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Eur J Cardiothorac Surg. 2019 Mar 20. pii: ezz080. doi: 10.1093/ejcts/ezz080. [Epub ahead of print]

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

Author information

1
Section of Pediatric and Congenital Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Medical School, Padova, Italy.
2
University Medical Center, Leiden, Netherlands.
3
Department for Cardiovascular Surgery, University Hospital, University of Bern, Bern, Switzerland.
4
Division of Cardiac Surgery, IRCCS Policlinico San Donato Milanese, Milan, Italy.
5
Department of Pediatric Cardiology and Congenital Heart Disease, Hôpital Marie Lannelongue, Université Paris-Sud, Le Plessis-Robinson, France.
6
Deutsches Herzzentrum, Munich, Germany.
7
Department of Cardiovascular Surgery, Katholieke Universiteit Leuven, Leuven, Belgium.
8
Cardiothoracic Surgery Hospital de Santa Marta Rua de Santa Marta, Lisbon, Portugal.
9
Department of Pediatric Cardiothoracic Surgery, Children's Hospital of Georgia, Augusta, GA, USA.
10
Department of Cardiac Surgery, University Hospital Ghent, Ghent, Belgium.
11
Division of Cardiac Surgery, University Hospital Center of Tirana, Tirana, Albania.
12
Department of Pediatric Cardiac Surgery, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland.
13
Congenital Cardiac Surgery Department, Hospital Universitario La Paz, Madrid, Spain.
14
Department of Pediatric Cardiac Surgery, National Institute of Cardio-Vascular Diseases-Childrens Heart Center, Bratislava, Slovakia.
15
PCare Laboratory, Fondazione Istituto di Ricerca Pediatrica Città della Speranza, Padova, Italy.
16
Athens Heart Surgery Institute and Iaso Children's Hospital, Athens, Greece.
17
Department of Statistical Sciences, University of Padova, Padova, Italy.

Abstract

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.

KEYWORDS:

Anomalous coronary arteries ; Cardiac surgery ; Congenital ; Outcomes

PMID:
30897195
DOI:
10.1093/ejcts/ezz080

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