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The Holmium:YAG (Ho:YAG) laser is a solid state near infra-red wavelength (2.1 microns) low power energy source. It is the most versatile laser platform available to medical professionals today. As a surgical tool, Ho:YAG has evolved as the laser of choice across a wide variety of medical specialties including orthopedics, urology, ENT, gynecology, gastroenterology and cardiac surgery. The fiberoptic delivery of the Ho:YAG laser makes available the minimally invasive delivery of the prescribed energy to the surgical site via ports or small incisions.
The fiberoptic delivery capability of the Ho:YAG laser provides several clinical advantages when performing TMR, including: laser channeling on a beating or stopped heart (does not require ECG synchronization); transesophageal echocardiogram not required to confirm channel transmurality; fiberoptic delivery for reduced surgical incisions and related morbidity; and thermoacoustic tissue effect to initiate angiogenic response.1,2,3
The mechanism of action for TMR is likely multifactorial. There can be an immediate effect due to surgical denervation.4 It is believed that the significant patient benefit now documented beyond 5 years is related to the angiogenesis that is created in the tissue surrounding the laser channels.5
The clinical benefits of TMR have been shown to be durable for more than 5 years in follow up to prospective, randomized controlled trials.6,7,8
The Instruction for Use (IFU) warns of an increased operative mortality in unstable angina patients (defined as unweanable from intravenous anti-anginal medications ).
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- Atluri P, et al. J Thorac Cardiovasc Surg 2008;135:283-291.
- Lu C, et al. Chin Med J 1999;36:614-618.
- Hughes GC, et al. Ann Thorac Surg 2000;70:504-509.
- Beek JF, et al. J Thorac Cardiovasc Surg 2004;127:517-524.
- Allen KB, et al. Aneshtesiology Clin 2008;26:501-519.
- Allen KB, et al. Ann Thorac Surg 2004;77:1228-1234.
- Aaberge L, et al. J Am Coll Cardiol 2002;39:1588-1593.
- Horvath KA, et al. Circulation 2001;104;I-81-I-84.