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Transmyocardial revascularization (TMR) is a laser surgery that opens tiny new pathways within the heart muscle. It is a procedure to treat the symptoms of angina in patients who cannot withstand more conventional treatments such as bypass surgery or balloon angioplasty, or in patients who have received maximum benefit from other therapies but are still experiencing symptoms of heart disease.

Although great strides have been made in treating coronary artery disease, there is little to offer people who continued to suffer from chronic chest pain, pressure or discomfort despite medical intervention. Some of these people may be too weak or too ill to undergo surgery. Others have already had or may not respond to traditional treatments such as bypass surgery or angioplasty with coronary stenting. In many cases, these patients were left with debilitating pain and little ability to treat it. Studies have also shown that such patients have worse outcomes than patients who no longer experience symptoms after treatment. One such study showed that about 25 percent of patients who still experienced symptoms after therapy experienced a heart attack within one year of treatment. 

TMR may be recommended for these patients. TMR has been shown to reduce symptoms and increase the patient’s capacity for exercise. The exact mechanism behind this improvement is still unknown. Some believe that this strategy offers less trauma for the patient, a shorter hospital stay and a lower risk of serious complications. Other research studies have cast doubt on TMR’s effectiveness.

As with any surgical procedure, there is the risk of side effects with TMR, including heart attack and abnormal heart rhythms. Surgeons have also developed an alternative catheter-based procedure called percutaneous transmyocardial laser revascularization. This procedure is performed with a catheter and does not require major surgery. Early studies have shown it is about as effective as the traditional method. TMR is a treatment for symptoms and not a cure for coronary artery disease. Healthy lifestyle choices are critical after TMR to maintain any improvements from the procedure.