Outcomes after anomalous aortic origin of a coronary artery repair: A Congenital Heart Surgeons’ Society Study

Surgery for Anomalous Aortic Origin of Coronary Arteries: Technical Safeguards and Pitfalls

“…Single-center (8)(9)(10)(11)(12)(13)(14)(15) and multi-center studies (16,17) have reported shallow operative risk, describing repair as safe and effective in the short-and mid-term. Various technical procedures have been applied and reported in the literature, but the necessary minutiae of each technique are often understated, as are the postoperative complications.…”

“…Various technical procedures have been applied and reported in the literature, but the necessary minutiae of each technique are often understated, as are the postoperative complications. Emerging data ( 17 ) show that coronary-related reoperations and adverse events may occur more often than expected. Given the potentially devastating consequences of unaddressed AAOCA (i.e., SCD), counterbalanced by the risk of iatrogenic coronary complications in the postoperative period, the optimal management strategy is still under debate ( 18 , 19 ).…”

Commentary: Anomalous coronary arteries and car crash testing

“…4 However, recent reports note worsening ventricular function, aortic valve function, or even death in a very small number of patients undergoing surgery for an anomalous coronary, even asymptomatic patients. 5 Therefore, a better understanding of who will benefit from surgical intervention is necessary to avoid surgery when the anatomy is unlikely to cause pathology. Currently, this decision is largely based on crosssectional imaging.…”

Commentary: No free lunch: What we talk about when we talk about anomalous aortic origin of a coronary artery

“…understanding that an intramural/interarterial/intraconal course could be remedied to (1) the realization that the 2 indications for operation (prevention of sudden death, resolution of symptoms) are incompletely addressed, and more recently (2) a growing appreciation of significant morbidity that can be incurred even with a "successful" intervention. [1][2][3][4][5] Jegatheeswaran and colleagues' article 1 helps us better appreciate the pitfalls of current operative strategies. As their data would suggest, the association of symptoms with bona fide ischemia is less than 50%, the risk of more than mild aortic insufficiency with commissural manipulation is considerable, and for some, there continues to be a need for additional coronary reoperations.…”

“…As their data would suggest, the association of symptoms with bona fide ischemia is less than 50%, the risk of more than mild aortic insufficiency with commissural manipulation is considerable, and for some, there continues to be a need for additional coronary reoperations. 1 In short, there is no free lunch in cardiac surgery. Of note, of the 287 patients not treated surgically, 6 (2.1%) died of non-AAOCA-related conditions during the study period, which is twice the number whose cause of death was "related to AAOCA."…”