Chronic stable angina transmyocardial revascularization
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Chronic stable angina Microchapters | ||
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Classification | ||
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Differentiating Chronic Stable Angina from Acute Coronary Syndromes | ||
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Diagnosis | ||
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Alternative Therapies for Refractory Angina | ||
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Discharge Care | ||
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Guidelines for Asymptomatic Patients | ||
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Editors-In-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-632-7753; Cafer Zorkun, M.D., Ph.D. [2]; Associate Editors-In-Chief: John Fani Srour, M.D.; Jinhui Wu, MD
Transmyocardial Revascularization (TMR)
Indication:
- Transmyocardial Revascularization is an alternative procedure for patients with severe [coronary artery disease] who are not a candidate for revascularization via PCI or CABG.
Mechanism of benefit:
- The goal is to create a series of transmural endomyocardial channels through the heart muscle to improve myocardial revascularization.
- This technique is either performed in the operating room (using a carbon dioxide or holmium:YAG laser)known as Laser TMR or by a percutaneous approach with a specialized(holmium:YAG laser) catheter referred as Percutaneous TMR. However, only Laser TMR is currently FDA approved.
- Another way to perform TMR is through epicardial surgical approach. This can be done alone or in combination with CABG.
- The outside of the heart muscle seals up immediately. In time, as these channels heal, they stimulate the creation of new small vessels or capillaries(angiogenesis). Other mechanism of benefit in TMR is thought to be sympathetic denervation.
ACC / AHA Guidelines- Alternative Therapies for Chronic Stable Angina in Patients Refractory to Medical Therapy Who Are Not Candidates for Percutaneous Intervention or Revascularization (DO NOT EDIT) [1] [2]
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Class IIa1. Surgical laser transmyocardial revascularization (TMR). (Level of Evidence: A) |
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See Also
Sources
- The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina [1]
- TheACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina [2]
- The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina [3]
References
- ↑ 1.0 1.1 Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina). Circulation 99 (21):2829-48. PMID: 10351980
- ↑ 2.0 2.1 Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina). Circulation 107 (1):149-58. PMID: 12515758
- ↑ Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007) 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina. Circulation 116 (23):2762-72. DOI:10.1161/CIRCULATIONAHA.107.187930 PMID: 17998462