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Patient care and expectations for recovery after transmyocardial laser revascularization.

Transmyocardial laser revascularization is an investigational cardiovascular surgical procedure that has been trialed in the United States since 1991. The procedure involves the use of a high-energy carbon dioxide (CO2) laser to penetrate ischemic myocardium of the left ventricle. The successful formation of patent laser channels results in the formation of a new circulation within the myocardium. This angiogenesis has shown to improve perfusion to the previously oxygen-deprived tissue. To date, more than 500 patients have undergone this procedure in the United States, and approximately 1,500 cases have been performed in Europe, Asia, and the Middle East. The perioperative nursing care for these patients is multifaceted, including, but not limited to, the need for noninvasive assessment skills, effective pain management, and thorough discharge teaching. Unlike other cardiovascular procedures, this surgery does not immediately repair the ischemic areas; recovery is an insidious process. A realistic understanding of this surgery is needed to assist the patient throughout his or her hospitalization and to properly prepare the individual for expectations of recovery after discharge.