Conway Brian D, Bates Michael J, Hanfland Robert A, Yerkes Nicholas S, Patel Sonali S, Calcaterra Domenico, Turek Joseph W
From the *Division of Pediatric Cardiac Surgery, †University of Iowa Children's Hospital, Iowa City, IA USA; and ‡Divisions of Pediatric Cardiac Surgery and Pediatric Cardiology, Colorado Children's Hospital, Aurora, CO USA.
Innovations (Phila). 2015 Mar-Apr;10(2):101-5. doi: 10.1097/IMI.0000000000000135.
Operative repair for anomalous aortic origin of a coronary artery (AAOCA) has been described using various innovative techniques. Common to each series is the use of a full sternotomy. As demand for minimally invasive approaches to adult cardiac surgery has increased, the upper hemisternotomy has emerged as a safe and effective technique for aortic valve and root replacement. This report reviews our results and describes the application of an upper hemisternotomy to an algorithm-based surgical approach for AAOCA.
From January 2012 to March 2013, the aortic root was approached via a 7-cm skin incision and upper hemisternotomy for all patients undergoing repair of an AAOCA. The type of repair performed was in accordance with a predefined surgical algorithm. The anomalous vessel had a slit-like ostium and followed a supracommissural intramural course in three patients with symptomatic anomalous right coronary artery. These patients underwent coronary unroofing. In contrast, a patient with an anomalous left coronary artery presented without an intramural segment and underwent vessel translocation and reimplantation.
All patients underwent AAOCA repair according to our surgical algorithm and via an upper hemisternotomy. The median length of stay was 4 days. All patients had resolution of symptoms, and there were no reported complications at a median follow-up of 16.5 months.
This series describes a minimally invasive approach to AAOCA repair. When used in conjunction with a defined surgical algorithm, this technique enables a safe and effective repair in all forms of AAOCA without concomitant coronary artery disease.
已经描述了使用各种创新技术对冠状动脉异常起源（AAOCA）进行手术修复。每个系列的共同之处在于使用全胸骨切开术。随着成人心脏手术微创方法需求的增加，上半胸骨切开术已成为主动脉瓣和根部置换的一种安全有效的技术。本报告回顾了我们的结果，并描述了上半胸骨切开术在基于算法的AAOCA手术方法中的应用。
从2012年1月至2013年3月，对于所有接受AAOCA修复的患者，通过7厘米的皮肤切口和上半胸骨切开术进入主动脉根部。所进行的修复类型符合预定义的手术算法。在3例有症状的异常右冠状动脉患者中，异常血管有一个狭缝状开口，并走行于瓣上壁内。这些患者接受了冠状动脉开窗术。相比之下，1例异常左冠状动脉患者没有壁内段，接受了血管移位和重新植入。
所有患者均根据我们的手术算法并通过上半胸骨切开术进行了AAOCA修复。中位住院时间为4天。所有患者症状均得到缓解，在中位随访16.5个月时未报告并发症。
本系列描述了一种AAOCA修复的微创方法。当与定义的手术算法结合使用时，该技术能够在不伴有冠状动脉疾病的所有形式的AAOCA中进行安全有效的修复。
