Li Baotong, Ding Li, Sun Hansong
State Key Laboratory of Cardiovascular Disease, Department of Adult Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, China.
Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Front Cardiovasc Med. 2024 Nov 22;11:1489303. doi: 10.3389/fcvm.2024.1489303. eCollection 2024.
Anomalous aortic origin of a coronary artery (AAOCA) is associated with an increased risk of myocardial ischemia and sudden cardiac death. This study aims to evaluate the medium-term outcomes of surgical repair for AAOCA and to introduce a novel off-pump technique for anomalous coronary artery reimplantation.
We retrospectively reviewed the medical records of 12 patients aged 12 years and older who underwent AAOCA surgery at Fuwai Hospital between 2009 and 2016.
The median age at surgery was 26 years (range, 13-57 years). Patients with an anomalous left coronary artery from the right sinus (ALCA-R) were significantly younger than those with an anomalous right coronary artery from the left sinus (ARCA-L) ( < 0.001). During a median follow-up of 13 years (range, 8-15years), 11 patients had widely patent repaired coronary arteries, with the exception of one patient (case 5) who experienced occlusion of the left internal mammary artery graft 1 year post-CABG. The incidence of postoperative cardiac-type symptoms (angina, syncope or dyspnea) was higher in ALCA-R patients compared to ARCA-L patients. Patch angioplasty using a pulmonary artery patch and RCA reimplantation without cardiopulmonary bypass yielded satisfactory medium-term outcomes.
Compared with ARCA-L, the incidence of postoperative cardiac-type symptoms was higher in ALCA-R patients. Properly selected surgical procedures can lead to successful outcomes in patients with AAOCA. Patch angioplasty with a pulmonary artery patch and RCA reimplantation without cardiopulmonary bypass are viable and effective surgical options. CABG may not be the preferred surgical approach for AAOCA.
冠状动脉异常起源（AAOCA）与心肌缺血和心源性猝死风险增加相关。本研究旨在评估AAOCA手术修复的中期结果，并介绍一种用于异常冠状动脉再植入的新型非体外循环技术。
我们回顾性分析了2009年至2016年期间在阜外医院接受AAOCA手术的12例12岁及以上患者的病历。
手术时的中位年龄为26岁（范围13 - 57岁）。右窦异常起源左冠状动脉（ALCA - R）的患者比左窦异常起源右冠状动脉（ARCA - L）的患者明显年轻（<0.001）。在中位随访13年（范围8 - 15年）期间，11例患者修复后的冠状动脉广泛通畅，除1例患者（病例5）在冠状动脉旁路移植术（CABG）后1年出现左乳内动脉移植物闭塞。与ARCA - L患者相比，ALCA - R患者术后心脏型症状（心绞痛、晕厥或呼吸困难）的发生率更高。使用肺动脉补片进行补片血管成形术和非体外循环下右冠状动脉再植入产生了满意的中期结果。
与ARCA - L相比，ALCA - R患者术后心脏型症状的发生率更高。正确选择手术方法可使AAOCA患者获得成功结果。使用肺动脉补片进行补片血管成形术和非体外循环下右冠状动脉再植入是可行且有效的手术选择。CABG可能不是AAOCA的首选手术方法。
