Related Experiment Video
Updated: Aug 7, 2026
Real-Time Cardiac Mapping with a Noninvasive Imageless Electrocardiographic Imaging System
Published on: April 11, 2025
Guidelines for the clinical use of transmyocardial laser revascularization
1Department of Surgery, the University of Pennsylvania Health System Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. cbridges@pahosp.com
Insights
Transmyocardial laser revascularization (TMR) offers a therapeutic option for patients with severe angina unresponsive to other treatments. It is recommended as a primary therapy or an adjunct to coronary artery bypass graft surgery (CABG) for select individuals.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Medical Technology
Background:
- Chronic, severe angina refractory to medical therapy presents significant clinical challenges.
- Patients unsuitable for complete revascularization via percutaneous catheter intervention or coronary artery bypass graft surgery (CABG) require alternative treatment strategies.
Purpose of the Study:
- To evaluate the role of Transmyocardial laser revascularization (TMR) in managing patients with refractory angina.
- To provide evidence-based recommendations for TMR as a sole therapy or as an adjunct to CABG.
Main Methods:
- Review of available evidence, including expert consensus opinions.
- Adherence to the guidelines format of the American Heart Association and the American College of Cardiology.
Main Results:
- Class I indications support TMR as a sole therapy for selected patients with refractory angina.
- Class IIA indications support TMR as an adjunct to CABG for patients who cannot be completely revascularized surgically.
Conclusions:
- Transmyocardial laser revascularization (TMR) is indicated for specific patient subsets with refractory angina.
- TMR may be an effective therapeutic option for patients with angina who are not candidates for complete surgical revascularization.
Abstract:
Patients with chronic, severe angina refractory to medical therapy who cannot be completely revascularized with either percutaneous catheter intervention or coronary artery bypass graft surgery (CABG) are clinically challenging. Transmyocardial laser revascularization (TMR), as sole therapy or as an adjunct to CABG, may be appropriate therapy for these patients. The recommendations are based on a review of the available evidence including expert consensus opinions. The author follows the format of the American Heart Association and the American College of Cardiology guidelines for diagnostic and therapeutic procedures. There are class I indications for sole therapy TMR and class IIA indications for TMR as an adjunct to CABG. TMR is indicated for selected patients: as sole therapy for a subset of patients with refractory angina. It also may be effective as an adjunct to CABG for a subset of patients with angina who cannot be completely revascularized surgically.
More Related Videos
05:26Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
12:00Evaluation of a Novel Laser-assisted Coronary Anastomotic Connector - the Trinity Clip - in a Porcine Off-pump Bypass Model
Published on: November 24, 2014