Anomalous aortic origin of coronary arteries

Early results on clinical management from an international multicenter study

Massimo A. Padalino, Nicola Franchetti, George E. Sarris, Mark Hazekamp, Thierry Carrel, Alessandro Frigiola, Jurgen Horer, Regine Roussin, Julie Cleuziou, Bart Meyns, Jose Fragata, Helena Telles, Anastasios Charalanpos Polimenakos, Katrien Francois, Altin Veshti, Jukka Salminen, Alvaro Gonzalez Rocafort, Matej Nosal, Luca Vedovelli, Eleftherios Protopapas & 11 others Roberto Tumbarello, Assunta Merola, Cinzia Pegoraro, Raffaella Motta, Giovanna Boccuzzo, Vladimir Sojak, Mauro Lo Rito, Federica Caldaroni, Domenico Corrado, Cristina Basso, Giovanni Stellin

Research output: Contribution to journalArticle

Abstract

Background: 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. Methods: 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. Results: 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). Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)189-193
Number of pages5
JournalInternational Journal of Cardiology
Volume291
DOIs
StatePublished - Sep 15 2019

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Multicenter Studies
Coronary Vessels
Sudden Cardiac Death
Survivors
Heart Diseases
Heart Failure
Databases
Exercise
Morbidity
Mortality
Therapeutics

Keywords

  • Anomalous coronary arteries
  • Clinical management
  • Congenital
  • Outcomes
  • Surgery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Anomalous aortic origin of coronary arteries : Early results on clinical management from an international multicenter study. / Padalino, Massimo A.; Franchetti, Nicola; Sarris, George E.; Hazekamp, Mark; Carrel, Thierry; Frigiola, Alessandro; Horer, Jurgen; Roussin, Regine; Cleuziou, Julie; Meyns, Bart; Fragata, Jose; Telles, Helena; Polimenakos, Anastasios Charalanpos; Francois, Katrien; Veshti, Altin; Salminen, Jukka; Rocafort, Alvaro Gonzalez; Nosal, Matej; Vedovelli, Luca; Protopapas, Eleftherios; Tumbarello, Roberto; Merola, Assunta; Pegoraro, Cinzia; Motta, Raffaella; Boccuzzo, Giovanna; Sojak, Vladimir; Rito, Mauro Lo; Caldaroni, Federica; Corrado, Domenico; Basso, Cristina; Stellin, Giovanni.

In: International Journal of Cardiology, Vol. 291, 15.09.2019, p. 189-193.

Research output: Contribution to journalArticle

Padalino, MA, Franchetti, N, Sarris, GE, Hazekamp, M, Carrel, T, Frigiola, A, Horer, J, Roussin, R, Cleuziou, J, Meyns, B, Fragata, J, Telles, H, Polimenakos, AC, Francois, K, Veshti, A, Salminen, J, Rocafort, AG, Nosal, M, Vedovelli, L, Protopapas, E, Tumbarello, R, Merola, A, Pegoraro, C, Motta, R, Boccuzzo, G, Sojak, V, Rito, ML, Caldaroni, F, Corrado, D, Basso, C & Stellin, G 2019, 'Anomalous aortic origin of coronary arteries: Early results on clinical management from an international multicenter study', International Journal of Cardiology, vol. 291, pp. 189-193. https://doi.org/10.1016/j.ijcard.2019.02.007
Padalino, Massimo A. ; Franchetti, Nicola ; Sarris, George E. ; Hazekamp, Mark ; Carrel, Thierry ; Frigiola, Alessandro ; Horer, Jurgen ; Roussin, Regine ; Cleuziou, Julie ; Meyns, Bart ; Fragata, Jose ; Telles, Helena ; Polimenakos, Anastasios Charalanpos ; Francois, Katrien ; Veshti, Altin ; Salminen, Jukka ; Rocafort, Alvaro Gonzalez ; Nosal, Matej ; Vedovelli, Luca ; Protopapas, Eleftherios ; Tumbarello, Roberto ; Merola, Assunta ; Pegoraro, Cinzia ; Motta, Raffaella ; Boccuzzo, Giovanna ; Sojak, Vladimir ; Rito, Mauro Lo ; Caldaroni, Federica ; Corrado, Domenico ; Basso, Cristina ; Stellin, Giovanni. / Anomalous aortic origin of coronary arteries : Early results on clinical management from an international multicenter study. In: International Journal of Cardiology. 2019 ; Vol. 291. pp. 189-193.
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T2 - Early results on clinical management from an international multicenter study

AU - Padalino, Massimo A.

AU - Franchetti, Nicola

AU - Sarris, George E.

AU - Hazekamp, Mark

AU - Carrel, Thierry

AU - Frigiola, Alessandro

AU - Horer, Jurgen

AU - Roussin, Regine

AU - Cleuziou, Julie

AU - Meyns, Bart

AU - Fragata, Jose

AU - Telles, Helena

AU - Polimenakos, Anastasios Charalanpos

AU - Francois, Katrien

AU - Veshti, Altin

AU - Salminen, Jukka

AU - Rocafort, Alvaro Gonzalez

AU - Nosal, Matej

AU - Vedovelli, Luca

AU - Protopapas, Eleftherios

AU - Tumbarello, Roberto

AU - Merola, Assunta

AU - Pegoraro, Cinzia

AU - Motta, Raffaella

AU - Boccuzzo, Giovanna

AU - Sojak, Vladimir

AU - Rito, Mauro Lo

AU - Caldaroni, Federica

AU - Corrado, Domenico

AU - Basso, Cristina

AU - Stellin, Giovanni

PY - 2019/9/15

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N2 - Background: 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. Methods: 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. Results: 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). Conclusions: 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.

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