Department of Cardiac Surgery, Mitera Hospital, Athens, Greece.
Department of Congenital Cardiology, Mitera Hospital, Athens, Greece.
Asian Cardiovasc Thorac Ann. 2021 Jan;29(1):51-58. doi: 10.1177/0218492320957818. Epub 2020 Sep 9.
Anomalous aortic origin of a coronary artery is a congenital abnormality of the origin or course of a coronary artery that arises from the aorta. The surgical treatment of this anomaly is highly variable and controversial and is achieved by implementing elaborate techniques of anatomic repair or by simple coronary artery bypass grafting. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two independent reviewers determined whether studies met the inclusion criteria. Eligible papers were published in English, clinical studies describing surgical repair of anomalous aortic origin of a coronary artery including coronary artery bypass in adults, and enrolled >5 patients. In the absence of multicentre trials, 7 single-center retrospective series were included, which demonstrated comparable short- and midterm outcomes of anatomic repair and coronary artery bypass in adults with anomalous aortic origin of a coronary artery. Coronary unroofing was the preferred technique when the anomalous artery has an intramural component, but there is a risk of aortic insufficiency. Anatomic repair is technically demanding and should be carried out in experienced centers. Coronary artery bypass with internal thoracic artery or vein grafts is technically straightforward with low operative risk and comparable midterm outcomes, however, long-term outcomes are unknown. Coronary artery bypass grafting is the technique of choice for older patients, in those with concomitant coronary artery disease, as a bailout procedure for failed anatomic repair, or in centers without experience in anatomic repair for anomalous aortic origin of a coronary artery.
冠状动脉异常起源于主动脉是一种冠状动脉起源或走行的先天性异常，它起源于主动脉。这种异常的手术治疗方法多种多样，存在争议，可通过实施精细的解剖修复技术或单纯的冠状动脉旁路移植术来实现。本综述是按照系统评价和荟萃分析的首选报告项目进行的。两名独立的评审员确定研究是否符合纳入标准。符合条件的论文均以英文发表，为描述冠状动脉旁路移植术治疗成人冠状动脉异常起源的临床研究，并纳入>5 例患者。由于缺乏多中心试验，纳入了 7 项单中心回顾性系列研究，这些研究表明在成人冠状动脉异常起源中，解剖修复和冠状动脉旁路的短期和中期结果相当。当异常动脉有壁内成分时，首选冠状动脉开窗术，但存在主动脉瓣关闭不全的风险。解剖修复技术要求高，应在有经验的中心进行。用内乳动脉或静脉移植物进行冠状动脉旁路移植术技术简单，手术风险低，中期结果相当，但长期结果尚不清楚。对于老年患者、伴有冠状动脉疾病的患者、解剖修复失败的抢救性手术患者，或在没有冠状动脉异常起源解剖修复经验的中心，冠状动脉旁路移植术是首选技术。
