Section of Pediatric and Congenital Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Medical School, Italy.
Section of Pediatric and Congenital Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Medical School, Italy.
Int J Cardiol. 2019 Sep 15;291:189-193. doi: 10.1016/j.ijcard.2019.02.007. Epub 2019 Feb 10.
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 < 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 < 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.
冠状动脉异常起源（AAOCA）是一种罕见的异常，其最佳治疗方法仍未确定。我们描述了不同治疗策略下患者的早期结果。
这是一项回顾性临床多中心研究，包括接受或未接受手术治疗的 AAOCA 患者。排除了仅存在高位冠状动脉起始和伴发重大先天性心脏病的患者。从一个共同数据库中检索了术前、术中、解剖学和术后数据。
在 217 例患者中，156 例行外科修复（中位年龄 39 岁，IQR：15-53），61 例接受内科治疗（中位年龄 15 岁，IQR：8-52），其中 AAOCA 是在筛查或临床评估中偶然诊断的。与内科患者相比，外科患者更多出现症状（87.2% vs 44.3%，p<0.001）。冠状动脉开窗术是最常见的手术（56.4%）。手术死亡率为 1.3%（2 例患者术前有严重心力衰竭）。中位随访 18 个月（范围 0.1-23 年），89.9%的存活者 NYHA≤Ⅱ级，仅有 3 例老年外科患者晚期死亡。外科患者重返运动的比例显著高于内科患者（48.1% vs 18.2%，p<0.001）。
AAOCA 的外科治疗是安全的，发病率低。与仍需限制运动和内科治疗的内科患者相比，外科患者在症状和恢复正常生活方面受益。由于发生心源性猝死的长期风险尚不清楚，我们目前建议所有 AAOCA 患者进行准确的长期监测。
