Hybrid repair of Kommerell diverticulum.

Abstract

OBJECTIVE:

Kommerell diverticulum carries the risk of rupture or dissection if left untreated. Various methods of repair have been described, and options have recently expanded to include the hybrid approach. This study describes hybrid repair techniques for Kommerell diverticulum and assesses outcomes.

METHODS:

Between 2005 and 2010, a total of 10 patients underwent hybrid repair of Kommerell diverticulum (3 right-sided arches) by elephant trunk with endovascular completion (n = 4), frozen elephant trunk (n = 3), or stent grafting with cervical debranching (n = 3). Mean age at procedure was 57 ± 25.5 years. Subclavian artery revascularization was performed preoperatively (n = 4), intraoperatively (n = 3), or postoperatively (n = 3), either as carotid-to-subclavian bypass (n = 7; n = 3 bilateral) or originating from the ascending aorta (n = 3). Data were obtained from the prospectively collected database and chart review.

RESULTS:

There was no in-hospital mortality, nor were there any cases of respiratory or renal failure. There were no cases of paraplegia, but there was 1 stroke. Two patients had type 2 endoleaks develop; 1 required subclavian coil embolization. Mean hospital stay was 8.73 ± 4 days. After repair, there were no ruptures, no significant growth, and all patients remain free of symptoms.

CONCLUSIONS:

Hybrid repair is a safe and effective surgical treatment option for Kommerell diverticulum. Selection of the specific type of intervention is based on patient anatomy and comorbid conditions.

• Authors: Jay Idrees, Suresh Keshavamurthy, Sreekumar Subramanian, Daniel G Clair, Lars G Svensson, Eric E Roselli
• Journal: The Journal of thoracic and cardiovascular surgery (J Thorac Cardiovasc Surg) Vol. 147 Issue 3 Pg. 973-6 (Mar 2014) ISSN: 1097-685X [Electronic] United States
• PMID: 23535153 (Publication Type: Journal Article)
• Copyright: Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

Topics

• Adult
• Aged
• Aneurysm (diagnosis, surgery)
• Aorta (abnormalities, surgery)
• Aortic Aneurysm (diagnosis, surgery)
• Aortography
• Blood Vessel Prosthesis Implantation (adverse effects)
• Cardiovascular Abnormalities (diagnosis, surgery)
• Deglutition Disorders (diagnosis, surgery)
• Diverticulum (diagnosis, surgery)
• Endoleak (etiology)
• Endovascular Procedures (adverse effects)
• Humans
• Length of Stay
• Middle Aged
• Retrospective Studies
• Stroke (etiology)
• Subclavian Artery (abnormalities, surgery)
• Time Factors
• Tomography, X-Ray Computed
• Treatment Outcome
• Vascular Malformations (diagnosis, surgery)