Transmyocardial revascularization (TMR) is a new treatment modality under evaluation
in patients with severely symptomatic, diffuse coronary artery disease, in whom the
potential for medical or interventional management has been exhausted. Preliminary
clinical trials show improved ischemic symptoms within the first 3 months in about
70% of TMR-treated patients. The original proposed mechanism of surgical or catheter-based
TMR (percutaneous myocardial revascularization [PMR]) was that channels mediate direct
blood flow between the left ventricular cavity and ischemic myocardium. However, several
alternative explanations for the clinical success of TMR have recently been suggested,
including improved perfusion by angiogenesis, an anesthetic effect by nerve destruction,
and a potential placebo effect. This article reviews the clinical role of TMR/PMR,
its possible pathophysiologic mechanisms, and its controversies. It provides an overview
of the actual scientific and clinical status of TMR and details future directions.
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© 1999 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
