A Cobra-head Reimplantation Of Right Coronary Artery When Anomalously Arising From Left Sinus: A Reproducible Safe Technique
Nicholas A. Oh, MD, Tara Karamlou, MD, MSc, Olivia McCloskey, Munir Ahmad, MD, Hani Najm, MD.
Cleveland Clinic Foundation, Cleveland, OH, USA.
Background: Anomalous aortic origin of the coronary arteries can be a cause of sudden death in the young. Coronary unroofing and coronary reimplantation have been described as repair techniques, but the optimal technique is still debated. Our institutional preference is to perform coronary translocation with a cobra-head anastomosis. Our objective is to review outcomes of patients with anomalous aortic origin of the right coronary artery (AAORCA) managed by this novel technique. Methods: Patients diagnosed with AAORCA who underwent coronary translocation from 2020 to 2022 were included in this study. Baseline characteristics, anatomy, and pre-operative imaging were reviewed. All patients underwent right coronary artery translocation using a cobra-head anastomosis technique. Outcomes and pre-/post-operative imaging and symptom were reviewed and compared. Results: 7 patients with median age of 18 years (16 years - 63 years) underwent RCA translocation using a cobra-head anastomosis technique (Video 1). All patients were symptomatic pre-operatively. Average cardiopulmonary bypass and cross-clamp times were 76 and 43 minutes, respectively. Post-operatively there were no mortalities and no re-operations. There were no changes between pre- and post-operative ventricular and valvar function. Median follow-up time was 3.7 months (1 week - 17 months). All patients reported symptom resolution and were cleared for physical activity.
Conclusions: This novel technique provides an effective alternative to the conventional unroofing technique. The post-operative outcomes demonstrate excellent relief of symptoms, improved coronary flow, and normal post-operative ventricular function. This technique is highly reproducible and allows the advantage of not disturbing the aortic valve.
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