When these treatment options are exhausted, the patient is left with no viable surgical alternative other than, in limited cases, heart transplantation.
Without a viable surgical alternative, the patient is generally managed with drug therapy, often with significant lifestyle limitations.
TMR, or transmyocardial laser revascularization, is a newer treatment aimed at improving blood flow to areas of the heart that were not treated by angioplasty or surgery.
When performed as a primary therapy, it is done through a small incision between the ribs (thoracotomy) with the patient under general anesthesia.
During a typical procedure, approximately 10 –50 channels are made in each targeted region of the heart muscle.