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Off-Pump Minithoracotomy Versus Sternotomy for Left Anterior Descending Myocardial Bridge Unroofing.
Wang, Hanjay; Pargaonkar, Vedant S; Hironaka, Camille E; Bajaj, Simar S; Abbot, Chad J; O'Donnell, Christian T; Miller, Shari L; Honda, Yasuhiro; Rogers, Ian S; Tremmel, Jennifer A; Fischbein, Michael P; Mitchell, R Scott; Schnittger, Ingela; Boyd, Jack H.
Affiliation
  • Wang H; Department of Cardiothoracic Surgery, Stanford University, Stanford, California.
  • Pargaonkar VS; Department of Cardiovascular Medicine, Stanford University, Stanford, California.
  • Hironaka CE; Department of Cardiothoracic Surgery, Stanford University, Stanford, California.
  • Bajaj SS; Department of Cardiothoracic Surgery, Stanford University, Stanford, California.
  • Abbot CJ; Department of Cardiothoracic Surgery, Stanford University, Stanford, California.
  • O'Donnell CT; Department of Cardiothoracic Surgery, Stanford University, Stanford, California.
  • Miller SL; Department of Cardiothoracic Surgery, Stanford University, Stanford, California.
  • Honda Y; Department of Cardiovascular Medicine, Stanford University, Stanford, California.
  • Rogers IS; Department of Cardiovascular Medicine, Stanford University, Stanford, California.
  • Tremmel JA; Department of Cardiovascular Medicine, Stanford University, Stanford, California.
  • Fischbein MP; Department of Cardiothoracic Surgery, Stanford University, Stanford, California.
  • Mitchell RS; Department of Cardiothoracic Surgery, Stanford University, Stanford, California.
  • Schnittger I; Department of Cardiovascular Medicine, Stanford University, Stanford, California.
  • Boyd JH; Department of Cardiothoracic Surgery, Stanford University, Stanford, California. Electronic address: jackboyd@stanford.edu.
Ann Thorac Surg ; 112(5): 1474-1482, 2021 11.
Article in En | MEDLINE | ID: mdl-33333083
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Subject(s)

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Abnormalities, Multiple / Thoracotomy / Coronary Vessel Anomalies / Sternotomy / Heart Defects, Congenital Type of study: Observational_studies / Prognostic_studies Aspects: Patient_preference Limits: Adult / Female / Humans / Male / Middle aged Language: En Journal: Ann Thorac Surg Year: 2021 Document type: Article Country of publication: Netherlands

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Abnormalities, Multiple / Thoracotomy / Coronary Vessel Anomalies / Sternotomy / Heart Defects, Congenital Type of study: Observational_studies / Prognostic_studies Aspects: Patient_preference Limits: Adult / Female / Humans / Male / Middle aged Language: En Journal: Ann Thorac Surg Year: 2021 Document type: Article Country of publication: Netherlands