Surgical treatment of aberrant aortic origin of coronary arteries
Marlotte Kooij1, Hubert W Vliegen2, Michiel A de Graaf2
1Department of Cardiothoracic Surgery D6-26, Leiden University Medical Center, Leiden, Netherlands marlottekooij@gmail.com.
Insights
Surgery for aberrant coronary artery origins is safe and effective, with no mortality in this study. Surgical repair is recommended for all cases, including asymptomatic aberrant right coronary artery, to prevent life-threatening events.
Area of Science:
- Cardiovascular Surgery
- Congenital Heart Disease
- Interventional Cardiology
Background:
- Aberrant coronary artery origin is a rare but potentially fatal condition, a leading cause of sudden death in young adults.
- Surgical repair is established for interarterial left coronary artery (LCA), but its necessity for interarterial right coronary artery (RCA) remains debated.
- This study evaluates surgical outcomes for various aberrant coronary artery origins.
Purpose of the Study:
- To analyze surgical experience and outcomes for patients with aberrant coronary artery origins.
- To assess the safety and efficacy of surgical repair for interarterial RCA and LCA, and intraseptal LCA.
- To determine indications for surgical intervention in aberrant coronary artery disease.
Main Methods:
- A retrospective analysis of 31 patients operated between 2001 and 2014 for interarterial RCA, interarterial LCA, or intraseptal LCA.
- Surgical techniques included ostium unroofing/reimplantation for RCA, ostium reconstruction for LCA, and septal release/reimplantation for intraseptal LCA.
- Follow-up involved clinical assessment, echocardiography, ECG, CT-angiography, and exercise testing.
Main Results:
- No early or late mortality was observed in the median 6-year follow-up.
- Three patients experienced post-operative ischemia with arrhythmias; two required reoperation, one received stent implantation.
- All other patients remained asymptomatic, with two showing slight left ventricular dysfunction at follow-up.
Conclusions:
- Surgical repair of aberrant coronary artery origins is a safe procedure.
- A slit-like ostium and intramural aortic course represent absolute indications for surgical repair, even in asymptomatic aberrant RCA.
- While generally safe, a risk of post-operative cardiac ischemia exists, particularly with LCA reconstruction.
Objectives:
Aberrant origin of the coronary arteries is rare but can be life threatening. It is an important cause of sudden death in athletes and other young adults, and may be treated surgically. Consensus exists that interarterial left coronary artery (LCA) should be surgically repaired. For interarterial right coronary artery (RCA), the discussion remains open. The purpose of this study was to analyse our surgical experience.
Methods:
From 2001 until 2014, 31 patients were operated for interarterial RCA, interarterial LCA or intraseptal course of the LCA. Twenty-six patients had interarterial RCA, 4 patients interarterial LCA and 1 patient an intraseptal course of the LCA. Median age at operation was 38 years (range 9-66 years). Twenty-eight patients had previous or current symptoms. The most important were a life-threatening event with resuscitation in 3 and myocardial infarction in 3 others. Surgical repair of interarterial RCA consisted of unroofing of the ostium with or without reimplantation in 25 patients and CABG on the RCA with a venous graft in 1 patient. Reconstruction of interarterial LCA consisted of ostium reconstruction of the LCA with a venous patch in 4 patients. The patient with an intraseptal course had a complete release of the LCA out of the septum and reimplantation in the correct coronary sinus. Follow-up was done by analysis of outpatient records, direct patient contact, echocardiography, electrocardiography, CT-angiography and an exercise test.
Results:
Median follow-up was 6 years (range 0-11 years). One patient was lost to follow-up. No early or late mortality occurred. Three patients had ischaemia with ventricular fibrillation or ventricular tachycardia shortly after surgery. Two were immediately reoperated, 1 had a stent implantation 1.5 months after release of intraseptal LCA. Two of these patients show a slight dysfunction of the left ventricle at follow-up. All other patients are asymptomatic.
Conclusions:
Surgery for aberrant origin of coronary arteries is safe. There is a risk of cardiac ischaemia shortly after operation, especially in LCA reconstruction. We strongly believe that a slit-like coronary ostium and an intramural aortic course is an absolute indication for surgical repair, also in asymptomatic aberrant RCA.
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