Surgical Outcomes of anomalous aortic origin of coronary arteries: early and mid-term results from a single-center experience

Anomalous aortic origin of a coronary artery (AAOCA) is the second leading cause of sudden cardiac death in young athletes. While anomalous aortic origin of the right coronary artery (AAORCA) predominates, anomalous aortic origin of the left coronary artery (AAOLCA) carries higher mortality. Surgical correction requires anatomical precision due to heterogeneous anatomy. A retrospective analysis (June 2016–June 2023) included 17 AAOCA patients (mean age: 11.9 ± 3.8 years). Surgical techniques included unroofing (94.1%), coronary reimplantation (11.8%), pulmonary translocation (5.9%). Preoperative computed tomography angiography (CTA) assessed take-off angles and anatomy. Outcomes included mortality, reoperations, and echocardiographic parameters. Symptomatology included exertional chest pain (35.3%) and syncope (52.9%). AAORCA predominated (64.7%), with 52.9% of coronaries originating above the sinotubular junction. Unroofing significantly increased coronary take-off angles (pre-op: 12.7° ± 5.9° vs. post-op: 38.7° ± 11.6°, p < 0.05). There was no in-hospital mortality. At the mean follow-up (50.5 ± 21.6 months), survival was 100% with preserved LVEF (67.6% ± 4.1%) and no aortic regurgitation. Two reinterventions occurred: one stent implantation for left main coronary artery stenosis and one mitral valve repair. One patient experienced recurrent angina. Unroofing, reimplantation, pulmonary translocation yield excellent early/mid-term survival and preserved ventricular function in AAOCA. Correction of take-off angle is critical for preventing residual ischemia. Individualized surgical planning based on anatomical variants optimizes outcomes.