Evolution To Modified Unroofing By A Neo-ostium Creation For Anomalous Aortic Origin Of The Coronary Artery
Frank G. Scholl, MD, Mark Ruzmetov, Immanuel I. Turner, MD, Steven Bibevski, MD, PhD.
Joe DiMaggio Children's Hospital, Hollywood, FL, USA.
Objective(s): Anomalous aortic origin of the coronary artery(AAOCA) has been associated with coronary ischemia, myocardial infarction, and sudden death. In our center, the treatment options include â€œclassicâ€? and/or modified unroofing by a neo-ostium creation strategy in all patients. We reviewed our experience for efficacy and safety.
Methods: Retrospective chart review of patients with isolated diagnosis of AAOCA(2011-2019). All patients presented with symptoms suggestive of ischemia (chest pain, dyspnea on exertion, or syncope). AAOCA was diagnosed by using echocardiogram and CT/MRI studies.
Results: Twenty-two patients were surgically managed for AAOCA. Median age was 16.5years. Twelve patients had rightAAOCA and ten patients had leftAAOCA. The two groups were similar in age, weight, anatomical varieties (ostial type, proximal vessel morphology, take-off angles and levels, intramural location, and length of narrowing). Surgical intervention included modified unroofing with neo-ostial creation in 9(41%), â€œclassicâ€? unroofing in 7(32%), and neo-ostial creation only in 6(27%). Time distribution of surgical procedures are shown in Figure. At follow-up (median,2years) all 100% of patients had no evidence of ischemia. Postoperative evaluation included echocardiography, CTangiogram, and MRIs. In all patients, the repaired coronary was patent, with demonstrated flow by echocardiogram.
Conclusions: Our program uses a surgical algorithm for surgical intervention of AAOCA. In more recent years, we favor modified unroofing procedures by creation of neo-ostium. With this paradigm, outcomes are excellent, as validated with anatomic- and function-based testing.