Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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) (P < 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. CONCLUSIONS: 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.