Laser heart surgery or Surgical Transmyocardial Laser Revascularisation (TMLR or TMR) is used to treat areas of the heart muscle where the blood supply is limited due to disease in the coronary arteries (atherosclerosis) which cannot be treated with standard stent/balloon angioplasty or bypass.

In 1999, while I had been working at Royal Infirmary Edinburgh, one Bangladeshi patient contacted me for advice on laser heart surgery. He had coronary artery bypass surgery done in Canada . He was suffering from symptomatic angina few years after surgery. Clinically he was not suitable for a second bypass surgery. We reviewed his medical documents and later on reviewed him and we did TMR on him. Now he is enjoying active life.

TMR surgery is an open heart surgery in which a special heart laser is used to create very small channels (1 mm in diameter) in the heart muscle. The arteries of the heart themselves are not treated with this procedure. TMR can be performed with or without Coronary Bypass Surgery (CABG), depending upon the nature of the disease in the arteries. When performed alone, TMR is completed through an incision on the left side of the chest between the fourth and fifth ribs without using the heart-lung machine.

When combined with CABG surgery, the incision may be either down the middle of the chest or through the left side of the chest. The bypass machine (heart-lung machine) may or may not be needed in the combined CABG/TMR surgery. It is thought to primarily involve stimulating the heart to grow small vessels (angiogenesis) in the areas where the channels are created.

More recently, the procedure involves threading a small catheter through coronary arteries. The laser light is carried through fiber optic bundles within the catheter. Another group of fibers shines a light at the tip to provide video pictures of the inside of the artery. Watching the video pictures, the doctor can spot areas of blockage and fire short bursts of laser beams to vaporise them.

TMR is a realistic option primarily for patients with heart disease that cannot be treated with CABG or angioplasty.

Dr Md Habibe Millat, FRCS is a Consultant Cardiac Surgeon at Square Hospital, Dhaka.