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

Padalino, Massimo A; Franchetti, Nicola; Hazekamp, Mark; Sojak, Vladimir; Carrel, Thierry; Frigiola, Alessandro; Lo Rito, Mauro; Horer, Jurgen; Roussin, Regine; Cleuziou, Julie; Meyns, Bart; Fragata, Jose; Telles, Helena; Polimenakos, Anastasios C; Francois, Katrien; Veshti, Altin; Salminen, Jukka; Rocafort, Alvaro Gonzalez; Nosal, Matej; Vedovelli, Luca; ... (2019). Surgery for anomalous aortic origin of coronary arteries: a multicentre study from the European Congenital Heart Surgeons Association. European journal of cardio-thoracic surgery, 56(4), pp. 696-703. Oxford University Press 10.1093/ejcts/ezz080

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiovascular Surgery

UniBE Contributor:

Carrel, Thierry

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1873-734X

Publisher:

Oxford University Press

Language:

English

Submitter:

Claudia Stalder

Date Deposited:

12 Aug 2019 14:38

Last Modified:

04 Nov 2019 02:17

Publisher DOI:

10.1093/ejcts/ezz080

PubMed ID:

30897195

Uncontrolled Keywords:

Anomalous coronary arteries Cardiac surgery Congenital Outcomes

BORIS DOI:

10.7892/boris.131995

URI:

https://boris.unibe.ch/id/eprint/131995

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