The anomalous circumflex coronary artery (ACCA) from the right coronary artery or sinus of Valsalva lies in proximity to the aortic valve annulus. We sought to determine the prevalence of injury to the ACCA during surgical aortic valve replacement (SAVR).
We queried the Cardiac Surgery and Cardiology databases for all patients who received SAVR in the setting of an ACCA. We identified 31 patients operated from September 2002 through December 2018. The endpoint was myocardial ischemia in the distribution of the ACCA.
The patient mean age was 69 ± 11 years, sex was female in 8 patients (26%), and ejection fraction was 62% (interquartile range 59-68). No patient received exploration of the ACCA, but 6 (19%) received a coronary artery bypass graft (CABG) to the ACCA. No patient demonstrated myocardial infarction or received perioperative intervention on the ACCA; however, discharge echocardiography demonstrated new lateral wall motion abnormality in 5 (16%) patients which was associated with a reduction in ejection fraction of -11% from baseline (P=0.007). CABG to the ACCA was not protective of new lateral wall motion abnormality (P=0.968). Mortality was 34 ± 10% at 10 years and was not associated with new lateral wall motion abnormality (Log rank test P=0.183).
Clinically apparent myocardial infarction was not identified following SAVR, but echocardiography evidence of myocardial ischemia in the distribution of the ACCA was identified in 16% of patients. Protective adjuvant intervention on the ACCA may be indicated. Further study is warranted.

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