Law Timothy, Dunne Ben, Stamp Nikki, Ho Kwok M, Andrews David
Department of Cardiothoracic Surgery, Western Australian Cardiothoracic Research and Audit Group, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.
Department of Cardiothoracic Surgery, Western Australian Cardiothoracic Research and Audit Group, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.
Ann Thorac Surg. 2016 Jul;102(1):192-8. doi: 10.1016/j.athoracsur.2016.02.002. Epub 2016 Apr 23.
Anomalous aortic origin of the right coronary artery (AAORCA) has been reported to cause myocardial ischemia, leading to angina, dyspnea, and decreased exercise tolerance. Reimplantation is a repair technique devised to exclude the abnormal intramural portion of the anomalous artery and avoid the known late attrition of saphenous vein grafts. Our study aims to evaluate the medium-term clinical outcomes with this technique.
A retrospective review was made of patients who underwent repair of AAORCA by reimplantation between 2002 and 2014 in two institutions in Western Australia. Follow-up computed tomography coronary angiography was used to assess the status of the reimplanted right coronary artery (RCA). Data on survival, freedom from symptoms, cardiac events, and cardiac interventions were also analyzed.
Of the 16 patients (aged 17 to 70 years old), 14 (88%) were symptomatic before surgery, with angina (50%) and exertional dyspnea (56%) being the most common symptoms. Surgical reimplantation was successful in 15 patients (94%) without operative mortality. One patient required saphenous vein bypass grafting of the RCA intraoperatively after presumed failed repair and difficulty weaning from cardiopulmonary bypass. All patients who had successful reimplantation of AAORCA were symptom-free after surgery, and none had subsequent cardiac events attributable to the RCA or required further interventions. Ten patients (67%) had computed tomography coronary angiography after surgery; none had stenosis, kinking, or compression of the RCA by the pulmonary artery. Two further patients (including the patient who underwent saphenous vein grafting for presumed failed reimplantation) underwent conventional angiography, which demonstrated patent reimplantations.
To the best of our knowledge, this is the largest reported series of anomalous RCA managed by surgical reimplantation. Our results suggest that this technique is safe and has excellent medium to long-term results regarding symptom-free survival.
据报道，右冠状动脉异常起源（AAORCA）可导致心肌缺血，进而引发心绞痛、呼吸困难和运动耐量下降。再植术是一种修复技术，旨在排除异常动脉的异常壁内部分，并避免已知的大隐静脉移植后期损耗。我们的研究旨在评估该技术的中期临床结果。
对2002年至2014年在西澳大利亚的两家机构接受AAORCA再植术修复的患者进行回顾性研究。采用随访计算机断层扫描冠状动脉造影评估再植右冠状动脉（RCA）的状况。还分析了生存、无症状、心脏事件和心脏干预的数据。
16例患者（年龄17至70岁）中，14例（88%）术前有症状，最常见的症状是心绞痛（50%）和劳力性呼吸困难（56%）。15例患者（94%）手术再植成功，无手术死亡。1例患者在假定修复失败且脱离体外循环困难后，术中需要对RCA进行大隐静脉旁路移植。所有成功再植AAORCA的患者术后均无症状，且无因RCA导致的后续心脏事件或需要进一步干预。10例患者（67%）术后进行了计算机断层扫描冠状动脉造影；均无RCA被肺动脉狭窄、扭结或压迫。另外2例患者（包括因假定再植失败而接受大隐静脉移植的患者）接受了传统血管造影，显示再植通畅。
据我们所知，这是报道的最大系列通过手术再植治疗的异常RCA病例。我们的结果表明，该技术是安全的，在无症状生存方面具有优异的中长期结果。
