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Do anomalous aortic origin of a coronary artery patients have higher risk of myocardial ischaemia and adverse cardiac events during aortic and mitral valve replacements?

Published online by Cambridge University Press:  07 November 2024

Olivia McCloskey Open the ORCID record for Olivia McCloskey [Opens in a new window] ,
Kiran Vaidya ,
Michael Jiang Open the ORCID record for Michael Jiang [Opens in a new window] ,
Meghana Iyer ,
Mayme Marshall Open the ORCID record for Mayme Marshall [Opens in a new window] ,
Joanna Ghobrial Open the ORCID record for Joanna Ghobrial [Opens in a new window] ,
Austin Firth ,
Jeevanantham Rajeswaran ,
Moses Anabila  and
Gosta Pettersson
...Show all authors
Olivia McCloskey
Affiliation:
Case Western Reserve University School of Medicine, Cleveland, OH, USA
Kiran Vaidya
Affiliation:
Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, OH, USA
Michael Jiang
Affiliation:
Department of Pediatric Cardiology, Pediatric Institute, Cleveland Clinic Children’s, Cleveland, OH, USA
Meghana Iyer
Affiliation:
Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, OH, USA
Mayme Marshall
Affiliation:
Department of Pediatric Cardiology, Pediatric Institute, Cleveland Clinic Children’s, Cleveland, OH, USA
Joanna Ghobrial
Affiliation:
Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
Austin Firth
Affiliation:
Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
Jeevanantham Rajeswaran
Affiliation:
Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
Moses Anabila
Affiliation:
Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
Gosta Pettersson
Affiliation:
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
Eugene Blackstone
Affiliation:
Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
Tara Karamlou*
Affiliation:
Department of Pediatric and Congenital Heart Surgery, Division of Pediatric Cardiac Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
*
Corresponding author: Tara Karamlou; Email: [email protected]
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Abstract

Objectives:

We assessed the effect of anomalous aortic origin of a coronary artery on the risk of early and late postoperative events after aortic or mitral valve replacement in adults.

Methods:

Between 2005 and 2022, 29,579 adults underwent surgical aortic or mitral valve replacement at Cleveland Clinic. Among these, 29 had an unrepaired coronary artery rising anomalously from the aorta that was not intervened upon during valve surgery, 19 (65%) an anomalous circumflex, and 9 (31%) an anomalous right. Operative outcomes were compared between the 29 patients with anomalous coronary arteries and 87 balancing score (1:3) matched patients with normal coronary origin. Median follow-up was 6.5 years.

Results:

Among matched groups, major morbidity and mortality 24% (n = 7) in patients with anomalous coronaries and 20% (n = 17) among patients with normal coronary origin (P = .7). Ten-year freedom from coronary reintervention was 83% versus 100% (P[log-rank] = .005), and 10-year survival was 59% versus 53% (P[log-rank] = .8). One patient experienced a coronary injury from valve surgery, in which the incidentally found anomalous retroaortic circumflex was immediately repaired without further complication. There was no coronary reintervention after discharge in the normal coronary origin group and three in the anomalous coronary group; however, only one of these patients required intervention on the anomalous coronary.

Conclusions:

Anomalous coronaries were uncommon in surgical valve replacement patients at a high-volume centre. The origin and course of each coronary should be assessed before valve replacement. With careful planning, valve replacement does not result in a significantly higher prevalence of postoperative ischaemia, mortality, or reintervention.

Keywords

Anomalous aortic origin of a coronary arteryAortic valve replacementMitral valve replacementCoronary artery anomaly
Type
Original Article
Information
Cardiology in the Young , Volume 34 , Issue 10 , October 2024 , pp. 2086 - 2093
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Copyright
© The Author(s), 2024. Published by Cambridge University Press

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