Surgical Results for Anomalous Aortic Origin of Coronary Artery - Is Right Side Prompt Surgery Necessary?
Sangil Yun1, Joowon Lee2, Jae Gun Kwak1
1Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine.
Insights
Surgical unroofing for anomalous aortic origin of a coronary artery (AAOCA) is safe and effective. This approach shows promise for asymptomatic patients with high-risk anatomy, potentially preventing sudden cardiac events.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Anomalous aortic origin of a coronary artery (AAOCA) can lead to myocardial ischemia and sudden cardiac events.
- Current guidelines for surgical intervention in AAOCA are often restrictive.
- Asymptomatic patients, particularly with anomalous aortic origin of the right coronary artery (AAORCA), represent an expanding area for surgical consideration.
Purpose of the Study:
- To evaluate the early and mid-term clinical outcomes of surgical correction for AAOCA.
- To assess the safety and efficacy of expanding surgical indications for AAOCA, including asymptomatic cases.
Main Methods:
- Retrospective analysis of 34 patients undergoing surgery for AAOCA between December 2004 and July 2023.
- Surgical intervention (primarily unroofing) was indicated by myocardial ischemia or high-risk anatomy.
- Pre- and postoperative imaging and functional studies were used to assess AAOCA.
Main Results:
- Anomalous aortic origin of the right coronary artery (AAORCA) was the predominant type (94.1%).
- Unroofing was performed in 94.1% of patients, with no surgical mortalities or coronary artery complications.
- Postoperative functional improvement was observed in 92.3% of patients with preoperative abnormalities; 2 patients had persistent symptoms, and 3 showed mild coronary stenosis or perfusion defects on follow-up.
Conclusions:
- Surgical unroofing for AAOCA is a safe and effective procedure with favorable early and mid-term outcomes.
- The study supports considering surgery for asymptomatic AAORCA patients with high-risk anatomy.
- Surgical intervention may mitigate the risk of sudden cardiac events in selected AAOCA patients.
Background:
This study evaluated early and mid-term clinical outcomes of surgical correction for anomalous aortic origin of a coronary artery (AAOCA) and expansion of surgical indications beyond current guidelines, particularly for asymptomatic patients with anomalous aortic origin of the right coronary artery (AAORCA).
Methods And Results:
Between December 2004 and July 2023, 34 patients underwent surgery for AAOCA. Surgical indications included evidence of myocardial ischemia and high-risk anatomy. AAOCA was assessed pre- and postoperatively using imaging and functional studies. Early and mid-term outcomes were evaluated retrospectively. AAORCA was the predominant type (n=32; 94.1%), and 32 of 34 patients (94.1%) underwent unroofing. Five (14.7%) asymptomatic AAORCA patients had a history of Kawasaki disease. There were no surgical mortalities or coronary artery-related complications. Of 12 patients with symptoms or signs likely related to the coronary artery in the early postoperative period, 2 had persistent symptoms until the last follow-up. During follow-up, 2 patients had suspicious mild coronary stenosis on computed tomography, and 1 had decreased stress perfusion on a myocardial perfusion scan. Among patients with preoperative abnormalities, 92.3% exhibited postoperative functional improvement.
Conclusions:
Surgical treatment of AAOCA, primarily through unroofing, is safe and effective, with favorable early and mid-term outcomes. Our findings support consideration of surgery for asymptomatic AAORCA patients with high-risk anatomy due to the potential risk of sudden cardiac events and the substantial benefits of the procedure.
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