Transmyocardial Revascularization (TMR)

Transmyocardial revascularization, also known as TMR or TMLR, is a surgical procedure that uses a special carbon dioxide (CO2) laser to shoot tiny pinholes or channels through the heart muscle and into the heart's lower left chamber (left ventricle). These new channels improve the flow of oxygen-rich blood to the heart muscle, reducing the effects of angina (chest pain), a symptom of coronary artery disease.

Typically, patients experiencing coronary artery disease have coronary artery bypass grafting (CABG surgery), angioplasty or stenting, but for patients with advanced heart disease or additional health problems, these procedures may be too risky. TMR is often the safest and most effective alternative. TMR is also done for previous CABG patients who cannot tolerate another bypass operation.

Cardiac surgeons in the Brigham and Women's Hospital (BWH) Heart & Vascular Center are national leaders in the use of minimally-invasive approaches for transmyocardial revascularization.

With 47,000 outpatient visits each year, the Heart & Vascular Center is one of the largest in the United States, treating over 7,000 inpatients and performing more than 8,000 procedures annually at our state-of-the-art Shapiro Cardiovascular Center.

Minimally Invasive Procedures for Transmyocardial Revascularization

Transmyocardial Laser Revascularization (TMLR)

Transmyocardial laser revascularization requires a small incision on the left side of the chest through which a laser drills tiny channels into the heart muscle. The heart continues to beat during the procedure, so there is no need for a heart-lung bypass machine.

Percutaneous Transmyocardial Revascularization (PTMR)

Transmyocardial revascularization can be performed as a percutaneous technique (percutaneous transmyocardial revascularization or PTMR) using a catheter-guided laser through a tiny incision in the skin.

Transmyocardial Revascularization and Coronary Artery Bypass Grafting (CABG)

Transmyocardial revascularization is sometimes done in conjunction with coronary artery bypass grafting (CABG surgery).

Why Have Transmyocardial Revascularization?

Transmyocardial revascularization is performed to treat a blockage or narrowing of one or more of the coronary arteries when a bypass procedure is not possible.

Patients who have TMR often suffer from angina, a symptom of coronary artery disease characterized by:

  • Chest pain
  • Chest pressure or discomfort
  • Jaw pain
  • Neck pain
  • Back pain
  • Arm pain

You may also be a candidate for transmyocardial revascularization if:

  • You are not a candidate for standard therapy (angioplasty or bypass surgery)
  • You have had multiple bypass operations and cannot withstand another
  • The heart muscle around the affected blood vessels is healthy
  • Your angina cannot be managed with medications or these medications are causing serious side effects

Learn more about coronary heart disease and treatments.

What You Should Expect

The Heart & Vascular Center is located in the Shapiro Cardiovascular Center, across the street from BWH's main 75 Francis Street entrance. The Heart & Vascular Center brings together the full range of services in one location, fostering seamless and coordinated care for all cardiovascular patients.

Prior to your procedure, you will be scheduled for a visit to the Watkins Clinic in the Shapiro Cardiovascular Center for preoperative information and tests.

The day of the procedure, your care will be provided by surgeons, anesthesiologists and nurses who specialize in coronary artery disease. The Heart & Vascular Center is home to one of the most advanced hybrid operating rooms in the country. After the procedure, you will go to the post-surgical care unit where you will receive comprehensive care by an experienced surgical and nursing staff.

During your procedure, family and friends can wait in the Shapiro Family Center where staff members will provide surgery updates.

Multidisciplinary Care

In addition to our cardiac surgeons, patients also benefit from the teamwork of medical cardiologists, interventional cardiologists, cardiovascular imaging experts and radiologists, and anesthesiologists, all experts in cardiovascular disease. They work alongside nurses, physician assistants, physical therapists, dietitians and social workers to achieve outstanding outcomes for our patients.

Cardiac Surgery Appointments and Locations


Learn more about coronary heart disease and treatments in our health library.

Visit the Kessler Health Education Library in the Bretholtz Center for Patients and Families.

Access a complete directory of patient and family services.

Learn about the Watkins Clinic in the Shapiro Cardiovascular Center.

Download Cardiac Surgery: A Guide for Patients in English or Spanish.

Learn more about Brigham and Women's Hospital

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