SURGICAL MANAGEMENT OF ANOMALOUS AORTIC ORIGIN OF THE CORONARY ARTERY (AAOCA): A 20 YEARS SINGLE CENTER EXPERIENCE

Background and Aim: Surgical repair of anomalous aortic origin of coronary artery (AAOCA) needs to be patient’s tailored to reduce early and late complications. We aim to assess the results of 21-years AAOCA surgical repair in a dedicated program. Methods: All consecutive AAOCA patients underwent surgical repair (01/2013- 09/2024). We collected anatomical operative and post-operative data, focusing on early complications and late outcomes. Results: From a cohort of 237 AAOCA subjects referred, 69 (29%) underwent surgical repair at a median age of 39,7 years (range: 5-71 years). The surgical techniques were unroofing of the intramural segment (n=53), osteoplasty (n=5), anatomical repair (n=4) CABG (n=3), transconal repair (n=1), external debridging of subpulmonary course (n=3). No early or late mortality was depicted. Early complications included unplanned CABG (n=1) a right coronary laceration requiring patch repair (n=1) and acute pericarditis requiring pericardiectomy (n=1). All patients were discharged in good clinical conditions, with no evidence of aortic valve regurgitation. After a mean follow-up of 4.5±3.98 years, the occurrence of late overall complications was rare, with only 1 case of RCA stenosis after unroofing treated with stenting; meanwhile we observed post-surgical pericarditis (n=3) treated medically 1 case of distal RCA spontaneous dissection. Conclusions: When tailored to the specific patient anatomy, surgical treatment of AAOCA may significantly reduce early and late complications. Surgery is safe when performed in large-volume centers, although the very long-term fate of a repaired coronary segment in young adults in terms of stenosis recurrence is still unknown.