Transmyocardial Revascularization indications and procedure
Transmyocardial revascularization is a highly specialized and complex procedure for people suffering from severe Coronary Artery Disease and angina but coronary artery bypass graft is contraindicated for them.
Indications for Transmyocardial revascularization:
TMR is indicated as a treatment in patients who have either of the following conditions:
- People who suffer from angina, where angina is so severe that it limits day to day activities. There is no relief even after medication
- People suffering from ischemia
- Medical history of angioplasty and bypass surgery and there is no more intervention available.
- When nothing can be done by the doctor to further relief from cardiac symptoms.
Contraindication of TMR
TMR is contraindicated in the following cases:
- In patients when the heart muscles is severely damaged due to heart attack
- If there is no area of ischemia in the heart muscles.
How is it done?
TMR is a surgical procedure involving a small incision either in the left or middle of the chest. Once the incision is made a laser hand piece is positioned on the area where the heart needs to be treated. A special Co2 is used to create channels in the left ventricle. The outer channels are closed but they remain open inside the heart to improve blood flow.
The laser light is controlled by a computer which instructs to direct laser beams to the appropriate areas of the heart between the heart beats to prevent arrhythmia.
Clinical evidence suggests that TMR improves blood flow in the heart by restoring oxygen rich blood when the heart contracts to the heart muscles.
Studies also suggest that TMR helps to promote growth of new capillaries thereby helping to improve blood supply to the heart muscles.
It takes about 1-2 hours to perform TMR.
Pre operative care
Doctor will first determine by conducting few tests if you are eligible for TMR or not. Those tests are:
- Cardiac catheterisation to see the blockage that is present.
- ECG
- Cardiac MRI
After going through the reports and previous health condition doctor will decide if he plans to go ahead with the surgery.
Post operative care
After the surgery the patient is moved to the ICU and will remain there for 1-2 days, where his heart function, blood pressure and other vital signs will be monitored.
After 2 days in ICU the patient will be moved to the normal room in the hospital, where the patient will be administered with medication to prevent formation of blood clots and manage other health problems like hypertension, hyperglycaemia and cholesterol levels.
If TMR was not performed with bypass surgery then the patient will be discharged from the hospital after 4-5 days but if the surgery is performed along with bypass then the patient is discharged after 7-10 days.
Once home the patient is advised the following:
- Eat healthy food
- Take medicines as directed
- Exercise regularly
- Manage weight
- Control blood pressure and diabetes
- Reduce blood cholesterol levels
- Quit smoking
- Do not lift heavy objects till 2 months post surgery.
Is TMR safe?
Transmyocardial revascularization is suggested for people who cannot undergo bypass surgery as bypass surgery is contraindicated for them.
Several studies revel that TMR reduces angina symptoms
Improves exercise tolerance
Diminishes rate of hospitalization
When to see a doctor post operation
If you experience following symptoms do consult your doctor:
- Chest pain
- Shortness of breath
- Fatigue
- Light headedness
- Confusion and dizziness
- Fever