Myocardial Revascularization (TMR & PMR)

Myocardial revascularization, or laser revascularization, is an alternative procedure for patients with ischemic heart disease who are unable to get percutaneous coronary intervention or coronary artery bypass graft procedures because of procedure failure, diffuse coronary artery disease, small coronary arteries, or stenosis.

There are two types of myocardial revascularization: transmyocardial revascularization (TMR) and the newer percutaneous myocardial revascularization (PMR).

Both use high-energy lasers to create holes in the heart between the epicardium (outer layer) and the endocardium (inner layer) to allow blood to flow directly from the left ventricle into the myocardium (middle, muscular layer).

Myocardial Revascularization Pre-Operative Details

Your surgeon will give specific instructions before the surgery, including risks such as bleeding, infection, and adverse reaction to anesthesia. Please be sure to contact your insurance company for coverage.

You will also meet with the anesthesiologist prior to the surgery to go over your medical history. Please do not eat after midnight the night before your surgery.

On the day of surgery, you will arrive at the hospital, register, and change into a hospital gown. A nurse will review your chart to make sure there are no problems.

The anesthesiologist will then start an IV and you will be taken to the operating room, where the surgeon will verify your name and procedure before any medication is given. Once you are under anesthesia, surgery will begin.

Myocardial Revascularization Operative Details

Transmyocardial Revascularization (TMR)

The surgeon will make an incision between the ribs and then spread the ribs along one side to allow access to the heart. You will not be on cardiopulmonary bypass, since the procedure is tolerated with the heart still beating.

A high-energy laser beam is then applied to the left ventricle area and will burrow a hole through the heart muscle layers to allow oxygenated blood to come directly out of the left ventricle to the myocardium, doing the work of the obstructed coronary artery. The surgeon will use stitches to close the initial incision.

Percutaneous Myocardial Revascularization (PMR)

The surgeon will use a local anesthetic to the groin area and then make a tiny incision to allow a catheter (thin tube) to be placed in the femoral artery. A fiber optic catheter is then placed inside the first catheter and guided through the blood vessels to the heart.

A high-energy laser beam is then emitted from the catheter through the endocardium of the left ventricle to the myocardium.

In TMR, the laser burns a hole through all three layers from outside in. In PMR, the laser burns a hole through two layers from inside out. Once completed, the catheters will be removed and the incision will be closed.

Myocardial Revascularization Post-Operative Details

After the surgery, you will be taken to the post-operative recovery area or the intensive care unit and be monitored. Pain is likely, and you’ll be given pain medication appropriately. It is important to keep the incision areas clean and dry.

The length of your hospital stay depends on how quickly you are able to recover and perform some physical activity.

Please let your doctor know immediately if you experience fevers, severe pain, redness, swelling, warmth where the incisions were made, or drainage from the incisions. Your surgeon will give specific instructions about recovery time.

Request an Appointment

To schedule an appointment with a myocardial revascularization expert at UT Southwestern's facilities in Dallas or for more information about our services, request an appointment or call 214-645-8300.