Congenital: Anomalous Aortic Origin of a Coronary Artery
Outcomes in anomalous aortic origin of a coronary artery after surgical reimplantation

https://doi.org/10.1016/j.jtcvs.2020.12.100Get rights and content
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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.

Graphical abstract

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. AAOCA, Anomalous aortic origin of the coronary artery; TAR, transection and reimplantation; CTA, computed tomography angiography; CABG, coronary artery bypass graft.

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Key Words

AAOCA
coronary anomalies

Abbreviations and Acronyms

AAOCA
anomalous aortic origin of a coronary artery
AAOLCA
anomalous aortic origin of the left coronary artery
AAORCA
anomalous aortic origin of the right coronary artery
CAAP
Coronary Artery Anomalies Program
CTA
computed tomography angiography
ECG
electrocardiogram
IM
intramural
IQR
interquartile range
SCA
sudden cardiac arrest
sCMR
stress cardiac magnetic resonance imaging
sNPI
stress nuclear perfusion imaging
TAR
transection and reimplantation

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Source of funding: internal.