# Chirurgisch unroofing van myocardiale brug verbetert angina-klachten langdurig (mediaan 5 jaar follow-up)

*geplaatst 2026-06-07 · Algemeen · European heart journal · doi 10.1093/eurheartj/ehag373 · https://hartvaat.nl/2026/05/22/chirurgisch-unroofing-van-myocardiale-brug-verbetert-angina-klachten-langdurig-m/*

Prospectieve studie van 218 volwassenen met angina pectoris bij niet-obstructief coronairlijden en een functioneel significante myocardiale brug van de LAD (dobutamine-stress diastolische FFR en/of RFR ≤ 0,76), die chirurgische unroofing ondergingen. Mediane follow-up 5 jaar. Patiënten rapporteerden significante en klinisch betekenisvolle verbetering op alle Seattle Angina Questionnaire-domeinen: fysieke beperking, stabiliteit en frequentie van angina, behandelsatisfactie en kwaliteit van leven. In een propensity-gematchte vergelijking met 65 niet-geopereerde patiënten was de verbetering op fysieke beperking (27,8 vs 11,4; p=0,004) en angina-frequentie (30 vs 20; p=0,01) significant groter na chirurgie. Bij ernstige angina ondanks maximale medicamenteuze therapie en bevestigde functioneel significante MB blijkt chirurgische unroofing een effectieve langetermijnoptie.

## English: 

Prospective study of 218 adults with angina in non-obstructive coronary arteries and a functionally significant LAD myocardial bridge (dobutamine-stress diastolic FFR and/or RFR ≤ 0.76) who underwent surgical unroofing. Median follow-up 5 years. Patients reported significant and clinically meaningful improvement across all Seattle Angina Questionnaire domains: physical limitation, anginal stability and frequency, treatment satisfaction, and quality of life. In a propensity-matched comparison with 65 non-surgical patients, improvement in physical limitation (27.8 vs 11.4; p=0.004) and anginal frequency (30 vs 20; p=0.01) was significantly greater after surgery. For severe angina refractory to maximal medical therapy with a confirmed functionally significant MB, surgical unroofing offers a durable long-term option.

## Abstract (original, from the publication)

BACKGROUND AND AIMS: A myocardial bridge (MB) can cause angina in patients with non-obstructive coronary arteries. For patients with a functionally significant MB and severe angina despite maximal medical therapy, surgical unroofing improves short-term symptoms and quality of life (QoL). This study evaluated long-term clinical and symptomatic outcomes of surgical unroofing of a functionally significant left anterior descending artery MB. METHODS: Two hundred eighteen adult patients who underwent surgical unroofing for an MB were prospectively followed. Preoperative assessments included stress echocardiography, coronary computed tomography angiography, invasive coronary angiography, and intravascular ultrasound. A functionally significant MB was defined as dobutamine-stress diastolic fractional flow reserve (dFFR) and/or resting full-cycle ratio (RFR) ≤ 0.76. The Seattle Angina Questionnaire (SAQ) assessed symptoms and QoL at baseline and follow-up. Additionally, among those with a functionally significant MB, 65 surgically unroofed patients were matched with 65 patients who did not undergo surgery using propensity score matching. RESULTS: The median follow-up was 5 (3-9) years. At follow-up, patients reported significant and highly clinically meaningful improvement in all SAQ domains-physical limitation, anginal stability, anginal frequency, treatment satisfaction, QoL, and SAQ summary score. Unroofed patients reported a significantly greater improvement in physical limitation (27.8 vs 11.4, P = .004) and angina frequency (30 vs 20, P = .01) than the non-surgical patients. CONCLUSIONS: Surgical unroofing of a symptomatic and functionally significant MB is associated with significant long-term improvement in symptoms and QoL. For patients with severe angina and failed medical management who have a functionally significant MB, surgical unroofing is a beneficial treatment strategy.

Auteurs: Vedant S Pargaonkar, Ingela Schnittger, Christopher C Y Wong, Hanjay Wang, Yasuhiro Honda, Peter Fitzgerald, Michael P Fischbein, Robert Scott Mitchell, Jack H Boyd, Jennifer A Tremmel

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Bron: European heart journal, https://doi.org/10.1093/eurheartj/ehag373. Bijgewerkt 2026-07-03T13:31:55Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.