Department of Cardiothoracic Surgery, Stanford University, Stanford, California.
Department of Cardiovascular Medicine, Stanford University, Stanford, California.
Ann Thorac Surg. 2021 Nov;112(5):1474-1482. doi: 10.1016/j.athoracsur.2020.11.023. Epub 2020 Dec 14.
Myocardial bridge (MB) of the left anterior descending (LAD) coronary artery occurs in approximately 25% of the population. When medical therapy fails in patients with a symptomatic, hemodynamically significant MB, MB unroofing represents the optimal surgical management. Here, we evaluated minimally invasive MB unroofing in selected patients compared with sternotomy.
MB unroofing was performed in 141 adult patients by sternotomy on-pump (ST-on, n = 40), sternotomy off-pump (ST-off, n = 62), or minithoracotomy off-pump (MT, n = 39). Angina symptoms were assessed preoperatively and 6 months postoperatively using the Seattle Angina Questionnaire. Matching included all MT patients and 31 ST-off patients with similar MB characteristics, no previous cardiac operations or coronary interventions, and no concomitant procedures.
MT patients tended to have a shorter MB length than ST-on and ST-off patients (2.57 vs 2.93 vs 3.09 cm, P = .166). ST-on patients had a longer hospital stay than ST-off and MT patients (5.0 vs 4.0 vs 3.0 days, P < .001), and more blood transfusions (15.2% vs 0.0% vs 2.6%, P = .002). After matching, MT patients had a shorter hospital stay than ST-off patients (3.0 vs 4.0 days, P = .005). No deaths or major complications occurred in any group. In all groups, MB unroofing yielded significant symptomatic improvement regarding physical limitation, angina stability, angina frequency, treatment satisfaction, and quality of life.
We report our single-center experience of off-pump minimally invasive MB unroofing, which may be safely performed in carefully selected patients, yielding dramatic improvements in angina symptoms at 6 months after the operation.
左前降支（LAD）心肌桥在人群中约占 25%。对于有症状且血流动力学显著的心肌桥患者，如果药物治疗失败，心肌桥松解术是最佳的手术治疗方法。在此，我们评估了与正中开胸相比，微创心肌桥松解术在选择患者中的应用。
141 例成人患者接受了心肌桥松解术，其中 40 例行正中开胸（ST-on）、62 例行非体外循环下正中开胸（ST-off）、39 例行微创小切口非体外循环下手术（MT）。采用西雅图心绞痛问卷（SAQ）评估术前和术后 6 个月的心绞痛症状。匹配包括所有 MT 患者和 31 例 ST-off 患者，这些患者的心肌桥特征相似，无先前的心脏手术或冠状动脉介入治疗，且无其他伴随手术。
MT 患者的心肌桥长度短于 ST-on 和 ST-off 患者（2.57cm vs 2.93cm vs 3.09cm，P=.166）。ST-on 患者的住院时间长于 ST-off 和 MT 患者（5.0d vs 4.0d vs 3.0d，P<.001），且需要输血的比例更高（15.2% vs 0.0% vs 2.6%，P=.002）。匹配后，MT 患者的住院时间短于 ST-off 患者（3.0d vs 4.0d，P=.005）。各组均未发生死亡或重大并发症。在所有组中，心肌桥松解术均显著改善了躯体受限、心绞痛稳定性、心绞痛发作频率、治疗满意度和生活质量等方面的症状。
我们报告了单中心微创心肌桥松解术的经验，对于精心选择的患者，该手术可安全进行，术后 6 个月心绞痛症状显著改善。
