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First report from the European registry for anomalous aortic origin of coronary artery (EURO-AAOCA)
Christoph Gräni1, Anselm W Stark1, Mauro Lo Rito2
1Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Interdisciplinary Cardiovascular and Thoracic Surgery
|April 22, 2024
Summary
Anomalous aortic origin of a coronary artery (AAOCA) management varies across European centers. Surgery for AAOCA is safe, but further data are needed to optimize treatment decisions for patients.
Area of Science:
- Cardiology
- Congenital Heart Disease
- Vascular Surgery
Background:
- Anomalous aortic origin of a coronary artery (AAOCA) encompasses rare congenital heart defects with diverse clinical manifestations.
- The long-term prognosis for individuals with AAOCA remains unclear, necessitating multicenter registry data for improved management guidelines.
- The European AAOCA Registry (EURO-AAOCA) was established to investigate variations in AAOCA management across European institutions.
Purpose of the Study:
- To evaluate differences in clinical presentations and management strategies for AAOCA among 13 European centers.
- To analyze treatment decisions and surgical outcomes within the EURO-AAOCA registry.
- To identify variations in diagnostic protocols and clinical management for AAOCA variants.
Main Methods:
- Prospective, multicenter registry study involving 13 European centers.
- Data collection spanned from January 2019 to June 2023.
- Evaluation of clinical presentations, management, treatment choices, and surgical outcomes.
Main Results:
- A total of 262 AAOCA patients were analyzed, with a median age of 33 years.
- Symptomatic presentation occurred in 53.1% of patients, most commonly chest pain (53.2%), followed by syncope (15.1%).
- Myocardial infarction (5%) and aborted sudden cardiac death (1.4%) were observed. Right-AAOCA was most frequent (57.5%). Significant inter-center variability in diagnostics was noted. Surgery was performed in 28.2% of patients with no operative mortality and minor complications in 3.8%.
Conclusions:
- Significant heterogeneity exists in diagnostic approaches and clinical management of AAOCA variants across European centers.
- Surgical intervention for AAOCA is associated with a low risk of operative mortality and morbidity.
- Longitudinal outcome data are crucial for refining treatment strategies, particularly in selecting patients for revascularization versus conservative management.
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