Surgical results and benefits of a minimally invasive coronary surgery in 38 patients with medically refractory symptomatic myocardial bridge

Aims: Minimal invasive coronary surgery without extracorporeal circulation and traditional longitudinal sternotomy is a safe less invasive surgical technique. Little information is available about the surgical results of patients with myocardial bridging. The purpose of this study was to evaluate the outcome of minimally invasive coronary surgery in patients with symptomatic myocardial bridging refractory to medical therapy.

Methods: Between March 2005 and August 2009, 38 consecutive patients (range: 33–86 years; w/m: 18/20) with medically refractory symptomatic myocardial bridging of LAD underwent beating-heart minimally invasive bypass surgery via reversed-J inferior mini-sternotomy approach. Flow in the bypass grafts was routinely measured with the transit-time method. Postoperative control of the grafts and the anastomoses was performed using cardiac CT imaging.

Results: All patients survived the procedure. Average mean flow within the ITA-grafts was 21±7ml/min. One case of postoperative graft failure was detected by cardiac CT. The cause of graft failure was kinking of IMA-graft. Surgical revision was performed with no complications. All other grafts were patent and could be demonstrated on 3-D reconstruction. None of these patients required any antianginal drugs and they have had no recurrence of chest pain. They returned to their normal daily life shortly after the operation and had a good cosmetic result.

Conclusion: The innovative minimally invasive surgical relief of symptoms due to medically refractory myocardial bridge can be accomplished with low operative risk and excellent results. This surgical therapeutic strategy by using ITA, the best choice of graft, with an excellent patency rate offers a definite solution for patients.