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. 2023 Nov 7;28(1):488.
doi: 10.1186/s40001-023-01478-9.

Surgical strategies and outcomes for myocardial bridges coexisting with other cardiac conditions

Mingkui Zhang  1 , Xiruo Xu  2 , Qingyu Wu  2 , Hongyin Li  2 , Zhonghua Xu  2 , Hui Xue  2 , Yongqiang Jin  2 , Lixin Fan  2 , Lina Li  2
Affiliations

Surgical strategies and outcomes for myocardial bridges coexisting with other cardiac conditions

Mingkui Zhang et al. Eur J Med Res. .

Abstract

Background: Myocardial bridges are congenital coronary artery anomalies. There are still many controversies surrounding surgical treatment strategies for myocardial bridges combined with other heart disorders. The purpose of this study was to evaluate the surgical treatment strategies and outcomes in patients with these conditions.

Methods: Between March 2004 and October 2021, our institution witnessed 77 patients diagnosed with myocardial bridging who underwent surgical intervention. According to the myocardial bridge and combined heart disorder, four groups were identified: 1. isolated LAD supra-arterial myotomy group, 2. LAD CABG and(or not) myotomy group, 3. LAD supra-arterial myotomy and grafting of other branches group, and 4. LAD supra-arterial myotomy and other cardiac surgery group. The perioperative outcomes, symptoms, life quality, mortality, and major adverse cardiac events (MACEs) were analyzed.

Results: There were no deaths during hospitalization and no rethoractomy for postoperative bleeding or major adverse cardiac events (MACEs). The follow-up period ranged from 2 months to 199.2 months (55.61 ± 10.21) months, the 10-year cumulative survival rates for the four groups of patients were 95.0%, 100%, 100% and 74.1%, and the 10-year freedom rates from the MACEs were 83.9%, 92.0%, 87.5% and 76.2%, respectively.

Conclusions: Supra-arterial myotomy is preferred in patients with isolated myocardial bridge, and acceptable results can be achieved by choosing supra-arterial myotomy in combination with CABG or other cardiac surgery simultaneously for patients with myocardial bridges and other heart disorders.

Keywords: Coronary artery bypass grafting; Follow-up; Myocardial bridging; Myotomy; Surgical treatment.

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Conflict of interest statement

We declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Fig. 1
Fig. 1
Coronary angiography before the surgery in a patient shows systolic compression (A, arrow), and recovery in diastole (B, arrow), bridged segment of left anterior descending artery unroofed (C). Coronary computed angiography shows completely relieved the left anterior descending artery myocardial bridge at 12-month follow-up (D, arrow)
Fig. 2
Fig. 2
Coronary angiography shows LAD proximal coronary artery stenosis (A, black arrow), systolic compression (B, white arrow), recovery in diastole (C, white arrow) before the surgery, and a failed left internal mammary artery graft (D, red arrow)
Fig. 3
Fig. 3
Kaplan–Meier survival curve of all postoperative patient during follow-up. Four groups were identified: 1. supra-arterial myotomy group, 2. coronary artery bypass grafting (CABG) group, 3. supra-arterial myotomy and other branches CABG group, and 4. LAD supra-arterial myotomy and other cardiac surgery group
Fig. 4
Fig. 4
Freedom from MACEs curve for all the postoperative patients. The grouping in Fig. 4 replicates the configuration depicted in Fig. 3
See this image and copyright information in PMC

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