Transmyocardial laser revascularization, by thoracotomy; performed at the time of other open cardiac procedure(s) (List separately in addition to code for primary procedure)
CPT4 code
Name of the Procedure:
Transmyocardial Laser Revascularization (TMLR), by Thoracotomy; Performed at the Time of Other Open Cardiac Procedure(s)
Summary
Transmyocardial laser revascularization (TMLR) is a surgical technique used to improve blood flow to the heart muscle in patients with severe coronary artery disease. It involves creating small channels in the heart muscle using a laser to enhance oxygen delivery. This procedure is conducted through a thoracotomy (an incision in the chest) and is often performed alongside other open-heart surgeries.
Purpose
Medical Condition:
- Severe coronary artery disease
- Angina (chest pain) refractory to other treatments
Goals:
- Relieve chest pain
- Improve blood flow and oxygenation to heart muscle
- Enhance overall cardiac function
Indications
- Chronic refractory angina despite maximum medical therapy
- Patients not suitable for conventional revascularization procedures like coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI)
- Severe, diffuse atherosclerosis
Preparation
- Pre-procedure fasting (usually at least 8 hours)
- Medication adjustments as per physician’s advice (e.g., anticoagulants)
- Diagnostic imaging (e.g., echocardiogram, coronary angiography)
- Blood tests and overall health assessment
Procedure Description
- Anesthesia: General anesthesia is administered to ensure the patient is asleep and pain-free.
- Incision: A thoracotomy incision is made in the chest.
- Laser Application: A specialized laser (often a CO2 laser) is used to create tiny channels (1 mm in diameter) in the heart muscle.
- Concurrent Procedures: Perform other indicated cardiac procedures, such as CABG.
- Closure: The chest is closed, and the patient is taken off the cardiopulmonary bypass, if used.
Duration
The procedure typically takes 2-4 hours, depending on the complexity and additional surgeries being performed.
Setting
The procedure is conducted in a hospital operating room, usually within the cardiac surgery unit.
Personnel
- Cardiothoracic surgeon
- Cardiac anesthesiologist
- Surgical nurses
- Perfusionist (if cardiopulmonary bypass is used)
- Scrub techs and OR support staff
Risks and Complications
- Infection
- Bleeding
- Heart attack
- Arrhythmias (irregular heart rhythms)
- Stroke
- Anesthesia-related complications
- Postoperative pain
Benefits
- Significant reduction in angina symptoms
- Improved quality of life
- Enhanced cardiac function
- Immediate and long-term relief from chest pain
Recovery
- Hospital stay for 5-7 days, with intensive monitoring initially.
- Pain management with medications.
- Gradual resumption of activities as advised by the doctor.
- Follow-up appointments for wound inspection and cardiac check-ups.
- Cardiac rehabilitation program participation for optimal recovery.
Alternatives
- Medical management with medications alone
- Percutaneous coronary intervention (PCI) such as angioplasty and stenting
- Enhanced external counterpulsation (EECP)
- Lifestyle modifications (diet, exercise, smoking cessation)
Patient Experience
During the Procedure:
- The patient will be under general anesthesia and won’t feel any pain. ##### After the Procedure:
- Postoperative pain manageable with medications.
- Possible temporary discomfort at the incision site.
- Gradual improvement in symptoms over weeks to months.
- Emotional and psychological support may be beneficial.
Having the above information helps in understanding the TMLR procedure, from preparation to recovery, highlighting its benefits, risks, and alternatives, ensuring patients can make informed decisions about their care.