Abstract 16653: Clinical Outcome and Short-term Follow up After Surgical Unroofing of a Myocardial Bridge in Patients With Angina and No Obstructive Coronary Artery Disease

Abstract

Introduction: Although a myocardial bridge (MB) is a common, generally benign anatomic variant, a small subset of patients experience severe anginal symptoms related to their MB, resulting in significant physical limitations and a poor quality of life. Surgical unroofing (supra-arterial myotomy) is a treatment option when medical management fails, but little is known regarding the clinical outcomes of patients who undergo surgical unroofing. Methods: A total of 34 patients (10 men, 24 women) with severe angina and a hemodynamically significant MB underwent surgical unroofing. All patients had failed medical management and had undergone extensive testing prior to surgery, including exercise echocardiography, coronary computerized tomography angiography, invasive coronary angiography, intravascular ultrasound (a MB was defined as an echolucent half-moon sign and/or ≥10% systolic compression), and hemodynamic testing using an intracoronary pressure and Doppler flow wire at rest and during dobutamine stress to calculate a diastolic fractional flow reserve (dFFR) (the ratio of diastolic intracoronary pressure divided by aortic pressure), as well as the peak Doppler flow velocity. An abnormal dFFR was defined as ≤0.76 during dobutamine stress. A Seattle angina questionnaire (SAQ) was administered to evaluate symptoms and quality of life before and after surgery. Results: The mean age was 45.1 ± 15.7 years and median follow-up was 6.6 (2 - 13) months after surgery. There were no major complications during the pre, intra, or post-operative period of the surgery. Following surgery, patients reported a significant improvement in all five dimensions of the SAQ (figure). Conclusions: In carefully selected patients with severe angina secondary to a hemodynamically significant MB who have failed medical management, surgical unroofing appears to be a safe and effective option for improving physical limitations, anginal symptoms, and overall quality of life.