Postoperative Outcomes of Unroofing Technique for Anomalous Aortic Origin of a Coronary Artery With Intramural
Daichi Hosokawa1, Mika Saito1, Kanako Kishiki1
1Department of Pediatric Cardiology, Sakakibara Heart Institute, Tokyo, JPN.
Insights
Unroofing surgery for anomalous aortic origin of a coronary artery (AAOCA) shows good outcomes. A shorter preoperative distance between the aortic commissure and intramural coronary artery may predict postoperative aortic regurgitation.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Imaging
Background:
- Anomalous aortic origin of a coronary artery (AAOCA) with an intramural course can cause sudden cardiac death.
- Unroofing is the standard surgical treatment for AAOCA.
- Postoperative aortic regurgitation (AR) and its predictors after unroofing are not fully understood.
Purpose of the Study:
- To evaluate the clinical outcomes of unroofing surgery for AAOCA with an intramural course.
- To identify anatomical predictors of postoperative AR after unroofing.
Main Methods:
- Retrospective analysis of 16 patients undergoing unroofing for AAOCA.
- Preoperative CT measurement of commissure-intramural distance.
- Evaluation of postoperative AR progression.
Main Results:
- Median follow-up of six months with no deaths or reinterventions.
- Postoperative AR progression occurred in 38% of patients (trivial to mild).
- Shorter commissure-intramural distance correlated with AR progression (2.66 mm vs. 4.81 mm, p=0.047).
Conclusions:
- Unroofing for AAOCA with intramural course offers favorable early outcomes.
- A shorter preoperative commissure-intramural distance may predict postoperative AR.
- Findings are exploratory due to small sample size.
Abstract:
Background Anomalous aortic origin of a coronary artery (AAOCA) with an intramural course is a recognized cause of sudden cardiac death. Unroofing is the standard surgical treatment; however, postoperative aortic regurgitation (AR) and its anatomical predictors remain incompletely understood. Methods We retrospectively analyzed 16 patients who underwent unroofing for AAOCA with an intramural course. The commissure-intramural distance was measured on preoperative computed tomography (CT), and its association with postoperative AR progression was evaluated. Results During a median follow-up of six months, there were no deaths or coronary-related reinterventions. Postoperative AR progression was observed in 38% of patients, and all cases were trivial to mild. The commissure-intramural distance was significantly shorter in patients with AR progression than in those without (2.66 mm vs. 4.81 mm, p = 0.047). Conclusions Unroofing for AAOCA with an intramural course was associated with favorable early clinical outcomes in our cohort. A shorter commissure-intramural distance on preoperative CT may be associated with postoperative AR progression. Given the small sample size, these findings should be interpreted as exploratory and hypothesis-generating.
