OC68 SURGERY FOR ANOMALOUS AORTIC ORIGIN OF CORONARY ARTERIES (AAOCA). A MULTICENTER STUDY FROM THE EUROPEAN CONGENITAL HEART SURGEONS ASSOCIATION (ECHSA)

Abstract

Background and aims: Anomalous aortic origin of coronary arteries (AAOCA) is a rare anatomical abnormality which is a consistent cause of sudden death in young people. There are no guidelines on either surgical indication or best surgical treatment. We sought to describe early and late outcomes in a large surgical series to evaluate safety and effectiveness of surgical procedures for AAOCA. Methods: This is a retrospective clinical multicenter study including patients undergoing surgical treatment for AAOCA since 1991. Patients with ONLY high coronary take off were excluded. Preoperative, intraoperative and postoperative data were retrieved from a common database. Anatomical characteristics evaluated were: AAORCA vs AAOLCA vs other anatomical variants (LAD or CX from anterior sinus, single coronary); Coronary course (interarterial, anterior to aorta, only intramural). Results: We included 157 patients undergoing AAOCA repair (median age 39.5 yrs, interquartile range 15–53). Symptoms were present in 136 (87 %). There were 106 AAORCA (67%); 36 AAOLCA (23%);15 other (10%). Surgical procedures were Unroofing (54%); Coronary reimplantation (19%); CABG (15%); Other (12%). Major postoperative complications occurred in 12.7%. Early death was 1.2%. At a median follow up time of 2 yrs (range 1 m -23 yrs) there were 4 late deaths; NYHA class was I-II in 92%; residual symptoms in 18%; adverse events in 8.2%. Conclusions: Surgery for AAOCA is low risk. Unroofing and coronary reimplantation are the most frequ with 0% operative mortality. Late adverse events occurrence (surgical, non surgical, SCD) is not negligible, and long term surveillance is mandatory.