Surgical strategy for treatment of Kommerell's diverticulum associated with aortic dissection

Abstract

Objective To summarize the experience and strategy of surgical treatment of Kommerell diverticulum and related aortic dissection aneurysm. Methods From November 2012 to January 2018, 4 patients(all males), with median age of 44(from 40 to 49) years old, underwent surgical treatment in our institution . All the patients had right-sided aortic arch and aberrant left subclavian artery. One patient had type A aortic dissection and other 3 had type B aortic dissection(one had chronic type B dissection). The patient with type A aortic dissection had Bentall procedure plus total arch replacement and frozen elephant trunk implantation. One patient with chronic type B aortic dissection received type 2 hybrid aortic arch repair. One patient with acute type B aortic dissection had ascending aorta and total arch replacement plus frozen elephant trunk implantation followed by TEVAR. The last patient underwent graft replacement of aorta, total arch and descending thoracic aorta. Results There was no operative mortality. The median mechanical ventilation time was 229(from 13 to 485) hours, the median ICU stay was 12(from 2 to 27) days. One patient died from respiratory and circulatory failure due to compression of left main bronchus on the 17th day after operation. One patient had irritating cough due to mild compression of bifucation of trachea and the symptom resolved spontaneously before discharge .One patient had critical illness polyneuropathy after operation and received mechanical ventilation therapy for 485 hours. He recovered through neurotrophic drug treatment. The median follow-up time is 15(from 4 to 36) months. The patients with type A dissection had delayed dilation of descending thoracic aorta beyond the frozen elephant trunk and received TEVAR 6 months later. The CT scans of the other two patients during follow-up time showed good morphology and patency of graft and branches. There was no anastomotic leakage and pseudoaneurysm. Conclusion The decision making of treatment of Kommerell diverticulum and related aortic dissection should be on the basis of classification of aortic dissection. Operation combined with TEVAR is safe and effective. Key words: Kommerell diverticulum; Aortic dissection; Cardiac surgical procedures