Repair of Anomalous Aortic Origin of a Coronary Artery in 113 Patients

Author:

Poynter Jeffrey A.12,Bondarenko Igor3,Austin Erle H.4,DeCampli William M.5,Jacobs Jeffrey P.6,Ziemer Gerhard7,Kirshbom Paul M.8,Tchervenkov Christo I.9,Karamlou Tara10,Blackstone Eugene H.11,Walters Henry L.3,Gaynor J. William12,Mery Carlos M.13,Pearl Jeffrey M.14,Brothers Julie A.12,Caldarone Christopher A.15,Williams William G.1,Jacobs Marshall L.16,Mavroudis Constantine17,DeCampli William M.,Fiore Andrew C.,Huddleston Charles B.,Weinstein Samuel,Bondarenko Igor,Walters Henry L.,Moga Francis X.,Morales David L.S.,Blackstone Eugene H.,Jacobs Jeffrey P.,Kanter Kirk R.,Mavroudis Constantine,Poynter Jeffrey A.,Jacobs Marshall L.,Austin Erle H.,Tchervenkov Christo I.,Pearl Jeffrey M.,Gruber Peter J.,Mainwaring Richard D.,Mery Carlos M.,Brothers Julie A.,Gaynor J. William,Caldarone Christopher A.,McCrindle Brian W.,Wilder Travis J.,Williams William G.,Karamlou Tara,Ziemer Gerhard,St. Louis James D.,Ricci Marco,Kirshbom Paul M.,

Affiliation:

1. Congenital Heart Surgeons Society Data Center, The Hospital for Sick Children, Toronto, Ontario, Canada

2. Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA

3. Department of Cardiovascular Surgery, Children’s Hospital of Michigan, Detroit, MI, USA

4. Kosair Children’s Hospital, University of Louisville, Louisville, KY, USA

5. Department of Cardiothoracic Surgery, Arnold Palmer Hospital for Children, Orlando, FL, USA

6. Johns Hopkins All Children's Heart Institute, Johns Hopkins University, All Children's Hospital, St Petersburg, FL, USA

7. Department of Surgery, University of Chicago, Chicago, IL, USA

8. Cardiothoracic Surgery, Yale University, New Haven, CT, USA

9. Montreal Children’s Hospital, Montreal, PQ, Canada

10. Department of Pediatric Cardiac Surgery, University of California-San Francisco Benioff Children's Hospital, San Francisco, CA, USA

11. Cleveland Clinic, Cleveland, OH, USA

12. Pediatric Cardiac Surgery, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

13. Division of Congenital Heart Surgery, Texas Children’s Hospital, Houston, TX, USA

14. Glendale Department of Childhealth, University of Arizona College of Medicine, Phoenix, AZ, USA

15. Division of Cardiac Surgery, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada

16. Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA

17. Johns Hopkins University, Florida Hospital for Children, Orlando, FL, USA

Abstract

Background: Anomalous aortic origin of a coronary artery (AAOCA) encompasses a wide morphologic spectrum, which has impeded consensus regarding indications for the diverse repair strategies. We constructed a profile of current surgical techniques and explore their application to morphologic variants. Methods: Patients <30 years old (n = 113) with isolated AAOCA who underwent operations at 29 Congenital Heart Surgeons Society (CHSS) institutions from 1998 to 2012 were identified from the CHSS AAOCA Registry. Operative findings were related to surgical techniques at index repairs by cross-tabulation. Results: Anomalous origin of the left main or left anterior descending coronary artery was present in 33 (29%) patients and of the right coronary artery in 78 (69%) patients; 2 arteries originated directly above the commissure between the left and right sinuses. There were 101 (89%) interarterial and intramural (IA/IM) arteries, 10 (9%) were interarterial but not intramural (IA/NIM) and 2 (2%) were neither interarterial nor intramural. Intramural arteries were unroofed in 100 (88%) operations, usually with intimal tacking after incision (n = 47) or excision (n = 25) of the common wall. Coronary reimplantation (n = 11), pulmonary artery relocation (n = 7; 5 for IA/NIM), simple ostioplasty (without unroofing; n = 3), coronary artery bypass grafting (n = 2), and ostial window (n = 1) were less common. In 37 (33%) operations, a valvar commissure was taken down; 33 were resuspended. Conclusion: Current surgical repair of AAOCA is individualized to morphology, particularly the presence of intramural and/or interarterial segments. This report is foundational for future planned CHSS studies that will examine interventional and noninterventional outcomes and ultimately guide management of AAOCA.

Publisher

SAGE Publications

Subject

Cardiology and Cardiovascular Medicine,General Medicine,Pediatrics, Perinatology and Child Health,Surgery

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