A Novel Approach to Treatment of Anomalous Coronary Arteries -- Surgical
Revascularisation using the Pure Internal Thoracic Artery Technique
Abstract
OBJECTIVES: To evaluate the use of CABG utilising an isolated pedicled
Right Internal Thoracic Artery (RITA) or Left Internal Thoracic Artery
(LITA) or the Pure Internal Thoracic Artery (PITA) technique to treat
anomalous aortic origin of coronary artery (AAOCA). METHODS: A
retrospective review of all patients at our institution over an 8-year
period (2013-2021) who underwent surgery for AAOCA was performed. Data
assessed included patient demographics, initial presentation, morphology
of coronary anomaly, surgical procedure, cross-clamp time,
cardiopulmonary bypass time and long-term outcome. RESULTS: 14 patients
underwent surgery which included 11 males (78.5%) with a median
logistic EuroSCORE of 1.605 (IQR 1.34). Median age was 62.5 years (IQR
48.75). Presentation was angina (7 patients), acute coronary syndrome (5
patients), incidental findings in aortic valve pathology (2 patients).
AAOCA morphology varied: RCA from left coronary sinus (6), RCA from left
main stem (3), left coronary artery from the right coronary sinus (1),
left main stem arising from right coronary sinus (2) and circumflex
artery arising from the right coronary sinus (2). Seven patients had
co-existing flow-limiting coronary artery disease. CABG was performed
using either a pedicled skeletonized RITA, LITA or PITA technique. There
was no perioperative mortality. Overall median follow-up time was 43
months. One patient presented with recurrent angina secondary to graft
failure at 2 years and there were 2 non-cardiac related deaths at 4 and
35 months. CONCLUSION: The use of internal thoracic artery grafts can
provide a durable treatment option in patients with anomalous coronary
arteries. The potential risk of graft failure in patients with no flow
limiting disease should be very carefully considered. However, a
proposed benefit of this technique is the use of a pedicle flow to
increase the long-term patency. More consistent results are obtained
when ischaemia can be demonstrated preoperatively.