Karen M Kim1, Richard P Cambria2, Eric M Isselbacher3, Joshua N Baker4, Glenn M LaMuraglia2, James R Stone5, Thomas E MacGillivray6. 1. Division of General Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts. 2. Division of Vascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts. 3. Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts. 4. Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts. 5. Department of Pathology and Center for Systems Biology, Massachusetts General Hospital, Boston, Massachusetts. 6. Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: tmacgillivray@partners.org.
Abstract
BACKGROUND: Surgery in patients with Kommerell diverticulum (KD) is controversial. Although the presence of symptoms is an accepted indication, the KD itself may be a risk factor for dissection and rupture, although size criteria for operation are undefined. METHODS: A retrospective review of 19 adult patients who underwent surgical treatment of KD between March 2004 and June 2013 was performed. Mean age was 48 years (range, 32 to 68 years). Fifteen patients were female, 15 were symptomatic, and 13 had a right aortic arch. Sixteen patients with aberrant subclavian artery underwent a two-stage procedure involving subclavian-common carotid artery transposition or bypass followed by aortic resection, including origin of the KD, with interposition graft reconstruction. Aortic resection was performed with left heart bypass (n = 10) or deep hypothermic circulatory arrest (n = 9). RESULTS: There were no deaths or strokes. Complications after aberrant subclavian artery revascularization were transient ptosis (n = 3), graft occlusion (n = 1), recurrent laryngeal nerve injury (n = 1),phrenic nerve injury (n = 1), and reintubation (n = 1). Complications after aortic resection were intraoperative type A dissection (n = 1), phrenic nerve injury (n = 1), chylothorax (n = 1), and transient neurologic dysfunction (n = 1). Mean hospital stay after aberrant subclavian artery revascularization was 2 ± 2 days and after aortic resection, 6.4 ± 2.4 days. Of 18 available pathology specimens, all 18 showed medial degeneration. Mean follow-up was 3.3 years. CONCLUSIONS: This is the largest reported single-center experience with the surgical management of KD in adults, verifying its safety and efficacy. The high percentage of KD with medial degeneration suggests asymptomatic patients with an enlarged KD also may benefit from resection.
BACKGROUND: Surgery in patients with Kommerell diverticulum (KD) is controversial. Although the presence of symptoms is an accepted indication, the KD itself may be a risk factor for dissection and rupture, although size criteria for operation are undefined. METHODS: A retrospective review of 19 adult patients who underwent surgical treatment of KD between March 2004 and June 2013 was performed. Mean age was 48 years (range, 32 to 68 years). Fifteen patients were female, 15 were symptomatic, and 13 had a right aortic arch. Sixteen patients with aberrant subclavian artery underwent a two-stage procedure involving subclavian-common carotid artery transposition or bypass followed by aortic resection, including origin of the KD, with interposition graft reconstruction. Aortic resection was performed with left heart bypass (n = 10) or deep hypothermic circulatory arrest (n = 9). RESULTS: There were no deaths or strokes. Complications after aberrant subclavian artery revascularization were transient ptosis (n = 3), graft occlusion (n = 1), recurrent laryngeal nerve injury (n = 1),phrenic nerve injury (n = 1), and reintubation (n = 1). Complications after aortic resection were intraoperative type A dissection (n = 1), phrenic nerve injury (n = 1), chylothorax (n = 1), and transient neurologic dysfunction (n = 1). Mean hospital stay after aberrant subclavian artery revascularization was 2 ± 2 days and after aortic resection, 6.4 ± 2.4 days. Of 18 available pathology specimens, all 18 showed medial degeneration. Mean follow-up was 3.3 years. CONCLUSIONS: This is the largest reported single-center experience with the surgical management of KD in adults, verifying its safety and efficacy. The high percentage of KD with medial degeneration suggests asymptomatic patients with an enlarged KD also may benefit from resection.
Authors: Young Kern Kwon; Sung Jun Park; Suk Jung Choo; Tae Jin Yun; Jae Won Lee; Joon Bum Kim Journal: Korean J Thorac Cardiovasc Surg Date: 2020-12-05
Authors: Lorenzo Faggioni; Michela Gabelloni; Vinicio Napoli; Francesco Iorio; Antonio Chella; Davide Caramella Journal: Eur J Radiol Open Date: 2016-07-30