Transmyocardial Revascularization

Your Care Explained > Tests and Procedures : Transmyocardial Revascularization

Transmyocardial revascularization is performed on patients with coronary artery disease that cannot be helped by bypass or angioplasty. The surgeon uses a laser to cut tiny channels, which penetrate through to the heart muscle, across the surface of the heart. When the heart contracts, blood is squeezed up through the channels to bring oxygen to cells throughout the heart muscle.

The size of a woman’s heart doesn’t affect this procedure.

Preparing for Transmyocardial Revascularization

In most cases, surgery is scheduled several weeks in advance, so you’ll have a little time to get ready. Because it helps to go into surgery in the best condition possible, you should try to follow a healthful diet, exercise as much as you can, get adequate rest and, if you’re anxious about your upcoming surgery, practice techniques to reduce stress.

What to Expect:

  • No food or drink for 8 hours before surgery.
  • You’ll sleep through the operation.
  • There’ll be a small incision between your ribs.
  • You’ll recover in the ICU one day.
  • You’ll spend another day or two in the hospital.

If you’re a smoker, this is a good time to stop, or at least cut down. If you drink alcohol daily, you might want to cut down to avoid the effects of alcohol withdrawal after surgery. You may have the opportunity to bank your blood, should you need a transfusion during the procedure.

A few days before surgery, you’ll meet with an anesthesiologist or nurse anesthetist, who will determine which type of anesthesia is best for you. You’ll answer questions on your health history and have a brief physical exam that may include ECG, blood work and urinalysis. You should bag all the medications—both prescription and over-the-counter—that you take regularly and bring the bag with you to the visit. The anesthesiologist or surgeon may want you to change the dose of, or even stop taking, some medications. The anesthesiologist will explain the type of anesthesia that you’ll receive, including the risks and benefits associated with it. You’ll read and sign a form consenting to the anesthesia to be used.

You’ll be asked not to eat or drink anything the night before your revascularization. You can take any drugs prescribed for surgery with a little water the morning of the procedure. You may be asked to wash your chest area with a special disinfecting soap.

You should arrive at the hospital without make-up, nail polish or jewelry, and dressed in clothing loose enough to fit over the surgical dressings you’ll be wearing when you go home. When you check in, you’ll be given an identification bracelet to wear during your stay. You’ll be given a hospital gown to wear and your clothes, handbag and other possessions will be tagged and taken to the room you will stay in after surgery.

A surgical attendant will explain what will happen during surgery as well as the slight risks involved. You’ll sign a second consent form, giving your permission to operate. Your anesthesiologist will greet you and might give you a sedative to relax you. A nurse will install an IV catheter in your arm or hand. You may be asked to remove any dental devices that can interfere with the tube that will be installed in your trachea to help you breathe during surgery. You will be transferred to a gurney and wheeled into the surgical suite.

During Transmyocardial Revascularization

In the operating room, you’ll meet the surgical team, who will make you comfortable on the table. The anesthetist will place a clear mask over your nose and mouth and ask you to count backward from 10. You’re likely to be asleep before you finish counting.

Once you are unconscious, a tracheal tube will be inserted into your throat and connected to a ventilator to help you breathe. One of the surgeons will make an incision on the left side of your chest between your fifth and sixth ribs to expose the heart. Then, using a laser, he or she will dot the surface of the heart with 20 to 40 tiny holes that penetrate into the heart’s pumping chamber. There won’t be much bleeding. The surgeons will finish the procedure by inserting drains in your chest cavity and closing the incision. They will perform an ultrasound examination to ensure that your heart valves are functioning properly.

After Surgery

You will be taken to the intensive care unit (ICU) and removed from the respirator. You’ll stay in the ICU for a day or so, while the staff monitors your blood pressure. You may be able to go home in another day or two.

Date Last Modified: January 21, 2011

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