed along with the coronary bypass surgery. Once the incision is made, the surgeon exposes the heart muscle. Your surgeon will then position a laser hand piece in the area of the heart to be treated. A special high-energy, computerized CO2 laser is used to create between 20-40 millimeter wide channels in the left ventricle of the heart. Your doctor will determine how many channels to be created during this procedure.

The outer areas of the channels close, but the inside of the channels remain open in the heart, thereby improves the blood flow. The CO2 heart laser uses a computer to direct the laser beams to the appropriate area of the heart in between the heartbeats when the ventricle is filled with blood and the heart is relatively still. This helps to prevent arrhythmias (electrical disturbances) in the heart.

Doctors aren’t sure how TMR helps to improve the blood flow to the heart, but the clinical evidence suggests that the blood flow improves in two ways:

  1. The channels act as bloodlines i.e. when the ventricles pump or squeezes the oxygen-rich blood out of the heart, then it sends blood through the channels by restoring the blood flow to the heart muscle.
  2. The procedure may promote angiogenesis where the growth of new capillaries, help supply the blood to your heart muscle.

What to expect before surgery?

The surgery will be scheduled at a time that is best for you and your surgeon, except in urgent cases. Tell your surgeon and cardiologist about any changes in your health, including the symptoms of a cold or the flu as any infection may affect your recovery. Also, review all the medications, including the prescription and over the counter medicines and supplements with your surgeon and cardiologist.

Before surgery, you may have an electrocardiogram (ECG or EKG), urine tests, blood tests and a chest X-ray to give your surgeon the latest information about your health. If you smoke, your doctor will ask you to stop smoking at least 2 weeks before your surgery. Smoking before surgery can lead to problems with breathing and blood clotting.

The night before surgery, you will be asked to bathe so as to reduce the amount of germs on your skin. You will be asked not to eat or drink after midnight, the night before surgery. You will be given the complete instructions from your cardiologist and surgeon about the procedure.

TMR usually takes one to two hours. But this procedure may last longer if it is combined with other heart procedures.

What to expect on the day of surgery?

Most patients are admitted to the hospital the day before surgery, or in some cases, on the morning of the surgery. Small metal disks called as electrodes are attached to your chest. These electrodes are connected to an electrocardiogram machine that will monitor the electrical activity of your heart and the heart’s rhythm.

You will be given a local anesthesia to numb the area where a plastic tube called as intravenous (IV) line will be inserted into your vein. The IV line will provide you anesthesia during the surgery. You will be given a mild tranquilizer to help you relax before being taken into the operation room. After you are completely asleep, a tube will be inserted down your windpipe and connected to a machine called as a respirator that will take over your breathing. Another tube will be inserted through your nose, down your throat into your stomach. This will stop the liquid and air from collecting in your stomach so that you will not feel sick and bloated after you wake up from the surgery. A thin tube called as a catheter will be inserted into your bladder to collect any urine produced during the operation.

The cardiovascular surgeon will lead the surgical team, including other assisting surgeons, an anesthesiologist and surgical nurses. First, your surgeon will make a cut in the left side of the chest to get to the left ventricle of the heart. Then, your surgeon will use a special carbon dioxide laser to make 20 to 40 tiny channels about 1mm wide, in the heart muscle. The surgeon will make the channels when the heart is still pumping blood (systole), because it’s when the heart’s walls are the thickest and the least chances of damage.

The channels may bleed for a few seconds, but the bleeding will stop when the surgeon presses lightly on the channels with a finger. The tops of these channels close over with a blood clot, but they remain open inside the heart.

Sometimes, one part of the heart can be treated with a bypass surgery while another part may require transmyocardial revascularization. In this case, both the TMR and bypass surgery are done at the same time.

Recovery Time:

After the surgery, you will be moved to the intensive care unit (ICU) to monitor your heart function, blood pressure and other vital signs. In most cases, the breathing tube will be removed within six to eight hours of surgery. You will then be moved to a regular hospital room. During your hospital stay, you will be given medications to prevent the blood clots and manage other diseases like high cholesterol, high blood pressure or diabetes.

You can expect to stay in the hospital for between 3 to 5 days after undergoing the surgery. If you underwent TMR along with bypass surgery, then you can go home after 4 to 7 days. Recovery may take a long time. You will have to rest and limit your activities. Your doctor may want you to joint a cardiac rehabilitation program or an exercise program. If you have an office job, you can usually go back to work in 4 to 6 weeks. Those of you requiring to do more physically demanding jobs may need to wait for longer.

Once you are at home, your doctor will advise you to:

  • Get regular exercise
  • Eat a heart-healthy diet
  • Quit smoking
  • Maintain a healthy weight

If you have had a bypass surgery with TMR, then you should not lift more than 10 pounds for the first month after surgery. This will allow healing your breastbone and you will be able to return to work within 2-3 months post surgery.

Life after Transmyocardial Laser Revascularization:

Often, the symptoms of coronary artery disease and angina get better after undergoing transmyocardial revascularization. It may take up to 3 months or more to see the improvement in angina and symptoms of CAD. Patients find that after undergoing TMR, they can perform all the activities that once caused them pain. They may also find that they need not require taking as many heart medicines like the nitroglycerin.

Studies have shown that, about 80-90% of patients treated with TMR still feel better one year post surgery. Also, they have a lower risk of heart attack.

Why Choose an Indian Hospital for Transmyocardial Laser Revascularization?

Cardiac care in India is renowned all the globe for a very good health infrastructure and highly skilled cardiac professionals. The medical units and hospitals in India have the latest innovations in the medical electronics with unmatched expertise of the leading cardiologists and cardio-thoracic surgeons. Choosing an Indian hospital for transmyocardial laser revascularization will improve your health at a very affordable price compared to the western countries offering the same. Cardiac surgeons have the distinction of providing a comprehensive cardiac care spanning from the basic facilities in preventive cardiology to the most sophisticated technology that match the global benchmarks.


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