Transmyocardial revascularization (TMLR) is not a traditional surgery for people suffering from coronary artery disease (CAD). It's usually performed when medicines, PCI or bypass surgery have not been successful treatments. No heart-lung machine is needed for this procedure, and a surgeon operates on the heart while it's beating and full of blood. Unlike a coronary artery bypass graft, surgeons do not cut into the chambers of the heart. Instead, they make an incision in the chest, and a laser cuts tiny channels through the heart muscle and into the left ventricle, which is the heart's main pumping chamber. The laser is usually able to reach areas where bypass grafting cannot, and if the surgery is successful, it will ultimately improve and restore blood flow to this all-important organ.
Complications that can occur during and after TMLR include unstable angina, heart attack and sudden death due to abnormal heart rhythms, also known as arrhythmias. In one examination of TMLR, it's noted that, "The reported mortality rate (7 to 10 percent) following TMLR is a significant cause for caution. Risk-factor assessment has shown that patients with unstable angina and poor myocardial function are at relatively greater risk" [source: Bhimji].
But even for those who have no complications, getting over the surgery takes time. Uncomfortable symptoms of CAD and angina -- such as severe chest pain -- may take up to three months to improve. A year after receiving TMLR, however, 80 to 90 percent of patients report a higher quality of life than before the surgery. Plus, their chances of having a heart attack are significantly reduced [source: Texas Heart Institute]. But since transmyocardial revascularization is a new kind of surgery, long-term effects are still unknown.
It's possible to prevent angina by lowering your risk for coronary artery disease. Don't smoke, and avoid second-hand smoke, too. Eat several servings of fruits and vegetables every day, maintain a low cholesterol level and get plenty of exercise -- at least 30 minutes of activity per day. Living a healthy life will greatly increase your likelihood of having a healthy heart, which will minimize your chances of needing any type of coronary-related revascularization surgery. They're impressive, groundbreaking procedures, but that doesn't mean you want to have one.
More Great Links
- AtlantiCare. "Minimally Invasive Heart Surgery." 2010. (Oct. 4, 2011) http://www.atlanticare.org/heart/services/ctsurgery/minimally_invasive.htm
- Bhimji, Shabir. "Transmyocardial Laser Revascularization." Medscape Reference. Oct. 22, 2008. (Sept. 28, 2011) http://emedicine.medscape.com/article/428355-overview
- Centers for Disease Control and Prevention. "Heart Disease Facts." Dec. 21, 2010. (Oct. 4, 2011)http://www.cdc.gov/heartdisease/facts.htm
- Center for Patient and Community Education, California Pacific Medical Center. "Cardiac Catheterization, Coronary Angiogram, and Percutaneous Coronary Intervention (PCI)." Mar. 2006. (Sept. 28, 2011) http://www.cpmc.org/learning/documents/cardiaccath-ws.html#What is a Percutaneous Coronary Intervention (PCI)?
- Dictionary. "Coronary." 2011. (Oct. 12, 2011) http://dictionary.reference.com/browse/coronary
- National Heart Lung and Blood Institute. "Types of Coronary Artery Bypass Grafting." Jan. 1, 2010. (Sept. 28, 2011) http://www.nhlbi.nih.gov/health/health-topics/topics/cabg/types.html
- National Heart Lung and Blood Institute. "What Are the Risks of Coronary Artery Bypass Grafting?" Jan. 1, 2010. (Sept. 28, 2011) http://www.nhlbi.nih.gov/health/health-topics/topics/cabg/risks.html
- National Heart Lung and Blood Institute. "What Is Coronary Artery Bypass Grafting?" Jan. 1, 2010. (Sept. 28, 2011) http://www.nhlbi.nih.gov/health/health-topics/topics/cabg/
- ScienceDaily. "Complete Revascularization Improves Outcomes for Coronary Artery Disease Patients." Apr. 25, 2010. (Sept. 28, 2011) http://www.sciencedaily.com/releases/2010/04/100423113726.htm
- Surgical Associates of Texas. "Coronary Artery Bypass Surgery - CABG and MIDCAB." April 2005. (Sept. 28, 2011) http://www.texheartsurgeons.com/CABG.htm
- Texas Heart Institute at St. Luke's Episcopal Hospital. "Angina." Sept. 2011. (Oct. 5, 2011) http://texasheart.org/HIC/Topics/Cond/Angina.cfm
- Texas Heart Institute at St. Luke's Episcopal Hospital. "Coronary Artery Disease." Sept. 2011. (Oct. 5, 2011) http://texasheart.org/HIC/Topics/Cond/CoronaryArteryDisease.cfm
- Texas Heart Institute at St. Luke's Episcopal Hospital. "Transmyocardial Laser Revascularization." 2011. (Sept. 28, 2011) http://texasheart.org/HIC/Topics/Proced/tmlrs.cf