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Physicians and Healthcare Professionals

Why Prescribe Transmyocardial Revascularization?

The American Heart Association estimates that over 10 million people in the United States suffer from the chest pain & pressure of angina with 400,000 new cases of chronic stable angina each year as a result of coronary and ischemic heart disease. Furthermore, the Heart Failure Association of America now considers coronary artery disease to be the leading cause of chronic heart failure in the US.

Patient Population

There is a complex and underserved patient population suffering from chronic angina refractory to medical treatment. Currently available options for treating CAD include:

  • Lifestyle changes in conjunction with drug therapy
  • Percutaneous coronary intervention (PCI)
  • Coronary artery bypass graft (CABG) surgery

Unfortunately, a growing number of patients who have medically refractory angina caused by diffuse CAD are not eligible for conventional revascularization or would be incompletely revascularized by CABG alone. In fact, a recent study from the Minneapolis Heart Institute shows that over 6% of patients with medically refractory chronic stable angina are not amenable to traditional revascularization options but may be candidates for other forms of revascularization.1

The hallmark of this patient population is the presence of diffuse CAD.  These medically refractory patients suffering from stable chronic angina with an area of their heart muscle not amenable to traditional revascularization may benefit from transmyocardial revascularization (TMR).

Give your last line patients an option, with TMR

TMR is an approved surgical procedure to treat patients with ischemic heart disease. Over 50,000 patients suffering with the profound physical limitations and chest-pain related ischemic heart disease have been treated with laser TMR since its approval by the FDA.

In prospective randomized trials, stand-alone TMR has demonstrated a significant improvement in chronic stable angina, longer event free survival, and a reduction in cardiac related hospitalizations compared with patients randomized to maximum medical therapy alone.2,3,4,5,6,7 Long-term follow-up of TMR as a primary therapy shows an enduring benefit over time, and 5-year follow-up of one prospective randomized trial involving the most severe Canadian cardiovascular class IV patients has shown improved survival in the TMR-treated patients.8


  1. Williams B, et al. Catheter Cardiovasc Interv 2010;75:886-891.
  2. Allen KB, et al. N Engl J Med 1999;341:1029-1036.
  3. Burkhoff D, et al. Lancet 1999;354:885-890.
  4. Schofield PM, et al. Lancet 1999;353:519-524.
  5. Jones JW, et al. Ann Thorac Surg 1999;67:1596-1602.
  6. Frazier OH, et al. N Engl J Med 1999;341:1021-1028.
  7. Aaberge L, et al. J Am Coll Cardiol 2002;39:1588-1593.
  8. Allen KB, et al. Ann Thorac Surg 2004;77:1228-1234.