Endoscopic Coronary Unroofing for Myocardial Bridging

coronary artery bridge

Left Anterior Descending Coronary Artery Bridge

The robot can be used to unroof myocardial bridges. Myocardial bridging is where the coronary artery which supplies blood to the heart muscle travels underneath a muscle “bridge” and can become compressed. In most patients, this causes no symptoms or problems. However, in some in can cause chest pain (also called angina). Many patients can be treated with medicines alone including beta blockers, calcium channel blockers, statin or even aspirin. There is some controversy as to whether surgical treatment is needed as most of the compression of the artery occurs during systole (when the heart squeezes) rather than diastole (when the heart relaxes). Normally most coronary blood flow to the heart occurs during diastole when the vessel is not compressed.

robotic myocardial bridge

Robotic endoscopic unroofing (division) of myocardial bridge

That being said, there are objective measures of diminished coronary blood flow that can help you and your doctor decide whether surgery is needed. These include a coronary angiogram, a CT coronary angiogram, a stress test, and some advanced testing such as iFR. While I was personally skeptical about the condition at first, I have become convinced there are patients who suffer angina from this condition and become improved after successful unroofing of the myocardial bridge.

One nice development is the ability to use totally endoscopic robotic techniques to perform the unroofing, either with or without the heart-lung machine. Such procedures involve only pencil or pen sized incision of 8 mm or less. This allows most patients to recover more quickly than if they had a full sternotomy (breastplate divided) or thoracotomy (large incision between the ribs with rib spreading).

Due to the need for extensive training, experience, high-level teamwork, and major institutional support, the robotic unroofing procedure is performed by a relatively small number of surgical teams in the country. We have all of the above. The procedure can be performed either off-pump (no heart-lung machine) or on-pump (with the heart-lung machine) depending on the patient and anatomy.


T. Sloane Guy, Robotic Heart Surgeon

T. Sloane Guy, MD

Dr. Guy earned his MD and completed surgery residency and cardiothoracic surgery fellowship at the University of Pennsylvania. He has extensive training and experience in robotic cardiac surgery. He is a former Lieutenant Colonel in U.S. Army who served 3 tours as a combat surgeon in Iraq and Afghanistan. Most recently he was Professor of Surgery and Clinical Director of Cardiac Surgery at Thomas Jefferson University Hospital prior to moving to the Georgia Heart Institute at the Northeast Georgia Physicians Group in Gainesville, Georgia.

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T. Sloane Guy, MD

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