Racab Approach For Functional Lad Stenosis Due To Myocardial Bridging
Wouter Oosterlinck, Herbert De Praetere, Filip Rega.
KU Leuven, Leuven, Belgium.
OBJECTIVE: Myocardial bridging is a functional stenosis of the LAD, often affecting young and very active patients. Symptoms vary from asymptomatic, to angina or life threatening arrhythmias. Conservative treatment options often limit the physical activity, while CABG or bridge incision consist of a major physical trauma. We propose robotically assisted coronary artery bypass grafting (RACAB) as a novel strategy in this specific population. With this technique we aim for an early recovery after surgery and a disappearance of signs of coronary ischemia.
METHODS: Two patients were treated by RACAB for myocardial bridging. Age was 41 and 46 yrs. The first patient presented preoperatively with recurrent angina and the second with a suspect cycling performance test. Both diagnoses were confirmed by coronary angiogram, with a severe myocardial bridging at the mid LAD level (figure 1). Conservative treatment options were refused by both patients due to side effects and insufficient symptomatic control.
RESULTS: Both patients were operated via RACAB , with trocar placement in 2th, 4th and 6th intercostal space and a small thoracotomy through the 4th intercostal space. Targets were determined after opening of the pericardium and the mammary artery was harvested with robotic assistance. Mean duration of surgery was 205±7 minutes and mean graft flow 16±5ml /min. Intubation time was 358±58 min. Highest troponin levels were 0.08 ±0.04 ug/l. Patients recovered well and left hospital at third and fifth day respectively. At moment of discharge and after 3 months patients succeeded a cycling performance test that was clinically no longer suspect for coronary ischemia and with power of 53±8Watt and 195±30Watt, respectively. Myocardial scintigraphy was performed in the second patient to allow him to participate cycling competition and showed no residual sign of ischemia.
CONCLUSIONS: Robotically assisted coronary artery bypass is a relatively new treatment option in functional LAD stenosis with proven ischemia. The minimal invasive approach reduces the length of stay and enhances early recovery with a great patient satisfaction and no signs of recurrence of ischemia after 3 months. Patient satisfaction is high and physical recovery to normal preoperative levels to be expected within the first 6-8 weeks.
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