Anomalous aortic origin of coronary arteries: Early results on clinical management from an international multicenter study

Anomalous aortic origin of coronary arteries (AAOCA) is a rare abnormality, whose optimal management is still undefined. We describe early outcomes in patients treated with different management strategies. This is a retrospective clinical multicenter study including patients with AAOCA, undergoing o...

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Published in:International journal of cardiology 2019-09, Vol.291, p.189-193
Main Authors: Padalino, Massimo A., Franchetti, Nicola, Sarris, George E., Hazekamp, Mark, Carrel, Thierry, Frigiola, Alessandro, Horer, Jurgen, Roussin, Regine, Cleuziou, Julie, Meyns, Bart, Fragata, Jose, Telles, Helena, Polimenakos, Anastasios C., Francois, Katrien, Veshti, Altin, Salminen, Jukka, Rocafort, Alvaro Gonzalez, Nosal, Matej, Vedovelli, Luca, Protopapas, Eleftherios, Tumbarello, Roberto, Merola, Assunta, Pegoraro, Cinzia, Motta, Raffaella, Boccuzzo, Giovanna, Sojak, Vladimir, Rito, Mauro Lo, Caldaroni, Federica, Corrado, Domenico, Basso, Cristina, Stellin, Giovanni
Format: Article
Language:English
Subjects:
Adolescent
Adult
Anomalous coronary arteries
Child
Clinical management
Congenital
Coronary Vessel Anomalies - diagnosis
Coronary Vessel Anomalies - therapy
Disease Management
Female
Follow-Up Studies
Humans
Internationality
Longitudinal Studies
Male
Middle Aged
Outcomes
Retrospective Studies
Surgery
Young Adult
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cited_by cdi_FETCH-LOGICAL-c436t-8aebd62478be08edc8eb2d8750a1680cd0c514a03a5f0f6c0e14290849b008af3
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container_title International journal of cardiology
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creator Padalino, Massimo A.
Franchetti, Nicola
Sarris, George E.
Hazekamp, Mark
Carrel, Thierry
Frigiola, Alessandro
Horer, Jurgen
Roussin, Regine
Cleuziou, Julie
Meyns, Bart
Fragata, Jose
Telles, Helena
Polimenakos, Anastasios C.
Francois, Katrien
Veshti, Altin
Salminen, Jukka
Rocafort, Alvaro Gonzalez
Nosal, Matej
Vedovelli, Luca
Protopapas, Eleftherios
Tumbarello, Roberto
Merola, Assunta
Pegoraro, Cinzia
Motta, Raffaella
Boccuzzo, Giovanna
Sojak, Vladimir
Rito, Mauro Lo
Caldaroni, Federica
Corrado, Domenico
Basso, Cristina
Stellin, Giovanni
description Anomalous aortic origin of coronary arteries (AAOCA) is a rare abnormality, whose optimal management is still undefined. We describe early outcomes in patients treated with different management strategies. This is a retrospective clinical multicenter study including patients with AAOCA, undergoing or not surgical treatment. Patients with isolated high coronary take off and associated major congenital heart disease were excluded. Preoperative, intraoperative, anatomical and postoperative data were retrieved from a common database. Among 217 patients, 156 underwent Surgical repair (median age 39 years, IQR: 15–53), while 61 were Medical (median age 15 years, IQR: 8–52), in whom AAOCA was incidentally diagnosed during screening or clinical evaluations. Surgical patients were more often symptomatic when compared to medical ones (87.2% vs 44.3%, p 
doi_str_mv 10.1016/j.ijcard.2019.02.007
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We describe early outcomes in patients treated with different management strategies. This is a retrospective clinical multicenter study including patients with AAOCA, undergoing or not surgical treatment. Patients with isolated high coronary take off and associated major congenital heart disease were excluded. Preoperative, intraoperative, anatomical and postoperative data were retrieved from a common database. Among 217 patients, 156 underwent Surgical repair (median age 39 years, IQR: 15–53), while 61 were Medical (median age 15 years, IQR: 8–52), in whom AAOCA was incidentally diagnosed during screening or clinical evaluations. Surgical patients were more often symptomatic when compared to medical ones (87.2% vs 44.3%, p &lt; 0.001). Coronary unroofing was the most frequent procedure (56.4%). Operative mortality was 1.3% (2 patients with preoperative severe heart failure). At a median follow up of 18 months (range 0.1–23 years), 89.9% of survivors are in NYHA ≤ II, while only 3 elderly surgical patients died late. Return to sport activity was significantly higher in Surgical patients (48.1% vs 18.2%, p &lt; 0.001). Surgery for AAOCA is safe and with low morbidity. When compared to Medical patients, who remain on exercise restriction and medical therapy, surgical patients have a benefit in terms of symptoms and return to normal life. 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We describe early outcomes in patients treated with different management strategies. This is a retrospective clinical multicenter study including patients with AAOCA, undergoing or not surgical treatment. Patients with isolated high coronary take off and associated major congenital heart disease were excluded. Preoperative, intraoperative, anatomical and postoperative data were retrieved from a common database. Among 217 patients, 156 underwent Surgical repair (median age 39 years, IQR: 15–53), while 61 were Medical (median age 15 years, IQR: 8–52), in whom AAOCA was incidentally diagnosed during screening or clinical evaluations. Surgical patients were more often symptomatic when compared to medical ones (87.2% vs 44.3%, p &lt; 0.001). Coronary unroofing was the most frequent procedure (56.4%). Operative mortality was 1.3% (2 patients with preoperative severe heart failure). At a median follow up of 18 months (range 0.1–23 years), 89.9% of survivors are in NYHA ≤ II, while only 3 elderly surgical patients died late. Return to sport activity was significantly higher in Surgical patients (48.1% vs 18.2%, p &lt; 0.001). Surgery for AAOCA is safe and with low morbidity. When compared to Medical patients, who remain on exercise restriction and medical therapy, surgical patients have a benefit in terms of symptoms and return to normal life. Since the long term-risk of sudden cardiac death is still unknown, we currently recommend accurate long term surveillance in all patients with AAOCA. •Anomalous aortic origin of coronary arteries (AAOCA) is a rare abnormality and its optimal management is still undefined.•In this large clinical multicenter study on AAOCA, we demonstrate that surgical repair is safe and with low morbidity.•Compared to medical treatment, surgery for AAOCA provides an important benefit in terms of returning to normal lifestyle.•Since the uncertain long term-risk, a regular long term surveillance is recommended in all patients with AAOCA.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>30772012</pmid><doi>10.1016/j.ijcard.2019.02.007</doi><tpages>5</tpages><orcidid>https://orcid.org/0000-0002-1038-4955</orcidid><orcidid>https://orcid.org/0000-0002-3175-3764</orcidid><orcidid>https://orcid.org/0000-0002-7881-6822</orcidid><orcidid>https://orcid.org/0000-0003-4847-2333</orcidid><oa>free_for_read</oa></addata></record>
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identifier ISSN: 0167-5273
ispartof International journal of cardiology, 2019-09, Vol.291, p.189-193
issn 0167-5273
1874-1754
language eng
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source ScienceDirect Journals
subjects Adolescent
Adult
Anomalous coronary arteries
Child
Clinical management
Congenital
Coronary Vessel Anomalies - diagnosis
Coronary Vessel Anomalies - therapy
Disease Management
Female
Follow-Up Studies
Humans
Internationality
Longitudinal Studies
Male
Middle Aged
Outcomes
Retrospective Studies
Surgery
Young Adult
title Anomalous aortic origin of coronary arteries: Early results on clinical management from an international multicenter study
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