Direct Reimplantation Procedure in Anomalous Aortic Origin of the Right Coronary Artery: Long-Term Single Center Outcomes

Abstract

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.

Reimplantation approach for an anomalous aortic origin of the right coronary artery with an aberrant right subclavian artery

“…Reimplantation is technically simple, and the lesion is easily approachable, even if a stenotic lesion in RCA occurs in the future. Previous cases also showed that it might enable surgeons to avoid aortotomy [ 2 , 4 ]. Although, depending on the diameter of the RCA in early childhood, reimplantation could be difficult in principle, it should be considered as an option for adolescent cases with AAORCA.…”

“…Although, depending on the diameter of the RCA in early childhood, reimplantation could be difficult in principle, it should be considered as an option for adolescent cases with AAORCA. Previous studies that reported on more than 10 cases [ 1 , 2 ] suggested that anastomosis could be performed if the proximal part of the RCA had a diameter of 3.5 mm because a 3.5 mm puncher was often used to create neo-ostium in the ascending aorta.…”

“…The main purpose was to evaluate the distance up to which the proximal part of the RCA could be detached to mobilize it for anastomosis without tension. Detaching the proximal part of the RCA until the first conal branch could be essential [ 1 , 2 ]. We thought that the assessment of preoperative CT was helpful.…”

“…Although there are a few reports on reimplantation, the report by Amadou et al [ 2 ] shows promising results in the mid-term follow-up of 7 years. Thus, it could be an effective method after adolescence.…”

“…Coronary artery abnormality is uncommon; however, there are various reports on its treatment. The prevalence of anomalous aortic origin of the right coronary artery (AAORCA) ranges between 0.1 and 1% [ 1 , 2 ]. There are various discussions regarding the surgical indications and treatment approaches.…”