Postoperative Outcomes of Unroofing Technique for Anomalous Aortic Origin of a Coronary Artery With Intramural Course: A Single-Center Study.

Background Anomalous aortic origin of a coronary artery (AAOCA) with an intramural course is a recognized cause of sudden cardiac death. Unroofing is the standard surgical treatment; however, postoperative aortic regurgitation (AR) and its anatomical predictors remain incompletely understood. Methods We retrospectively analyzed 16 patients who underwent unroofing for AAOCA with an intramural course. The commissure-intramural distance was measured on preoperative computed tomography (CT), and its association with postoperative AR progression was evaluated. Results During a median follow-up of six months, there were no deaths or coronary-related reinterventions. Postoperative AR progression was observed in 38% of patients, and all cases were trivial to mild. The commissure-intramural distance was significantly shorter in patients with AR progression than in those without (2.66 mm vs. 4.81 mm, p = 0.047). Conclusions Unroofing for AAOCA with an intramural course was associated with favorable early clinical outcomes in our cohort. A shorter commissure-intramural distance on preoperative CT may be associated with postoperative AR progression. Given the small sample size, these findings should be interpreted as exploratory and hypothesis-generating.