ENDOSCOPIC TRANSTHORACIC SYMPATHICOTOMY FOR SEVERE ANGINA

We evaluated the antianginal effects of endoscopic transthoracic sympa thicotomy (ETS) in 24 patients not eligible for coronary bypass surger y or angioplasty. In this procedure, the sympathetic chain is electroc oagulated under general anaesthesia. No major surgical complications o ccurred. The frequency of anginal attacks was significantly reduced (p =0.001). The mean increase in maximum exercise capacity was 13 (SD 21) W (p=0.009). ST depression at maximum comparable workload was reduced by 0.052 (0.10) mV (p=0.005). Global ejection fraction during exercis e and metaiodobenzylguanidine uptake were unchanged. Heart rate variab ility analysis showed a reduction of the ratio between low and high fr equencies at tilt test (-1.00 [0.96]; p<0.001). We conclude that ETS c an be done without major complications, alleviates angina, and increas es maximum working capacity in patients with advanced coronary disease .