Does surgical sympathectomy improve clinical outcomes in patients with refractory angina pectoris?

Interactive Cardiovascular and Thoracic Surgery
Luke C HollandDavid P Taggart

Abstract

A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was: In patients with angina pectoris refractory to medical therapy, does surgical sympathectomy improve clinical outcomes? A total of 528 papers were identified using the search protocol described, of which 6 represented the best evidence to answer the clinical question. There were 5 case series and 1 prospective cohort study. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. All 5 of the case series demonstrated an improvement in symptoms, exercise tolerance or quality of life in patients undergoing surgical sympathectomy. An early case series investigating an open approach had a high morbidity and mortality rate, but the 4 other series used a minimally invasive technique and had low morbidity and zero perioperative mortality rates. The cohort study compared surgical sympathectomy with transmyocardial laser revascularization (TMR) and concluded TMR to be superior. However, this study looked only at unilateral sympathectomy, whereas all 5 case series focused on bilateral surgery. We conclude that the best curre...Continue Reading

References

Dec 1, 1996·Cardiovascular Surgery : Official Journal of the International Society for Cardiovascular Surgery·G ClaesG Rådberg
Oct 28, 1999·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·S S KhogaliJ M Beattie
Jun 30, 2004·The Annals of Thoracic Surgery·Manuel GaliñanesNilesh J Samani
Aug 3, 2007·Interactive Cardiovascular and Thoracic Surgery·Joel DunningKevin Mackway-Jones
Aug 3, 2007·Interactive Cardiovascular and Thoracic Surgery·Martin StriteskyIvan Malek
Jul 24, 1965·British Medical Journal·D A BirkettE G Tuckwell

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Citations

Jun 2, 2018·AJNR. American Journal of Neuroradiology·A ChaudhryA M Blitz
May 15, 2021·Pain Medicine : the Official Journal of the American Academy of Pain Medicine·Jianguo Cheng
Sep 24, 2021·Frontiers in Cardiovascular Medicine·Beatrice BassettiGiulio Pompilio

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