Jay Idrees1, Suresh Keshavamurthy1, Sreekumar Subramanian1, Daniel G Clair2, Lars G Svensson1, Eric E Roselli3. 1. Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. 2. Department of Vascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. 3. Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: roselle@ccf.org.
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.
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.