title: A minimally invasive, algorithm-based approach for anomalous aortic origin of a coronary artery.
abstract: 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.
authors: From the *Division of Pediatric Cardiac Surgery, †University of Iowa Children's Hospital, Iowa City, IA USA; and ‡Divisions of Pediatric Cardiac Surgery and Pediatric Cardiology, Colorado Children's Hospital, Aurora, CO USA.
authors: Brian D
authors: BD
authors: Conway
authors: Michael J
authors: MJ
authors: Bates
authors: Robert A
authors: RA
authors: Hanfland
authors: Nicholas S
authors: NS
authors: Yerkes
authors: Sonali S
authors: SS
authors: Patel
authors: Domenico
authors: D
authors: Calcaterra
authors: Joseph W
authors: JW
authors: Turek
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D001013:Aorta, Thoracic / Q000002:abnormalities* / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000379:methods; D003330:Coronary Vessel Anomalies / Q000601:surgery*; D003331:Coronary Vessels / Q000601:surgery*; D004452:Echocardiography; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D011446:Prospective Studies; D055815:Young Adult