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Saint Thomas Heart

Transmyocardial Laser Revascularization

Like every other organ or tissue in the body, the heart muscle needs oxygen-rich blood from the coronary arteries to survive. In patients with coronary artery disease (CAD), the coronary arteries are clogged and diseased and can no longer deliver enough blood to the heart. The heart's lack of oxygen-rich blood is called ischemia, and also increases the risk of heart attack and angina.

Most of the time, the best treatment for angina is coronary artery bypass surgery. But for some patients with very serious heart disease or other health problems, bypass surgery may be too dangerous. For patients who cannot have bypass surgery, there is a procedure called Transmyocardial Laser Revascularization, also called TMLR. TMLR cannot cure CAD, but may reduce the pain of angina.

TMLR is a surgical procedure that improves blood flow to areas of the heart not treated by angioplasty or surgery. A small incision in either the left side or middle of the chest is performed, and a special carbon dioxide (CO2) laser is used to create small channels in the heart muscle, improving blood flow to the heart muscle. A special high-energy, computerized CO2 laser is used to create between 20 and 40 one-millimeter-wide channels (about the width of the head of a pin) in the left ventricle. The laser uses a computer to direct laser beams to the appropriate area of the heart in between heartbeats, when the ventricle is filled with blood and the heart is relatively still. This helps to prevent electrical disturbances (arrhythmias) in the heart. TMR usually takes one to two hours. The procedure may last longer if it is combined with other heart procedures.