Outcomes in anomalous aortic origin of a coronary artery after surgical reimplantation

J Thorac Cardiovasc Surg. 2021 Oct;162(4):1191-1199. doi: 10.1016/j.jtcvs.2020.12.100. Epub 2021 Jan 5.

Abstract

Objective: Anomalous aortic origin of a coronary artery (AAOCA) can be associated with myocardial ischemia and sudden cardiac arrest. We compared outcomes data of patients who underwent transection and reimplantation (TAR) and patients who underwent an unroofing.

Methods: Patients who presented to the Coronary Artery Anomalies Program were evaluated and managed following a standardized approach. Anatomy was determined using computed tomography angiography, myocardial perfusion using advanced stress imaging, and surgical intervention according to anatomic features.

Results: Sixty-one patients underwent surgical repair of AAOCA between 2012 and 2019: 16 (26%) patients underwent TAR of the anomalous coronary without an aortic button and 45 (74%) patients underwent coronary unroofing. Compared with patients who underwent an unroofing, patients who underwent TAR had similar intramural length (5 mm with interquartile range of 4-7.7 vs 6 mm with interquartile range of 5-7; P = .6). One patient with an anomalous right coronary underwent coronary artery bypass grafting after TAR because of persistent postoperative ischemic changes. One patient with unroofing of an anomalous left coronary artery presented with recurrent aborted sudden cardiac death and underwent subsequent TAR, without further events. At last follow-up, 15 of 16 patients (94%) who underwent TAR and 42 of 45 (93%) patients who underwent an unroofing were released to unrestricted exercise activities.

Conclusions: Coronary artery TAR is a useful surgical alternative for AAOCA when there is a course below the commissure, when unroofing does not relocate the ostium to the appropriate sinus, or when unroofing results in compression by the intercoronary pillar.

Keywords: AAOCA; coronary anomalies.

MeSH terms

  • Adolescent
  • Aorta, Thoracic* / abnormalities
  • Aorta, Thoracic* / surgery
  • Computed Tomography Angiography / methods
  • Coronary Vessel Anomalies* / diagnosis
  • Coronary Vessel Anomalies* / surgery
  • Coronary Vessels* / diagnostic imaging
  • Coronary Vessels* / surgery
  • Death, Sudden, Cardiac* / etiology
  • Death, Sudden, Cardiac* / prevention & control
  • Female
  • Humans
  • Image Processing, Computer-Assisted
  • Imaging, Three-Dimensional
  • Male
  • Outcome and Process Assessment, Health Care
  • Postoperative Complications* / diagnosis
  • Postoperative Complications* / surgery
  • Reoperation / methods
  • Reoperation / statistics & numerical data
  • Replantation* / adverse effects
  • Replantation* / methods
  • Vascular Malformations* / diagnosis
  • Vascular Malformations* / surgery