The Aberrant Coronary Artery - The Management Approach

Area of Science:

• Cardiology
• Thoracic Surgery
• Congenital Heart Disease

Background:

• Aberrant coronary arteries are rare (0.05-1.2% incidence), often found incidentally.
• Symptomatic presentations include angina, arrhythmia, sudden death, dyspnea, and syncope.
• Current management guidelines and dedicated studies are lacking, leading to controversial treatment options.

Purpose of the Study:

• To assess international cardiothoracic surgeons' consensus on managing aberrant coronary arteries arising from the contralateral sinus with an interarterial course.
• To identify preferred surgical strategies when intervention is indicated.

Main Methods:

• Electronic survey of selected international cardiothoracic surgeons in November 2016.
• Focus on management of aberrant left main coronary artery (ALMCA) and aberrant right main coronary artery (ARMCA).

Main Results:

• No consensus on surgical correction for asymptomatic ALMCA or ARMCA.
• Consensus for surgical correction if myocardial ischemia is demonstrated (via coronary angiography with FFR or stress perfusion scan).
• Internal mammary artery bypass favored for ALMCA; coronary ostium unroofing for ARMCA, if surgery is chosen. No age-based consensus for treatment differences.

Conclusions:

• Surgical correction is indicated for symptomatic patients with aberrant coronary arteries.
• Surgical correction is indicated if myocardial ischemia is demonstrated, regardless of coronary artery type.
• Management of asymptomatic aberrant coronary arteries lacks consensus.