A Comparison of Perioperative Management of Anomalous Aortic Origin of a Coronary Artery Between an Adult and Pediatric Cardiac Center

Herrmann, Jeremy L.; Goldberg, Lawrence G.; Khan, Abigail; Partington, Sara L.; Mascio, Christopher E.; Spray, Thomas L.; Kim, Yuli Y.; Fuller, Stephanie

doi:10.1177/2150135116668333

Cited by 8 publications

(13 citation statements)

References 34 publications

(45 reference statements)

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“…The best method for initially identifying AAOCA is a carefully performed transthoracic echocardiogram with Doppler color flow mapping. 11,27,32,[53][54][55][56][57][58][59][60][61][62][63][64][65] This is generally the initial diagnostic modality due to availability, cost-effectiveness, ease of performance, and absence of radiation exposure. Imaging should clarify origin of left or right, as well as the presence or absence of an intramural course.…”

Section: Diagnostic Studiesmentioning

confidence: 99%

Expert consensus guidelines: Anomalous aortic origin of a coronary artery

Brothers

Frommelt

Jaquiss

et al. 2017

The Journal of Thoracic and Cardiovascular Surgery

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258

340

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Anomalous aortic origin of the right coronary artery. Central Message We sought to establish evidence-based guidelines for the management anomalous aortic origin of a coronary artery. Perspective Anomalous aortic origin of a coronary artery is associated with sudden cardiac death. Although the risk for any single affected individual is small, the loss of an otherwise healthy person is particularly devastating. Surgical and interventional therapies have been developed that appear to be protective but these therapies carry risks. The challenge is identifying those individuals at such risk.

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Section: Diagnostic Studiesmentioning

confidence: 99%

Expert consensus guidelines: Anomalous aortic origin of a coronary artery

Brothers

Frommelt

Jaquiss

et al. 2017

The Journal of Thoracic and Cardiovascular Surgery

Self Cite

258

340

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“…Unroofing of the intramural segment was the most common procedure, with no early deaths. It was a simple procedure, more congenial to congenital surgeons [20], that was performed in 88/98 cases of AAOCA with an intramural course. Its protective effect on late-onset AE is due to the excision of the intervening roof of the intramural segment, whose removal prevents coronary compression and ischaemia during effort, relocates the functional orifice to the appropriate sinus, enlarges the orifice significantly and eliminates the portion of the vessel that lies between the great arteries.…”

Section: Discussionmentioning

confidence: 99%

“…There is a significant variation between adult and paediatric hospitals, both in terms of training of caregivers and surgical abilities. In his series of 29 patients (20 at a paediatric centre, 9 at an adult centre), Herrman [20] noticed that the unroofing procedure was most commonly performed in paediatric centres and that 2/105 (1.9) 0/35 (0) 0/16 (0) NS Numbers represent median (interquartile range) for continuous variables and n (%) for categorical variables. Values in the same row that have different superscript letters are significantly different from each other.…”

Section: Discussionmentioning

confidence: 99%

Surgery for anomalous aortic origin of coronary arteries: a multicentre study from the European Congenital Heart Surgeons Association†

Padalino

Franchetti

Hazekamp

et al. 2019

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES: We sought to describe early and late outcomes in a large surgical series of patients with anomalous aortic origin of coronary arteries. METHODS: We performed a retrospective multicentre study including surgical patients with anomalous aortic origin of coronary arteries since 1991. Patients with isolated high coronary takeoff and associated major congenital heart disease were excluded. RESULTS: We collected 156 surgical patients (median age 39.5 years, interquartile range 15–53) affected by anomalous right (67.9%), anomalous left (22.4%) and other anatomical abnormalities (9.6%). An interarterial course occurred in 86.5%, an intramural course in 62.8% and symptoms in 85.9%. The operations included coronary unroofing (56.4%), reimplantation (19.2%), coronary bypass graft (15.4%) and other (9.0%). Two patients with preoperative cardiac failure died postoperatively (1.3%). All survivors were discharged home in good clinical condition. At a median follow-up of 2 years (interquartile range 1–5, 88.5% complete), there were 3 deaths (2.2%), 9 reinterventions in 8 patients (5 interventional, 3 surgical); 91.2% are in New York Heart Association functional class ≤ II, but symptoms persisted in 14.2%; 48.1% of them returned to sport activity. On Kaplan–Meier analysis, event-free survival at follow-up was 74.6%. Morbidity was not significantly different among age classes, anatomical variants and types of surgical procedures. Furthermore, return to sport activity was significantly higher in younger patients who participated in sports preoperatively. CONCLUSIONS: Surgical repair of anomalous aortic origin of coronary arteries is effective and has few complications. Unroofing and coronary reimplantation are safe and are the most common procedures. The occurrence of late adverse events is not negligible, and long-term surveillance is mandatory. Most young athletes can return to an unrestrained lifestyle.

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“…Herrmann et al (38) performed a comparative study examining the differences in AAOCA peri-operative management and outcomes in a pediatric vs. an adult center (The Children's Hospital of Philadelphia vs. Hospital of the University of Pennsylvania). Cardiac catheterization was utilized more frequently at the adult center and cardiac magnetic resonance imaging was more commonly employed at the pediatric center.…”

Section: Surgical Outcomesmentioning

confidence: 99%

Surgical management of anomalous coronary arteries

Ong

Cameron

Jacobs

2018

Ann. Cardiothorac. Surg.

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Anomalies in the coronary arterial circulation have been described since classical antiquity by Galen and through the Medical Renaissance by Vesalius, but their clinical significance and association with sudden cardiac death (SCD) has only been appreciated over the last 4 decades. Advances in cardiac surgery and cardiovascular intensive care have led to decreasing overall postoperative mortality and morbidity associated with cardiac surgery. The decision whether to surgically treat an anomaly of coronary artery origin and course, and the risk-to-benefit ratio of surgical treatment in preventing a potentially lethal complication of SCD, requires careful, deliberate consideration based on the best available evidence. In this keynote lecture, we aim to deliver a concise discussion of the current surgical management of anomalous coronary arteries.

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A Comparison of Perioperative Management of Anomalous Aortic Origin of a Coronary Artery Between an Adult and Pediatric Cardiac Center

Abstract: Management strategies for AAOCA vary depending on both patient-specific factors and expertise of the managing team. Further studies are needed to optimally standardize diagnostic and treatment pathways regardless of location venue.

Cited by 8 publications

References 34 publications

Expert consensus guidelines: Anomalous aortic origin of a coronary artery

Expert consensus guidelines: Anomalous aortic origin of a coronary artery

Surgery for anomalous aortic origin of coronary arteries: a multicentre study from the European Congenital Heart Surgeons Association†

Surgical management of anomalous coronary arteries

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