Anomalous Aortic Origin of a Coronary Artery: Surgical Repair With Anatomic- and Function-Based Follow-Up

• Published in: The Annals of thoracic surgery Vol. 101; no. 1; pp. 169 - 176
• Main Authors: Feins, Eric N., MD, DeFaria Yeh, Doreen, MD, Bhatt, Ami B., MD, Stefanescu, Ada, MD, Youniss, Mohamed A., MD, Ghoshhajra, Brian B., MD, Inglessis-Azuaje, Ignacio, MD, Liberthson, Richard R., MD, MacGillivray, Thomas E., MD
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.01.2016
• Subjects: Adult; Aged; Anastomosis, Surgical - methods; Aorta, Thoracic - abnormalities; Aorta, Thoracic - physiopathology; Aorta, Thoracic - surgery; Cardiothoracic Surgery; Coronary Angiography; Coronary Circulation - physiology; Coronary Vessel Anomalies - diagnostic imaging; Coronary Vessel Anomalies - physiopathology; Coronary Vessel Anomalies - surgery; Female; Follow-Up Studies; Humans; Male; Middle Aged; Retrospective Studies; Surgery; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Vascular Surgical Procedures - methods; Young Adult
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2015.07.003

Background Anomalous aortic origin of the coronary artery (AAOCA) with an interarterial (IAC) course is an uncommon congenital anomaly. Surgical indications and repair techniques have evolved. We have managed 259 adult patients with AAOCA over 40 years. Our management strategy includes anatomic- and function-based surveillance to select surgical candidates. We reviewed our surgical cohort and analyzed anatomic and functional outcomes. Methods We queried our heart center databases to obtain the names of all patients with AAOCA managed at our institution between 1974 and 2014. We performed a retrospective chart review. Results Two hundred fifty-nine patients were managed for AAOCA. Sixty-one underwent surgical intervention. Twenty-six with associated coronary atherosclerosis were excluded. Thirty-one who underwent surgical repair were analyzed. Mean age was 42.5 ± 2.7 years. Twenty-four patients (77.4%) had right AAOCA. Six (19.4%) had left AAOCA. One (3.2%) had bilateral coronary anomalies. Repair techniques included 21 unroofing procedures (67.7%), 6 translocations (19.4%), and 4 coronary artery bypass grafting (CABG) procedures (12.9%). Mean follow-up was 3.8 ± 0.8 years. Thirteen patients underwent follow-up anatomic testing with computed tomography. Twelve of these patients had widely patent coronary arteries, and 1 patient had mild coronary artery stenosis. Seventeen patients underwent functional testing. Fifteen of these patients had no evidence of ischemia. One patient had reversible ischemia after CABG, and 1 had subclinical ischemia after unroofing. There was 1 late mortality from endocarditis. Conclusions Our multidisciplinary program uses a treatment algorithm to select patients with AAOCA for surgical intervention. Only a small subset requires an operation, and we favor unroofing and translocation techniques. With this paradigm, outcomes are excellent, as validated with anatomic- and function-based testing.