Surgical strategy for Kommerell's diverticulum: total arch replacement

Area of Science:

• Cardiovascular Surgery
• Congenital Heart Disease
• Aortic Arch Anomalies

Background:

• Kommerell's diverticulum is a rare congenital anomaly of the aortic arch.
• Surgical strategies for Kommerell's diverticulum remain controversial.
• This study evaluates a specific surgical approach for this condition.

Purpose of the Study:

• To assess the efficacy of total arch replacement (TAR) combined with anatomic reconstruction of the subclavian artery (SCA) for treating Kommerell's diverticulum.
• To evaluate the prevention of postoperative complications associated with this anomaly.

Main Methods:

• Four patients with Kommerell's diverticulum (right aortic arch with aberrant left SCA) underwent TAR and SCA reconstruction between 2000 and 2012.
• Surgery involved median sternotomy, right anterolateral thoracotomy, hypothermic cardiopulmonary bypass, and circulatory arrest.
• Kommerell's diverticulum was resected, and the SCA was reconstructed with a graft.

Main Results:

• No hospital deaths or major complications were observed.
• One patient required prolonged hospitalization for respiratory failure.
• All patients were symptom-free postoperatively, with no recurrence of rupture, dissection, hand ischemia, or subclavian steal syndrome at long-term follow-up.

Conclusions:

• Total arch replacement (TAR) is a viable surgical technique for Kommerell's diverticulum, ensuring complete vascular ring release and preventing recurrence, rupture, and dissection.
• Anatomic reconstruction of the SCA effectively prevents complications such as hand ischemia and subclavian steal syndrome.