Anomalous Aortic Origin of Coronary Arteries: A Single-Center Experience

Abstract

The aim of this article is to determine the clinical course and outcomes in subjects with anomalous aortic origin of coronary arteries (AAOCA), particularly after surgical repair. A single-center, retrospective review of patients with AAOCA with right or left interarterial or IM (IA or IM) or intraconal course from 1996-2014. Among 155 patients, median age at diagnosis was 8.5 (range: 0.1-50) years, and 65% were male. The AAOCA course was IA or IM in 151 (97%) and intraconal in 4 (3%). Anomalous right coronary artery (CA) was present in 127 (82%), of whom 52 (42%) had repair. Anomalous left CA (ALCA) was present in 28 (18%), of whom 20 (71%) had repair. In the surgical group, 70 (97%) had IA or IM CAs; CA unroofing was performed in 62 (86%). In univariable analysis, surgical management was associated with ALCA (28% vs 10%, P = 0.003), age > 10 years (median 11 vs 6 years, P < 0.001), symptoms (63% vs 13%, P < 0.001), and exercise restriction at the time of diagnosis (47% vs 13%, P < 0.001). In multivariable modeling, surgery was associated with chest pain or syncope (P < 0.001) and older age (P = 0.03). Major perioperative complications occurred in 4 cases (6%) and 1 patient had late aortic valve repair. In the surgical group, no patients died; in the observed group, 2 patients with anomalous right CA (2.3%) died of severe noncardiac comorbidities. In our center, surgery for AAOCA was not associated with mortality, and surgery was recommended in patients with ALCA with IA or IM course. Rare but serious surgical complications highlight the importance of long-term follow up of patients with AAOCA to develop evidence-based management guidelines.