Medicare beneficiaries covered for TMR

Since July 1, Medicare has provided coverage of transmyocardial revascularization (TMR) procedures performed with Food and Drug Administration-approved devices for patients with severe angina "which [have] been found refractory to standard medical therapy, including drug therapy at the maximum tolerated or maximum safe dosages. In addition, the angina symptoms must be caused by areas of the heart not amenable to surgical therapies such as PTCA, stenting, coronary atherectomy, or coronary bypass," according to a Health Care Financing Administration memorandum. TMR creates additional blood flow in the heart for treatment of angina and other symptoms of heart problems and is performed on a beating heart, generally through a small left chest incision. (See Cost Management in Cardiac Care, October 1998, pp. 125-127.) The FDA-approved carbon dioxide Heart Laser System, manufactured by PLC Medical Systems of Franklin, MA, is synchronized to the patient’s heartbeat and used to create 20 to 40 channels through oxygen-deprived muscle into the heart’s left ventricle. It is believed this allows blood to flow into the heart muscle again, despite blocked arteries.