Chill, really. Open-chest surgery is not the solution to CVD mortality. Even a little rib window for TMR is a hole in the chest. That's a bunch of money, and a lot of specialized talent at work. Very much a similar case on Renal-Guard: lotta money and talent deployed to use a contrast agent in the first place.
Most patients for whom TMR is appropriate are served fairly well by stents and/or calcium channel blockers. Neither one is as scary-sounding as having 2 dozen holes blown through your heart with a laser. So really, the total market is "rich" people who have failed stenting and first-line drugs. Even there, bypass is a competitor. Probably an overly painful and costly competitor for most patients, but it's familiar. I can think of subgroups where one of the other would be a clear choice: if you're in a group where TMR is clearly better you'll know it; you might not know and might not care to risk being in a group where CABG was clearly better.
Nice thing about Renal-Guard is that it patches right onto existing practices. If the early results are confirmed, it'll just roll into radiology practice like a fog. But too many promising leads have failed before on CIN.
But if you want to save a big fraction of those people dying of CVD you have to find a way to stop injured hearts from fibrillating; you have to find a way to encourage small brain lesions to heal; you have to find a way to stabilize progressive pumping failure.
Points well taken. Indeed, RenalGuard takes a prophylactic approach in the course of diagnosis of Heart Disease, while TMR is in position to treat the existing condition.
Where TMR loses its appeal to patients is the fact that researchers nor the procedures inventor (Rudko) never bothered to explore and investigate the mechanism for the devices effectiveness. In other words, patients balk tremendously at the idea of having holes punched into their heart without the doctor being able to explain why or how it works.
But the procedure does work. My best explanation as to why TMR works and why patients should look into it as a first line of defense against the development of heart disease, as aggressive of an appproach as that might seem, is due to the fact that the heart, above all else, despite it's importance and intracacy, is still a muscle. A smooth striated involuntary muscle, but a muscle nonetheless.
And evidence exists suggesting that muscles, as well as other tissues in the body benefit immensely from mild exercise and controlled periodic insult.
Not only does it spur healing, but induces evolutionary strenthening and development as well. The reason why heart attacks or heart failure occur in so many people is because as we age, the heart as well as the labyrinth of vessels leading to it, begin to lose their elasticity, durability and functionality.
Certain parts of the heart become inaccesible to exercise and endurance regimens. Making the muscle less capable of supporting and nourishing the critical organs and extremities of the human body.
Treating the left ventrical with TMR promotes a healing, revascularization, or neovascularization (VEGF) of a very important chamber of the heart, often unamenable to exercise or strengthening. Injury and insult promotes strengthening, like in the words of Malcom X, "by any means necessary".
What does not kill you, more often than not, makes you stronger. Especially when muscles are involved.
The disconnect with patients being receptive to the idea of TMR surgery is the fact that a euphemism for the procedure has not been coined. Such as the word "exercise"---which sounds so much more innocuous than the actual act itself--which is tearing apart, stretching and damaging tiny muscle fibres and tendons, for later rejuvenation and rebuilding.
Personally, I don't know what the long-term strategy of Rudko et. al. is for PLC Systems and TMR. They seem to either be satisfied with their personal enrichment from the device, while lacking the ambition to further its reach into society. I could be wrong in my assessment, but so far, that's what it seems.
I agree that the concept of TMR and the inability to explain why the mechanism works made it a tough sell. It has been proven to work but just never gained acceptance. I know of other devices which cause temporary tissue damage to promote re-growth. I believe the purpose behind some wrinkle reduction lasers is to damage the collagen layer beneath the skin, causing reduced wrinkles upon re-growth. The re-vamped web site, change in incentive structure, and overall focus of management leads me to believe that they have essentially conceded the market for TMR and will not push forward with it. Perhaps someday the techology will land in more motivated hands, and experience a re-birth.