Patient Population

In a contemporary series of patients with CAD, 28.8% had incomplete revascularization.1 The mortality of patients with diffuse CAD and incomplete revascularization is a significant clinical issue as mortality rates are more than double for this group of patients. 1 Furthermore, these patients have a higher incidence of major adverse cardiac events2 and decreased quality of life(QoL)1. In all, some 100,000 – 200,000 patients per year may be eligible for new revascularization techniques.3

Patient Selection

If you answering yes to any of the following, your patient may benefit from TMR:

  • Stable patient with severe angina CCS Class IV, refractory to medical management
  • Regions of the myocardium demonstrating reversible ischemia which are not amenable to direct coronary revascularization (either PCI or CABG)
  • Patients with one or more vessels or branches that are not bypassable (small vessels 1.0 – 1.5 mm diameter or less may be indicators)
  • Diffuse Distal Coronary Artery Disease (diffuse atherosclerotic end-stage disease)
  • Left ventricular ejection fraction ≥ 30%
  • Area of ischemia located in lower 2/3rd of left ventricle (≥ 10% reversibility of perfusion defect)
  • Incomplete revascularization
  • Profound physical limitations due to severe angina that produces patient/physician sense of hopelessness
  • Diabetes

Patient Exclusion

TMR will not improve or treat any of the following:

  • Not a treatment for congestive heart failure
  • Does not improve shortness of breath (dyspnea) unrelated to angina
  • Will not improve a failing pump
  • Q-wave MI within past 3 weeks
  • Non Q-wave MI within past 2 weeks
  • Severely unstable patients (unweanable from I.V. anti-anginal medication)
  • Uncontrolled ventricular tachy-arrhythmia
  • Cardiac failure, decompensated

Patient Selection Presentation

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Learn which of your patients are excellent candidates for transmyocardial revascularization and how they can be appropriately treated with TMR.

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  1. Williams B, et al. Catheter Cardiovasc Interv 2010;75:886-891.
  2. Andrell P, et al. Int J Cardiol 2011;147:377-82.
  3. Mukherjee D, et al. Am J Cardiol 1999;84:598-600.

Clinical Applications

Learn how to perform TMR as a sole therapy or adjunctive with CABG and the clinical outcomes when treating angina.