Outcomes in anomalous aortic origin of a coronary artery after surgical reimplantation

Bonilla-Ramirez, Carlos; Molossi, Silvana; Sachdeva, Shagun; Reaves-O’Neal, Dana; Masand, Prakash; Mery, Carlos M.; Caldarone, Christopher A.; McKenzie, E. Dean; Binsalamah, Ziyad M.

doi:10.1016/j.jtcvs.2020.12.100

Cited by 35 publications

(27 citation statements)

References 31 publications

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“…Studies showing postoperative induced myocardial ischemia and AI led us to change our technical approach, to eliminate postoperative morbidity. 9,12 The only patient that developed AI postoperatively in our cohort of reimplantation underwent commissural manipulation. Because of the inadequate granularity of operative reports, we can't make meaningful statements of what could lead to AI in our patient population.…”

Section: Resultsmentioning

confidence: 98%

“…intramural segment. [8][9][10] Most intramural coronary arteries travel behind the right-left commissure. The aortic commissure is supported by a pillar, which is a thickened area of the aortic wall causing a particular area of compression.…”

Section: Resultsmentioning

confidence: 99%

“…In our hospital, un‐roofing was performed as initial treatment for patients with AAOCA. Studies showing postoperative induced myocardial ischemia and AI led us to change our technical approach, to eliminate postoperative morbidity 9,12 . The only patient that developed AI postoperatively in our cohort of reimplantation underwent commissural manipulation.…”

Section: Discussionmentioning

confidence: 99%

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Surgical approach for anomalous aortic origin of a coronary artery: A comparison of two techniques

Mills

Dobrila

Podgorsek

et al. 2021

Journal of Cardiac Surgery

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Background: Un-roofing is the most common technique utilized for repair of anomalous aortic origin of a coronary artery (AAOCA). There are very few publications directly comparing un-roofing to another surgical technique, like reimplantation. Methods:The prospectively collected Children's Memorial Hermann Heart Institute Society of Thoracic Surgeon's Database was retrospectively reviewed from 2007 to 2021. Surgical patients were included if they underwent un-roofing or reimplantation of the AAOCA. The primary outcomes of this study were operative characteristics and postoperative outcomes. Secondary outcomes included angiographic outcomes, aortic regurgitation incidence, ventricular function, and symptom relief.Results: From 2007 to 2021, there were 12 patients who underwent either a reimplantation (n = 9, 73%) or un-roofing (n = 3, 27%) for an AAOCA. The hospital length of stay was a median of 1.8 days longer for reimplantation compared to unroofing. The last follow-up echocardiogram was a median of 52.2 days later in the reimplantation group. There was one patient (11%) in the reimplantation group that had more than or equal to mild aortic regurgitation and mild systolic ventricular dysfunction. Outpatient follow-up was incomplete and there was no postoperative computed tomographic angiography in the un-roofing cohort.Conclusions: Coronary artery reimplantation is a valuable alternative surgical technique to un-roofing for the repair of AAOCA. There are still some concerns with the creation of aortic regurgitation or incomplete symptom relief with any surgical technique. Longer-term follow-up and prospective studies will be needed to show an effective reduction of myocardial ischemia and risk of sudden cardiac death. K E Y W O R D S congenital heart disease, coronary artery disease 1 | INTRODUCTION Normally, the right coronary artery arises from the anterior-facing sinus of Valsalva, and the left coronary artery arises from the leftward and posterior-facing sinus. Anomalous aortic origin of a coronary artery (AAOCA) describes either coronary artery arising from inside or above the inappropriate sinus of Valsalva. Coronary artery abnormalities are the second most common cause of sudden cardiac death (SCD) in children less than 18 years old, 1 and AAOCA is the most common congenital coronary anomaly. 2

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Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Surgical approach for anomalous aortic origin of a coronary artery: A comparison of two techniques

Mills

Dobrila

Podgorsek

et al. 2021

Journal of Cardiac Surgery

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“…The method of transecting the coronary artery and reimplanting obviates the intramural and commissural concerns, making this technique appealing, especially if the vessel is of reasonable size. Bonilla-Ramirez and colleagues 5 recently published on their experience utilizing reimplantation in 16 of 61 patients treated surgically for AAOCA. There was no early or late mortality, although 1 patient required a saphenous vein bypass graft following Transection and reimplantation of anomalous aortic origin of a right coronary artery is a technique with which all cardiac surgeons should be familiar.…”

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confidence: 99%

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

2021

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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:

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“…In the current issue of the Journal, Bonilla-Ramirez and colleauges 1 present the retrospective single-center results of 16 patients who underwent transection and reimplantation (TAR) within their Coronary Artery Anomalies Program between 2012 and 2019. TAR was their chosen surgical repair strategy for patients with an intramural anomalous aortic origin of the coronary artery(ies) (AAOCA) who could not undergo isolated unroofing due to presence of a coronary pathway below a commissure and with potential compression by the intercoronary pillar, proximity of the orifice to the commissural pillar, or when unroofing alone would not achieve relocation to the appropriate sinus.…”

mentioning

confidence: 99%

Commentary: Transection and reimplantation: Putting all your eggs in one basket?

Jegatheeswaran

2021

The Journal of Thoracic and Cardiovascular Surgery

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Outcomes in anomalous aortic origin of a coronary artery after surgical reimplantation

Cited by 35 publications

References 31 publications

Surgical approach for anomalous aortic origin of a coronary artery: A comparison of two techniques

Surgical approach for anomalous aortic origin of a coronary artery: A comparison of two techniques

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

Commentary: Transection and reimplantation: Putting all your eggs in one basket?

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