A minimally invasive, algorithm-based approach for anomalous aortic origin of a coronary artery.


Journal Article

OBJECTIVE: Operative repair for anomalous aortic origin of a coronary artery (AAOCA) has been described using various innovative techniques. Common to each series is the use of a full sternotomy. As demand for minimally invasive approaches to adult cardiac surgery has increased, the upper hemisternotomy has emerged as a safe and effective technique for aortic valve and root replacement. This report reviews our results and describes the application of an upper hemisternotomy to an algorithm-based surgical approach for AAOCA. METHODS: From January 2012 to March 2013, the aortic root was approached via a 7-cm skin incision and upper hemisternotomy for all patients undergoing repair of an AAOCA. The type of repair performed was in accordance with a predefined surgical algorithm. The anomalous vessel had a slit-like ostium and followed a supracommissural intramural course in three patients with symptomatic anomalous right coronary artery. These patients underwent coronary unroofing. In contrast, a patient with an anomalous left coronary artery presented without an intramural segment and underwent vessel translocation and reimplantation. RESULTS: All patients underwent AAOCA repair according to our surgical algorithm and via an upper hemisternotomy. The median length of stay was 4 days. All patients had resolution of symptoms, and there were no reported complications at a median follow-up of 16.5 months. CONCLUSIONS: This series describes a minimally invasive approach to AAOCA repair. When used in conjunction with a defined surgical algorithm, this technique enables a safe and effective repair in all forms of AAOCA without concomitant coronary artery disease.

Full Text

Duke Authors

Cited Authors

  • Conway, BD; Bates, MJ; Hanfland, RA; Yerkes, NS; Patel, SS; Calcaterra, D; Turek, JW

Published Date

  • March 2015

Published In

Volume / Issue

  • 10 / 2

Start / End Page

  • 101 - 105

PubMed ID

  • 25803771

Pubmed Central ID

  • 25803771

Electronic International Standard Serial Number (EISSN)

  • 1559-0879

Digital Object Identifier (DOI)

  • 10.1097/IMI.0000000000000135


  • eng

Conference Location

  • United States