Myocardial Revascularization

UT Southwestern Medical Center’s skilled cardiothoracic surgeons perform myocardial revascularization – also called laser revascularization – to treat patients with ischemic heart disease who cannot undergo other procedures.

Our skilled cardiothoracic surgeons are experts in these techniques, including minimally invasive options when appropriate.

An Alternative to Heart Bypass Surgery

Myocardial revascularization is an alternative procedure for patients with ischemic heart disease who aren’t candidates for other interventions such as heart bypass surgery due to procedure failure, widespread coronary artery disease, small coronary arteries, or cardiac stenosis (thickening or stiffening of the heart tissue).

There are two types of myocardial revascularization: transmyocardial revascularization (TMR) and the less invasive 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).

UT Southwestern also offers a dedicated Cardiac Rehabilitation Program. Cardiac rehabilitation is a critical component of recovery and can prevent future heart disease.

What to Expect

Myocardial Revascularization Preoperative Details

The surgeon provides specific instructions to the patient before the myocardial revascularization procedure, including risks such as bleeding, infection, or adverse reaction to anesthesia.

Patients also meet with the anesthesiologist prior to the surgery to review their medical history. Patients should not eat after midnight the night before the surgery.

On the day of surgery, the patient arrives at the hospital, registers, and changes into a hospital gown. A nurse reviews the patient’s charts to make sure there are no problems.

The anesthesiologist then starts an IV, and the patient is taken to the operating room, where the surgeon verifies the patient’s name and procedure before any medication is given. Surgery will begin once the patient is under anesthesia.

Myocardial Revascularization Operative Details

Transmyocardial Revascularization (TMR)

The surgeon makes an incision between the ribs and then spreads the ribs along one side to allow access to the heart. The patient does not need to be on a cardiopulmonary bypass machine because the procedure can be done with the heart still beating.

A high-energy laser beam is then applied to the left ventricle area and penetrates the layers of the heart muscle from the outside in 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 uses stitches to close the initial incision.

Percutaneous Myocardial Revascularization (PMR)

The surgeon injects local anesthetic into an area on the groin and then makes a tiny incision to place a catheter (thin tube) 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 other words, the laser creates a hole through two layers of heart muscle from inside out. Once PMR is completed, the catheters are removed and the incision closed.

Myocardial Revascularization Postoperative Details

After surgery, patients are taken to the intensive care unit and monitored. Pain is likely, and pain medication is given as appropriate. Patients also might be on a respirator for up to a day after the surgery.

The length of the hospital stay depends on how quickly the patient is able to recover and perform some physical activity.

Clinical Trials

Clinical trials often give patients access to leading-edge treatments that are not yet widely available. Eligible patients who choose to participate in one of UT Southwestern’s clinical trials can receive treatments years before they are available to the public.