Surgical Management of Anomalous Aortic Origin of a Coronary Artery
Elbert E. Williams, Karthik Seetharam, Farzan Filsoufi, Khanh Nguyen, Paul Stelzer, John D. Puskas, Ramachandra C. Reddy.
Mount Sinai Medical Center, New York, NY, USA.
BACKGROUND: Anomalous aortic origin of the coronary artery (AAOCA) is an uncommon condition occurring in 0.1 to 0.3% of the population but may be associated with sudden death and myocardial ischemia. Surgical correction including unroofing, reimplantation, and coronary artery bypass grafting (CABG) is required. The choice of the optimal surgical intervention and their outcomes remain undetermined. Here, we report our contemporary experience in a large cohort of patients with AAOCA. METHODS: We retrospectively analyzed prospectively collected data of 53 patients with AAOCA who underwent surgical correction at our institution between 01/2007 and 05/2017. Outcome measures included hospital mortality and postoperative complications. RESULTS: Thirty-one patients were male whereas 19 were female. The age ranged from 17 to 82 years (mean 48 years). Eighteen patients had anomalous left coronary artery (ALCA) and 33 presented with anomalous right coronary artery (ARCA). Indications for surgery included symptoms (n=21), positive stress examinations (n=4) and other concomitant cardiac operations (n=12). The procedure performed was determined by surgeonís preference and included: unroofing (n=21), reimplantation (n=5), minimally invasive coronary bypass (n=6), and CABG (n=13). Looking at long term follow-up, there was 1 mortality in a patient who underwent unroofing of an ARCA who required ECMO post-operatively. One patient who underwent minimally invasive right internal mammary artery grafting to his right coronary artery required subsequent unroofing after the graft occluded several years later. One patient developed a hemothorax and 1 other required re-exploration for bleeding. CONCLUSIONS: A variety of techniques can be applied to correct AAOCA with excellent results. The choice of procedure does not affect early surgical outcomes. Continued longer term follow-up is necessary to better determine the exact role of each surgical intervention in the correction of AAOCA.
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