Surgical approach and outcomes in adults with anomalous aortic origin of coronary arteries at a reference center: Outcomes of proximal coronary surgery

Background Considerations in the management of anomalous aortic origin of a coronary artery (AAOCA) in adults differ from those in the pediatric population owing to the difference in risk profile. In adults for whom surgery is indicated, data on surgical outcomes can help guide decision making. Methods Between January 2006 and January 2023, adults who underwent surgery for AAOCA were identified from our retrospective registry that includes medically and surgically managed patients of all ages. We reviewed the preoperative and operative characteristics and in-hospital and 30-day follow-up data for the surgical adult population. Results A total of 316 patients with AAOCA were identified, 123 of whom (38.9%) were adults, of whom 54 (43.9%) underwent surgery. The median age of the operative adult cohort was 46 years (interquartile range, 35-52 years), and 51.9% (n = 28) were female. Presentation was because of symptoms in 85% (n = 46), including exertional chest pain in 51.9% (n = 28). Preoperative workup included cardiac computed tomography angiography in 94% (n = 51) and stress testing in 66.7% (n = 36), which was positive in 47% of these 36 patients. Anomalous left coronary was diagnosed in 35.2% of the 54 patients (n = 19), anomalous right in 63.0% (n = 34), and left coronary from noncoronary sinus in 1.9% (n = 1). Surgical approaches included unroofing in 92.6% (n = 50) with commissure resuspension in 7.4% (n = 4), and CABG in 9.2% (n = 5), as a salvage operation in 3.7% (n = 2). There was no operative mortality or stroke. New left ventricular dysfunction was severe in 1 patient (1.9%), and new aortic regurgitation was mild in 2 patients (3.7%). Conclusions Knowledge of the various surgical approaches is essential to providing safe treatment for adult patients with AAOCA. While unroofing should remain the mainstay approach, there remains a role for CABG when proximal surgery is not sufficient, possible, or successful.