Department of Cardiothoracic and Vascular Surgery, Mainz University Hospital, Mainz, Germany.
Department of Cardiothoracic Surgery, Cairo University, Cairo, Egypt.
Interact Cardiovasc Thorac Surg. 2021 Jul 26;33(2):203-209. doi: 10.1093/icvts/ivab084.
Coronary artery bypass grafting or supra-arterial myotomy is now suggested as a better therapeutic option in myocardial bridging (MB) when medical treatment fails to control symptoms. For left anterior descending (LAD) MB, minimally invasive coronary artery bypass via a lower ministernotomy can be offered.
Forty-four consecutive patients who underwent elective minimally invasive coronary artery bypass surgery from 2005 to 2014 via an inferior sternotomy using the left internal mammary artery as a bypass graft for LAD MB were evaluated retrospectively.
The mean age was 59.1 ± 13.1 years with 26 (59%) men and 18 (41%) women. The mean body mass index was 27.2 ± 3.9 and the mean EuroSCORE II was 1.6 ± 1.8. Routine coronary multislice computed tomography angiography on the 6th postoperative day revealed 97.7% graft patency. During the initial hospital stay, 1 patient (2.3%) underwent a reoperation for early graft failure. Forty patients (91%) could be followed up for a mean period of 64.4 ± 24.5 months after the procedure, during which 2 patients (4.5%) died of non-cardiac causes and 9 patients (20.5%) underwent postoperative coronary angiography with confirmed graft occlusion in only 1 case (2.3%). The improvement in the distribution of patients in the Canadian Cardiovascular Society class 0 was from 4 patients (9%) preoperatively to 37 patients (84%) at the end of the follow-up period (P-value 0.001).
Minimally invasive coronary artery bypass surgery via a lower ministernotomy may be safe and efficient for treating LAD artery MB with acceptable complication rates, cosmetic benefits and patency rates.
当药物治疗无法控制症状时，对于心肌桥（MB），现在建议冠状动脉旁路移植术或动脉上方肌切开术作为更好的治疗选择。对于左前降支（LAD）MB，可以通过下胸骨切开术进行微创冠状动脉旁路移植术。
回顾性分析了 2005 年至 2014 年间通过下胸骨切开术使用左内乳动脉作为旁路移植物治疗 LAD MB 的 44 例连续择期微创冠状动脉旁路手术患者。
平均年龄为 59.1±13.1 岁，其中男性 26 例（59%），女性 18 例（41%）。平均体重指数为 27.2±3.9，EuroSCORE II 平均为 1.6±1.8。术后第 6 天行常规冠状动脉多层螺旋 CT 血管造影显示 97.7%的移植物通畅。在初始住院期间，1 例患者（2.3%）因早期移植物失败再次手术。40 例患者（91%）在术后平均 64.4±24.5 个月后可获得随访，其中 2 例（4.5%）死于非心脏原因，9 例（20.5%）在术后进行了冠状动脉造影，仅 1 例（2.3%）证实移植物闭塞。加拿大心血管学会（CCS）0 级患者的分布从术前的 4 例（9%）改善到随访结束时的 37 例（84%）（P 值<0.001）。
通过下胸骨切开术进行微创冠状动脉旁路移植术治疗 LAD 动脉 MB 可能是安全有效的，其并发症发生率、美容效果和通畅率可接受。
