The choice of surgical procedure for the correction of anomalous aortic origin of the coronary artery does not affect early results
Modesto J. Colon, Farzan Filsoufi, Khan Nguyen, Paul Stelzer, Ramachandra C. Reddy.
Mount Sinai Medical Center, New York, NY, USA.
OBJECTIVE: Anomalous aortic origin of the coronary artery (AAOCA) is an uncommon condition occurring in 0.1 to 0.3% of the population but may be associated with sudden death and myocardial ischemia. Surgical correction including unroofing, reimplantation and coronary artery bypass grafting is required in the latter groups. The choice of the optimal surgical intervention and their outcomes remainundetermined. Here, we report our contemporary experience in a large cohort of patience with AAOCA.
METHODS: We retrospectively analyzed prospectively collected data of 42 patients with AAOCA who underwent surgical correction at Mount Siani Hospital between 2007 to 2015. Outcomes measured included hospital mortality, and postoperative complications.
RESULTS: Twentynine patients were male and 13 female. The age ranged from 7 to 82 years. Sixteen patients had anomalous left coronary artery (ALCA) and 26 presented with anomalous right coronary artery (ARCA). Indications for surgery included symptoms, positive stress test, and other concomitant cardiac operations. The procedure performed was determined by surgeons preference and included: unroofing (n=15), reimplantation (n=6), minimally invasive CABG (n=8) and CABG (n=13). Nine patients with ARCA who underwent CABG had proximal ligation of the proximal artery but none in the ALCA group. There were no mortalities. One pt developed a hemothorax and one needed a reexploration for bleeding.
CONCLUSIONS: A variety of techniques can be applied to correct AAOCA with excellent results. The choice of procedures does not affect early surgical outcomes. Long term follow-up is necessary to better determine the exact role of each surgical intervention in the correction of AAOCA.
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