Department of Cardiothoracic Surgery, University of Chicago Medicine, IL, USA.
Department of Cardiology, University of Chicago Medicine, IL, USA.
Innovations (Phila). 2024 Jul-Aug;19(4):409-415. doi: 10.1177/15569845241266817. Epub 2024 Sep 13.
Myocardial bridging (MB) occurs when a coronary artery, commonly the left anterior descending (LAD), has an intramyocardial course. In symptomatic patients who fail medical therapy, surgical unroofing can provide symptomatic relief by improving coronary blood flow. We present a series of patients undergoing robotic totally endoscopic beating-heart MB unroofing.
There were 34 patients with an LAD-MB who failed medical therapy and underwent robotic totally endoscopic, off-pump unroofing between January 2017 and October 2023. Patients were evaluated by a multidisciplinary team and underwent provocative coronary angiography to confirm hemodynamic significance. We reviewed perioperative outcomes and contacted patients for midterm follow-up, including completion of a modified Seattle Angina Questionnaire (SAQ).
The mean age was 48 ± 8 years, and 56% were female patients. One patient had prior septal myectomy via sternotomy. All patients had significant dobutamine Pd/Pa reduction on preoperative coronary angiography. One patient had atrial fibrillation and underwent concomitant ablation with left atrial appendage ligation. The mean procedure time was 140 ± 69 min. All were completed totally endoscopically off-pump without intraoperative conversions. The mean MB length was 4.5 ± 1.4 cm, and the mean depth was 1.6 ± 0.9 cm. Of the patients, 76% were extubated in the operating room. The mean intensive care unit and hospital length of stay were 0.97 ± 0.58 and 1.73 ± 1.1 days, respectively. There were no mortalities or strokes. There was 1 postoperative take-back for bleeding. At midterm follow-up (19 ± 14 months), 28 patients completed the SAQ; 86% reported "much less angina" during activity compared with before surgery, and 93% reported taking no antianginal medication since surgery.
In appropriate patients with hemodynamically significant LAD-MB who fail medical therapy, robotic beating-heart unroofing is possible with good outcomes. Further studies are warranted.
当冠状动脉（通常为左前降支）出现心肌内行程时，会发生心肌桥（MB）。在药物治疗无效的有症状患者中，通过改善冠状动脉血流，外科搭桥术可提供症状缓解。我们介绍了一系列接受机器人全内腔不停跳搭桥术的患者。
2017 年 1 月至 2023 年 10 月，有 34 名左前降支 MB 且药物治疗失败的患者接受了机器人全内腔、非体外循环搭桥术。患者通过多学科团队评估，并接受激发性冠状动脉造影以确认血流动力学意义。我们回顾了围手术期结果，并联系患者进行中期随访，包括完成改良西雅图心绞痛问卷（SAQ）。
平均年龄为 48 ± 8 岁，56%为女性患者。1 名患者曾行胸骨切开术的间隔心肌切除术。所有患者术前冠状动脉造影显示多巴酚丁胺 Pd/Pa 显著减少。1 名患者患有心房颤动，并行同期消融术并结扎左心耳。平均手术时间为 140 ± 69 分钟。所有手术均在非体外循环下完全内腔镜下完成，无术中转换。MB 平均长度为 4.5 ± 1.4 cm，平均深度为 1.6 ± 0.9 cm。76%的患者在手术室拔管。平均 ICU 和住院时间分别为 0.97 ± 0.58 和 1.73 ± 1.1 天。无死亡或中风。有 1 例术后因出血再次手术。在中期随访（19 ± 14 个月）时，28 名患者完成了 SAQ；86%的患者报告活动时“心绞痛明显减少”，93%的患者报告手术后未服用抗心绞痛药物。
在药物治疗无效且存在有血流动力学意义的左前降支 MB 的合适患者中，机器人不停跳搭桥术是可行的，且结果良好。需要进一步的研究。
