Surgical strategy for Kommerell's diverticulum: Total arch replacement

Abstract

TAR is a reasonable surgical technique for Kommerell's diverticulum, because it enables the vascular ring to be completely released, preventing recurrence, rupture, and dissection. Anatomic reconstruction of the SCA was effective to prevent hand ischemia and subclavian steal syndrome.

Outcomes of Anterolateral Thoracotomy With or Without Partial Sternotomy for Kommerell Diverticulum

“…1. total aortic arch replacement can completely release the vascular ring; 2. to prevent retrograde type A aortic dissection in the future (late retrograde dissections occurred in 2 patients after 18 partial arch replacement by ALPS for extended aortic aneurysms, although they were not KD); and 3. to prevent clamping of aortic arch, which sometimes leads to clamp injury or stroke (aortic arch dissection after clamping the arch occurred in a patient in this series) [2,11].…”

“…No major postoperative complications were reported in our study. Several reports of other open operations for KD also indicated good results [2][3][4][5][6]. Comparison of complications between ALPS and other open operations is difficult because of small patient numbers.…”

“…Surgical approaches reported in the literature included thoracotomy of the aortic arch side [3], left thoracotomy, regardless of the side of aortic arch [4], median sternotomy [11], and median sternotomy plus thoracotomy [2]. The selection of a surgical approach is also related to the range of replacement.…”

“…T he indications for surgical intervention and the proper management of Kommerell diverticulum (KD), a rare aortic anomaly, are controversial [1]. Although several case reports have been published, the indications for an operative repair varied [1][2][3][4]. Surgical repair is needed for symptomatic KD because of the vascular ring [5,6].…”

Single-Stage Surgical Repair of Kommerell Diverticulum with Annuloaortic Ectasia via a Median Sternotomy: Frozen Elephant Trunk Technique with an Antler-Like Shape Reconstruction of Arch Branches

“…Various surgical techniques have been reported for repair of KD, including open surgical repair with thoracotomy, endovascular repair, and hybrid repair. 1 – 6 ) We present a case of KD with annuloaortic ectasia (AAE) in which single-stage surgical repair was performed via a median sternotomy using frozen elephant trunk (FET) technique.…”