CORONARY UNROOFING DOES NOT FITS ALL ANOMALOUS AORTIC ORIGIN OF CORONARY
Introduction Anomalous aortic origin of coronary artery (AAOCA)
is the second leading cause of sudden cardiac death in children and
young adults. Intramural-interarterial course is the most frequent
anatomic variation and coronary unroofing is widest adopted for surgical
management. Symptoms recurrence is described regardless of the technique
used. This study aims to describe how an anatomic patient-centered
approach aimed to restore a normal coronary artery take-off is
associated with symptoms resolution. Methods From 2008 to 2021,
25 patients were operated on for an AAOCA at a median age of 20 years.
Nineteen patients had a right AAOCA and six had left AAOCA. Intramural
course was present in 18 patients. Seventy-six percent were symptomatic.
No episodes of aborted sudden cardiac death before surgery was described
in the population. Surgical technique used were coronary unroofing in 18
patients, coronary neo-ostioplasty in 3, coronary re-implantation in 3
and main pulmonary artery re-location in one. Results No
hospital mortality or re-operation was observed in our experience as
well as major complications related to surgery. Mean hospital length of
stay was 8.5 days. None of patients reported symptoms recurrence at
follow-up. Young athletes returned to play competitive sport.
Postoperative computed-tomography scan evaluation showed a general
improvement of the take-off angle. Conclusions AAOCA requires a
patient anatomic-based surgical management. There is not a single
surgical technique that can fits all anatomic subtype of AAOCA. Surgical
techniques may be selected on the base of the preoperative images and
intraoperative findings. In our experience this policy is associated
with no symptoms recurrence.