TY - JOUR
T1 - Anomalous aortic origin of coronary arteries
T2 - Early results on clinical management from an international multicenter study
AU - Padalino, Massimo A.
AU - Franchetti, Nicola
AU - Sarris, George E.
AU - Hazekamp, Mark
AU - Carrel, Thierry
AU - Frigiola, Alessandro
AU - Horer, Jurgen
AU - Roussin, Regine
AU - Cleuziou, Julie
AU - Meyns, Bart
AU - Fragata, Jose
AU - Telles, Helena
AU - Polimenakos, Anastasios C.
AU - Francois, Katrien
AU - Veshti, Altin
AU - Salminen, Jukka
AU - Rocafort, Alvaro Gonzalez
AU - Nosal, Matej
AU - Vedovelli, Luca
AU - Protopapas, Eleftherios
AU - Tumbarello, Roberto
AU - Merola, Assunta
AU - Pegoraro, Cinzia
AU - Motta, Raffaella
AU - Boccuzzo, Giovanna
AU - Sojak, Vladimir
AU - Rito, Mauro Lo
AU - Caldaroni, Federica
AU - Corrado, Domenico
AU - Basso, Cristina
AU - Stellin, Giovanni
N1 - Publisher Copyright:
© 2019 The Authors
PY - 2019/9/15
Y1 - 2019/9/15
N2 - Background: Anomalous aortic origin of coronary arteries (AAOCA) is a rare abnormality, whose optimal management is still undefined. We describe early outcomes in patients treated with different management strategies. Methods: This is a retrospective clinical multicenter study including patients with AAOCA, undergoing or not surgical treatment. Patients with isolated high coronary take off and associated major congenital heart disease were excluded. Preoperative, intraoperative, anatomical and postoperative data were retrieved from a common database. Results: Among 217 patients, 156 underwent Surgical repair (median age 39 years, IQR: 15–53), while 61 were Medical (median age 15 years, IQR: 8–52), in whom AAOCA was incidentally diagnosed during screening or clinical evaluations. Surgical patients were more often symptomatic when compared to medical ones (87.2% vs 44.3%, p < 0.001). Coronary unroofing was the most frequent procedure (56.4%). Operative mortality was 1.3% (2 patients with preoperative severe heart failure). At a median follow up of 18 months (range 0.1–23 years), 89.9% of survivors are in NYHA ≤ II, while only 3 elderly surgical patients died late. Return to sport activity was significantly higher in Surgical patients (48.1% vs 18.2%, p < 0.001). Conclusions: Surgery for AAOCA is safe and with low morbidity. When compared to Medical patients, who remain on exercise restriction and medical therapy, surgical patients have a benefit in terms of symptoms and return to normal life. Since the long term-risk of sudden cardiac death is still unknown, we currently recommend accurate long term surveillance in all patients with AAOCA.
AB - Background: Anomalous aortic origin of coronary arteries (AAOCA) is a rare abnormality, whose optimal management is still undefined. We describe early outcomes in patients treated with different management strategies. Methods: This is a retrospective clinical multicenter study including patients with AAOCA, undergoing or not surgical treatment. Patients with isolated high coronary take off and associated major congenital heart disease were excluded. Preoperative, intraoperative, anatomical and postoperative data were retrieved from a common database. Results: Among 217 patients, 156 underwent Surgical repair (median age 39 years, IQR: 15–53), while 61 were Medical (median age 15 years, IQR: 8–52), in whom AAOCA was incidentally diagnosed during screening or clinical evaluations. Surgical patients were more often symptomatic when compared to medical ones (87.2% vs 44.3%, p < 0.001). Coronary unroofing was the most frequent procedure (56.4%). Operative mortality was 1.3% (2 patients with preoperative severe heart failure). At a median follow up of 18 months (range 0.1–23 years), 89.9% of survivors are in NYHA ≤ II, while only 3 elderly surgical patients died late. Return to sport activity was significantly higher in Surgical patients (48.1% vs 18.2%, p < 0.001). Conclusions: Surgery for AAOCA is safe and with low morbidity. When compared to Medical patients, who remain on exercise restriction and medical therapy, surgical patients have a benefit in terms of symptoms and return to normal life. Since the long term-risk of sudden cardiac death is still unknown, we currently recommend accurate long term surveillance in all patients with AAOCA.
KW - Anomalous coronary arteries
KW - Clinical management
KW - Congenital
KW - Outcomes
KW - Surgery
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U2 - 10.1016/j.ijcard.2019.02.007
DO - 10.1016/j.ijcard.2019.02.007
M3 - Article
C2 - 30772012
AN - SCOPUS:85061395258
SN - 0167-5273
VL - 291
SP - 189
EP - 193
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -