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Transmyocardial Revascularization (TMR) is reimbursed when:
- It’s performed as a stand-alone procedure in patients with medically refractory angina who are not candidates for further conventional revascularization procedures or
- It’s performed in conjunction with CABG in patients who would be incompletely revascularized by CABG alone.
Sole therapy TMR is performed in an OR under general anesthesia and generally takes 60 – 90 minutes. Access to the heart must be created either through a left thoracotomy or thoracoscopically.
TMR can be performed adjunct to CABG in a variety of scenarios. TMR can be applied to beating or arrested hearts as well as fully heparinized patients. Adjunctive TMR can be performed in as little as 5 – 10 minutes and can be applied before or after the placement of grafts on an arrested heart.
Clinically Significant Outcomes
The results are clinically significant, with the majority of patients moving from class IV to class I and II and the many becoming completely angina-free. A growing number of cardiologists and cardiac surgeons are seeing these life-changing effects.
TMR demonstrates long-term efficacy of significant angina relief. Primary outcomes include:
- Relief of angina by two or more classes
- Increased exercise tolerance
- Reduction in re-hospitalizations
- Reduction in medication usage
- Increased event free survival and perfusion
- Improved quality of life as secondary outcomes
As illustrated below, TMR’s stand-alone five-year results are proven in six prospective, randomized control trials, involving more than 1,000 patients.1,2,3,4,5,6,7
- Allen KB, et al. Ann Thorac Surg 2004;77:1228-1234.
- Burkhoff D, et al. Lancet 1999;354:885-890.
- Allen KB, et al. N Engl J Med 1999;341:1029-1036.
- Jones JW, et al. Ann Thorac Surg 1999;67:1596-1602.
- Aaberge L, et al. J Am Coll Cardiol 2002;39:1588-1593.
- Frazier OH, et al. N Engl J Med 1999;341:1021-1028.
- Schofield PM, et al. Lancet 1999;353:519-524.
- Allen KB, et al. In: American College of Cardiology; 2011 April 2-5; New Orleans, Louisiana.