Transmyocardial Laser Revascularization
Transmyocardial Laser Revascularization
Transmyocardial laser revascularization is an alternative treatment option for patients with refractory angina who are not suitable candidates for more conventional coronary intervention or surgery. The laser creates channels that provide blood flow from the left ventricular chamber to areas of ischemic myocardium. Results have been impressive with patients reporting a reduction in angina of two classes according to the Canadian Heart Association Angina Classification. Care of the patient post transmyocardial laser revascularization procedure is comparable to that of other cardiac surgery patients. Innovations in this relatively new procedure include less invasive approaches and using it as an adjunctive or delivery modality for gene therapy.
Heart disease is the leading cause of death in the U.S. This statistic remains unchanged despite advances in cardiovascular surgery techniques, such as minimally invasive coronary artery bypass graft (CABG) surgery and CABG performed without the use of cardiopulmonary bypass. Interventional cardiology offers an even greater spectrum of procedures from percutaneous coronary angioplasty (PTCA) to the placement of coronary artery stents. All of these advances in the treatment of coronary artery disease have made the care of many patients, traditionally considered to be high risk due to previous procedures or the presence of comorbid conditions, possible. Despite this variety of options, there still remains a group of patients, estimated to be as high as 60,000, that cannot be helped by current medical or surgical therapies.
Transmyocardial laser revascularization (TMLR) is a recently Food and Drug Administration approved therapy suitable for patients who experience angina in spite of maximal medical management. TMLR utilizes a high power carbon dioxide or holmium:Yttrium-aluminum garnet (YAG) laser to create channels that can bring blood flow from inside the left ventricle to the underperfused areas of the myocardium. This oxygen rich blood provides significant relief from angina symptoms through mechanisms that still remain somewhat unclear.
Transmyocardial laser revascularization is an alternative treatment option for patients with refractory angina who are not suitable candidates for more conventional coronary intervention or surgery. The laser creates channels that provide blood flow from the left ventricular chamber to areas of ischemic myocardium. Results have been impressive with patients reporting a reduction in angina of two classes according to the Canadian Heart Association Angina Classification. Care of the patient post transmyocardial laser revascularization procedure is comparable to that of other cardiac surgery patients. Innovations in this relatively new procedure include less invasive approaches and using it as an adjunctive or delivery modality for gene therapy.
Heart disease is the leading cause of death in the U.S. This statistic remains unchanged despite advances in cardiovascular surgery techniques, such as minimally invasive coronary artery bypass graft (CABG) surgery and CABG performed without the use of cardiopulmonary bypass. Interventional cardiology offers an even greater spectrum of procedures from percutaneous coronary angioplasty (PTCA) to the placement of coronary artery stents. All of these advances in the treatment of coronary artery disease have made the care of many patients, traditionally considered to be high risk due to previous procedures or the presence of comorbid conditions, possible. Despite this variety of options, there still remains a group of patients, estimated to be as high as 60,000, that cannot be helped by current medical or surgical therapies.
Transmyocardial laser revascularization (TMLR) is a recently Food and Drug Administration approved therapy suitable for patients who experience angina in spite of maximal medical management. TMLR utilizes a high power carbon dioxide or holmium:Yttrium-aluminum garnet (YAG) laser to create channels that can bring blood flow from inside the left ventricle to the underperfused areas of the myocardium. This oxygen rich blood provides significant relief from angina symptoms through mechanisms that still remain somewhat unclear.