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CORONARY UNROOFING DOES NOT FITS ALL ANOMALOUS AORTIC ORIGIN OF CORONARY ARTERIES.
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  • Luigi Arcieri,
  • Massimo Colaneri,
  • Francesco Bianco,
  • Ettore Merlino,
  • Gaetano Santoro,
  • Raffaele Silvano,
  • Alessandra Baldinelli,
  • Marco Pozzi
Luigi Arcieri
Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi

Corresponding Author:luigi.arcieri@ospedaliriuniti.marche.it

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Massimo Colaneri
Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi
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Francesco Bianco
Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi
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Ettore Merlino
Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi
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Gaetano Santoro
Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi
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Raffaele Silvano
Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi
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Alessandra Baldinelli
Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi
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Marco Pozzi
Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi
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Abstract

Introduction Anomalous aortic origin of coronary artery (AAOCA) is the second leading cause of sudden cardiac death in children and young adults. Intramural-interarterial course is the most frequent anatomic variation and coronary unroofing is widest adopted for surgical management. Symptoms recurrence is described regardless of the technique used. This study aims to describe how an anatomic patient-centered approach aimed to restore a normal coronary artery take-off is associated with symptoms resolution. Methods From 2008 to 2021, 25 patients were operated on for an AAOCA at a median age of 20 years. Nineteen patients had a right AAOCA and six had left AAOCA. Intramural course was present in 18 patients. Seventy-six percent were symptomatic. No episodes of aborted sudden cardiac death before surgery was described in the population. Surgical technique used were coronary unroofing in 18 patients, coronary neo-ostioplasty in 3, coronary re-implantation in 3 and main pulmonary artery re-location in one. Results No hospital mortality or re-operation was observed in our experience as well as major complications related to surgery. Mean hospital length of stay was 8.5 days. None of patients reported symptoms recurrence at follow-up. Young athletes returned to play competitive sport. Postoperative computed-tomography scan evaluation showed a general improvement of the take-off angle. Conclusions AAOCA requires a patient anatomic-based surgical management. There is not a single surgical technique that can fits all anatomic subtype of AAOCA. Surgical techniques may be selected on the base of the preoperative images and intraoperative findings. In our experience this policy is associated with no symptoms recurrence.
21 Mar 2022Submitted to Journal of Cardiac Surgery
21 Mar 2022Submission Checks Completed
21 Mar 2022Assigned to Editor
28 Apr 2022Reviewer(s) Assigned
18 May 2022Review(s) Completed, Editorial Evaluation Pending
13 Jun 2022Editorial Decision: Revise Minor
29 Jun 20221st Revision Received
29 Jun 2022Submission Checks Completed
29 Jun 2022Assigned to Editor
29 Jun 2022Reviewer(s) Assigned
09 Jul 2022Review(s) Completed, Editorial Evaluation Pending
22 Jul 2022Editorial Decision: Accept
Nov 2022Published in Journal of Cardiac Surgery volume 37 issue 11 on pages 3536-3542. 10.1111/jocs.16876