Clinical Outcomes of Surgical Unroofing of Myocardial Bridging in Symptomatic Patients

Pouya Hemmati, Hartzell V. Schaff, Joseph A. Dearani, Richard C. Daly, Brian D. Lahr, Amir Lerman

Research output: Contribution to journalArticle

Abstract

Background: There is a paucity of data regarding results of surgical management of myocardial bridging. Our objective was to evaluate the clinical outcomes of unroofing procedures in patients with myocardial bridging of the left anterior descending (LAD) coronary artery who had chest pain refractory to medical therapy. Methods: Among 274 adult patients diagnosed with myocardial bridging at our institution (1996-2017), 71 underwent surgical intervention. To understand the potential benefit of unroofing, we excluded patients with concomitant operations for other diagnoses or known obstructive coronary disease. The study included 35 patients with preoperative chest pain and isolated LAD coronary artery bridging who underwent surgical unroofing. We analyzed recurrent symptoms, postoperative medication use, and mortality. Results: Mean age was 48.2 ± 11.2 years (18 men [51%]). All patients underwent preoperative coronary angiography. Endothelial dysfunction in the LAD coronary artery bridged segment was confirmed in 20 of 24 patients (83%). Mean cardiopulmonary bypass and cross-clamp times were 47.6 ± 29.8 minutes and 33.7 ± 22.2 minutes, respectively. Median lengths of hospital and intensive care unit stay were 5 days and 1 day, respectively. During follow-up (median, 31 months; 95% confidence interval, 18-49) there were no cardiac-related deaths, and 22 patients (63%) reported no chest pain. Among 13 symptomatic patients, 10 underwent postoperative noninvasive testing, which was negative for ischemia in all cases. Conclusions: Myocardial unroofing can be performed safely in patients with chest pain and isolated LAD coronary artery myocardial bridging. However, patients should be aware of the potential for recurrent nonischemic chest pain and continued medical therapy despite relief of coronary compression.

Original languageEnglish (US)
JournalAnnals of Thoracic Surgery
DOIs
StateAccepted/In press - Jan 1 2019

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Myocardial Bridging
Chest Pain
Coronary Vessels
Coronary Angiography
Cardiopulmonary Bypass
Coronary Disease
Intensive Care Units

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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Clinical Outcomes of Surgical Unroofing of Myocardial Bridging in Symptomatic Patients. / Hemmati, Pouya; Schaff, Hartzell V.; Dearani, Joseph A.; Daly, Richard C.; Lahr, Brian D.; Lerman, Amir.

In: Annals of Thoracic Surgery, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "Background: There is a paucity of data regarding results of surgical management of myocardial bridging. Our objective was to evaluate the clinical outcomes of unroofing procedures in patients with myocardial bridging of the left anterior descending (LAD) coronary artery who had chest pain refractory to medical therapy. Methods: Among 274 adult patients diagnosed with myocardial bridging at our institution (1996-2017), 71 underwent surgical intervention. To understand the potential benefit of unroofing, we excluded patients with concomitant operations for other diagnoses or known obstructive coronary disease. The study included 35 patients with preoperative chest pain and isolated LAD coronary artery bridging who underwent surgical unroofing. We analyzed recurrent symptoms, postoperative medication use, and mortality. Results: Mean age was 48.2 ± 11.2 years (18 men [51{\%}]). All patients underwent preoperative coronary angiography. Endothelial dysfunction in the LAD coronary artery bridged segment was confirmed in 20 of 24 patients (83{\%}). Mean cardiopulmonary bypass and cross-clamp times were 47.6 ± 29.8 minutes and 33.7 ± 22.2 minutes, respectively. Median lengths of hospital and intensive care unit stay were 5 days and 1 day, respectively. During follow-up (median, 31 months; 95{\%} confidence interval, 18-49) there were no cardiac-related deaths, and 22 patients (63{\%}) reported no chest pain. Among 13 symptomatic patients, 10 underwent postoperative noninvasive testing, which was negative for ischemia in all cases. Conclusions: Myocardial unroofing can be performed safely in patients with chest pain and isolated LAD coronary artery myocardial bridging. However, patients should be aware of the potential for recurrent nonischemic chest pain and continued medical therapy despite relief of coronary compression.",
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