The TMR Procedure
At UW Health in Madison, Wisconsin, the transmyocardial laser revascularization (TMR) procedure takes approximately 2-3 hours if performed by itself, or approximately 4-6 hours if performed with coronary artery bypass surgery.
You will be asleep during surgery. First, an anesthesiologist inserts a breathing tube into your trachea (the airway from your mouth to your lungs). This tube will help you breathe during surgery.
Next, the Heart and Vascular Care surgeon makes an incision in your chest.
If you are undergoing TMR only, the surgeon usually makes an incision in the left side of the chest.
If you are undergoing TMR plus bypass surgery, the surgeon may make the incision in the front of the chest and split the breastbone.
If you are undergoing coronary artery bypass surgery at the same time as TMR, the surgeon will also redirect blood from the heart to a bypass machine. The bypass machine does the job of the heart and lungs during the operation. The bypass machine is usually not needed if you are undergoing TMR by itself.
Once the heart is exposed, the surgeon places a laser handpiece on the area of the left ventricle to be treated (see Figure 1).
The surgeon then uses a computerized laser to create 20 to 40 small channels, each approximately 1 millimeter in diameter, in the heart muscle (see Figures 2 and 3).
The laser is controlled by a computer, which synchronizes it with your heartbeat. The channels are made when the heart is in systole, which means that the ventricle is filled with blood and the heart wall is the thickest. This helps prevent electrical disturbances, abnormal heart rhythms and damage to the heart muscle.
The channels may bleed for a moment or two, but the tops of the channels quickly clot and seal.
After the channels have sealed, the surgeon then closes the incision (and the breastbone, if it was opened). The surgeon then applies bandages to the incision site.