Feins Eric N, DeFaria Yeh Doreen, Bhatt Ami B, Stefanescu Ada, Youniss Mohamed A, Ghoshhajra Brian B, Inglessis-Azuaje Ignacio, Liberthson Richard R, MacGillivray Thomas E
Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
Ann Thorac Surg. 2016 Jan;101(1):169-75; discussion 175-6. doi: 10.1016/j.athoracsur.2015.07.003. Epub 2015 Oct 1.
Anomalous aortic origin of the coronary artery (AAOCA) with an interarterial (IAC) course is an uncommon congenital anomaly. Surgical indications and repair techniques have evolved. We have managed 259 adult patients with AAOCA over 40 years. Our management strategy includes anatomic- and function-based surveillance to select surgical candidates. We reviewed our surgical cohort and analyzed anatomic and functional outcomes.
We queried our heart center databases to obtain the names of all patients with AAOCA managed at our institution between 1974 and 2014. We performed a retrospective chart review.
Two hundred fifty-nine patients were managed for AAOCA. Sixty-one underwent surgical intervention. Twenty-six with associated coronary atherosclerosis were excluded. Thirty-one who underwent surgical repair were analyzed. Mean age was 42.5 ± 2.7 years. Twenty-four patients (77.4%) had right AAOCA. Six (19.4%) had left AAOCA. One (3.2%) had bilateral coronary anomalies. Repair techniques included 21 unroofing procedures (67.7%), 6 translocations (19.4%), and 4 coronary artery bypass grafting (CABG) procedures (12.9%). Mean follow-up was 3.8 ± 0.8 years. Thirteen patients underwent follow-up anatomic testing with computed tomography. Twelve of these patients had widely patent coronary arteries, and 1 patient had mild coronary artery stenosis. Seventeen patients underwent functional testing. Fifteen of these patients had no evidence of ischemia. One patient had reversible ischemia after CABG, and 1 had subclinical ischemia after unroofing. There was 1 late mortality from endocarditis.
Our multidisciplinary program uses a treatment algorithm to select patients with AAOCA for surgical intervention. Only a small subset requires an operation, and we favor unroofing and translocation techniques. With this paradigm, outcomes are excellent, as validated with anatomic- and function-based testing.
冠状动脉异常起源于主动脉（AAOCA）且走行于动脉间（IAC）是一种罕见的先天性异常。手术指征和修复技术不断发展。40年来，我们已诊治了259例成年AAOCA患者。我们的管理策略包括基于解剖和功能的监测以选择手术候选者。我们回顾了我们的手术队列并分析了解剖和功能结局。
我们查询了我们心脏中心的数据库，以获取1974年至2014年间在我们机构接受治疗的所有AAOCA患者的姓名。我们进行了回顾性病历审查。
259例患者接受了AAOCA治疗。61例接受了手术干预。排除26例合并冠状动脉粥样硬化的患者。对31例接受手术修复的患者进行了分析。平均年龄为42.5±2.7岁。24例患者（77.4%）为右冠状动脉AAOCA。6例（19.4%）为左冠状动脉AAOCA。1例（3.2%）为双侧冠状动脉异常。修复技术包括21例开窗手术（67.7%）、6例移位术（19.4%）和4例冠状动脉旁路移植术（CABG）（12.9%）。平均随访时间为3.8±0.8年。13例患者接受了计算机断层扫描的随访解剖检查。其中12例患者冠状动脉广泛通畅，1例患者有轻度冠状动脉狭窄。17例患者接受了功能测试。其中15例患者无缺血证据。1例患者在CABG后有可逆性缺血，1例患者在开窗手术后有亚临床缺血。有1例因心内膜炎导致的晚期死亡。
我们的多学科项目使用一种治疗算法来选择AAOCA患者进行手术干预。只有一小部分患者需要手术，我们倾向于开窗和移位技术。采用这种模式，基于解剖和功能的测试验证了其结果非常好。
