Commentary: Refining the reimplantation technique for anomalous aortic origin of a coronary artery

Abstract

Anomalous aortic origin of a coronary artery (AAOCA) may be associated with myocardial ischemia and sudden cardiac death in the presence of high-risk anatomic characteristics. The most common pathological variant involves the right coronary artery arising from the left sinus of Valsalva (AAORCA). Surgical intervention is typically recommended if there are signs or symptoms of myocardial ischemia or if there is inducible ischemia with exercise testing. 1 Although several surgical approaches, including unroofing, pulmonary artery translocation, osteoplasty, bypass grafting, and reimplantation, have been described, superiority of 1 technique over the others has not been established. [1][2][3] Grau and colleagues 4 describe their preferred surgical approach to AAORCA. Advocating for surgical transection and reimplantation into the respective sinus, they detail their technique and point out critical maneuvers to ensure a good outcome. Key technical points include: