FAQs

For Medical Professionals

Q:  What is a Holmium:YAG laser?

A:  The Holmium:YAG (Ho:YAG) laser is a solid state near infra-red wavelength (2.1 microns) low power energy source.  It is the most versatile laser platform available to medical professionals today.  As a surgical tool, Ho:YAG has evolved as the laser of choice across a wide variety of medical specialties including orthopedics, urology, ENT, gynecology, gastroenterology and cardiac surgery. The fiberoptic delivery of the Ho:YAG laser makes available the minimally invasive delivery of the prescribed energy to the surgical site via ports or small incisions.

Q:  What are the benefits of using a Ho:YAG laser for TMR?

A:  The fiberoptic delivery capability of the Ho:YAG laser provides several clinical advantages when performing TMR, including:  laser channeling on a beating or stopped heart (does not require ECG synchronization); transesophageal echocardiogram not required to confirm channel transmurality; fiberoptic delivery for reduced surgical incisions and related morbidity; and thermoacoustic tissue effect to initiate angiogenic response.14,19,46

Q:  What is “Robotic Assisted” TMR?

A:  The Cardiogenesis PEARL 5.0 Robotic Handpiece delivery system is designed for delivery through a 5mm port.  It is compatible with the Intuitive da Vinci surgical robot for performing TMR through small ports.  While a standard stand-alone procedure is performed through a left anterior thoracotomy, the PEARL 5.0 can be used to further reduce the surgical incision and related morbidity.

Q:  How does TMR work in relieving angina pectoris?

A:  The mechanism of action for TMR is likely multifactorial.  There can be an immediate effect due to surgical denervation.  It is believed that the significant patient benefit now documented beyond 5 years is related to the angiogenesis that is created in the tissue surrounding the laser channels.46

Q:  How long do the benefits of TMR last in relieving severe angina?

A:  The clinical benefits of TMR has been shown to be durable for more than 5 years in follow up to prospective, randomized controlled trials. 17,25,26

Q:  Can TMR be performed in patients with unstable angina?

A:  The Instruction for Use (IFU) warns of an increased operative mortality in unstable angina patients (defined as unweanable from intravenous anti-anginal medications ).