society

Professional Society Practice Guidelines

Recommendations Evidence Rating
ACC/AHA Guideline for Management of Patients with Chronic Stable Angina1

Surgical TMR as alternative therapy for chronic stable angina in patients:

  • Refractory to medical therapy
  • Not candidates for percutaneous intervention or revascularization
Class IIa, Level A
ACC/AHA Guideline Update for Coronary Artery Bypass Graft Surgery2

Surgical TMR, either alone or in combination with CABG, is reasonable in patients:

  • With angina refractory to medical therapy
  • Not candidates for PCI or surgical revascularization
Class IIb, Level A
STS Practice Guideline for Transmyocardial Laser Revascularization3

TMR sole therapy for patients with:

  • Ejection fraction >30%
  • Class III-IV angina refractory to maximal medical therapy
  • Reversible ischemia of left ventricular free wall and CAD in region of myocardial ischemia
  • CAD not amenable to CABG or PTCA, due to either:
    • Severe diffuse disease, or
    • Lack of suitable targets or conduits for complete revascularization
Class I, Level A
TMR adjunctive to CABG for patients with:

  • Angina Class I-IV in whom CABG is the standard of care, with at least one accessible and viable ischemic region with CAD that cannot be bypassed, due to either:
    • Severe diffuse disease, or
    • Lack of suitable targets or conduits for complete revascularization
Class IIa, Level B
ISMICS Consensus Statement for Transmyocardial Laser Revascularization4

TMR sole therapy for stable patients with refractory severe angina not amenable to conventional revascularization, to:

  • Improve sustained angina relief
  • Reduce MACE and improve exercise performance
  • Reduce readmissions and reinterventions
Class I, Level A

Class I, Level A

Class IIa, Level B

TMR adjunctive to CABG for patients with diffuse CAD who cannot be completely revascularized by CABG alone, to:

  • Improve long term angina relief
  • Reduce 30-day mortality and MACE
Class IIa, Level B

Class IIa, Level A/B

TMR Case Study Kit

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Learn from three case studies about how TMR can reduce or eliminate angina pain by these patients' five- or six-month follow up.

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References

  1. Gibbons RJ, et al. Circulation 2003;107:00-00.
  2. Hillis LD, et al. Circulation 2011;124:2610-2642
  3. Bridges CR, et al. Ann of Thorac Surg 2004;77:1494-1502.
  4. Diegeler A, et al. Innovations 2006;1:314-322.

Clinical Applications

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

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