Transmyocardial laser revascularization: An anesthetic perspective

RANSMYOCARDIAL laser revascularization (TMLR) is a relatively new procedure that has been developed to treat severe coronary artery disease (CAD) considered inoperable by standard coronary artery bypass grafting (CABG), not amenable to percutaneous transluminal coronary angioplasty (PTCA), and refractory to medical therapy, vl2 The procedure involves creating small transmural myocardial channels using an epicardially placed carbon dioxide laser. The transmural channels act as conduits for the flow of oxygenated blood from the chamber of the left ventricle into ischemic myocardium. Based on encouraging published preliminary results, TMLR represents a promising new technique for the treatment of CAD. As a result, it is likely that the cardiac anesthesiologist will be exposed to this procedure. In this article, the technique, both its rationale and early results, as well as its unique perioperative anesthetic considerations, are discussed.