Congenital Heart Surgeons' Society

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Coronary Artery Reimplantation As A Surgical Alternative For The Treatment Of Anomalous Aortic Origin Of The Coronary Artery
Carlos Bonilla-Ramirez, Jeffrey S. Heinle, Christopher Caldarone, Dean McKenzie, Prakash Masand, Silvana Molossi, Ziyad M. Binsalamah.
Baylor College of Medicine, Houston, TX, USA.

Objective(s):
Anomalous aortic origin of the coronary artery (AAOCA) can be associated with myocardial ischemia and sudden cardiac death. We describe our experience with coronary reimplantation for the surgical management of these patients.
Methods:
We report 10 cases of patients who underwent a coronary reimplantation for surgical correction of AAOCA at our center between January 2012 and April 2019.
Results:
Median follow-up was 6 months (4-17.7). There were 8 anomalous right and 2 anomalous left coronaries. Patients underwent surgery at a median age of 15 years (10.3-17.7). Intraoperatively, an intramural course was found in 9 patients, with a median intramural length of 4.5mm (3.25-6.95). An unroofing procedure was attempted in 6 patients. In all cases, it was decided to proceed with a coronary reimplantation because of persistent compression by the intercoronary pillar or because of the potential damage to an aortic commissure. Postoperatively, one patient developed a pericardial effusion and one patient was found to have ostial stenosis which required a coronary artery bypass grafting procedure. Overall, there was a 90% 6-months reintervention-free survival. At last follow-up, all patients were asymptomatic with no evidence of ischemia on functional studies.
Conclusions:
The coronary reimplantation is a viable alternative for the management of AAOCA when there is potential damage to the aortic commissure or when unroofing is unlikely to resolve compression by the intercoronary pillar.