Direct Reimplantation Procedure in Anomalous Aortic Origin of the Right Coronary Artery: Long-Term Single Center
Daouda Amadou1, Julia Mitchell1, Christian Bulescu1
1Service de Chirurgie Cardiaque Congénitale, Hôpital Louis-Pradel, Hospices Civils de Lyon, Bron, France.
Insights
Anomalous aortic origin of the right coronary artery (AORCA) can cause sudden cardiac death. Direct reimplantation surgery effectively restores coronary anatomy, allowing athletes to return to normal physical activity safely.
Area of Science:
- Cardiovascular Surgery
- Congenital Heart Disease
- Sports Cardiology
Background:
- Anomalous aortic origin of the right coronary artery (AORCA) is a recognized cause of sudden cardiac death, particularly in athletes.
- Current literature lacks specific treatment guidelines for AORCA.
- This anomaly necessitates surgical intervention to mitigate risks.
Purpose of the Study:
- To describe the surgical experience with direct reimplantation for AORCA.
- To evaluate the efficacy of this technique in restoring coronary anatomy and function.
- To assess patient outcomes, including return to physical activity.
Main Methods:
- Retrospective single-center study of 30 patients.
- Patients underwent surgery between January 2003 and December 2016.
- Mean follow-up duration was seven years.
Main Results:
- Thirty patients (median age 17 years, 24 males) underwent surgery.
- Most patients (26/30) presented with exertional chest pain or syncope.
- 90% of patients had successful reimplantation without transverse aortotomy; all returned to normal activity with no ischemia.
Conclusions:
- Direct coronary artery reimplantation effectively restores normal anatomy.
- The technique enables patients to resume normal physical activity.
- Encouraging outcomes were observed using direct reimplantation, especially without aortotomy.
Background:
Anomalous aortic origin of the right coronary artery is known to be a cause of sudden cardiac death in athletes. There are no specific guidelines concerning treatment strategy in the literature. The aim of this study is to describe and report our experience of direct reimplantation technique in the treatment of this anomaly.
Methods:
This was a retrospective single center study of 30 patients who underwent surgery in the congenital heart disease unit of Louis Pradel Heart and Lung Hospital between January 2003 and December 2016. The mean follow-up was seven years (3 months-17 years).
Results:
Thirty patients underwent surgery. The median age was 17 years (0.2-52 years). There were 24 males. The median weight was 58 kg (3.6-118 kg). Fourteen patients were actively engaged in sports. Twenty-six patients had exertional chest pain or syncope. The median time lapse between diagnosis and intervention was 4.5 months (0.5-179 months). Twenty-seven (90%) patients underwent reimplantation of the anomalous coronary artery without transverse aortotomy, while in 3 (10%) patients transverse aortotomy was used to facilitate reimplantation to avoid tension at the anastomosis. There was no early death; one late death occurred in the third postoperative month. At the last follow-up, all patients had returned to normal physical activity without evidence of ischemia.
Conclusions:
Direct reimplantation allows for a complete restoration of the coronary anatomy and enables patients to return to normal physical activity. Our study shows encouraging results using a direct reimplantation technique without aortotomy.
