Outcomes of surgical intervention for anomalous aortic origin of a coronary artery: A large contemporary prospective cohort study

Mery, Carlos M.; León, Luis E. De; Molossi, Silvana; Sexson-Tejtel, S. Kristen; Agrawal, Hitesh; Krishnamurthy, Rajesh; Masand, Prakash; Qureshi, Athar M.; McKenzie, E. Dean; Fraser, Charles D.

doi:10.1016/j.jtcvs.2017.08.116

Cited by 98 publications

(77 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Surgical treatment has been widely proposed, aiming at removing any risk of myocardial ischemia and SCD. Single-center studies are based on limited series describing surgical repair as safe and effective [7][8][9][10][11][12][13], although late effects on symptoms and risk of SCD are undefined and concerns about the surgical effectiveness remain [14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Anomalous aortic origin of coronary arteries: Early results on clinical management from an international multicenter study

Padalino

Franchetti

Sarris

et al. 2019

International Journal of Cardiology

View full text Add to dashboard Cite

Background: Anomalous aortic origin of coronary arteries (AAOCA) is a rare abnormality, whose optimal management is still undefined. We describe early outcomes in patients treated with different management strategies. Methods: This is a retrospective clinical multicenter study including patients with AAOCA, undergoing or not surgical treatment. Patients with isolated high coronary take off and associated major congenital heart disease were excluded. Preoperative, intraoperative, anatomical and postoperative data were retrieved from a common database. Results: Among 217 patients, 156 underwent Surgical repair (median age 39 years, IQR: 15-53), while 61 were Medical (median age 15 years, IQR: 8-52), in whom AAOCA was incidentally diagnosed during screening or clinical evaluations. Surgical patients were more often symptomatic when compared to medical ones (87.2% vs 44.3%, p b 0.001). Coronary unroofing was the most frequent procedure (56.4%). Operative mortality was 1.3% (2 patients with preoperative severe heart failure). At a median follow up of 18 months (range 0.1-23 years), 89.9% of survivors are in NYHA ≤ II, while only 3 elderly surgical patients died late. Return to sport activity was significantly higher in Surgical patients (48.1% vs 18.2%, p b 0.001). Conclusions: Surgery for AAOCA is safe and with low morbidity. When compared to Medical patients, who remain on exercise restriction and medical therapy, surgical patients have a benefit in terms of symptoms and return to normal

show abstract

Section: Introductionmentioning

confidence: 99%

Anomalous aortic origin of coronary arteries: Early results on clinical management from an international multicenter study

Padalino

Franchetti

Sarris

et al. 2019

International Journal of Cardiology

View full text Add to dashboard Cite

show abstract

“…Mery et al have recently reported their experience with 44 patients who underwent surgical intervention for AAOCA over a 4½‐year time period . These 44 patients were part of a large, prospective cohort study in which all of the patients had extensive and comprehensive testing.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of anomalous left main coronary artery with an intraconal course

Mainwaring

Hanley

2019

Congenital Heart Disease

View full text Add to dashboard Cite

Objective Anomalous left main coronary artery (LMCA) with an intraconal course is a relatively rare form of anomalous aortic origin of a coronary artery (AAOCA) from the wrong sinus of Valsalva. There is currently a paucity of information regarding this entity. The purpose of this article is to review our surgical experience with repair of anomalous LMCA with an intraconal course. Methods This was a retrospective review of 12 patients with an anomalous LMCA and an intraconal course who underwent surgical repair. The median age at surgery was 15 years (range 2‐47). The seven oldest patients all had preoperative symptoms of exertional chest pain and one also had exertional syncope. The five youngest patients had no preoperative symptoms. One of these patients had a hemodynamically significant ventricular septal defect and one patient was the sibling of a patient who had undergone repair of AAOCA. Results The 12 patients underwent surgical repair including unroofing of the myocardial bridge overlying the intraconal LMCA and a LeCompte procedure. There was no early or late mortality and there were no significant complications. All 12 patients have resumed normal, unrestricted activities. Conclusions Twelve patients with an anomalous LMCA and intraconal course presented to our institution for treatment. Surgical repair was performed successfully in all 12, with resolution of symptoms in the 7 patients who were symptomatic preoperatively. These results suggest that the surgical treatment is safe and efficacious in patients with an anomalous LMCA and intraconal course.

show abstract

“…Single-centre studies report on limited series, describing surgical repair as safe and effective [6][7][8][9][10][11][12], although late effects on symptoms and risk of SCD are undefined and concerns about the surgical effectiveness remain [13][14][15].…”

Section: Introductionmentioning

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

View full text Add to dashboard Cite

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.

show abstract

Outcomes of surgical intervention for anomalous aortic origin of a coronary artery: A large contemporary prospective cohort study

Cited by 98 publications

References 32 publications

Anomalous aortic origin of coronary arteries: Early results on clinical management from an international multicenter study

Anomalous aortic origin of coronary arteries: Early results on clinical management from an international multicenter study

Surgical treatment of anomalous left main coronary artery with an intraconal course

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

Contact Info

Product

Resources

About