University of Virginia Health System

New Laser Therapy For Heart Disease Performed At U.Va. Medical Center

The typical TMR candidate has run out of options, Dr. Irving Kron, professor of surgery at the University of Virginia Health System. He or she is immobilized by angina (chest pain) and shortness of breath and fatigue. Traditional surgery is not feasible and a daily, heavy dose of drug therapy is not enough. TMR is a chance for a better life.

Each year, an estimated 80,000 Americans are diagnosed with severe coronary artery disease (CAD), which is not treatable by conventional coronary revascularization techniques (e.g. bypass surgery and angioplasty). CAD is a form of heart disease caused by blockage of blood flow into the coronary arteries, which supply oxygen-rich blood to the heart muscle. It can lead to heart attack and is the major cause of death in the U.S. About 500,000 Americans die from CAD annually.

TMR is a new way of restoring oxygen-rich blood flow to the heart. Clinical studies have demonstrated that TMR using the high-energy, carbon dioxide (CO2) laser can create new channels believed to restore blood flow. The computer-controlled laser is synchronized with the heartbeat and triggered to fire when the heart is relatively still and unresponsive to stimuli. Therefore, it may reduce risk of arrhythmia (harmful heart rhythms) that may be seen in TMR systems that are not synchronized.

In clinical studies, TMR was shown to be safe and effective in decreasing angina by two or more classes (angina is measured in classes from one to four, one being the least painful and four being the most) in nearly 75 percent of study patients, and, in fact, eliminating all angina in one-third of patients.

TMR is performed on a beating heart, generally through a small left chest incision. The one-pulse used to create between 20 and 40 one-millimeter-wide channels through oxygen-deprived heart muscle (myocardium), into the heart's left ventricle, allowing blood to flow into the heart muscle again, despite blocked arteries.

TMR is generally considered less invasive heart surgery. It usually involves a small left chest incision; generally does not necessitate a blood transfusion; and, because it is performed on a beating heart, does not require the use of a heart-lung machine. Therefore, recovery is potentially quicker, less traumatic and less costly than in open-heart procedures.

September 2, 1998