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A Survey on the Management of Anomalous Aortic Origins of the Coronary Arteries

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Abstract

The management of patients with an anomalous aortic origin of a coronary artery (AAOCA) remains controversial despite the publication of the 2017 American Association for Thoracic Surgery (AATS) expert guidelines. We surveyed the American Academy of Pediatrics Section on Cardiology and Cardiac Surgery and the Pediheart.net online community regarding their care of patients with anomalous origins of the right or left coronary from the opposite cusp with inter-arterial courses and compared them to the AATS guidelines. We received 111 complete responses. Four notable variations from the AATS recommendations were identified. Respondents were more likely to use ECG exercise testing than the stress imaging recommended in the AATS guidelines. For a 16-year-old with AAOCA, recommendations for surgery generally followed the AATS guidelines. However, for asymptomatic left AAOCA without signs of ischemia on stress imaging, only 69.4% felt surgery was appropriate or somewhat appropriate. In the setting of a 16-year-old with right AAOCA free from signs or symptoms of ischemia, respondents were more likely to recommend surgery if the patient was a competitive athlete, a topic not directly addressed in the AATS guidelines. After surgical treatment of AAOCA, only 24% of respondents recommended lifelong antiplatelet therapy despite recommendations for this in the AATS guidelines. Respondents recommendations were generally consistent with the 2017 AATS guidelines but with important variations in the use of stress imaging, indications for surgery in asymptomatic left AAOCA, the impact of identification as a competitive athlete and duration of postoperative antiplatelet therapy.

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Abbreviations

AAOCA:

Anomalous aortic origin of a coronary artery

AAOLCA:

Anomalous left coronary artery from the right coronary cusp

AAORCA:

Anomalous right coronary artery from the left coronary cusp

AAP SOCCS:

American academy of pediatrics section cardiology and cardiac surgery

AATS:

American association for thoracic surgery

SCD:

Sudden cardiac death

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Acknowledgements

We would like to thank the members of the AAP SOCCS and Pediheart community for participating in our survey.

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Authors and Affiliations

  1. Undergraduate Research Scholars Program, University of Wisconsin, Madison, WI, USA

    Hareem Rauf

  2. Division of Pediatric Cardiology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Xiao Zhang & John S. Hokanson

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  1. Hareem Rauf
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  2. Xiao Zhang
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  3. John S. Hokanson
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Contributions

All authors contributed to the study conception and design. Material preparation and data collection were performed by HR and JSH. Statistical analysis was performed by XZ. Analysis of the final data was performed by all authors. Tables were prepared by JSH. The first draft of the manuscript was written by HR and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to John S. Hokanson.

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Competing interest

This project was performed as part of Hareem Rauf’s coursework in the Undergraduate Research Scholar program. The authors did not receive financial support from any organization for the submitted work. The authors have no financial or proprietary interests in any material discussed in this article.

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Rauf, H., Zhang, X. & Hokanson, J.S. A Survey on the Management of Anomalous Aortic Origins of the Coronary Arteries. Pediatr Cardiol (2023). https://doi.org/10.1007/s00246-023-03206-w

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