ANOMALOUS AORTIC ORIGIN OF RIGHT CORONARY ARTERY: SHOULD CORONARY ARTERY DOMINANCE IMPACT MANAGEMENT?
Corinne Tan, Kaley Marcinski, BS, Jorge R. Gonzalez, MD, Laura Schoeneberg, MD, Wilson King, Andrew Fiore, MD, Charles Huddleston
Saint Louis University, Saint Louis, MO, USA.
Objectives: Operating on asymptomatic patients with anomalous aortic origin of the right coronary artery (AAORCA) remains controversial. We examined coronary artery dominance in AAORCA, its impact on symptoms and clinical outcomes. Methods: From January 2013 to May 2022, 86 patients were retrospectively reviewed with AAORCA.Patients were stratified by symptoms (chest pain, syncope, arrhythmia) and coronary dominance. Using cross-sectional imaging, right coronary artery is dominant if posterior descending branch extends completely to the LV apex. Operation was transostial intramural unroofing with aortic wall tacking. Results: Symptomatic patients, Group S (n=53) were older than Asymptomatic patients, Group A (n=33); (11.4 yrs vs. 6.4 yrs; p=0.02). Cohorts were otherwise similar in BSA (S, 1.5m2; A, 1.3m2; p=0.2) and follow-up (S, 4 yrs; A, 3 yrs; p=0.9). RCA dominance was equally distributed among both groups (S, 85% vs. A, 82%; p=0.8). The frequency of operation was also similar between cohorts (S, 79% vs. A, 79%; p=0.9). There were no mortalities nor patients who required reoperation.Conclusions: These data demonstrate that RCA dominance occurs in ~80% of patients with AAORCA. Although subserving more myocardium, RCA dominance does not impact symptoms nor mid-term outcomes. This observation extends even to non-operated patients. This study suggests right coronary artery dominance should not impact clinical management in patients with AAORCA.
Table 1. Comparison of Symptomatic vs. Asymptomatic AAORCA Patients
| Anomalous Right Coronary Arteries (n=86) | Symptomatic (n=53) | Asymptomatic (n=33) | p value |
| * Age at diagnosis (years), median (IQR) | 11.4 (7.2 - 15.2) | 6.4 (0.2 - 13.5) | 0.021 |
| * Weight (kg), median (IQR) | 48.5 (30.1 - 63.2) | 37.6 (28.9 - 59.9) | 0.33 |
| * Body Surface Area (m2), median (IQR) | 1.5 (1.2-1.7) | 1.3 (1.01-1.71) | 0.20 |
| Gender, n(%) | 0.12 | ||
| Male | 28 (52.8%) | 23 (69.7%) | |
| Female | 25 (47.2%) | 10 (30.3%) | |
| Coronary dominance, n(%) | |||
| Right | 45 (84.9%) | 27 (81.8%) | 0.77 |
| Left | 8 (15.1%) | 4 (12.1%) | 0.76 |
| Co-dominant | 0 (0%) | 2 (6.1%) | NA |
| Aborted Sudden Cardiac Death, n(%) | 0 (0%) | 0 (0%) | NA |
| Mortality, n(%) | 0 (0%) | 0 (0%) | NA |
| ** Follow - up Time (years), median (IQR) | 3.8 (1.6 - 7.8) | 3.2 (1.1 - 7.8) | 0.92 |
| Surgery, n(%) | 42 (79.2%) | 26 (78.8%) | 0.96 |
| Age at Surgery (years), median (IQR) | 13.0 (9.5 - 15.6) | 9.5 (7.2 - 13.8) | 0.026 |
| Wait time to surgery from diagnosis (years), median (IQR) | ^0.25 (0.1 - 1.2) | ^^3.2 (0.2 - 6.5) | 0.024 |
| Bypass Time, mean (SD) | % 49.6 (9.7) | 54.23 (25.2) | 0.30 |
| Cross Clamp Time, mean (SD) | @24.82 (6.0) | 27.85 (13.5) | 0.22 |
| *Age/Weight/BSA at time of surgery OR at last Follow-up if no surgery | |||
| ** Follow - up Time (From time of Diagnosis to last Follow-up) | |||
| ^ n=41 | ^^ n=25 | ||
| % n = 40 | |||
| @n=39 |
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