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

Padalino, Massimo A; Franchetti, Nicola; Sarris, George E; Hazekamp, Mark; Carrel, Thierry; Frigiola, Alessandro; 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; Protopapas, Eleftherios; ... (2019). Anomalous aortic origin of coronary arteries: Early results on clinical management from an international multicenter study. International journal of cardiology, 291, pp. 189-193. Elsevier 10.1016/j.ijcard.2019.02.007

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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 < 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 < 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 life. Since the long term-risk of sudden cardiac death is still unknown, we currently recommend accurate long term surveillance in all patients with AAOCA.

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:

0167-5273

Publisher:

Elsevier

Language:

English

Submitter:

Claudia Stalder

Date Deposited:

12 Aug 2019 14:42

Last Modified:

13 Mar 2021 17:49

Publisher DOI:

10.1016/j.ijcard.2019.02.007

PubMed ID:

30772012

Uncontrolled Keywords:

Anomalous coronary arteries Clinical management Congenital Outcomes Surgery

BORIS DOI:

10.7892/boris.131997

URI:

https://boris.unibe.ch/id/eprint/131997

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