Abstract Body: Background: Anomalous aortic origin of a coronary artery (AAOCA) is a rare congenital heart defect that might lead to myocardial ischemia and sudden cardiac death (SCD). Despite that AATS guidelines recommended indefinite daily aspirin medication after surgery for AAOCA, efficacy of antiplatelet therapy (APT) remains unclear. The purpose of this study is to evaluate and compare the clinical results of different antiplatelet strategies after unroofing procedure for AAOCA.
Methods: A total of 86 patients who underwent surgical unroofing of AAOCA at Guangdong Provincial People's Hospital between Jun 2013 and Sept 2025 were enrolled in this retrospective study. All patients accepted routine electrocardiogram (ECG), transthoracic echocardiogram (TTE), and computed tomography angiography (CTA) before operation, as well as repeated TTE at discharge and latest follow-up. The cohort was divided into three subgroups according to the APT after surgery: the control (no antiplatelet therapy) group, the single antiplatelet therapy (SAPT) group and the dual antiplatelet therapy (DAPT) group.
Results: The cohort comprised 61 males and 25 females, with a mean age of 162.4 (118.4, 306.3) months at surgery and a median follow-up of 13.1 (8.8, 23.7) months. There were 10 patients in the control group, 47 in the SAPT group, and 29 in the DAPT group. Baseline characteristics were comparable among three groups (P＞0.05). There was no significance regarding echocardiographic and ECG results at discharge and follow-up (P＞0.05), except for latest left ventricular ejection fraction (LVEF) between the control and SAPT group (P=0.038). Mid-term follow-up revealed no significant difference in terms of cardiac function and recurrence of symptoms (P＞0.05), but a higher incidence of bleeding in both APT groups than in the control group [P = 0.034, adjusted odds ratio (OR) = 7.39 and 11.31, adjusted 95% confidence interval (CI) = 0.40-135.40 and 0.60-212.70 for SAPT and DAPT, respectively].
Conclusions：APT doesn't contribute to better prognosis for AAOCA patients undergoing surgical unroofing, but is associated with higher risk of hemorrhage. A larger and multi-center cohort is required to assess risk factors that might demand individualized APT.

Keywords: anomalous aortic origin of a coronary artery, unroofing, antiplatelet strategy, clinical outcomes