Clinical Outcomes of Surgical Unroofing of Myocardial Bridging in Symptomatic Patients.

Abstract

BACKGROUND\nThere 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 coronary artery (LAD) who had chest pain refractory to medical therapy.\n\n\nMETHODS\nAmong 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 bridging who underwent surgical unroofing. We analyzed recurrent symptoms, postoperative medication use, and mortality.\n\n\nRESULTS\nMean age was 48.2 ± 11.2 years (18 male, 51%). All underwent preoperative coronary angiography. Endothelial dysfunction in the LAD bridged segment was confirmed in 20/24 (83%) patients. Mean cardiopulmonary bypass and cross-clamp times were 47.6 ± 29.8 min and 33.7 ± 22.2 min, respectively. Median lengths of hospital and ICU stay were 5 days and 1 day, respectively. During follow-up (median 31 months, 95% confidence interval 18-49 months), there were no cardiac-related deaths and 22 patients (63%) reported no chest pain. Among symptomatic patients (n=13), 10 underwent postoperative non-invasive testing which was negative for ischemia in all cases.\n\n\nCONCLUSIONS\nMyocardial unroofing can be performed safely in patients with chest pain and isolated LAD myocardial bridging. However, patients should be aware of the potential for recurrent non-ischemic chest pain and continued medical therapy despite relief of coronary compression.