Minimally Invasive Surgery

Transmyocardial Laser Revascularization

Transmyocardial revascularization (TMR) is a procedure to treat coronary artery disease that cannot be treated with bypass grafting or angioplasty. TMR uses a laser to create 1-mm channels within the heart muscle to supplement the heart muscle with blood. Depending on the blood vessels treated, up to 50 channels may be created at the time of surgery through the heart muscle. New blood vessels then grow around the channels that are created alleviating angina and reducing the risk of myocardial infarction. There are two types of patients who receive TMR. The first type are patients who are undergoing coronary bypass grafting in the usual manner but have one or more areas that cannot be bypassed or treated with angioplasty. In this case, the TMR is used just after the bypass grafts are placed and prior to the completion of the operation. The second type of patient who may benefit from TMR are those patients with completely inoperable blood vessels. These patients are treated through a small incision in the side of the chest and the procedure is carried out on the beating heart. Recent studies have suggested 70% to 80% of patients are relieved of their angina pectoris and the need for medications is markedly reduced as well as the need for rehospitalization secondary to heart disease.

The Sacramento Cardiovascular Surgeons Medical Group has played an important role in the development of laser revascularization and a main contributor to a national study regarding its use. We are also the leading center on the West Coast to help train other surgeons in this technique.