Off-Pump Minithoracotomy Versus Sternotomy for Left Anterior Descending Myocardial Bridge Unroofing

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Minimally Invasive Surgery

Background:

• Myocardial bridge (MB) of the left anterior descending (LAD) coronary artery affects approximately 25% of the population.
• Surgical MB unroofing is optimal when medical therapy fails for symptomatic, hemodynamically significant MB.
• This study compares minimally invasive MB unroofing with sternotomy in selected patients.

Purpose of the Study:

• To evaluate the safety and efficacy of minimally invasive MB unroofing.
• To compare outcomes of minithoracotomy off-pump (MT) MB unroofing with sternotomy on-pump (ST-on) and sternotomy off-pump (ST-off) approaches.
• To assess symptomatic improvement and quality of life post-procedure.

Main Methods:

• 141 adult patients underwent MB unroofing via sternotomy on-pump (n=40), sternotomy off-pump (n=62), or minithoracotomy off-pump (n=39).
• Seattle Angina Questionnaire assessed angina symptoms preoperatively and 6 months postoperatively.
• Matching was performed for MT patients and a subset of ST-off patients based on MB characteristics and prior interventions.

Main Results:

• Minithoracotomy off-pump (MT) patients had shorter hospital stays (3.0 days) compared to sternotomy off-pump (ST-off) patients (4.0 days) after matching (P=.005).
• ST-on patients experienced longer hospital stays (5.0 days) and more blood transfusions (15.2%) than ST-off and MT groups (P<.001, P=.002).
• No deaths or major complications were observed in any group; all groups showed significant symptomatic improvement.

Conclusions:

• Off-pump minimally invasive MB unroofing can be safely performed in carefully selected patients.
• This approach leads to dramatic improvements in angina symptoms at 6 months post-operation.
• Minimally invasive surgery offers a viable alternative to sternotomy for MB unroofing.