In 1994, Norton Audubon Hospital became one of the first centers to investigate the use of transmyocardial revascularization (TMR) for intractable angina. Since then, the hospital has become the leading center for TMR in the United States and the world, treating more patients than any other facility.
TMR is often the last hope for those who no longer have the option of bypass surgery or angioplasty, and in whom all other attempts at treatment have failed. The procedure works by bringing blood to the outer walls of the heart through a channel created in the heart with a laser. The laser is fired through the ventricle wall when the heart is at rest and the ventricle is full of blood. When the laser reaches the blood in the ventricle the liquid absorbs the beam and prevents the laser from penetrating all the way through the heart. TMR is performed on a beating heart in less than one hour under general anesthesia. In comparison, traditional bypass surgery can take up to six hours to perform.
Dr. Allan M. Lansing, medical director of the Norton Audubon Heart Institute until his retirement in 2001, first brought this pioneering heart surgery to Louisville through a clinical trial. Today Dr. Sam F. Yared is continuing the innovative work and study of Dr. Lansing. In addition to sole TMR therapy, Dr. Yared performs combination TMR/CABG surgery when complete revascularization is available.
What to expect during this procedure
- Pre-admission testing may be required prior to your surgery. This consists of multiple tests to help your care team and surgeons prepare to care for you during and after surgery.
- The day of your surgery, you will be asked to arrive at the hospital several hours before your surgery. Please be sure to follow all pre-surgery instructions.
- Prior to your surgery, you will be taken to the hospital’s pre-surgery area, where you will be prepped for surgery. Some tests will be performed, an IV will be started and other preparations will be made. You will be asked to change into a gown and remove all jewelry. Your family and friends will be asked to wait in the hospital’s surgery family room.
- Members of your surgery team, including your cardiovascular surgeon and anesthesiologist, will meet with you prior to surgery to answer any questions.
- You will be transported from the pre-surgery area to the operating room, and an anesthesiologist will give you medication to help you sleep.
- During heart laser surgery, the surgeon makes an incision down the center of your chest, cuts through your breastbone and retracts your ribcage to get direct access to your heart.
- Unlike traditional heart bypass surgery, your heart is not stopped. The surgeon will use a special laser to create small channels in the wall of your heart that allow blood to flow from inside the chambers of your heart to the heart’s outer wall, where the muscle is located.
- Once the surgery is complete, your surgeon will close your breastbone with special sternal wires and your incision with special internal and/or external stitches. A tube to drain fluid may be placed in your chest before it is closed completely. Sometimes a temporary pacemaker is attached to pacing wires to regulate your heart rhythm until you have recovered.
- Heart laser surgery typically is completed in less than one hour, however if the procedure is performed in combination with other treatments, like traditional bypass surgery, total surgery time will be much longer.
What to expect after this procedure
- You will be transferred to the hospital’s open-heart unit for monitoring. The open-heart unit is a special intensive care unit staffed with specially trained intensive care nurses and staff. Members of your surgical team will update your family and friends on your condition and results from surgery.
- Your health and progress will be continuously monitored, which includes frequent checks of your vital signs, heart sounds, blood oxygen and carbon dioxide levels.
- As your condition improves, you eventually will be removed from some monitors. Patients typically stay in the open-heart unit for two to three days after surgery.
- You will be transferred to a step-down unit, sometimes called the progressive heart unit, and will remain in the hospital for three to five days of additional monitoring after your time in the open-heart unit.
- Full recovery from laser surgery takes two to three months. Most patients are able to drive three to eight weeks after surgery. Sexual activity can be resumed in three to four weeks, depending on your rate of recovery.
- Most people with jobs that require little physical exertion can start back to work four to six weeks after surgery. If your job is physically demanding (such as construction work or heavy lifting), you may have to wait up to 12 weeks or longer before returning.
- Your surgeon and cardiologist will schedule multiple follow-up visits with you after surgery and will work with you to develop a recovery plan. Often, cardiac rehabilitation is recommended by your physician to help you regain strength and energy, and encourage healthy lifestyle changes.
- No heart surgery prevents heart disease from recurring. Lifestyle changes are important, including quitting smoking, exercising regularly, managing weight, treating high cholesterol, controlling diabetes and high blood pressure, improving your diet, taking prescribed medications, and following up with your doctor for regular visits.
This test or treatment is offered at these facilities:
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