Transmyocardial revascularization (TMR) is a highly specialized procedure to treat patients with severe coronary artery disease and angina who cannot undergo standard coronary artery bypass grafting.

It uses a laser to make “channels,” or small holes, directly into the heart muscle. The outside of the heart muscle seals up immediately. TMR can reduce angina (severe pain the chest, neck, jaw and shoulders) and improve the quality of life in patients with coronary artery disease.

Here’s how it works:

  1. Our team creates channels through the heart muscle, using a laser.
  2. As the channels heal, they stimulate the creation of new small vessels or capillaries. This process is called angiogenesis.
  3. In some cases, we may do a conventional coronary bypass surgery in combination with TMR. Learn more about coronary artery bypass grafting
  4. During the next few weeks or months, your angina will improve or disappear.

Read more about our expertise with coronary revascularization.

At the University of Maryland Heart and Vascular Center, our heart specialists have the experience, expertise and resources to perform this complex procedure.

Candidates for TMR

You may be a candidate for the TMR procedure if:

  • You have angina due to advanced cardiovascular disease
  • Your physician believes that you are not a candidate for standard therapy (such as balloon angioplasty or bypass surgery)
  • The heart muscle around these affected blood vessels is healthy
  • We cannot manage your angina with medications or the medications are causing serious side effects

TMR may not be appropriate if you:

  • Are unable to undergo general anesthesia
  • Have had a heart attack (myocardial infarction) within three weeks
  • Have uncontrollable or severe heart rhythm problems. Learn more about arrhythmias
  • Have debilitating chronic lung disease, such as chronic obstructive pulmonary disease, which significantly impairs your ability to breathe
  • Have heart failure, also known as congestive heart failure

TMR Benefits

One of the major benefits of TMR is the use of smaller incisions rather than a large chest incision. This leads to less scarring, a reduced hospital stay and a shorter recovery. Other benefits include:

  • Reduced angina pain
  • Return to a more active lifestyle and improved quality of life
  • Possibly, reduced need for some of the medications you are currently taking to manage your angina pain