TY - JOUR
T1 - Repair of Anomalous Aortic Origin of a Coronary Artery in 113 Patients
T2 - A Congenital Heart Surgeons' Society Report
AU - The Congenital Heart Surgeons Society AAOCA Working Group
AU - Poynter, Jeffrey A.
AU - Bondarenko, Igor
AU - Austin, Erle H.
AU - Decampli, William M.
AU - Jacobs, Jeffrey P.
AU - Ziemer, Gerhard
AU - Kirshbom, Paul M.
AU - Tchervenkov, Christo I.
AU - Karamlou, Tara
AU - Blackstone, Eugene H.
AU - Walters, Henry L.
AU - Gaynor, J. William
AU - Mery, Carlos M.
AU - Pearl, Jeffrey M.
AU - Brothers, Julie A.
AU - Caldarone, Christopher A.
AU - Williams, William G.
AU - Jacobs, Marshall L.
AU - Mavroudis, Constantine
N1 - Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The Congenital Heart Surgeons Society AAOCA Registry is funded in part by grants from the Children’s Heart Foundation, The Michael H. Ludwig Memorial Foundation, The Cardiac Center Development Grant at The Children’s Hospital of Philadelphia, and CHSS members and institutions.
PY - 2014/10
Y1 - 2014/10
N2 - 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. 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. 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. 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.
AB - 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. 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. 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. 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.
KW - congenital heart disease
KW - congenital heart surgery
KW - coronary artery anomaly
KW - myocardial morphology
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UR - http://www.scopus.com/inward/citedby.url?scp=84925883692&partnerID=8YFLogxK
U2 - 10.1177/2150135114540182
DO - 10.1177/2150135114540182
M3 - Article
C2 - 25324246
AN - SCOPUS:84925883692
SN - 2150-1351
VL - 5
SP - 507
EP - 514
JO - World Journal for Pediatric and Congenital Heart Surgery
JF - World Journal for Pediatric and Congenital Heart Surgery
IS - 4
ER -